Leg length Equalisation, Gait and MUSCLE (The LEG MUSCLE study)
Research type
Research Study
Full title
Leg length Equalisation, Gait and MUSCLE (The LEG MUSCLE study); Developing treatments for muscle and neural function in leg length discrepancy
IRAS ID
145909
Contact name
Thomas O'Brien
Contact email
Research summary
A leg length discrepancy (LLD) presents in a child when there is an unequal growth of the lower limb skeleton and a between-limb difference develops in the length of the femur, tibia or both. This is a widely seen problem in paediatric orthopaedics and numerous dedicated centres exist across the UK for its treatment; including at Alder Hey Children’s Hospital, the collaborating clinical setting in this proposal. In a child the existence of a LLD necessitates compensatory movement strategies at the pelvis, hip and knee, leading to asymmetric gait patterns and impaired function.
LLD is corrected surgically (costing≈£100,000), but normal function is not always restored and patient satisfaction can be low (Alder Hey Children’s Hospital follow-up audit). These continuing asymmetries impair a child’s movement, can cause scoliosis and abnormal joint loading, leading to degenerative arthritis of the lower limbs and lumbar spine. Moreover, the impaired function may reduce physical activity levels, increasing obesity and cardiovascular and metabolic sequelae. These poor outcomes likely occur because surgery does not consider (a) muscle and tendon lengths and strength, which may not adapt to achieve symmetry and proportionality to surgically-equalised skeleton lengths; (b) central nervous system (CNS) control of movement asymmetries due to persistence of previously learned compensations. These mechanisms have not been explored previously.
This project aims to (1) quantify the muscle-tendon asymmetry that occurs with LLD and (2) determine whether the residual functional asymmetry following LLD equalisation is due to muscle-tendon-skeletal asymmetries. This will inform the future design of effective therapy pathways to improve movement in children who have been treated for LLD.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
14/NW/0015
Date of REC Opinion
15 Apr 2014
REC opinion
Further Information Favourable Opinion