{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:12:50Z","timestamp":1793157170950,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2026,2,15]]},"abstract":"<jats:p>Legg-Calv\u00e9-Perthes disease has been recognized for more than 100 years. It is an idiopathic osteonecrosis of the femoral head in children that follows a predictable course of bone death, revascularization, bone resorption, and eventually reossification and bone healing. The natural history is often favorable for children younger than 6 years and poor for children older than 8 to 10 years. The final outcome is determined by the shape of the healed femoral head and its congruence with the acetabulum. Treatment is aimed at preserving range of motion, maintaining containment, and limiting mechanical damage to the femoral head. Nonsurgical interventions include restricted weight-bearing, range of motion exercises, and casting or bracing treatment. Surgical interventions include osteotomies of the femur or pelvis or both to maintain containment, as well as joint distraction for containment and decreasing mechanical force. Superiority of a particular treatment strategy has been difficult to demonstrate due to relative rarity of the condition, variable natural history, and long-time horizon to predict final outcome. Recent research has focused on better imaging predictors and understanding and altering the pathophysiology subsequent to the vascular disturbance.<\/jats:p>","DOI":"10.5435\/jaaos-d-24-01469","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:00:44Z","timestamp":1758744044000},"page":"e488-e497","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Legg-Calv\u00e9-Perthes Disease"],"prefix":"10.5435","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0683-3172","authenticated-orcid":false,"given":"Shawn R.","family":"Gilbert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Laine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wudbhav N.","family":"Sankar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry K. W.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"R1-20260206","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.2106\/JBJS.RVW.15.00063","article-title":"The pathogenesis and treatment of Legg-Calve-Perthes disease","volume":"4","author":"Ibrahim","year":"2016","journal-title":"JBJS Rev"},{"key":"R2-20260206","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12891-020-03889-9","article-title":"High blood pressure and overweight in children with Legg-Calve-Perthes disease: A nationwide population-based cohort study","volume":"22","author":"Morlin","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"R3-20260206","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/BPB.0000000000000725","article-title":"Influence of passive smoking on the onset of Legg-Calve-Perthes disease: A systematic review and meta-analysis","volume":"29","author":"Gao","year":"2020","journal-title":"J Pediatr Orthop B"},{"key":"R4-20260206","doi-asserted-by":"crossref","first-page":"e612","DOI":"10.1097\/BPO.0000000000002708","article-title":"Pathogenic gene variants identified in patients presenting with perthes or perthes-like hip disorder","volume":"44","author":"Marchelli","year":"2024","journal-title":"J Pediatr Orthop"},{"key":"R5-20260206","doi-asserted-by":"crossref","first-page":"116215","DOI":"10.1016\/j.bone.2021.116215","article-title":"Damage associated molecular patterns in necrotic femoral head inhibit osteogenesis and promote fibrogenesis of mesenchymal stem cells","volume":"154","author":"Deng","year":"2022","journal-title":"Bone"},{"key":"R6-20260206","doi-asserted-by":"crossref","first-page":"526","DOI":"10.5435\/JAAOS-D-16-00856","article-title":"Role of advanced imaging in the diagnosis and management of active Legg-Calve-Perthes disease","volume":"26","author":"Laine","year":"2018","journal-title":"J Am Acad Orthop Surg"},{"key":"R7-20260206","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1007\/s00467-013-2636-z","article-title":"Gadolinium and nephrogenic systemic fibrosis: An update","volume":"29","author":"Weller","year":"2014","journal-title":"Pediatr Nephrol"},{"key":"R8-20260206","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/01241398-200309000-00005","article-title":"Natural evolution of Perthes disease: A study of 610 children under 12 years of age at disease onset","volume":"23","author":"Joseph","year":"2003","journal-title":"J Pediatr Orthop"},{"key":"R9-20260206","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/01241398-199203000-00001","article-title":"The lateral pillar classification of Legg-Calve-Perthes disease","volume":"12","author":"Herring","year":"1992","journal-title":"J Pediatr Orthop"},{"key":"R10-20260206","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.2106\/00004623-200410000-00002","article-title":"Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome","volume":"86","author":"Herring","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"R11-20260206","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/01202412-200501000-00002","article-title":"How does a femoral varus osteotomy alter the natural evolution of Perthes' disease?","volume":"14","author":"Joseph","year":"2005","journal-title":"J Pediatr Orthop B"},{"key":"R12-20260206","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1097\/BPO.0b013e3182a05dc1","article-title":"MR perfusion index as a quantitative method of evaluating epiphyseal perfusion in Legg-Calve-Perthes disease and correlation with short-term radiographic outcome: A preliminary study","volume":"33","author":"Du","year":"2013","journal-title":"J Pediatr Orthop"},{"key":"R13-20260206","doi-asserted-by":"crossref","first-page":"36","DOI":"10.2106\/JBJS.23.01429","article-title":"Early-stage femoral head hypoperfusion correlates with femoral head deformity at intermediate Follow-up in Legg-Calve-Perthes disease","volume":"107","author":"Kang","year":"2025","journal-title":"J Bone Joint Surg Am"},{"key":"R14-20260206","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.2106\/JBJS.G.00191","article-title":"Legg-calve-perthes disease: A review of cases with onset before six years of age","volume":"89","author":"Rosenfeld","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"R15-20260206","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1302\/0301-620X.104B4.BJJ-2021-1708.R1","article-title":"The British orthopaedic surgery surveillance study: Perthes' disease: The epidemiology and two-year outcomes from a prospective cohort in Great Britain","volume":"104-B","author":"Perry","year":"2022","journal-title":"Bone Joint J"},{"key":"R16-20260206","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.2106\/00004623-198163070-00006","article-title":"The natural history of Legg-Calve-Perthes disease","volume":"63","author":"Stulberg","year":"1981","journal-title":"J Bone Joint Surg Am"},{"key":"R17-20260206","doi-asserted-by":"crossref","first-page":"584","DOI":"10.2106\/JBJS.J.01073","article-title":"A prospective multicenter study of Legg-Calve-Perthes disease: Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years","volume":"94","author":"Larson","year":"2012","journal-title":"J Bone Joint Surg Am"},{"key":"R18-20260206","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.2106\/JBJS.L.00300","article-title":"Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: An experimental investigation in immature pigs","volume":"94","author":"Kim","year":"2012","journal-title":"J Bone Joint Surg Am"},{"key":"R19-20260206","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/BPB.0000000000000873","article-title":"Prolonged non-weightbearing treatment decreases femoral head deformity compared to symptomatic treatment in the initial stage of Legg-Calve-Perthes disease","volume":"31","author":"Peck","year":"2022","journal-title":"J Pediatr Orthop B"},{"key":"R20-20260206","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1097\/CORR.0000000000001608","article-title":"Weightbearing and activity restriction treatments and quality of life in patients with perthes disease","volume":"479","author":"Do","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"R21-20260206","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/CORR.0000000000002010","article-title":"Moderate weightbearing restrictions are associated with worse depressive symptoms and anxiety in children aged 5 to 7 years with perthes disease","volume":"480","author":"Do","year":"2022","journal-title":"Clin Orthop Relat Res"},{"key":"R22-20260206","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1302\/0301-620X.90B10.20649","article-title":"Prognostic factors and outcome of treatment in Perthes' disease: A prospective study of 368 patients with five-year follow-up","volume":"90","author":"Wiig","year":"2008","journal-title":"J Bone Joint Surg Br"},{"key":"R23-20260206","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/BPO.0b013e318281ab44","article-title":"Management of Legg-Calve-Perthes disease using an A-frame orthosis and hip range of motion: A 25-year experience","volume":"33","author":"Rich","year":"2013","journal-title":"J Pediatr Orthop"},{"key":"R24-20260206","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1097\/BPO.0000000000002787","article-title":"Adherence to wide-abduction brace treatment is associated with improved hip abduction and radiographic outcomes in Legg-Calve-Perthes disease","volume":"44","author":"Prasadh","year":"2024","journal-title":"J Pediatr Orthop"},{"key":"R25-20260206","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2106\/JBJS.J.00830","article-title":"How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in Legg-Calve-Perthes disease?","volume":"93","author":"Kim","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"R26-20260206","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1302\/1863-2548.14.190153","article-title":"Evolution of Legg-Calve-Perthes disease following proximal femoral varus osteotomy performed in the avascular necrosis stage:a prospective study","volume":"14","author":"Singh","year":"2020","journal-title":"J Child Orthop"},{"key":"R27-20260206","doi-asserted-by":"crossref","first-page":"e322","DOI":"10.1097\/BPO.0000000000001451","article-title":"Does early proximal femoral varus osteotomy shorten the duration of fragmentation in perthes disease? Lessons from a prospective multicenter cohort","volume":"40","author":"Sankar","year":"2020","journal-title":"J Pediatr Orthop"},{"key":"R29-20260206","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1007\/s11999-011-2220-4","article-title":"What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calve-Perthes disease?","volume":"470","author":"Hsu","year":"2012","journal-title":"Clin Orthop Relat Res"},{"key":"R30-20260206","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1097\/BPO.0000000000000714","article-title":"Advanced containment with triple innominate osteotomy in Legg-Calve-Perthes Disease: A viable option Even in severe cases","volume":"37","author":"Stepanovich","year":"2017","journal-title":"J Pediatr Orthop"},{"key":"R31-20260206","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/BPO.0000000000001791","article-title":"Hip morphology in early-stage LCPD: Is there an argument for anatomic-specific containment?","volume":"41","author":"Selberg","year":"2021","journal-title":"J Pediatr Orthop"},{"key":"R32-20260206","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2106\/JBJS.16.00255","article-title":"Outcome after combined pelvic and femoral osteotomies in patients with Legg-Calve-Perthes disease","volume":"99","author":"Mosow","year":"2017","journal-title":"J Bone Joint Surg Am"},{"key":"R33-20260206","doi-asserted-by":"crossref","first-page":"5718","DOI":"10.3390\/jcm12175718","article-title":"Long-term outcomes at skeletal maturity of combined pelvic and femoral osteotomy for the treatment of Legg-Calve-Perthes disease","volume":"12","author":"Regan","year":"2023","journal-title":"J Clin Med"},{"key":"R34-20260206","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1097\/BPB.0000000000000690","article-title":"Arthrodiastasis in the management of Perthes disease: A systematic review","volume":"29","author":"Ibrahim","year":"2020","journal-title":"J Pediatr Orthop B"},{"key":"R35-20260206","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.joca.2018.10.010","article-title":"IL6 receptor blockade preserves articular cartilage and increases bone volume following ischemic osteonecrosis in immature mice","volume":"27","author":"Kamiya","year":"2019","journal-title":"Osteoarthritis Cartilage"},{"key":"R36-20260206","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.otsr.2020.01.006","article-title":"Development of a novel minimally invasive technique to washout necrotic bone marrow content from epiphyseal bone: A preliminary cadaveric bone study","volume":"106","author":"Alves do Monte","year":"2020","journal-title":"Orthop Traumatol Surg Res"},{"key":"R37-20260206","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/s41536-023-00322-2","article-title":"Local BMP2 hydrogel therapy for robust bone regeneration in a porcine model of Legg-Calve-Perthes disease","volume":"8","author":"Ma","year":"2023","journal-title":"NPJ Regen Med"},{"key":"R38-20260206","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1002\/jor.25044","article-title":"T1\u03c1 and T2 mapping detect acute ischemic injury in a piglet model of Legg-Calv\u00e9-Perthes disease","volume":"40","author":"Johnson","year":"2022","journal-title":"J Orthop Res"},{"key":"R39-20260206","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/jor.25733","article-title":"Intravoxel incoherent motion (IVIM) detects femoral head ischemia in a piglet model of Legg-Calve-Perthes disease","volume":"42","author":"Buko","year":"2024","journal-title":"J Orthop Res"},{"key":"R40-20260206","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1002\/jor.25761","article-title":"Fully automatic system to detect and segment the proximal femur in pelvic radiographic images for Legg-Calve-Perthes disease","volume":"42","author":"Ditmer","year":"2024","journal-title":"J Orthop Res"},{"key":"R41-20260206","doi-asserted-by":"crossref","first-page":"6870","DOI":"10.1038\/s41598-023-34176-x","article-title":"An AI based classifier model for lateral pillar classification of Legg-Calve-Perthes","volume":"13","author":"Soydan","year":"2023","journal-title":"Sci Rep"},{"key":"R42-20260206","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/BPO.0000000000002494","article-title":"Outcome prediction model following proximal femoral osteotomy in Legg-Calve-Perthes disease using machine learning algorithms","volume":"43","author":"Kim","year":"2023","journal-title":"J Pediatr Orthop"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-24-01469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:51:00Z","timestamp":1787669460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.5435\/JAAOS-D-24-01469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-24-01469","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]},"assertion":[{"value":"2024-12-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}