Variability in Bracing Design and Bracing Protocols for the Non-Operative Management of Legg-Calvé-Perthes Disease: A Scoping Systematic Review.

Legg-Calvé-Perthes disease (LCPD) is a self-limiting avascular necrosis of the femoral head in children, with management aimed at preserving hip joint congruency and reducing the risk of long-term degenerative changes. Bracing is a commonly used containment strategy; however, its effectiveness remains controversial owing to variation in brace design, biomechanical principles, and treatment protocols. This systematic review evaluates and synthesizes the variability in bracing design and bracing protocols for non-operative management of LCPD. This review adhered to the PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, Science Citation Index, and Google Scholar was performed using keywords such as "Perthes" OR "Coxa Plana" and "treatment" OR "non-operative" OR "orthoses" OR "conservative" OR "brace". Only full-text articles in English were included. Studies were required to document initial radiographs using the Catterall or Herring classification and assess outcomes with the Mose or Stulberg criteria. Exclusion criteria included non-English language articles and research with inadequate methodology. Patient demographics, therapy type, type of bracing, and radiological results were among the information retrieved. Radiographic results were classified as good or poor using the Mose and Stulberg ratings. A total of 12 studies were examined to determine the efficacy of conservative treatments, especially bracing, for LCPD. Age of onset was a key prognostic factor, with better outcomes indicated in children under the age of eight. Bracing was more beneficial in younger individuals with milder illness, although adherence was crucial. Various braces, including the Atlanta Scottish Rite, trilateral socket, and non-weight-bearing ambulatory hip abduction brace, have been developed to maintain hip abduction. However, limitations such as discomfort, poor adherence, reduced mobility, and inconsistent radiological and clinical outcomes undermine their efficacy. Additionally, significant variability exists in indications, duration, and patient selection, with no universally accepted bracing protocol. Despite theoretical containment advantages, the effectiveness of bracing in LCPD remains inconclusive due to heterogeneity in brace designs, patient selection, and treatment protocols, as well as limitations in the underlying evidence base. Further prospective, methodologically robust studies with standardized protocols and transparent reporting of adherence are needed to clarify the role of bracing in clinically meaningful outcomes.