Revascularization of the Artery of the Ligamentum Teres in Perthes Disease

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To study revascularization of the artery of the ligamentum teres in Perthes disease, superselective angiography was done in 22 hips. Normal appearance of the artery of the ligamentum teres was observed in two hips, both of which were of Catterall Group II in the healing stage. Thirteen hips of Catterall Group III or IV with collapse (initial stage in nine hips, fragmentation in two hips, healing in two hips) were free from apparent subluxation; however, their epiphyses were not vascularized to the medial margin. Seven hips with apparent subluxation of Catterall Group III or IV (fragmentation stage in three hips, healing in four hips) had extensive vascularized medial viable segments consisting of newly formed small arteries. Penetration of revascularization from the artery of the ligamentum teres was inhibited by collapse initially at the medial margin of the epiphysis. Revascularization consisted of newly formed small arteries that penetrated the medial area of the epiphysis after subluxation. After completion of healing, blood supply from the artery of the ligamentum teres was not important for nourishment of the capital femoral epiphysis. The authors conclude that normal vascular anatomy of the artery of the ligamentum teres is not related to the onset of Perthes disease.

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