Musculoskeletal models for decision making in children with CP
Research type
Research Study
Full title
Personalised Musculoskeletal Models to Aid in Decision Making in Children with Cerebral Palsy
IRAS ID
260198
Contact name
Claudia Mazza
Contact email
Sponsor organisation
Sheffield Children's Hospital NHS Foundation Trust
Duration of Study in the UK
2 years, 3 months, 30 days
Research summary
Research Summary
Femoral Derotation Osteotomy (FDO) is a surgical procedures used in the management of increased femoral anteversion, and consequent gait abnormalities in patients with cerebral palsy [1,2]. While the short-term success of this procedure has been well documented, several studies have also reported levels of recurrence of excessive internal hip rotation (an indication for FDO) in the long term. In children, especially where FDO is performed prior to their pubertal growth spurt, this is a challenge that needs addressing. Several factors have been cited as potential contributors to reoccurrence including: age at surgery, reduced preoperative gait speed, increased hamstring spasticity, and under correction during surgery [4]. This preliminary research seeks to identify if there are outcome measures from 3D gait analysis and imaging, that may predict which patients are most likely to maintain functional correction after FDO in the long term. This will be investigated through retrospective analysis and re-processing of 3D gait analysis and imaging data, that has been routinely collected pre- and post- operatively at Sheffield Children's Hospital. It is predicted that re-processing data using musculoskeletal (MSK) models may offer further insights into the cause of relapse. The format of the MSK modelling will also be investigated, comparing the differences seen when using scaled generic models versus incorporating patient specific details. The aim of the project is to provide preliminary data, which in the future could lead to improved information for clinicians when making surgical recommendations of candidates for FDO, thereby minimising the risk of recurrence and hence the likelihood of revision surgeries.
[1] Ounpuu, S., et al. (2017). Gait & Posture 56: 82-88.
[2] Dreher, T., et al. (2007). Gait & Posture 26: 25-31.
[3] Church, C., et al. (2017). Journal of Pediatric Orthopaedics 37(7): 447-453.
[4] Niklasch, M., et al. (2015). Gait & Posture 42(4): 460-465.Summary of Results
Femoral Derotation Osteotomy (FDO) is a surgical procedure used in the management of increased femoral anteversion, and consequent gait abnormalities in patients with cerebral palsy. While the short-term success of this procedure has been well documented, several studies have also reported levels of recurrence of excessive internal hip rotation (an indication for FDO) in the long term. This is a challenge that needs addressing. This study aimed to provide preliminary data which could lead to improved information for clinicians when making surgical recommendations of candidates for FDO, thereby minimising the risk of recurrence. To achieve this aim, this study proposed to employ a retrospective analysis of gait analysis data together with the use of musculoskeletal modelling techniques to identify quantities that may predict which patients are most likely to maintain functional correction after Femoral Derotation Osteotomies.
The first part of the study’s findings showed that the kinematic output from the musculoskeletal modelling approach was capable of quantifying post-operative changes that discriminate positive and negative responders to the FDO as well as the currently employed 3D gait analysis pipeline when using a metric of overall gait quality (i.e. Gait Profile Score). When looking at what pertains to the specific effect of the FDO (changes in hip rotation and foot progression angle), the musculoskeletal modelling approach agreed most with the clinical judgement of outcome after the intervention. These results supported the premise of the usefulness of the musculoskeletal models in providing insights and have been published..
Following on from the positive results from using the musculoskeletal models, the second aspect of the study investigated the role of pre-surgery muscle-tendon lengths on the outcomes after the FDO. Our findings identified three muscles whose maximum lengths during gait were different between the responders and non-responders at pre-surgery. Of note were the changes in these lengths after FDO in the response group. The above can potentially inform decisions on whether concomitant lengthening surgeries for these muscles are indicated and also the degree of lengthening that may be necessary. These results were presented at both a European and International Conference in 2021.
Overall, the aim of the study was achieved, providing insights for clinical decision-making in the treatment of children with cerebral palsy and also providing directions for future studies. The student also gained research skills and knowledge that can be transferred as part of the PhD training.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
19/SC/0329
Date of REC Opinion
10 Jul 2019
REC opinion
Further Information Favourable Opinion