Perthes disease. Pathogenesis

An original view on the pathogenesis of Perthes' disease (femoral head osteochondropathy, Legg-Calvé-Perthes disease).

By the onset of Perthes disease, the hip joint is generally formed, and the femoral head and acetabulum represent bone structures. From our perspective, the initiating factor is trauma, specifically, damage to the ligamentum capitis femoris (LCF). This can be its rupture (most commonly), detachment from its attachment point, or irreversible plastic elongation. In other words, the amount of mechanical energy acting on the LCF, at a certain moment, exceeds the amount that it can absorb. Another option is possible when individual LCF fibers are damaged. Bioeffective stresses arise and increase in it, inducing biological processes that transform the LCF (for more details, see the Law of Bioinduction). As a result, it is either permanently damaged or significantly lengthened.

Due to damage or uncompensated lengthening of the LCF, the statics and dynamics of the hip joint are disrupted. In the single-support phase of gait and in the single-support posture, it no longer functions as a second-class lever, but as a first-class lever. In the upper sector of the femoral head and acetabulum, the value of the actual average daily stresses increases, which turns out to be greater than optimal stresses. Bioeffective stresses emerge. The volume of the femoral head is smaller than the volume of the pelvic bone, therefore the magnitude of the effective stresses, and therefore the average daily stresses in it is greater. Accordingly, bioeffective stresses are higher in the head of the femur and biological processes are more active.

Due to mechanical phenomena and biological processes in the upper sector of the femoral head, an area of compression of the spongy substance is formed with its subsequent restructuring. Partially the bone tissue atrophies, its mass in the upper sector decreases. The presence of bioeffective stresses induces adaptive processes in the femoral head. The granulation tissue that appears at the site of damage through the processes of metaplasia is gradually transformed into fibrous and then into bone tissue. With a satisfactory course of adaptive processes in the head of the femur, not only qualitative, but also quantitative changes are observed. The trabecular systems are rearranged, the shape of the femoral head changes, which increases in size.

Changes in the head of the femur neutralize bioeffective stresses in it. This is achieved by eliminating zones of stress concentration, increasing the contact area of the femoral head and acetabulum, strengthening their upper sectors due to subchondral sclerosis, thickening and increasing the number of trabeculae. As these changes develop, the optimal average daily stresses for the newly formed femoral head are equalized with the actual stresses, and the bioeffective stresses are leveled. After this, the ongoing adaptive processes induced by bioeffective stresses fade away. The hip joint acquires a different structure from the norm, and the kinematics of locomotion also changes.

Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, biomechanics, osteochondropathy, Perthes' disease, pathogenesis

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The first version of the text in:

Архипов-Балтийский СВ. Рассуждение о морфомеханике. Норма. В 2 т. Т. 2. Гл. 5-6. испр. и доп. изд. Калининград, 2004. (Archipov-Baltic SV. Reasoning about Morphomechanics. The norm – Kaliningrad, 2004. [Rus]) [aleph.rsl.ru]

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ETIOLOGY AND PATHOGENESIS

Comments

1902RilkeRM

Works of art that mention ligamentum capitis femoris (LCF) are extremely rare. One such work is the poem «Der Schauende» ( He Who Visions, The Seer, The Man Watching, The Beholder) b y Rainer Rilke. Below is the original text in German. Der Schauende 1. Ich sehe den Bäumen die Stürme an, die aus laugewordenen Tagen an meine ängstlichen Fenster schlagen, und höre die Fernen Dinge sagen, die ich nicht ohne Freund ertragen, nicht ohne Schwester lieben kann. 2. Da geht der Sturm, ein Umgestalter, geht durch den Wald und durch die Zeit, und alles ist wie ohne Alter: die Landschaft, wie ein Vers im Psalter, ist Ernst und Wucht und Ewigkeit. 3. Wie ist das klein, womit wir ringen, was mit uns ringt, wie ist das groß; ließen wir, ähnlicher den Dingen, uns so vom großen Sturm bezwingen, - wir würden weit und namenlos. 4. Was wir besiegen, ist das Kleine, und der Erfolg selbst macht uns klein. Das Ewige und Ungemeine will nicht von uns gebogen sein. Das ist der Enge...

1730CheseldenW

Fragments from the book Cheselden W. The Anatomy of the Human Body (1730). The author draws attention to the role of ligamentum capitis femoris (LCF) in counteracting hip dislocation and maintaining the femoral head in the joint. The work notes that the LCF is “powerful” and “short” - “about two inches” i.e. approximately 5 cm! This error will be corrected in a subsequent treatise ( 1733CheseldenW ) . Quote pp. 43 - 44 Chap. VII. Of the Ligaments At the upper part of the articulation of the Os Femoris and Os Innominatum, is a strong ligament of great consequence; it contributing very much to preserve that joint from being luxated by the weight of the body. And from the lower edge of the Acetabulum of the Os Innominatum, runs a ligament to the middle of the head of the Os Femoris, about two inches long (which the Motion in this joint requires) called Teres, or Rotundum, whose use is to prevent the Os Femoris from being luxated upwards, but down wards it will le...

LCF in 2026 (May)

LCF in 2026 (May ) (Quotes from articles and books published in May 2026 mentioning the ligamentum capitis femoris) Kim, P. S., Kang, C., Lee, J. K., & Hwang, J. M. (2026). Hip arthroscopy to treat symptomatic paralabral cysts: a retrospective analysis of clinical outcomes. Arthroscopy and Orthopedic Sports Medicine , 13 (1), 27-34. [i] e-aosm.org Ko, H. Y. (2026). Vascular Anatomy of the Extremities and Lungs. In Practical Functional Anatomy for Spinal Cord Injury Rehabilitation: A Guide for Physiatrists and Rehabilitation Specialists (pp. 191-223). Singapore: Springer Nature Singapore. [ii] link.springer.com Aiba, H., Yamaguchi, M., Kimura, H., & Murakami, H. (2026). Advances in limb-salvage surgery and reconstruction for pediatric bone and soft tissue tumors. Frontiers in Pediatrics , 14 , 1817788. [iii] pmc.ncbi.nlm.nih.gov Bajwa, A., Villar, R., ...

1851HyrtlJ

The author expresses a classic view on the functions of the ligamentum capitis femoris (LCF): a conductor of blood vessels and a limiter of adduction of the femur. J. Hyrtl believed that it was impossible to completely dislocate the hip without tearing the LCF. Hyrtl J. Lehrbuch der Anatomie des Menschen, mit Rücksicht auf physiologische Begründung und praktische Anwendung. Wien: W. Braumüller, 1851. [fragment] Quote p. 265 In der Höhle des Gelenks liegt das runde Band des Schenkelkopfes (Lig. teres), welches an der Incisura acetabuli entspringt, und bei richtiger Neigung des Beckens, senkrecht zur Grube des Schenkelkopfes aufsteigt. Es beschränkt dieses Band die Zuziehung des Schenkels, und schreibt zugleich den durch die Incisura acetabuli eindringenden Blutgefässen den Weg vor, den sie zum Oberschenkelkopfe zu nehmen haben. Da das Band, wenn es in die Höhle des Gelenkes vorragen würde, durch Reibung viel zu leiden hätte, so...

16с.Archangel_Michael

Icon «Michael the Archangel (in deeds)», stigma «The struggle of Jacob with the angel» (16th cent.). Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Ja cob was left alone; and there wrestled a man with him until the breaking of the day. 26 And when he saw that he could not pre vail against him, he struck against the hollow of his thigh ; and the hollow of Jacob's thigh was put out of joint, as he was wrestling with him. … 33 Therefore do the children of Israel not eat the sinew which shrank, which is upon the hollow of the thigh, unto this day; because he struck against the hollow of Jacob's thigh on the sinew that shrank. ( 1922LeeserI , Genesis (Bereshit) 32:25-26,33) More about the plot in our work: Ninth month, eleventh day ( 2024АрхиповСВ. Девятый месяц, одиннадцатый день ). Unknown author – Icon «Michael the Archangel (in deeds)»...

1626BartholinC

Fragment from the book Bartholin C. Anatomicae Institutiones Corporis Humani (1626). The author describes the anatomy, topography, geometric and mechanical properties of the ligamentum capitis femoris (LCF). The term «terete» (rounded) is used to indicate its geometry. The term «cartilagine» (cartilaginous) is used to describe the hardness of the LCF, and the analogy of «nervus esset cartilaginosus» (like a cartilaginous sinew) is given. Similar terminological elements are present in the works of Galen of Pergamon and Theophilus Protospatharius ( 2020ArkhipovSV_ProlyginaIV ). See the previous edition at the link: 1611BartholinC Quote p. 409 [Lat] Cap. XXI. DE OSSIBUS TOTIUS PEDIS. … I. Est caput maximum & rotundum, ex appendice factum, quod in coxendicis acetabulum inseritur, & duplici ligamento cum coxendice nectitur: uno communi, lato, membraneo, sed satis crasso, orbiculatum articulum ambiente; altero terete, quasi cartilagine (ac si nervus esset cart...

1905BardeenCR

An excerpt from the article by Bardeen CR. Studies of the development of the human skeleton (1905). The author briefly discusses the emergence of the ligamentum capitis femoris (LCF). Quote p. 287 The hip-joint is represented at first by a dense mass of scleroblastema, Fig. 55. The development of the acetabulum by ingrowth and fusion of processes from the iliac, ischial and pubic cartilages has already been described. The cartilagenous joint-cavity is at first quite shallow, Fig. 56. But extension of cartilage into the blastemal tissue which passes from the pelvis over the head of the femur serves greatly to deepen it on all sides except in the region of the cotyloid notch. The joint-cavity is at first completely filled with a dense blastemat tissue, Fig. 56. While the embryo is growing from 20 to 30 mm. in length cavity formation begins in the tissue lying between the cartilagenous floor of the acetabulum and the head of the femur. The first stage in the process is marked by a c...

1720RuyschF

The author draws attention to the well-developed blood supply of the acetabular fossa, as well as the ligamentum capitis femoris (LCF). In the work, it is referred to as the «ligamentum nerveo-cartilagineum», which literally means the tough cartilaginous ligament and implies its strength. With the difficulty of accessing the acetabular fossa, and therefore the LCF, Frederik Ruysch associates the inefficiency of treating hip joint pain. The writer presumably implies osteoarthritis. In our opinion, its development is initiated by the pathology of the LCF ( 2012АрхиповСВ ). The discussed work includes a black and white drawing of the LCF of a child, made by the illustrator Jan Wandelaar. In color, the same preparation, but from a different angle, was depicted by the artist Jan l'Admiral in a separate publication ( 1738LadmiralJ ). Ruysch F. Adversarium anatomico-medico-chirurgicorum decas secunda. In quâ varia notatu digna recensentur. Cum figuris aeneis. Amsterdami: a...

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