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

In translating to English, the author is assisted by ChatGPT (version 3.5) and the Google Translate service.

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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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1948EpsteinI

Content [i] Annotation [ii] Original text [iii] Illustration [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragments from the book: Epstein I. Babylonian Talmud. Seder Kodashim. Vol. 2. Hullin (1948). The editor comments on the words of Rabbi Samuel (Shmuel) in the tractate Hullin of the Babylonian Talmud, explaining the location of the ligamentum capitis femoris (LCF) in relation to the joint and its differences from the sciatic nerve. The original in Russian is available at: 1948EpsteinI . [ii] Original text Quote p. 500 Hullin. Chapter 7.89b MISHNAH. [THE PROHIBITION OF] THE SCIATIC NERVE(1) IS IN FORCE BOTH WITHIN THE HOLY LAND AND OUTSIDE IT, BOTH DURING THE EXISTENCE OF THE TEMPLE AND AFTER IT, IN RESPECT OP BOTH UNCONSECRATED AND CONSECRATED [ANIMALS]. IT APPLIES TO CATTLE AND TO WILD ANIMALS, TO THE RIGHT AND LEFT HIP, BUT IT DOES NOT APPLY TO BIRDS BECAUSE THEY HAVE NO SPOON-SHAPED HIP(2). IT ALSO APPLIES TO A F...

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., ...

1753AstrucJ

Content [i] Annotation [ii] Original text (in French) [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragments from the book: Astruc J . Conjectures sur les memoires originaux dont il paroit que Moyse s'est servi pour composer le livre de la Genese (Conjectures on the Original Documents Which Moses Apparently Used in Compiling the Book of Genesis, 1753). In analyzing the book of Genesis, the author cites a French text mentioning a hip injury, damage to the ligamentum capitis femoris (LCF), and the consequences of an accident. An Russian translation is available at: 1753AstrucJ . [ii] Original text (in French) Quote p. 176 Genesis. Chap. XXXII A 25. Et quand cest hommeld vid qu’il ne le pouvoit vaincre, il toucha l'enrdroit de l'emboifiement de la hanche d'icelui: ainsi l'emboifiement de l'os de la hanche de Jacob fut entors quand l'homme luictoit avec lui. Quote p. 177...

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2008ArkhipovSV

On the Role of the Ligamentum Capitis Femoris in the Maintenance of Different Types of Erect Posture S.V. Arkhipov Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, abductor muscle group, role, function, hip joint, model, biomechanics, walk, gait cycle, single-legged stance ABSTRACT New experimental and clinical data on the function of the ligamentum capitis femoris (LCF) and its participation in maintaining an erect posture were obtained. It was established that this anatomical element is involved in constraining the hip joint adduction and may ﬁ x the joint in the frontal plane, turning it into an analogue of a second-class lever. In both unstrained one-support and asymmetrical two-support orthostatic postures, when the LCF is stretched and the abductor muscle group is exerted, a load equal to the body weight is evenly distributed between the upper and lower hemispheres of the caput femoris. In addition, the LCF fu...

1914RickettsCS

Ricketts C.S. , Jacob Wrestling with the Angel (before 1914). 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 ). Charles S. Ricketts – Jacob Wrestling with the Angel (before 1914). Presented by Miss Katherine Harris Bradley, origina...

1845HollsteinL

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1665LindenJA

Content [i] Annotation [ii] Original text (in Latin) [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragment from the book: Linden JA . Magni Hippocratis Coi Opera Omnia Graece Et Latine Edita. Vol. I. (1665). This article presents an excerpt from the treatise «Mochlicus» (Instruments of Reductions) by Hippocrates of Cos (b. 460 BC), translated into Latin. The author describes for the first time the localization and area of distal attachment of the ligamentum capitis femoris (LCF) describit, mentionem in alio tractatu ponens. A translation of this article into Russian is available at the link: 1665LindenJA . The original source in Greek sees at the link: 1844LittreE , and in English at: 1886AdamsF . [ii] Original text (in Latin) Quote pp. 294-295 Vol. I. Ossium natura II. Ipsum aurem femur foras, & in anteriore parte incurvum est. Caput autem ejus appendix eft r...

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...

20c.WikstromB

Wikstrom B , s culpture I will not let you go» (Jacob wrestling the Angel , 20th 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 ). Brit Wikstrom – « I will not let you go» (Jacob wrestling the Angel , 20th?) . O riginal in gg...

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