1
|
Conconi M, Pompili A, Sancisi N, Durante S, Leardini A, Belvedere C. Foot kinematics as a function of ground orientation and weightbearing. J Orthop Res 2024; 42:148-163. [PMID: 37442638 DOI: 10.1002/jor.25661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
The foot is responsible for the bodyweight transfer to the ground, while adapting to different terrains and activities. Despite this fundamental role, the knowledge about the foot bone intrinsic kinematics is still limited. The aim of the study is to provide a quantitative and systematic description of the kinematics of all bones in the foot, considering the full range of dorsi/plantar flexion and pronation/supination of the foot, both in weightbearing and nonweightbearing conditions. Bone kinematics was accurately reconstructed for three specimens from a series of computed tomography scans taken in weightbearing configuration. The ground inclination was imposed through a set of wedges, varying the foot orientation both in the sagittal and coronal planes; the donor body-weight was applied or removed by a cable-rig. A total of 32 scans for each foot were acquired and segmented. Bone kinematics was expressed in terms of anatomical reference systems optimized for the foot kinematic description. Results agree with previous literature where available. However, our analysis reveals that bones such as calcaneus, navicular, intermediate cuneiform, fourth and fifth metatarsal move more during foot pronation than flexion. Weightbearing significantly increase the range of motion of almost all the bone. Cuneiform and metatarsal move more due to weightbearing than in response to ground inclination, showing their role in the load-acceptance phase. The data here reported represent a step toward a deeper understanding of the foot behavior, that may help in the definition of better treatment and medical devices, as well as new biomechanical model of the foot.
Collapse
Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Alessandro Pompili
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Stefano Durante
- Area Tecnico Diagnostica Radiologica, IRCCS S. Orsola Malpighi Hospital, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
2
|
Fernández-Marín MR, González-Martín D, Herrera-Pérez M, Paulano-Godino F, Vilá-Rico J, Tejero S. Increased subtalar rotational motion in patients with symptomatic ankle instability under load and stress conditions. Knee Surg Sports Traumatol Arthrosc 2023; 31:5214-5221. [PMID: 37770749 DOI: 10.1007/s00167-023-07553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Differentiating subtalar and ankle instability in the clinical setting is challenging. This study aims to analyze the rotational laxity of the subtalar joint bilaterally in patients with asymptomatic and symptomatic ankle instability under simulated load and stress-induced position of the subtalar joint. METHODS A case-control study was conducted using an adjustable load device (ALD). Patients with chronic ankle instability and healthy volunteers were included. Each subject underwent a CT scan under mechanical stress and simulated weight-bearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained in a single model, allowing calculations of the motion vector as well as the helical axis. The helical axis was defined by a rotation angle and a translation distance. RESULTS A total of 72 feet were included in the study. Thirty-one patients with unilateral symptoms and five healthy controls were selected, defining two groups: symptomatic (n = 31) and asymptomatic (n = 41). An absolute difference of 4.6º (95%CI 2-11.1) rotation angle was found on the helical axis of the symptomatic vs. asymptomatic group (p = 0.001). No significant differences were detected in the translation distance (n.s.) between the groups. Additionally, a significant positive correlation was found between the rotation angle and translation distance through the helical axis in the asymptomatic group (r = 0.397, p = 0.027). CONCLUSION Patients with chronic ankle instability suspected of having subtalar joint instability showed a wider subtalar range of laxity in terms of rotation about the helical axis. Furthermore, differences in kinematics between symptomatic and asymptomatic hindfeet was demonstrated when both feet were compared. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | - David González-Martín
- Orthopedic Surgery and Traumatology Deparment, Origen, Grupo Recoletas, C. Paulina Harriet, 4-6, 47006, Valladolid, Spain.
- Universidad Europea Miguel de Cervantes, Valladolid, Spain.
| | - Mario Herrera-Pérez
- Universidad de La Laguna, La Laguna, Spain
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Jesús Vilá-Rico
- University Hospital 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Sergio Tejero
- Head Foot Ankle Unit, University Hospital Virgen del Rocío, Sevilla, Spain
- University of Sevilla, Sevilla, Spain
| |
Collapse
|
3
|
Hulleck AA, Menoth Mohan D, Abdallah N, El Rich M, Khalaf K. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:901331. [PMID: 36590154 PMCID: PMC9800936 DOI: 10.3389/fmedt.2022.901331] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait. Research objective This study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms. Methods A comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included. Results and significance Clinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges.
Collapse
Affiliation(s)
- Abdul Aziz Hulleck
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dhanya Menoth Mohan
- School of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, Australia
| | - Nada Abdallah
- Weill Cornell Medicine, New York City, NY, United States
| | - Marwan El Rich
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates,Health Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates,Correspondence: Kinda Khalaf
| |
Collapse
|
4
|
Vuurberg G, Dahmen J, Dobbe IGG, Kleipool RP, Hayat B, Sierevelt IN, Streekstra G, Kerkhoffs GMMJ, Stufkens SAS. Lower leg symmetry: a Q3D-CT analysis. Surg Radiol Anat 2022; 44:851-860. [PMID: 35534775 PMCID: PMC9246803 DOI: 10.1007/s00276-022-02940-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/07/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE In fracture and realignment surgery, the contralateral unaffected side is often used as a model or template for the injured bone even though clinically valuable quantitative data of bilateral symmetry are often unavailable. Therefore, the objective of the present study was to quantify and present the bilateral symmetry of the tibia and fibula. METHODS Twenty bilateral lower-leg CT scans were acquired in healthy volunteers. The left and right tibia and fibula were segmented resulting in three-dimensional polygons for geometrical analyses (volume, surface and length). The distal and proximal segment of the right tibia of each individual was subsequently matched to the left tibia to quantify alignment differences (translation and rotation). Bone symmetry on group level was assessed using the Student's t test and intra-individual differences were assessed using mixed-models analyses. RESULTS Intra-individuals differences were found for tibia volume (5.2 ± 3.3 cm3), tibia surface (5.2 ± 3.3 cm2), translations in the lateral (X-axis; 9.3 ± 8.9 mm) and anterior direction (Y-axis; 7.1 ± 7.0 mm), for tibia length (translation along Z-axis: 3.1 ± 2.4 mm), varus/valgus (φz: 1.7o ± 1.4°), and endotorsion/exotorsion (φz: 4.0o ± 2.7°). CONCLUSION This study shows intra-individual tibia asymmetry in both geometric and alignment parameters of which the surgeon needs to be aware in pre-operative planning. The high correlation between tibia and fibula length allows the ipsilateral fibula to aid in estimating the original tibia length post-injury. Future studies need to establish whether the found asymmetry is clinically relevant when the contralateral side is used as reference in corrective surgery. LEVEL OF EVIDENCE III cohort study.
Collapse
Affiliation(s)
- Gwendolyn Vuurberg
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands. .,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands. .,Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Jari Dahmen
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Iwan G G Dobbe
- Amsterdam UMC, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Roeland P Kleipool
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam UMC, Department of Medical Biology, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Batur Hayat
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Geert Streekstra
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Amsterdam UMC, Department of Orthopedic Surgery, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| |
Collapse
|
5
|
Conconi M, Pompili A, Sancisi N, Leardini A, Durante S, Belvedere C. New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions. J Foot Ankle Res 2021; 14:66. [PMID: 34930383 PMCID: PMC8686310 DOI: 10.1186/s13047-021-00504-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background A complete definition of anatomical reference systems (ARS) for all bones of the foot and ankle complex is lacking. Using a morphological approach, we propose new ARS for these bones with the aim of being highly repeatable, consistent among individuals, clinically interpretable, and also suited for a sound kinematic description. Methods Three specimens from healthy donors and three patients with flat feet were scanned in weight-bearing CT. The foot bones were segmented and ARS defined according to the proposed approach. To assess repeatability, intra class coefficients (ICC) were computed both intra- and inter-operator. Consistency was evaluated as the mean of the standard deviations of the ARS position and orientation, both within normal and flat feet. Clinical interpretability was evaluated by providing a quantification of the curvature variation in the medial-longitudinal and transverse arches and computing the Djiann-Annonier angle for normal and flat feet from these new ARS axes. To test the capability to also provide a sound description of the foot kinematics, the alignment between mean helical axes (MHA) and ARS axes was quantified. Results ICC was 0.99 both inter- and intra-operator. Rotational consistency was 4.7 ± 3.5 ° and 6.2 ± 4.4° for the normal and flat feet, respectively; translational consistency was 4.4 ± 4.0 mm and 5.4 ± 2.9 mm for the normal and flat feet, respectively. In both these cases, the consistency was better than what was achieved by using principal axes of inertia. Curvature variation in the arches were well described and the measurements of the Djiann-Annoier angles from both normal and flat feet matched corresponding clinical observations. The angle between tibio-talar MHA and ARS mediolateral axis in the talus was 12.3 ± 6.0, while the angle between talo-calcaneal MHA and ARS anteroposterior axis in the calcaneus was 17.2 ± 5.6, suggesting good capability to represent joint kinematics. Conclusions The proposed ARS definitions are robust and provide a solid base for the 3-dimensional description of posture and motion of the foot and ankle complex from medical imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00504-5.
Collapse
Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy.
| | - Alessandro Pompili
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Durante
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| |
Collapse
|
6
|
Li HY, Cao L, Li H, Hua YH, Chen SY. Decreasing the Abnormal Internally Rotated Talus After Lateral Ankle Stabilization Surgery. Orthop J Sports Med 2021; 9:23259671211023447. [PMID: 34485582 PMCID: PMC8414625 DOI: 10.1177/23259671211023447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Increased internal rotation of the talus has been found in patients with mechanical ankle instability (MAI). Purpose/Hypothesis To evaluate and compare the talar rotation position before and after lateral ankle lateral stabilization surgery in patients with MAI. We hypothesized that the abnormal internal talus rotation in patients with MAI will decrease after surgery for ankle lateral instability and that there will be no significant difference in internal talus rotation between the ligament repair and reconstruction groups. Study Design Case-control study; Level of evidence, 3. Methods We retrospectively studied 56 patients with MAI who underwent ankle lateral stabilization surgery after arthroscopic evaluation (repair, 36 cases; reconstruction, 20 cases). Before and after the operation, magnetic resonance images of all the participants were reviewed. The rotated position of the talus was measured and calculated by the Malleolar Talus Index at the magnetic resonance axial plane. Results The internal rotation of the talus decreased significantly after ankle lateral stabilization surgery in patients with MAI as compared with before surgery (mean ± SD, 83.3° ± 3.3° vs 86.7° ± 3.9°; P < .01). However, there was no statistically significant difference between the ligament repair and reconstruction groups before or after the operation. Conclusion Abnormal internal rotation of the talus in patients with MAI was decreased after ankle lateral stabilization surgery.
Collapse
Affiliation(s)
- Hong-Yun Li
- Sports Medicine Center of Fudan University; Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Li Cao
- Department of Nursing, Huashan Hospital, Shanghai, China
| | - Hong Li
- Sports Medicine Center of Fudan University; Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Ying-Hui Hua
- Sports Medicine Center of Fudan University; Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Shi-Yi Chen
- Sports Medicine Center of Fudan University; Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| |
Collapse
|
7
|
Zhang YJ, Long X, Du JY, Liu T, Lin XJ. Effect of soft inflatable orthosis on the medial longitudinal arch in patients with flexible flatfoot deformity. Clin Biomech (Bristol, Avon) 2021; 88:105418. [PMID: 34216988 DOI: 10.1016/j.clinbiomech.2021.105418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthoses can stabilize the foot and restore the medial longitudinal arch for symptomatic flexible flatfoot. However, the effectiveness of orthoses remains controversial. The purpose of this study was to evaluate effectiveness of a customized soft inflatable orthosis on the medial longitudinal arch of flexible flatfoot patients under load. METHODS We obtained CT scans of the feet of 14 healthy volunteers and 14 patients with flexible flatfoot under non- and simulated weight-bearing conditions. Then CT scans under the same conditions were taken for patients with flexible flatfoot equipped with soft inflatable orthosis. Three-dimensional models of the medial longitudinal arch and hindfoot were constructed from CT images. The three-dimensional mobility of the medial longitudinal arch joints under load was compared between patients with flexible flatfoot equipped with soft inflatable orthosis or not. FINDINGS From non- to simulated weight-bearing condition, the eversion and dorsiflexion of the talocalcaneal joint, the eversion of the talonavicular joint, the abduction and dorsiflexion of the cuneonavicular joint, and the dorsiflexion of the first tarsometatarsal joint were significantly larger in patients with flexible flatfoot than healthy volunteers. The customized soft inflatable orthosis could reduce the eversion of the talonavicular joint and the eversion and dorsiflexion of the talocalcaneal joint. INTERPRETATION The soft inflatable orthosis is effective to improve medial longitudinal arch height and reduce excessive mobility of joints for flexible flatfoot deformity. The results of this study could provide evidence for the optimal orthosis design to treat flexible flatfoot in the future.
Collapse
Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China.
| | - Xiao Long
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Jing-Yu Du
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| | - Tao Liu
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University School of Mechanical Engineering, Hangzhou 310027, PR China.
| | - Xiang-Jin Lin
- Department of Orthopedics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, PR China
| |
Collapse
|
8
|
Kim BH, Lee SY. Validity and Reliability of a Novel Instrument for the Measurement of Subtalar Joint Axis of Rotation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105494. [PMID: 34065532 PMCID: PMC8160632 DOI: 10.3390/ijerph18105494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Inclination of the subtalar joint (STJ) in the sagittal and transverse planes may be highly associated with ankle pathology. However, the validity and reliability of measuring the inclination of the STJ axis of rotation (AoR) is not well established. This study aimed to develop a custom-made STJ locator (STJL) and evaluate its reliability and validity. To establish the reliability and validity of the measurement device for STJ AoR, 38 healthy male participants were recruited. For the reliability analysis, test–retest was used, and for validity analysis, Pearson’s correlation and Bland–Altman plot analyses were performed. In the reliability analysis of the STJL, a higher correlation was observed with the sagittal plane (0.930) and transverse plane (0.748) (standard error of measurement: 0.56–0.78; minimal detectable difference: 1.57–2.16). In the validity analysis between radiography and STJL, a significantly higher value of 0.798 was obtained with radiography (42.5) and STJL (43.5) with the sagittal plane. The custom-made STJL may be used in the clinical setting as its validity and intraclass correlation coefficient were high, indicating consistent measurements. Further studies including motion analysis are necessary to provide more information regarding the relationship between STJ AoR inclinations and STJ movements.
Collapse
Affiliation(s)
- Byong Hun Kim
- Department of Physical Education, Yonsei University, Seoul 03722, Korea;
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, Seoul 03722, Korea;
- International Olympic Committee Research Centre Korea, Yonsei University, Seoul 03722, Korea
- Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2123-6189; Fax: +82-2-2123-8375
| |
Collapse
|
9
|
Garetier M, Borotikar B, Makki K, Brochard S, Rousseau F, Ben Salem D. Dynamic MRI for articulating joint evaluation on 1.5 T and 3.0 T scanners: setup, protocols, and real-time sequences. Insights Imaging 2020; 11:66. [PMID: 32430739 PMCID: PMC7237553 DOI: 10.1186/s13244-020-00868-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/02/2020] [Indexed: 01/31/2023] Open
Abstract
Dynamic magnetic resonance imaging (MRI) is a non-invasive method that can be used to increase the understanding of the pathomechanics of joints. Various types of real-time gradient echo sequences used for dynamic MRI acquisition of joints include balanced steady-state free precession sequence, radiofrequency-spoiled sequence, and ultra-fast gradient echo sequence. Due to their short repetition time and echo time, these sequences provide high temporal resolution, a good signal-to-noise ratio and spatial resolution, and soft tissue contrast. The prerequisites of the evaluation of joints with dynamic MRI include suitable patient installation and optimal positioning of the joint in the coil to allow joint movement, sometimes with dedicated coil support. There are currently few recommendations in the literature regarding appropriate protocol, sequence standardizations, and diagnostic criteria for the use of real-time dynamic MRI to evaluate joints. This article summarizes the technical parameters of these sequences from various manufacturers on 1.5 T and 3.0 T MRI scanners. We have reviewed pertinent details of the patient and coil positioning for dynamic MRI of various joints. The indications and limitations of dynamic MRI of joints are discussed.
Collapse
Affiliation(s)
- Marc Garetier
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest, Cedex 9, France. .,Department of Radiology, University Hospital Morvan, Brest, France. .,Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.
| | - Bhushan Borotikar
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,University Hospital, Brest, France
| | - Karim Makki
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Sylvain Brochard
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Physical and Medical Rehabilitation, University Hospital Morvan, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, Fondation Ildys, Brest, France
| | - François Rousseau
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Douraïed Ben Salem
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Radiology, University Hospital La Cavale Blanche, Brest, France
| |
Collapse
|
10
|
Functional limitations after lateral column lengthening osteotomy of the calcaneus are associated with lower quality of life. INTERNATIONAL ORTHOPAEDICS 2020; 44:1091-1097. [PMID: 32170470 DOI: 10.1007/s00264-020-04526-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to quantify limitations in sagittal ankle range of motion (ROM) at least two years after lateral column lengthening osteotomy of the calcaneus (LLC) and their implications regarding quality of life. METHODS Fifteen patients with a mean follow-up of 80 ± 27 months after LLC and 15 age-matched healthy persons participated in this study. Ankle joint complex ROM in plantarflexion and dorsiflexion was measured bilaterally using a goniometer and fluoroscopy (patients only). Quality of life was assessed using the short-form health questionnaire (SF36). Differences in ROM parameters (for the tibiotalar and subtalar joint) between sides (affected vs. unaffected) and between groups (patient vs. controls) and the relationship between ROM parameters and quality of life scores were assessed. RESULTS ROM of the ankle joint complex on the affected side in patients was smaller than on the contralateral side (goniometer and fluoroscopy) and in healthy persons (goniometer; all P < .05). Among patients, SF36 total and pain scores, respectively, correlated with ROM of the subtalar joint (fluoroscopy; R = 0.379, P = 0.039 and R = 0.537, P = 0.001). Among patients and healthy persons, those with smaller dorsiflexion (goniometer) had lower quality of life scores. CONCLUSIONS The smaller sagittal ROM of the affected ankle joint complex compared with the contralateral foot and healthy controls was mainly explained by limitations in the tibiotalar joint. Because of its association with quality of life, ROM should be considered in the treatment and rehabilitation planning in patients who are candidates for LLC.
Collapse
|
11
|
Benemerito I, Modenese L, Montefiori E, Mazzà C, Viceconti M, Lacroix D, Guo L. An extended discrete element method for the estimation of contact pressure at the ankle joint during stance phase. Proc Inst Mech Eng H 2020; 234:507-516. [PMID: 32036769 PMCID: PMC7469707 DOI: 10.1177/0954411920905434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abnormalities in the ankle contact pressure are related to the onset of osteoarthritis. In vivo measurements are not possible with currently available techniques, so computational methods such as the finite element analysis (FEA) are often used instead. The discrete element method (DEM), a computationally efficient alternative to time-consuming FEA, has also been used to predict the joint contact pressure. It describes the articular cartilage as a bed of independent springs, assuming a linearly elastic behaviour and absence of relative motion between the bones. In this study, we present the extended DEM (EDEM) which is able to track the motion of talus over time. The method was used, with input data from a subject-specific musculoskeletal model, to predict the contact pressure in the ankle joint during gait. Results from EDEM were also compared with outputs from conventional DEM. Predicted values of contact area were larger in EDEM than they were in DEM (4.67 and 4.18 cm2, respectively). Peak values of contact pressure, attained at the toe-off, were 7.3 MPa for EDEM and 6.92 MPa for DEM. Values predicted from EDEM fell well within the ranges reported in the literature. Overall, the motion of the talus had more effect on the extension and shape of the pressure distribution than it had on the magnitude of the pressure. The results indicated that EDEM is a valid methodology for the prediction of ankle contact pressure during daily activities.
Collapse
Affiliation(s)
- Ivan Benemerito
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Automatic Control and Systems Engineering, The University of Sheffield, Sheffield, UK
| | - Luca Modenese
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Erica Montefiori
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Claudia Mazzà
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Damien Lacroix
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Lingzhong Guo
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Automatic Control and Systems Engineering, The University of Sheffield, Sheffield, UK
| |
Collapse
|
12
|
Wenning M, Lohrer H, Gollhofer A, Gehring D. In vivo arthrometer measurements of mechanical ankle instability-A systematic review. J Orthop Res 2019; 37:1133-1142. [PMID: 30908733 DOI: 10.1002/jor.24280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/25/2019] [Indexed: 02/04/2023]
Abstract
Chronic ankle instability is caused by functional and/or mechanical deficits. To differentiate the two entities, mechanical ankle instability can be assessed using arthrometers. The measurement of mechanical instability is essential, since it can only be addressed surgically. The aim of this systematic literature review was to find out whether chronic mechanical ankle instability could be adequately and objectively assessed using in vivo arthrometer measurements. Articles were included if the main focus was to evaluate the contribution of mechanical deficits to chronic ankle instability and if they provided sufficient description of the device used. This systematic review was performed according to the PRISMA-recommendations. Initially 47 articles were screened for eligibility, of which 33 studies reporting 10 different devices were included. While the reliability of the measurements was mostly good to excellent, only two studies aimed to assess the sensitivity and specificity of their results in regard to chronic ankle instability. Several devices reported conflicting results about mechanical deficits. In summary, this systematic review reveals a substantial deficit in diagnostic accuracy when assessing mechanical ankle instability in a clinical setting. Biases in recruiting and classification of participants raise the question whether the two entities of functional and mechanical ankle instability are properly defined. Clinical Significance: In recent years, this may have led to a misinterpretation of mechanical deficits and the subsequent need for surgical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Collapse
Affiliation(s)
- Markus Wenning
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
| | - Heinz Lohrer
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany.,European SportsCare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany.,Lilium-Klinik, Borsigstrasse 2, 65205 Wiesbaden-Nordenstadt, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
| | - Dominic Gehring
- Department of Sport and Sport Science, University of Freiburg, Freiburg 79117, Germany
| |
Collapse
|
13
|
Chappell A, Liew B, Murphy AT, Gibson N, Allison GT, Williams G, Morris SL. The effect of joint translation constraint on within-participant variability of kinematics and kinetics during running in cerebral palsy. Clin Biomech (Bristol, Avon) 2019; 63:54-62. [PMID: 30844578 DOI: 10.1016/j.clinbiomech.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical data in cerebral palsy are inherently variable but no optimal model of translational joint constraint has been identified. The primary aim of this study was to determine which model of translational joint constraint resulted in the lowest within-participant variability of lower limb joint angles and moments. The secondary aim was to determine which model best distinguished known functional groups in Cerebral Palsy. METHODS Three models (three degrees of freedom, six degrees of freedom and six degrees of freedom with specified joint translation constraint) were applied to data from running trials of 40 children with cerebral palsy. FINDINGS Joint angle standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model (p < 0.050). For all joints in all planes of motion, joint moment standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model; standard deviations using the constrained model were smaller than the three degrees of freedom model by 10-30% of moment magnitude (0.01-0.03 Nm/kg; p < 0.001). The six degrees of freedom models distinguished functional subgroups with larger effect size than the three degrees of freedom model only for hip power generation in swing. INTERPRETATION A model with specified joint constraint minimized within-participant variability during running and was useful for detecting differences in functional capacity in cerebral palsy.
Collapse
Affiliation(s)
- A Chappell
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
| | - B Liew
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - A T Murphy
- Clinical Research Centre for Movement Disorders and Gait, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - N Gibson
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia.
| | - G T Allison
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - G Williams
- School of Health Sciences, University of Melbourne, Victoria, Australia; Epworth HealthCare, Victoria, Australia.
| | - S L Morris
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
14
|
Makki K, Borotikar B, Garetier M, Brochard S, Ben Salem D, Rousseau F. In vivo ankle joint kinematics from dynamic magnetic resonance imaging using a registration-based framework. J Biomech 2019; 86:193-203. [DOI: 10.1016/j.jbiomech.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
|
15
|
Children with cerebral palsy have larger Achilles tendon moment arms than typically developing children. J Biomech 2019; 82:307-312. [DOI: 10.1016/j.jbiomech.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/14/2018] [Accepted: 11/02/2018] [Indexed: 01/19/2023]
|
16
|
Borotikar B, Lempereur M, Lelievre M, Burdin V, Ben Salem D, Brochard S. Dynamic MRI to quantify musculoskeletal motion: A systematic review of concurrent validity and reliability, and perspectives for evaluation of musculoskeletal disorders. PLoS One 2017; 12:e0189587. [PMID: 29232401 PMCID: PMC5726646 DOI: 10.1371/journal.pone.0189587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report evidence for the concurrent validity and reliability of dynamic MRI techniques to evaluate in vivo joint and muscle mechanics, and to propose recommendations for their use in the assessment of normal and impaired musculoskeletal function. Materials and methods The search was conducted on articles published in Web of science, PubMed, Scopus, Academic search Premier, and Cochrane Library between 1990 and August 2017. Studies that reported the concurrent validity and/or reliability of dynamic MRI techniques for in vivo evaluation of joint or muscle mechanics were included after assessment by two independent reviewers. Selected articles were assessed using an adapted quality assessment tool and a data extraction process. Results for concurrent validity and reliability were categorized as poor, moderate, or excellent. Results Twenty articles fulfilled the inclusion criteria with a mean quality assessment score of 66% (±10.4%). Concurrent validity and/or reliability of eight dynamic MRI techniques were reported, with the knee being the most evaluated joint (seven studies). Moderate to excellent concurrent validity and reliability were reported for seven out of eight dynamic MRI techniques. Cine phase contrast and real-time MRI appeared to be the most valid and reliable techniques to evaluate joint motion, and spin tag for muscle motion. Conclusion Dynamic MRI techniques are promising for the in vivo evaluation of musculoskeletal mechanics; however results should be evaluated with caution since validity and reliability have not been determined for all joints and muscles, nor for many pathological conditions.
Collapse
Affiliation(s)
- Bhushan Borotikar
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
- * E-mail:
| | - Mathieu Lempereur
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
| | | | - Valérie Burdin
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
| | - Douraied Ben Salem
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- Université de Bretagne Occidentale, Brest, France
- CHRU de Brest, Neuroradiologie, Imagerie Médico-Légale, Brest, France
| | - Sylvain Brochard
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
- Université de Bretagne Occidentale, Brest, France
| |
Collapse
|
17
|
Kim JB, Yi Y, Kim JY, Cho JH, Kwon MS, Choi SH, Lee WC. Weight-bearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane. Skeletal Radiol 2017; 46:1071-1080. [PMID: 28432396 DOI: 10.1007/s00256-017-2655-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). MATERIALS AND METHODS We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. RESULTS In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). CONCLUSION Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis.
Collapse
Affiliation(s)
- Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 764-30, Bang bae dong, Seochogu, Seoul, 06554, Republic of Korea
| | - Young Yi
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 764-30, Bang bae dong, Seochogu, Seoul, 06554, Republic of Korea
| | - Jae-Young Kim
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea
| | - Jae-Ho Cho
- Department of Orthopaedic Surgery, Hallym University, ChunCheon Sacred Heart Hospital, 153 Gyo-dong, Chuncheon, GangWon-do, 200-704, Republic of Korea
| | - Min-Soo Kwon
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea
| | - Seung-Hyuk Choi
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul, 100-032, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 764-30, Bang bae dong, Seochogu, Seoul, 06554, Republic of Korea.
| |
Collapse
|
18
|
Subject-Specific Axes of Rotation Based on Talar Morphology Do Not Improve Predictions of Tibiotalar and Subtalar Joint Kinematics. Ann Biomed Eng 2017. [PMID: 28639171 DOI: 10.1007/s10439-017-1874-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Use of subject-specific axes of rotation may improve predictions generated by kinematic models, especially for joints with complex anatomy, such as the tibiotalar and subtalar joints of the ankle. The objective of this study was twofold. First, we compared the axes of rotation between generic and subject-specific ankle models for ten control subjects. Second, we quantified the accuracy of generic and subject-specific models for predicting tibiotalar and subtalar joint motion during level walking using inverse kinematics. Here, tibiotalar and subtalar joint kinematics measured in vivo by dual-fluoroscopy served as the reference standard. The generic model was based on a cadaver study, while the subject-specific models were derived from each subject's talus reconstructed from computed tomography images. The subject-specific and generic axes of rotation were significantly different. The average angle between the modeled axes was 12.9° ± 4.3° and 24.4° ± 5.9° at the tibiotalar and subtalar joints, respectively. However, predictions from both models did not agree well with dynamic dual-fluoroscopy data, where errors ranged from 1.0° to 8.9° and 0.6° to 7.6° for the generic and subject-specific models, respectively. Our results suggest that methods that rely on talar morphology to define subject-specific axes may be inadequate for accurately predicting tibiotalar and subtalar joint kinematics.
Collapse
|
19
|
Alexander C, Lum I, Reid S, Clarke E, Stannage K, El-Sallam Abd A, Herbert R, Donnelly C. A simple but reliable method for measuring 3D Achilles tendon moment arm geometry from a single, static magnetic resonance scan. J Biomech 2017; 55:134-138. [DOI: 10.1016/j.jbiomech.2017.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/03/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
|
20
|
Nichols JA, Roach KE, Fiorentino NM, Anderson AE. Predicting tibiotalar and subtalar joint angles from skin-marker data with dual-fluoroscopy as a reference standard. Gait Posture 2016; 49:136-143. [PMID: 27414041 PMCID: PMC5810542 DOI: 10.1016/j.gaitpost.2016.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 02/02/2023]
Abstract
Evidence suggests that the tibiotalar and subtalar joints provide near six degree-of-freedom (DOF) motion. Yet, kinematic models frequently assume one DOF at each of these joints. In this study, we quantified the accuracy of kinematic models to predict joint angles at the tibiotalar and subtalar joints from skin-marker data. Models included 1 or 3 DOF at each joint. Ten asymptomatic subjects, screened for deformities, performed 1.0m/s treadmill walking and a balanced, single-leg heel-rise. Tibiotalar and subtalar joint angles calculated by inverse kinematics for the 1 and 3 DOF models were compared to those measured directly in vivo using dual-fluoroscopy. Results demonstrated that, for each activity, the average error in tibiotalar joint angles predicted by the 1 DOF model were significantly smaller than those predicted by the 3 DOF model for inversion/eversion and internal/external rotation. In contrast, neither model consistently demonstrated smaller errors when predicting subtalar joint angles. Additionally, neither model could accurately predict discrete angles for the tibiotalar and subtalar joints on a per-subject basis. Differences between model predictions and dual-fluoroscopy measurements were highly variable across subjects, with joint angle errors in at least one rotation direction surpassing 10° for 9 out of 10 subjects. Our results suggest that both the 1 and 3 DOF models can predict trends in tibiotalar joint angles on a limited basis. However, as currently implemented, neither model can predict discrete tibiotalar or subtalar joint angles for individual subjects. Inclusion of subject-specific attributes may improve the accuracy of these models.
Collapse
Affiliation(s)
- Jennifer A. Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, 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, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240 Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Correspondence address: Andrew E. Anderson, PhD, University of Utah, Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, 590 Wakara Way, Salt Lake City, UT 84108, +1 801 587-5208
| |
Collapse
|
21
|
Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1022-8. [PMID: 26515772 DOI: 10.1007/s00167-015-3828-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/06/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy. METHODS Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position. RESULTS Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p < 0.001). CONCLUSION Stress ultrasound may be useful for the diagnosis of chronic ankle instability in addition to the manual anterior drawer test and stress radiography. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Jae Ho Cho
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Doo Hyung Lee
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Joon Young Bang
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Kyung Tai Lee
- Foot and Ankle Service, KT Lee's Orthopedic Hospital, Seoul, Republic of Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
| |
Collapse
|
22
|
McHenry BD, Exten E, Long JT, Harris GF. Sagittal Fluoroscopy for the Assessment of Hindfoot Kinematics. J Biomech Eng 2016; 138:4032445. [PMID: 26746901 DOI: 10.1115/1.4032445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Indexed: 11/08/2022]
Abstract
Current methods of quantifying foot kinematics during gait typically use markers placed externally on bony anatomic locations. These models are unable to analyze talocrural or subtalar motion because the talus lacks palpable landmarks to place external markers. Alternative methods of measuring these clinically relevant joint motions are invasive and have been limited to research purposes only. This study explores the use of fluoroscopy to noninvasively quantify talocrural and subtalar sagittal plane kinematics. A fluoroscopy system (FS) was designed and built to synchronize with an existing motion analysis system (MAS). Simultaneous fluoroscopic, marker motion, and ground reaction force (GRF) data were collected for five subjects to demonstrate system application. A hindfoot sagittal plane model was developed to evaluate talocrural and subtalar joint motion. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at 12% and 83% of stance, respectively, with a range of motion of 20.1 deg. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at toe-off and 67% of stance, respectively, with a range of motion of 8.7 deg. Based on the favorable comparison between the current fluoroscopically measured kinematics and previously reported results from alternative methods, it is concluded that fluoroscopic technology is well suited for measuring the sagittal plane hindfoot motion.
Collapse
|
23
|
Xu J, Zhang Y, Muhammad H, Wang X, Huang J, Zhang C, Geng X, Ma X. In vivo three-dimensional analysis of hindfoot kinematics in stage II PTTD flatfoot. J Orthop Sci 2015; 20:488-97. [PMID: 25666487 DOI: 10.1007/s00776-015-0698-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aims to evaluate the rotation and translation of each joint in the hindfoot and compare the differences in healthy foot with that in stage II PTTD flatfoot by analyzing the reconstructive three-dimensional (3D) computed tomography (CT) image data during several extreme positions. METHODS CT scans of 20 healthy feet and 20 feet with stage II PTTD flatfoot were taken in maximal positions of plantarflexion, dorsiflexion, inversion, eversion, external rotation and internal rotation conditions. The images of the hindfoot bones were reconstructed into 3D models. The "twice registration" method was used to calculate the spatial changes of the talus relative to the calcaneus in the talocalcaneal joint, the navicular relative to the talus in talonavicular joint, and the cuboid relative to the calcaneus in the calcaneocuboid joint. RESULTS Compared with normal participants, with the calcaneus relative to the talus, participants with stage II PTTD flatfoot presented more dorsiflexion (p < 0.05), adduction (p < 0.05), and eversion (p < 0.05) in rotation, and more anterior (p < 0.05) and distal translation (p < 0.05) from maximal plantarflexion to maximal dorsiflexion; more dorsiflexion (p < 0.05), eversion (p < 0.05), and abduction (p < 0.05) in rotation and more lateral translation (p < 0.05) from maximal inversion to maximal eversion; and a greater degree of adduction (p < 0.05) in rotation, and more lateral (p < 0.05) and posterior translation (p < 0.05) from maximal internal rotation to maximal external rotation condition. For navicular relative to the talus, they demonstrated more eversion (p < 0.05) and adduction (p < 0.05) in rotation, and more lateral (p < 0.05), anterior (p < 0.05), and distal translation (p < 0.05) from maximal plantarflexion to maximal dorsiflexion; more eversion (p < 0.05) and adduction (p < 0.05) in rotation, and more lateral (p < 0.05) and proximal (p < 0.05) translation from maximal inversion to maximal eversion; more eversion (p < 0.05) and abduction (p < 0.05) in rotation and more lateral (p < 0.05) translation from maximal internal to maximal external rotation condition. The cuboid position relative to the calcaneus in the calcaneocuboid joint did not change significantly in rotation and translation in different positions (p > 0.05). CONCLUSIONS As previous studies shown, regarding both of the cadaveric foot and the live foot, hindfoot joint instability occurred in patients with stage II PTTD flatfoot.
Collapse
Affiliation(s)
- Jian Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, 200040, Shanghai, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Leardini A, O'Connor JJ, Giannini S. Biomechanics of the natural, arthritic, and replaced human ankle joint. J Foot Ankle Res 2014; 7:8. [PMID: 24499639 PMCID: PMC3918177 DOI: 10.1186/1757-1146-7-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 02/03/2014] [Indexed: 11/16/2022] Open
Abstract
The human ankle joint complex plays a fundamental role in gait and other activities of daily living. At the same time, it is a very complicated anatomical system but the large literature of experimental and modelling studies has not fully described the coupled joint motion, position and orientation of the joint axis of rotation, stress and strain in the ligaments and their role in guiding and stabilizing joint motion, conformity and congruence of the articular surfaces, patterns of contact at the articular surfaces, patterns of rolling and sliding at the joint surfaces, and muscle lever arm lengths. The present review article addresses these issues as described in the literature, reporting the most recent relevant findings.
Collapse
Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | | |
Collapse
|
25
|
Kobayashi T, Saka M, Suzuki E, Yamazaki N, Suzukawa M, Akaike A, Shimizu K, Gamada K. In vivo kinematics of the talocrural and subtalar joints during weightbearing ankle rotation in chronic ankle instability. Foot Ankle Spec 2014; 7:13-9. [PMID: 24334366 DOI: 10.1177/1938640013514269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronic ankle instability (CAI) results in abnormal ankle kinematics, but there exists limited quantitative data characterizing these alterations. This study was undertaken to investigate kinematic alterations of the talocrural and subtalar joints in CAI. METHODS A total of 14 male patients with unilateral CAI (mean age = 21.1 ± 2.5 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities during weightbearing passive ankle joint complex (AJC) rotation were obtained. Three-dimensional bone models created from the computed tomography images were matched with the fluoroscopic images to compute the 6 degrees-of-freedom talocrural, subtalar, and AJC kinematics. RESULTS In 20° plantarflexion, ankles with CAI demonstrated significantly increased anterior translation of the talocrural joint during AJC internal rotation from 5° to 7° and significantly decreased talocrural internal rotation within an AJC arc of motion from -1° to 5°. CAI joints demonstrated significantly increased internal rotation of the subtalar joint within an AJC arc of motion from -1° to 3°. DISCUSSION In CAI, altered subtalar internal rotation occurs with increased talocrural anterior translation and reduced talocrural internal rotation during weightbearing ankle internal rotation in plantarflexion. These results suggest that altered subtalar mechanics may contribute to CAI symptoms.
Collapse
Affiliation(s)
- Takumi Kobayashi
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima (TK, MS, KG)
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Marquez-Barrientos C, Liu XC, Lyon R, Tassone C, Thometz J, Tarima S. Correlation between anatomic foot and ankle movement measured with MRI and with a motion analysis system. Gait Posture 2012; 36:389-93. [PMID: 22542241 DOI: 10.1016/j.gaitpost.2012.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 03/14/2012] [Accepted: 03/27/2012] [Indexed: 02/02/2023]
Abstract
Several studies have attempted to measure how well external markers track internal bone movement using pins drilled into the foot, but this is too invasive for the pediatric population. This study investigated how well a six segment foot model (6SFM) using external markers was able to measure bone movement in the foot compared to MRI measurements. The foot was moved into different positions using a plastic foot jig and measurements were taken with both systems. The aims were to: (1) Look at the correlation between movement tracked with an Electronic Motion Tracking System (EMTS) and by measurements derived from MRI images, specifically the principal intercept angles (PIAs) which are the angles of intersection between principal axes of inertia of bone volumes. (2) To see how well external motion measured by the 6SFM could predict PIAs. Four bone pairs had their movement tracked: Tibia-Calcaneus, Calcaneus-Cuboid, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux. The results showed moderate correlation between measured PIAs and those predicted at the Tibia-Calcaneus, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux joints. Moderate to high correlation was found between the PIA and movement in a single anatomic plane for all four joints at several positions. The 6SFM using the EMTS allows reliable tracking of 3D rotations in the pediatric foot, except at the Calcaneus-Cuboid joint.
Collapse
Affiliation(s)
- C Marquez-Barrientos
- Children's Hospital of Wisconsin, The Musculoskeletal Functional Assessment Center, United States
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
Magnetic resonance imaging-based methods for measuring the mechanics of human joints have been successfully applied to quantitatively evaluate biomechanics in a wide variety of joints, pathologies, and interventions. The objective of this review was to provide a detailed overview of methods in the literature for measuring joint kinematics, meniscal and ligament movement, and cartilage strain using MRI.
Collapse
|
28
|
Akiyama K, Sakai T, Sugimoto N, Yoshikawa H, Sugamoto K. Three-dimensional distribution of articular cartilage thickness in the elderly talus and calcaneus analyzing the subchondral bone plate density. Osteoarthritis Cartilage 2012; 20:296-304. [PMID: 22281263 DOI: 10.1016/j.joca.2011.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/27/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To unveil the three-dimensional (3D) distribution of talocrural and posterior subtalar articular cartilage thickness in the elderly cadavers using 3D computed tomography (CT) and a 3D-digitizer and to evaluate the relationship between subchondral bone plate density and the overlying cartilage thickness. DESIGN Sixteen tali and 16 calcanei from eight cadavers were scanned with 3D-CT to create bone surface models, and with a 3D-digitizer to make cartilage surface models. These two surface models were merged using surface registration method. Articular cartilage thickness was evaluated as the distance between the two models, and the distribution was mapped. The anatomic cartilage thickness of five tali and five calcanei was compared with the distance between the cartilage and bone surface models to calculate optimum threshold for extracting the subchondral bone plate. Generalized estimating equations were used for comparison and measurement errors. Canonical correlation analysis was performed to determine the strength of association between subchondral bone plate threshold and cartilage thickness. RESULTS The talar-subtalar articular cartilage tended to be the thickest of the three joints. In the talocrural joint, the anterior region was the thinnest, and increasing cartilage thickness was seen toward the posterior. In the talar-subtalar joint, the central region was the thickest. Mean measurement errors were 0.059±0.066 mm, 0.038±0.040 mm, and 0.018±0.065 mm in the talocrural, talar-subtalar, and calcaneal-subtalar joints, respectively. The canonical correlation coefficient was 0.995 (P<0.001). CONCLUSIONS The articular cartilage thickness was distributed in the elderly hindfoot. The subchondral bone plate density was significantly correlated with the anatomic cartilage thickness.
Collapse
Affiliation(s)
- K Akiyama
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan.
| | | | | | | | | |
Collapse
|
29
|
Barg A, Tochigi Y, Amendola A, Phisitkul P, Hintermann B, Saltzman CL. Subtalar instability: diagnosis and treatment. Foot Ankle Int 2012; 33:151-60. [PMID: 22381348 DOI: 10.3113/fai.2012.0151] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Subtalar instability is challenging to diagnose. It rarely follows a complete subtalar dislocation, an event more likely to result in subtalar pain, stiffness, and arthritis. By history, subtalar instability can be suggested by the patient’s feeling of ankle instability, easy “rolling over,” and a need to look at the ground constantly when walking. Clinical measures for inversion and eversion do not accurately reflect isolated subtalar motion, as soft tissue and other joint motion confound the examination. Stress radiographs have high false positive rates. Magnetic resonance imaging can show injured or disorganized ligaments suggestive of recurrent subtalar strain, but are not dynamic studies and cannot alone diagnose instability. Operative treatment, when elected, should focus on determining the source of the problem. Generally direct repair of the lateral ligaments is sufficient. Bony malalignment should always be considered especially in the setting when previous ligament reconstruction has failed.
Collapse
Affiliation(s)
- Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, CH-4410 Liestal, Switzerland.
| | | | | | | | | | | |
Collapse
|
30
|
Sheehan FT. The 3D in vivo Achilles' tendon moment arm, quantified during active muscle control and compared across sexes. J Biomech 2011; 45:225-30. [PMID: 22138193 DOI: 10.1016/j.jbiomech.2011.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 11/01/2011] [Accepted: 11/05/2011] [Indexed: 10/14/2022]
Abstract
The Achilles' tendon moment arm (ATma) is a critical quantity in that it defines the triceps surae's ability to generate a moment on the calcaneus, which is then transferred to the foot. This measure has been primarily acquired two-dimensionally in small male populations. Thus, the primary purpose of this study was to establish the first in vivo three-dimensional measures of the ATma, measured non-invasively during dynamic activity in a large normative population, inclusive of both males and female subjects (n=20). Subjects were each placed supine in a 1.5 T MRI and asked to repeat a simulated toe-raise while a full sagittal-cine-phase contrast (dynamic) MRI dataset was acquired. From these data, the 3D and 2D ATma was calculated. The ATma was scaled by the distal tibial width, based on a correlation analysis. The 2D ATma overestimated its 3D counterpart by 3.1 mm, on average. The scaled ATma was no different between the male and female cohorts, but the scaled Achilles' tendon area was smaller in the male cohort. The magnitudes of the ATma were most similar to previously reported values when variations in ankle angle were taken into account. The results of this study have important implications for the applicability of ATma data to both clinical questions and modeling. Any future studies should adapt the ATma based on subject size and/or sex, ensure compatibility between the manner in which the ankle angle is defined and the data being used, and account for the influence that muscle force has on the 3D ATma.
Collapse
Affiliation(s)
- Frances T Sheehan
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD 20892-1604, USA.
| |
Collapse
|
31
|
Features of hindfoot 3D kinetics in flat foot in ankle-joint maximal dorsiflexion and plantarflexion. J Orthop Sci 2011; 16:638-43. [PMID: 21674204 DOI: 10.1007/s00776-011-0103-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/12/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND It is difficult to evaluate the kinematics of flat foot from 2D images, and no definitive methods have so far been established to diagnose flat foot. This study evaluated hindfoot kinetics through the progression of posterior tibial tendon dysfunction (PTTD) in patients with stages II and III PTTD flat foot compared with those in normal patients under dorsiflexion and plantarflexion conditions using 3D computed tomography (CT) reconstruction images. MATERIALS CT images were taken of 26 normal and 32 flat feet in neutral, plantarflexion, and dorsiflexion positions of the ankle joint, from which 3D virtual models were made of each hindfoot bone. The 3D bone motion of these models was calculated using volume merge methods in three major planes. RESULTS Tibiotalar-joint motion in ankle-joint plantarflexion became less plantarflexed (normal -41.2°, stage II -33.5°, stage III -25.3°) and less adducted (normal -13.9°, stage II -10.7°, stage III -5.6°) as the stage progressed. Talocalcaneal-joint motion in stage III became more plantarflexed (normal -0.8°, stage II -3.0°, stage III -8.7°) and more adducted (normal -0.3°, stage II -4.7°, stage III -10.3°) as the stage progressed. Talonavicular-joint motion in stage III became more plantarflexed (normal -7.2°, stage II -7.6°, stage III -14.9°) and more adducted (normal 1.0°, stage II -7.3°, stage III -17.9°) as the stage progressed. CONCLUSIONS Tibiotalar-joint plantarflexion decreased and talocalcaneal and talonavicular-joint adduction increased in the maximal ankle-joint plantarflexion in stage II in comparison with normal cases. Tibiotalar-joint plantarflexion and adduction were decreased and of the talocalcaneal and talonavicular joints increased in stage III in comparison with stage II cases.
Collapse
|
32
|
Yamaguchi S, Tanaka Y, Kosugi S, Takakura Y, Sasho T, Banks SA. In vivo kinematics of two-component total ankle arthroplasty during non-weightbearing and weightbearing dorsiflexion/plantarflexion. J Biomech 2011; 44:995-1000. [DOI: 10.1016/j.jbiomech.2011.02.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/19/2011] [Accepted: 02/19/2011] [Indexed: 11/15/2022]
|
33
|
Sheehan FT. The instantaneous helical axis of the subtalar and talocrural joints: a non-invasive in vivo dynamic study. J Foot Ankle Res 2010; 3:13. [PMID: 20626876 PMCID: PMC2912255 DOI: 10.1186/1757-1146-3-13] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 07/13/2010] [Indexed: 11/29/2022] Open
Abstract
Background An understanding of rear-foot (talocrural and subtalar joints) kinematics is critical for diagnosing foot pathologies, designing total ankle implants, treating rear-foot injuries and quantifying gait abnormalities. The majority of kinematic data available have been acquired through static cadaver work or passive in vivo studies. The applicability of these data to dynamic in vivo situations remains unknown. Thus, the purpose of this study was to fully quantify subtalar, talocrural and calcaneal-tibial in vivo kinematics in terms of the instantaneous helical axis (IHA) in twenty-five healthy ankles during a volitional activity that simulated single-leg toe-raises with partial-weight support, requiring active muscle control. Methods Subjects were each placed supine in a 1.5 T MRI and asked to repeat this simulated toe-raise while a full sagittal-cine-phase contrast (dynamic) MRI dataset was acquired. From the cine-phase contrast velocity a full kinematic description for each joint was derived. Results Nearly all motion quantified at the calcaneal-tibial joint was attributable to the talocrural joint. The subtalar IHA orientation and position were highly variable; whereas, the talocrural IHA orientation and position were extremely consistent. Conclusion The talocrural was well described by the IHA and could be modeled as a fixed-hinge joint, whereas the subtalar could not be.
Collapse
Affiliation(s)
- Frances T Sheehan
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
34
|
Tourné Y, Besse JL, Mabit C. Chronic ankle instability. Which tests to assess the lesions? Which therapeutic options? Orthop Traumatol Surg Res 2010; 96:433-46. [PMID: 20493798 DOI: 10.1016/j.otsr.2010.04.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
This paper purpose is to suggest an in-depth approach to diagnose the causes and lesions associated with and consecutive to chronic ankle instability due to ankle collateral ligament laxity. The different therapeutic and medicosurgical options adapted to this diagnostic approach are identified. The diagnostic aim is to precisely locate the ligamentous injuries of the tibiofibular, subtalar, talar and calcanean system, to identify the predisposing factors such as the hindfoot morphology, and any lesions associated with chronicity: anterolateral impingement, fibular injury, osteochondral lesions of the talus dome and early osteoarthritis. Clinical tools are used in particular to identify areas of pain and for comparative analysis of mobility and laxity (ligament testing). There are also radiological tests, weight-bearing plain X-ray (stress X-ray), (alignment of the hind foot, with a Meary view [metal wire circling the heel], arthrosis), dynamic images to confirm and quantify laxity (manually, with a Telos device, with patient-controlled varus) and also more sophisticated techniques (ultrasound, CT arthrogramm, gadolinium enhanced MRI, MR arthrogramm) to identify ligament, tendon and cartilage damages. They are adapted to the lesions which have been identified in the diagnostic work-up: conservative first, to treat proprioceptive deficits (a new neuromuscular reprogramming technique which emphasizes muscle preactivation) and any static disorders (plantar orthotics); then surgical, to repair any collateral ligament (or sometimes subtalar) injury with three types of procedures: tightening the capsuloligamentous structures, ligament reconstruction with reinforcement (using the fibrous periosteum, the frondiform ligament (of Retzius) or tendinous reconstruction with the plantaris muscle, the peroneus tertius or even the calcanean tendon) and tendon tansfer procedures using all or part of the peroneus brevis (whole peroneus brevis and half peroneus brevis procedures). Any additional surgical procedures which may be indicated based on the results of the diagnostic work-up are performed at the same time as primary surgery when possible as needed (medial complex repair, calcaneal realignment osteotomies, talus osteochondral injuries debridment or fixation, anterior and posterior impingement suppression, tendon tears repair). The goal of this diagnostic and therapeutic approach is to stop the progression of laxity and to protect the ankle against degenerative arthritis, which is the main risk in these chronic conditions.
Collapse
Affiliation(s)
- Y Tourné
- Republic Surgical Group, 15, rue de la République, Grenoble, France.
| | | | | | | |
Collapse
|
35
|
Kleipool RP, Blankevoort L. The relation between geometry and function of the ankle joint complex: a biomechanical review. Knee Surg Sports Traumatol Arthrosc 2010; 18:618-27. [PMID: 20300732 DOI: 10.1007/s00167-010-1088-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
This review deals with the relation between the anatomy and function of the ankle joint complex. The questions addressed are how high do the forces in the ankle joint get, where can the joints go (range of motion) and where do they go during walking and running. Finally the role of the ligaments and the articular surfaces is discussed, i.e. how does it happen. The magnitude of the loads on the ankle joint complex are primarily determined by muscle activity and can be as high as four times the body weight during walking. For the maximal range of motion, plantar and dorsiflexion occurs in the talocrural joint and marginally at the subtalar joint. In-eversion takes place at both levels. The functional range of motion is well within the limits of the maximal range of motion. The ligaments do not contribute to the forces for the functional range of motion but determine the maximal range of motion together with the articular surfaces. The geometry of the articular surfaces primarily determines the kinematics. Clinical studies must include these anatomical aspects to better understand the mechanism of injury, recovery, and interventions. Models can elucidate the mechanism by which the anatomy relates to the function. The relation between the anatomy and mechanical properties of the joint structures and joint function should be considered for diagnosis and treatment of ankle joint pathology.
Collapse
Affiliation(s)
- Roeland P Kleipool
- Department of Anatomy, Embryology and Physiology, Academical Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | | |
Collapse
|
36
|
Imai K, Tokunaga D, Takatori R, Ikoma K, Maki M, Ohkawa H, Ogura A, Tsuji Y, Inoue N, Kubo T. In vivo three-dimensional analysis of hindfoot kinematics. Foot Ankle Int 2009; 30:1094-100. [PMID: 19912721 DOI: 10.3113/fai.2009.1094] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of normal bone motion of the foot is important for understanding the gait as well as for various pathologies; however, the pattern of 3D motion is not completely understood. The aim of this study was to quantify the in vivo motion of the tibiotalar joint, talocalcaneal joint, and talonavicular joint in normal adult feet using a noninvasive (e.g., nonsurgical) measurement technique. MATERIALS AND METHODS CT images were taken of both feet of ten normal young adults (six males, four females) in neutral, plantarflexion, and dorsiflexion positions of the ankle joint, from which 3D virtual models were made of each mid-hind foot bones. The 3D bone motion of these models was calculated using volume merge methods in three major planes. These data were used to analyze the relationship between the motion of the ankle joint and each other joint. RESULTS Tibiotalar rotation was observed in dorsiflexion, abduction, and eversion during maximal dorsiflexion of the ankle joint. Talocalcaneal and talonavicular rotation was very small because the ankle joint motion was limited to the sagittal plane. Tibiotalar rotation was also observed in plantarflexion and adduction during maximal plantarflexion of the ankle joint, and talocalcaneal rotation was very small. Talonavicular rotation was observed in plantarflexion and inversion. The motion of the x-axis and the z-axis of tibiotalar joint, and the x-axis and the y-axis of the talonavicular and talocalcaneal joint were associated with the ankle motion. CONCLUSION Bone motion could be easily and accurately calculated using volume merge methods more effectively than it could with other methods. CLINICAL RELEVANCE The data elucidates the baseline segmental motion for comparison with symptomatic subjects which could help us to better understand pathokinematics of various foot and ankle pathologies.
Collapse
Affiliation(s)
- Kan Imai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Yamaguchi S, Sasho T, Kato H, Kuroyanagi Y, Banks SA. Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities. Foot Ankle Int 2009; 30:361-6. [PMID: 19356362 DOI: 10.3113/fai.2009.0361] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding the effect of weightbearing on subtalar and ankle joint kinematics is critical for the diagnosis and treatment of foot disorders. However, dynamic in vivo kinematics of these joints are not well studied. The purpose of this study was to compare in vivo kinematics during nonweightbearing and weightbearing activities in healthy subjects. METHODS Seven healthy subjects with a mean age of 32 (range, 23 to 42) years were enrolled. Oblique lateral fluoroscopic images of nonweightbearing and weightbearing dorsiflexion-plantarflexion activities were recorded. Three dimensional subtalar, ankle, and ankle-subtalar joint complex kinematics were determined using 3D-2D model registration techniques with 3D bone models and single-plane fluoroscopy. RESULTS During the weightbearing activity from 20 degrees dorsiflexion to 15 degrees plantarflexion, the subtalar joint was significantly more everted, dorsiflexed, and abducted, and the calcaneus showed a significantly more posterior position, than during the nonweightbearing activity. The ankle joint was significantly more plantarflexed and adducted during the weightbearing activity than the nonweightbearing activity. The ankle-subtalar joint complex was significantly more everted, and the calcaneus showed significantly greater posterior position than the nonweightbearing activity. CONCLUSION These observations provide basic quantitative descriptions of weightbearing and nonweightbearing kinematics for healthy joints. CLINICAL RELEVANCE These data can serve as the basis for comparison with pathologic feet for both diagnostic and therapeutic purposes.
Collapse
|
38
|
Abstract
INTRODUCTION The current study provides an overview of history and evolution in total ankle arthroplasty. METHODS We conducted a comprehensive literature search without limitations to language. Information from any source, providing evidence of the use ankle of prostheses (e.g. biomechanical testing, cadaveric implantations or clinical use) was evaluated. Data regarding biomechanical concepts, design considerations, published results (patient numbers, surgical method, follow-up, complications and survival rates) were collected. RESULTS Only level IV studies were found. Mobile-bearing prostheses are mainly used in Europe, and fixed-bearing implants are mainly used in the USA. The current designs' failure rate is 10-12% at approximately 5 years. Survival rates vary among different institutions. Increased surgeons' experience is associated with better outcomes. DISCUSSION Biomechanical studies and review of previous implant failures has led to the development of a new generation of implants. CONCLUSIONS Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients.
Collapse
Affiliation(s)
- Nikolaos E Gougoulias
- Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire, UK
| | | | | |
Collapse
|
39
|
Lewis GS, Cohen TL, Seisler AR, Kirby KA, Sheehan FT, Piazza SJ. In vivo tests of an improved method for functional location of the subtalar joint axis. J Biomech 2008; 42:146-51. [PMID: 19010472 DOI: 10.1016/j.jbiomech.2008.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 10/13/2008] [Indexed: 11/16/2022]
Abstract
The subtalar joint is important in frontal plane movement and posture of the hindfoot. Abnormal subtalar joint moments caused by muscle forces and the ground reaction force acting on the foot are thought to play a role in various foot deformities. Calculating joint moments typically requires knowledge of the location of the joint axis; however, location of the subtalar axis from measured movement is difficult because the talus cannot be tracked using skin-mounted markers. The accuracy of a novel technique for locating the subtalar axis was assessed in vivo using magnetic resonance imaging. The method was also tested with skin-mounted markers and video motion analysis. The technique involves applying forces to the foot that cause pure subtalar joint motion (with negligible talocrural joint motion), and then using helical axis decomposition of the resulting tibiocalcaneal motion. The resulting subtalar axis estimates differed by 6 degrees on average from the true best-fit subtalar axes in the MRI tests. Motion was found to have been applied primarily about the subtalar joint with an average of only 3 degrees of talocrural joint motion. The proposed method provides a potential means for obtaining subject-specific subtalar axis estimates which can then be used in inverse dynamic analyses and subject-specific musculoskeletal models.
Collapse
Affiliation(s)
- Gregory S Lewis
- Department of Mechanical and Nuclear Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | | | | | | | | | | |
Collapse
|
40
|
In-vivo range of motion of the subtalar joint using computed tomography. J Biomech 2008; 41:1390-7. [DOI: 10.1016/j.jbiomech.2008.02.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 02/10/2008] [Accepted: 02/21/2008] [Indexed: 11/24/2022]
|