ESB Clinical Biomechanics Award 2020: Pelvis and hip movement strategies discriminate typical and pathological femoral growth – Insights gained from a multi-scale mechanobiological modelling framework. (July 2021)

• Record Type: Journal Article
• Authors: Kainz, Hans; Killen, Bryce A.; Van Campenhout, Anja; Desloovere, Kaat; Garcia Aznar, Jose Manuel; Shefelbine, Sandra; Jonkers, Ilse
• Is Part Of: Clinical biomechanics. Volume 87(2021)
• Publication Date: 2021-07
• Subjects: Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2021.105405
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Many children with cerebral palsy (CP) develop skeletal deformities during childhood. So far, it is unknown why some children with CP develop bony deformities whereas others do not. The aims of this study were to (i) investigate what loading characteristics lead to typical and pathological femoral growth, and (ii) evaluate why some children with CP develop femoral deformities whereas other do not. Methods: A multi-scale mechanobiological modelling workflow was used to simulate femoral growth based on three-dimensional motion capture data of six typically developing children and 16 children with CP. Based on the growth results, the participants with CP were divided into two groups: typical growth group and pathological growth group. Gait kinematics and femoral loading were compared between simulations resulting in typical growth and those resulting in pathologic growth. Findings: Hip joint contact forces were less posteriorly-oriented in the pathological growth simulations compared to the typical ones. Compared to the typically developing participants, the CP group with pathological femoral growth presented increased knee flexion and no hip extension. The CP group with simulated typical growth presented similar sagittal plane joint kinematics but differed in the frontal plane pelvic and hip movement strategy, which normalized the hip joint contact force and therefore contributed to typical femoral growth trends. Interpretation: Our simulation results identified specific gait features, which may contribute to pathological femoral growth. Furthermore, the hip joint contact force orientation in the sagittal plane seems to be the dominant factor for determining femoral growth simulations. Highlights: Multi-scale mechanobiological modelling workflow was used to simulate femoral growth. Femoral growth was simulated in healthy children and children with cerebral palsy. Less posterior-oriented hip joint contact force leads to pathological femoral growth. Altered pelvic and hip movement strategy led to a normalization of femoral growth. Sagittal plane hip joint contact force orientation determines femoral growth trends.