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Legg-Calvé-Perthes Disease
Arthur B. Meyers, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Legg-Calvé-Perthes (LCP) disease
            • Synonyms

              • Legg-Perthes or Perthes disease
              • Juvenile idiopathic osteonecrosis
            • Definitions

              • Idiopathic osteonecrosis of femoral head in children

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Chong DY et al: Reliability and validity of visual estimation of femoral head hypoperfusion on perfusion MRI in Legg-Calve-Perthes disease. J Pediatr Orthop. 41(9):e780-6, 2021
                                          2. Jones CE et al: T1ρ and T2 MRI show hip cartilage damage in adolescents with healed Legg-Calvé-Perthes disease. J Pediatr Orthop B. ePub, 2021
                                          3. Tis JE et al: Reproducibility of radiographic measurements made in the active stages of Legg-Calvé-Perthes disease: evaluation of a prognostic indicator and an interim outcome measure. J Pediatr Orthop. 41(2):93-8, 2021
                                          4. Pavone V et al: Aetiology of Legg-Calvé-Perthes disease: a systematic review. World J Orthop. 10(3):145-65, 2019
                                          5. Jandl NM et al: MRI and sonography in Legg-Calvé-Perthes disease: clinical relevance of containment and influence on treatment. J Child Orthop. 12(5):472-9, 2018
                                          6. Divi SN et al: Legg-Calvé-Perthes disease. Pediatr Ann. 45(4):e144-9, 2016
                                          7. Yoo WJ et al: Risk factors for femoral head deformity in the early stage of Legg-Calvé-Perthes disease: MR contrast enhancement and diffusion indexes. Radiology. 279(2):562-70, 2016
                                          8. Heesakkers N et al: The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 39(5):859-63, 2015
                                          9. Hyman JE et al: Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 97(8):643-50, 2015
                                          10. Kotoura Y et al: Assessment of lateral subluxation in Legg-Calvé-Perthes disease: a time-sequential study of magnetic resonance imaging and plain radiography. J Pediatr Orthop B. 24(6):493-506, 2015
                                          11. Accadbled F et al: "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood. Orthop Traumatol Surg Res. 100(6):647-9, 2014
                                          12. Kim HK et al: Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: a preliminary study. J Bone Joint Surg Am. 96(14):1152-60, 2014
                                          13. Mazloumi SM et al: Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Jt Surg. 2(2):86-92, 2014
                                          14. Park KW et al: Extent of physeal involvement in Legg-Calvé-Perthes disease. Int Orthop. 38(11):2303-8, 2014
                                          15. Shah H: Perthes disease: Evaluation and management. Orthop Clin North Am. 45(1):87-97, 2014
                                          16. Kim HK et al: A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease. Pediatr Radiol. 43(9):1166-73, 2013
                                          17. Shah H et al: Quantitative measures for evaluating the radiographic outcome of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 95(4):354-61, 2013
                                          18. Nguyen NA et al: Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop. 32(7):697-705, 2012
                                          19. Park MS et al: Reliability and stability of three common classifications for Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 470(9):2376-82, 2012
                                          20. Ross JR et al: Intraarticular abnormalities in residual Perthes and Perthes-like hip deformities. Clin Orthop Relat Res. 470(11):2968-77, 2012
                                          21. Kuo KN et al: Classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 31(2 Suppl):S168-73, 2011
                                          22. Lobert PF et al: Unexpected MRI findings in clinically suspected Legg-Calvé-Perthes disease. Pediatr Radiol. 41(3):369-73, 2011
                                          23. Merlini L et al: Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol. 40(3):318-25, 2010
                                          24. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in the long-term follow-up after Perthes disease. J Pediatr Orthop. 30(2):147-53, 2010
                                          25. Dillman JR et al: MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 193(5):1394-407, 2009
                                          26. Ha AS et al: Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children. Pediatr Radiol. 38(11):1195-200, 2008
                                          27. Link TM et al: Cartilage imaging: motivation, techniques, current and future significance. Eur Radiol. 17(5):1135-46, 2007
                                          28. Van Tongel A et al: Epiphysiodesis of the greater trochanter in Legg-Calvé-Perthes disease: the importance of timing. Acta Orthop Belg. 72(3):309-13, 2006
                                          29. Rowe SM et al: Dysplasia epiphysealis capitis femoris: Meyer dysplasia. J Pediatr Orthop. 25(1):18-21, 2005
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Legg-Calvé-Perthes (LCP) disease
                                                    • Synonyms

                                                      • Legg-Perthes or Perthes disease
                                                      • Juvenile idiopathic osteonecrosis
                                                    • Definitions

                                                      • Idiopathic osteonecrosis of femoral head in children

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Chong DY et al: Reliability and validity of visual estimation of femoral head hypoperfusion on perfusion MRI in Legg-Calve-Perthes disease. J Pediatr Orthop. 41(9):e780-6, 2021
                                                                                  2. Jones CE et al: T1ρ and T2 MRI show hip cartilage damage in adolescents with healed Legg-Calvé-Perthes disease. J Pediatr Orthop B. ePub, 2021
                                                                                  3. Tis JE et al: Reproducibility of radiographic measurements made in the active stages of Legg-Calvé-Perthes disease: evaluation of a prognostic indicator and an interim outcome measure. J Pediatr Orthop. 41(2):93-8, 2021
                                                                                  4. Pavone V et al: Aetiology of Legg-Calvé-Perthes disease: a systematic review. World J Orthop. 10(3):145-65, 2019
                                                                                  5. Jandl NM et al: MRI and sonography in Legg-Calvé-Perthes disease: clinical relevance of containment and influence on treatment. J Child Orthop. 12(5):472-9, 2018
                                                                                  6. Divi SN et al: Legg-Calvé-Perthes disease. Pediatr Ann. 45(4):e144-9, 2016
                                                                                  7. Yoo WJ et al: Risk factors for femoral head deformity in the early stage of Legg-Calvé-Perthes disease: MR contrast enhancement and diffusion indexes. Radiology. 279(2):562-70, 2016
                                                                                  8. Heesakkers N et al: The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 39(5):859-63, 2015
                                                                                  9. Hyman JE et al: Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 97(8):643-50, 2015
                                                                                  10. Kotoura Y et al: Assessment of lateral subluxation in Legg-Calvé-Perthes disease: a time-sequential study of magnetic resonance imaging and plain radiography. J Pediatr Orthop B. 24(6):493-506, 2015
                                                                                  11. Accadbled F et al: "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood. Orthop Traumatol Surg Res. 100(6):647-9, 2014
                                                                                  12. Kim HK et al: Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: a preliminary study. J Bone Joint Surg Am. 96(14):1152-60, 2014
                                                                                  13. Mazloumi SM et al: Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Jt Surg. 2(2):86-92, 2014
                                                                                  14. Park KW et al: Extent of physeal involvement in Legg-Calvé-Perthes disease. Int Orthop. 38(11):2303-8, 2014
                                                                                  15. Shah H: Perthes disease: Evaluation and management. Orthop Clin North Am. 45(1):87-97, 2014
                                                                                  16. Kim HK et al: A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease. Pediatr Radiol. 43(9):1166-73, 2013
                                                                                  17. Shah H et al: Quantitative measures for evaluating the radiographic outcome of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 95(4):354-61, 2013
                                                                                  18. Nguyen NA et al: Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop. 32(7):697-705, 2012
                                                                                  19. Park MS et al: Reliability and stability of three common classifications for Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 470(9):2376-82, 2012
                                                                                  20. Ross JR et al: Intraarticular abnormalities in residual Perthes and Perthes-like hip deformities. Clin Orthop Relat Res. 470(11):2968-77, 2012
                                                                                  21. Kuo KN et al: Classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 31(2 Suppl):S168-73, 2011
                                                                                  22. Lobert PF et al: Unexpected MRI findings in clinically suspected Legg-Calvé-Perthes disease. Pediatr Radiol. 41(3):369-73, 2011
                                                                                  23. Merlini L et al: Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol. 40(3):318-25, 2010
                                                                                  24. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in the long-term follow-up after Perthes disease. J Pediatr Orthop. 30(2):147-53, 2010
                                                                                  25. Dillman JR et al: MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 193(5):1394-407, 2009
                                                                                  26. Ha AS et al: Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children. Pediatr Radiol. 38(11):1195-200, 2008
                                                                                  27. Link TM et al: Cartilage imaging: motivation, techniques, current and future significance. Eur Radiol. 17(5):1135-46, 2007
                                                                                  28. Van Tongel A et al: Epiphysiodesis of the greater trochanter in Legg-Calvé-Perthes disease: the importance of timing. Acta Orthop Belg. 72(3):309-13, 2006
                                                                                  29. Rowe SM et al: Dysplasia epiphysealis capitis femoris: Meyer dysplasia. J Pediatr Orthop. 25(1):18-21, 2005