THE SEARCH FOR INDIVIDUALIZED LOWER EXTREMITY MODELS: THE NEEDS AND WHAT CAN BE DONE?

Since functional clinical gait analysis was first established in the 1990s, numerous studies have proven it's worth in surgical decision making particularly in children with cerebral palsy. From a health care perspective, an increase of surgical volume in paediatric sports medicine has been reported. Limitations are given by the simplicity of the biomechanical models, mainly providing joint kinematics and net joint loading, but no detailed information on, e.g., load distributions within a joint across muscles within a muscle group. Recently researchers and engineers have developed more detailed musculoskeletal (MSK) models allowing to take individual anatomy into account. Individualised MSK models will provide deeper insights into musculoskeletal loading, in particular in children and patient groups with compromised function. Modern imaging technology, machine learning, automated segmentation and their integration into advanced MSK modeling will provide opportunities for biomechanists, engineers and clinicians to colaborate on a new level. Several modeling platforms are in use already with continuous refinements widening the applicability of these models. The prospects lie on an improved understanding of individual anatomy on the load distribution in joint structures. Further, the interaction of the musculoskeletal system with external devices, like orthoses, can be improved. Last, the approach allows for more realistic predictions of surgical outcomes which is desireable in particular in children. In this presentation, the evolvement of MSK modeling will be illustrated with examples from previous publications, on calf muscle function in CP, on the biomechanics of symptomatic snapping hip, the influence of ankle orthotics on ankle joint mechanics, the assessment of knee loading in for injury risk screening in adolescents and a study simulating surgical outcomes based on predicted osteotomy angles. While these examples are taken from studies of different anatomical areas they will serve to derive a conceptual overview and set the scene for this symposium.