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.

If you notice an error, please let us know!

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

1886LesshaftP

According to the author, the ligamentum capitis femoris (LCF) reduces shocks and impacts of the articular surfaces. In addition, P. Lesshaft states an anatomical fact: the LCF is located vertically under the part of the acetabulum, which mainly bears the weight of the body. The text is prepared for machine translation using a service built into the blog from Google or your web browser. In some cases, we have added links to quotations about LCF available on our resource, as well as to publications posted on the Internet. Über die Vorriehtungen in den Gelenken zur Milderung der mit den Bewegungen verbundenen Stösse und Erschütterungen . Von P. Lesshaft, Professor der Anatomie in St. Petersburg. (Schluß.) Die Bewegungen im Kiefergelenke werden auch von einer hier liegenden Bandscheibe (Meniscus interarticularis) gemindert, aber außerdem von Syndesmosen, die als Gomphosis der Zähne und als Nahtverschmelzung (sutura) hier vorkommen und welche nichts anderes als eine (...

1140St.Marie-Madeleine

Basilica of Saint Mary Magdalene of Vézelay, capital s – Jacob with the Angel (1125 – 1140). 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 ( 2024 АрхиповСВ. Девятый месяц, одиннадцатый день ). Basilica of Saint Mary Magdalene of Vézelay (1125 – 1140). Capital (...

1857HyrtlJ

The author discusses the anatomy, structure, and role of the ligamentum capitis femoris (LCF). Based on his own research, Josef Hyrtl asserts that the vessels of the LCF do not participate in supplying blood to the femoral head. The author highlights the high strength of the LCF and changes in congenital dislocations. Apparently, this work was the first to suggest that the LCF serves as a conductor of inflammatory processes and a cause of coxalgia. Hyrtl J. Handbuch der topagraphischen Anatomie und ihrer praktisch medicinisch-chirurgischen Anwendungen. Zweiter band. Wien: W. Braumüller, 1857. [fragment] Quote p. 410-412 c. Rundes Band des Schenkelkopfes. Einfluss desselben auf die Stellung des Beins bei Coxalgie. Ein verticaler, durch die Mitte der Pfanne und des Schenkelkopfes und bei richtiger Beckenneigung von aussen nach innen geführter Schnitt, trennt das runde Band in zwei gleiche Schenkel, einen vorderen und hinteren. Das Band ...

The First Scientific Mention

European science has known the LCF for about 2500 years. It is the most important functional connection of the hip joint. The first person to describe the LCF was Hippocrates (c. 460-370 BCE). A written mention of the LCF is found in §1 of his treatise "On the Instrument of redactions". In our opinion, a book created in the library of the Asclepeion of the island of Kos. Hippocrates did not dissection of the human body, did not operate on the hip joint, did not have a CT scan and MRI. How he could discover the LCF? In our view, it is possible that Hippocrates treated a patient with an open hip dislocation. Track Music: Blue Dot Sessions , Vittoro (CC BY-NC 4.0 DEED / fragment) keywords: ligamentum capitis femoris, ligament of head of femur, ligamentum teres, hip dislocation . ...

163-192Galen

Fragment from the treatise Galen. On anatomical procedures (Περὶ Ἀνατομικῶν Ἐγχειρήσεων, ca. 163-192). The author writes about the high resiliency and hardness of ligamentum capitis femoris (LCF), and also notes its connective function. See our commentary at the link: 163-192Galen [Rus], and 2020ArkhipovSV_ProlyginaIV . Quote [Grc] Περὶ Ἀνατομικῶν Ἐγχειρήσεων. Βιβλιον B. K εφ . ι ʹ . Αλλά χρή σε, καθάπερ επί της χειρός επεσκέψω τους συνδέσμους των οστών, ούτω και νυν επισκέψασθαι πασών των γεγυμνωμένων διαρθρώσεων, πρώτης μεν της κατ' ισχίον, εχούσης ένα μεν εν κύκλω σύνδεσμον, απάντων των άρθρων κοινόν, (ουδέν γάρ έστιν, ότω μή περιβέβληται τοιούτος σύνδεσμος,) έτερον δε τον διά του βάθους εν τη διαρθρώσει κατακεκρυμμένον, ος συνάπτει την κεφαλήν του μηρού τη κατ' ισχίον κοιλότητι, πάνυ σκληρός ών, ώς ήδη δύνασθαι λέγεσθαι νεύρον χονδρώδες. (original source: 1821KühnCG, pp. 328-329) [Lat] De Anatomicis Administrationibus. Liber II. Cap. X. Verum considerare te convenit, ut i...

1614PagniniS

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: Pagnini S. Thesaurus linguae sanctae, sive lexicon hebraicum (1614, Vol. 1). The author examines the translation into Latin of the term denoting ligamentum capitis femoris (LCF) in Hebrew biblical texts. The text in Russian is available at the following link: 1614PagniniS . [ii] Original text (in Latin) Quote, p. 392 ניר est Neruus Genesis 32.32 Idcirco non comedent (pro, comedunt) filij Israel ניר את neruum. Et Iesah 48.4 וניד & nerruus serreus ceruix tua: vel, secundum Rab. Dair. & virga ferrea: sic appellate, quòd nerui sint ceruice בניד in neruo Genes. 32.32. Iech 37.6. Et dabo super vos צירים neruos. Ijob 10. II ossibusq;...

280-352Rava

Sayings of Rava extracted from the tractates Chullin and Horayot (Babylonian Talmud). Babylonian Talmud was written between about 450 - 550 in present-day Iraq (formerly Babylonia). The rabbi identifies the location and distal attachment site of the ligamentum capitis femoris (LCF) and demonstrates knowledge of its function. See our commentary at the link: 280-352Rava [Rus]. Quote 1. [Heb] Chullin 54b3 (original source: sefaria.org ) Quote 2. [Heb] Chullin 91a12 (original source: sefaria.org ) Quote 3. [Heb] Horayot 12a:16 (original source: sefaria.org ) Translation Quote 1. [Eng] Chullin 54b3 The Gemara addresses the matter itself: Rav Mattana says: This head of the femur that was completely dislocated renders the animal a tereifa. And Rava said: The animal is kosher, but if its sinew holding the bone in place is cut, it is a tereifa. The Gemara concludes: And the halakha is: Even if the sinew is cut, the animal is still kosher...

14c.Rudolf_von_Ems

Rudolf von Ems. Weltchronik, m iniature Jacob Wrestling with an Angel ( 14th cent., between 1350 and 1375). 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 , m iniature Jacob Wrestling with an Ang...

Human LCF intersection

HUMAN LCF INTERSECTION In the south of China, in the Guangxi Zhuang Autonomous Region, the archaeological Neolithic site of Dingsishan was investigated. Burials of 355 people were found in this place. The authors of the article (2024YeZ_LiFJ) identified 91 skeletons with traces of manipulations with the remains. They are attributed to burials of the Dingsishan III-IV phase, aged 8.0-4.5 thousand years. 13 notches were found on the proximal part of various femurs. « Cutmarks on the femoral head, neck and intertrochanteric line, as well as along the medial linea aspera of the femoral shaft, suggest that soft tissue around the hip, including the iliofemoral ligament and the iliacus and adductor muscles, was severed to disarticulate the joint.» This and other postmortem bone injuries «... suggests that corpse treatment at Dingsishan included disarticulation » (2024YeZ_LiFJ). Figure 4 of the cited article shows the distribution and direction of cutmarks on human skeletons from Dingx...

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