Revascularization of the Artery of the Ligamentum Teres in Perthes Disease

Atsumi, Takashi; Yoshihara, Satoshi; Hiranuma, Y.

doi:10.1097/00003086-200105000-00027

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…He identified that flow through the femoral capital vein (the venous analog to the artery to ligamentum teres) increased during the initial stages of Perthes disease while the medial femoral circumflex artery (MFCA) was occluded and that flow diminished once again once flow through the MFCA was re‐established. Similar findings were reproduced in a subsequent study by Atsumi et al wherein neovascularization of the ligamentum teres was demonstrated with superselective angiography in patients with Perthes disease. This increased flow may represent a compensatory collateral circulation through ligamentum teres vasculature, which would be consistent with the revascularization pattern seen on perfusion MRI and vascular channel patterns seen in our study.…”

Section: Discussionsupporting

confidence: 80%

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Morris

Liu

Chen

et al. 2019

Journal Orthopaedic Research

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Legg-Calve-Perthes disease is characterized by the capital femoral epiphyseal collapse, which occurs more reliably in the anterior quadrant than the more weight-bearing lateral quadrant. The purpose of this study was to determine whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Perthes disease. Thirty-two cadaveric proximal femoral epiphyses from 17 subjects (age 4-14 years old) underwent micro-computed tomography at 10-μm resolution. Each quadrant was analyzed for four markers of trabecular architecture: bone volume fraction (BV/TV), trabecular thickness, trabecular separation (TbSp), and trabecular number (TbN). Vascular channels were then mapped in each quadrant, identified by correlating surface topography with cross-sectional imaging. One-way analysis of variance revealed an overall difference between quadrants (p < 0.001) in BV/TV, TbN, and TbSp. However, post hoc analysis revealed there was no significant difference between the anterior and lateral quadrants for any of the four markers of trabecular architecture. Vascular channel mapping illustrated a predominance of vessels in the posterior half of the epiphysis compared to the anterior half (8.7 ± 4.0 vs. 3.4 ± 3.1 vascular channels, p < 0.001). The lack of microstructural differences between the anterior and lateral quadrants, and the predominance of vascular channels in the posterior half of the epiphysis with posteriorly-based medial femoral circumflex and ligamentum teres vessels suggests that the anterior femoral epiphysis may be a relative vascular watershed region, which predisposes it to collapse after the vascular insult of Perthes disease. Clinical significance: Improved understanding of the pathophysiology of anterior femoral epiphyseal collapse may inform future treatments aimed at revascularization.

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Section: Discussionsupporting

confidence: 80%

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Morris

Liu

Chen

et al. 2019

Journal Orthopaedic Research

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“…Hence, the blood circulation in femoral heads of young dogs may be especially vulnerable to a variety of insults. 1 , 31 , 34 , 39 , 57 , 63 Perhaps the same holds true for the femoral head of children.…”

Section: Animal Models Of Legg-calvé-perthes Diseasementioning

confidence: 90%

Osteonecrosis of the Femoral Head of Laboratory Animals: The Lessons Learned from a Comparative Study of Osteonecrosis in Man and Experimental Animals

2003

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Animal models of osteonecrosis of the femoral head are indispensable to the understanding of successful treatment modalities for avascular necrosis of the femoral head in adults and in children with Legg-Calvé-Perthes disease. Many of these models adequately reflect the current "vascular deprivation" theory regarding the etiology of the disease. In addition to spontaneous occurrence, surgical- and corticosteroid-induced models are suitable, common experimental ones. Osteonecrosis of spontaneously hypertensive rats appears to be due to defective bone formation and compression of the arteries entering the femoral head at its lateral facets by daily weight-bearing loads. Successful modeling of surgical-induced femoral capital necrosis can be a challenge in animals with a dual epiphyseal blood supply. High doses of corticosteroids are a pivotal risk factor in the development of osteonecrosis. The pathogenesis of corticosteroid-induced osteonecrosis likely resides in reduced blood flow. Steroids may reduce blood flow by numerous mechanisms, including marrow adipocytic hypertrophy leading to sinusoidal compression, venous stasis and, eventually, obstruction of the arteries, and arterial occlusion by fat emboli and lipid-loaded fibrin-platelet thrombi. Other, less common varieties of osteonecrosis include those secondary to endotoxin-induced disseminated intravascular coagulation, immune reactions, immoderately low or high temperatures, and high-impact-related injuries. Common to these diverse forms of osteonecrosis are fibrin thrombi clogging arterioles and small arteries.

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“…In order to examine the significance of the blood flow through the ligamentum capitis femoris in Perthes' disease, intraosseous venography was performed on 81 hips [12]. Atsumi et al [13] concluded that normal vascular anatomy of the artery of the ligamentum capitis femoris was not related to the onset of Perthes' disease.…”

Section: Discussionmentioning

confidence: 99%

The Ligament of Head of Femur and Its Arteries

Yal��n¹

2010

J Clin Anal Med

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Revascularization of the Artery of the Ligamentum Teres in Perthes Disease

Cited by 11 publications

References 13 publications

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Analysis of Trabecular Microstructure and Vascular Distribution of Capital Femoral Epiphysis Relevant to Legg–Calve–Perthes Disease

Osteonecrosis of the Femoral Head of Laboratory Animals: The Lessons Learned from a Comparative Study of Osteonecrosis in Man and Experimental Animals

The Ligament of Head of Femur and Its Arteries

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