Longitudinal bone growth is regulated by mechanical forces arising from physical activity, whose directions and magnitudes depend on activity kinematics and intensity. This study aims to investigate the influence of common physical activities on proximal femoral morphological tendency due to growth at the femoral head growth plate. A subject-specific femur model based on magnetic resonance images of one able-bodied 6-year old child was developed, and the directions of hip contact force were described as load samples at a constant magnitude. Finite element analysis was performed to predict growth rate and growth direction, and expected changes in neck-shaft angle and femoral anteversion were computed corresponding to circa 4 months of growth. For most loading conditions, neck-shaft angle and femoral anteversion decreased during growth, corresponding to the femur & rsquo;s natural course during normal growth. The largest reduction in neck-shaft angle and femoral anteversion was approximately 0.25 degrees and 0.15 degrees. Our results suggest that most common physical activities induce the expected morphological changes in normal growth in able-bodied children. Understanding the influence of contact forces during less common activities on proximal femoral development might provide improved guidelines and treatment planning for children who have or are at risk of developing a femoral deformity.

Muscle and joint contact force influence stresses at the proximal growth plate of the femur and thus bone growth, affecting the neck shaft angle (NSA) and femoral anteversion (FA). This study aims to illustrate how different muscle groups' activation during gait affects NSA and FA development in able-bodied children. Subject-specific femur models were developed for three able-bodied children (ages 6, 7, and 11 years) using magnetic resonance images. Contributions of different muscle groups-hip flexors, hip extensors, hip adductors, hip abductors, and knee extensors-to overall hip contact force were computed. Specific growth rate for the growth plate was computed, and the growth was simulated in the principal stress direction at each element in the growth front. The predicted growth indicated decreased NSA and FA (of about over a four-month period) for able-bodied children. Hip abductors contributed the most, and hip adductors, the least, to growth rate. All muscles groups contributed to a decrease in predicted NSA (similar to 0.01 degrees-0.04 degrees and FA (similar to 0.004 degrees-0.2 degrees), except hip extensors and hip adductors, which showed a tendency to increase the FA (similar to 0.004 degrees-0.2 degrees). Understanding influences of different muscle groups on long bone growth tendency can help in treatment planning for growing children with affected gait.

Mechanical stimuli play a significant role in the process of endochondral growth. Thus far, approaches to understand the endochondral mechanical growth rate have been limited to the use of approximated location and geometry of the growth plate. Furthermore, growth has been simulated based on the average deflection of the growth plate or of the femoral neck. It has also been reported in the literature that the growth plate lies parallel to one of the principal stresses acting on it, to reduce the shear between epiphysis and diaphysis. Hence the current study objectives were (1) to evaluate the significance of a subject-specific finite element model of the femur and growth plate compared to a simplified growth plate model and (2) to explore the different growth direction models to better understand proximal femoral growth mechanisms. A subject-specific finite element model of an able-bodied 7-year old child was developed. The muscle forces and hip contact force were computed for one gait cycle and applied to a finite element model to determine the specific growth rate. Proximal femoral growth was simulated for two different growth direction models: femoral neck deflection direction and principal stress direction. The principal stress direction model captured the expected tendency for decreasing the neck shaft angle and femoral anteversion for both growth plate models. The results of this study suggest that the subject-specific geometry and consideration of the principal stress direction as growth direction may be a more realistic approach for correct prediction of proximal femoral growth morphology.

Background: In children with bilateral cerebral palsy (CP) maintaining a standing position can be difficult. The fundamental motor task of standing independently is achieved by an interaction between the visual, somatosensory, and vestibular systems. In CP, the motor disorders are commonly accompanied by sensory and perceptual disturbances. Our aims were to examine the influence of visual stimuli on standing posture in relation to standing ability. Methods: Three dimensional motion analysis with surface electromyography was recorded to describe body position, body movement, and muscle activity during three standing tasks: in a self-selected position, while blindfolded, and during an attention-demanding task. Participants were twenty-seven typically-developing (TD) children and 36 children with bilateral CP, of which 17 required support for standing (CP-SwS) and 19 stood without support (CP-SwoS). Results: All children with CP stood with a more flexed body position than the TD children, even more pronounced in the children in CP-SwS. While blindfolded, the CP-SwS group further flexed their hips and knees, and increased muscle activity in knee extensors. In contrast, the children in CP-SwoS maintained the same body position but increased calf muscle activity. During the attention-demanding task, the children in CP-SwoS stood with more still head and knee positions and with less muscle activity. Conclusions: Visual input was important for children with CP to maintain a standing position. Without visual input the children who required support dropped into a further crouched position. The somatosensory and vestibular systems alone could not provide enough information about the body position in space without visual cues as a reference frame. In the children who stood without support, an intensified visual stimulus enhanced the ability to maintain a quiet standing position. It may be that impairments in the sensory systems are major contributors to the difficulties to stand erect in children with CP.

The long bones grow by the process of endochondral ossification, which occurs at the growth plate. This process is regulated by biological factors and mechanical factors. The biological factors which contribute to endochondral ossification process are genes, hormones, nutrients etc. The mechanical factor is the load acting on the bone. The major forces on the bone are due to joint contact load and muscle forces, which induce stresses in the bone. Carter and Wong proposed in a theory that cyclic or intermittent octahedral shear stress promotes the bone growth and cyclic or intermittent hydrostatic compressive stress inhibits the bone growth. Previously this theory has been used to predict the morphological development of long bones, but with studies using simplified femur and growth plate models. Furthermore, the Carter and Wong theory has a limitation that it does not intrinsically incorporate the resulting growth direction.In the first study, the importance of a subject-specific growth plate over a simplified growth plate has been studied, and growth has been simulated using two different growth direction models: Femoral neck shaft deformation direction and minimum shear stress direction. This study favors the minimum shear stress growth direction model, as it is less sensitive to applied boundary condition than the femoral neck shaft deformation direction model.The second study aims to understand how different muscle groups affect the bone growth tendency. Subject-specific femur and growth plate models of able-bodied children were used. The muscle forces and associated hip contact force from specific muscle groups were applied, and neck shaft angle and femoral anteversion growth tendencies were predicted. This study indicated a tendency for reduction of neck shaft angle and femoral anteversion. Hip abductor muscle forces contribute most, and hip adductor muscle forces least, to bone growth rate.Accurate prediction of bone growth tendency and knowledge of the influence of different muscle groups on bone growth tendency may help in better treatment planning for children at risk of developing bone deformity problems.