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

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1803LarreyDJ

Content [i] Annotation [ii] Original text [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragment from the book: Larrey DJ. Relation historique et chirurgique de l'expedition de l'armée d'Orient, en Egypte et Syrie (Historical account and surgery of the expedition of the Army of the Orient, in Egypt and Syria, 1803). The author describes exarticulation in the hip joint and the technique of cutting the ligamentum capitis femoris (LCF), which he calls the "interarticular ligament". The text in Russian is available at the following link: 1803LarreyDJ . [ii] Original text (France ) Quote pp. 325-328 Les praticiens qui ont proposé l'extirpation de la cuisse ne sont point d'accord sur la manière de la faire; cependant presque tous, craignant l'hémorragie de l'artère crurale, commencent par la ligature de ce vaisseau, forment ensuite un lambeau aux dépens des muscles ...

Memorial Day

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LCF in 2026 (May)

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Vertebrates

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Human LCF intersection

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Inferior Portal. Part 1.

Original in Russian is available at the link: Нижний портал. Часть 1. below is a machine translation edited by a non-native speaker ( version dated 03/02/2025 ) . INFERIOR PORTAL FOR HIP ARTHROSCOPY: A PILOT STUDY PART 1. Background and Hypothesis Arkhipov S.V., Independent Researcher, Joensuu, Finland Abstract: The article presents, theoretically and graphically substantiates the technique of a new arthroscopic approach to the central compartment of the hip joint. It is proposed to introduce the optical system of the arthroscope from below through the acetabular notch without traction. Similar approaches were used for puncture, arthroscopy, arthrography, and arthrotomy of the hip joint. Diagnostics using the described lower portal will exclude complications caused by distraction of the leg and compression of the perineal support during surgery. CONTENTS PART 1. Background and Hypothesis [1] . Introduction [2] . Passage through t...

17c.Archangel_Cathedral

Archangel Cathedral of the Moscow Kremlin, fresco – «Jacob’s Wrestling with God» (1652 – 1666). 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 – Archangel Cathedral of the Moscow Kremlin, fr...

Hip disarticulation of the human

Hip disarticulation of the human Hip disarticulation of the human. Postmortem surgery with transection of the LCF in humans 15-12.5 thousand years ago. Presumably, the first postmortem arthrotomy of the hip joint with disarticulation was performed in Morocco 15.000-12.500 years ago. This is confirmed by multiple cuts on the femoral neck of a man from the burial of Taf V-18 ( Taforalt Iberomaurusian necropolis ). «T he cuts on the femoral neck were produced by severing the ligaments of the articular capsula in order to disarticulate the bone from the pelvis. There are no pelvic bones in the grave.» ( 2016MariottiV_CondemiS:Fig.2 ). We counted more than a dozen longitudinal, fairly deep cuts in the middle part of the femoral neck. Their length varies from about two to ten millimeters and occupies a surface of 1 cm along the length of the femoral neck and 2 cm in width. The mentioned cuts on the cortical plate and the absence of pelvic bones in the burial are evidence of the disarti...

17th Century

17th Century Catalog of archived publications of the specified period 1600-1609 1600LaurensA The author writes about the anatomy, attachment, properties, shape and size LCF. 1603IngrassiaeIP The author writes about the topography of LCF, its geometric and mechanical properties. 1605BauhinC The author writes about the attachment, function, possible elongation and damage of the LCF. 1610-1619 1610RiolanJ The author discusses the localization, function, attachment and mentions rare synonyms of LCF. 1611BartholinC The author describes the anatomy, topography, geometric and mechanical properties of the LCF. 1611GuidiG The author briefly writes about the anatomy, function, and attachment of the LCF. 1614PlatterF The author notes the role of the LCF in fixing the femur in the acetabulum and the possibility of its lengthening. 1615BauhinC The author describes the consist...

1858IvanovAA

Ivanov A.A., Jacob’s Wrestling with God (1849-1858) . Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Jacob 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 ( 2024 АрхиповСВ. Девятый месяц, одиннадцатый день ). Alexander Ivanov – Jacob’s Wrestling with God (1849-1858); original in the ekzeget.ru col...

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