Evidence brief
Legg-Calvé-Perthes Disease: Classification and Prognosis
Herring lateral pillar classification predicts outcome
Group A: lateral pillar maintained, good prognosis
Group B: 50% lateral pillar height, moderate prognosis
Group C: <50% lateral pillar, poor prognosis
Age at onset and lateral pillar key prognostic factors
The Herring lateral pillar classification during fragmentation stage is the best predictor of Perthes disease outcome and guides treatment decisions.
Know Herring classification and Catterall classification. Age is critical: <6 years good prognosis, >8 years poor. Treatment: containment if indicated. Surgical containment (varus osteotomy or Salter) for Group B/C border and Group C in older children. Stulberg classification for final outcome.
Herring JA et al. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004;86(10):2121-2134.
Level II
Lesser quality RCT or prospective comparative study