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Ackermann J, Hoch A, Snedeker JG, Zingg PO, Esfandiari H, Fürnstahl P. Automatic 3D Postoperative Evaluation of Complex Orthopaedic Interventions. J Imaging 2023; 9:180. [PMID: 37754944 PMCID: PMC10532700 DOI: 10.3390/jimaging9090180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
In clinical practice, image-based postoperative evaluation is still performed without state-of-the-art computer methods, as these are not sufficiently automated. In this study we propose a fully automatic 3D postoperative outcome quantification method for the relevant steps of orthopaedic interventions on the example of Periacetabular Osteotomy of Ganz (PAO). A typical orthopaedic intervention involves cutting bone, anatomy manipulation and repositioning as well as implant placement. Our method includes a segmentation based deep learning approach for detection and quantification of the cuts. Furthermore, anatomy repositioning was quantified through a multi-step registration method, which entailed a coarse alignment of the pre- and postoperative CT images followed by a fine fragment alignment of the repositioned anatomy. Implant (i.e., screw) position was identified by 3D Hough transform for line detection combined with fast voxel traversal based on ray tracing. The feasibility of our approach was investigated on 27 interventions and compared against manually performed 3D outcome evaluations. The results show that our method can accurately assess the quality and accuracy of the surgery. Our evaluation of the fragment repositioning showed a cumulative error for the coarse and fine alignment of 2.1 mm. Our evaluation of screw placement accuracy resulted in a distance error of 1.32 mm for screw head location and an angular deviation of 1.1° for screw axis. As a next step we will explore generalisation capabilities by applying the method to different interventions.
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Affiliation(s)
- Joëlle Ackermann
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jess Gerrit Snedeker
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Patrick Oliver Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Hooman Esfandiari
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Nukuto K, Hoshino Y, Yamamoto T, Miyaji N, Nagai K, Araki D, Kanzaki N, Matsushita T, Kuroda R. Anatomic double-bundle anterior cruciate ligament reconstruction could not achieve sufficient control of pivot-shift when accompanying tibial tunnel coalition. Knee Surg Sports Traumatol Arthrosc 2021; 29:3743-3750. [PMID: 33388827 DOI: 10.1007/s00167-020-06383-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the effect of tibial tunnel coalition on knee rotatory laxity and clinical outcomes after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS Forty-one patients who underwent anatomic DB ACL reconstruction were included prospectively. Three-dimensional computed tomography of the knee joint was obtained at approximately 1 year postoperatively to determine if tunnel coalition occurred. After excluding seven cases of femoral tunnel coalition, two groups were established based on the existence of a tibial tunnel coalition. The pivot-shift test was quantitatively evaluated on the basis of tibial acceleration preoperatively and at 1 year postoperatively. Two subjective scores, the International Knee Documentation Committee (IKDC) subjective and Lysholm scores, were also collected. The pivot-shift measurement and subjective scores were compared between the ACL-reconstructed knees with and without tibial tunnel coalition. The independent t test, Pearson's chi-square test, and Student t tests were used in data analysis. RESULTS Twenty-one knees had tibial tunnel coalition (group C), whereas 13 knees did not have tunnel coalition(group N). Pivot-shift was significantly diminished postoperatively in both groups on the basis of the clinical examination and quantitative evaluations (p < 0.05). However, there was a small but significant difference in tibial acceleration demonstrating larger pivot-shift in group C (1.0 ± 0.6 m/s2) than in group N (0.5 ± 0.3 m/s2, p < 0.05). No significant difference was observed in the IKDC subjective and Lysholm scores (both n.s.). CONCLUSION When the tibial tunnel coalition occurs after DB ACL reconstruction, knee rotatory laxity may not be restored in ACL-reconstructed knees, as expected in those without tunnel coalition. It is recommended that two tibial tunnels should be created separately when performing DB-ACL reconstruction to achieve better control of rotatory knee laxity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Koji Nukuto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Nobuaki Miyaji
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Uozumi Y, Nagamune K, Nakano N, Nagai K, Araki D, Hoshino Y, Matsushita T, Kuroda R, Kurosaka M. Fully Automated Determination of Femoral Coordinate System in CT Image Based on Epicondyles. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2015. [DOI: 10.20965/jaciii.2015.p0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We propose a fully automated determination of the femoral coordinates in computerized tomography (CT) imaging based on epicondyles. The challenge point of this paper is that we take up how to calculate the femoral coordinate system (FCS), which is difficult to determine automatically. Our proposed method automatically determines the FCS based on anatomical reference points. We evaluated 10 subjects (six men and four women 28.9 ± 9.3 years old, three left-handed and seven right-handed) who had no history of joint injury. We examined the proposed method by comparing the expert and algorithm. The medial epicondyle was 1.41 ± 0.75 mmp= 0.42 > 0.05, student’sttest) in positioning accuracy. The lateral epicondyle was 1.36 ± 0.70 mmp= 0.42) in positioning accuracy. The origin was 0.87 ± 0.40 mmp= 0.71). in positioning accuracy. The lateral axis angle accuracy was 0.53 ± 0.84°p= 0.44). In short, the proposed method constructed patient-specific coordinate systems more accurately than expert manual.
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Uozumi Y, Nagamune K, Nakano N, Nagai K, Nishizawa Y, Hoshino Y, Matsushita T, Kuroda R, Kurosaka M. A Three-Dimensional Evaluation of EndoButton Displacement Direction After Anterior Cruciate Ligament Reconstruction in CT Image Using Tunnel Axis. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2014. [DOI: 10.20965/jaciii.2014.p0830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of this study was to propose a threedimensional evaluation of the EndoButton displacement direction after anterior cruciate ligament reconstruction in the multidetector-row computed tomography (MDCT) image by using the tunnel axis. The proposed method was applied experimentally to six subjects. The result of the simulated experiment revealed that the proposed method could analyze EndoButton displacement direction satisfactorily because the error was less than that of the MDCT image resolution. The clinical experiment results revealed displacement relative to the tunnel between time-zero and the followup point. We conclude that the proposed method can quantitatively evaluate the EndoButton displacement direction from the raw MDCT image after anterior cruciate ligament reconstruction; further, our findings suggest that the EndoButton was displaced relative to the tunnel between time-zero and the follow-up point.
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Araki D, Kuroda R, Matsumoto T, Nagamune K, Matsushita T, Hoshino Y, Oka S, Nishizawa Y, Kurosaka M. Three-dimensional analysis of bone tunnel changes after anatomic double-bundle anterior cruciate ligament reconstruction using multidetector-row computed tomography. Am J Sports Med 2014; 42:2234-41. [PMID: 25023441 DOI: 10.1177/0363546514540274] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The femoral and tibial bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction (ACL-R) has not been fully documented. PURPOSE To evaluate the region-specific bone tunnel volume changes and those transpositions using 3-dimensional multidetector-row computed tomography (MDCT) after anatomic double-bundle ACL-R. STUDY DESIGN Case series; Level of evidence, 4. METHODS Eleven patients who underwent unilateral double-bundle ACL-R with hamstring tendon autografts were included in this study. MDCT scanning of their knees was performed at 3 weeks and 1 year after surgery. The bone tunnel regions were extracted from the MDCT images, and the longitudinal axis of each bone tunnel was divided into 3 equal sections. The centroids of the outside and the articular thirds were then extracted from the bone tunnel position. Changes in the bone tunnel volume and the transposition of the articular third were calculated and compared. RESULTS At 1 year postoperatively, as compared with the 3-week postoperative value (set at 100%), the femoral bone tunnel volume of the anteromedial bundle (AMB) and posterolateral bundle (PLB) changed to 77.4% ± 15.3% and 102.3% ± 19.2% in the outside third and 122.3% ± 31.8% and 112.5% ± 34.4% in the articular third, respectively. The tibial bone tunnel volume of the AMB and the PLB changed to 108.6% ± 28.7% and 105.4% ± 22.6% in the tibial articular third and 54.9% ± 25.8% and 52.5% ± 26.9% in the outside third, respectively. The femoral outside third of the AMB and the tibial outside third of both the AMB and PLB were significantly reduced in bone tunnel volume. The centroid of the femoral articular third of the AMB moved 13°, 1.1 ± 0.6 mm posterodistally, and that of the PLB moved 35°, 0.8 ± 0.4 mm anterodistally. Furthermore, the centroid of the tibial articular third of the AMB moved 14°, 2.0 ± 1.6 mm posterolaterally, and that of the PLB moved 72°, 1.0 ± 1.3 mm posterolaterally. CONCLUSION Compared with 3 weeks postoperatively, the articular side outlets of the femoral and tibial bone tunnels at 1 year postoperatively had enlarged slightly but statistically maintained their volume, and they had moved a little in the direction that the grafts were pulled.
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Affiliation(s)
- Daisuke Araki
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kouki Nagamune
- Department of Human and Artificial Intelligent Systems, Graduate School of Engineering, University of Fukui, Fukui, Japan
| | - Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Shinya Oka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichiro Nishizawa
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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