Intra- and inter-subject variability of femoral growth plate stresses in typically developing children and children with cerebral palsy

Köller, W.; Gonçalves, Basílio A.M.; Baca, Arnold; Kainz, Hans

doi:10.3389/fbioe.2023.1140527

Cited by 4 publications

(2 citation statements)

References 51 publications

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“…In the future, altering joint loads with personalized muscle coordination retraining might help to treat or prevent clinical symptoms in a non-invasive way. For example, the direction of the hip JCF has been shown to determine typical and pathological growth plate stresses and bone growth 9 , 54 . Normalizing the direction of the hip JCF with personalized muscle coordination retraining at an early stage might, therefore, help to prevent the development of torsional femoral deformities.…”

Section: Discussionmentioning

confidence: 99%

A framework based on subject-specific musculoskeletal models and Monte Carlo simulations to personalize muscle coordination retraining

Kainz,

Koller,

Wallnöfer

et al. 2024

Sci Rep

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Excessive loads at lower limb joints can lead to pain and degenerative diseases. Altering joint loads with muscle coordination retraining might help to treat or prevent clinical symptoms in a non-invasive way. Knowing how much muscle coordination retraining can reduce joint loads and which muscles have the biggest impact on joint loads is crucial for personalized gait retraining. We introduced a simulation framework to quantify the potential of muscle coordination retraining to reduce joint loads for an individuum. Furthermore, the proposed framework enables to pinpoint muscles, which alterations have the highest likelihood to reduce joint loads. Simulations were performed based on three-dimensional motion capture data of five healthy adolescents (femoral torsion 10°–29°, tibial torsion 19°–38°) and five patients with idiopathic torsional deformities at the femur and/or tibia (femoral torsion 18°–52°, tibial torsion 3°–50°). For each participant, a musculoskeletal model was modified to match the femoral and tibial geometry obtained from magnetic resonance images. Each participant’s model and the corresponding motion capture data were used as input for a Monte Carlo analysis to investigate how different muscle coordination strategies influence joint loads. OpenSim was used to run 10,000 simulations for each participant. Root-mean-square of muscle forces and peak joint contact forces were compared between simulations. Depending on the participant, altering muscle coordination led to a maximum reduction in hip, knee, patellofemoral and ankle joint loads between 5 and 18%, 4% and 45%, 16% and 36%, and 2% and 6%, respectively. In some but not all participants reducing joint loads at one joint increased joint loads at other joints. The required alteration in muscle forces to achieve a reduction in joint loads showed a large variability between participants. The potential of muscle coordination retraining to reduce joint loads depends on the person’s musculoskeletal geometry and gait pattern and therefore showed a large variability between participants, which highlights the usefulness and importance of the proposed framework to personalize gait retraining.

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Section: Discussionmentioning

confidence: 99%

A framework based on subject-specific musculoskeletal models and Monte Carlo simulations to personalize muscle coordination retraining

Kainz,

Koller,

Wallnöfer

et al. 2024

Sci Rep

Self Cite

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“…In a recent simulation study, Kainz et al [ 18 ] showed that the orientation of the HJCF in the sagittal plane can differentiate between children with CP who are likely to have typical and pathological femoral growth. Asymmetric HJCF can alter growth plate loading [ 19 ] and therefore lead to asymmetric development of bones in length and shape resulting in altered biomechanics. Previous studies showed that not only the subject-specific gait pattern but also the femoral geometry has a big impact on the estimation of the HJCF [ 16 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

The gait pattern and not the femoral morphology is the main contributor to asymmetric hip joint loading

Koller,

Baca,

Kainz

2023

PLoS ONE

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Gait asymmetry and skeletal deformities are common in many children with cerebral palsy (CP). Changes of the hip joint loading, i.e. hip joint contact force (HJCF), can lead to pathological femoral growth. A child’s gait pattern and femoral morphology affect HJCFs. The twofold aim of this study was to (1) evaluate if the asymmetry in HJCFs is higher in children with CP compared to typically developing (TD) children and (2) identify if the bony morphology or the subject-specific gait pattern is the main contributor to asymmetric HJCFs. Magnetic resonance images (MRI) and three-dimensional gait analysis data of twelve children with CP and fifteen TD children were used to create subject-specific musculoskeletal models and calculate HJCF using OpenSim. Root-mean-square-differences between left and right HJCF magnitude and orientation were computed and compared between participant groups (CP versus TD). Additionally, the influence on HJCF asymmetries solely due to the femoral morphology and solely due to the gait pattern was quantified. Our findings demonstrate that the gait pattern is the main contributor to asymmetric HJCFs in CP and TD children. Children with CP have higher HJCF asymmetries which is probably the result of larger asymmetries in their gait pattern compared to TD children. The gained insights from our study highlight that clinical interventions should focus on normalizing the gait pattern and therefore the hip joint loading to avoid the development of femoral deformities.

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ESMAC Best Paper Award 2023: Increased knee flexion in participants with cerebral palsy results in altered stresses at the distal femoral growth plate compared to a typically developing cohort

Koller,

Wallnöfer,

Holder

et al. 2024

Gait & Posture

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Intra- and inter-subject variability of femoral growth plate stresses in typically developing children and children with cerebral palsy

Cited by 4 publications

References 51 publications

A framework based on subject-specific musculoskeletal models and Monte Carlo simulations to personalize muscle coordination retraining

A framework based on subject-specific musculoskeletal models and Monte Carlo simulations to personalize muscle coordination retraining

The gait pattern and not the femoral morphology is the main contributor to asymmetric hip joint loading

ESMAC Best Paper Award 2023: Increased knee flexion in participants with cerebral palsy results in altered stresses at the distal femoral growth plate compared to a typically developing cohort

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