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Caravaggi P, Rogati G, Zamagni L, Boriani L, Arceri A, Ortolani M, Lullini G, Berti L, Leardini A. Functional evaluation of a novel fibreglass-reinforced polyamide custom dynamic AFO for foot drop patients: A pilot study. Gait Posture 2024; 109:41-48. [PMID: 38266422 DOI: 10.1016/j.gaitpost.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are orthopaedic devices often prescribed to treat foot drop. For patients who are not satisfied with off-the-shelf solutions, custom AFOs personalized to the patient's lower limb anatomy are required. Dynamic AFOs provide stability while allowing for physiological ankle mobility in the stance phase of walking. RESEARCH QUESTION Can a morphology-based dynamic custom AFO made of fiberglass-reinforced polyamide restore a quasi-normal gait pattern and improve comfort in patients with foot drop? METHODS In this pilot study, the legs and feet of ten foot drop patients (age=64.9 ± 11.4 years; BMI=26.2 ± 2.1 kg/m2) were scanned using a Kinect-based 3D scanner. A custom AFO was designed and produced for each patient using a fiberglass-reinforced polyamide through selective laser sintering. To assess kinematics, skin markers were placed on relevant bony landmarks according to a validated protocol. Each patient was instructed to walk at a self-selected comfortable speed under three conditions: wearing the custom AFO, wearing an off-the-shelf orthosis (Codivilla spring), and without any AFO (shod condition). Muscle activation in the tibialis anterior, gastrocnemius, rectus femoris and biceps femoris muscles in both legs was recorded using wireless sEMG sensors. The comfort and of each AFO was evaluated using a Visual Analogue Scale. RESULTS The custom AFO resulted in significant increase of stride length and walking speed compared to the shod condition. Except for the hip joint, which exhibited greater maximum flexion and reduced range of motion, the kinematic parameters of all other joints were similar to those observed in a healthy control population. Furthermore, the custom AFO received significantly higher comfort scores compared to the Codivilla spring. SIGNIFICANCE This study has provided evidence supporting the effectiveness of custom orthotic solutions in restoring lower limb kinematics and improving the perceived comfort in foot drop patients compared to off-the-shelf solutions.
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Affiliation(s)
- P Caravaggi
- Laboratorio di Analisi del Movimento e Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - G Rogati
- Laboratorio di Analisi del Movimento e Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - L Zamagni
- Laboratorio di Analisi del Movimento e Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - L Boriani
- Chirurgia Vertebrale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - A Arceri
- Chirurgia Vertebrale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - M Ortolani
- Laboratorio di Analisi del Movimento e Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - G Lullini
- Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto Scienze Neurologiche, Bologna (Italia).
| | - L Berti
- Università di Bologna, Bologna (Italia); Medicina Fisica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
| | - A Leardini
- Laboratorio di Analisi del Movimento e Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna (Italia).
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Arin-Bal G, Livanelioglu A, Leardini A, Belvedere C. Correlations between plantar pressure and postural balance in healthy subjects and their comparison according to gender and limb dominance: A cross-sectional descriptive study. Gait Posture 2024; 108:124-131. [PMID: 38039867 DOI: 10.1016/j.gaitpost.2023.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Lower extremity injuries rank among the most common injuries affecting young population, and numerous factors affect the outcomes of plantar pressure and balance assessment. RESEARCH QUESTION Does a correlation exist between plantar pressure and postural balance in healthy subjects and are there any difference in the results based on gender and limb dominance? METHODS This study involved thirty healthy recreationally active young adults (15 females, 15 males). Plantar pressures were analyzed using the MatScan Pressure Mat System, and postural balance was evaluated using Biodex Balance System. All assessments conducted under both static and dynamic conditions. Correlations were tested by Spearman Correlation Coefficient, and comparative tests were performed for gender and limb dominance. RESULTS Correlations were observed between plantar pressure parameters and balance scores, particularly in the dynamic conditions (p < 0.05). Gender-based differences were noted in plantar pressure parameters (p < 0.05), with females demonstrating improved balance stability scores. No significant differences were found based on limb dominance in plantar pressure and postural balance data (p > 0.05). SIGNIFICANCE This study provides valuable detailed insights into the existing literature concerning plantar pressure and postural balance assessments within the healthy population. A strong correlation was observed between plantar pressure and postural balance, and the comparisons of these assessments were affected by gender but not by limb dominance. These results could lead the way for better rehabilitation approaches by considering the correlations and differences across diverse populations.
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Affiliation(s)
- Gamze Arin-Bal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Ayse Livanelioglu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Leardini A, Carpes FP. Corrigendum to "Special message from the leadership of the International Society of Biomechanics" [J. Biomech. 161 (2023) 111739]. J Biomech 2024; 162:111903. [PMID: 38101981 DOI: 10.1016/j.jbiomech.2023.111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, Director, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Felipe P Carpes
- Federal University of Pampa, Laboratory of Neuromechanics, Po box 118 - ZIP 97500-970, Uruguaiana, RS, Brazil.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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.
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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
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Leardini A, Carpes FP. Special message from the leadership of the International Society of Biomechanics. J Biomech 2023; 161:111739. [PMID: 37541807 DOI: 10.1016/j.jbiomech.2023.111739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, Director, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Felipe P Carpes
- Federal University of Pampa, Laboratory of Neuromechanics, Po box 118 - ZIP 97500-970, Uruguaiana, RS, Brazil.
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Sorrentino R, Carlson KJ, Orr CM, Pietrobelli A, Figus C, Li S, Conconi M, Sancisi N, Belvedere C, Zhu M, Fiorenza L, Hublin JJ, Jashashvili T, Novak M, Patel BA, Prang TC, Williams SA, Saers JPP, Stock JT, Ryan T, Myerson M, Leardini A, DeSilva J, Marchi D, Belcastro MG, Benazzi S. Morphological and evolutionary insights into the keystone element of the human foot's medial longitudinal arch. Commun Biol 2023; 6:1061. [PMID: 37857853 PMCID: PMC10587292 DOI: 10.1038/s42003-023-05431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
The evolution of the medial longitudinal arch (MLA) is one of the most impactful adaptations in the hominin foot that emerged with bipedalism. When and how it evolved in the human lineage is still unresolved. Complicating the issue, clinical definitions of flatfoot in living Homo sapiens have not reached a consensus. Here we digitally investigate the navicular morphology of H. sapiens (living, archaeological, and fossil), great apes, and fossil hominins and its correlation with the MLA. A distinctive navicular shape characterises living H. sapiens with adult acquired flexible flatfoot, while the congenital flexible flatfoot exhibits a 'normal' navicular shape. All H. sapiens groups differentiate from great apes independently from variations in the MLA, likely because of bipedalism. Most australopith, H. naledi, and H. floresiensis navicular shapes are closer to those of great apes, which is inconsistent with a human-like MLA and instead might suggest a certain degree of arboreality. Navicular shape of OH 8 and fossil H. sapiens falls within the normal living H. sapiens spectrum of variation of the MLA (including congenital flexible flatfoot and individuals with a well-developed MLA). At the same time, H. neanderthalensis seem to be characterised by a different expression of the MLA.
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Affiliation(s)
- Rita Sorrentino
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy.
| | - Kristian J Carlson
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
| | - Caley M Orr
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Department of Anthropology, University of Colorado Denver, Denver, CO, 80217, USA
| | - Annalisa Pietrobelli
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Carla Figus
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
| | - Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Michele Conconi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mingjie Zhu
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Luca Fiorenza
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, 3800, Australia
| | - Jean-Jacques Hublin
- Chaire Internationale de Paléoanthropologie, CIRB (UMR 7241-U1050), Collège de France, Paris, France
- Max Planck Institute for Evolutionary Anthropology, Leipzig, 04103, Germany
| | - Tea Jashashvili
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Department of Geology and Paleontology, Georgian National Museum, Tbilisi, 0105, Georgia
| | - Mario Novak
- Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, 10000, Croatia
| | - Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, 90089, USA
| | - Thomas C Prang
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Scott A Williams
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
- Center for the Study of Human Origins, Department of Anthropology, New York University, New York, 10003, USA
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
| | - Jaap P P Saers
- Naturalis Biodiversity Center, 2333, CR, Leiden, the Netherlands
| | - Jay T Stock
- Department of Anthropology, Western University, London, Ontario, N6A 3K7, Canada
| | - Timothy Ryan
- Department of Anthropology, The Pennsylvania State University, State College, PA, 16802, USA
| | - Mark Myerson
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy DeSilva
- Department of Anthropology, Dartmouth College, Hanover, NH, 03755, USA
| | - Damiano Marchi
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
- Department of Biology, University of Pisa, Pisa, 56126, Italy
| | - Maria Giovanna Belcastro
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Stefano Benazzi
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
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Zaffagnini S, Dal Fabbro G, Lucidi GA, Agostinone P, Belvedere C, Leardini A, Grassi A. Personalised opening wedge high tibial osteotomy with patient-specific plates and instrumentation accurately controls coronal correction and posterior slope: Results from a prospective first case series. Knee 2023; 44:89-99. [PMID: 37562120 DOI: 10.1016/j.knee.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patient specific devices represent a promising tool to improve accuracy and simplify high tibial osteotomy (HTO) procedures. The current study aims to assess accuracy of the correction of alignment and posterior tibial slope (PTS), and provide patient reported outcomes (PROMs) of a new personalised cutting guide and fixation plate (TOKA) system for HTO in patients with medial osteoarthritis (OA) and varus knee. METHODS 25 patients (mean age 54.4 years) with medial OA and varus knee malalignment who underwent HTO with the TOKA system were prospectively evaluated pre-operatively, 1, 3, 6 and 12-months follow-up. Standing long-leg and lateral radiographs of the knee were used to assess the hip-knee-ankle (HKA) angle and the PTS, respectively. Accuracy was defined as the difference in planned minus achieved correction. The patient reported outcomes collected were the KOOS score, EQ5D, KSS score, and VAS pain scores. All statistical analyses were performed using IBM SPSS Statistics for Windows. RESULTS The mean preoperative HKA was 170.7° (SD ± 3.2°); the mean postoperative HKA was 177.4° (SD ± 2.9°). The overall mean difference between planned and achieved correction in terms of HKA was 2.1° (SD ± 2.0°). The mean difference between planned and achieved PTS was 0.2° (SD ± 0.4°). All the assessed PROMs had a significant (p < 0.001) increase from the pre-operative value to postoperative evaluation and showed a significant (p < 0.001) improvement with follow-up time. CONCLUSIONS TOKA personalised HTO system showed accurate correction in terms of both coronal and sagittal alignment, and excellent patient reported outcomes. LEVEL OF EVIDENCE 4, prospective case series. Registration in public trial registry: registered at ClinicalTrial.gov [NCT04574570].
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Affiliation(s)
- Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Giacomo Dal Fabbro
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy.
| | - Gian Andrea Lucidi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Piero Agostinone
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy
| | - Claudio Belvedere
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Leardini
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Grassi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
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Romagnoli M, Zaffagnini M, Carillo E, Raggi F, Casali M, Leardini A, Marcheggiani Muccioli GM, Grassi A, Zaffagnini S. Custom-made implants for massive acetabular bone loss: accuracy with CT assessment. J Orthop Surg Res 2023; 18:742. [PMID: 37777776 PMCID: PMC10544156 DOI: 10.1186/s13018-023-04230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Custom-made implants are a valid option in revision total hip arthroplasty to address massive acetabular bone loss. The aim of this study was to assess the accuracy of custom-made acetabular implants between preoperative planning and postoperative positioning using CT scans. METHODS In a retrospective analysis, three patients who underwent an acetabular custom-made prosthesis were identified. The custom-made designs were planned through 3D CT analysis considering surgical points of attention. The accuracy of intended implants positioning was assessed by comparing pre- and postoperative CT analyzing the center of rotation (CoR), anteversion, inclination, screws, and implant surface in contact with the bone. RESULTS The three cases presented satisfactory accuracy in positioning. A malpositioning in the third case was observed due to the posterization of the CoR of the implant of more than 10 mm. The other CoR vectors considered in the third patient and all vectors in the other two cases fall within 10 mm. All the cases were positioned with a difference of less than 10° of anteversion and inclination with respect to the planning. CONCLUSIONS The current case series revealed promising accuracy in the positioning of custom-made acetabular prosthesis comparing the planned implant in preoperative CT with postoperative CT.
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Affiliation(s)
- Matteo Romagnoli
- Ortopedia e Traumatologia Rizzoli Argenta, Via Nazionale Ponente 5, 44011, Argenta, FE, Italy
| | - Marco Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.
| | - Eleonora Carillo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Marco Casali
- Ortopedia e Traumatologia Rizzoli Argenta, Via Nazionale Ponente 5, 44011, Argenta, FE, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | | | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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Valente G, Benedetti MG, De Paolis M, Sambri A, Frisoni T, Leardini A, Donati DM, Taddei F. Corrigendum to "Long-term functional recovery in patients with custom-made 3D-printed anatomical prostheses following bone tumor excision" [Gait Posture 97 (2022) 73-79]. Gait Posture 2023; 105:177. [PMID: 37121838 DOI: 10.1016/j.gaitpost.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Sambri
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Frisoni
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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De Blasiis P, Caravaggi P, Fullin A, Leardini A, Lucariello A, Perna A, Guerra G, De Luca A. Postural stability and plantar pressure parameters in healthy subjects: variability, correlation analysis and differences under open and closed eye conditions. Front Bioeng Biotechnol 2023; 11:1198120. [PMID: 37545891 PMCID: PMC10399229 DOI: 10.3389/fbioe.2023.1198120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction: The "postural control system" acts through biomechanical strategies and functional neuromuscular adaptations to maintain body balance under static and dynamic conditions. Postural stability and body weight distribution can be affected by external sensory inputs, such as different visual stimuli. Little information is available about the influence of visual receptors on stabilometric and plantar pressure parameters. The aim of this study was to analyze variability, correlations, and changes in these parameters under open- (OE) and closed-eye (CE) conditions. Methods: A total of 31 stabilometric and plantar pressure parameters were acquired in 20 young and healthy adults during baropodometric examination performed in bipedal standing under both visual conditions. Variability of parameters was evaluated via the coefficient of variation, correlation analysis via Pearson's R2, and statistical differences via the Wilcoxon test. Results: High intra-subject repeatability was found for all plantar pressure parameters and CoP-speed (CV < 40%) under OE and CE conditions, while CoP-sway area (CoPsa) and length surface function (LSF) showed larger variability (CV > 50%). Mean and peak pressures at midfoot and total foot loads showed the least number of significant correlations with other parameters under both visual conditions, whereas the arch-index and rearfoot loads showed the largest number of significant correlations. The limb side significantly affected most plantar pressure parameters. A trend of larger LSF and lower CoPsa and mean and peak pressures at the right forefoot was found under the CE condition. Discussion: The present study provides a deeper insight into the associations between postural stability and foot load. Interesting postural adaptations, particularly with respect to different visual stimuli, the effect of the dominant side, and the specific role of the midfoot in balance control were highlighted.
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Affiliation(s)
- P. De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - P. Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A. Fullin
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - A. Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A. Lucariello
- Department of Sport Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
| | - A. Perna
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - G. Guerra
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - A. De Luca
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania “Luigi Vanvitelli”, Naples, Italy
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11
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Leardini A, Belvedere C, de Cesar Netto C. Total Ankle Replacement: Biomechanics of the Designs, Clinical Outcomes, and Remaining Issues. Foot Ankle Clin 2023; 28:e1-e14. [PMID: 36935170 DOI: 10.1016/j.fcl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and clinical concerns. Designers shall target at the same time restoration of natural ankle kinematics and congruity of the artificial surfaces throughout the range of motion. Surgeons are recommended to expand biomechanical knowledge on ankle joint replacement, and provide appropriate training and key factors to make arthroplasty a good alternative to arthrodesis. Moreover, adequate selection of patients and careful rehabilitation are critical. In the future, custom-made prosthesis components and patient-specific instrumentation are major developments for more complex cases.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA; Orthopedic Functional Imaging Research Laboratory, University of Iowa, Iowa City, IA, USA; Department of Orthopedics, Duke University, Durham, NC, USA
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12
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Caravaggi P, Rogati G, Leardini A, Bevoni R, Girolami M, Berti L. Clinical and multi-segment kinematic analysis of a modified Grice arthrodesis to correct type II adult-acquired flat-foot. Gait Posture 2023; 100:268-275. [PMID: 36682320 DOI: 10.1016/j.gaitpost.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Adult acquired flat foot (AAFF) is a symptomatic postural alteration of the foot due to modifications in bony structures and/or soft tissues supporting the medial longitudinal arch. For the most severe cases, when orthotic solutions do not provide enough pain relief, surgery may be necessary. RESEARCH QUESTION Is it possible to restore a normal medial longitudinal arch and to correct the static and dynamic frontal plane alignment of the rearfoot via a modified Grice surgical procedure in AAFF patients? METHODS Eleven patients with stage II AAFF were recruited in the study and underwent the Grice procedure. Patients were assessed via gait analysis using a validated multi-segment foot protocol. Double-leg standing static posture and foot joint kinematics during barefoot walking were measured before surgery and at a mean follow-up of 15 ± 8 months. Twenty-seven age-matched healthy subjects without foot morphological alterations were used as control. Patients' feet were clinically assessed via the Foot Function Index and the Foot Posture Index. Wilcoxon signed rank test was used to assess differences in kinematic and spatio-temporal parameters between pre-op and follow-up evaluations. 1D statistical parametric mapping was used to assess differences in temporal profiles of foot joint rotations. RESULTS The clinical indexes significantly improved at post-op (p < 0.05). No differences in sagittal plane static and dynamic joint rotations were observed between pre-op and post-op. In the frontal plane, metatarsus to calcaneus and midfoot to calcaneus rotation angles significantly improved from pre-op to post-op, with the latter resulting consistent with control data. Range of motion and maximum value of the medial longitudinal arch angle were reduced following surgery. SIGNIFICANCE The modified Grice procedure restored a good frontal-plane alignment of rearfoot and midfoot, and the clinical scores provided evidence of its effectiveness in significantly reducing pain and improving the quality of daily activities.
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Affiliation(s)
- Paolo Caravaggi
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy.
| | - Giulia Rogati
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy.
| | - Alberto Leardini
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy.
| | - Roberto Bevoni
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy.
| | - Mauro Girolami
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy.
| | - Lisa Berti
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136, Bologna, Italy; University of Bologna, Italy.
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13
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Zhu Y, Babazadeh-Naseri A, Dunbar NJ, Brake MRW, Zandiyeh P, Li G, Leardini A, Spazzoli B, Fregly BJ. Finite element analysis of screw fixation durability under multiple boundary and loading conditions for a custom pelvic implant. Med Eng Phys 2023; 111:103930. [PMID: 36792235 DOI: 10.1016/j.medengphy.2022.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Despite showing promising functional outcomes for pelvic reconstruction after sarcoma resection, custom-made pelvic implants continue to exhibit high complication rates due to fixation failures. Patient-specific finite element models have been utilized by researchers to evaluate implant durability. However, the effect of assumed boundary and loading conditions on failure analysis results of fixation screws remains unknown. In this study, the postoperative stress distributions in the fixation screws of a state-of-the-art custom-made pelvic implant were simulated, and the risk of failure was estimated under various combinations of two bone-implant interaction models (tied vs. frictional contact) and four load cases from level-ground walking and stair activities. The study found that the average weighted peak von Mises stress could increase by 22-fold when the bone-implant interactions were modeled with a frictional contact model instead of a tied model, and the likelihood of fatigue and pullout failure for each screw could change dramatically when different combinations of boundary and loading conditions were used. The inclusion of additional boundary and loading conditions led to a more reliable analysis of fixation durability. These findings demonstrated the importance of simulating multiple boundary conditions and load cases for comprehensive implant design evaluation using finite element analysis.
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Affiliation(s)
- Yuhui Zhu
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | | | - Nicholas J Dunbar
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Matthew R W Brake
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Payam Zandiyeh
- Department of Orthopedic Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Geng Li
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Benedetta Spazzoli
- Clinica Ortopedica III, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA.
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14
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Zaffagnini S, Dal Fabbro G, Belvedere C, Leardini A, Caravelli S, Lucidi GA, Agostinone P, Mosca M, Neri MP, Grassi A. Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System. J Clin Med 2022; 11:jcm11195717. [PMID: 36233583 PMCID: PMC9571741 DOI: 10.3390/jcm11195717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks. Methods: The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customized devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customized system for valgus HTO with three pilot cases at one-year follow-up was presented. Results: 28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3° or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.
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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Giacomo Dal Fabbro
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6075
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Silvio Caravelli
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gian Andrea Lucidi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Piero Agostinone
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Pia Neri
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
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15
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Valente G, Benedetti MG, Paolis MD, Sambri A, Frisoni T, Leardini A, Donati DM, Taddei F. Long-term functional recovery in patients with custom-made 3D-printed anatomical pelvic prostheses following bone tumor excision. Gait Posture 2022; 97:73-79. [PMID: 35914386 DOI: 10.1016/j.gaitpost.2022.07.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomical custom-made prostheses make it possible to reconstruct complicated bone defects following excision of bone tumors, thanks to 3D-printed technology. To date, clinical measures have been used to report clinical-functional outcome and provide evidence for the effectiveness of this new surgical approach. However, there are no studies that quantified the achievable recovery during common activities by using instrumental clinical-functional evaluation in these patients. RESEARCH QUESTION What is the motor performance, functional outcome and quality of life in patients with custom-made 3D-printed pelvic prostheses following bone tumor? METHODS To analyze motor performance, six patients performed motion analysis during five motor activities at follow-up of 32 ± 18 months. Joint angles, ground reaction forces and joint moments of the operated and contralateral limbs were compared. On-off activity of lower-limb muscles were calculated from electromyography and compared to a healthy matched population. To analyze functional outcome and quality of life, differences in measured hip abductor strength between limbs were evaluated, as well as clinical-functional scores (Harris Hip Score, Barthel Index, Musculoskeletal Tumor Society score), and quality of life (SF-36 health survey). RESULTS We found only slight differences in joint kinematics when comparing operated and contralateral limb. The activity of gluteal muscles was normal, while hamstrings showed out-of-phase activities. Ground reaction forces and hip moments showed asymmetries between limbs, particularly in more demanding motor activities. We found a mean difference in hip abductor strength of 48 ± 82 N between limbs, good clinical-functional scores, and quality of life scores within normative. SIGNIFICANCE Our study showed optimal long-term results in functional recovery, mainly achieved through recovery of the gluteal function, although minor impairments were found, which may be considered for future improvement of this innovative surgery. The effect of a more loaded contralateral limb on internal loads and long-term performance of the implant remains unknown and deserves further investigation.
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Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Massimiliano De Paolis
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Andrea Sambri
- Department of Orthopaedics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tommaso Frisoni
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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16
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Rogati G, Caravaggi P, Leardini A, Erani P, Fognani R, Saccon G, Boriani L, Baleani M. A novel apparatus to assess the mechanical properties of Ankle-Foot Orthoses: Stiffness analysis of the Codivilla spring. J Biomech 2022; 142:111239. [PMID: 35940017 DOI: 10.1016/j.jbiomech.2022.111239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
Abstract
Ankle-Foot Orthoses (AFOs) are the most common devices prescribed to support the ankle and restore a quasi-normal gait pattern in drop-foot patients. AFO stiffness is possibly the main mechanical property affecting foot and ankle biomechanics. A variety of methods to evaluate this property have been reported, however no standard procedure has been validated and widely used. This study is reporting the repeatability of a novel apparatus to measure AFO stiffness in ideal frictionless conditions. The apparatus is based on a servo-hydraulic testing machine and allows to apply a displacement-controlled rotation of the AFO shell, simulating the physiological ankle dorsi/plantarflexion movement. The repeatability of the apparatus in measuring AFO stiffness in dorsiflexion and plantarflexion was assessed intra- and inter-session in a sample of standard polypropylene AFOs of different sizes (Codivilla spring). The repeatability of the apparatus in measuring the AFO stiffness was high. The Intra- and Inter-session Coefficient of Variation ranged between 0.02 ÷ 1.3 % and 1.3 ÷ 5 %, respectively. The Intra Class Correlation Coefficient ranged between 0.999 ÷ 1 intra- and 0.993 ÷ 0.997 inter-session. AFOs stiffness was observed to increase with the AFO size. The setup is easy to replicate and can be implemented with any torsion-controlled servo-hydraulic testing machine and has resulted simple to use and flexible enough to adapt to AFOs with different sizes. The frictionless contacts characterizing the apparatus make it possible to measure the ideal AFO stiffness by excluding the effect of the fixation methods to the leg and help to improve the repeatability of measurements.
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Affiliation(s)
- G Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - P Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - A Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - P Erani
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - R Fognani
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - G Saccon
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - L Boriani
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - M Baleani
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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17
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Assirelli E, Caravaggi P, Mazzotti A, Ursini F, Leardini A, Belvedere C, Neri S. Location-Dependent Human Osteoarthritis Cartilage Response to Realistic Cyclic Loading: Ex-Vivo Analysis on Different Knee Compartments. Front Bioeng Biotechnol 2022; 10:862254. [PMID: 35782520 PMCID: PMC9240619 DOI: 10.3389/fbioe.2022.862254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Osteoarthritis (OA) is a multifactorial musculoskeletal disorder affecting mostly weight-bearing joints. Chondrocyte response to load is modulated by inflammatory mediators and factors involved in extracellular cartilage matrix (ECM) maintenance, but regulatory mechanisms are not fully clarified yet. By using a recently proposed experimental model combining biomechanical data with cartilage molecular information, basally and following ex-vivo load application, we aimed at improving the understanding of human cartilage response to cyclic mechanical compressive stimuli by including cartilage original anatomical position and OA degree as independent factors.Methods: 19 mono-compartmental Knee OA patients undergoing total knee replacement were recruited. Cartilage explants from four different femoral condyles zones and with different degeneration levels were collected. The response of cartilage samples, pooled according to OA score and anatomical position was tested ex-vivo in a bioreactor. Mechanical stimulation was obtained via a 3-MPa 1-Hz sinusoidal compressive load for 45-min to replicate average knee loading during normal walking. Samples were analysed for chondrocyte gene expression and ECM factor release.Results: Non parametric univariate and multivariate (generalized linear mixed model) analysis was performed to evaluate the effect of compression and IL-1β stimulation in relationship to the anatomical position, local disease severity and clinical parameters with a level of significance set at 0.05. We observed an anti-inflammatory effect of compression inducing a significant downmodulation of IL-6 and IL-8 levels correlated to the anatomical regions, but not to OA score. Moreover, ADAMTS5, PIICP, COMP and CS were upregulated by compression, whereas COL-2CAV was downmodulated, all in relationship to the anatomical position and to the OA degree.Conclusion: While unconfined compression testing may not be fully representative of the in-vivo biomechanical situation, this study demonstrates the importance to consider the original cartilage anatomical position for a reliable biomolecular analysis of knee OA metabolism following mechanical stimulation.
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Affiliation(s)
- Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- *Correspondence: Claudio Belvedere,
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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18
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Rogati G, Caravaggi P, Leardini A. Design principles, manufacturing and evaluation techniques of custom dynamic ankle-foot orthoses: a review study. J Foot Ankle Res 2022; 15:38. [PMID: 35585544 PMCID: PMC9118871 DOI: 10.1186/s13047-022-00547-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Ankle-Foot Orthoses (AFO) can be prescribed to allow drop-foot patients to restore a quasi-normal gait pattern. Standard off-the-shelf AFOs are cost-effective solutions to treat most patients with foot and ankle weakness, but these devices have several limitations, especially in terms of comfort. Therefore, custom AFOs are increasingly adopted to address drop-foot when standard solutions are not adequate. While the solid ones are the most common type of AFO, providing full stability and strong resistance to ankle plantarflexion, passive dynamic AFOs (PD-AFOs) represent the ideal solution for patients with less severe ankle weakness. PD-AFOs have a flexible calf shell, which can bend during the stance phase of walking and absorb energy that can be released to support the limb in the push-off phase. The aim of this review is to assess the state-of-the-art and identify the current limitations of PD-AFOs. An extensive literature review was performed in Google Scholar to identify all studies on custom PD-AFOs. Only those papers reporting on custom PD-AFOs were included in the review. Non peer-reviewed papers, abstract shorter than three pages, lecture notes and thesis dissertations were excluded from the analysis. Particular attention was given to the customization principles and the mechanical and functional tests. For each topic, the main results from all relevant papers are reported and summarized herein. There were 75 papers that corresponded to the search criteria. These were grouped according to the following macro-topics: 16 focusing on scanning technologies and geometry acquisition; 14 on customization criteria; 19 on production techniques; 16 on mechanical testing, and 33 on functional testing. According to the present review, design and production of custom PD-AFOs are becoming increasingly feasible due to advancements in 3D scanning techniques and additive manufacturing. In general, custom PD-AFOs were shown to provide better comfort and improved spatio-temporal parameters with respect to standard solutions. However, no customization principle to adapt PD-AFO stiffness to the patient's degree of ankle impairment or mechanical/functional demand has thus far been proposed.
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Affiliation(s)
- Giulia Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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19
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Ruggeri M, Gill HS, Leardini A, Zaffagnini S, MacLeod A, Ortolani M, Faccia F, Grassi A, Fabbro GD, Durante S, Belvedere C. Superimposition of ground reaction force on tibial-plateau supporting diagnostics and post-operative evaluations in high-tibial osteotomy. A novel methodology. Gait Posture 2022; 94:144-152. [PMID: 35334334 DOI: 10.1016/j.gaitpost.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A fully personalised combination of Gait Analysis (GA), including Ground Reaction Force (GRF), and patient-specific knee joint morphology has not yet been reported. This can provide valuable biomechanical insight in normal and pathological conditions. Abnormal knee varus results in medial knee condylar hyper-compression and osteoarthritis, which can be prevented by restoring proper condylar load distribution via High Tibial Osteotomy (HTO). RESEARCH QUESTION This study was aimed at reporting on an original methodology, merging GA, GRF and Computer-Tomography (CT) to depict a patient-specific representation of the knee mechanical condition during locomotion. It was hypothesised that HTO results in a lateralized pattern of GRF with respect to the tibial plateau. METHODS Four patients selected for HTO received clinical, radiological and instrumental examinations, pre- and post-operatively at 6-month follow-up. GA was performed during level walking and more demanding motor tasks using a 9-camera motion-capture system, combined with two force platforms, and an established protocol. Additional skin markers were positioned around the tibial-plateau rim. Weight-bearing CT scans of the knee were collected while still wearing these markers. Proximal tibial and marker morphological models were reconstructed. The markers from CT reconstruction were then registered to the corresponding trajectories as tracked by GA data. Resulting registration matrices were used to report GRF vectors on the plane best matching the tibial-plateau model and the intersection paths were calculated. RESULTS AND SIGNIFICANCE The registration procedure was successfully executed, with a max registration error of about 3 mm. GRF intersection paths were found medially to the tibial plateau pre-op, and lateralized post-op, thus much closer to the knee centre, as expected after HTO. The exploitation of the present methodology offers personalised quantification of the original mechanical misalignment and of the effect of surgical correction which could enhance diagnostics and planning of HTO as well as other knee treatments.
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Affiliation(s)
- Miriana Ruggeri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Harinderjit Singh Gill
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alisdair MacLeod
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Faccia
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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.
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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
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21
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Caravaggi P, Rogati G, Leardini A, Ortolani M, Barbieri M, Spasiano C, Durante S, Matias AB, Taddei U, Sacco ICN. Accuracy and correlation between skin-marker based and radiographic measurements of medial longitudinal arch deformation. J Biomech 2021; 128:110711. [PMID: 34481280 DOI: 10.1016/j.jbiomech.2021.110711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Static and dynamic measurements of the medial longitudinal arch (MLA) in the foot are critical across different clinical and biomechanical research fields. While MLA deformation can be estimated using skin-markers for gait analysis, the current understanding of the correlates between skin-marker based models and radiographic measures of the MLA is limited. This study aimed at assessing the correlation and accuracy of skin-marker based measures of MLA deformation with respect to standard clinical X-ray based measures, used as reference. 20 asymptomatic subjects without morphological alterations of the foot volunteered in the study. A lateral X-ray of the right foot of each subject was taken in monopodalic upright posture with and without a metatarsophalangeal-joint dorsiflexing wedge. MLA angle was estimated in the two foot postures and during gait using 16 skin-marker based models, which were established according to the marker set of a validated multi-segment foot kinematic protocol. The error of each model in tracking MLA deformation was assessed and correlated with respect to standard radiographic measurements. Estimation of MLA deformation was highly affected by the skin-marker models. Skin-marker models using the marker on the navicular tuberosity as apex of the MLA angle showed the smallest errors (about 2 deg) and the largest correlations (R = 0.64-0.65; p < 0.05) with respect to the radiographic measurements. According to the outcome of this study, skin-marker based definitions of the MLA angle using the navicular tuberosity as apex of the arch may provide a more accurate estimation of MLA deformation with respect to that from radiographic measures.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulia Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Chiara Spasiano
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra B Matias
- Physical Therapy, Speech and Occupational Therapy Dept., School of Medicine, University of Sao Paulo, SP, Brazil
| | - Ulisses Taddei
- Physical Therapy, Speech and Occupational Therapy Dept., School of Medicine, University of Sao Paulo, SP, Brazil
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Dept., School of Medicine, University of Sao Paulo, SP, Brazil
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22
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Belvedere C, Tamarri S, Ensini A, Durante S, Ortolani M, Leardini A. Can Computer-Assisted Total Knee Arthroplasty Support the Prediction of Postoperative Three-Dimensional Kinematics of the Tibiofemoral and Patellofemoral Joints at the Replaced Knee? J Knee Surg 2021; 34:1014-1025. [PMID: 32074653 DOI: 10.1055/s-0040-1701265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to analyze the extent to which postoperative patellofemoral joint (PFJ) kinematics assessed at 6-month follow-up after total knee arthroplasty (TKA) mimics the intraoperative kinematics after final component implantation. The study hypothesis, already proved in terms of tibiofemoral joint (TFJ) kinematics, is that the intraoperative assessment of PFJ kinematics after component implantation is also capable of predicting postoperative knee kinematics during activities of daily living. Twenty patients selected for TKA with patellar resurfacing were implanted using surgical navigation, including patellar component positioning via a novel computer-assisted procedure. This allowed for intraoperative TFJ and PFJ kinematic assessment after final component implantation. At 6-month follow-up, all patients were contacted for follow-up control; in addition to clinical examination, this implied postoperative kinematics assessments by three-dimensional video fluoroscopy of the replaced knee during standard activities of daily living. Several traditional PFJ, as well as TFJ, rotations and translations were calculated intra- and postoperatively and then statistically compared. Good postoperative replication of the intraoperative measurements was observed for most of PFJ variables analyzed, as well as those for TFJ. Relevant statistical analysis also supported the significant consistency between the intra- and postoperative measurements. Pertaining to the present findings on a statistical basis, intraoperative measurements performed at both TFJ and PFJ kinematics using a surgical navigation system under passive conditions, are predictive of the overall knee kinematics experienced at postoperative follow-ups by the same replaced knees in typical activities of daily living.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Tamarri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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23
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Lullini G, Belvedere C, Ortolani M, Ruzzi S, Mazzotti A, Leardini A. Custom-Made Total Talonavicular Replacement in a Professional Rock Climber: Functional Evaluation With Gait Analysis and 3-Dimensional Medical Imaging in Weightbearing at 5 Years' Follow-Up. J Foot Ankle Surg 2021; 59:1118-1127. [PMID: 32684404 DOI: 10.1053/j.jfas.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
With the goal to restore ankle and foot function also in the long term, custom-made prostheses are becoming more frequently possible solutions for severe bone loss and avascular necrosis of the talus. A young professional rock climber was implanted with a custom-made talonavicular prosthesis, and short-term (30 months) assessment has been published. A thorough assessment at the intermediate term (60 months), with state-of-the-art gait and medical imaging analyses, is reported here. Level walking and more demanding motor tasks were analyzed with both a full-body and a multisegment foot protocol on the operated and contralateral limbs. Cone-beam computer-tomography was also used to obtain 3-dimensional (3D) position and orientation of bone models on the operated ankle. These models were also used for a 3D video fluoroscopy analysis, with the ankle in 3 joint positions at the extremes of motion. Distance map analysis was performed to check for possible changes over time of bone morphology and joint contact areas, in all 3 joint positions. Very satisfactory functional results were observed, with large and symmetric joint motion and physiological muscular recruitment even in demanding motor tasks. Distance map analyses revealed that very small morphologic and contact patterns changes occurred in the replaced ankle between 30 and 60 months. Concerns about possible wear of the cartilage in the tibial mortise are not yet supported by experimental evidence.
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Affiliation(s)
- Giada Lullini
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Senior Biomedical Engineer Researcher, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maurizio Ortolani
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Ruzzi
- Laboratory Computer Technician, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Executive Orthopaedic Surgeon, I Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Laboratory Director, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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24
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Leardini A, Stebbins J, Hillstrom H, Caravaggi P, Deschamps K, Arndt A. ISB recommendations for skin-marker-based multi-segment foot kinematics. J Biomech 2021; 125:110581. [PMID: 34217032 DOI: 10.1016/j.jbiomech.2021.110581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both kinematic and kinetic analyses. These models differ in the number of segments analyzed, bony landmarks identified, required marker set, defined anatomical axes and frames, the convention used to calculate joint rotations and the determination of neutral positions or other offsets from neutral. Many of these models lack validation. The terminology used is inconsistent and frequently confusing. Biomechanical and clinical studies using these models should use established references and describe how results are obtained and reported. The International Society of Biomechanics has previously published proposals for standards regarding kinematic and kinetic measurements in biomechanical research, and in this paper also addresses multi-segment foot kinematics modeling. The scope of this work is not to prescribe a particular set of standard definitions to be used in all applications, but rather to recommend a set of standards for collecting, calculating and reporting relevant data. The present paper includes recommendations for the overall modeling and grouping of the foot bones, for defining landmarks and other anatomical references, for addressing the many experimental issues in motion data collection, for analysing and reporting relevant results and finally for designing clinical and biomechanical studies in large populations by selecting the most suitable protocol for the specific application. These recommendations should also be applied when writing manuscripts and abstracts.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, NY, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kevin Deschamps
- Faculty of Movement & Rehabilitation Sciences, KULeuven, Bruges, Belgium
| | - Anton Arndt
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden
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25
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Caravaggi P, Assirelli E, Ensini A, Ortolani M, Mariani E, Leardini A, Neri S, Belvedere C. Biomechanical-Based Protocol for in vitro Study of Cartilage Response to Cyclic Loading: A Proof-of-Concept in Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:634327. [PMID: 34012954 PMCID: PMC8126668 DOI: 10.3389/fbioe.2021.634327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is an evolving disease and a major cause of pain and impaired mobility. A deeper understanding of cartilage metabolism in response to loading is critical to achieve greater insight into OA mechanisms. While physiological joint loading helps maintain cartilage integrity, reduced or excessive loading have catabolic effects. The main scope of this study is to present an original methodology potentially capable to elucidate the effect of cyclic joint loading on cartilage metabolism, to identify mechanisms involved in preventing or slowing down OA progression, and to provide preliminary data on its application. In the proposed protocol, the combination of biomechanical data and medical imaging are integrated with molecular information about chondrocyte mechanotransduction and tissue homeostasis. The protocol appears to be flexible and suitable to analyze human OA knee cartilage explants, with different degrees of degeneration, undergoing ex vivo realistic cyclic joint loading estimated via gait analysis in patients simulating mild activities of daily living. The modulation of molecules involved in cartilage homeostasis, mechanotransduction, inflammation, pain and wound healing can be analyzed in chondrocytes and culture supernatants. A thorough analysis performed with the proposed methodology, combining in vivo functional biomechanical evaluations with ex vivo molecular assessments is expected to provide new insights on the beneficial effects of physiological loading and contribute to the design and optimization of non-pharmacological treatments limiting OA progression.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- I Orthopaedic and Traumatologic Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erminia Mariani
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
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26
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Pagani S, Liverani E, Giavaresi G, De Luca A, Belvedere C, Fortunato A, Leardini A, Fini M, Tomesani L, Caravaggi P. Mechanical and in vitro biological properties of uniform and graded Cobalt-chrome lattice structures in orthopedic implants. J Biomed Mater Res B Appl Biomater 2021; 109:2091-2103. [PMID: 33964120 PMCID: PMC8518749 DOI: 10.1002/jbm.b.34857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/14/2020] [Accepted: 04/24/2021] [Indexed: 12/11/2022]
Abstract
Human bones are biological examples of functionally graded lattice capable to withstand large in vivo loading and allowing optimal stress distribution. Disruption of bone integrity may require biocompatible implants capable to restore the original bone structure and properties. This study aimed at comparing mechanical properties and biological behavior in vitro of uniform (POR‐FIX) and graded (POR‐VAR) Cobalt‐chrome alloy lattice structures manufactured via Selective Laser Melting. In compression, the POR‐VAR equivalent maximum stress was about 2.5 times lower than that of the POR‐FIX. According to the DIC analysis, the graded lattice structures showed a stratified deformation associated to unit cells variation. At each timepoint, osteoblast cells were observed to colonize the surface and the first layer of both scaffolds. Cell activity was always significantly higher in the POR‐VAR (p < 0.0005). In terms of gene expression, the OPG/RANKL ratio increased significantly over time (p < 0.0005) whereas IL1β and COX2 significantly decreased (7 day vs 1 day; p < 0.0005) in both scaffolds. Both uniform‐ and graded‐porosity scaffolds provided a suitable environment for osteoblasts colonization and proliferation, but graded structures seem to represent a better solution to improve stress distribution between implant and bone of orthopedic implants.
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Affiliation(s)
- Stefania Pagani
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Gianluca Giavaresi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angela De Luca
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Tomesani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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27
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Gurrera D, Leardini A, Ortolani M, Durante S, Caputo V, Gallias KK, Abbate BF, Rinaldi C, Iacoviello G, Acri G, Vermiglio G, Marrale M. Experimental and Modeling Analyses of Human Motion Across the Static Magnetic Field of an MRI Scanner. Front Bioeng Biotechnol 2021; 9:613616. [PMID: 34026738 PMCID: PMC8131562 DOI: 10.3389/fbioe.2021.613616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
It is established that human movements in the vicinity of a permanent static magnetic field, such as those in magnetic resonance imaging (MRI) scanners induce electric fields in the human body; this raises potential severe risks of health to radiographers and cleaners exposed routinely to these fields in MRI rooms. The relevant directives and parameters, however, are based on theoretical models, and accurate studies on the simulation of the effects based on human movement data obtained in real conditions are still lacking. Two radiographers and one cleaner, familiar with MRI room activities and these directives, were gait analyzed during the execution of routine job motor tasks at different velocities. Full body motion was recorded in a gait laboratory arranged to reproduce the workspace of a room with an MRI full-body scanner. Body segments were tracked with clusters of at least three markers, from which position and velocity of the centroids were calculated. These were used as input in an established computer physical model able to map the stray field in an MRI room. The spatial peak values of the calculated electric field induced by motion of the head and of the entire body during these tasks, for both the health and sensory effects, were found smaller than the thresholds recommended by the European directives, for both 1.5 T and 3.0 T MRI. These tasks therefore seem to guarantee the safety of MRI room operators according to current professional good practice for exposure risks. Physical modeling and experimental measures of human motion can also support occupational medicine.
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Affiliation(s)
- Davide Gurrera
- Advanced Radiation Oncology Department, Cancer Care Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy.,Dipartimento di Fisica e Chimica, Università degli Studi di Palermo, Palermo, Italy
| | - Alberto Leardini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, Bologna, Italy
| | - Maurizio Ortolani
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, Bologna, Italy
| | - Stefano Durante
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, Bologna, Italy
| | - Vittorio Caputo
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (A.R.N.A.S.) Civico-Di Cristina-Benfratelli, Unità Operativa Complessa (U.O.C.) Fisica Sanitaria, Palermo, Italy
| | - Karmenos K Gallias
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (A.R.N.A.S.) Civico-Di Cristina-Benfratelli, Unità Operativa Complessa (U.O.C.) Fisica Sanitaria, Palermo, Italy
| | - Boris F Abbate
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (A.R.N.A.S.) Civico-Di Cristina-Benfratelli, Unità Operativa Complessa (U.O.C.) Fisica Sanitaria, Palermo, Italy
| | - Calogero Rinaldi
- Villa Santa Teresa, Unità Operativa (U.O.) Fisica Sanitaria, Bagheria, Italy
| | - Giuseppina Iacoviello
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (A.R.N.A.S.) Civico-Di Cristina-Benfratelli, Unità Operativa Complessa (U.O.C.) Fisica Sanitaria, Palermo, Italy
| | - Giuseppe Acri
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Università degli Studi di Messina, Messina, Italy
| | - Giuseppe Vermiglio
- Scuola di Specializzazione in Fisica Medica, Università degli Studi di Messina, Messina, Italy
| | - Maurizio Marrale
- Dipartimento di Fisica e Chimica, Università degli Studi di Palermo, Palermo, Italy
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28
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Rogati G, Leardini A, Ortolani M, Caravaggi P. Semi-automatic measurements of foot morphological parameters from 3D plantar foot scans. J Foot Ankle Res 2021; 14:18. [PMID: 33731179 PMCID: PMC7972185 DOI: 10.1186/s13047-021-00461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Background Foot healthcare research is focusing increasingly on personalized orthotic and prosthetic devices to address patient-specific morphology and ailments. Customization requires advanced 3D image processing tools to assess foot and leg geometrical parameters and alterations. The aim of this study is to present a new software for the measurement of the foot shape from 3D scans of the foot plantar surface. Methods A Kinect-based scanning device was used to acquire the 3D foot shape of 44 healthy subjects. A software was developed in Matlab to measure the foot main morphological parameters from foot scans. Principal Component Analysis was used to orientate the foot scans with respect to the same reference system. Accuracy, via percentage errors and Bland-Altman plots, and correlation of the software-based foot parameters were assessed against manual measurements. A normalized Arch Volume Index (nAVI) was proposed and correlated to the traditional Arch Index. Test-retest Intraclass Correlation Coefficient was used to assess the inter-session repeatability of foot measurements. Results The average percentage error between software and manual measurements was 1.2 ± 0.8% for foot length, 9.1 ± 3.7% for foot width, 22.3 ± 13.5% for arch height and 23.1 ± 12.7% for arch depth. Very strong correlations were observed for foot length (R = 0.97) and foot width (R = 0.83), and strong correlations for arch height (R = 0.62) and arch depth (R = 0.74). nAVI was negatively correlated to the Arch Index (R = -0.54). A small difference was found between software and manual measurements of foot length (Δ = 0.92 mm), a software overestimation of foot width (Δ = 8.6 mm) and underestimation of arch height (Δ = -1.4%) and arch depth (Δ = -11%). Moderate to excellent repeatability was observed for all measurements (0.67–0.99). Conclusions The present software appears capable to estimate the foot main morphological parameters without the need for skin markers or for identification of anatomical landmarks. Moreover, measurements are not affected by the foot orientation on the scanning device. The good accuracy and repeatability of measurements make the software a potentially useful operator-independent tool for the assessment of foot morphological alterations and for orthotics customization. nAVI may be used for a more realistic classification of foot types when 3D foot images are available.
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Affiliation(s)
- Giulia Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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Usuelli FG, Indino C, Leardini A, Manzi L, Ortolani M, Caravaggi P. Range of motion of foot joints following total ankle replacement and subtalar fusion. Foot Ankle Surg 2021; 27:150-155. [PMID: 32381452 DOI: 10.1016/j.fas.2020.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/06/2020] [Accepted: 03/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In severe cases of ankle and subtalar arthritis, arthrodesis of the subtalar joint is performed in combination with ankle arthroplasty. In these special cases gait analysis reveals real motion at the replaced tibiotalar joint. METHODS Twenty-three patients affected by ankle and subtalar arthritis, treated either with a 3-component or a 2-component prosthesis in combination with subtalar arthrodesis, were clinically evaluated preoperatively and at a minimum of 1-year follow-up. Gait analysis was performed postoperatively using a multi-segment foot protocol. Foot kinematics were compared to corresponding data from a healthy control group. RESULTS Clinical scores significantly improved from preoperative to follow-up. The clinically measured passive ankle dorsiflexion/plantarflexion significantly improved at the follow-up. Patients' normalized walking speed and stride length were significantly lower than those in control. With exception of the ankle frontal-plane motion, sagittal-plane mobility of foot joints was about 50% than that in healthy joints. CONCLUSIONS Improvement in clinical scores was found for both prostheses. Normal spatio-temporal parameters were not restored. In these patients, fusion of the subtalar joint appeared to be compensated by larger frontal-plane motion at the tibiotalar joint. LEVEL OF EVIDENCE Level III- retrospective comparative study. The study was approved by the local Ethics Committee as protocol MAT (protocol registration at clinicaltrials.gov NCT03356951).
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Affiliation(s)
- Federico G Usuelli
- C.A.S.C.O. - IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161 Milan, Italy
| | - Cristian Indino
- C.A.S.C.O. - IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161 Milan, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136 Bologna, Italy
| | - Luigi Manzi
- C.A.S.C.O. - IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20161 Milan, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136 Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10 40136 Bologna, Italy
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Carrara C, Belvedere C, Caravaggi P, Durante S, Leardini A. Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography. Foot Ankle Surg 2021; 27:168-174. [PMID: 32370949 DOI: 10.1016/j.fas.2020.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the diagnosis and treatment of foot and ankle disorders, objective quantification of the absolute and relative orientation angles is necessary. The present work aims at assessing novel techniques for 3D measures of foot bone angles from current Cone-Beam technology. METHODS A normal foot was scanned via weight-bearing CT and 3D-model of each bone was obtained. Principal Component Analysis, landmark-based and mid-diaphyseal axes were exploited to obtain bone anatomical references. Absolute and relative angles between calcaneus and first metatarsal bone were calculated both in 3D and in a simulated sagittal projections. The effects of malpositioning were also investigated via rotations of the entire foot model. RESULTS Large angle variations were found between the different definitions. For the 3D relative orientation, variations larger than 10 degrees were found. Foot malposition in axial rotation or in varus/valgus can result in errors larger than 5 and 3 degrees, respectively. CONCLUSIONS New measures of foot bone orientation are possible in 3D and in weight-bearing, removing operator variability and the effects of foot positioning.
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Affiliation(s)
- Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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31
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Marcheggiani Muccioli GM, Lullini G, Cammisa E, Leardini A, Zaffagnini S. A professional athlete functionally active 10 years after an arthroscopic lateral collagen meniscus implant. Knee Surg Sports Traumatol Arthrosc 2021; 29:117-119. [PMID: 32016579 DOI: 10.1007/s00167-020-05876-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Abstract
The case of a former high-level professional soccer player is presented at 10-year follow-up after arthroscopically implanted lateral Collagen Meniscus Implant (CMI). The patient achieved a full-knee functional recovery and a complete sport resumption to the same pre-injury level for several soccer seasons and he is still performing semi-professional soccer activity (minor league) 10 years after surgery.Level of evidence Case Report. Level IV.
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Affiliation(s)
- Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, DIBINEM-University of Bologna, via Pupilli, 1, 40136, Bologna, Italy.
| | - Giada Lullini
- Laboratorio di Analisi del Movimento e di Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, DIBINEM-University of Bologna, via Pupilli, 1, 40136, Bologna, Italy
| | - Alberto Leardini
- Laboratorio di Analisi del Movimento e di Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, DIBINEM-University of Bologna, via Pupilli, 1, 40136, Bologna, Italy
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Ferraresi C, De Benedictis C, Bono L, Del Gaudio F, Ferrara L, Masiello F, Franco W, Maffiodo D, Leardini A. A methodology for the customization of hinged ankle-foot orthoses based on in vivo helical axis calculation with 3D printed rigid shells. Proc Inst Mech Eng H 2020; 235:367-377. [PMID: 33323034 DOI: 10.1177/0954411920981543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to develop techniques for ankle joint kinematics analysis using motion capture based on stereophotogrammetry. The scope is to design marker attachments on the skin for a most reliable identification of the instantaneous helical axis, to be targeted for the fabrication of customized hinged ankle-foot orthoses. These attachments should limit the effects of the experimental artifacts, in particular the soft-tissue motion artifact, which affect largely the accuracy of any in vivo ankle kinematics analysis. Motion analyses were carried out on two healthy subjects wearing customized rigid shells that were designed through 3D scans of the subjects' lower limbs and fabricated by additive manufacturing. Starting from stereophotogrammetry data collected during walking and dorsi-plantarflexion motor tasks, the instantaneous and mean helical axes of ankle joint were calculated. The customized shells matched accurately the anatomy of the subjects and allowed for the definition of rigid marker clusters that improved the accuracy of in vivo kinematic analyses. The proposed methodology was able to differentiate between subjects and between the motor tasks analyzed. The observed position and dispersion of the axes were consistent with those reported in the literature. This methodology represents an effective tool for supporting the customization of hinged ankle-foot orthoses or other devices interacting with human joints functionality.
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Affiliation(s)
- Carlo Ferraresi
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Carlo De Benedictis
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Loris Bono
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Federica Del Gaudio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Laura Ferrara
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Fabiana Masiello
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Walter Franco
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Daniela Maffiodo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Lullini G, Caravaggi P, Leardini A, Ortolani M, Mazzotti A, Giannini S, Berti L. Retrospective comparison between a two- and three-component ankle arthroplasty: clinical and functional evaluation via gait analysis. Clin Biomech (Bristol, Avon) 2020; 80:105180. [PMID: 32992079 DOI: 10.1016/j.clinbiomech.2020.105180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle arthroplasty is intended to restore physiological joint function in case of severe ankle arthritis. However, little is known about the functional outcome associated to different prosthesis designs. The aim of this retrospective study was to compare clinical and functional outcomes via gait analysis of two ankle prostheses designed to preserve ankle ligamentous isometry. METHODS Two groups of twenty patients who underwent ankle arthroplasty using either a three-component or a two-component prosthesis, were clinically evaluated, both pre-operatively and at minimal 2-year follow-up, by means of the AOFAS score. The spatio-temporal parameters, along with the kinetics and kinematics of the lower limb joints were also assessed at follow-up via gait analysis. The non-parametric Kruskal-Wallis test was used to assess differences in functional data between the two patient groups and with respect to those from a control group of 20 healthy subjects. FINDINGS All AOFAS scores significantly improved from pre-operative to post-operative assessment in both patient groups (P < 0.05). Most spatio-temporal and functional parameters in the patients were worse than those in the control group, but no significant differences were observed between the two arthroplasty groups. INTERPRETATION Both patient groups showed improved clinical outcome at follow-up, with a few differences in gait parameters. However, neither of the two groups achieved normal locomotion patterns. Since both prostheses were designed to preserve ligamentous isometry, the choice of one implant over the other should be due to preferences in the surgical approach and to other patient-specific factors.
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Affiliation(s)
- Giada Lullini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sandro Giannini
- Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli & Università di Bologna, Bologna, Italy
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Belvedere C, Giacomozzi C, Carrara C, Lullini G, Caravaggi P, Berti L, Marchesini G, Baccolini L, Durante S, Leardini A. Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot. J Foot Ankle Res 2020; 13:64. [PMID: 33126903 PMCID: PMC7597032 DOI: 10.1186/s13047-020-00431-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Measurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. METHODS Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable. RESULTS Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D. CONCLUSION These preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (Italian National Institute of Health), Viale Regina Elena 299, 00161, Rome, Italy.
| | - Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Luca Baccolini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Schallig W, van den Noort JC, McCahill J, Stebbins J, Leardini A, Maas M, Harlaar J, van der Krogt MM. Comparing the kinematic output of the Oxford and Rizzoli Foot Models during normal gait and voluntary pathological gait in healthy adults. Gait Posture 2020; 82:126-132. [PMID: 32920448 DOI: 10.1016/j.gaitpost.2020.08.126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Oxford Foot Model (OFM) and Rizzoli Foot Model (RFM) are the two most frequently used multi-segment models to measure foot kinematics. However, a comprehensive comparison of the kinematic output of these models is lacking. RESEARCH QUESTION What are the differences in kinematic output between OFM and RFM during normal gait and typical pathological gait patterns in healthy adults?. METHODS A combined OFM and RFM marker set was placed on the right foot of ten healthy subjects. A static standing trial and six level walking trials were collected for normal gait and for four voluntarily adopted gait types: equinus, crouch, toe-in and toe-out. Joint angles were calculated for every trial for the hindfoot relative to shank (HF-SH), forefoot relative to hindfoot (FF-HF) and hallux relative to forefoot (HX-FF). Average static joint angles of both models were compared between models. After subtracting these offsets, the remaining dynamic angles were compared using statistical parametric mapping repeated measures ANOVAs and t-tests. Furthermore, range of motion was compared between models for every angle. RESULTS For the static posture, RFM compared to OFM measured more plantar flexion (Δ = 6°) and internal rotation (Δ = 7°) for HF-SH, more plantar flexion (Δ = 34°) and inversion (Δ = 13°) for FF-HF and more dorsal flexion (Δ = 37°) and abduction (Δ = 12°) for HX-FF. During normal walking, kinematic differences were found in various parts of the gait cycle. Moreover, range of motion was larger in the HF-SH for OFM and in FF-HF and HX-FF for RFM. The differences between models were not the same for all gait types. Equinus and toe-out gait demonstrated most pronounced differences. SIGNIFICANCE Differences are present in kinematic output between OFM and RFM, which also depend on gait type. Therefore, kinematic output of foot and ankle studies should be interpreted with careful consideration of the multi-segment foot model used.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jennifer McCahill
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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Matias AB, Caravaggi P, Leardini A, Taddei UT, Ortolani M, Sacco I. Repeatability of skin-markers based kinematic measures from a multi-segment foot model in walking and running. J Biomech 2020; 110:109983. [DOI: 10.1016/j.jbiomech.2020.109983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 11/16/2022]
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Carrara C, Caravaggi P, Belvedere C, Leardini A. Radiographic angular measurements of the foot and ankle in weight-bearing: A literature review. Foot Ankle Surg 2020; 26:509-517. [PMID: 31402285 DOI: 10.1016/j.fas.2019.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/17/2019] [Accepted: 07/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND For the diagnosis and treatment of the foot and ankle, bone alignments have long been evaluated using planar radiographs in weight-bearing conditions and a large number of measurements have been reported. The present survey reviews the major radiographic angles that are currently present in the literature for a possible better comprehension and classification of them. METHODS PubMed and Google Scholar were used to retrieve technical and clinical papers related to these angles, and were classified based on five typologies and the three projection planes. These angles were grouped into one definition if they described similar concepts, regardless of their anatomical references and names. A corresponding original definition and diagrammatic representation are offered. RESULTS Thirty-one conceptual radiographic angles were identified across all descriptions from the literature: 18 in the sagittal plane, 9 in the transverse, and 4 in the coronal. Most angular measures represent relative bone orientations; absolute orientations, bone morphology and joint lines are less frequently used or reported. CONCLUSIONS The present survey reveals a confused scenario of angular measures, particularly in terms of anatomical references and names. It is therefore recommended to establish common relevant techniques and terminology.
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Affiliation(s)
- Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy.
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
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Lullini G, Giangrande A, Caravaggi P, Leardini A, Berti L. Functional Evaluation of a Shock Absorbing Insole During Military Training in a Group of Soldiers: A Pilot Study. Mil Med 2020; 185:e643-e648. [PMID: 32175582 DOI: 10.1093/milmed/usaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/01/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Soldiers' lower limbs and feet are frequently affected by overload- and overuse-related injuries. In order to prevent or limit the incidence of these injuries, the use of foot orthoses is often recommended. The aim of this study is to assess the effects of shock-absorbing insoles on in-shoe plantar pressure magnitude and distribution in a group of professional infantry soldiers wearing military boots during standard indoor military training. METHODS Twenty male professional soldiers of the Italian Army (age 35.1 ± 6.1 years; BMI 25.2 ± 2.3 kg/m2) were recruited for this study. Each subject underwent clinical examination to assess possible overuse-related diseases of the lower limb and trunk. Subjects with altered foot morphology according to the Foot Posture Index (FPI) were excluded from this study. Twelve subjects were considered eligible and therefore underwent an indoor training routine comprised of marching, running, jumping inside parallel bars and jumping from different heights. Soldiers repeated the training session twice wearing standard military boots along with two types of insoles: the standard prefabricated insole within the boots (STI), and a special shock-absorbing insole (SAI) featuring an elastic medial arch support. A 99-capacitive sensor insole system was used to record plantar pressure distribution in both feet. Analysis of in-shoe pressure parameters at rearfoot, midfoot and forefoot and in the total foot was performed via a custom-software application developed in MATLAB. Perceived foot comfort (VAS 0-15) was also assessed. RESULTS Pressure parameters recorded during walking and running were considered suitable for statistical analysis. In the whole foot region, pressure parameters were 18-22% lower in military boots fitted with the SAI during walking and 14-18% lower during running. SAI resulted in better comfort (+25%) with respect to the prefabricated boot orthotics (median comfort: SAI = 15/15; STI = 12/15; p = 0.0039) both during walking and running. CONCLUSIONS Shock-absorbing insoles can be an effective solution when fitted inside military boots. The present functional evaluation shows that wearing a prefabricated shock-absorbing insole can provide a significant amelioration of perceived foot comfort and plantar pressure parameters. Further studies are now needed with a larger population and more demanding exercises.
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Affiliation(s)
- Giada Lullini
- Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40100 Bologna Italy.,DIBIMNEM-University of Bologna, Via Zamboni 33, 40110 Bologna, Italy
| | - Alessia Giangrande
- Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40100 Bologna Italy
| | - Paolo Caravaggi
- Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40100 Bologna Italy
| | - Alberto Leardini
- Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40100 Bologna Italy
| | - Lisa Berti
- Motion Analysis Laboratory, IRCCS-Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40100 Bologna Italy.,DIBIMNEM-University of Bologna, Via Zamboni 33, 40110 Bologna, Italy
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Milosevic B, Leardini A, Farella E. Kinect and wearable inertial sensors for motor rehabilitation programs at home: state of the art and an experimental comparison. Biomed Eng Online 2020; 19:25. [PMID: 32326957 PMCID: PMC7178588 DOI: 10.1186/s12938-020-00762-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 03/27/2020] [Indexed: 01/23/2023] Open
Abstract
Background Emerging sensing and communication technologies are contributing to the development of many motor rehabilitation programs outside the standard healthcare facilities. Nowadays, motor rehabilitation exercises can be easily performed and monitored even at home by a variety of motion-tracking systems. These are cheap, reliable, easy-to-use, and allow also remote configuration and control of the rehabilitation programs. The two most promising technologies for home-based motor rehabilitation programs are inertial wearable sensors and video-based motion capture systems. Methods In this paper, after a thorough review of the relevant literature, an original experimental analysis is reported for two corresponding commercially available solutions, a wearable inertial measurement unit and the Kinect, respectively. For the former, a number of different algorithms for rigid body pose estimation from sensor data were also tested. Both systems were compared with the measurements obtained with state-of-the-art marker-based stereophotogrammetric motion analysis, taken as a gold-standard, and also evaluated outside the lab in a home environment. Results The results in the laboratory setting showed similarly good performance for the elementary large motion exercises, with both systems having errors in the 3–8 degree range. Usability and other possible limitations were also assessed during utilization at home, which revealed additional advantages and drawbacks for the two systems. Conclusions The two evaluated systems use different technology and algorithms, but have similar performance in terms of human motion tracking. Therefore, both can be adopted for monitoring home-based rehabilitation programs, taking adequate precautions however for operation, user instructions and interpretation of the results.
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Affiliation(s)
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Deschamps K, Matricali G, Peters H, Eerdekens M, Wuite S, Leardini A, Staes F. Contribution of foot joints in the energetics of human running. Comput Methods Biomech Biomed Engin 2020; 23:557-563. [DOI: 10.1080/10255842.2020.1746287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kevin Deschamps
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
- Institut D’Enseignement, Division of Podiatry, Supérieur Parnasse Deux-Alice, Bruxelles, Belgium
- Department of Podiatry, Artevelde University College, Ghent, Belgium
| | - Giovanni Matricali
- Department of Development and Regeneration, KULeuven, Leuven, Belgium
- Foot and Ankle Surgery, UZ Leuven, Leuven, Belgium
- Member Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium
| | - Helen Peters
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
| | - Sander Wuite
- Department of Development and Regeneration, KULeuven, Leuven, Belgium
- Foot and Ankle Surgery, UZ Leuven, Leuven, Belgium
- Member Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium
| | | | - Filip Staes
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Leuven, Belgium
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Palazzi E, Siegler S, Balakrishnan V, Leardini A, Caravaggi P, Belvedere C. Estimating the stabilizing function of ankle and subtalar ligaments via a morphology-specific three-dimensional dynamic model. J Biomech 2020; 98:109421. [PMID: 31653506 DOI: 10.1016/j.jbiomech.2019.109421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Knowledge of the stabilizing role of the ankle and subtalar ligaments is important for improving clinical techniques such as ligament repair and reconstruction. However, this knowledge is incomplete. The goal of this study was to expand this knowledge by investigating the stabilizing function of the ligaments using multiple morphologically subject-specific computational models. Nine models were created from the lower extremities of nine donors. Each model consisted of the articulating bones, articular cartilage, and ligaments. Simulations were conducted in ADAMS™ - a dynamic simulation program. During simulation, tibia and fibula were fixed while cyclic moments in all three anatomical planes were applied to the calcaneus one-at-a-time. The resulting displacements between the bones and the forces in each ligament were computed. Simulations were conducted with all ligaments intact and after simulated ligament serial sectioning. Each model was validated by comparing the simulation results to experimental data obtained from the specimen used to construct the model. From the results the stabilizing role of each ligament was established and the effect of ligament sectioning on Range of Motion and Overall Laxity was identified. On the lateral side, ATFL provided stabilization in supination, CFL restrained inversion, external rotation and dorsiflexion and PTFL limited dorsiflexion and external rotation. On the medial side, PTTL restrained dorsiflexion and internal rotation, ATTL limited plantarflexion and external rotation, and TCL limited dorsiflexion, eversion and external rotation. At the subtalar joint, ITCL limited plantarflexion and its posterior-lateral bundle restrained subtalar inversion. CL restrained plantarflexion/dorsiflexion, and internal and external rotation. The large inter-model variability observed in the results indicate the importance of using multiple subject-specific models rather than relying on one "representative" model.
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Affiliation(s)
- Emanuele Palazzi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, University of Bologna, Italy; Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA.
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Peiffer M, Belvedere C, Clockaerts S, Leenders T, Leardini A, Audenaert E, Victor J, Burssens A. Three-dimensional displacement after a medializing calcaneal osteotomy in relation to the osteotomy angle and hindfoot alignment. Foot Ankle Surg 2020; 26:78-84. [PMID: 30581061 DOI: 10.1016/j.fas.2018.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND A medializing calcaneal osteotomy is frequently performed to correct adult-acquired flatfoot deformities, but there is lack of data on the associated three-dimensional variables defining the final correction. The aim of this study was to assess the correlation between the pre-operative hindfoot valgus deformity and calcaneal osteotomy angles and the post-operative calcaneal displacement. METHODS Weight-bearing CT scans obtained pre- and post-operatively were retrospectively analyzed for sixteen patients. Corresponding three-dimensional bone models were used to measure valgus deformity pre- and post-operatively, inclination of the osteotomy and displacement of the calcaneus. Linear regression was conducted to assess the relationship between these measurements. RESULTS On average, the hindfoot valgus changed from 13.1° (±4.6) pre-operatively to 5.7° (±4.3) post-operatively. A mean inferior displacement of 3.2mm (±1.3) was observed along the osteotomy with a mean inclination of 54.6° (±5.6), 80.5° (±10.7), -13.7° (±15.7) in the axial, sagittal and coronal planes, respectively. A statistically significant positive relationship (p<.05, R2=0.6) was found between the pre-operative valgus, the axial osteotomy inclination, and the inferior displacement. CONCLUSIONS This study shows that the degree of pre-operative hindfoot valgus and the axial osteotomy angle are predictive factors for the amount of post-operative inferior displacement of the calcaneus. These findings demonstrate the added value of a computer-based pre-operative planning in clinical practice. Level of evidence II Prospective comparative study.
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Affiliation(s)
- M Peiffer
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
| | - C Belvedere
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136 Bologna, Italy
| | - S Clockaerts
- Department of Orthopaedic Surgery, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium
| | - T Leenders
- Department of Orthopaedic Surgery, AZ Monica, Florent Pauwelslei 21, 2100 Deurne, Belgium
| | - A Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136 Bologna, Italy
| | - E Audenaert
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - J Victor
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - A Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium; University Orthopaedic Center, University of Utah, 590 Wakara Way Salt Lake City, UT 84108, USA
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Derrick TR, van den Bogert AJ, Cereatti A, Dumas R, Fantozzi S, Leardini A. ISB recommendations on the reporting of intersegmental forces and moments during human motion analysis. J Biomech 2019; 99:109533. [PMID: 31791632 DOI: 10.1016/j.jbiomech.2019.109533] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 02/08/2023]
Abstract
The International Society of Biomechanics (ISB) has charged this committee with development of a standard similar in scope to the kinematic standard proposed in Wu et al. (2002) and Wu et al. (2005). Given the variety of purposes for which intersegmental forces and moments are used in biomechanical research, it is not possible to recommend a particular set of analysis standards that will be acceptable in all applications. Instead, it is the purpose of this paper to recommend a set of reporting standards that will result in an understanding of the differences between investigations and the ability to reproduce the research. The end products of this standard are (1) a critical checklist that can be used during submission of manuscripts and abstracts to insure adequate description of methods, and (2) a web based visualization tool that can be used to alter the coordinate system, normalization technique and internal/external perspective of intersegmental forces and moments during walking and running so that the shape and magnitude of the curves can be compared to one's own data.
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Leardini A, Durante S, Belvedere C, Caravaggi P, Carrara C, Berti L, Lullini G, Giacomozzi C, Durastanti G, Ortolani M, Guglielmi G, Bazzocchi A. Weight-bearing CT Technology in Musculoskeletal Pathologies of the Lower Limbs: Techniques, Initial Applications, and Preliminary Combinations with Gait-Analysis Measurements at the Istituto Ortopedico Rizzoli. Semin Musculoskelet Radiol 2019; 23:643-656. [PMID: 31745954 DOI: 10.1055/s-0039-1697939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Musculoskeletal radiology has been mostly limited by the option between imaging under load but in two dimensions (i.e., radiographs) and three-dimensional (3D) scans but in unloaded conditions (i.e., computed tomography [CT] and magnetic resonance imaging in a supine position). Cone-beam technology is now also a way to image the extremities with 3D and weight-bearing CT. This article discusses the initial experience over a few studies in progress at an orthopaedic center. The custom design of total ankle replacements, the patellofemoral alignment after medial ligament reconstruction, the overall architecture of the foot bones in the diabetic foot, and the radiographic assessment of the rearfoot after subtalar fusion for correction of severe flat foot have all taken advantage of the 3D and weight-bearing feature of relevant CT scans. To further support these novel assessments, techniques have been developed to obtain 3D models of the bones from the scans and to merge these with state-of-the-art gait analyses.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Roma, Italy
| | - Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Rogati G, Leardini A, Ortolani M, Caravaggi P. Validation of a novel Kinect-based device for 3D scanning of the foot plantar surface in weight-bearing. J Foot Ankle Res 2019; 12:46. [PMID: 31497070 PMCID: PMC6720393 DOI: 10.1186/s13047-019-0357-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background Advancements in additive manufacturing, along with new 3D scanning tools, are increasingly fulfilling the technological need for custom devices in personalized medicine. In podiatry and in the footwear industry, custom orthotic and footwear solutions are often required to address foot pathologies or morphological alterations which cannot be managed with standard devices. While laser scanners are the current gold-standard for 3D digitization of the foot shape, their costs limit their applications and diffusion, therefore traditional operator-dependent casting methods are still in use. The aim of this study was to design and validate a novel 3D foot scanner based on the Microsoft Kinect sensor, allowing a 3D scan of the plantar shape of the foot to be acquired in weight-bearing. Methods The accuracy and repeatability of the prototypal foot scanner were investigated in a population of 14 asymptomatic healthy subjects, with no history of foot or lower limb injuries. The accuracy was estimated by comparing the Kinect foot scans with those obtained with a high-resolution laser scanner used as reference. The repeatability was assessed by comparing scans of the same foot acquired in different sessions. Results The inter-subject average Root Mean Square Error (RMSE) of the Kinect scans was lower than 3 mm for the whole plantar surface, and lower than 1.6 mm for the arch region alone, both in left and right feet. The repeatability, quantified as the average RMSE of pairwise comparisons between sessions, was 1.2 ± 0.4 mm. Conclusions The present Kinect-based 3D foot scanner showed optimal intra-operator repeatability and its accuracy appears adequate to obtain 3D scans of the foot plantar surface suitable for different clinical applications. This device could represent a valid low-cost alternative to expensive laser-based scanners and could be used for automatic foot measurements, supporting the design of custom insoles and footwear.
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Affiliation(s)
- Giulia Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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Durastanti G, Leardini A, Siegler S, Durante S, Bazzocchi A, Belvedere C. Comparison of cartilage and bone morphological models of the ankle joint derived from different medical imaging technologies. Quant Imaging Med Surg 2019; 9:1368-1382. [PMID: 31559166 DOI: 10.21037/qims.2019.08.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurate geometrical models of bones and cartilage are necessary in biomechanical modelling of human joints, and in planning and designing of joint replacements. Image-based subject-specific model development requires image segmentation, spatial filtering and 3-dimensional rendering. This is usually based on computed tomography (CT) for bone models, on magnetic resonance imaging (MRI) for cartilage models. This process has been reported extensively in the past, but no studies have ever compared the accuracy and quality of these models when obtained also by merging different imaging modalities. The scope of the present work is to provide this comparative analysis in order to identify optimal imaging modality and registration techniques for producing 3-dimensional bone and cartilage models of the ankle joint. Methods One cadaveric leg was instrumented with multimodal markers and scanned using five different imaging modalities: a standard, a dual-energy and a cone-beam CT (CBCT) device, and a 1.5 and 3.0 Tesla MRI devices. Bone, cartilage, and combined bone and cartilage models were produced from each of these imaging modalities, and registered in space according to matching model surfaces or to corresponding marker centres. To assess the quality in overall model reconstruction, distance map analyses were performed and the difference between model surfaces obtained from the different imaging modalities and registration techniques was measured. Results The registration between models worked better with model surface matching than corresponding marker positions, particularly with MRI. The best bone models were obtained with the CBCT. Models with cartilage were defined better with the 3.0 Tesla than the 1.5 Tesla. For the combined bone and cartilage models, the colour maps and the numerical results from distance map analysis (DMA) showed that the smallest distances and the largest homogeneity were obtained from the CBCT and the 3.0 T MRI via model surface registration. Conclusions These observations are important in producing accurate bone and cartilage models from medical imaging and relevant for applications such as designing of custom-made ankle replacements or, more in general, of implants for total as well as focal joint replacements.
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Affiliation(s)
- Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Belvedere C, Siegler S, Fortunato A, Caravaggi P, Liverani E, Durante S, Ensini A, Konow T, Leardini A. New comprehensive procedure for custom-made total ankle replacements: Medical imaging, joint modeling, prosthesis design, and 3D printing. J Orthop Res 2019; 37:760-768. [PMID: 30537247 DOI: 10.1002/jor.24198] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis can be created by laser-melting metal powders layer-by-layer. Ankle replacement is particularly suitable for this progress because of the limited number of sizes and the poor bone stock. In this study a novel procedure is presented for subject-specific ankle replacements, including medical-imaging, joint modelling, prosthesis design, and 3D-printing. Three shank-foot specimens were CT-scanned, and corresponding 3D bone models of the tibia, fibula, talus, and calcaneus were obtained. From these models, specimen-specific implant sets were designed according to three different concepts, and 3D-printed from cobalt-chromium-molybdenum powder. Accuracy of the overall procedure was assessed via distance map comparisons between original anatomical and final metal implants. Restoration of natural ankle joint mechanics was check after implantation of each of the three sets. In a special rig, a manually-driven dorsi/plantar-flexion was applied throughout the passive arc. Additionally, at three different joint positions, joint torques were imposed in the frontal and axial anatomical planes. Mean manufacturing errors were found to be smaller than 0.08 mm. Consistent motion patterns were observed over repetitions, with the mean standard deviation smaller than 1.0 degree. In each ankle specimen, mobility, and stability at the replaced joints compared well with the original natural condition. For the first time, custom-made implants for total ankle replacements were designed, manufactured with additive technology and tested. This procedure is a first fundamental step toward the development of completely personalized prostheses. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | | | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic-Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tobias Konow
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Leardini A, Caravaggi P, Theologis T, Stebbins J. Multi-segment foot models and their use in clinical populations. Gait Posture 2019; 69:50-59. [PMID: 30665039 DOI: 10.1016/j.gaitpost.2019.01.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications. RESEARCH QUESTION Can multi-segment foot models be used in clinical populations? METHODS Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: 'multisegment'; 'foot'; 'model'; 'kinematics', 'joints' and 'gait'. RESULTS More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population. SIGNIFICANCE This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Tim Theologis
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Julie Stebbins
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK.
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Caravaggi P, Liverani E, Leardini A, Fortunato A, Belvedere C, Baruffaldi F, Fini M, Parrilli A, Mattioli‐Belmonte M, Tomesani L, Pagani S. CoCr porous scaffolds manufactured via selective laser melting in orthopedics: Topographical, mechanical, and biological characterization. J Biomed Mater Res B Appl Biomater 2019; 107:2343-2353. [DOI: 10.1002/jbm.b.34328] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/16/2018] [Accepted: 12/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Paolo Caravaggi
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | - Alberto Leardini
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | - Claudio Belvedere
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Fabio Baruffaldi
- Medical Technology LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Annapaola Parrilli
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | | | - Stefania Pagani
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
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Caravaggi P, Sforza C, Leardini A, Portinaro N, Panou A. Effect of plano-valgus foot posture on midfoot kinematics during barefoot walking in an adolescent population. J Foot Ankle Res 2018; 11:55. [PMID: 30302128 PMCID: PMC6167855 DOI: 10.1186/s13047-018-0297-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Plano-valgus is a common alteration of the paediatric foot, characterized by valgus hindfoot, foot pronation and drop of the medial longitudinal arch. Despite their importance in the diagnosis and classification of plano-valgus foot condition, little information is available on functional alterations of the major joints spanning the medial longitudinal arch – i.e. midtarsal and tarso-metatarsal. Aim of the study was to provide objective description of the alterations in plano-valgus midfoot joints with respect to those in an age-matched normally-developed feet population. Methods Twenty adolescents (13.3 ± 0.8 years) with bilateral plano-valgus feet underwent clinical examination and were gait-analysed via a validated 4-segment foot model. This allowed to measure static foot posture, kinematics of the main foot joints, and medial longitudinal arch deformation during walking at comfortable speed. Range of motion and temporal profiles of joint rotations were compared to those from a control population of age-matched adolescents with normally-developed feet. Results The plano-valgus midtarsal joint was more dorsiflexed, everted and abducted than that in the control group, and showed reduced sagittal-plane RoM (plano-valgus = 15.9 degrees; control = 22.2 degrees; P < 0.01). The tarso-metarsal joint was more plantarflexed and adducted, and showed larger frontal-plane RoM. The MLA showed larger RoM and was lower throughout the stance phase of the gait cycle. Conclusion Significant postural and kinematic alterations are present at the midtarsal and tarso-metarsal joints of adolescents with plano-valgus feet. Objective identification and quantification of plano-valgus foot alterations, via non-invasive gait-analysis, is relevant to improving the diagnosis of this condition and to evaluating the effect of conservative treatments and of surgical corrections by different techniques.
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Affiliation(s)
- Paolo Caravaggi
- 1Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Chiarella Sforza
- 2Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy
| | - Alberto Leardini
- 1Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Nicola Portinaro
- 3Department of Pediatric Orthopedics and Neuro-orthopedics, Humanitas Research Hospital, University of Milan, Via Manzoni 56, 20089 Rozzano, MI Italy.,4Department of Translational Medicine, Orthopaedic and Traumatology Clinic, Humanitas Research Hospital, University of Milan, Rozzano, Milan Italy
| | - Artemisia Panou
- 2Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy.,3Department of Pediatric Orthopedics and Neuro-orthopedics, Humanitas Research Hospital, University of Milan, Via Manzoni 56, 20089 Rozzano, MI Italy
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