Femoral bone growth predictions based on personalized multi-scale simulations: validation and sensitivity analysis of a mechanobiological model

Musculoskeletal function is pivotal to long-term health. However, various patient groups develop torsional deformities, leading to clinical, functional problems. Understanding the interplay between movement pattern, bone loading and growth is crucial for improving the functional mobility of these patients and preserving long-term health. Multi-scale simulations in combination with a mechanobiological bone growth model have been used to estimate bone loads and predict femoral growth trends based on cross-sectional data. The lack of longitudinal data in the previous studies hindered refinements of the mechanobiological model and validation of subject-specific growth predictions, thereby limiting clinical applications. This study aimed to validate the growth predictions using magnetic resonance images and motion capture data-collected longitudinally-from ten growing children. Additionally, a sensitivity analysis was conducted to refine model parameters. A linear regression model based on physical activity information, anthropometric data and predictions from the refined mechanobiological model explained 70% of femoral anteversion development. Notably, the direction of femoral development was accurately predicted in 18 out of 20 femurs, suggesting that growth predictions could help to revolutionize treatment strategies for torsional deformities.