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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LCF in 2025 (November)

LCF in 2025 ( November ) (Quotes from articles and books published in October 2025 mentioning the ligamentum capitis femoris) Awad, A., Rizk, A., ElAlfy, M., Hamed, M., Abdelghany, A. M., Mosbah, E., ... & Karrouf, G. (2025). Synergistic Effects of Hydroxyapatite Nanoparticles and Platelet Rich Fibrin on Femoral Head Avascular Necrosis Repair in a Rat Model. Journal of Biomedical Materials Research Part B: Applied Biomaterials , 113 (11), e35672. [i] onlinelibrary.wiley.com Loughzail, M. R., Aguenaou, O., Fekhaoui, M. R., Mekkaoui, J., Bassir, R. A., Boufettal, M., ... & Lamrani, M. O. (2025). Posterior Fracture–Dislocation of the Femoral Head: A Case Report and Review of the Literature. Sch J Med Case Rep , 10 , 2483-2486. [ii] saspublishers.com , saspublishers.com Vertesich, K., Noebauer-Huhmann, I. M., Schreiner, M., Schneider, E., Willegger,...

2025ChenJH_AcklandD

The article by Chen JH, Al’Khafaji I, Ernstbrunner L, O’Donnell J, Ackland D. Joint contact behavior in the native, ligamentum teres deficient and surgically reconstructed hip: A biomechanics study on the anatomically normal hip (2025). The authors experimentally demonstrated the role of the ligamentum capitis femoris (LCF) in unloading the upper sector of the acetabulum and the femoral head. The text in Russian is available at the following link: 2025ChenJH_AcklandD . Joint contact behavior in the native, ligamentum teres deficient and surgically reconstructed hip: A biomechanics study on the anatomically normal hip By Chen JH, Al’Khafaji I, Ernstbrunner L, O’Donnell J, Ackland D. CONTENT [i] Abstract [ii] Introduction [iii] Materials and methods [iv] Results [v] Discussion and Conclusion [vi] References [vii] Application [i] Abstract Background The ligamentum teres is known to contribute to hip joint st...

1996(r)ArkhipovSV

METHOD OF PELVIS OSTEOTOMY (Способ остеотомии таза) Patent Application RU96120699A Inventor Сергей Васильевич Архипов Original Assignee Sergey Vasilyevich Arkhipov Application RU96120699/14A events 1996-10-01 Application filed by С . В . Архипов 1999-01-20 Publication of RU96120699A Claims The method of pelvic osteotomy by complete intersection of the ilium above the capsule and acetabulum, characterized in that after arthrotomy of the hip joint the hip bones additionally intersect in front and behind the acetabulum, as well as above it between the capsule and limb, with the displacement of the formed intermediate fragment laterally and osteosynthesis fragments, in addition, plastic or prosthetics of the ligament of the femoral head can be performed, and an osteograft can be fixed over the intermediate fragment. Description of the invention Description in Russian is available at the link: 1996(r) АрхиповСВ (the blog has a translation function)....

1836-1840PartridgeR

«Prof. Partridge in his lectures on anatomy at King's College was accustomed to compare the Ligamentum Teres, in its function, to the leathern straps by which the body of a carriage is suspended on springs » ( 1874SavoryWS ). Perhaps Nikolai Pirogov listened to these lectures ( 1859PirogoffN ). The analogy that Richard Partridge used could have arisen after reading the monograph Bell J. The Principles of Surgery (1801) . In it, the author depicted a cart and a pelvis resting on the head of one and two femurs. However, there is no mention of ligamentum capitis femoris (LCF) in the chart descriptions. References Savory WS. On the use of the ligamentum teres of the hip joint. J Anat Physiol. 1874;8(2)291-6. [ ncbi.nlm.nih.gov , archive.org ] Pirogoff N. Anatome topographica sectionibus per corpus humanum congelatum triplici directione ductus illustrate. Petropoli: Typis Jacobi Trey, 1859. [ books.google , archive.org ] ...

Human Children. Retelling of Chapter 15

Short retelling of chapter 15 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian] Chapter 15. EXODUS FROM HARAN Jacob thrives as a shepherd in Haran, amassing wealth while his father-in-law, Laban, grows poorer. Sensing Laban’s growing resentment, Jacob foresees trouble and flees with his family, livestock, and possessions, aiming for “the land of Canaan.” His caravan crosses a river—likely the Euphrates—and heads toward “Mount Gilead.” Genesis doesn’t specify the journey’s duration, but ten days later, Laban overtakes Jacob at Gilead. Here, it’s revealed Jacob labored 20 years in Haran: 14 for his wives, Leah and Rachel, and six under a later deal for livestock. At Mount Gilead, the families reconcile, sealing peace with a monument—a rock pillar encircled by stones—named “Jegar-Sahadutha,” “Galeed,” and “Mizpah.” Laban returns home, and Jacob presses on to “Mahanaim.” ...

2007ArkhipovSV_ArkhipovaLN

METHOD OF ARTHROSCOPY OF HIP JOINT ( Способ артроскопии тазобедренного сустава ) Patent Application RU2007103463A Inventor Сергей Васильевич Архипов Людмила Николаевна Архипова Original Assignee Sergey Vasilyevich Arkhipov Ludmila Nikolaevna Arkhipova Application RU2007103463/14A events 2007-01-29 Application filed by Сергей Васильевич Архипов (RU), Людмила Николаевна Архипова (RU) 2007-01-29 Priority to RU2007103463/14A 2008-08-10 Publication of RU2007103463A Claims A method for arthroscopy of a hip joint by introducing an optical system and instruments into its acetabular part, characterized in that they are inserted from lateral access through one or more through channels made in the femur in the direction from its outer side to the femoral head, and during examination the acetabular part of the joint, the patient turns so that this hip joint is below the opposite. Description of the invention Description in Russian is available ...

1996(p)ArkhipovSV

METHOD FOR TRANSPOSITION OF THE ACETABULUM (Способ транспозиции вертлужной впадины) Patent Application RU96120311A Inventor Сергей Васильевич Архипов Original Assignee Sergey Vasilyevich Arkhipov Application RU96120311/14A events 1996-10-09 Application filed by С . В . Архипов 1999-01-20 Publication of RU96120311A Claims A method for transposition of the acetabulum by dissecting the iliac, pubic and sciatic bones of the pelvis around the circumference of the acetabulum, characterized in that after arthrotomy of the hip joint, the dissection of the pelvic bones is performed between the capsule and limb, and the resulting fragment is displaced medially and fixed; in addition, plastic or prosthetics of the ligament of the femoral head. Description of the invention Description in Russian is available at the link: 1996(p) АрхиповСВ (the blog has a translation function). External links: Arkhipov SV. Method for transposition of the acet...

1543(b)VesaliusA

Fragment from the book Vesalius A. Humani corporis fabrica librorum Epitome (1543). The author describes the attachment and shape of the ligamentum capitis femoris (LCF). Our brief commentary is available at the link: 1543(b)VesaliusA [Rus]. Quote. [Lat] Caput. II. De ossium ac cartilaginvm ligamentis, et musculis arbitrarij motus instrumentis Ex femoris superiori capite teres ligamentum in coxendicis acetabulum insertur. Translation [Eng] Quote. Chapter II. On the ligaments of the bones, cartilages, and muscles that perform voluntary movements. From the upper head of the femur, the round ligament is inserted into the acetabulum of the hip joint. Jan Stephan van Calcar (ca. 1543) External links Vesalius A. Humani corporis fabrica librorum Epitome. Basileae: Ex officina Joannis Oporini, Anno MDXLIII Mense Iunio [June, 1543]. [ books.google ] Authors & Affiliations Andreas Vesalius (And ries van Wezel, 1514-1564) physician, anatomist, professor at the Univers...

1841StanleyE

The article primarily discusses pathological hip dislocations and mentions pathology of the ligamentum capitis femoris (LCF). In particular, the author personally observed elongation of the LCF in hemiplegia. Analyzing one of the observations, Edward Stanley suggested the idea of primary LCF injury as the cause of subsequent dislocation. Discussing the variable morphology of this structure, the author lists witnesses of the absence of LCF ( Palletta , Bonn , Sandifort , Kaldani) and its elongation (M. Vrolik from Amsterdam). ON DISLOCATIONS, ESPECIALLY OF THE HIP-JOINT, ACCOMPANIED BY ELONGATION OF THE CAPSULE AND LIGAMENTS. By EDWARD STANLEY, F.R.S., SURGEON TO ST. BARTHOLOMEW'S HOSPITAL. READ JANUARY 12TH, 1841. It may be presumed that observations similar to those which I am about to submit to the Society, have occurred to other pathologists and surgeons; yet as the subject of dislocations of the larger joints, and especially of the hip, occurring ...

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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