Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy

Alexander, Nathalie; Wegener, Regina; Lengnick, Harald; Payne, Erika; Klima, Harry; Cip, Johannes; Studer, Kathrin

doi:10.1016/j.gaitpost.2020.01.011

Cited by 23 publications

(21 citation statements)

References 29 publications

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“…Excessive femoral torsion can affect both hip and knee mechanics ( Passmore et al, 2018 ) and is associated with functional impairments and motor limitations ( Bruderer-Hofstetter et al, 2015 ). Torsional deformities of the femur and tibia ( Bruce and Stevens, 2004 ; Alexander et al, 2020 ) have also been associated with knee and patellar complications ( Eckhoff et al, 1997 ; Powers, 2003 ; Stevens et al, 2014 ; Bretin et al, 2011 ). However, a better understanding of the femorotibial and femoropatellar joint mechanics, specifically of their response to torsional forces, would require a more complex multi-DOF modeling approach of the knee complex, accounting for specific morphological variations of the tibia and femur, specifically of their articulating surfaces, as well as passive soft-tissue structures which constrain knee rotations ( Marra et al, 2014 ; Lenhart et al, 2015 ; Dejtiar et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Pieri

Friesenbichler

List

et al. 2021

Front. Bioeng. Biotechnol.

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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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Section: Discussionmentioning

confidence: 99%

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Pieri

Friesenbichler

List

et al. 2021

Front. Bioeng. Biotechnol.

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“…Additionally, an increased knee flexion in mid- and terminal stance was found for some children with increased femoral anteversion ( Bruderer-Hofstetter et al, 2015 ; Passmore et al, 2018 ; Alexander et al, 2019 ; Mackay et al, 2021 ). In general, children with different lower-limb torsional deformities, tend to present kinematic compensatory mechanisms ( Alexander et al, 2020 ; Byrnes et al, 2020 ). A stratified analysis based on different kinematic gait patterns might help identifying specific subgroups of patients who present a higher risk of joint overloading as a consequence of both altered morphology and kinematics.…”

Section: Introductionmentioning

confidence: 99%

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

Alexander

Brunner

Cip³

et al. 2022

Front. Bioeng. Biotechnol.

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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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“…De-rotation osteotomies are used to correct femoral and tibial malrotations with the aim to improve the patients' gait pattern and avoid degenerative joint diseases in the long run. Indeed, femoral de-rotation osteotomies improved the gait pattern in people with idiopathic femoral AVA [85], whereas tibial derotation osteotomies improved the gait pattern in people with increased tibial torsion [86]. Our ndings suggest that the clinical team should include the quanti cation and consideration of the NSA when planning de-rotation osteotomies.…”

Section: Discussionmentioning

confidence: 75%

Influence of femoral anteversion angle and neck-shaft angle on muscle forces and joint loading during walking

Kainz

Mindler

Kranzl

2023

Preprint

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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. Hence, we conducted a comprehensive musculoskeletal modelling study to investigate the influence of femoral AVA and NSA on muscle forces and joint loads during walking. We created 25 musculoskeletal models with a variety of NSA and AVA. For each model we calculated moment arms, muscle forces, muscle moments, and joint loads based on motion capture data of a healthy person with a typical gait pattern. 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. Neglecting an individual’s femoral geometry when estimating joint contact forces can lead to errors above five times body weight. 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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Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy

Cited by 23 publications

References 29 publications

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

Influence of femoral anteversion angle and neck-shaft angle on muscle forces and joint loading during walking

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