Radiologic and clinical outcomes of an arthroscopic bridging graft for irreparable rotator cuff tears with a modified MasonAllen stitch using a plantaris tendon autograft: a case series with minimum 2-year outcomes

Orthopedic surgeon level joint angle assessment with artificial intelligence based on photography: a pilot study

Accurate assessment of shoulder range of motion (ROM) is crucial for evaluating patient progress. Traditional manual goniometry often lacks precision and is subject to inter-observer variability, especially in measuring shoulder internal rotation (IR). This study introduces an artificial intelligence (AI)-based approach that uses clinical photography to improve the accuracy of ROM quantification. We analyzed a total of 150 clinical photographs, including 100 shoulder and 50 elbow images, taken between January and April 2022. An MMPose model with an HR-NET backbone architecture, pre-trained on the COCO-WholeBody dataset, was used to detect 17 anatomical landmarks. A random forest classifier (PoseRF) then categorized poses, and ROM angles were calculated. Concurrently, two clinicians independently measured shoulder IR at the vertebral level, and inter-observer agreement was evaluated. Linear regression analyses were conducted to correlate the AI-derived measurements with the clinicians' assessments. The AI-based algorithm accurately detected anatomical landmarks in 96% of shoulder and 100% of elbow images. Pose detection achieved 95% accuracy overall, with 100% accuracy for specific shoulder (abduction, flexion, external rotation) and elbow (flexion, extension) poses. Intraclass correlation coefficients (ICCs) between the AI algorithm and human observers ranged from 0.965 to 0.997, indicating excellent inter-observer reliability. Kruskal-Wallis test showed no statistically significant differences in ROM measurements among the AI algorithm and two human observers across all joint angles (p > 0.05). The AI-based algorithm demonstrated performance comparable to that of human observers in quantifying shoulder and elbow ROM from clinical photographs. For shoulder internal rotation, the AI approach showed potential for improved consistency compared to traditional methods.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-024-00432-w.

[Anatomical and biomechanical characteristics of plantaris tendon and its application in ligament reconstruction]

Objective

To improve the clinical utility of the plantaris tendon mainly by summarizing its anatomical characteristics, biomechanical properties, harvesting methods, and its applications in ligament reconstruction.

Methods

The relevant literature from domestic and international databases regarding the anatomical and biomechanical characteristics of the plantaris tendon and its applications in ligament reconstruction was comprehensively reviewed and systematically summarized.

Results

The plantaris tendons have an absence. The majority of plantaris tendon forms a fan-shape on the anterior and medial sides of the Achilles tendon and terminates at the calcaneal tuberosity. There are significant differences in biomechanical parameters between plantaris tendon with different numbers of strands, and multi strand plantaris tendon have significant advantages over single strand tendon. The plantaris tendon can be harvested through proximal and distal approaches, and it is necessary to ensure that there are no obvious anatomical variations or adhesions in the surrounding area before harvesting. The plantaris tendon is commonly utilized in ligament reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture, with satisfactory effectiveness. There is limited research on the use of plantar tendon in the reconstruction of upper limb and knee joint ligaments.

Conclusion

The plantaris tendon is relatively superficial, easy to be harvested, and has less impact on local function. The plantaris tendon is commonly utilized in ligaments reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture. The study on the plantaris tendon for upper limbs and knee joints ligament reconstruction is rarely and require further research.