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Stevens PM, Grothaus OF, MacWilliams BA. Drop landing analysis of rotational osteotomies. J Pediatr Orthop B 2024; 33:488-496. [PMID: 37751370 DOI: 10.1097/bpb.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Pathomechanics resulting from rotational deformities of the long bones in an idiopathic population have not been extensively studied, and are chiefly limited to level over ground walking. Thirty-five adolescents with excessive idiopathic outward tibial torsion (TT), femoral rotation, or both (pan genu) were studied both before and after corrective surgery. Data collected included computational motion analysis of a drop jump and patient-reported outcomes consisting of PODCI and Goal Attainment Scores. Results were compared to an age-matched typically developing cohort (n = 25). Subjects with femoral anteversion (FA) exhibited compensatory hip rotations to normalize knee progression angles at landing. Subjects with only TT did not compensate at the hip, landing with typical knee progression but excessive outward foot progression. These strategies resulted in elevated frontal plane knee moments for FA ( P = 0.008), and elevated lateral knee forces in all groups compared to typical, with the TT group reaching significance ( P < 0.001). Rotational osteotomies successfully restored elevated kinematics and kinetics to within or below typically developing ranges. Patient-reported outcomes generally improved after surgery across all domains studied. Drop jump testing elucidated compensation strategies employed by these cohorts. Compensation did not fully alleviate elevated forces at the knees. Surgical intervention normalized pathokinematics and pathokinetics, reduced pain, and improved patients' perception of their functional abilities. Greater improvements were found in individuals in the two groups with FA compared to the group with TT only.
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Affiliation(s)
- Peter M Stevens
- Department of Orthopedic Surgery, University of Utah
- Primary Children's
| | | | - Bruce A MacWilliams
- Department of Orthopedic Surgery, University of Utah
- Motion Analysis Center, Shriners Children's, Salt Lake City, Utah, USA
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2
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Harrington MS, Di Leo SD, Hlady CA, Burkhart TA. Musculoskeletal modeling and movement simulation for structural hip disorder research: A scoping review of methods, validation, and applications. Heliyon 2024; 10:e35007. [PMID: 39157349 PMCID: PMC11328100 DOI: 10.1016/j.heliyon.2024.e35007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
Musculoskeletal modeling is a powerful tool to quantify biomechanical factors typically not feasible to measure in vivo, such as hip contact forces and deep muscle activations. While technological advancements in musculoskeletal modeling have increased accessibility, selecting the appropriate modeling approach for a specific research question, particularly when investigating pathological populations, has become more challenging. The purposes of this review were to summarize current modeling and simulation methods in structural hip disorder research, as well as evaluate model validation and study reproducibility. MEDLINE and Web of Science were searched to identify literature relating to the use of musculoskeletal models to investigate structural hip disorders (i.e., involving a bony abnormality of the pelvis, femur, or both). Forty-seven articles were included for analysis, which either compared multiple modeling methods or applied a single modeling workflow to answer a research question. Findings from studies comparing methods were summarized, such as the effect of generic versus patient-specific modeling techniques on model-estimated hip contact forces or muscle forces. The review also discussed limitations in validation practices, as only 11 of the included studies conducted a validation and used qualitative approaches only. Given the lack of information related to model validation, additional details regarding the development and validation of generic models were retrieved from references and modeling software documentation. To address the wide variability and under-reporting of data collection, data processing, and modeling methods highlighted in this review, we developed a template that researchers can complete and include as a table within the methodology section of their manuscripts. The use of this table will help increase transparency and reporting of essential details related to reproducibility and methods without being limited by word count restrictions. Overall, this review provides a comprehensive synthesis of modeling approaches that can help researchers make modeling decisions and evaluate existing literature.
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Affiliation(s)
- Margaret S. Harrington
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Stefania D.F. Di Leo
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Courtney A. Hlady
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Timothy A. Burkhart
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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3
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Carman L, Besier TF, Rooks NB, Choisne J. An articulated shape model to predict paediatric lower limb bone geometry using sparse landmarks. J Biomech 2024; 172:112211. [PMID: 38955093 DOI: 10.1016/j.jbiomech.2024.112211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/22/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
Creating musculoskeletal models in a paediatric population currently involves either creating an image-based model from medical imaging data or a generic model using linear scaling. Image-based models provide a high level of accuracy but are time-consuming and costly to implement, on the other hand, linear scaling of an adult template musculoskeletal model is faster and common practice, but the output errors are significantly higher. An articulated shape model incorporates pose and shape to predict geometry for use in musculoskeletal models based on existing information from a population to provide both a fast and accurate method. From a population of 333 children aged 4-18 years old, we have developed an articulated shape model of paediatric lower limb bones to predict bone geometry from eight bone landmarks commonly used for motion capture. Bone surface root mean squared errors were found to be 2.63 ± 0.90 mm, 1.97 ± 0.61 mm, and 1.72 ± 0.51 mm for the pelvis, femur, and tibia/fibula, respectively. Linear scaling produced bone surface errors of 4.79 ± 1.39 mm, 4.38 ± 0.72 mm, and 4.39 ± 0.86 mm for the pelvis, femur, and tibia/fibula, respectively. Clinical bone measurement errors were low across all bones predicted using the articulated shape model, which outperformed linear scaling for all measurements. However, the model failed to accurately capture torsional measures (femoral anteversion and tibial torsion). Overall, the articulated shape model was shown to be a fast and accurate method to predict lower limb bone geometry in a paediatric population, superior to linear scaling.
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Affiliation(s)
- Laura Carman
- Auckland Bioengineering Institute, 70 Symonds Street, Level 8, The University of Auckland, Auckland, New Zealand.
| | - Thor F Besier
- Auckland Bioengineering Institute, 70 Symonds Street, Level 8, The University of Auckland, Auckland, New Zealand; Department of Engineering Science & Biomedical Engineering, 70 Symonds Street, Level 0, The University of Auckland, Auckland, New Zealand.
| | - Nynke B Rooks
- Auckland Bioengineering Institute, 70 Symonds Street, Level 8, The University of Auckland, Auckland, New Zealand; Formus Labs, 70 Symonds Street, Level 9, Auckland, New Zealand.
| | - Julie Choisne
- Auckland Bioengineering Institute, 70 Symonds Street, Level 8, The University of Auckland, Auckland, New Zealand.
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Brand A, Alexander N, Bauer L, Böhm H, Stief F, van Drongelen S, Wolf SI, Trinler U. [An update on clinical gait analysis : Current developments and applications]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:494-502. [PMID: 38847874 DOI: 10.1007/s00132-024-04516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/29/2024]
Abstract
The objective acquisition and assessment of joint movements and loads using instrumented gait analysis has become an established tool in clinical diagnostics. In particular, marker-based 3D gait analyses make use of an increasingly comprehensive database for the assessment of orthopaedic or neurological questions. Based on this data and medical-scientific experience, increasingly reliable approaches and evaluation strategies are emerging, which also draw on methods from artificial intelligence and musculoskeletal modelling. This article focusses on marker-based gait analyses of the lower extremity (hip, knee, foot) and how these can be used in a clinically relevant way using current methods, e.g. for determining indications or optimization of surgical planning. Finally, current developments and applications by using alternative methods from sensor technology and optical motion capture will be briefly discussed.
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Affiliation(s)
- Andreas Brand
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
- Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Nathalie Alexander
- Labor für Bewegungsanalyse, Ostschweizer Kinderspital, St. Gallen, Schweiz
| | - Leandra Bauer
- Experimentelle Orthopädie, Universitätsklinikum Jena, Campus Eisenberg, Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - Harald Böhm
- Orthopädische Kinderklinik, Behandlungszentrum Aschau gGmbH, Aschau im Chiemgau, Deutschland
- Fakultät Ingenieurwissenschaften und Gesundheit, Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Deutschland
| | - Felix Stief
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main, Deutschland
- BG Service- und Rehabilitationszentrum, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Forschungsbereich für Arthrose, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Sebastian I Wolf
- Klinik für Orthopädie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Kainz H, Mindler GT, Kranzl A. Influence of femoral anteversion angle and neck-shaft angle on muscle forces and joint loading during walking. PLoS One 2023; 18:e0291458. [PMID: 37824447 PMCID: PMC10569567 DOI: 10.1371/journal.pone.0291458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
Femoral deformities, e.g. increased or decreased femoral anteversion (AVA) and neck-shaft angle (NSA), can lead to pathological gait patterns, altered joint loads, and degenerative joint diseases. The mechanism how femoral geometry influences muscle forces and joint load during walking is still not fully understood. The objective of our study was to investigate the influence of femoral AVA and NSA on muscle forces and joint loads during walking. We conducted a comprehensive musculoskeletal modelling study based on three-dimensional motion capture data of a healthy person with a typical gait pattern. We created 25 musculoskeletal models with a variety of NSA (93°-153°) and AVA (-12°-48°). For each model we calculated moment arms, muscle forces, muscle moments, co-contraction indices and joint loads using OpenSim. Multiple regression analyses were used to predict muscle activations, muscle moments, co-contraction indices, and joint contact forces based on the femoral geometry. We found a significant increase in co-contraction of hip and knee joint spanning muscles in models with increasing AVA and NSA, which led to a substantial increase in hip and knee joint contact forces. Decreased AVA and NSA had a minor impact on muscle and joint contact forces. Large AVA lead to increases in both knee and hip contact forces. Large NSA (153°) combined with large AVA (48°) led to increases in hip joint contact forces by five times body weight. Low NSA (108° and 93°) combined with large AVA (48°) led to two-fold increases in the second peak of the knee contact forces. Increased joint contact forces in models with increased AVA and NSA were linked to changes in hip muscle moment arms and compensatory increases in hip and knee muscle forces. Knowing the influence of femoral geometry on muscle forces and joint loads can help clinicians to improve treatment strategies in patients with femoral deformities.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria
| | - Gabriel T. Mindler
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| | - Andreas Kranzl
- Vienna Bone and Growth Center, Vienna, Austria
- Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Speising, Vienna, Austria
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6
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Roda GF, Stoneback JW, Gimarc D, Gaffney BMM. Above knee socket prosthesis use changes proximal femur morphology. Bone 2023; 172:116752. [PMID: 37004980 PMCID: PMC10198956 DOI: 10.1016/j.bone.2023.116752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
Patients with transfemoral amputation (TFA) are up to six times more likely to develop hip osteoarthritis (OA) in either or both the intact and residual limb, which is primarily attributed to habitually altered joint loading due to compensatory movement patterns. However, joint loading patterns differ between limbs, which confounds the understanding of loading-induced OA etiology across limbs. It remains unknown if altered loading due to amputation results in bony shape changes at the hip, which is a known etiological factor in the development of hip OA. Retrospective computed tomography images were collected of the residual limb for 31 patients with unilateral TFA (13F/18M; age: 51.7 ± 9.9 y/o; time since amputation: 13.7 ± 12.4 years) and proximal femur for a control group of 29 patients (13F/16M; age: 42.0 ± 12.27 years) and used to create 3D geometries of the proximal femur. Femoral 3D geometric variation was quantified using statistical shape modeling (SSM), a computational tool which placed 2048 corresponding particles on each geometry. Independent modes of variation were created using principal component analysis. 2D radiographic measures of the proximal femur, including common measures such as α-angle, head neck offset, and neck shaft angle, were quantified on digitally reconstructed radiographs (DRRs). SSM results were then compared to 2D measures using Pearson correlation coefficients (r). Two-sample t-tests were used to determine if there were significant differences between the TFA and control group means of 2D radiographic measurements (p < 0.05). Patients with TFA had greater femoral head asphericity within the SSM, which was moderately correlated to head-neck offset (r = -0.54) and α-angle (r = 0.63), as well as greater trochanteric torsion, which was strongly correlated to the novel radiographic measure of trochanteric torsion (r = -0.78), compared to controls. For 2D measures, the neck-shaft angle was smaller in the TFA group compared to the control group (p = 0.01) while greater trochanter height was larger in the TFA group compared to the control group (p = 0.04). These results indicate altered loading from transfemoral prosthesis use changes proximal femur bony morphology, including femoral head asphericity and greater trochanter changes. Greater trochanter morphologic changes, though not a known factor to OA, affect moment arm and line of action of the primary hip abductors, the major muscles which contribute to joint loading and hip stability. Thus, chronic altered loading of the amputated limb hip, whether under- or overloading, results in bony changes to the proximal femur which may contribute to the etiological progression and development of OA.
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Affiliation(s)
- Galen F Roda
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - David Gimarc
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
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7
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Boekesteijn RJ, van de Ven MPF, Wilders LM, Bisseling P, Groen BE, Smulders K. The effect of functional calibration methods on gait kinematics in adolescents with idiopathic rotational deformity of the femur. Clin Biomech (Bristol, Avon) 2023; 107:106028. [PMID: 37331152 DOI: 10.1016/j.clinbiomech.2023.106028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Due to anatomical deviations, assumptions of the conventional calibration method for gait analysis may be violated in individuals with rotational deformities of the femur. Functional calibration methods were compared with conventional methods in this group for 1) localization of the hip joint center and orientation of the knee axis, and 2) gait kinematics. METHODS Twenty-four adolescents with idiopathic rotational deformity of the femur underwent gait analysis and a CT scan. During standing, distance between hip joint centers and knee axis orientation were compared between calibration methods, with CT serving as reference for hip joint center estimation. Gait kinematics were compared using statistical parametric mapping. FINDINGS The conventional calibration method estimated the hip joint center closer to the CT reference (4±12 mm more lateral) than the functional calibration method (26 ± 20 mm more lateral). Orientation of the knee joint axis was 2.6° less internal in the functional calibration method. During gait, statistical parametric mapping revealed significantly more hip flexion, less external hip rotation during the swing phase, less knee varus-valgus motion, and larger knee flexion angles when applying the functional method. INTERPRETATION Functional calibration methods were less accurate in determining the hip joint center location than the conventional calibration method and resulted in a knee joint axis that was less internally rotated. Importantly, there was less knee joint angle crosstalk during gait when using the functional method. Although differences between methods on gait kinematics were within clinically acceptable limits for the sagittal plane, relatively larger differences on transversal hip kinematics may hold clinical importance.
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Affiliation(s)
- Ramon J Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | - Lise M Wilders
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Pepijn Bisseling
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Brenda E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
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8
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Apti A, Akalan NE. Does Increased Femoral Anteversion Can Cause Hip Abductor Muscle Weakness? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050782. [PMID: 37238330 DOI: 10.3390/children10050782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Increased femoral anteversion (IFA) causes functional problems (i.e., tripping, frequently falling, and fatigue) by affecting the pelvis and lower extremity biomechanics. In the frontal plane, increased contralateral pelvic drop and ipsilateral hip adduction, which are mainly considered deteriorated hip abductor muscle mechanisms, are associated with hip and knee injuries. AIMS The aim of this study was to examine the effects of femoral anteversion on hip abductor weakness and frontal plane pelvis-hip biomechanics during walking. METHODS The study included nine subjects with increased femoral anteversion and a control group of eleven subjects. Maximum isometric voluntary contraction (MIVC) values of the hip abductor muscles were measured with a handheld dynamometer. Three-dimensional gait analysis was performed for kinetic, kinematic, and temporo-spatial gait parameters. Non-parametric tests were used for statistical analysis (p < 0.05). RESULTS There was no significant difference found between the MIVC values of the IFA and control groups (p = 0.14). Moreover, no significant difference was determined between the ipsilateral peak hip adduction (p = 0.088) and contralateral pelvic drop (p = 0.149) in the stance phase. Additionally, there was no correlation between the peak hip adduction angle in the stance phase and normalized MIVC values in the IFA group (r = -0.198, p = 0.44), or in the control group (r = -0.174, p = 0.55). The deviations of pelvic rotation (p = 0.022), hip internal rotation (p = 0.003), and internal foot progression (p = 0.022), were found to be higher in the IFA group than in the controls. CONCLUSIONS IFA may not be associated with hip abductor muscle weakness, and it may not lead to the hip adduction and pelvic depression that can be seen in hip abductor weakness. Increased pelvic rotation and internal hip rotation during walking might be considered as a compensation for the femoral head-acetabulum alignment mechanism in the frontal plane.
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Affiliation(s)
- Adnan Apti
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Kültür University, Istanbul 34158, Turkey
| | - Nazif Ekin Akalan
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Kültür University, Istanbul 34158, Turkey
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9
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Wheatley BB, Chaclas NA, Seeley MA. Patellofemoral joint load and knee abduction/adduction moment are sensitive to variations in femoral version and individual muscle forces. J Orthop Res 2023; 41:570-582. [PMID: 35689506 PMCID: PMC9741666 DOI: 10.1002/jor.25396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/18/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Torsional profiles of the lower limbs, such as femoral anteversion, can dictate gait and mobility, joint biomechanics and pain, and functional impairment. It currently remains unclear how the interactions between femoral anteversion, kinematics, and muscle activity patterns contribute to joint biomechanics and thus conditions such as knee pain. This study presents a computational modeling approach to investigating the interactions between femoral anteversion, muscle forces, and knee joint loads. We employed an optimal control approach to produce actuator and muscle-driven simulations of the stance phase of gait for femoral anteversion angles ranging from -8° (retroversion) to 52° (anteversion) with a typically developing baseline of 12° of anteversion and implemented a Monte Carlo analysis for variations in lower limb muscle forces. While total patellofemoral joint load decreased with increasing femoral anteversion, patellofemoral joint load alignment worsened, and knee abduction/adduction magnitude increased with both positive and negative changes in femoral anteversion (p < 0.001). The rectus femoris muscle was found to greatly influence patellofemoral joint loads across all femoral anteversion alignments (R > 0.8, p < 0.001), and the medial gastrocnemius was found to greatly influence knee abduction/adduction moments for the extreme version cases (R > 0.74, p < 0.001). Along with the vastus lateralis, which decreased with increasing femoral anteversion (R = 0.89, p < 0.001), these muscles are prime candidates for future experimental and clinical efforts to address joint pain in individuals with extreme femoral version. These findings, along with future modeling efforts, could help clinicians better design treatment strategies for knee joint pain in populations with extreme femoral anteversion or retroversion.
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Affiliation(s)
- Benjamin B Wheatley
- Department of Mechanical Engineering, Bucknell University, Lewisburg, PA
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | | | - Mark A Seeley
- Geisinger Commonwealth School of Medicine, Scranton, PA
- Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
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10
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De Pieri E, Cip J, Brunner R, Weidensteiner C, Alexander N. The functional role of hip muscles during gait in patients with increased femoral anteversion. Gait Posture 2023; 100:179-187. [PMID: 36563590 DOI: 10.1016/j.gaitpost.2022.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Femoral anteversion affects the lever arm and moment-generating capacity of the hip abductors, while an increased hip internal rotation during walking was proposed to be a compensatory mechanism to restore the abductive lever arm. Children with isolated increased femoral anteversion, however, do not always present a deficit in the net hip abduction moment during gait, suggesting that a more comprehensive understanding of the effect of morphology and motion on muscle forces and moments is needed to aid clinical decision making. RESEARCH QUESTION Are muscle contributions to hip joint moments and muscle forces altered in patients with increased femoral anteversion and internally rotated gait pattern compared to a control group of typically developing children? And how would the functional role of the muscle be altered if the patients walked straight? METHODS This follow-up study compared patients with increased femoral anteversion (n = 42, 12.8 ± 1.9 years, femoral anteversion: 39.6 ± 6.9°) to controls (n = 9, 12.0 ± 3.0 years, femoral anteversion: 18.7 ± 4.1°). Muscle forces and moment contributions were calculated using personalized musculoskeletal models. Additionally, a hypothetical scenario, in which the gait of the controls was modelled with an anteverted femoral morphology, was used to understand what would happen if the patients walked straight. RESULTS Gluteus medius abductive contribution was lower in patients compared to controls, despite a comparable net abduction moment around the hip. Patients presented lower muscle forces. However, if modelled to walk straight, they would require higher forces as well as a larger co-contraction of both hip internal and external rotators in the transversal plane. SIGNIFICANCE This study suggests that patients with increased femoral anteversion walking with an internally rotated gait pattern present lower muscle forces, but when modelled to walk straight muscle forces increase. The current results provide important information to better understand this condition and improve treatment recommendations in these patients.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Paediatric Orthopaedics, University of Basel Children's Hospital, Basel, Switzerland
| | - Claudia Weidensteiner
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, Switzerland.
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11
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Alammari A, Spence N, Narayan A, Karnad SD, Ottayil ZC. Effect of hip abductors and lateral rotators' muscle strengthening on pain and functional outcome in adult patients with patellofemoral pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2023; 36:35-60. [PMID: 35988215 DOI: 10.3233/bmr-220017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Even though literature indicates presence of weak hip abductors and lateral rotators' in Patellofemoral Pain (PFP), studies evaluating the effect of hip abductors and lateral rotators strengthening to improve knee function and quality of life in PFP are limited. OBJECTIVE This study systematically reviews and meta-analyzes the best evidence on the therapeutic value of strengthening hip abductors and lateral rotators muscles for treating PFP with a presumptive hypothesis that strengthening hip muscles stabilizes the patellofemoral joint, relieves pain, and enhances knee functions. METHOD Medline, EMBASE, CINAHL, PEDro and PubMed Central databases were searched between January 1994 and September 2019 using the PICOS tool. The methodological quality of the selected studies were appraised individually using the 20-item McMaster Critical Review Form for Quantitative Studies. Supplemental quality appraisal of randomized controlled clinical trials performed using the Cochrane Collaboration's 'Risk of bias' quality criteria. Data on patient population demographics, interventions, duration of intervention, and outcome measures were extracted and summarized in evidence tables and descriptive analysis. Meta-analyses under both fixed and random-effects models determined pooled effects size from appropriate RCTs. RESULTS All fourteen studies demonstrated that hip muscle strengthening improved pain and knee function. All RCTs, except one, demonstrated that hip muscle strengthening is superior to quadriceps strengthening. Of the five RCTs assessing the additional effect of hip-quad versus quadriceps strengthening, four suggested that hip-quad strengthening is superior to standard quadriceps strengthening alone to improve PFP and knee function. CONCLUSION In adult patients with PFP, strengthening hip abductors and lateral rotators' have beneficial therapeutic effects than the conventional quadriceps exercises in improving knee pain and function both in the short- and long term. However, the present review data can be used to develop a standardized hip-quad protocol in the future.
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Affiliation(s)
- Abdulaziz Alammari
- Department of Rehabilitation, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nicola Spence
- School of Health and Society, Salford University, Salford, UK
| | - Amitesh Narayan
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Shreekanth D Karnad
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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12
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Qiao Y, Xu J, Zhang X, Ye Z, Wu C, Xu C, Zhao S, Zhao J. Correlation of Tibial Torsion With Lower Limb Alignment and Femoral Anteversion in Patients With Patellar Instability. Orthop J Sports Med 2022; 10:23259671221141484. [PMID: 36532155 PMCID: PMC9747878 DOI: 10.1177/23259671221141484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/13/2022] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Alignment and rotation of the lower extremities have been suggested to be predisposing pathologic factors for patellar instability. PURPOSE To elucidate the relationship between the lower limb alignment and lower extremity rotation in patients with patellar instability. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Included were 83 patients with patellar instability. Computed tomography scans and standing full-leg radiographs were used to measure the tibial tuberosity-trochlear groove (TT-TG) distance, mechanical femorotibial angle (mFTA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), femoral torsion, and tibial torsion of the different segments. The relationships between femoral torsion, tibial torsion of the different segments, and the mFTA, mLDFA, and mMPTA were evaluated. The levels of tibial torsion and femoral torsion in patients with varus, normal, or valgus alignment were compared with 1-way analysis of variance and chi-square test. RESULTS The total tibial torsion was significantly associated with total femoral anteversion (r = 0.329; P = .002) and mFTA (r = -0.304; P = .005). There were no significant correlations between mFTA and TT-TG distance or femoral anteversion. Compared with patients with valgus malalignment, patients with varus malalignment tended to have higher tibial torsion. CONCLUSION Tibial torsion was associated with leg axis alignment and femoral anteversion in patients with patellar instability. Patients with patellar instability, especially those with concurrent leg axis deformities, should undergo further radiological imaging so that tibial torsion can be assessed and a diagnosis of torsion deformity made early in the treatment pathway and the proper surgical plan formulated.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuyuan Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hamid J, Do P, Bauer J. 3D Gait Analysis and Patient-reported Outcomes of Femoral Osteotomies for Torsional Deformity. J Pediatr Orthop 2022; 42:496-502. [PMID: 35968999 DOI: 10.1097/bpo.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Idiopathic torsional deformities causing pain and/or functional difficulty is an indication for a femoral derotational osteotomy (FDRO). Past studies have focused entirely on children with internal femoral torsional deformity (IFTD). This study aims to compare gait and outcomes between children with IFTD and those with external femoral torsional deformity (EFTD) after a FDRO. METHODS A retrospective review of all patients who underwent an FDRO between 1997 and 2020 at our institution. Data on typically developing (TD) children with no torsional deformity was used as a control group. We analyzed preoperative and postoperative standardized physical examination, 3-dimensional gait analysis, and Pediatric Outcomes Data Collection Instrument questionnaires. RESULTS There were 54 patients in total (IFTD=37, EFTD=17) and 20 patients in the control group. The EFTD cohort was older (IFTD=11.7, EFTD=14.7, P <0.05) and had a higher body mass index both preoperatively (IFTD=21.1 kg/m 2 , EFTD=32.1 kg/m 2 , P <0.05) and postoperatively (IFTD=20.2 kg/m 2 , EFTD=34.1 kg/m 2 , P <0.05). Preoperatively, 3-dimensional gait analysis elicited mean hip rotation in stance was more internal for IFTD cohort (10.8 degrees) and external for the EFTD cohort (-17.8 degrees) in comparison to the TD (2.4 degrees, P <0.001). Postoperatively, dynamic mean hip rotation during stance was -1.4 degrees for IFTD, whereas for EFTD, it was -5.4 degrees, which was different to the TD ( P <0.05). The IFTD group's Pediatric Outcomes Data Collection Instrument improved for transfer/basic mobility, sports/physical function, global functioning, and satisfaction with symptoms ( P <0.05). The EFTD group that only reported an improvement with the satisfaction with symptoms after surgery ( P <0.05). CONCLUSIONS Adolescents with surgically corrected IFTD show more improvement in gait and in patient-reported outcomes than those with surgically corrected EFTD. Children with EFTD persist in external rotation and have less satisfactory patient-reported outcomes after a FDRO in comparison those with IFTD. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Jehan Hamid
- Department of Orthopedics, Bankstown Hospital, New South Wales, Australia
| | | | - Jeremy Bauer
- Department of Orthopedics, Shriners Hospital for Children Portland & Oregon Health Science University, Portland, OR
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14
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Chandrananth J, Hannan R, Bouton D, Raney E, Sienko S, Do P, Bauer JP. The Effects of Lower Extremity Rotational Malalignment on Pediatric Patient-reported Outcomes Measurement and Information System (PROMIS) Scores. J Pediatr Orthop 2022; 42:e889-e894. [PMID: 35818169 PMCID: PMC9351693 DOI: 10.1097/bpo.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is sparse literature demonstrating the relationship between lower limb pediatric idiopathic rotational malalignment (IRM) and patient-reported outcomes measurement information system (PROMIS) scores. Our goal is to determine and quantify the amount that IRM deformities, as measured with the 3D gait analysis, affect childrens' pain interference, mobility, and peer relationship PROMIS domains. Secondary outcomes include investigating the potential relationships between IRM and various subgroups (Pediatric Outcomes Data Collection Instrument (PODCI), gender, Body Mass Index (BMI), femur Versus tibia). We also examine whether the PROMIS domains correlate with PODCI in this population. METHODS This study was a retrospective cohort, single institution, and consecutively recruited cases series. We identified 47 children over a 3-year period who were evaluated at the motion analysis center at our tertiary care hospital, with increased torsion of the femur or tibia. After exclusions, 25 children with IRM, documented PROMIS data and gait analysis were considered. RESULTS Femoral malrotation had a significant relationship with female gender ( P =0.001) and increased BMI ( P <0.001). Femoral malrotation had a correlation with PROMIS pain interference ( P =0.016), whereas tibial rotation did not achieve significance ( P =0.084). In the ANOVA regression analysis, there was a strong prediction of the PROMIS mobility domain when both malrotation and pain interference were present ( P =0.007). There were Pearson Correlations of PROMIS and PODCI domains for Mobility Versus Sports ( P =0.007) and Pain Interference Versus Comfort/Pain ( P =0.004), respectively. CONCLUSION The evident relationship between lower limb rotational malalignment and PROMIS scores signifies the likelihood for gait and pain disturbance. This in turn could show us that children are likely to be more debilitated and thus may benefit from timely correction. We aim to conduct this as a multicentre trial to confirm our findings. LEVEL OF EVIDENCE Level IV.
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15
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Xu C, Cui Z, Yan L, Chen Z, Wang F. Anatomical Components Associated With Increased Tibial Tuberosity-Trochlear Groove Distance. Orthop J Sports Med 2022; 10:23259671221113841. [PMID: 36003969 PMCID: PMC9393578 DOI: 10.1177/23259671221113841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Increased tibial tuberosity–trochlear groove (TT-TG) distance is an important
indicator of medial tibial tubercle transfer in the surgical management of
lateral patellar dislocation (LPD). Changes to TT-TG distance are determined
by a combination of several anatomical factors. Purpose: To (1) determine the anatomical components related to increased TT-TG
distance and (2) quantify the contribution of each to identify the most
prominent component. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 80 patients with recurrent LPD and 80 age- and body mass
index–matched controls. The 2 groups were compared in TT-TG distance and its
related anatomical components: tibial tubercle lateralization (TTL),
trochlear groove medialization, femoral anteversion, tibiofemoral rotation
(TFR), tibial torsion, and mechanical axis deviation (MAD). The Pearson
correlation coefficient (r) was calculated to evaluate the
association between increased TT-TG distance and its anatomical parameters,
and factors that met the inclusion criteria of P < .05
and r ≥ 0.30 were analyzed via stepwise multivariable
linear regression analysis to predict TT-TG distance. Results: The LPD and control groups differed significantly in TT-TG distance, TTL,
TFR, and MAD (P < .001 for all). Increased TT-TG
distance was significantly positively correlated with TTL
(r = 0.376; P < .001), femoral
anteversion (r = 0.166; P = .036), TFR
(r = 0.574; P < .001), and MAD
(r = 0.415; P < .001), and it was
signficantly negatively correlated with trochlear groove medialization
(r = −0.178; P = .024). The stepwise
multivariable analysis revealed that higher TTL, excessive knee external
rotation, and excessive knee valgus were statistically significant
predictors of greater TT-TG distance (P < .001 for all).
The standardized estimates that were used for evaluating the predictive
values were larger for TFR compared with those for TTL and MAD. Conclusion: TTL, TFR, and MAD were the main independent anatomical components associated
with increased TT-TG distance, with the most prominent component being TFR.
The association of TT-TG distance to each component analyzed in our study
may help guide surgical planning.
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Affiliation(s)
- Chenyue Xu
- Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhaoxia Cui
- Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lirong Yan
- Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zheng Chen
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fei Wang
- Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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Alexander N, Brunner R, Cip J, Viehweger E, De Pieri E. Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients. Front Bioeng Biotechnol 2022; 10:914990. [PMID: 35733525 PMCID: PMC9207384 DOI: 10.3389/fbioe.2022.914990] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Orthopedic complications were previously reported for patients with increased femoral anteversion. A more comprehensive analysis of the influence of increased femoral anteversion on joint loading in these patients is required to better understand the pathology and its clinical management. Therefore, the aim was to investigate lower-limb kinematics, joint moments and forces during gait in adolescent patients with increased, isolated femoral anteversion compared to typically developing controls. Secondly, relationships between the joint loads experienced by the patients and different morphological and kinematic features were investigated. Patients with increased femoral anteversion (n = 42, 12.8 ± 1.9 years, femoral anteversion: 39.6 ± 6.9°) were compared to typically developing controls (n = 9, 12.0 ± 3.0 years, femoral anteversion: 18.7 ± 4.1°). Hip and knee joint kinematics and kinetics were calculated using subject-specific musculoskeletal models. Differences between patients and controls in the investigated outcome variables (joint kinematics, moments, and forces) were evaluated through statistical parametric mapping with Hotelling T2 and t-tests (α = 0.05). Canonical correlation analyses (CCAs) and regression analyses were used to evaluate within the patients’ cohort the effect of different morphological and kinematic predictors on the outcome variables. Predicted compressive proximo-distal loads in both hip and knee joints were significantly reduced in patients compared to controls. A gait pattern characterized by increased knee flexion during terminal stance (KneeFlextSt) was significantly correlated with hip and knee forces, as well as with the resultant force exerted by the quadriceps on the patella. On the other hand, hip internal rotation and in-toeing, did not affect the loads in the joints. Based on the finding of the CCAs and linear regression analyses, patients were further divided into two subgroups based KneeFlextSt. Patients with excessive KneeFlextSt presented a significantly higher femoral anteversion than those with normal KneeFlextSt. Patients with excessive KneeFlextSt presented significantly larger quadriceps forces on the patella and a larger posteriorly-oriented shear force at the knee, compared to patients with normal KneeFlextSt, but both patients’ subgroups presented only limited differences in terms of joint loading compared to controls. This study showed that an altered femoral morphology does not necessarily lead to an increased risk of joint overloading, but instead patient-specific kinematics should be considered.
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Affiliation(s)
- Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Dpartment of Biomedical Engineering, University of Basel, Basel, Switzerland
- *Correspondence: Enrico De Pieri,
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De Pieri E, Romkes J, Wyss C, Brunner R, Viehweger E. Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking. Front Bioeng Biotechnol 2022; 10:810560. [PMID: 35480978 PMCID: PMC9036482 DOI: 10.3389/fbioe.2022.810560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/02/2022] [Indexed: 01/02/2023] Open
Abstract
Toe-walking characterizes several neuromuscular conditions and is associated with a reduction in gait stability and efficiency, as well as in life quality. The optimal choice of treatment depends on a correct understanding of the underlying pathology and on the individual biomechanics of walking. The objective of this study was to describe gait deviations occurring in a cohort of healthy adult subjects when mimicking a unilateral toe-walking pattern compared to their normal heel-to-toe gait pattern. The focus was to characterize the functional adaptations of the major lower-limb muscles which are required in order to toe walk. Musculoskeletal modeling was used to estimate the required muscle contributions to the joint sagittal moments. The support moment, defined as the sum of the sagittal extensive moments at the ankle, knee, and hip joints, was used to evaluate the overall muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Compared to a normal heel-to-toe gait pattern, toe-walking was characterized by significantly different lower-limb kinematics and kinetics. The altered kinetic demands at each joint translated into different necessary moment contributions from most muscles. In particular, an earlier and prolonged ankle plantarflexion contribution was required from the soleus and gastrocnemius during most of the stance phase. The hip extensors had to provide a higher extensive moment during loading response, while a significantly higher knee extension contribution from the vasti was necessary during mid-stance. Compensatory muscular activations are therefore functionally required at every joint level in order to toe walk. A higher support moment during toe-walking indicates an overall higher muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Higher muscular demands during gait may lead to fatigue, pain, and reduced quality of life. Toe-walking is indeed associated with significantly larger muscle forces exerted by the quadriceps to the patella and prolonged force transmission through the Achilles tendon during stance phase. Optimal treatment options should therefore account for muscular demands and potential overloads associated with specific compensatory mechanisms.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- *Correspondence: Enrico De Pieri,
| | - Jacqueline Romkes
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Wyss
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Reinald Brunner
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland
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Taboada Díaz JE, Carreño Juan D, Dunn García E, Díaz Novo C, Rodríguez Moliner T. [Essential features for obtaining the biomechanical pattern of gait in healthy children. A systematic review]. Rehabilitacion (Madr) 2022; 56:195-203. [PMID: 35305836 DOI: 10.1016/j.rh.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 10/18/2022]
Abstract
The gait patter in childhood is constantly changing as a result of the neuro-anatomical maturation due to growth, for this reason we propose to identify from published studies and the motion capture method, the essential features for obtaining the biomechanical pattern of gait in children. A search for scientific articles was carried out in Scopus, SciELO, PudMed and PEDro where gait is evaluated in subjects under 18 years old, based on motion capture methods and biomechanical parameters. The results showed that from 7 to 9 years old the child acquires the definitive gait pattern, the most used motion capture method was Vicon, with the use of video, force platform and electromyography and the parameters used were the spatial, temporal, spatial-temporal, kinematic, kinetic and electromyographic.
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Affiliation(s)
- J E Taboada Díaz
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba.
| | - D Carreño Juan
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba
| | - E Dunn García
- Centro Nacional de Rehabilitación Hospital Julio Díaz, La Habana, Cuba
| | - C Díaz Novo
- Universidad Tecnológica Suroeste ITR UTEC, Fray Bentos, Río Negro, Uruguay
| | - T Rodríguez Moliner
- Universidad Tecnológica de La Habana José Antonio Echeverría, La Habana, Cuba
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Bailly R, Lempereur M, Thepaut M, Pons C, Houx L, Brochard S. Relationship between 3D lower limb bone morphology and 3D gait variables in children with uni and bilateral Cerebral Palsy. Gait Posture 2022; 92:51-59. [PMID: 34826693 DOI: 10.1016/j.gaitpost.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2021] [Accepted: 11/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medical and surgical interventions to prevent or reduce bone deformities and improve gait in children with cerebral palsy (CP) are based on empirical evidence that there is a relationship between bone deformities and gait deviations. RESEARCH QUESTION What is the relationship between tibial-femoral bone morphology and kinematic gait variables in ambulant children with CP? METHODS A retrospective analysis was conducted on data from 121 children with uni- (n = 64, mean age 9.9 (SD 3.4) years) and bi- lateral (n = 57, mean age 10.4 (SD 3.6) years) CP who had undergone 3D gait analysis and biplanar X-rays (EOS® system). The limbs were split as DIP (the more impaired limb of children with bilateral CP), HEMI (the impaired limb of unilateral CP) and REF (the unimpaired limb of unilateral CP). Multi-variable Linear Regressions were performed between 23 kinematic variables, the Gait Deviation Index (GDI) and a model composed of nine 3D bone variables for each limb type. RESULTS When the whole sample was pooled, 72% of R2 values were poor, 16% were fair, and 12% were moderate. Lower limb bone morphology models explained less than 1% of GDI variability. Correlations between tibial-femoral rotational parameters and hip rotation were mostly poor. Mean foot progression angle was the only kinematic parameter that was fairly to moderately correlated with bone variables in the 3 limb types. A tibial-femoral bone model explained 48% of the variability of mean foot progression angle in the REF limbs, 31% in the HEMI limbs and 25% in the DIP limbs. SIGNIFICANCE Tibial-femoral bone morphology was only weakly related to kinematic gait variables, in contrast with common clinical assumptions. These results suggest that factors other than bone morphology influence gait quality and thus a thorough clinical examination and gait analysis is required prior to making treatment decisions.
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Affiliation(s)
- Rodolphe Bailly
- Fondation Ildys, Brest, France; LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France.
| | - Mathieu Lempereur
- LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Service de Médecine Physique et de Réadaptation, CHRU Brest, France
| | | | - Christelle Pons
- Fondation Ildys, Brest, France; LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Service de Médecine Physique et de Réadaptation, CHRU Brest, France
| | - Laetitia Houx
- LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Service de Médecine Physique et de Réadaptation, CHRU Brest, France
| | - Sylvain Brochard
- Fondation Ildys, Brest, France; LATIM, Inserm U1101, Brest, France; Université de Bretagne Occidentale, Brest, France; Service de Médecine Physique et de Réadaptation, CHRU Brest, France
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20
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Buehler C, Koller W, De Comtes F, Kainz H. Quantifying Muscle Forces and Joint Loading During Hip Exercises Performed With and Without an Elastic Resistance Band. Front Sports Act Living 2021; 3:695383. [PMID: 34497999 PMCID: PMC8419330 DOI: 10.3389/fspor.2021.695383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
An increase in hip joint contact forces (HJCFs) is one of the main contributing mechanical causes of hip joint pathologies, such as hip osteoarthritis, and its progression. The strengthening of the surrounding muscles of the joint is a way to increase joint stability, which results in the reduction of HJCF. Most of the exercise recommendations are based on expert opinions instead of evidence-based facts. This study aimed to quantify muscle forces and joint loading during rehabilitative exercises using an elastic resistance band (ERB). Hip exercise movements of 16 healthy volunteers were recorded using a three-dimensional motion capture system and two force plates. All exercises were performed without and with an ERB and two execution velocities. Hip joint kinematics, kinetics, muscle forces, and HJCF were calculated based on the musculoskeletal simulations in OpenSim. Time-normalized waveforms of the different exercise modalities were compared with each other and with reference values found during walking. The results showed that training with an ERB increases both target muscle forces and HJCF. Furthermore, the ERB reduced the hip joint range of motion during the exercises. The type of ERB used (soft vs. stiff ERB) and the execution velocity of the exercise had a minor impact on the peak muscle forces and HJCF. The velocity of exercise execution, however, had an influence on the total required muscle force. Performing hip exercises without an ERB resulted in similar or lower peak HJCF and lower muscle forces than those found during walking. Adding an ERB during hip exercises increased the peak muscle and HJCF but the values remained below those found during walking. Our workflow and findings can be used in conjunction with future studies to support exercise design.
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Affiliation(s)
- Callum Buehler
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Willi Koller
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Florentina De Comtes
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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21
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De Pieri E, Friesenbichler B, List R, Monn S, Casartelli NC, Leunig M, Ferguson SJ. Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults. Front Bioeng Biotechnol 2021; 9:679360. [PMID: 34368092 PMCID: PMC8334869 DOI: 10.3389/fbioe.2021.679360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023] Open
Abstract
Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | | | - Renate List
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Samara Monn
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zürich, Switzerland
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Mackay J, Thomason P, Sangeux M, Passmore E, Francis K, Graham HK. The impact of symptomatic femoral neck anteversion and tibial torsion on gait, function and participation in children and adolescents. Gait Posture 2021; 86:144-149. [PMID: 33725582 DOI: 10.1016/j.gaitpost.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Torsional deformities of the lower limbs in children and adolescents are a common cause of in-toeing gait and cause gait deviations. The purpose of this study was to examine the relationship of children and adolescents with suspected Idiopathic Torsional Deformities (ITD) and pain, gait function, activity and participation. METHODS A retrospective review of all children and adolescents who attended our Centre over a 5-year period for evaluation of the effect of ITD. All children completed three-dimensional gait analysis (3DGA), standardized physical examination, medical imaging and the Pediatric Outcomes Data Collection Instrument (PODCI). Statistical analysis was completed using two sample t-tests, Pearson's Correlation and linear regression. RESULTS Fifty children and adolescents, 40 females and 10 males with a mean age of 13.5 years were included. Children reported a high prevalence of pain(86%), had increased internal hip rotation(p = 0.002) and decreased external hip rotation(p < 0.001) on physical examination when compared to published normative data. Medical imaging showed a mean(SD) femoral neck anteversion (FNA) of 38°(13°) and external tibial torsion of 39°(12°). Mean(SD) PODCI score was 32(16), indicating these children are functioning below their typically developing peers. The 3DGA kinematics show deviations from typical data including hip rotation, foot progression, pelvic tilt, hip flexion and knee extension. Observed mild kinetic deviations were within typical limits. The relationship between FNA and gait parameters, FNA and PODCI and gait and PODCI were weak. SIGNIFICANCE These children and adolescents have altered gait and experience pain leading to impaired function and diminished participation. Therefore, ITD is not purely a cosmetic issue.
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Affiliation(s)
- Jessie Mackay
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Pam Thomason
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Morgan Sangeux
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Elyse Passmore
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Kate Francis
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - H Kerr Graham
- Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
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23
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Schranz C, Belohlavek T, Sperl M, Kraus T, Svehlik M. Does femoral anteversion and internally rotated gait correlate in subjects with patellofemoral instability? Clin Biomech (Bristol, Avon) 2021; 84:105333. [PMID: 33845347 DOI: 10.1016/j.clinbiomech.2021.105333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patellar instability is a considerable problem that leads to pain and anxiety during simple functional tasks. Femoral derotational osteotomy has become a common surgical procedure to improve patella mechanics, stability and loading. However, it remains unclear if static (MRI measured) femoral anteversion is sufficient to capture the dynamic femoral rotation during walking and represents a good indication for the surgical procedure. This research investigates the relationship between static femoral anteversion and internally rotated gait in adolescents with patellofemoral instability. METHODS This retrospective study included 30 adolescents with recurrent patella instability (minimum three patella dislocations) aged 12 to 18 years (28 female/2 male; 22 unilateral/8 bilateral). All participants were assessed with 3D gait analysis and the femoral anteversion was examined using a rotational MRI. Multiple kinematic parameter were correlated with the ipsilateral femoral anteversion and tibia torsion using the Pearson coefficient. FINDINGS The correlation between parameters of dynamic hip rotation (e.g. maximum and mean internal hip rotation in stance and swing) and MRI measured femoral anteversion (mean 26.5° ± 9°) was weak and did not reach statistical significance. We found 47% (14 out of 30) subjects with increased femoral anteversion but normal hip rotation in stance. INTERPRETATION There was no relationship between increased femoral anteversion and dynamic hip rotation. Consequently, femoral anteversion should not be used as the only indication for femoral derotational osteotomy. Three-dimensional gait analysis might be necessary to assess the appropriate surgical intervention in adolescents with patello femoral instability.
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Affiliation(s)
- Christian Schranz
- Paediatric Orthopaedic Unit, Department of Orthopeadics and Trauma, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
| | - Teresa Belohlavek
- Physiotherapy Unit, KAGES - University hospital Graz, Auenbruggerplatz 1, A-8036 Graz, Austria
| | - Matthias Sperl
- Paediatric Orthopaedic Unit, Department of Orthopeadics and Trauma, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
| | - Tanja Kraus
- Paediatric Orthopaedic Unit, Department of Orthopeadics and Trauma, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
| | - Martin Svehlik
- Paediatric Orthopaedic Unit, Department of Orthopeadics and Trauma, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria
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Kim JI, Kim BH, Han HS, Lee MC. Rotational Changes in the Tibia After High Tibial Valgus Osteotomy: A Comparative Study of Lateral Closing Versus Medial Opening Wedge Osteotomy. Am J Sports Med 2020; 48:3549-3556. [PMID: 33090892 DOI: 10.1177/0363546520960114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND After high tibial valgus osteotomy (HTO), rotational changes in the tibia may occur, which can affect the biomechanics of the patellofemoral joint and may lead to anterior knee pain. PURPOSE To compare the rotational changes in the tibia between closing wedge HTO (CWHTO) and opening wedge HTO (OWHTO). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among the patients who underwent HTO between May 2012 and August 2015, 53 (28 CWHTO and 25 OWHTO) who had computed tomography scans before and at 1 year after the HTO were included. The following parameters were compared between CWHTO and OWHTO: (1) tibial torsion angle, (2) knee rotation angle, and (3) tibial tuberosity-trochlear groove (TT-TG) distance. During the last follow-up, patients were asked to rate their anterior knee pain when climbing the stairs, using the visual analog scale. RESULTS The tibial torsion angle significantly decreased (internal rotation of the distal fragment) after CWHTO (mean ± SD, -2.1°± 4.1°; P = .019) and OWHTO (-1.8°± 3.3°; P = .029). The knee rotation angle significantly decreased (external rotation of the proximal fragment) after OWHTO (-1.8°± 3.4°; P = .039) but was not changed after CWHTO (0.1°± 3.1°; P = .859). The mean TT-TG distance significantly decreased after CWHTO (-3.1 ± 3.0 mm; P < .001) but increased after OWHTO (2.0 ± 4.3 mm; P = .012). At the final follow-up (minimum, 4 years), the visual analog scale pain score during stair climbing was significantly higher after OWHTO than after CWHTO (3.1 ± 1.4 vs 2.2 ± 1.3, P = .024). CONCLUSION Internal rotation of the distal fragment occurred after both CWHTO and OWHTO. However, external rotation of the proximal fragment and increased TT-TG distance occurred after OWHTO. Because such rotational changes could affect anterior knee pain, further studies are warranted to investigate the definite relationship between tibial rotational changes and anterior knee pain after HTO.
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Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Bo Hyun Kim
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyuk Soo Han
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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25
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A multi-scale modelling framework combining musculoskeletal rigid-body simulations with adaptive finite element analyses, to evaluate the impact of femoral geometry on hip joint contact forces and femoral bone growth. PLoS One 2020; 15:e0235966. [PMID: 32702015 PMCID: PMC7377390 DOI: 10.1371/journal.pone.0235966] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
Multi-scale simulations, combining muscle and joint contact force (JCF) from musculoskeletal simulations with adaptive mechanobiological finite element analysis, allow to estimate musculoskeletal loading and predict femoral growth in children. Generic linearly scaled musculoskeletal models are commonly used. This approach, however, neglects subject- and age-specific musculoskeletal geometry, e.g. femoral neck-shaft angle (NSA) and anteversion angle (AVA). This study aimed to evaluate the impact of proximal femoral geometry, i.e. altered NSA and AVA, on hip JCF and femoral growth simulations. Musculoskeletal models with NSA ranging from 120° to 150° and AVA ranging from 20° to 50° were created and used to calculate muscle and hip JCF based on the gait analysis data of a typically developing child. A finite element model of a paediatric femur was created from magnetic resonance images. The finite element model was morphed to the geometries of the different musculoskeletal models and used for mechanobiological finite element analysis to predict femoral growth trends. Our findings showed that hip JCF increase with increasing NSA and AVA. Furthermore, the orientation of the hip JCF followed the orientation of the femoral neck axis. Consequently, the osteogenic index, which is a function of cartilage stresses and defines the growth rate, barely changed with altered NSA and AVA. Nevertheless, growth predictions were sensitive to the femoral geometry due to changes in the predicted growth directions. Altered NSA had a bigger impact on the growth results than altered AVA. Growth simulations based on mechanobiological principles were in agreement with reported changes in paediatric populations.
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26
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Hegarty AK, Kurz MJ, Stuberg W, Silverman AK. Muscle capacity to accelerate the body during gait varies with foot position in cerebral palsy. Gait Posture 2020; 78:54-59. [PMID: 32244189 DOI: 10.1016/j.gaitpost.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) often have altered gait patterns compared to their typically developing peers. These gait patterns are characterized based on sagittal plane kinematic deviations; however, many children with CP also walk with altered transverse plane kinematics. RESEARCH QUESTION How do both altered skeletal alignment and kinematic deviations affect muscles' capacity to accelerate the body during gait? METHODS A three-dimensional gait analysis was completed for 18 children with spastic CP (12.5 ± 2.9 years; GMFCS level II). Musculoskeletal models were developed for each participant, and tibial torsion, measured during a static standing trial and assessed using motion capture, was incorporated. An induced acceleration analysis was performed to evaluate the capacity of muscles to accelerate the body center of mass throughout stance. Differences between the root-mean-square muscle capacity for children with CP walking with internally rotated, standard, and externally rotated postures were evaluated. RESULTS Externally rotated postures resulted in a lower capacity to accelerate the body center of mass compared with internally rotated postures. Both changes in skeletal alignment and kinematics contributed to changes in muscle capacity to accelerate the body. SIGNIFICANCE Altered transverse plane skeletal alignment and compensatory kinematics should both be considered in surgical treatment of children with CP.
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Affiliation(s)
- Amy K Hegarty
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, United States
| | - Max J Kurz
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Wayne Stuberg
- Department of Physical Therapy, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, United States.
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27
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Xu Z, Zhang H, Chen J, Mohamed SI, Zhou A. Femoral Anteversion Is Related to Tibial Tubercle-Trochlear Groove Distance in Patients with Patellar Dislocation. Arthroscopy 2020; 36:1114-1120. [PMID: 31843647 DOI: 10.1016/j.arthro.2019.10.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the potential relationship between the tibial tubercle-trochlear groove (TT-TG) distance and the femoral anteversion of different segments of the femur in patients with patellar dislocation. METHODS A total of 60 patients with a diagnosis of patellar dislocation were included in our study. Patients with previous knee surgeries, previous fractures, or lack of necessary radiologic examinations were excluded from our study. The data of computed tomography scanning within a week before the surgery was used to measure the TT-TG distance, total anteversion, proximal anteversion, diaphyseal anteversion, distal anteversion, and tibial torsion. All the data were obtained from the picture archiving and communication system (PACS) workstation. The Pearson correlation analysis was performed to confirm the potential relationship between TT-TG distance and femoral anteversion of different segments. The intraclass correlation coefficient was used to assess the interobserver reliability of measurements. RESULTS The TT-TG distance was significantly correlated with the diaphyseal anteversion (r = -0.305, P = 0.008) and distal anteversion (r = 0.365, P = 0.004). The total anteversion was associated with proximal anteversion (r = 0.392, P = 0.02) and diaphyseal anteversion (r = 0.631, P < 0.001). The intraclass correlation coefficient showed the measurements of included parameters were presented with excellent agreement. CONCLUSION Our study showed that patients with high diaphyseal anteversion and distal anteversion tend to had a higher TT-TG distance but the value of total and proximal femoral anteversion were independent of the value of TT-TG distance. LEVEL OF EVIDENCE Level IV therapeutic case series.
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Affiliation(s)
- Zijie Xu
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaxing Chen
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Aiguo Zhou
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Dannenmaier J, Kaltenbach C, Kölle T, Krischak G. Application of functional data analysis to explore movements: walking, running and jumping - A systematic review. Gait Posture 2020; 77:182-189. [PMID: 32058281 DOI: 10.1016/j.gaitpost.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/24/2019] [Accepted: 02/02/2020] [Indexed: 02/02/2023]
Abstract
Background Signals are continuously captured during the recording of motion data. Statistical analysis, however, usually uses only a few aspects of the recorded data. Functional data analysis offers the possibility to analyze the entire signal over time. Research question The review is based on the question of how functional data analysis is used in the study of lower limb movements. Methods The literature search was based on the databases EMBASE, PUBMED and OVID MEDLINE. All articles on the application of functional data analysis to motion-associated variables trajectories, ground reaction force,electromyography were included. The references were assessed independently by two reviewers. Results In total 1448 articles were found in the search. Finally, 13 articles were included in the review. All were of moderate methodological quality. The publication year of the studies ranges from 2009 to 2019. Healthy volunteers and persons with cruciate ligament injuries, knee osteoarthritis, gluteal tendinopathy, idiopathic torsional deformities, slipped capital femoral epiphysis and chronic ankle instability were examined in the studies. Movements were analyzed on basis of kinematics (3D motion analysis), ground reaction forces and electromyography. Functional Data Analysis was used in terms of landmark registration, functional principal component analysis, functional t-test and functional ANOVA. Significance Functional data analysis provides the possibility to gain detailed and in-depth insights into the analysis of motion patterns. As a result of the increase in references over the past year, the FDA is becoming more important in the analysis of continuous signals and the explorative analysis of movement data.
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Affiliation(s)
- Julia Dannenmaier
- Institute for Research in Rehabilitation Medicine at Ulm University (IFR Ulm), Bad Buchau, Germany
| | - Christina Kaltenbach
- Institute for Research in Rehabilitation Medicine at Ulm University (IFR Ulm), Bad Buchau, Germany
| | - Theresa Kölle
- Institute for Research in Rehabilitation Medicine at Ulm University (IFR Ulm), Bad Buchau, Germany
| | - Gert Krischak
- Institute for Research in Rehabilitation Medicine at Ulm University (IFR Ulm), Bad Buchau, Germany; Department of Orthopedics and Orthopedic Surgery, Federseeklinik, Bad Buchau, Germany.
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Davico G, Pizzolato C, Killen BA, Barzan M, Suwarganda EK, Lloyd DG, Carty CP. Best methods and data to reconstruct paediatric lower limb bones for musculoskeletal modelling. Biomech Model Mechanobiol 2019; 19:1225-1238. [DOI: 10.1007/s10237-019-01245-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/25/2019] [Indexed: 11/28/2022]
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30
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Leblebici G, Akalan E, Apti A, Kuchimov S, Kurt A, Onerge K, Temelli Y, Miller F. Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue. Gait Posture 2019; 70:336-340. [PMID: 30952106 DOI: 10.1016/j.gaitpost.2019.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased femoral anteversion (IFA) is defined as forwardly rotated femoral head relative to the transcondylar knee axis which may have a potential to reduce the functional quality of adolescents. Therefore, the aim of our study was to investigate the effects of IFA on lower-extremity function, falling frequency, and fatigue onset in neurologically intact children. RESEARCH QUESTION Does increased femoral anteversion influence lower extremity function, falling frequency and fatigue on set in healthy children? METHODS Sixty-five participants with increased femoral anteversion (IFA) and thirty-two healthy peers as control were included into the study. For the function, the lower extremity function form (LEFF) which is adapted from Lower Extremity Function Test used. Falling frequency and fatigue onset time were assessed by a Likert-type scale. In addition, the activities which cause frequently fall for the participants were questioned. RESULTS Lower extremity function was found deteriorated (p= 0.02) and falling frequency was higher (p = 0.00) in IFA than in controls. Fatigue onset time was not different between groups, although lower extremity function was strongly correlated with fatigue onset (rho = -0.537, p < 0.001). IFA children fall four times more during running (60%), three times more during fast walking (21.42%) than their healthy peers (14.28%, 7.14% respectively). SIGNIFICANCE IFA leads functional problems, especially in the form of high falling frequencies. According to the LEFF score, the most difficult functional parameters for these children were walking long distances, becoming tired, walking more than a mile, and standing on one spot. Also, shorter fatigue onset time may worsen the lower-extremity function secondarily. Because of the higher frequency of falling and functional problems, children with IFA may be more defenseless to injuries, especially in high-motor-skill activities such as running and soccer.
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Affiliation(s)
- Gokce Leblebici
- Istanbul Medeniyet University, Physiotherapy and Rehabilitation Department, Turkey
| | - Ekin Akalan
- Istanbul Kultur University, Physiotherapy and Rehabilitation Department, Turkey.
| | - Adnan Apti
- Istanbul Kultur University, Physiotherapy and Rehabilitation Department, Turkey
| | | | - Aslihan Kurt
- Biruni University, Physiotherapy and Rehabilitation Department, Turkey
| | - Kubra Onerge
- Istanbul Kultur University, Physiotherapy and Rehabilitation Department, Turkey
| | - Yener Temelli
- MedAmerikan Medical Center, Orthopedics Department, Turkey
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31
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Alexander N, Studer K, Lengnick H, Payne E, Klima H, Wegener R. The impact of increased femoral antetorsion on gait deviations in healthy adolescents. J Biomech 2019; 86:167-174. [DOI: 10.1016/j.jbiomech.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/30/2022]
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