The impact of increased femoral antetorsion on gait deviations in healthy adolescents

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

doi:10.1016/j.jbiomech.2019.02.005

Cited by 20 publications

(23 citation statements)

References 46 publications

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“…The overall gait pattern of the investigated cohort of patients, characterized by increased internal hip rotation and in-toeing, is in agreement with previous research focusing on the gait of adolescent patients with increased femoral anteversion ( Bruderer-Hofstetter et al, 2015 ; Passmore et al, 2018 ; Alexander et al, 2019 ; Mackay et al, 2021 ).…”

Section: Discussionsupporting

confidence: 90%

“…Previous studies have shown that these patients tend to walk with a more internally-rotated foot progression angle, increased hip internal rotation, increased hip flexion and greater anterior pelvic tilt. 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 ).…”

Section: Introductionmentioning

confidence: 95%

“…Although increased femoral anteversion is often considered a primarily cosmetic problem, it can also be associated with orthopedic and functional problems in pediatric and adolescent patients, who may eventually require surgical intervention. Increased femoral torsion was reported to lead to functional problems, especially concerning high falling frequencies ( Leblebici et al, 2019 ; Mackay et al, 2021 ) and altered lower-limb kinematics during gait, such as in-toeing and increased hip internal rotation ( Bruderer-Hofstetter et al, 2015 ; Passmore et al, 2018 ; Alexander et al, 2019 ; Mackay et al, 2021 ). Since femoral anteversion measured by computed tomography (CT) scans correlates weakly with hip internal rotation during walking, a complete three-dimensional (3D) gait analysis was recommended when planning a surgical correction of torsional deformities ( Radler et al, 2010 ; Gaston et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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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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“…In addition to cosmetic considerations regarding their gait ( Fabry, 2010 ), these deformities have been associated with the development of gait impairment and joint pain ( Bruderer-Hofstetter et al, 2015 ). Nevertheless, there is no consistent definition of what can be considered excessive or pathological femoral antetorsion, with threshold values spanning between > 30° and > 50° ( Jani et al, 1979 ; Cordier and Katthagen, 2000 ; Hefti, 2000 ; Alexander et al, 2019 ). Moreover, optimal surgical treatment for mechanically induced hip pain depends upon understanding the forces that are produced within the acetabulum and the potential mechanical consequences of femoral reorientation.…”

Section: Introductionmentioning

confidence: 99%

“…There is a general understanding that the rotational alignment of the whole lower limb plays a critical role in the onset of hip pathologies ( Eckhoff, 1994 ; Keshmiri et al, 2016 ). Additionally, several kinematic compensatory strategies can be adopted at the hip ( Bruderer-Hofstetter et al, 2015 ; Alexander et al, 2019 ), as a consequence of either pain avoidance ( Leigh et al, 2016 ; Popovic et al, 2020 ) or lever arm dysfunction, particularly of the hip abductors ( Arnold et al, 1997 ; van der Krogt et al, 2012 ; Boyer et al, 2016 ). Moreover, modeling excessive femoral antetorsion was shown to alter magnitude and orientation of predicted joint contact forces in pediatric pathological populations ( Bosmans et al, 2014 ; Passmore et al, 2018 ), as well as in typically developing children ( Kainz et al, 2020 ).…”

Section: Introductionmentioning

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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The effect of functional calibration methods on gait kinematics in adolescents with idiopathic rotational deformity of the femur

Boekesteijn

Ven

Wilders

et al. 2023

Clinical Biomechanics

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The impact of increased femoral antetorsion on gait deviations in healthy adolescents

Cited by 20 publications

References 46 publications

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

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

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

The effect of functional calibration methods on gait kinematics in adolescents with idiopathic rotational deformity of the femur

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