{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T18:57:28Z","timestamp":1758394648925,"version":"3.41.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>Legg\u2013Calv\u00e9\u2013Perthes disease (LCPD) often produces a residual deformity, typically consistent with coxa magna, coxa plana, and ellipsoidal shape. Depending on the degree of asphericity and flatness, this morphology was classified by Stulberg in stages III and IV. Thus far, few studies have investigated physeal injury as an etiological cause or evaluated its progressive profile throughout Waldenstr\u00f6m\u2019s reossification stage and the remodelling stage. In this study, we analysed the ellipsoidal process of the femoral head. This was a retrospective control case study involving 83 unoperated hips with LCPD and Stulberg stages III and IV outcome. The data were compared with those obtained for 49 healthy contralateral hips (control). The Ellipsoidal Index, the presence of a double epiphyseal reossification nucleus, physeal narrowing, intraphyseal angle, epiphyseal height, diameter of the head, and Reimer\u2019s Index were determined. Measurements were performed at four-time points: the year the reossification stage was initiated, the final growth stage, and two equally spaced time points in between. The Ellipsoidal Index gradually increased throughout the course of the disease from 1.6 in the initial reossification stage to 2.0 at the end of growth. In the control cases, this value was consistently 1.4. More ellipsoidal deformity was observed in Stulberg stage IV versus Stulberg stage III patients (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.05). Moreover, there was a direct link between a high Ellipsoidal Index and the appearance of a double reossification nucleus, a physeal narrowing in the area underlying the anterosuperior nucleus, intraphyseal angle. Reimer\u2019s Index showed a gradual extrusion from baseline to the end of growth (26.1 versus 31.8, respectively; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.05). The ellipsoidal process of the femoral head occurs gradually throughout the reossification and remodelling stages. This was linked to the appearance of a double epiphyseal nucleus, gradual extrusion, an angulated physis appearance, an asymmetrical narrowing of the physis and a high Ellipsoidal Index, which may be indicative of poor prognosis. Levels of Evidence for Primary Research Question: Level III, case-control study.<\/jats:p>","DOI":"10.1097\/bpb.0000000000000748","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T01:38:16Z","timestamp":1591234696000},"page":"309-315","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Ellipsoidal process of the femoral head in Legg\u2013Calv\u00e9\u2013Perthes disease. Part I"],"prefix":"10.1097","volume":"30","author":[{"given":"Juan Carlos","family":"Abril","sequence":"first","affiliation":[{"name":"Hospital Universitario Ni\u00f1o Jes\u00fas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarita","family":"Montero","sequence":"additional","affiliation":[{"name":"Ruber International Hospital, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa M.","family":"Egea-G\u00e1mez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ni\u00f1o Jes\u00fas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryem Fama","family":"Ismael","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ni\u00f1o Jes\u00fas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"key":"R1-20250526","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.2106\/00004623-198163070-00006","article-title":"The natural history of Legg-Calv\u00e9-Perthes disease.","volume":"63","author":"Stulberg","year":"1981","journal-title":"J Bone Joint Surg Am"},{"key":"R2-20250526","doi-asserted-by":"crossref","first-page":"354","DOI":"10.2106\/JBJS.L.00172","article-title":"Quantitative measures for evaluating the radiographic outcome of Legg-Calv\u00e9-Perthes disease.","volume":"95","author":"Shah","year":"2013","journal-title":"J Bone Joint Surg Am"},{"key":"R3-20250526","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1302\/0301-620X.89B10.18747","article-title":"The deformity index as a predictor of final radiological outcome in Perthes\u2019 disease.","volume":"89","author":"Nelson","year":"2007","journal-title":"J Bone Joint Surg Br"},{"key":"R4-20250526","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/01241398-200007000-00007","article-title":"Prognostic evaluation of Legg-Calv\u00e9-Perthes disease by MRI. 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