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Maikos JT, Chomack JM, Herlihy DV, Paglia DN, Wetterstrand C, O'Connor JP, Hyre MJ, Loan JP, D'Andrea SE. Quantifying Bone and Skin Movement in the Residual Limb-Socket Interface of Individuals With Transtibial Limb Loss Using Dynamic Stereo X-Ray: Protocol for a Lower Limb Loss Cadaver and Clinical Study. JMIR Res Protoc 2024; 13:e57329. [PMID: 38669065 PMCID: PMC11087852 DOI: 10.2196/57329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Relative motion between the residual limb and socket in individuals with transtibial limb loss can lead to substantial consequences that limit mobility. Although assessments of the relative motion between the residual limb and socket have been performed, there remains a substantial gap in understanding the complex mechanics of the residual limb-socket interface during dynamic activities that limits the ability to improve socket design. However, dynamic stereo x-ray (DSX) is an advanced imaging technology that can quantify 3D bone movement and skin deformation inside a socket during dynamic activities. OBJECTIVE This study aims to develop analytical tools using DSX to quantify the dynamic, in vivo kinematics between the residual limb and socket and the mechanism of residual tissue deformation. METHODS A lower limb cadaver study will first be performed to optimize the placement of an array of radiopaque beads and markers on the socket, liner, and skin to simultaneously assess dynamic tibial movement and residual tissue and liner deformation. Five cadaver limbs will be used in an iterative process to develop an optimal marker setup. Stance phase gait will be simulated during each session to induce bone movement and skin and liner deformation. The number, shape, size, and placement of each marker will be evaluated after each session to refine the marker set. Once an optimal marker setup is identified, 21 participants with transtibial limb loss will be fitted with a socket capable of being suspended via both elevated vacuum and traditional suction. Participants will undergo a 4-week acclimation period and then be tested in the DSX system to track tibial, skin, and liner motion under both suspension techniques during 3 activities: treadmill walking at a self-selected speed, at a walking speed 10% faster, and during a step-down movement. The performance of the 2 suspension techniques will be evaluated by quantifying the 3D bone movement of the residual tibia with respect to the socket and quantifying liner and skin deformation at the socket-residuum interface. RESULTS This study was funded in October 2021. Cadaver testing began in January 2023. Enrollment began in February 2024. Data collection is expected to conclude in December 2025. The initial dissemination of results is expected in November 2026. CONCLUSIONS The successful completion of this study will help develop analytical methods for the accurate assessment of residual limb-socket motion. The results will significantly advance the understanding of the complex biomechanical interactions between the residual limb and the socket, which can aid in evidence-based clinical practice and socket prescription guidelines. This critical foundational information can aid in the development of future socket technology that has the potential to reduce secondary comorbidities that result from complications of poor prosthesis load transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57329.
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Affiliation(s)
- Jason T Maikos
- Veterans Affairs New York Harbor Healthcare System, New York, NY, United States
| | - John M Chomack
- Veterans Affairs New York Harbor Healthcare System, New York, NY, United States
| | - David V Herlihy
- Narrows Institute for Biomedical Research and Education, Inc., Brooklyn, NY, United States
| | - David N Paglia
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Charlene Wetterstrand
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, United States
| | - Michael J Hyre
- Narrows Institute for Biomedical Research and Education, Inc., Brooklyn, NY, United States
| | | | - Susan E D'Andrea
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
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Johnson CC, Dzewaltowski AC, Dever DE, Krajewski KT, Rai A, Ahamed NU, Allison KF, Flanagan SD, Graham SM, Lovalekar M, Anderst WJ, Connaboy C. Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women. Sci Rep 2024; 14:9542. [PMID: 38664550 PMCID: PMC11045865 DOI: 10.1038/s41598-024-60187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0-30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women.
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Affiliation(s)
- Camille C Johnson
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex C Dzewaltowski
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Dennis E Dever
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kellen T Krajewski
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajinkya Rai
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nizam U Ahamed
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katelyn F Allison
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn D Flanagan
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA
| | - Scott M Graham
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Mita Lovalekar
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Anderst
- Orthopaedic Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chris Connaboy
- Center of Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine & Science, Chicago, IL, USA.
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Croci E, Hess H, Warmuth F, Künzler M, Börlin S, Baumgartner D, Müller AM, Gerber K, Mündermann A. Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence. Eur Radiol 2024; 34:270-278. [PMID: 37566272 DOI: 10.1007/s00330-023-10082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Patients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head. MATERIALS AND METHODS Fluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere. RESULTS The nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°. CONCLUSION The proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane. CLINICAL RELEVANCE STATEMENT This nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders. KEY POINTS • Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears. • Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements. • The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Hanspeter Hess
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Fabian Warmuth
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Marina Künzler
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Sean Börlin
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Kate Gerber
- School for Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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Schuring LL, Mozingo JD, Lenz AL, Uemura K, Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Anderson AE. Acetabular labrum and cartilage contact mechanics during pivoting and walking tasks in individuals with cam femoroacetabular impingement syndrome. J Biomech 2023; 146:111424. [PMID: 36603366 PMCID: PMC9869780 DOI: 10.1016/j.jbiomech.2022.111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities. Previous in silico studies have employed generalized model geometry or kinematics to simulate impingement between the femur and acetabulum, which may not accurately capture the interplay between morphology and motion. In this study, we utilized models with participant-specific bone and articular soft tissue anatomy and kinematics measured by dual-fluoroscopy to compare hip contact mechanics of cam FAIS patients to controls during four activities of daily living (internal/external pivoting and level/incline walking). Averaged across the gait cycle during incline walking, patients displayed increased strain in the anterior joint (labrum strain: p-value = 0.038, patients: 11.7 ± 6.7 %, controls: 5.0 ± 3.6 %; cartilage strain: p-value = 0.029, patients: 9.1 ± 3.3 %, controls: 4.2 ± 2.3). Patients also exhibited increased average anterior cartilage strains during external pivoting (p-value = 0.039; patients: 13.0 ± 9.2 %, controls: 3.9 ± 3.2 %]). No significant differences between patient and control contact area and strain were found for level walking and internal pivoting. Our study provides new insights into the biomechanics of cam FAIS, including spatiotemporal hip joint contact mechanics during activities of daily living.
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Affiliation(s)
- Lindsay L Schuring
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Joseph D Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
| | - Niccolo M Fiorentino
- Mechanical Engineering Department, University of Vermont, Burlington, VT 05405, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Andrew E Anderson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA.
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Johnson CC, Ruh ER, Frankston NE, Charles S, McClincy M, Anderst WJ. Hip kinematics in healthy adults during gait and squatting: Sex differences and asymmetry revealed through dynamic biplane radiography. J Biomech 2022; 143:111280. [DOI: 10.1016/j.jbiomech.2022.111280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
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Lenz AL, Lisonbee RJ, Peterson AC, Roach KE, Foreman KB, Barg A, Anderson AE. Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study. Foot Ankle Int 2022; 43:818-829. [PMID: 35293257 PMCID: PMC9980879 DOI: 10.1177/10711007221078001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In vivo measurements of tibiotalar and subtalar joint motion following TAR are unavailable. Using biplane fluoroscopy, we tested the hypothesis that the prosthetic tibiotalar joint and adjacent subtalar joint would demonstrate kinematic and range of motion differences compared to the contralateral untreated limb, and control participants. METHODS Six patients of 41 identified candidates that all underwent unilateral Zimmer TAR (5.4 ± 1.9 years prior) and 6 control participants were imaged with biplane fluoroscopy during overground walking and a double heel-rise activity. Computed tomography scans were acquired; images were segmented and processed to serve as input for model-based tracking of the biplane fluoroscopy data. Measurements included tibiotalar and subtalar kinematics for the TAR, untreated contralateral, and control limbs. Statistical parametric mapping quantified differences in kinematics throughout overground walking and the double heel-rise activity. RESULTS Patients with this TAR performed walking and heel-rise activities symmetrically with no significant kinematic differences at the tibiotalar and subtalar joints between limbs. Compared to control participants, patients exhibited reduced dorsi/plantarflexion range of motion that corresponded to decreased peak dorsiflexion, but only in the late stance phase of walking. This reduction in tibiotalar dorsi/plantarflexion range of motion in the TAR group became more apparent with double heel-rise activity. CONCLUSION Patients with a Zimmer TAR had symmetric kinematics during activities of walking and double heel-rise, but they did exhibit minor compensations in tibiotalar kinematics as compared to controls. CLINICAL RELEVANCE The lack of significant kinematic compensation at the subtalar joint may explain why secondary subtalar osteoarthritis is reported as being relatively uncommon in patients with some TAR designs.
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Affiliation(s)
- Amy L. Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Rich J. Lisonbee
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Koren E. Roach
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, USA
| | - K. Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany,Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Hamburg, Germany
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA,Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, UT, USA
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Kefala V, Ali AA, Hamilton LD, Mannen EM, Shelburne KB. Effects of Weight-Bearing on Tibiofemoral, Patellofemoral, and Patellar Tendon Kinematics in Older Adults. Front Bioeng Biotechnol 2022; 10:820196. [PMID: 35497367 PMCID: PMC9048742 DOI: 10.3389/fbioe.2022.820196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Quantification of natural knee kinematics is essential for the assessment of joint function in the diagnosis of pathologies. Combined measurements of tibiofemoral and patellofemoral joint kinematics are necessary because knee pathologies, such as progression of osteoarthritis and patellar instability, are a frequent concern in both articulations. Combined measurement of tibiofemoral and patellofemoral kinematics also enables calculation of important quantities, specifically patellar tendon angle, which partly determines the loading vector at the tibiofemoral joint and patellar tendon moment arm. The goals of this research were to measure the differences in tibiofemoral and patellofemoral kinematics, patellar tendon angle (PTA), and patellar tendon moment arm (PTMA) that occur during non-weight-bearing and weight-bearing activities in older adults. Methods: High-speed stereo radiography was used to measure the kinematics of the tibiofemoral and patellofemoral joints in subjects as they performed seated, non-weight-bearing knee extension and two weight-bearing activities: lunge and chair rise. PTA and PTMA were extracted from the subject’s patellofemoral and tibiofemoral kinematics. Kinematics and the root mean square difference (RMSD) between non-weight-bearing and weight-bearing activities were compared across subjects and activities. Results: Internal rotation increased with weight-bearing (mean RMSD from knee extension was 4.2 ± 2.4° for lunge and 3.6 ± 1.8° for chair rise), and anterior translation was also greater (mean RMSD from knee extension was 2.2 ± 1.2 mm for lunge and 2.3 ± 1.4 mm for chair rise). Patellar tilt and medial–lateral translation changed from non-weight-bearing to weight-bearing. Changes of the patellar tendon from non-weight-bearing to weight-bearing were significant only for PTMA. Conclusions: While weight-bearing elicited changes in knee kinematics, in most degrees of freedoms, these differences were exceeded by intersubject differences. These results provide comparative kinematics for the evaluation of knee pathology and treatment in older adults.
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Affiliation(s)
- Vasiliki Kefala
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Azhar A Ali
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Stryker Orthopedics, Kalamazoo, MI, United States
| | - Landon D Hamilton
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Erin M Mannen
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, United States
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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Burton WS, Myers CA, Jensen A, Hamilton L, Shelburne KB, Banks SA, Rullkoetter PJ. Automatic tracking of healthy joint kinematics from stereo-radiography sequences. Comput Biol Med 2021; 139:104945. [PMID: 34678483 DOI: 10.1016/j.compbiomed.2021.104945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Kinematic tracking of healthy joints in radiography sequences is frequently performed by maximizing similarities between computed perspective projections of 3D computer models and corresponding objects' appearances in radiographic images. Significant human effort associated with manual tracking presents a major bottleneck in biomechanics research methods and limits the scale of target applications. The current work introduces a method for fully-automatic tracking of tibiofemoral and patellofemoral kinematics in stereo-radiography sequences for subjects performing dynamic activities. The proposed method involves the application of convolutional neural networks for annotating radiographs and a multi-stage optimization pipeline for estimating bone pose based on information provided by neural net predictions. Predicted kinematics are evaluated by comparing against manually-tracked trends across 20 distinct trials. Median absolute differences below 1.5 millimeters or degrees for 6 tibiofemoral and 3 patellofemoral degrees of freedom demonstrate the utility of our approach, which improves upon previous semi-automatic methods by enabling end-to-end automation. Implementation of a fully-automatic pipeline for kinematic tracking will benefit evaluation of human movement by enabling large-scale studies of healthy knee kinematics.
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Affiliation(s)
- William S Burton
- Center for Orthopaedic Biomechanics at the University of Denver, 2155 E. Wesley Ave., Denver, CO, 80208, USA.
| | - Casey A Myers
- Center for Orthopaedic Biomechanics at the University of Denver, 2155 E. Wesley Ave., Denver, CO, 80208, USA.
| | - Andrew Jensen
- Department of Mechanical and Aerospace Engineering at the University of Florida, 939 Center Dr., Gainesville, FL, 32611, USA.
| | - Landon Hamilton
- Center for Orthopaedic Biomechanics at the University of Denver, 2155 E. Wesley Ave., Denver, CO, 80208, USA.
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics at the University of Denver, 2155 E. Wesley Ave., Denver, CO, 80208, USA.
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering at the University of Florida, 939 Center Dr., Gainesville, FL, 32611, USA.
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics at the University of Denver, 2155 E. Wesley Ave., Denver, CO, 80208, USA.
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Akhbari B, Shah KN, Morton AM, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. Biomechanics of the Distal Radioulnar Joint During In Vivo Forearm Pronosupination. J Wrist Surg 2021; 10:208-215. [PMID: 34109063 PMCID: PMC8169167 DOI: 10.1055/s-0040-1722334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Background Ulnar variance (UV) and center of rotation (COR) location at the level of the distal radioulnar joint (DRUJ) change with forearm rotation. Nevertheless, these parameters have not been assessed dynamically during active in vivo pronosupination. This assessment could help us to improve our diagnosis and treatment strategies. Questions/purposes We sought to (1) mathematically model the UV change, and (2) determine the dynamic COR's location during active pronosupination. Methods We used biplanar videoradiography to study DRUJ during in vivo pronation and supination in nine healthy subjects. UV was defined as the proximal-distal distance of ulnar fovea with respect to the radial sigmoid notch, and COR was calculated using helical axis of motion parameters. The continuous change of UV was evaluated using a generalized linear regression model. Results A second-degree polynomial with R 2 of 0.85 was able to model the UV changes. Maximum negative UV occurred at 38.0 degrees supination and maximum positive UV occurred at maximum pronation. At maximum pronation, the COR was located 0.5 ± 1.8 mm ulnarly and 0.6 ± 0.8 mm volarly from the center of the ulnar fovea, while at maximum supination, the COR was located 0.2 ± 0.6 mm radially and 2.0 ± 0.5 mm volarly. Conclusion Changes in UV and volar translation of the COR are nonlinear at the DRUJ during pronosupination. Clinical Relevance Understanding the dynamic nature of UV as a function of pronosupination can help guide accurate evaluation and treatment of wrist pathology where the UV is an important consideration. The dynamic behavior of COR might be useful in designing DRUJ replacement implants to match the anatomical motion.
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Affiliation(s)
- Bardiya Akhbari
- Center for Biomedical Engineering, Brown University, Providence, Rhode Island
| | - Kalpit N. Shah
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Amy M. Morton
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Douglas C. Moore
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Arnold-Peter C. Weiss
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
- Division of Hand, Upper Extremity & Microvascular Surgery, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Scott W. Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, New York
- Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York
| | - Joseph J. Crisco
- Center for Biomedical Engineering, Brown University, Providence, Rhode Island
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
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11
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Christensen R, Petersen ET, Jürgens-Lahnstein J, Rytter S, Lindgren L, De Raedt S, Brüel A, Stilling M. Assessment of knee kinematics with dynamic radiostereometry: Validation of an automated model-based method of analysis using bone models. J Orthop Res 2021; 39:597-608. [PMID: 33030797 DOI: 10.1002/jor.24875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/26/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Radiostereometic analysis (RSA) is a precise method for the functional assessment of joint kinematics. Traditionally, the method is based on tracking of surgically implanted bone markers and analysis is user intensive. We propose an automated method of analysis based on models generated from computed tomography (CT) scans and digitally reconstructed radiographs. The study investigates method agreement between marker-based RSA and the CT bone model-based RSA method for assessment of knee joint kinematics in an experimental setup. Eight cadaveric specimens were prepared with bone markers and bone volume models were generated from CT-scans. Using a mobile fixture setup, dynamic RSA recordings were obtained during a knee flexion exercise in two unique radiographic setups, uniplanar and biplanar. The method agreement between marker-based and CT bone model-based RSA methods was compared using bias and LoA. Results obtained from uniplanar and biplanar recordings were compared and the influence of radiographic setup was considered for clinical relevance. The automated method had a bias of -0.19 mm and 0.11° and LoA within ±0.42 mm and ±0.33° for knee joint translations and rotations, respectively. The model pose estimation of the tibial bone was more precise than the femoral bone. The radiographic setup had no clinically relevant effect on results. In conclusion, the automated CT bone model-based RSA method had a clinical precision comparable to that of marker-based RSA. The automated method is non-invasive, fast, and clinically applicable for functional assessment of knee kinematics and pathomechanics in patients.
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Affiliation(s)
- Rasmus Christensen
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Emil Toft Petersen
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark
| | - Jonathan Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Søren Rytter
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Lindgren
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Sepp De Raedt
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,NRT X-RAY, Hasselager, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
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12
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Gustafson JA, Elias JJ, Fitzgerald GK, Tashman S, Debski RE, Farrokhi S. Combining advanced computational and imaging techniques as a quantitative tool to estimate patellofemoral joint stress during downhill gait: A feasibility study. Gait Posture 2021; 84:31-37. [PMID: 33264730 PMCID: PMC7902369 DOI: 10.1016/j.gaitpost.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The onset and progression of patellofemoral osteoarthritis (OA) has been linked to alterations in cartilage stress-a potential precursor to pain and subsequent cartilage degradation. A lack in quantitative tools for objectively evaluating patellofemoral joint contact stress limits our understanding of pathomechanics associated with OA. RESEARCH QUESTION Could computational modeling and biplane fluoroscopy techniques be used to discriminate in-vivo, subject-specific patellofemoral stress profiles in individuals with and without patellofemoral OA? METHODS The current study employed a discrete element modeling framework driven by in-vivo, subject-specific kinematics during downhill gait to discriminate unique patellofemoral stress profiles in individuals with patellofemoral OA (n = 5) as compared to older individuals without OA (n = 6). All participants underwent biplane fluoroscopy kinematic tracking while walking on a declined instrumented treadmill. Subject-specific kinematics were combined with high resolution geometrical models to estimate patellofemoral joint contact stress during 0%, 25 %, 50 %, 75 % and 100 % of the loading response phase of downhill gait. RESULTS Individuals with patellofemoral OA demonstrated earlier increases in patellofemoral stress in the lateral patellofemoral compartment during loading response as compared to OA-free controls (P = 0.021). Overall, both groups exhibited increased patellofemoral contact stress early in the loading response phase of gait as compared to the end of loading response. Results from this study show increased stress profiles in individuals with patellofemoral OA, indicating increasing joint loading in early phases of gait. SIGNIFICANCE This modeling framework-combining arthrokinematics with discrete element models-can objectively estimate changes in patellofemoral joint stress, with potential applications to evaluate outcomes from various treatment programs, including surgical and non-surgical rehabilitation treatments.
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Affiliation(s)
- Jonathan A. Gustafson
- Postdoctoral Research Fellow, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John J. Elias
- Senior Research Scientist, Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - G. Kelley Fitzgerald
- Professor & Director of the Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Professor & Director of Biodynamics Laboratory, Department of Orthopedic Surgery, University of Texas Health Center, Houston, TX, USA
| | - Richard E. Debski
- Professor, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Facility Research Director, DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA
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13
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Kefala V, Ali AA, Mannen EM, Shelburne KB. Patellofemoral kinematics in healthy older adults during gait activities. Hum Mov Sci 2020; 75:102746. [PMID: 33378727 DOI: 10.1016/j.humov.2020.102746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
The patellofemoral (PF) joint is susceptible to many pathologies resulting from acute injury, chronic disease and complications following surgical treatment of the knee. The objectives of this study were to describe case series measurements of patellar motion in healthy older adults as they performed three gait activities, determine patellar tendon angle and moment arm, and show if these quantities were activity dependent. A stereo radiography system was utilized to obtain the 3D PF kinematics of seventeen healthy people over 55 years of age (8F/9M, 66 ± 7.9 years old, 75.7 ± 20.5 kg) as they performed level walking, a step down, and a pivot turn. For a similar portion of the gait cycle, patellar flexion (6.2° ± 5.8) and average range of motion (ROM) (11.0° ± 5.9°) for walking with a step down was greater compared to the other gait activities (gait ROM 6.9° ± 4.3°, pivot ROM 5.7° ± 3.3°), while the average range of motion for patella tilt was greater during walking with a pivot turn (8.6° ± 3.9°). However, each subject displayed distinct PF kinematic trends during all activities with a few notable exceptions. Importantly, the knee extensor mechanism characteristics of patellar tendon angle and moment arm showed considerable variation across subjects but were largely unaltered by changing activities. The variation between subjects and the different behavior of the patella during the step down and pivot emphasized the need for analysis of a range of activities to reveal individual response to pathology and treatment in patellar maltracking and osteoarthritis.
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Affiliation(s)
- Vasiliki Kefala
- Center for Orthopaedic Biomechanics, Dept. of Mechanical and Materials Engineering, The University of Denver, CO, USA
| | | | - Erin M Mannen
- Dept. of Mechanical and Biomedical Engineering Boise State University, Boise, ID, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, Dept. of Mechanical and Materials Engineering, The University of Denver, CO, USA.
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14
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Lee D, Hong KT, Lim TS, Lee E, Lee YH, Park JS, Kim W, Oh JH, Choi JA, Song Y. Alterations in articular cartilage T2 star relaxation time following mechanical disorders: in vivo canine supraspinatus tendon resection models. BMC Musculoskelet Disord 2020; 21:424. [PMID: 32615950 PMCID: PMC7331159 DOI: 10.1186/s12891-020-03447-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background The role of altered joint mechanics on cartilage degeneration in in vivo models has not been studied successfully due to a lack of pre-injury information. We aimed 1) to develop an accurate in vivo canine model to measure the changes in joint loading and T2 star (T2*) relaxation time before and after unilateral supraspinatus tendon resections, and 2) to find the relationship between regional variations in articular cartilage loading patterns and T2* relaxation time distributions. Methods Rigid markers were implanted in the scapula and humerus of tested dogs. The movement of the shoulder bones were measured by a motion tracking system during normal gaits. In vivo cartilage contact strain was measured by aligning 3D shoulder models with the motion tracking data. Articular cartilage T2* relaxation times were measured by quantitative MRI scans. Articular cartilage contact strain and T2* relaxation time were compared in the shoulders before and 3 months after the supraspinatus tendon resections. Results Excellent accuracy and reproducibility were found in our in vivo contact strain measurements with less than 1% errors. Changes in articular cartilage contact strain exhibited similar patterns with the changes in the T2* relaxation time after resection surgeries. Regional changes in the articular cartilage T2* relaxation time exhibited positive correlations with regional contact strain variations 3 months after the supraspinatus resection surgeries. Conclusion This is the first study to measure in vivo articular cartilage contact strains with high accuracy and reproducibility. Positive correlations between contact strain and T2* relaxation time suggest that the articular cartilage extracellular matrix may responds to mechanical changes in local areas.
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Affiliation(s)
- Dokwan Lee
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ki-Taek Hong
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea
| | - Tae Seong Lim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ye Hyun Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul, South Korea
| | - Ji Soon Park
- Department of Orthopedic Surgery, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Woo Kim
- Seoul Kiwoonchan Orthopedics Clinic, Seoul, South Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Yongnam Song
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea.
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15
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Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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16
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Graffos A, Mohtajeb M, Mony M, Esculier JF, Cibere J, Wilson DR, Zhang C, Zakani S, Hunt MA. Biomechanics during cross-body lunging in individuals with and without painful cam and/or pincer morphology. Clin Biomech (Bristol, Avon) 2020; 76:105030. [PMID: 32416407 DOI: 10.1016/j.clinbiomech.2020.105030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular impingement is a patho-mechanical hip condition that can lead to restrictions in hip motion, particularly in end-range hip flexion, adduction and/or internal rotation. Radiographic evidence of femoroacetabular impingement - cam and/or pincer morphology - is prevalent in the general and athletic populations. There is, however, a lack of studies that have analyzed the performance of sport-specific movements in people possessing these morphologies. Therefore, the purpose of this study was to compare cross-body lunge biomechanics between individuals with and without painful cam and/or pincer morphology. METHODS This was an exploratory, cross-sectional study where nine participants with cam and/or pincer morphology and symptoms, thirteen participants with asymptomatic cam and/or pincer morphology, and eleven pain-free controls performed the cross-body lunge during a single session. Trunk, pelvis, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and vertical ground reaction forces were examined. FINDINGS Overall, the groups performed the movement similarly, with most variables statistically similar between groups. However, pelvis sagittal plane excursion throughout the entire cross-body lunge was significantly larger in those with cam and/or pincer morphology and symptoms compared to those with asymptomatic cam and/or pincer morphology (P = .046, effect size = 0.98). INTERPRETATION The results of this study show that cross-body lunge performance is similar across individuals with and without painful cam and/or pincer morphology. However, future research should aim to better understand pelvis biomechanics during sporting activities, as pelvis sagittal plane excursion may have important implications in rehabilitation and sport performance.
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17
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Blair DJ, Barg A, Foreman KB, Anderson AE, Lenz AL. Methodology for Measurement of in vivo Tibiotalar Kinematics After Total Ankle Replacement Using Dual Fluoroscopy. Front Bioeng Biotechnol 2020; 8:375. [PMID: 32432091 PMCID: PMC7214754 DOI: 10.3389/fbioe.2020.00375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Biomechanical data could improve our clinical understanding of failures in total ankle replacement (TAR) patients, leading to better surgical approaches and implant designs. Kinematics of the prosthetic tibiotalar joint in TAR patients have yet to be measured using dual fluoroscopy. With dual fluoroscopy, computed tomography (CT) images are acquired to track bone motion. One challenge with this approach is dealing with metal artifact in the CT images that distorts implant visualization and the surrounding bone to implant interfaces. The aim of this study was to develop a methodology to measure in vivo TAR kinematics using inputs of computer-aided design (CAD) models, dual fluoroscopy and CT imaging with metal artifact reduction. To develop this methodology, we created a hybrid three-dimensional (3D) model that contained both: (1) the segmented bone; and (2) the CAD models of the TAR components. We evaluated a patient following total ankle replacement to demonstrate feasibility. The patient performed a self-selected overground walk during which dual fluoroscopy images were collected at 200 Hz. In vivo tracking verifications were performed during overground walking using a distance calculation between the implant articular surfaces to evaluate the model-based tracking 3D solution. Tracking verification indicated realistic alignment of the hybrid models with an evenly distributed distance map pattern during the trial. Articular surface distance calculations were reported as an average of 1.3 mm gap during the entirety of overground walking. The successful implementation of our new tracking methodology with a hybrid model presents a new approach to evaluate in vivo TAR kinematics. Measurements of in vivo kinematics could improve our clinical understanding of failures in TAR patients, leading to better long-term surgical outcomes.
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Affiliation(s)
- Dylan J Blair
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alexej Barg
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
| | - K Bo Foreman
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Amy L Lenz
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
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18
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Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
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19
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Lenz AL, Nichols JA, Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis: An in Vivo Dual-Fluoroscopy Imaging Study. J Bone Joint Surg Am 2020; 102:600-608. [PMID: 32079879 PMCID: PMC7289138 DOI: 10.2106/jbjs.19.01132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle. METHODS Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured. RESULTS During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°). CONCLUSIONS A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. CLINICAL RELEVANCE Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.
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Affiliation(s)
- Amy L. Lenz
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Jennifer A. Nichols
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Koren E. Roach
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Radiology, University of California-San Francisco, San Francisco, California
| | - K. Bo Foreman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Alexej Barg
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Charles L. Saltzman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Email address for A.E. Anderson:
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Maharaj JN, Kessler S, Rainbow MJ, D'Andrea SE, Konow N, Kelly LA, Lichtwark GA. The Reliability of Foot and Ankle Bone and Joint Kinematics Measured With Biplanar Videoradiography and Manual Scientific Rotoscoping. Front Bioeng Biotechnol 2020; 8:106. [PMID: 32211386 PMCID: PMC7075816 DOI: 10.3389/fbioe.2020.00106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
The intricate motion of the small bones of the feet are critical for its diverse function. Accurately measuring the 3-dimensional (3D) motion of these bones has attracted much attention over the years and until recently, was limited to invasive techniques or quantification of functional segments using multi-segment foot models. Biplanar videoradiography and model-based scientific rotoscoping offers an exciting alternative that allows us to focus on the intricate motion of individual bones in the foot. However, scientific rotoscoping, the process of rotating and translating a 3D bone model so that it aligns with the captured x-ray images, is either semi- or completely manual and it is unknown how much human error affects tracking results. Thus, the aim of this study was to quantify the inter- and intra-operator reliability of manually rotoscoping in vivo bone motion of the tibia, talus, and calcaneus during running. Three-dimensional CT bone volumes and high-speed biplanar videoradiography images of the foot were acquired on six participants. The six-degree-of-freedom motions of the tibia, talus, and calcaneus were determined using a manual markerless registration algorithm. Two operators performed the tracking, and additionally, the first operator re-tracked all bones, to test for intra-operator effects. Mean RMS errors were 1.86 mm and 1.90° for intra-operator comparisons and 2.30 mm and 2.60° for inter-operator comparisons across all bones and planes. The moderate to strong similarity values indicate that tracking bones and joint kinematics between sessions and operators is reliable for running. These errors are likely acceptable for defining gross joint angles. However, this magnitude of error may limit the capacity to perform advanced analyses of joint interactions, particularly those that require precise (sub-millimeter) estimates of bone position and orientation. Optimizing the view and image quality of the biplanar videoradiography system as well as the automated tracking algorithms for rotoscoping bones in the foot are required to reduce these errors and the time burden associated with the manual processing.
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Affiliation(s)
- Jayishni N Maharaj
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah Kessler
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Susan E D'Andrea
- Department of Orthopaedics, Brown University, Providence, RI, United States.,Department of Kinesiology, The University of Rhode Island, Kingston, RI, United States
| | - Nicolai Konow
- Department of Biological Science, University of Massachusetts, Lowell, MA, United States
| | - Luke A Kelly
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Glen A Lichtwark
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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Rosa SB, Ewen PM, Doma K, Ferrer JFL, Grant A. Dynamic Evaluation of Patellofemoral Instability: A Clinical Reality or Just a Research Field? A Literature review. Orthop Surg 2019; 11:932-942. [PMID: 31797563 PMCID: PMC6904628 DOI: 10.1111/os.12549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Patellofemoral instability (PFI) is one of the most disabling conditions in the knee, often affecting young individuals. Despite its not uncommon presentation, the underlying biomechanical features leading to this entity are not entirely understood. The suitability of classic physical examination manoeuvres and imaging tests is a matter of discussion among treating surgeons, and so are the findings provided by these means. A potential cause for this lack of consensus is the fact that, classically, the diagnostic approach for PFI has relied on statically obtained data. Many authors advocate for the study of this entity in a dynamic scenario, closer to the actual situation in which the instability episodes occur. In this literature review, we have compiled the available data from the last decades regarding dynamic evaluation methods for PFI and related conditions. Several categories are presented, grouping the related techniques and devices: physical examination, imaging modalities (ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and combined methods), arthroscopic evaluation, and others. In conclusion, although a vast number of quality studies are presented, in which comprehensive data about the biomechanics of the patellofemoral joint (PFJ) are described, this evidence has not yet reached clinical practice universally. Most of the data still stays in the research field and is seldom employed to assist a better understanding of the PFI cases and their ideal treatment targets.
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Affiliation(s)
- Sergio Barroso Rosa
- The ORIQL, Orthopaedic Research Institute of Queensland, Townsville (QLD), Australia.,Clinical Sciences Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Peter Mc Ewen
- The ORIQL, Orthopaedic Research Institute of Queensland, Townsville (QLD), Australia
| | - Kenji Doma
- The ORIQL, Orthopaedic Research Institute of Queensland, Townsville (QLD), Australia.,College of Healthcare Sciences, James Cook University, Townsville (QLD), Australia
| | - Juan Francisco Loro Ferrer
- Clinical Sciences Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Andrea Grant
- The ORIQL, Orthopaedic Research Institute of Queensland, Townsville (QLD), Australia
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Akbar M, Farahmand F, Arjmand N. Mechanical characterization of the ligaments in subject-specific models of the patellofemoral joint using in vivo laxity tests. Knee 2019; 26:1220-1233. [PMID: 30948304 DOI: 10.1016/j.knee.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/22/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to propose a methodology for mechanical characterization of the ligaments in subject-specific models of the patellofemoral joint (PFJ) of living individuals. METHOD PFJ laxity tests were performed on a healthy volunteer using a specially designed loading apparatus under biplane fluoroscopy. A three-dimensional (3D) parametric model of the PFJ was developed in the framework of the rigid body spring model using the geometrical data acquired from the subject's computed tomography and magnetic resonance images. The stiffness and pre-strains of the medial and lateral PFJ ligaments were characterized using a two-step optimization procedure which minimized the deviation between the model predictions and the calibration test results. Sensitivity analyses were performed to investigate the effect of mechanical properties of the non-characterized model components on the characterization procedure and its results. RESULTS The overall findings indicate that the proposed methodology is applicable and can improve the model predictions effectively. For the subject under study, ligament characterization reduced the root mean square of the deviations between the patellar shift and tilt predicted by the model and obtained experimentally for the validation laxity test (from 6.2 mm to 0.5 mm, and from 8.4° to 1.5°, respectively) and passive knee flexion test (from 1.4 mm to 0.3 mm, and from 2.3° to 1.3°, respectively). The non-characterized mechanical properties were found to have a minimal effect on the characterization procedure and its results. CONCLUSION The proposed methodology can help in developing truly patient-specific models of the PFJ, to be used for personalized preplanning of the clinical interventions.
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Affiliation(s)
- Mohammad Akbar
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; RCBTR, Tehran University of Medical Sciences, Tehran, Iran.
| | - Navid Arjmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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Abstract
The wrist is a complex joint involving many small bones and complicated kinematics. It has, therefore, been traditionally difficult to image and ascertain information about kinematics when making a diagnosis. Although MRI and fluoroscopy have been used, they both have limitations. Recently, there has been interest in the use of 4D-CT in imaging the wrist. This review examines the literature regarding the use of 4D-CT in imaging the wrist to assess kinematics and its ability to diagnose pathology. Some questions remain about the description of normal ranges, the most appropriate method of measuring intercarpal stability, the accuracy compared with established standards, and the place of 4D-CT in postoperative assessment. Cite this article: Bone Joint J 2019;101-B:1325–1330.
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Affiliation(s)
- Jordy White
- University of Queensland, St Lucia, Australia
| | - Greg Couzens
- Brisbane Hand and Upper Limb Research Institute, Spring Hill, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- Field Orthopaedics Research Group, Spring Hill, Australia
| | - Chris Jeffery
- Princess Alexandra Hospital, Brisbane, Australia
- Field Orthopaedics Research Group, Spring Hill, Queensland, Australia
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Akhbari B, Morton AM, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. Accuracy of biplane videoradiography for quantifying dynamic wrist kinematics. J Biomech 2019; 92:120-125. [PMID: 31174845 DOI: 10.1016/j.jbiomech.2019.05.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/26/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
Accurately assessing the dynamic kinematics of the skeletal wrist could advance our understanding of the normal and pathological wrist. Biplane videoradiography (BVR) has allowed investigators to study dynamic activities in the knee, hip, and shoulder joint; however, currently, BVR has not been utilized for the wrist joint because of the challenges associated with imaging multiple overlapping bones. Therefore, our aim was to develop a BVR procedure and to quantify its accuracy for evaluation of wrist kinematics. BVR was performed on six cadaveric forearms for one neutral static and six dynamic tasks, including flexion-extension, radial-ulnar deviation, circumduction, pronation, supination, and hammering. Optical motion capture (OMC) served as the gold standard for assessing accuracy. We propose a feedforward tracking methodology, which uses a combined model of metacarpals (second and third) for initialization of the third metacarpal (MC3). BVR-calculated kinematic parameters were found to be consistent with the OMC-calculated parameters, and the BVR/OMC agreement had submillimeter and sub-degree biases in tracking individual bones as well as the overall joint's rotation and translation. All dynamic tasks (except pronation task) showed a limit of agreement within 1.5° for overall rotation, and within 1.3 mm for overall translations. Pronation task had a 2.1° and 1.4 mm limit of agreement for rotation and translation measurement. The poorest precision was achieved in calculating the pronation-supination angle, and radial-ulnar and volar-dorsal translational components, although they were sub-degree and submillimeter. The methodology described herein may assist those interested in examining the complexities of skeletal wrist function during dynamic tasks.
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Affiliation(s)
- Bardiya Akhbari
- Department of Biomedical Engineering, Brown University, Providence, RI 02912, United States
| | - Amy M Morton
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Douglas C Moore
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Arnold-Peter C Weiss
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Scott W Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021, United States
| | - Joseph J Crisco
- Department of Biomedical Engineering, Brown University, Providence, RI 02912, United States; Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States.
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25
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Gustafson JA, Elias JJ, Debski RE, Farrokhi S. Development and validation of a kinematically-driven discrete element model of the patellofemoral joint. J Biomech 2019; 88:164-172. [PMID: 31003752 DOI: 10.1016/j.jbiomech.2019.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/27/2022]
Abstract
Quantifying the complex loads at the patellofemoral joint (PFJ) is vital to understanding the development of PFJ pain and osteoarthritis. Discrete element analysis (DEA) is a computationally efficient method to estimate cartilage contact stresses with potential application at the PFJ to better understand PFJ mechanics. The current study validated a DEA modeling framework driven by PFJ kinematics to predict experimentally-measured PFJ contact stress distributions. Two cadaveric knee specimens underwent quadriceps muscle [215 N] and joint compression [350 N] forces at ten discrete knee positions representing PFJ positions during early gait while measured PFJ kinematics were used to drive specimen-specific DEA models. DEA-computed contact stress and area were compared to experimentally-measured data. There was good agreement between computed and measured mean and peak stress across the specimens and positions (r = 0.63-0.85). DEA-computed mean stress was within an average of 12% (range: 1-47%) of the experimentally-measured mean stress while DEA-computed peak stress was within an average of 22% (range: 1-40%). Stress magnitudes were within the ranges measured (0.17-1.26 MPa computationally vs 0.12-1.13 MPa experimentally). DEA-computed areas overestimated measured areas (average error = 60%; range: 4-117%) with magnitudes ranging from 139 to 307 mm2 computationally vs 74-194 mm2 experimentally. DEA estimates of the ratio of lateral to medial patellofemoral stress distribution predicted the experimental data well (mean error = 15%) with minimal measurement bias. These results indicate that kinematically-driven DEA models can provide good estimates of relative changes in PFJ contact stress.
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Affiliation(s)
- Jonathan A Gustafson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - John J Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA
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Gale T, Anderst W. Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle. J Orthop Res 2019; 37:609-614. [PMID: 30644134 DOI: 10.1002/jor.24222] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
One commonly used criterion in evaluating a patients' response to knee surgery or rehabilitation is bilateral symmetry. However, the natural symmetry in uninjured healthy adult knee kinematics remains relatively unknown, making it challenging to determine if clinical treatment has adequately restored bilateral symmetry. The primary purpose of this study was to determine the typical side-to-side differences in 6 degree of freedom (DOF) knee kinematics over the entire gait cycle in healthy adults using biplane radiography. Six DOF tibiofemoral kinematics were measured during treadmill walking in 19 participants using a validated volumetric model-based tracking process that matched subject-specific bone models to biplane radiographs collected at 100 images/s. Average absolute side-to-side differences in knee kinematics at foot strike were 1.3 mm or less in translation and 3.8° or less in rotation. Peak side-to-side differences in knee kinematics occurred during the swing phase and were up to 2.2 mm in translation and 7.1° in rotation. Dominant versus non-dominant leg differences were 0.8 mm and 2.8° or less at foot strike and reached maximum values of 0.8 mm and 7.2° over the full gait cycle. Statement of Clinical Significance: This study quantifies the inherent asymmetry of knee kinematics in healthy individuals over the entire gait cycle. The values of asymmetry presented here may serve as a guide for evaluating functional outcomes and restoration of so-called "normal" kinematics after injury and clinical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Tom Gale
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, Pennsylvania, 15203
| | - William Anderst
- Biodynamics Lab, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, Pennsylvania, 15203
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27
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Gharaibeh MA, Monk E, Chen DB, MacDessi SJ. Evaluation of the patellofemoral joint in total knee arthroplasty: Validation of the weight bearing merchant radiographic view. Knee 2018; 25:1262-71. [PMID: 30409497 DOI: 10.1016/j.knee.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Standard radiographic views for patellofemoral joint assessment do not reflect loading at which TKA patients may describe post-operative anterior symptoms. A novel weight bearing (WB) Merchant view has been described and demonstrated a number of tracking changes that correlated with clinical outcomes. In this study, we aim to validate the WB Merchant view and assess relationships with patient outcome scores. METHODS Patients were randomly allocated to receive one of the three commonly used patellar implants with a single TKA prosthesis. Patients were evaluated at six months post-operatively using both NWB and WB Merchant views. Indicators of patellar tracking were correlated with improvement in KOOS, WOMAC and Kujala scores. For reliability assessment, radiographs were assessed twice by two readers. RESULTS The WB Merchant view showed a reduction in the percentage of outliers of tracking indices in comparison to the NWB view (Congruence angle: NWB = 37%, WB = 24%; Displacement: NWB = 2%, WB = 0%; Tilt angle: NWB = 60%, WB = 56%). There was an increase in the lateral contact state with the WB Merchant view (Type I: NWB = 19%, WB = 28%; Type II: NWB = 3%, WB = 4%). The state of lateral contact had a consistent and statistically significant correlation with the improvement in KOOS, WOMAC and Kujala scores (p value = 0.01, 0.01 and 0.03, respectively). All radiographic indices had good reliability with accepted variability. CONCLUSION The WB Merchant radiograph is an easy to perform and reliable view for the evaluation of patellar tracking and may provide additional information to the routinely used NWB view.
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Pitcairn S, Lesniak B, Anderst W. In vivo validation of patellofemoral kinematics during overground gait and stair ascent. Gait Posture 2018; 64:191-7. [PMID: 29929162 DOI: 10.1016/j.gaitpost.2018.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The patellofemoral (PF) joint is a common site for non-specific anterior knee pain. The pathophysiology of patellofemoral pain may be related to abnormal motion of the patella relative to the femur, leading to increased stress at the patellofemoral joint. Patellofemoral motion cannot be accurately measured using conventional motion capture. RESEARCH QUESTION The aim of this study was to determine the accuracy of a biplane radiography system for measuring in vivo PF motion during walking and stair ascent. METHODS Four subjects had three 1.0 mm diameter tantalum beads implanted into the patella. Participants performed three trials each of over ground walking and stair ascent while biplane radiographs were collected at 100 Hz. Patella motion was tracked using radiostereophotogrammetric analysis (RSA) as a "gold standard", and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs. RESULTS The average RMS difference between the RSA and model-based tracking was 0.41 mm and 1.97° when there was no obstruction from the contralateral leg. These differences increased by 34% and 40%, respectively, when the patella was at least partially obstructed by the contralateral leg. The average RMS difference in patellofemoral joint space between tracking methods was 0.9 mm or less. SIGNIFICANCE Previous validations of biplane radiographic systems have estimated tracking accuracy by moving cadaveric knees through simulated motions. These validations were unable to replicate in vivo kinematics, including patella motion due to muscle activation, and failed to assess the imaging and tracking challenges related to contralateral limb obstruction. By replicating the muscle contraction, movement velocity, joint range of motion, and obstruction of the patella by the contralateral limb, the present study provides a realistic estimate of patellofemoral tracking accuracy for future in vivo studies.
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Rath B, Asseln M, Betsch M, Prescher A, Tingart M, Eschweiler J. Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. Biomed Res Int 2018; 2018:7189714. [PMID: 29850554 DOI: 10.1155/2018/7189714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/01/2023]
Abstract
Purpose The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics. Methods Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked. Results Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees. Conclusion We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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Abstract
STUDY DESIGN Systematic review of literature. OBJECTIVES This systematic review was conducted to investigate the accuracy of radiostereometric analysis (RSA), its assessment of spinal motion and disorders, and to investigate the limitations of this technique in spine assessment. METHODS Systematic review in all current literature to invesigate the role of RSA in spine. RESULTS The results of this review concluded that RSA is a very powerful tool to detect small changes between 2 rigid bodies such as a vertebral segment. The technique is described for animal and human studies for cervical and lumbar spine and can be used to analyze range of motion, inducible displacement, and fusion of segments. However, there are a few disadvantages with the technique; RSA percutaneous procedure needs to be performed to implant the markers (and cannot be used preoperatively), one needs a specific knowledge to handle data and interpret the results, and is relatively time consuming and expensive. CONCLUSIONS RSA should be looked at as a very powerful research instrument and there are many questions suitable for RSA studies.
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Affiliation(s)
- Ali Humadi
- The Alfred Hospital, Melbourne, Victoria, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Sulaf Dawood
- The Alfred Hospital, Melbourne, Victoria, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Klas Halldin
- Sahlgrenska University Hospital, Gothenburg, Sweden,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Brian Freeman
- Royal Adelaide Hospital, Adelaide, SA, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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Gobbi RG, Demange MK, de Ávila LFR, Araújo Filho JAB, Moreno RA, Gutierrez MA, de Sá Rebelo M, Tírico LEP, Pécora JR, Camanho GL. Patellar tracking after isolated medial patellofemoral ligament reconstruction: dynamic evaluation using computed tomography. Knee Surg Sports Traumatol Arthrosc 2017; 25:3197-205. [PMID: 27544273 DOI: 10.1007/s00167-016-4284-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Medial patellofemoral ligament (MPFL) reconstruction offers good clinical results with a very low rate of instability recurrence. However, its in vivo effect on patellar tracking is not clearly known. The aim of this study is to investigate the effects of MPFL reconstruction on patellar tracking using dynamic 320-detector-row CT. METHODS Ten patients with patellofemoral instability referred to isolated MPFL reconstruction surgery were selected and subjected to dynamic CT before and ≥6 months after surgery. Patellar tilt angles and shift distance were analysed using computer software specifically designed for this purpose. Kujala and Tegner scores were applied, and the radiation of the CTs was recorded. Two protocols for imaging acquisition were compared: a tube potential of 80 kV and 50 mA versus a tube potential of 120 kV and 100 mA, both with a slice thickness of 0.5 mm and an acquisition duration of 10 s. RESULTS There were no changes in patellar tracking after MPFL reconstruction. There was no instability relapse. Clinical scores improved from a mean of 51.9 (±15.6)-74.2 (±20.9) on the Kujala scale (p = 0.011) and from a median of 2 (range 0-4) to 4 (range 1-6) on the Tegner scale (p = 0.017). The imaging protocols produced a dose-length product (DLP) of 254 versus 1617 mGycm and a radiation effective estimated dose of 0.2 versus 1.3 mSv, respectively. Both protocols allowed the analysis of the studied parameters without loss of precision. CONCLUSIONS Reconstruction of the MPFL produced no improvement in patellar tilt or shift in the population studied. The low-radiation protocol was equally effective in measuring changes in patellar tracking and is recommended. Although the procedure successfully stabilized the patella, knee surgeons should not expect patellar shift and tilt correction when performing isolated patellofemoral ligament reconstruction in patients with recurrent patellar instability. LEVEL OF EVIDENCE IV.
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Kahan LG, Guertler C, Blatnik JA, Lake SP. Validation of Single C-Arm Fluoroscopic Technique for Measuring In Vivo Abdominal Wall Deformation. J Biomech Eng 2017; 139:2633404. [DOI: 10.1115/1.4037073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 11/08/2022]
Abstract
Hernia meshes significantly reduce the recurrence rates in hernia repair. It is known that they affect the abdominal wall postimplantation, yet the understanding of in vivo mechanics in the mesh placement area is lacking. We established a single C-arm biplane fluoroscopic system to study strains at the interface between the mesh and repaired abdominal tissues. We aimed to validate this system for future porcine hernia repair studies. Custom matlab programs were written to correct for pincushion distortion, and direct linear transformation (DLT) reconstructed objects in 3D. Using a custom biplane-trough setup, image sets were acquired throughout the calibrated volume to evaluate a radio-opaque test piece with known distances between adjacent beads. Distances were measured postprocessing and compared to known measurements. Repeatability testing was conducted by taking image sets of the test piece in a fixed location to determine system movement. The error in areal stretch tracking was evaluated by imaging a square plate with fixed radio-opaque beads and using matlab programs to compare the measured areal stretch to known bead positions. Minor differences between measured and known distances in the test piece were not statistically different, and the system yielded a 0.01 mm bias in the XY plane and a precision of 0.61 mm. The measured areal stretch was 0.996, which was not significantly different than the expected value of 1. In addition, preliminary stretch data for a hernia mesh in a porcine model demonstrated technique feasibility to measure in vivo porcine abdominal mechanics.
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Affiliation(s)
- Lindsey G. Kahan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Charlotte Guertler
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130 e-mail:
| | - Jeffrey A. Blatnik
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Spencer P. Lake
- Mem. ASME Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Orthopaedic Surgery, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130 e-mail:
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Smoger LM, Shelburne KB, Cyr AJ, Rullkoetter PJ, Laz PJ. Statistical shape modeling predicts patellar bone geometry to enable stereo-radiographic kinematic tracking. J Biomech 2017; 58:187-194. [PMID: 28554493 PMCID: PMC5532741 DOI: 10.1016/j.jbiomech.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/12/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022]
Abstract
Complications in the patellofemoral (PF) joint of patients with total knee replacements include patellar subluxation and dislocation, and remain a cause for revision. Kinematic measurements to assess these complications and evaluate implant designs require the accuracy of dynamic stereo-radiographic systems with 3D-2D registration techniques. While tibiofemoral kinematics are typically derived by tracking metallic implants, PF kinematic measurements are difficult as the patellar implant is radiotransparent and a representation of the resected patella bone requires either pre-surgical imaging and precise implant placement or post-surgical imaging. Statistical shape models (SSMs), used to characterize anatomic variation, provide an alternative means to obtain the representation of the resected patella for use in kinematic tracking. Using a virtual platform of a stereo-radiographic system, the objectives of this study were to evaluate the ability of an SSM to predict subject-specific 3D implanted patellar geometries from simulated 2D image profiles, and to formulate an effective data collection methodology for PF kinematics by considering accuracy for a variety of patient pose scenarios. An SSM of the patella was developed for 50 subjects and a leave-one-out approach compared SSM-predicted and actual geometries; average 3D errors were 0.45±0.07mm (mean±standard deviation), which is comparable to the accuracy of traditional segmentation. Further, initial imaging of the patella in five unique stereo radiographic perspectives yielded the most accurate representation. The ability to predict the remaining patellar geometry of the implanted PF joint with radiographic images and SSM, instead of CT, can reduce radiation exposure and streamline in vivo kinematic evaluations.
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Affiliation(s)
- Lowell M Smoger
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Adam J Cyr
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
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Gray HA, Guan S, Pandy MG. Accuracy of mobile biplane X-ray imaging in measuring 6-degree-of-freedom patellofemoral kinematics during overground gait. J Biomech 2017; 57:152-6. [DOI: 10.1016/j.jbiomech.2017.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/16/2017] [Accepted: 04/09/2017] [Indexed: 11/19/2022]
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Cross JA, Mchenry BD, Molthen R, Exten E, Schmidt TG, Harris GF. Biplane fluoroscopy for hindfoot motion analysis during gait: A model-based evaluation. Med Eng Phys 2017; 43:118-23. [DOI: 10.1016/j.medengphy.2017.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/05/2017] [Accepted: 02/12/2017] [Indexed: 11/23/2022]
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Mahato NK, Montuelle S, Goubeaux C, Cotton J, Williams S, Thomas J, Clark BC. Quantification of intervertebral displacement with a novel MRI-based modeling technique: Assessing measurement bias and reliability with a porcine spine model. Magn Reson Imaging 2016; 38:77-86. [PMID: 28027908 DOI: 10.1016/j.mri.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to develop a novel magnetic resonance imaging (MRI)-based modeling technique for measuring intervertebral displacements. Here, we present the measurement bias and reliability of the developmental work using a porcine spine model. Porcine lumbar vertebral segments were fitted in a custom-built apparatus placed within an externally calibrated imaging volume of an open-MRI scanner. The apparatus allowed movement of the vertebrae through pre-assigned magnitudes of sagittal and coronal translation and rotation. The induced displacements were imaged with static (T1) and fast dynamic (2D HYCE S) pulse sequences. These images were imported into animation software, in which these images formed a background 'scene'. Three-dimensional models of vertebrae were created using static axial scans from the specimen and then transferred into the animation environment. In the animation environment, the user manually moved the models (rotoscoping) to perform model-to-'scene' matching to fit the models to their image silhouettes and assigned anatomical joint axes to the motion-segments. The animation protocol quantified the experimental translation and rotation displacements between the vertebral models. Accuracy of the technique was calculated as 'bias' using a linear mixed effects model, average percentage error and root mean square errors. Between-session reliability was examined by computing intra-class correlation coefficients (ICC) and the coefficient of variations (CV). For translation trials, a constant bias (β0) of 0.35 (±0.11) mm was detected for the 2D HYCE S sequence (p=0.01). The model did not demonstrate significant additional bias with each mm increase in experimental translation (β1Displacement=0.01mm; p=0.69). Using the T1 sequence for the same assessments did not significantly change the bias (p>0.05). ICC values for the T1 and 2D HYCE S pulse sequences were 0.98 and 0.97, respectively. For rotation trials, a constant bias (β0) of 0.62 (±0.12)° was detected for the 2D HYCE S sequence (p<0.01). The model also demonstrated an additional bias (β1Displacement) of 0.05° with each degree increase in the experimental rotation (p<0.01). Using T1 sequence for the same assessments did not significantly change the bias (p>0.05). ICC values for the T1 and 2D HYCE S pulse sequences were recorded 0.97 and 0.91, respectively. This novel quasi-static approach to quantifying intervertebral relationship demonstrates a reasonable degree of accuracy and reliability using the model-to-image matching technique with both static and dynamic sequences in a porcine model. Future work is required to explore multi-planar assessment of real-time spine motion and to examine the reliability of our approach in humans.
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Affiliation(s)
- Niladri K Mahato
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - Stephane Montuelle
- Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - Craig Goubeaux
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Mechanical Engineering, Ohio University, Athens, OH 45701, United States.
| | - John Cotton
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Mechanical Engineering, Ohio University, Athens, OH 45701, United States.
| | - Susan Williams
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - James Thomas
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States; School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH 45701, United States.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States; Department of Geriatric Medicine, Ohio University, Athens, OH 45701, United States.
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Baumer TG, Giles JW, Drake A, Zauel R, Bey MJ. Measuring Three-Dimensional Thorax Motion Via Biplane Radiographic Imaging: Technique and Preliminary Results. J Biomech Eng 2016; 138:2473568. [PMID: 26592901 DOI: 10.1115/1.4032058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/08/2022]
Abstract
Measures of scapulothoracic motion are dependent on accurate imaging of the scapula and thorax. Advanced radiographic techniques can provide accurate measures of scapular motion, but the limited 3D imaging volume of these techniques often precludes measurement of thorax motion. To overcome this, a thorax coordinate system was defined based on the position of rib pairs and then compared to a conventional sternum/spine-based thorax coordinate system. Alignment of the rib-based coordinate system was dependent on the rib pairs used, with the rib3:rib4 pairing aligned to within 4.4 ± 2.1 deg of the conventional thorax coordinate system.
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Mahato NK, Montuelle S, Cotton J, Williams S, Thomas J, Clark B. Development of a morphology-based modeling technique for tracking solid-body displacements: examining the reliability of a potential MRI-only approach for joint kinematics assessment. BMC Med Imaging 2016; 16:38. [PMID: 27189195 PMCID: PMC4870733 DOI: 10.1186/s12880-016-0140-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background Single or biplanar video radiography and Roentgen stereophotogrammetry (RSA) techniques used for the assessment of in-vivo joint kinematics involves application of ionizing radiation, which is a limitation for clinical research involving human subjects. To overcome this limitation, our long-term goal is to develop a magnetic resonance imaging (MRI)-only, three dimensional (3-D) modeling technique that permits dynamic imaging of joint motion in humans. Here, we present our initial findings, as well as reliability data, for an MRI-only protocol and modeling technique. Methods We developed a morphology-based motion-analysis technique that uses MRI of custom-built solid-body objects to animate and quantify experimental displacements between them. The technique involved four major steps. First, the imaging volume was calibrated using a custom-built grid. Second, 3-D models were segmented from axial scans of two custom-built solid-body cubes. Third, these cubes were positioned at pre-determined relative displacements (translation and rotation) in the magnetic resonance coil and scanned with a T1 and a fast contrast-enhanced pulse sequences. The digital imaging and communications in medicine (DICOM) images were then processed for animation. The fourth step involved importing these processed images into an animation software, where they were displayed as background scenes. In the same step, 3-D models of the cubes were imported into the animation software, where the user manipulated the models to match their outlines in the scene (rotoscoping) and registered the models into an anatomical joint system. Measurements of displacements obtained from two different rotoscoping sessions were tested for reliability using coefficient of variations (CV), intraclass correlation coefficients (ICC), Bland-Altman plots, and Limits of Agreement analyses. Results Between-session reliability was high for both the T1 and the contrast-enhanced sequences. Specifically, the average CVs for translation were 4.31 % and 5.26 % for the two pulse sequences, respectively, while the ICCs were 0.99 for both. For rotation measures, the CVs were 3.19 % and 2.44 % for the two pulse sequences with the ICCs being 0.98 and 0.97, respectively. A novel biplanar imaging approach also yielded high reliability with mean CVs of 2.66 % and 3.39 % for translation in the x- and z-planes, respectively, and ICCs of 0.97 in both planes. Conclusions This work provides basic proof-of-concept for a reliable marker-less non-ionizing-radiation-based quasi-dynamic motion quantification technique that can potentially be developed into a tool for real-time joint kinematics analysis.
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Affiliation(s)
- Niladri K Mahato
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Stephane Montuelle
- Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA
| | - John Cotton
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA.,Department of Mechanical Engineering, Ohio University, Athens, OH, 45701, USA
| | - Susan Williams
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA
| | - James Thomas
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA.,School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA
| | - Brian Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA.,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.,Department of Geriatric Medicine, Ohio University, Athens, OH, 45701, USA
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Cross JA, McHenry B, Schmidt TG. Quantifying cross-scatter contamination in biplane fluoroscopy motion analysis systems. J Med Imaging (Bellingham) 2016; 2:043503. [PMID: 26835494 DOI: 10.1117/1.jmi.2.4.043503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/24/2015] [Indexed: 11/14/2022] Open
Abstract
Biplane fluoroscopy is used for dynamic in vivo three-dimensional motion analysis of various joints of the body. Cross-scatter between the two fluoroscopy systems may limit tracking accuracy. This study measured the magnitude and effects of cross-scatter in biplane fluoroscopic images. Four cylindrical phantoms of 4-, 6-, 8-, and 10-in. diameter were imaged at varying kVp levels to determine the cross-scatter fraction and contrast-to-noise ratio (CNR). Monte Carlo simulations quantified the effect of the gantry angle on the cross-scatter fraction. A cadaver foot with implanted beads was also imaged. The effect of cross-scatter on marker-based tracking accuracy was investigated. Results demonstrated that the cross-scatter fraction varied from 0.15 for the 4-in. cylinder to 0.89 for the 10-in. cylinder when averaged across kVp. The average change in CNR due to cross-scatter ranged from 5% to 36% CNR decreases for the 4- and 10-in. cylinders, respectively. In simulations, the cross-scatter fraction increased with the gantry angle for the 8- and 10-in. cylinders. Cross-scatter significantly increased static-tracking error by 15%, 25%, and 38% for the 6-, 8-, and 10-in. phantoms, respectively, with no significant effect for the foot specimen. The results demonstrated submillimeter marker-based tracking for a range of phantom sizes, despite cross-scatter degradation.
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Affiliation(s)
- Janelle A Cross
- Marquette University , Department of Biomedical Engineering, 1515 W. Wisconsin Avenue, Milwaukee, Wisconsin 53233, United States
| | - Ben McHenry
- Marquette University , Department of Biomedical Engineering, 1515 W. Wisconsin Avenue, Milwaukee, Wisconsin 53233, United States
| | - Taly Gilat Schmidt
- Marquette University , Department of Biomedical Engineering, 1515 W. Wisconsin Avenue, Milwaukee, Wisconsin 53233, United States
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Dagneaux L, Thoreux P, Eustache B, Canovas F, Skalli W. Sequential 3D analysis of patellofemoral kinematics from biplanar x-rays: In vitro validation protocol. Orthop Traumatol Surg Res 2015; 101:811-8. [PMID: 26514850 DOI: 10.1016/j.otsr.2015.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Developing criteria for assessing patellofemoral kinematics is crucial to understand, evaluate, and monitor patellofemoral function. The objective of this study was to assess a sequential 3D analysis method based on biplanar radiographs, using an in vitro protocol. HYPOTHESIS Biplanar radiography combined with novel 3D reconstruction methods provides a reliable evaluation of patellofemoral function, without previous imaging. MATERIAL AND METHODS Eight cadaver specimens were studied during knee flexion cycles from 0° to 60° induced by an in vitro simulator. The protocol was validated by investigating sequential and continuous motion using an optoelectronic system, evaluating measurement accuracy and reproducibility using metallic beads embedded in the patella, and comparing the 3D patellar geometry to computed tomography (CT) images. RESULTS The differences in position between the sequential and continuous kinematic analyses were less than 1mm and 1°. The protocol proved reliable for tracking several components of knee movements, including patellar translations, flexion, and tilt. In this analysis, uncertainty was less than 2 mm for translations and less than 3° for rotations, except rotation in the coronal plane. For patellar tilt, uncertainty was 5°. Mean difference in geometry was 0.49 mm. DISCUSSION Sequential analysis results are consistent with continuous kinematics. This analysis method provides patellar position parameters without requiring previous CT or magnetic resonance imaging. A clinical study may deserve consideration to identify patellofemoral kinematic profiles and position criteria in vivo. LEVEL OF EVIDENCE IV, experimental study.
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Affiliation(s)
- L Dagneaux
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France; Département de chirurgie orthopédique et traumatologie, unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - P Thoreux
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France; Hôpital Avicenne, université Paris 13, Sorbonne Paris Cité, AP-HP, 93017 Bobigny, France
| | - B Eustache
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France
| | - F Canovas
- Département de chirurgie orthopédique et traumatologie, unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - W Skalli
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France
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Sharma GB, Kuntze G, Kukulski D, Ronsky JL. Validating Dual Fluoroscopy System Capabilities for Determining In-Vivo Knee Joint Soft Tissue Deformation: A Strategy for Registration Error Management. J Biomech 2015; 48:2181-5. [PMID: 26003485 DOI: 10.1016/j.jbiomech.2015.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
Knee osteoarthritis (OA) causes structural and mechanical changes within tibiofemoral (TF) cartilage affecting tissue load deformation behavior. Quantifying in-vivo TF soft tissue deformations in healthy and early OA may provide a novel biomechanical marker, sensitive to alterations occurring prior to radiographic change. Dual Fluoroscopy (DF) allows accurate in-vivo TF soft tissue deformation assessment but requires validation. In-vivo healthy and early OA TF cartilage deforms 0.3-1.2mm during static standing full body-weight loading. Our aim was to establish minimum detectable displacement (MDD) for femoral translation in a DF system using a marker-based and markerless approach with variable image intensifier magnifications. An instrumented frame allowed controlled femur specimen translations. Bone positions were reconstructed from DF data using centroids of affixed steel beads (marker-based) and 2D-3D bone feature registration (markerless). Statistical analyses included independent samples t-tests and reliability analysis. Markerless measurements by three trained operators had large variations making it prudent to have an appropriate error management strategy when performing 2D-3D registration. Marker-based MDD improved with image resolution and was 0.05 mm at 3.2 LP/mm (LP: line pairs). Markerless MDD at 3.2 LP/mm was 0.08 mm. Average femur and tibia 2D-3D registrations yielded excellent reliability (84.4%). Therefore, DF images acquired at resolution greater than 3.2 LP/mm would be capable for determining accurate and reliable in-vivo healthy and early OA TF soft tissue deformation. This study provides a registration error management strategy for in-vivo TF soft tissue deformation assessment that could be applied for future clinical applications to establish non-invasive biomechanical markers for early OA diagnosis.
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Affiliation(s)
- Gulshan B Sharma
- University of Calgary, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
| | - Gregor Kuntze
- University of Calgary, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Diane Kukulski
- University of Calgary, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta, Canada
| | - Janet L Ronsky
- University of Calgary, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Zhao K, Breighner R, Holmes D, Leng S, McCollough C, An KN. A technique for quantifying wrist motion using four-dimensional computed tomography: approach and validation. J Biomech Eng 2015; 137:2279319. [PMID: 25901447 DOI: 10.1115/1.4030405] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 12/21/2022]
Abstract
Accurate quantification of subtle wrist motion changes resulting from ligament injuries is crucial for diagnosis and prescription of the most effective interventions for preventing progression to osteoarthritis. Current imaging techniques are unable to detect injuries reliably and are static in nature, thereby capturing bone position information rather than motion which is indicative of ligament injury. A recently developed technique, 4D (three dimensions + time) computed tomography (CT) enables three-dimensional volume sequences to be obtained during wrist motion. The next step in successful clinical implementation of the tool is quantification and validation of imaging biomarkers obtained from the four-dimensional computed tomography (4DCT) image sequences. Measures of bone motion and joint proximities are obtained by: segmenting bone volumes in each frame of the dynamic sequence, registering their positions relative to a known static posture, and generating surface polygonal meshes from which minimum distance (proximity) measures can be quantified. Method accuracy was assessed during in vitro simulated wrist movement by comparing a fiducial bead-based determination of bone orientation to a bone-based approach. The reported errors for the 4DCT technique were: 0.00-0.68 deg in rotation; 0.02-0.30 mm in translation. Results are on the order of the reported accuracy of other image-based kinematic techniques.
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Farrokhi S, Meholic B, Chuang WN, Gustafson JA, Fitzgerald GK, Tashman S. Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis. J Biomech 2015; 48:1707-12. [PMID: 26087880 DOI: 10.1016/j.jbiomech.2015.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/23/2022]
Abstract
Patients with knee osteoarthritis often present with signs of mixed tibiofemoral and patellofemoral joint disease. It has been suggested that altered frontal and transverse plane knee joint mechanics play a key role in compartment-specific patterns of knee osteoarthritis, but in-vivo evidence in support of this premise remains limited. Using Dynamic Stereo X-ray techniques, the aim of this study was to compare the frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during the loading response phase of downhill gait in three groups of older adults: patients with medial tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=11); patients with lateral tibiofemoral compartment and coexisting patellofemoral osteoarthritis (n=10); and an osteoarthritis-free control group (n=22). Patients with lateral compartment osteoarthritis walked with greater and increasing degrees of tibiofemoral abduction compared to the medial compartment osteoarthritis and the control groups who walked with increasing degrees of tibiofemoral adduction. Additionally, the medial and lateral compartment osteoarthritis groups demonstrated reduced degrees of tibiofemoral internal rotation compared to the control group. Both medial and lateral compartment osteoarthritis groups also walked with increasing degrees of lateral patella tilt and medial patella translation during the loading response phase of downhill gait. Our findings suggest that despite the differences in frontal and transverse plane tibiofemoral kinematics between patients with medial and lateral compartment osteoarthritis, the malalignments of their arthritic patellofemoral joint appears to be similar. Further research is needed to determine if these kinematic variations are relevant targets for interventions to reduce pain and disease progression in patients with mixed disease.
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Henderson SE, Tudares MA, Tashman S, Almarza AJ. Decreased Temporomandibular Joint Range of Motion in a Model of Early Osteoarthritis in the Rabbit. J Oral Maxillofac Surg 2015; 73:1695-705. [PMID: 25889371 DOI: 10.1016/j.joms.2015.03.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Analysis of mandibular biomechanics could help with understanding the mechanisms of temporomandibular joint (TMJ) disorders (TMJDs), such as osteoarthritis (TMJ-OA), by investigating the effects of injury or disease on TMJ movement. The objective of the present study was to determine the functional kinematic implications of mild TMJ-OA degeneration caused by altered occlusion from unilateral splints in the rabbit. MATERIALS AND METHODS Altered occlusion of the TMJ was mechanically induced in rabbits by way of a unilateral molar dental splint (n = 3). TMJ motion was assessed using 3-dimensional (3D) skeletal kinematics twice, once before and once after 6 weeks of splint placement with the splints removed, after allowing 3 days of recovery. The relative motion of the condyle to the fossa and the distance between the incisors were tracked. RESULTS An overall decrease in the range of joint movement was observed at the incisors and in the joint space between the condyle and fossa. The incisor movement decreased from 7.0 ± 0.5 mm to 6.2 ± 0.5 mm right to left, from 5.5 ± 2.2 mm to 4.6 ± 0.8 mm anterior to posterior, and from 13.3 ± 1.8 mm to 11.6 ± 1.4 mm superior to inferior (P < .05). The total magnitude of the maximum distance between the points on the condyle and fossa decreased from 3.6 ± 0.8 mm to 3.1 ± 0.6 mm for the working condyle and 2.8 ± 0.4 mm to 2.5 ± 0.4 mm for the balancing condyle (P < .05). The largest decreases were seen in the anteroposterior direction for both condyles. CONCLUSION Determining the changes in condylar movement might lead to a better understanding of the early predictors in the development of TMJ-OA and determining when the symptoms become a chronic, irreversible problem.
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Affiliation(s)
- Sarah E Henderson
- Graduate Student Researcher, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Mauro A Tudares
- Research Technician, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA
| | - Scott Tashman
- Associate Professor, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Alejandro J Almarza
- Associate Professor, Department of Bioengineering; Department of Oral Biology; and McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Kedgley AE, McWalter EJ, Wilson DR. The effect of coordinate system variation on in vivo patellofemoral kinematic measures. Knee 2015; 22:88-94. [PMID: 25656245 DOI: 10.1016/j.knee.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of different coordinate system definitions for the patella leads to difficulties in comparing kinematic results between studies. The purpose of this work was to establish the effect of using a range of coordinate system definitions to quantify patellar kinematics. Additionally, intra- and inter-investigator repeatabilities of the digitization of anatomic landmarks on the patella were determined. METHODS Four different patellar coordinate system definitions were applied using digitisations in two and three dimensions and a single femoral coordinate system was used for comparison. Intra-investigator variability was established by having one investigator digitize the patellar landmarks of three subjects on five separate occasions. Inter-investigator variability was quantified by having five participants digitize the same landmarks on the same three subjects. Patellofemoral kinematics were quantified for ten subjects, at six angles of tibiofemoral flexion, using MRI. RESULTS As a result of changes in the patellar coordinate system, differences of up to 11.5° in flexion, 5.0° in spin, and 27.3° in tilt were observed in the resultant rotations for the same motion, illustrating the importance of standardizing the coordinate system definition. CONCLUSIONS To minimize errors due to variability while still maintaining physiologically sensible kinematic angles, a coordinate system based upon an intermediate flexion axis between the most medial and lateral points on the patella, and a superiorly-directed long axis located between the most proximal and distal points on the patella, with an origin at the centre of the most proximal, distal, medial, and lateral points on the patella is recommended. CLINICAL RELEVANCE The recommended anatomic coordinate frame may be employed in the calculation of dynamic in vivo patellar kinematics when used in combination with any method that reliably quantifies patellar motion.
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Affiliation(s)
- Angela E Kedgley
- Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
| | - Emily J McWalter
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada
| | - David R Wilson
- Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Robert H.N. Ho Research Centre, 7/F, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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Freedman BR, Brindle TJ, Sheehan FT. Re-evaluating the functional implications of the Q-angle and its relationship to in-vivo patellofemoral kinematics. Clin Biomech (Bristol, Avon) 2014; 29:1139-45. [PMID: 25451861 PMCID: PMC4255138 DOI: 10.1016/j.clinbiomech.2014.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Q-angle is widely used clinically to evaluate individuals with anterior knee pain. Recent studies have questioned the utility of this measure and have suggested that a large Q-angle may not be associated with lateral patellofemoral translation, as often assumed. The objective of this study was to determine: 1) how accurately the Q-angle represents the line-of-action of the quadriceps and 2) if adding active quadriceps contraction or a bent knee position to the measurement of the Q-angle improves its reliability, accuracy, and association with patellofemoral kinematics. METHODS The study included individuals diagnosed with chronic idiopathic patellofemoral pain and control subjects (n=43 and n=30 knees). Three measures of the clinical Q-angle (straight- and bent-knee with relaxed quadriceps and straight-knee with maximum isometric quadriceps contraction) were obtained with a goniometer and compared to a fourth MR-based measure of Q-angle. Patellofemoral kinematics were derived from dynamic cine-phase contrast images, acquired while subjects extended/flexed their knee from approximately 0° and 45°. FINDINGS The Q-angle did not represent the line-of-action of the quadriceps. The average difference between each clinical and the MR-based Q-angle ranged from 5° to 8°. These differences varied greatly across subjects (range: -28.5° to 3.9(o)). Adding an active quadriceps contraction or a bent knee position, did not improve the reliability of the Q-angle. An increased Q-angle correlated to medial patellar displacement and tilt (r=0.38-0.54, P<0.001) in the cohort with anterior knee pain. INTERPRETATION Clinicians are cautioned against using the Q-angle to infer patellofemoral kinematics.
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Affiliation(s)
- Benjamin R. Freedman
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J. Brindle
- Instructor, Physical Therapy and Rehabilitation Science, University of Maryland, College Park, MD, USA
| | - Frances T. Sheehan
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
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Abstract
Background: Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency. Hypothesis/Purpose: The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplane radiographs were obtained of both their affected and unaffected knees. Moving 3-dimensional models of tibiofemoral kinematics were calculated using model-based tracking to assess overall kinematic variables and specific measures of tibiofemoral joint contact. The affected knees of the subjects were then compared to their unaffected contralateral knees. Results: Affected knees demonstrated significantly more lateral tibial translation than the uninjured contralateral limb in all dynamic activities. Additionally, the medial compartment displayed greater amounts of mobility than the lateral compartment in the injured limbs. Conclusion: This study suggests that MMRT causes significant changes in in vivo knee kinematics and arthrokinematics and that the magnitude of these changes is influenced by dynamic task difficulty. Clinical Relevance: Medial meniscus root tears lead to significant changes in joint arthrokinematics, with increased lateral tibial translation and greater medial compartment excursion. With complete root tears, essentially 100% of circumferential fibers are lost. This study will further our knowledge of meniscal deficiency and osteoarthritis and provide a baseline for more common forms of medial meniscal injuries (vertical, horizontal, radial), with various degrees of circumferential fiber function remaining.
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Affiliation(s)
- Chelsea A Marsh
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel E Martin
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ; Kaiser Permanente, Napa-Solano, Vacaville, California, USA
| | - Christopher D Harner
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott Tashman
- Biodynamics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Henderson SE, Desai R, Tashman S, Almarza AJ. Functional analysis of the rabbit temporomandibular joint using dynamic biplane imaging. J Biomech 2014; 47:1360-7. [PMID: 24594064 DOI: 10.1016/j.jbiomech.2014.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 11/23/2022]
Abstract
The dynamic function of the rabbit temporomandibular joint (TMJ) was analyzed through non-invasive, three-dimensional skeletal kinematics, providing essential knowledge for understanding normal joint motion. The objective of this study was to evaluate and determine repeatable measurements of rabbit TMJ kinematics. Maximal distances, as well as paths were traced and analyzed for the incisors and for the condyle-fossa relationship. From one rabbit to another, the rotations and translations of both the incisors and the condyle relative to the fossa contained multiple clear, repeatable patterns. The slope of the superior/inferior incisor distance with respect to the rotation about the transverse axis was repeatable to 0.14 mm/deg and the right/left incisor distance with respect to the rotation about the vertical axis was repeatable to 0.03 mm/deg. The slope of the superior/inferior condylar translation with respect to the rotational movement about the transverse axis showed a consistent relationship to within 0.05 mm/deg. The maximal translations of the incisors and condyles were also consistent within and between rabbits. With an understanding of the normal mechanics of the TMJ, kinematics can be used to compare and understand TMJ injury and degeneration models.
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McDonald CP, Moutzouros V, Bey MJ. Measuring dynamic in-vivo elbow kinematics: description of technique and estimation of accuracy. J Biomech Eng 2014; 134:124502. [PMID: 23363209 DOI: 10.1115/1.4007951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objectives of this study were to characterize the translational and rotational accuracy of a model-based tracking technique for quantifying elbow kinematics and to demonstrate its in vivo application. METHOD OF APPROACH The accuracy of a model-based tracking technique for quantifying elbow kinematics was determined in an in vitro experiment. Biplane X-ray images of a cadaveric elbow were acquired as it was manually moved through flexion-extension. The 3D position and orientation of each bone was determined using model-based tracking. For comparison, the position and orientation of each bone was also determined by tracking the position of implanted beads with dynamic radiostereometric analysis. Translations and rotations were calculated for both the ulnohumeral and radiohumeral joints, and compared between measurement techniques. To demonstrate the in vivo application of this technique, biplane X-ray images were acquired as a human subject extended their elbow from full flexion to full extension. RESULTS The in vitro validation demonstrated that the model-based tracking technique is capable of accurately measuring elbow motion, with reported errors averaging less than ±1.0 mm and ±1.0 deg. For the in vivo application, the carrying angle changed from an 8.3 ± 0.5 deg varus position in full flexion to an 8.4 ± 0.5 deg valgus position in full extension. CONCLUSIONS Model-based tracking is an accurate technique for measuring in vivo, 3D, dynamic elbow motion. It is anticipated that this experimental approach will enhance our understanding of elbow motion under normal and pathologic conditions.
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Affiliation(s)
- Colin P McDonald
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI 48202, USA.
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Borotikar BS, Sheehan FT. In vivo patellofemoral contact mechanics during active extension using a novel dynamic MRI-based methodology. Osteoarthritis Cartilage 2013; 21:1886-1894. [PMID: 24012620 PMCID: PMC5548374 DOI: 10.1016/j.joca.2013.08.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/23/2013] [Accepted: 08/23/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To establish an in vivo, normative patellofemoral (PF) cartilage contact mechanics database acquired during voluntary muscle control using a novel, dynamic, magnetic resonance (MR) imaging-based, computational methodology and validate the contact mechanics sensitivity to the known sub-millimeter methodological accuracies. DESIGN Dynamic cine phase-contrast and multi-plane cine (MPC) images were acquired while female subjects (n = 20, sample of convenience) performed an open kinetic chain (knee flexion-extension) exercise inside a 3-T MR scanner. Static cartilage models were created from high resolution three-dimensional static MR data and accurately placed in their dynamic pose at each time frame based on the cine-PC (CPC) data. Cartilage contact parameters were calculated based on the surface overlap. Statistical analysis was performed using paired t-test and a one-sample repeated measures ANOVA. The sensitivity of the contact parameters to the known errors in the PF kinematics was determined. RESULTS Peak mean PF contact area was 228.7 ± 173.6 mm(2) at 40° knee angle. During extension, contact centroid and peak strain locations tracked medially on the femoral and patellar cartilage and were not significantly different from each other. At 25°, 30°, 35°, and 40° of knee extension, contact area was significantly different. Contact area and centroid locations were insensitive to rotational and translational perturbations. CONCLUSION This study is a first step towards unfolding the biomechanical pathways to anterior PF pain and osteoarthritis (OA) using dynamic, in vivo, and accurate methodologies. The database provides crucial data for future studies and for validation of, or as an input to, computational models.
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Affiliation(s)
- B S Borotikar
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - F T Sheehan
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
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