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Female Patients With Late-Onset Legg-Calvé-Perthes Disease Are Frequently Gymnasts: Is There a Mechanical Etiology for This Subset of Patients?

Larson, A. Noelle MD*; Kim, Harry K.W. MD, MSc; Herring, John A. MD

Journal of Pediatric Orthopaedics: December 2013 - Volume 33 - Issue 8 - p 811–815
doi: 10.1097/BPO.0000000000000096

Background: The cause of Legg-Calvé-Perthes disease (LCPD) is unknown. We have observed a relatively high prevalence of female gymnasts presenting with LCPD. The purpose of this study was to determine: (1) the percentage of LCPD patients exposed to high-level gymnastics training, (2) the demographics of this subset of patients, and (3) their clinical outcomes.

Methods: Several adolescent female gymnasts presented to our clinic with recent-onset LCPD. We reviewed our cases to discern the prevalence and treatment of the disorder in this patient cohort. From 1999 to 2010, 572 patients were evaluated for a diagnosis of LCPD at our tertiary referral center. Clinical records were retrospectively reviewed. Of those, 13 patients had a history of gymnastics participation with 8 patients (all females) having competitive participation.

Results: For females aged 10 years and older presenting with LCPD, 7 of 9 patients (78%) were involved in high-level competitive gymnastics. These patients had disease onset between 10 and 12 years of age (mean, 11 y). Competitive gymnasts represented 6.6% (8 of 120) of females with LCPD and 1.4% (8 of 572) of all patients evaluated with LCPD during the study period. Only 1 of 111 females below 10 years with LCPD participated in competitive gymnastics (χ2, P<0.0001).

Patients underwent a variety of treatments. Two patients underwent nonoperative treatment, and the remainder underwent surgical management. All 7 gymnasts had a Stulberg IV result. In the nongymnast group of females 10 years and older, there were 1 Stulberg III result and 1 Stulberg IV result.

Conclusions: At our center, competitive gymnasts comprise >75% of the female patients over the age of 10 who presented with late-onset LCPD. Results in general were poor. Further studies are needed to explore the association between the physical demands of advanced gymnastic training and the development of LCPD in this subset of patients.

Level of Evidence: IV, case series.

*Mayo Clinic, Rochester, MN

Texas Scottish Rite Hospital for Children, Dallas, TX

A.N.L., H.K.W.K., and J.A.H. are the members of The International Perthes Study Group.

The study was performed at Texas Scottish Rite Hospital for Children.

The authors declare no conflicts of interest.

Reprints: John A. Herring, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219. E-mail:

© 2013 by Lippincott Williams & Wilkins