Metaphyseal cysts in Legg-Calve-Perthes' disease may actually be epiphyseal changes superimposed on the metaphysis due to three-dimensional distortion.
Radiographic metaphyseal cysts in LCP may reflect epiphyseal distortion; hypothesis-generating and should not yet change practice.
Summary: Radiographic changes in the femoral metaphysis in Legg-Calve-Perthes' (LCP) remain poorly under-stood. Our hypothesis was that these “cysts” are not truly metaphyseal but are metaphyseal changes radio-graphically projected onto the metaphysis. Surface epiphyseal changes were made on a normal hip and a hip with LCP. These “lesions” appeared metaphyseal on radiograph, and in the specimen with LCP, projected deep within the metaphysis due to flattening and threedimensional distortion. “Metaphyseal” cysts in LCP may be epiphyseal changes superimposed on the metaphysis. This would explain the correlation between the presence of a “metaphyseal” lucency and final result, since it is simply another indicator of the extent of epiphyseal involvement.
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Hoffinger et al. (1991) studied this question.
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