Hip- and patellofemoral-joint loading during gait are increased in children with idiopathic torsional deformities

Elyse Passmore; H Kerr Graham; Marcus G Pandy; Morgan Sangeux

doi:10.1016/j.gaitpost.2018.05.003

Hip- and patellofemoral-joint loading during gait are increased in children with idiopathic torsional deformities

Gait Posture. 2018 Jun:63:228-235. doi: 10.1016/j.gaitpost.2018.05.003. Epub 2018 May 9.

Authors

Elyse Passmore¹, H Kerr Graham², Marcus G Pandy³, Morgan Sangeux⁴

Affiliations

¹ Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Australia; Gait Lab & Orthopaedics, Murdoch Children's Research Institute, Australia; The University of Melbourne, Department of Mechanical Engineering, Australia. Electronic address: elyse.passmore@rch.org.au.
² Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Australia; Gait Lab & Orthopaedics, Murdoch Children's Research Institute, Australia; The University of Melbourne, Department of Paediatrics, Australia.
³ The University of Melbourne, Department of Mechanical Engineering, Australia.
⁴ Hugh Williamson Gait Analysis Laboratory, The Royal Children's Hospital, Australia; Gait Lab & Orthopaedics, Murdoch Children's Research Institute, Australia; The University of Melbourne, Department of Mechanical Engineering, Australia.

PMID: 29775910
DOI: 10.1016/j.gaitpost.2018.05.003

Abstract

Background: Torsional deformities of the femur and tibia are associated with gait impairments and joint pain. Several studies have investigated these gait deviations in children with cerebral palsy. However, relatively little is known about gait deviations in children with idiopathic torsion and debate ensues about the management of these patients.

Research question: What are the effects of idiopathic increased femoral neck anteversion and external tibial torsion on lower-limb kinematics, kinetics and joint loading during gait in children and adolescents.

Methods: Patient-specific musculoskeletal models were created for 12 children/adolescents (mean age of 14 years) with torsional deformities using low-dose biplane radiographic imaging and 3D gait analysis. Comparisons of joint motion and net joint torques during gait were made to an age-matched control group with no torsional deformities. The effects of torsional deformities on muscle and joint contact forces were investigated using two personalised musculoskeletal models: one with normal torsion and another with patient-specific torsion.

Results: Femoral neck anteversion and external tibial torsion for the patients were (mean ± SD) 38° ± 9° and 40° ± 10°, respectively. Patients had increased internal hip rotation and external knee rotation as well as increased pelvic tilt during gait. Additionally, the efficacy of the plantarflexor-knee extension mechanism was diminished. Hip joint contact force was higher in the model with patient-specific torsion. The mediolateral component of the patellofemoral joint contact force was also increased despite the magnitude of the resultant patellofemoral contact force being unchanged.

Significance: It has been previously established that idiopathic lower-limb torsional deformities alter gait kinematics. However, this study also showed that loading of the hip and patellofemoral joints are increased. This is an important insight for the clinical management of these patients and highlights that idiopathic lower-limb torsional deformities are not a purely cosmetic issue.

Keywords: 3D gait analysis; Biplanar radiographs; External tibial torsion; Femoral neck anteversion; Patient-specific musculoskeletal modelling.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Biomechanical Phenomena
Child
Female
Femur Neck / pathology
Gait / physiology*
Hip Joint / physiopathology*
Humans
Kinetics
Male
Models, Biological
Patellofemoral Joint / physiopathology*
Prospective Studies
Range of Motion, Articular / physiology*
Tibia / pathology
Torsion Abnormality / physiopathology*