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Lee EC, Roach NT, Clouthier AL, Bicknell RT, Bey MJ, Young NM, Rainbow MJ. Three-dimensional scapular morphology is associated with rotator cuff tears and alters the abduction moment arm of the supraspinatus. Clin Biomech (Bristol, Avon) 2020; 78:105091. [PMID: 32580097 PMCID: PMC8161464 DOI: 10.1016/j.clinbiomech.2020.105091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies have reported an association between rotator cuff injury and two-dimensional measures of scapular morphology. However, the mechanical underpinnings explaining how these shape features affect glenohumeral joint function and lead to injury are poorly understood. We hypothesized that three-dimensional features of scapular morphology differentiate asymptomatic shoulders from those with rotator cuff tears, and that these features would alter the mechanical advantage of the supraspinatus. METHODS Twenty-four individuals with supraspinatus tears and twenty-seven age-matched controls were recruited. A statistical shape analysis identified scapular features distinguishing symptomatic patients from asymptomatic controls. We examined the effect of injury-associated morphology on mechanics by developing a morphable model driven by six degree-of-freedom biplanar videoradiography data. We used the model to simulate abduction for a range of shapes and computed the supraspinatus moment arm. FINDINGS Rotator cuff injury was associated with a cranial orientation of the glenoid and scapular spine (P = .011, d = 0.75) and/or decreased subacromial space (P = .001, d = 0.94). The shape analysis also identified previously undocumented features associated with superior inclination and subacromial narrowing. In our computational model, warping the scapula from a cranial to a lateral orientation increased the supraspinatus moment arm at 20° of abduction and decreased the moment arm at 160° of abduction. INTERPRETATIONS Three-dimensional analysis of scapular morphology indicates a stronger relationship between morphology and cuff tears than two-dimensional measures. Insight into how morphological features affect rotator cuff mechanics may improve patient-specific strategies for prevention and treatment of cuff tears.
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Affiliation(s)
- Erin C.S. Lee
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada,Corresponding author at: Department of Mechanical and Materials Engineering and Human Mobility Research Centre, Queen’s University, 130 Stuart Street, Kingston, ON K7L 3N6, Canada., (E.C.S. Lee)
| | - Neil T. Roach
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | | | - Ryan T. Bicknell
- Department of Surgery, Kingston Health Sciences Centre, Kingston, Canada
| | - Michael J. Bey
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Nathan M. Young
- Department of Orthopaedic Surgery, University of California San Francisco, CA, USA
| | - Michael J. Rainbow
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
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Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 PMCID: PMC7405358 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Lee D, Hong KT, Lim TS, Lee E, Lee YH, Park JS, Kim W, Oh JH, Choi JA, Song Y. Alterations in articular cartilage T2 star relaxation time following mechanical disorders: in vivo canine supraspinatus tendon resection models. BMC Musculoskelet Disord 2020; 21:424. [PMID: 32615950 PMCID: PMC7331159 DOI: 10.1186/s12891-020-03447-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background The role of altered joint mechanics on cartilage degeneration in in vivo models has not been studied successfully due to a lack of pre-injury information. We aimed 1) to develop an accurate in vivo canine model to measure the changes in joint loading and T2 star (T2*) relaxation time before and after unilateral supraspinatus tendon resections, and 2) to find the relationship between regional variations in articular cartilage loading patterns and T2* relaxation time distributions. Methods Rigid markers were implanted in the scapula and humerus of tested dogs. The movement of the shoulder bones were measured by a motion tracking system during normal gaits. In vivo cartilage contact strain was measured by aligning 3D shoulder models with the motion tracking data. Articular cartilage T2* relaxation times were measured by quantitative MRI scans. Articular cartilage contact strain and T2* relaxation time were compared in the shoulders before and 3 months after the supraspinatus tendon resections. Results Excellent accuracy and reproducibility were found in our in vivo contact strain measurements with less than 1% errors. Changes in articular cartilage contact strain exhibited similar patterns with the changes in the T2* relaxation time after resection surgeries. Regional changes in the articular cartilage T2* relaxation time exhibited positive correlations with regional contact strain variations 3 months after the supraspinatus resection surgeries. Conclusion This is the first study to measure in vivo articular cartilage contact strains with high accuracy and reproducibility. Positive correlations between contact strain and T2* relaxation time suggest that the articular cartilage extracellular matrix may responds to mechanical changes in local areas.
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Affiliation(s)
- Dokwan Lee
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ki-Taek Hong
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea
| | - Tae Seong Lim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ye Hyun Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul, South Korea
| | - Ji Soon Park
- Department of Orthopedic Surgery, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Woo Kim
- Seoul Kiwoonchan Orthopedics Clinic, Seoul, South Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Yongnam Song
- Department of Mechanical Engineering, Korea University Engineering Campus, Innovation Hall, Room 306, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea.
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Blair DJ, Barg A, Foreman KB, Anderson AE, Lenz AL. Methodology for Measurement of in vivo Tibiotalar Kinematics After Total Ankle Replacement Using Dual Fluoroscopy. Front Bioeng Biotechnol 2020; 8:375. [PMID: 32432091 PMCID: PMC7214754 DOI: 10.3389/fbioe.2020.00375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Biomechanical data could improve our clinical understanding of failures in total ankle replacement (TAR) patients, leading to better surgical approaches and implant designs. Kinematics of the prosthetic tibiotalar joint in TAR patients have yet to be measured using dual fluoroscopy. With dual fluoroscopy, computed tomography (CT) images are acquired to track bone motion. One challenge with this approach is dealing with metal artifact in the CT images that distorts implant visualization and the surrounding bone to implant interfaces. The aim of this study was to develop a methodology to measure in vivo TAR kinematics using inputs of computer-aided design (CAD) models, dual fluoroscopy and CT imaging with metal artifact reduction. To develop this methodology, we created a hybrid three-dimensional (3D) model that contained both: (1) the segmented bone; and (2) the CAD models of the TAR components. We evaluated a patient following total ankle replacement to demonstrate feasibility. The patient performed a self-selected overground walk during which dual fluoroscopy images were collected at 200 Hz. In vivo tracking verifications were performed during overground walking using a distance calculation between the implant articular surfaces to evaluate the model-based tracking 3D solution. Tracking verification indicated realistic alignment of the hybrid models with an evenly distributed distance map pattern during the trial. Articular surface distance calculations were reported as an average of 1.3 mm gap during the entirety of overground walking. The successful implementation of our new tracking methodology with a hybrid model presents a new approach to evaluate in vivo TAR kinematics. Measurements of in vivo kinematics could improve our clinical understanding of failures in TAR patients, leading to better long-term surgical outcomes.
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Affiliation(s)
- Dylan J Blair
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alexej Barg
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
| | - K Bo Foreman
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Amy L Lenz
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
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55
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Yeni YN, Baumer T, Oravec D, Basheer A, Bey MJ, Bartol SW, Chang V. Correlation of neural foraminal motion after surgical treatment of cervical radiculopathy with long-term patient reported outcomes. JOURNAL OF SPINE SURGERY 2020; 6:18-25. [PMID: 32309642 DOI: 10.21037/jss.2020.03.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Post-surgical changes in adjacent segment motion are considered a factor in further development of degeneration and cervical radiculopathy. The objective was to examine the extent of correlations between physiological motion of cervical foramina and long-term patient reported outcomes (PRO). Methods Biplane X-ray imaging and CT-based markerless tracking were used to measure 3D static and dynamic dimensions during neck axial rotation and extension from 18 patients treated for C5-6 radiculopathy with fusion or arthroplasty. Minimum foraminal height (FH.Min) and width (FW.Min), and their range (FH.Range and FW.Range) achieved during a motion task were calculated for adjacent levels (C4-5 and C6-7) at 2.0±0.6 years post-surgery. The modified Japanese Orthopedic Association score (mJOAS), the Neck Disability Index (NDI) including the visual analogue scale (VAS) for neck and arm pain, and the EuroQol EQ-5D score were recorded at 6.5±1.1 years post-surgery. The relationships between 6.5-year outcomes and 2-year foraminal motion were examined using regression. Results Worsening patient-reported outcomes were generally associated with lower values of FW.Min (P<0.05 to P<0.008), the associations being stronger for neck extension (r2 up to 0.43). Dynamic foraminal measurements from the C6-7 level more significantly and consistently correlated with mJOAS, EQ-5D and NDI Arm Pain VAS (r2=0.27 to 0.43; P<0.03 to P<0.008), whereas those from the C4-5 level correlated with NDI Neck Pain VAS (r2=0.33; P<0.02). Conclusions Dynamic 3D foraminal dimensions at 2-year post-surgery, notably FW.Min measured in neck extension at adjacent levels, were associated with PRO at 6.5 years post-surgery. These relationships provide insight into the motion related factors in development of pain and loss of function, and may help develop markers or objective outcome measures.
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Affiliation(s)
- Yener N Yeni
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Timothy Baumer
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Daniel Oravec
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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56
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Lenz AL, Nichols JA, Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis: An in Vivo Dual-Fluoroscopy Imaging Study. J Bone Joint Surg Am 2020; 102:600-608. [PMID: 32079879 PMCID: PMC7289138 DOI: 10.2106/jbjs.19.01132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle. METHODS Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured. RESULTS During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°). CONCLUSIONS A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. CLINICAL RELEVANCE Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.
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Affiliation(s)
- Amy L. Lenz
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Jennifer A. Nichols
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Koren E. Roach
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Radiology, University of California-San Francisco, San Francisco, California
| | - K. Bo Foreman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Alexej Barg
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Charles L. Saltzman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Email address for A.E. Anderson:
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Atkins PR, Fiorentino NM, Hartle JA, Aoki SK, Peters CL, Foreman KB, Anderson AE. In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study. J Orthop Res 2020; 38:823-833. [PMID: 31693209 PMCID: PMC7301904 DOI: 10.1002/jor.24509] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) may alter the kinematic function of the hip, resulting in pain and tissue damage. Previous motion analysis studies of FAIS have employed skin markers, which are prone to soft tissue artifact and inaccurate calculation of the hip joint center. This may explain why the evidence linking FAIS with deleterious kinematics is contradictory. The purpose of this study was to employ dual fluoroscopy (DF) to quantify in vivo kinematics of patients with cam FAIS relative to asymptomatic, morphologically normal control participants during various activities. Eleven asymptomatic, morphologically normal controls and seven patients with cam FAIS were imaged with DF during standing, level walking, incline walking, and functional range of motion activities. Model-based tracking calculated the kinematic position of the hip by registering projections of three-dimensional computed tomography models with DF images. Patients with FAIS stood with their hip extended (mean [95% confidence interval], -2.2 [-7.4, 3.1]°, flexion positive), whereas controls were flexed (5.3 [2.6, 8.0]°; p = 0.013). Male patients with cam FAIS had less peak internal rotation than the male control participants during self-selected speed level-walking (-0.2 [-6.5, 6.1]° vs. -9.8 [-12.2, -7.3]°; p = 0.007) and less anterior pelvic tilt at heel-strike of incline (5°) walking (3.4 [-1.0, -7.9]° vs. 9.8 [6.4, 13.2]°; p = 0.032). Even during submaximal range of motion activities, such as incline walking, patients may alter pelvic motion to avoid positions that approximate the cam lesion and the acetabular labrum. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:823-833, 2020.
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Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA
| | - Joseph A. Hartle
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA
| | - Andrew. E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
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Maharaj JN, Kessler S, Rainbow MJ, D'Andrea SE, Konow N, Kelly LA, Lichtwark GA. The Reliability of Foot and Ankle Bone and Joint Kinematics Measured With Biplanar Videoradiography and Manual Scientific Rotoscoping. Front Bioeng Biotechnol 2020; 8:106. [PMID: 32211386 PMCID: PMC7075816 DOI: 10.3389/fbioe.2020.00106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
The intricate motion of the small bones of the feet are critical for its diverse function. Accurately measuring the 3-dimensional (3D) motion of these bones has attracted much attention over the years and until recently, was limited to invasive techniques or quantification of functional segments using multi-segment foot models. Biplanar videoradiography and model-based scientific rotoscoping offers an exciting alternative that allows us to focus on the intricate motion of individual bones in the foot. However, scientific rotoscoping, the process of rotating and translating a 3D bone model so that it aligns with the captured x-ray images, is either semi- or completely manual and it is unknown how much human error affects tracking results. Thus, the aim of this study was to quantify the inter- and intra-operator reliability of manually rotoscoping in vivo bone motion of the tibia, talus, and calcaneus during running. Three-dimensional CT bone volumes and high-speed biplanar videoradiography images of the foot were acquired on six participants. The six-degree-of-freedom motions of the tibia, talus, and calcaneus were determined using a manual markerless registration algorithm. Two operators performed the tracking, and additionally, the first operator re-tracked all bones, to test for intra-operator effects. Mean RMS errors were 1.86 mm and 1.90° for intra-operator comparisons and 2.30 mm and 2.60° for inter-operator comparisons across all bones and planes. The moderate to strong similarity values indicate that tracking bones and joint kinematics between sessions and operators is reliable for running. These errors are likely acceptable for defining gross joint angles. However, this magnitude of error may limit the capacity to perform advanced analyses of joint interactions, particularly those that require precise (sub-millimeter) estimates of bone position and orientation. Optimizing the view and image quality of the biplanar videoradiography system as well as the automated tracking algorithms for rotoscoping bones in the foot are required to reduce these errors and the time burden associated with the manual processing.
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Affiliation(s)
- Jayishni N Maharaj
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah Kessler
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Susan E D'Andrea
- Department of Orthopaedics, Brown University, Providence, RI, United States.,Department of Kinesiology, The University of Rhode Island, Kingston, RI, United States
| | - Nicolai Konow
- Department of Biological Science, University of Massachusetts, Lowell, MA, United States
| | - Luke A Kelly
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Glen A Lichtwark
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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59
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Validation and application of dynamic biplane radiography to study in vivo ankle joint kinematics during high-demand activities. J Biomech 2020; 103:109696. [PMID: 32139098 DOI: 10.1016/j.jbiomech.2020.109696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 12/26/2022]
Abstract
Ankle ligament injuries are the most common musculoskeletal injury in physically active populations. Failure to restore native kinematics post-injury often leads to long-term consequences including chronic instability and arthritis. Using traditional motion capture, it is difficult to distinguish independent motions of the tibiotalar and subtalar joints to assess the effects of injury, surgical repair, and rehabilitation on ankle joint complex (AJC) kinematics. Therefore, the aims of this study were to determine the accuracy of dynamic biplane radiography for determining in vivo AJC kinematics and arthrokinematics, and to identify sport-related movements that require the largest AJC range of motion (ROM) during support. Two subjects had three to five 1.0 mm diameter tantalum beads implanted into the tibia, fibula, talus, and calcaneus during lateral ankle ligament repair. Six months after surgery, the subjects executed seven movements while biplane radiographs were collected. Bone motion was tracked using radiostereophotogrammetric analysis (RSA) as a "gold standard", and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs. Over all movements, the average tibiotalar, subtalar and tibiofibular RMS errors were 0.5 mm ± 0.2 mm, 0.8 mm ± 0.5 mm and 0.8 mm ± 0.3 mm in translation and 1.4° ± 0.4°, 1.5° ± 0.5° and 1.7° ± 0.6° in rotation, respectively. Tibiotalar joint space was determined with an average precision of 0.5 mm. ROM results indicate that jumping and a forward-to-backward push-off movement are the best of the seven sport-related movements evaluated for eliciting full ROM kinematics.
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Sang D, Cui W, Guo Z, Sang H, Liu B. The Differences Among Kinematic Parameters for Evaluating the Quality of Intervertebral Motion of the Cervical Spine in Clinical and Experimental Studies: Concepts, Research and Measurement Techniques. A Literature Review. World Neurosurg 2020; 133:343-357.e1. [DOI: 10.1016/j.wneu.2019.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
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Sahoo S, Baker AR, Jun BJ, Erdemir A, Ricchetti ET, Iannotti JP, Derwin KA. A novel radiopaque tissue marker for soft tissue localization and in vivo length and area measurements. PLoS One 2019; 14:e0224244. [PMID: 31626672 PMCID: PMC6799909 DOI: 10.1371/journal.pone.0224244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of the study was to describe the characteristics and demonstrate proof-of-concept and clinical use of a barium sulfate infused polypropylene radiopaque tissue marker for soft tissue localization and in vivo measurement of lengths and areas. METHODS Marker mechanical properties were evaluated by tensile tests. Biocompatibility was evaluated following 8-12 weeks' implantation in a pig model. Proof-of-concept of marker application was performed in a human cadaveric shoulder model, and methods for CT imaging and measurement of dimensions were established. Lastly, the method of clinical use of the markers was described in one patient undergoing arthroscopic rotator cuff repair (RCR). RESULTS The radiopaque markers had a tensile strength of 28 ±4.7 N and were associated with minimal to mild inflammatory tissue reaction similar to polypropylene control. CT-based measurements showed relatively high precisions for lengths (0.66 mm), areas (6.97 mm2), and humeral orientation angles (2.1°) in the cadaveric model, and demonstrated 19 ±3 mm medio-lateral tendon retraction and 227 ±3 mm2 increase in tendon area in the patient during 26 weeks following RCR. No radiographic leaching, calcification or local adverse events were observed. CONCLUSIONS The radiopaque tissue marker was biocompatible and had adequate strength for handling and affixation to soft tissues using standard suturing techniques. The marker could be used with low-dose, sequential CT imaging to quantitatively measure rotator cuff tendon retractions with clinically acceptable accuracy. We envision the radiopaque tissue marker to be useful for soft tissue localization and in vivo measurement of tissue and organ dimensions following surgery.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Andrew R. Baker
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Bong Jae Jun
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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The effect of using different coordinate systems on in-vivo hip angles can be estimated from computed tomography images. J Biomech 2019; 95:109318. [PMID: 31471111 DOI: 10.1016/j.jbiomech.2019.109318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
Measurements of hip kinematics inherently depend on the coordinate system in which they are derived, yet the effect of the coordinate system definition on calculations of hip angles is not well-understood. Herein, hip angles calculated during dynamic activities were compared using coordinate systems described in the literature. In-vivo kinematic data of 24 participants (13 males) were analyzed during gait and the anterior impingement test using dual fluoroscopy and model-based tracking. Two coordinate systems for the pelvis (anterior pelvic plane, International Society of Biomechanics [ISB]) and three coordinate systems for the femur (table top plane with two definitions of the superior-inferior axis, ISB) were evaluated. Bony landmarks visible on computed tomography (CT) images were identified to establish each coordinate system and used as the basis to calculate differences in hip angles between coordinate system pairs. In the analysis during gait, the maximum differences derived from various coordinate system definitions were 6.7° ± 5.5° for flexion, 7.7° ± 2.1° for rotation, and 5.5° ± 0.7° for adduction. For the anterior impingement test, the differences were 8.1° ± 5.9°, 7.1° ± 1.2°, and 5.3° ± 0.7°, respectively. Landmark-based analysis using CT images could estimate these dynamic differences with errors less than 1.0°. Our results indicate that hip angles can be accurately transformed to angles calculated in different coordinate systems by accounting for the inherent bony anatomy. This information may aid in the interpretation of results across biomechanical studies of the hip.
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Abstract
Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic.
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Affiliation(s)
- Rebekah L Lawrence
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan
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Akhbari B, Morton AM, Moore DC, Weiss APC, Wolfe SW, Crisco JJ. Accuracy of biplane videoradiography for quantifying dynamic wrist kinematics. J Biomech 2019; 92:120-125. [PMID: 31174845 DOI: 10.1016/j.jbiomech.2019.05.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/26/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
Accurately assessing the dynamic kinematics of the skeletal wrist could advance our understanding of the normal and pathological wrist. Biplane videoradiography (BVR) has allowed investigators to study dynamic activities in the knee, hip, and shoulder joint; however, currently, BVR has not been utilized for the wrist joint because of the challenges associated with imaging multiple overlapping bones. Therefore, our aim was to develop a BVR procedure and to quantify its accuracy for evaluation of wrist kinematics. BVR was performed on six cadaveric forearms for one neutral static and six dynamic tasks, including flexion-extension, radial-ulnar deviation, circumduction, pronation, supination, and hammering. Optical motion capture (OMC) served as the gold standard for assessing accuracy. We propose a feedforward tracking methodology, which uses a combined model of metacarpals (second and third) for initialization of the third metacarpal (MC3). BVR-calculated kinematic parameters were found to be consistent with the OMC-calculated parameters, and the BVR/OMC agreement had submillimeter and sub-degree biases in tracking individual bones as well as the overall joint's rotation and translation. All dynamic tasks (except pronation task) showed a limit of agreement within 1.5° for overall rotation, and within 1.3 mm for overall translations. Pronation task had a 2.1° and 1.4 mm limit of agreement for rotation and translation measurement. The poorest precision was achieved in calculating the pronation-supination angle, and radial-ulnar and volar-dorsal translational components, although they were sub-degree and submillimeter. The methodology described herein may assist those interested in examining the complexities of skeletal wrist function during dynamic tasks.
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Affiliation(s)
- Bardiya Akhbari
- Department of Biomedical Engineering, Brown University, Providence, RI 02912, United States
| | - Amy M Morton
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Douglas C Moore
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Arnold-Peter C Weiss
- Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States
| | - Scott W Wolfe
- Hand and Upper Extremity Center, Hospital for Special Surgery, New York, NY 10021, United States
| | - Joseph J Crisco
- Department of Biomedical Engineering, Brown University, Providence, RI 02912, United States; Department of Orthopedics, Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02912, United States.
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Hatch DJ, Santrock RD, Smith B, Dayton P, Weil L. Triplane Hallux Abducto Valgus Classification. J Foot Ankle Surg 2019; 57:972-981. [PMID: 29784530 DOI: 10.1053/j.jfas.2018.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 02/03/2023]
Abstract
One of the most common procedures performed in the foot and ankle is correction of hallux abducto valgus deformity or "bunion surgery." Most foot and ankle surgeons recognize the challenges associated with defining each patient's individual deformity and selecting the optimal procedure for the best long-term results. Using current 2-dimensional algorithms that focus on the severity of the transverse plane deformity, surgical outcomes have varied. In the past 10 years, high recurrence and complication rates for popular procedures have been reported. In the same period, the reported data have elucidated an evolving anatomic understanding of the bunion deformity, with an expansion to 3 dimensions, including the frontal/coronal plane. We present a new classification and approach for the evaluation and procedure selection for bunion surgery. We hope this conceptual treatise on hallux abducto valgus based on clinical consensus and current data will stimulate academic discussion and further research. This anatomic classification is based on the 3-dimensional anatomy of the first ray.
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Affiliation(s)
- Daniel J Hatch
- Surgical Director, Northern Colorado Podiatric Medicine & Surgery Residency, Greeley, CO; Clinical Instructor, Dr William M Scholl College of Podiatric Medicine, North Chicago, IL.
| | - Robert D Santrock
- Assistant Professor and Chief of Foot & Ankle Surgery, Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, WV
| | - Bret Smith
- Director, Foot & Ankle Division, Palmetto Health-USC Orthopedic Center, Columbia, SC; Assistant Professor, Orthopedics, University of South Carolina, Columbia, SC
| | - Paul Dayton
- Attending Staff, UnityPoint Clinic, Fort Dodge, IA; Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA
| | - Lowell Weil
- President and Fellowship Director, Weil Foot and Ankle Institute, Des Plaines, IL
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Englander ZA, Martin JT, Ganapathy PK, Garrett WE, DeFrate LE. Automatic registration of MRI-based joint models to high-speed biplanar radiographs for precise quantification of in vivo anterior cruciate ligament deformation during gait. J Biomech 2018; 81:36-44. [PMID: 30249338 PMCID: PMC6434938 DOI: 10.1016/j.jbiomech.2018.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/04/2018] [Accepted: 09/08/2018] [Indexed: 11/25/2022]
Abstract
Understanding in vivo joint mechanics during dynamic activity is crucial for revealing mechanisms of injury and disease development. To this end, laboratories have utilized computed tomography (CT) to create 3-dimensional (3D) models of bone, which are then registered to high-speed biplanar radiographic data captured during movement in order to measure in vivo joint kinematics. In the present study, we describe a system for measuring dynamic joint mechanics using 3D surface models of the joint created from magnetic resonance imaging (MRI) registered to high-speed biplanar radiographs using a novel automatic registration algorithm. The use of MRI allows for modeling of both bony and soft tissue structures. Specifically, the attachment site footprints of the anterior cruciate ligament (ACL) on the femur and tibia can be modeled, allowing for measurement of dynamic ACL deformation. In the present study, we demonstrate the precision of this system by tracking the motion of a cadaveric porcine knee joint. We then utilize this system to quantify in vivo ACL deformation during gait in four healthy volunteers.
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Affiliation(s)
- Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - John T Martin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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A survey of human shoulder functional kinematic representations. Med Biol Eng Comput 2018; 57:339-367. [PMID: 30367391 PMCID: PMC6347660 DOI: 10.1007/s11517-018-1903-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/17/2017] [Indexed: 10/28/2022]
Abstract
In this survey, we review the field of human shoulder functional kinematic representations. The central question of this review is to evaluate whether the current approaches in shoulder kinematics can meet the high-reliability computational challenge. This challenge is posed by applications such as robot-assisted rehabilitation. Currently, the role of kinematic representations in such applications has been mostly overlooked. Therefore, we have systematically searched and summarised the existing literature on shoulder kinematics. The shoulder is an important functional joint, and its large range of motion (ROM) poses several mathematical and practical challenges. Frequently, in kinematic analysis, the role of the shoulder articulation is approximated to a ball-and-socket joint. Following the high-reliability computational challenge, our review challenges this inappropriate use of reductionism. Therefore, we propose that this challenge could be met by kinematic representations, that are redundant, that use an active interpretation and that emphasise on functional understanding.
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Akbari-Shandiz M, Lawrence RL, Ellingson AM, Johnson CP, Zhao KD, Ludewig PM. MRI vs CT-based 2D-3D auto-registration accuracy for quantifying shoulder motion using biplane video-radiography. J Biomech 2018; 82:375-380. [PMID: 30385001 DOI: 10.1016/j.jbiomech.2018.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models. However, the accuracy of MRI-based 2D-3D registration for quantifying glenohumeral kinematics is unknown. We developed an automatic 2D-3D registration program that works with both CT- and MRI-based image volumes for quantifying joint motions. The purpose of this study was to use the proposed 2D-3D auto-registration algorithm to describe the humerus and scapula tracking accuracy of CT- and MRI-based registration relative to radiostereometric analysis (RSA) during dynamic biplanar video-radiography. The GH kinematic accuracy (RMS error) was 0.6-1.0 mm and 0.6-2.2° for the CT-based registration and 1.4-2.2 mm and 1.2-2.6° for MRI-based registration. Higher kinematic accuracy of CT-based registration was expected as MRI provides lower spatial resolution and bone contrast as compared to CT and suffers from spatial distortions. However, the MRI-based registration is within an acceptable accuracy for many clinical research questions.
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Affiliation(s)
- Mohsen Akbari-Shandiz
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Rebekah L Lawrence
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Arin M Ellingson
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Paula M Ludewig
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA.
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An interpolation technique to enable accurate three-dimensional joint kinematic analyses using asynchronous biplane fluoroscopy. Med Eng Phys 2018; 60:109-116. [PMID: 30098937 DOI: 10.1016/j.medengphy.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/25/2018] [Accepted: 07/22/2018] [Indexed: 11/22/2022]
Abstract
Biplane 2D-3D model-based registration and radiostereometric analysis (RSA) approaches have been commonly used for measuring three-dimensional, in vivo joint kinematics. However, in clinical biplane systems, the x-ray images are acquired asynchronously, which introduces registration errors. The present study introduces an interpolation technique to reduce image registration error by generating synchronous fluoroscopy image estimates. A phantom study and cadaveric shoulder study were used to evaluate the level of improvement in image registration that could be obtained as a result of using our interpolation technique. Our phantom study results show that the interpolated bead tracking technique was in better agreement with the true bead positions than when asynchronous images were used alone. The overall RMS error of glenohumeral kinematics for interpolated biplane registration was reduced by 1.27 mm, 0.40 mm, and 0.47 mm in anterior-posterior, superior-inferior, and medial-lateral translation, respectively; and 0.47°, 0.67°, and 0.19° in ab-adduction, internal-external rotation and flexion-extension, respectively, compared to asynchronous registration. The interpolated biplane registration results were consistent with previously reported studies using custom synchronous biplane fluoroscopy technology. This approach will be particularly useful for improving the kinematic accuracy of high velocity activities when using clinical biplane fluoroscopes or two independent c-arms, which are available at a number of institutions.
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Additively manufactured implant components for imaging validation studies. Proc Inst Mech Eng H 2018; 232:690-698. [PMID: 29962327 DOI: 10.1177/0954411918784086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiographic imaging is the current standard for evaluating postoperative joint replacements. Prior to application, such imaging methods need to be validated to determine the lower limits of performance under ideal conditions, using either a phantom or cadaver setup. Conventionally manufactured orthopedic implants for use in such studies are not always accessible and may be cost-prohibitive to purchase. We propose the use of additively manufactured implants as a cheaper, more accessible alternative for use in radiographic imaging validation studies. Bias and repeatability were compared between conventionally manufactured and additively manufactured reverse total shoulder implant sets under a standard model-based radiostereometric analysis phantom study environment. Measurements were compared using the humeral stem or glenosphere model relative to reference bone beads, and the humeral stem relative to the glenosphere model to measure implant relative displacement. Compared to the conventionally manufactured implants, the additively manufactured implants had less bias along the internal-external rotation axis (p < 0.001), but greater bias along the abduction-adduction and flexion-extension rotation axes (p = 0.005, 0.011). Additively manufactured implants had greater repeatability along the internal-external rotation axis (p < 0.001), but worse repeatability along the medial-lateral translation axis (p = 0.001) and the abduction-adduction rotation axis (p < 0.001). Differences were on the orders of 0.01 mm and 0.5°. For the purpose of validating two-dimensional-three-dimensional radiographic imaging techniques of orthopedic implants, additively manufactured implants can be used in place of conventionally manufactured implants, assuming they are fabricated to the manufacturer's specifications. Observed differences were within the errors of the measurement technique and not clinically meaningful.
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Affiliation(s)
- Madeleine L Van de Kleut
- 1 Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,2 Biomedical Engineering, Western University, London, ON, Canada.,3 Lawson Health Research Institute, London, ON, Canada
| | - Xunhua Yuan
- 1 Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada
| | - George S Athwal
- 3 Lawson Health Research Institute, London, ON, Canada.,4 Division of Orthopaedic Surgery, London Health Sciences Center, London, ON, Canada.,5 Department of Surgery, Western University, London, ON, Canada
| | - Matthew G Teeter
- 1 Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,3 Lawson Health Research Institute, London, ON, Canada.,4 Division of Orthopaedic Surgery, London Health Sciences Center, London, ON, Canada.,5 Department of Surgery, Western University, London, ON, Canada.,6 Department of Medical Biophysics, Western University, London, ON, Canada
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In vivo validation of patellofemoral kinematics during overground gait and stair ascent. Gait Posture 2018; 64:191-197. [PMID: 29929162 PMCID: PMC6084796 DOI: 10.1016/j.gaitpost.2018.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The patellofemoral (PF) joint is a common site for non-specific anterior knee pain. The pathophysiology of patellofemoral pain may be related to abnormal motion of the patella relative to the femur, leading to increased stress at the patellofemoral joint. Patellofemoral motion cannot be accurately measured using conventional motion capture. RESEARCH QUESTION The aim of this study was to determine the accuracy of a biplane radiography system for measuring in vivo PF motion during walking and stair ascent. METHODS Four subjects had three 1.0 mm diameter tantalum beads implanted into the patella. Participants performed three trials each of over ground walking and stair ascent while biplane radiographs were collected at 100 Hz. Patella motion was tracked using radiostereophotogrammetric analysis (RSA) as a "gold standard", and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs. RESULTS The average RMS difference between the RSA and model-based tracking was 0.41 mm and 1.97° when there was no obstruction from the contralateral leg. These differences increased by 34% and 40%, respectively, when the patella was at least partially obstructed by the contralateral leg. The average RMS difference in patellofemoral joint space between tracking methods was 0.9 mm or less. SIGNIFICANCE Previous validations of biplane radiographic systems have estimated tracking accuracy by moving cadaveric knees through simulated motions. These validations were unable to replicate in vivo kinematics, including patella motion due to muscle activation, and failed to assess the imaging and tracking challenges related to contralateral limb obstruction. By replicating the muscle contraction, movement velocity, joint range of motion, and obstruction of the patella by the contralateral limb, the present study provides a realistic estimate of patellofemoral tracking accuracy for future in vivo studies.
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Yeni YN, Baumer T, Oravec D, Basheer A, McDonald CP, Bey MJ, Bartol SW, Chang V. Dynamic foraminal dimensions during neck extension and rotation in fusion and artificial disc replacement: an observational study. Spine J 2018; 18:575-583. [PMID: 28882520 DOI: 10.1016/j.spinee.2017.08.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/25/2017] [Accepted: 08/21/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Changes in the dimensions of the cervical neural foramina (CNF) are considered to be a key factor in nerve root compression and development of cervical radiculopathy. However, to what extent foraminal geometry differs between patients who underwent anterior cervical discectomy and fusion (ACDF) and those who underwent total disc arthroplasty with an artificial disc (AD) during physiological motion is largely unknown. PURPOSE The objective of this study is to compare CNF dimensions during physiological neck motion between ACDF and AD. STUDY DESIGN/SETTING This is a retrospective comparative analysis of prospectively collected, consecutive, non-randomized series of patients at a single institution. PATIENT SAMPLE A total of 16 single-level C5-C6 ACDF (4 males, 12 females; 28-71 years) and 7 single-level C5-C6 cervical arthroplasty patients (3 males, 4 females; 38-57 years), at least 12 months after surgery (23.6±6.8 months) were included. OUTCOME MEASURES Patient demographics, preoperative magnetic resonance imaging (MRI)-based measurements of cervical spine degeneration, and 2-year postoperative measurements of dynamic foraminal geometry were the outcome measures. METHODS Biplane X-ray images were acquired during axial neck rotation and neck extension. A computed tomography scan was also acquired from C3 to the first thoracic vertebrae. The subaxial cervical vertebrae (C3-C7) were reconstructed into three-dimensional (3D) bone models for use with model-based tracking. Foraminal height (FH) was calculated as the 3D distance between the superior point of the inferior pedicle and the inferior point of the superior pedicle using custom software. Foraminal width (FW) was similarly calculated as the 3D distance between the anterolateral aspect of the superior vertebral body inferior notch and the posterolateral aspect of the inferior vertebral body superior notch. Dynamic foraminal dimensions were quantified as the minimum (FH.Min, FW.Min), the range (FH.Range, FW.Range), and the median (FH.Med, FW.Med) of each trial and then averaged over trials. Mixed model analysis of variance framework was used to examine the differences between ACDF and AD groups. The initial severity of disc degeneration as determined from preoperative MRI images was introduced as covariates in the models. RESULTS At the operated level (C5-C6), FH.Med and FH.Range were smaller in ACDF than in AD during axial rotation and neck extension (p<.003 to p<.05). At the superior adjacent level (C4-C5), no significant difference was found. At the inferior adjacent level (C6-C7), FW.Range was greater in ACDF than in AD during axial rotation and extension (p<.05). At the non-adjacent level (C3-C4), FW.Range was greater in ACDF than in AD during extension (p<.008). CONCLUSIONS This study demonstrated decreases in foraminal dimensions and their range for ACDF compared with AD at the operated level. In contrast, it demonstrated increases in the range of foraminal dimensions during motion for ACDF compared with AD at the non-operated segments. Together, these data support the notion that increased mobility at the non-operated segments after ACDF may contribute to a greater risk for adjacent segment degeneration. Because of the significant presence of range variables in the findings, the current data also indicate that a dynamic evaluation is likely more appropriate for evaluation of the differences in foramina between ACDF and AD than a static evaluation.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Integrative Biosciences Center (iBio), Department of Orthopedics, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202, USA.
| | - Timothy Baumer
- Bone and Joint Center, Integrative Biosciences Center (iBio), Department of Orthopedics, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202, USA
| | - Daniel Oravec
- Bone and Joint Center, Integrative Biosciences Center (iBio), Department of Orthopedics, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202, USA
| | - Azam Basheer
- Henry Ford Hospital, Department of Neurosurgery, Henry Ford Health System, K-11, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Colin P McDonald
- McMaster University, Department of Mechanical Engineering, McMaster University, 1280 Main St W, JHE-310, Hamilton, Ontario, Canada L8S 4L7
| | - Michael J Bey
- Bone and Joint Center, Integrative Biosciences Center (iBio), Department of Orthopedics, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202, USA
| | - Stephen W Bartol
- Bone and Joint Center, Integrative Biosciences Center (iBio), Department of Orthopedics, Henry Ford Health System, 6135 Woodward Ave, Detroit, MI 48202, USA
| | - Victor Chang
- Henry Ford Hospital, Department of Neurosurgery, Henry Ford Health System, K-11, 2799 W. Grand Blvd, Detroit, MI 48202, USA
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Uemura K, Atkins PR, Fiorentino NM, Anderson AE. Hip rotation during standing and dynamic activities and the compensatory effect of femoral anteversion: An in-vivo analysis of asymptomatic young adults using three-dimensional computed tomography models and dual fluoroscopy. Gait Posture 2018; 61:276-281. [PMID: 29413797 PMCID: PMC6599491 DOI: 10.1016/j.gaitpost.2018.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals are thought to compensate for femoral anteversion by altering hip rotation. However, the relationship between hip rotation in a neutral position (i.e. static rotation) and dynamic hip rotation is poorly understood, as is the relationship between anteversion and hip rotation. RESEARCH OBJECTIVE Herein, anteversion and in-vivo hip rotation during standing, walking, and pivoting were measured in eleven asymptomatic, morphologically normal, young adults using three-dimensional computed tomography models and dual fluoroscopy. METHODS Using correlation analyses, we: 1) determined the relationship between hip rotation in the static position to that measured during dynamic activities, and 2) evaluated the association between femoral anteversion and hip rotation during dynamic activities. Hip rotation was calculated while standing (static-rotation), throughout gait, as a mean during gait (mean gait rotation), and as a mean (mid-pivot rotation), maximum (max-rotation) and minimum (min-rotation) during pivoting. RESULTS Static-rotation (mean ± standard deviation; 11.3° ± 7.3°) and mean gait rotation (7.8° ± 4.7°) were positively correlated (r = 0.679, p = 0.022). Likewise, static-rotation was strongly correlated with mid-pivot rotation (r = 0.837, p = 0.001), max-rotation (r = 0.754, p = 0.007), and min-rotation (r = 0.835, p = 0.001). Strong positive correlations were found between anteversion and hip internal rotation during all of the stance phase (0-60% gait) and during mid- and terminal-swing (86-100% gait) (all r > 0.607, p < 0.05). CONCLUSIONS Our results suggest that the static position may be used cautiously to express the neutral rotational position of the femur for dynamic movements. Further, our results indicate that femoral anteversion is compensated for by altering hip rotation. As such, both anteversion and hip rotation may be important to consider when diagnosing hip pathology and planning for surgical procedures.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA.
| | - Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA.
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Validation of imaging-based quantification of glenohumeral joint kinematics using an unmodified clinical biplane fluoroscopy system. J Biomech 2018; 71:306-312. [PMID: 29478696 DOI: 10.1016/j.jbiomech.2018.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/23/2022]
Abstract
Model-based tracking, using CT and biplane fluoroscopy, allows highly accurate quantification of glenohumeral motion and changes in the subacromial space. Previous investigators have used custom-built biplane fluoroscopes designed specifically for kinematic applications, which are available at few institutions and require FDA approval prior to clinical use. The aim of this study was to demonstrate the utility of an off-the-shelf clinical biplane fluoroscope for kinematic applications by validating model-based tracking for measurement of glenohumeral motion using an unmodified clinical system. Biplane images of each shoulder of a cadaver torso were acquired at various joint positions and during simulated movements along anatomical planes of motion. The pose of each humerus and scapula was determined using model-based tracking and compared to a bead-based gold standard. Error due to a temporal-offset between corresponding biplane images, characteristic of clinical biplane systems, was determined by comparison of measured and known relative position of 2 bead clusters of a phantom that was imaged while moved throughout the fluoroscopy image volume. Model-based tracking had global kinematic mean absolute errors of 0.27 mm and 0.29° (static), and 0.22-0.32 mm and 0.12-0.45° (dynamic). Glenohumeral mean absolute errors were 0.39 mm and 0.45° (static), and 0.36-0.42 mm and 0.41-0.48° (dynamic). The temporal-offset was predicted to add errors of 0.06-0.85 mm and 0.05-0.28° for cadaveric trials for the speeds examined. For defined speeds, sub-millimeter and sub-degree kinematic accuracy and precision were achieved using an unmodified clinical biplane fluoroscope for quantification of glenohumeral motion.
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Validation of radiostereometric analysis in six degrees of freedom for use with reverse total shoulder arthroplasty. J Biomech 2018; 68:126-131. [DOI: 10.1016/j.jbiomech.2017.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 11/15/2022]
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Iaquinto JM, Kindig MW, Haynor DR, Vu Q, Pepin N, Tsai R, Sangeorzan BJ, Ledoux WR. Model-based tracking of the bones of the foot: A biplane fluoroscopy validation study. Comput Biol Med 2018; 92:118-127. [PMID: 29175098 DOI: 10.1016/j.compbiomed.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/26/2022]
Abstract
Measuring foot kinematics using optical motion capture is technically challenging due to the depth of the talus, small bone size, and soft tissue artifact. We present a validation of our biplane X-ray system, demonstrating its accuracy in tracking the foot bones directly. Using an experimental linear/rotary stage we imaged pairs of tali, calcanei, and first metatarsals, with embedded beads, through 30 poses. Model- and bead-based algorithms were employed for semi-automatic tracking. Translational and rotational poses were compared to the experimental stage (a reference standard) to determine registration performance. For each bone, 10 frames per pose were analyzed. Model-based: The resulting overall translational bias of the six bones was 0.058 mm with a precision of ± 0.049 mm. The overall rotational bias of the six bones was 0.42° with a precision of ± 0.41°. Bead-based: the overall translational bias was 0.037 mm with a precision of ± 0.032 mm and for rotation was 0.29° with a precision of ± 0.26°. We validated the accuracy of our system to determine the spatial position and orientation of isolated foot bones, including the talus, calcaneus, and first metatarsal over a range of quasi-static poses. Although the accuracy of dynamic motion was not assessed, use of an experimental stage establishes a reference standard.
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Affiliation(s)
- Joseph M Iaquinto
- RR&D Center for Limb Loss and MoBility, Department of Veterans Affairs, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Matthew W Kindig
- RR&D Center for Limb Loss and MoBility, Department of Veterans Affairs, Seattle, WA 98108, USA
| | - David R Haynor
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - QuocBao Vu
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Nathan Pepin
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Richard Tsai
- RR&D Center for Limb Loss and MoBility, Department of Veterans Affairs, Seattle, WA 98108, USA
| | - Bruce J Sangeorzan
- RR&D Center for Limb Loss and MoBility, Department of Veterans Affairs, Seattle, WA 98108, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA 98195, USA
| | - William R Ledoux
- RR&D Center for Limb Loss and MoBility, Department of Veterans Affairs, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA 98195, USA.
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Exercise therapy for treatment of supraspinatus tears does not alter glenohumeral kinematics during internal/external rotation with the arm at the side. Knee Surg Sports Traumatol Arthrosc 2018; 26:267-274. [PMID: 28865049 DOI: 10.1007/s00167-017-4695-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Rotator cuff tears are a significant clinical problem, with exercise therapy being a common treatment option for patients. Failure rates of exercise therapy may be due to the failure to improve glenohumeral kinematics. Tears involving the supraspinatus may result in altered glenohumeral kinematics and joint instability for internal/external rotation with the arm at the side because not all muscles used to stabilize the glenohumeral joint are functioning normally. The objective of the study is to assess in vivo glenohumeral kinematic changes for internal/external rotation motions with the arm at the side of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy programme. METHODS Five patients underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral kinematics during transverse plane internal/external rotation with the arm at the side. Patient-reported outcomes and shoulder strength were also evaluated. RESULTS No patient sought surgery immediately following exercise therapy. Significant improvements in isometric shoulder strength and patient-reported outcomes were observed (p < 0.05). No significant changes in glenohumeral kinematics following physical therapy were found. CONCLUSION Isolated supraspinatus tears resulted in increased joint translations compared to healthy controls from the previous literature for internal/external rotation with the arm at the side. Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. The lack of changes may be due to the motion studied or the focus of current exercise therapy protocols being increasing shoulder strength and restoring range of motion. Current exercise therapy protocols should be adapted to also focus on restoring glenohumeral kinematics to improve joint stability since exercise therapy may have different effects depending on the motions of daily living. LEVEL OF EVIDENCE Prognostic study, Level II.
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Roach KE, Wang B, Kapron AL, Fiorentino NM, Saltzman CL, Bo Foreman K, Anderson AE. In Vivo Kinematics of the Tibiotalar and Subtalar Joints in Asymptomatic Subjects: A High-Speed Dual Fluoroscopy Study. J Biomech Eng 2017; 138:2539410. [PMID: 27455417 DOI: 10.1115/1.4034263] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/08/2022]
Abstract
Measurements of joint kinematics are essential to understand the pathomechanics of ankle disease and the effects of treatment. Traditional motion capture techniques do not provide measurements of independent tibiotalar and subtalar joint motion. In this study, high-speed dual fluoroscopy images of ten asymptomatic adults were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of each bone and dual fluoroscopy images were used to quantify in vivo kinematics for the tibiotalar and subtalar joints. Dynamic tibiotalar and subtalar mean joint angles often exhibited opposing trends during captured stance. During both speeds of walking, the tibiotalar joint had significantly greater dorsi/plantarflexion (D/P) angular ROM than the subtalar joint while the subtalar joint demonstrated greater inversion/eversion (In/Ev) and internal/external rotation (IR/ER) than the tibiotalar joint. During balanced heel-rise, only D/P and In/Ev were significantly different between the tibiotalar and subtalar joints. Translational ROM in the anterior/posterior (AP) direction was significantly greater in the subtalar than the tibiotalar joint during walking at 0.5 m/s. Overall, our results support the long-held belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. However, the subtalar joint provided considerable D/P rotation, and the tibiotalar joint rotated about all three axes, which, along with translational motion, suggests that each joint undergoes complex, 3D motion.
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Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Application of High-Speed Dual Fluoroscopy to Study In Vivo Tibiotalar and Subtalar Kinematics in Patients With Chronic Ankle Instability and Asymptomatic Control Subjects During Dynamic Activities. Foot Ankle Int 2017; 38:1236-1248. [PMID: 28800713 PMCID: PMC5914166 DOI: 10.1177/1071100717723128] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abnormal angular and translational (ie, kinematic) motion at the tibiotalar and subtalar joints is believed to cause osteoarthritis in patients with chronic ankle instability (CAI). METHODS In this preliminary study the investigators quantified and compared in vivo tibiotalar and subtalar kinematics in 4 patients with CAI (3 women) and 10 control subjects (5 men) using dual fluoroscopy during a balanced, single-leg heel-rise and treadmill walking at 0.5 and 1.0 m/s. RESULTS During balanced heel-rise, 69%, 54%, and 66% of mean CAI tibiotalar internal rotation/external rotation (IR/ER), subtalar inversion/eversion, and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 0.5-m/s gait, 50% and 60% of mean CAI tibiotalar dorsi/plantarflexion and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 1.0-m/s gait, 62%, 65%, and 73% of mean CAI subtalar dorsi/plantarflexion, inversion/eversion, and IR/ER, respectively, were outside the 95% confidence intervals of control subjects. Patients with CAI exhibited less tibiotalar and subtalar translational motion during gait; no clear differences in translations were noted during balanced heel-rise. CONCLUSION Overall, the balanced heel-rise activity exposed more tibiotalar and subtalar kinematic variation between patients with CAI and control subjects. Therefore, weight-bearing activities involving large range of motion, balance, and stability may be best for studying kinematic adaptations in patients with CAI. CLINICAL RELEVANCE These preliminary results suggest that patients with CAI require more tibiotalar external rotation, subtalar eversion, and subtalar external rotation during weight-bearing stability exercises, all with less overall joint translation.
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Affiliation(s)
- Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
- Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA
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Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. In Vivo Measurements of the Ischiofemoral Space in Recreationally Active Participants During Dynamic Activities: A High-Speed Dual Fluoroscopy Study. Am J Sports Med 2017; 45:2901-2910. [PMID: 28682639 PMCID: PMC6599761 DOI: 10.1177/0363546517712990] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is a dynamic process, but its diagnosis is often based on static, supine images. PURPOSE To couple 3-dimensional (3D) computed tomography (CT) models with dual fluoroscopy (DF) images to quantify in vivo hip motion and the ischiofemoral space (IFS) in asymptomatic participants during weightbearing activities and evaluate the relationship of dynamic measurements with sex, hip kinematics, and the IFS measured from axial magnetic resonance imaging (MRI). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Eleven young, asymptomatic adults (5 female) were recruited. 3D reconstructions of the femur and pelvis were generated from MRI and CT. The axial and 3D IFS were measured from supine MRI. In vivo hip motion during weightbearing activities was quantified using DF. The bone-to-bone distance between the lesser trochanter and ischium was measured dynamically. The minimum and maximum IFS were determined and evaluated against hip joint angles using a linear mixed-effects model. RESULTS The minimum IFS occurred during external rotation for 10 of 11 participants. The IFS measured from axial MRI (mean, 23.7 mm [95% CI, 19.9-27.9]) was significantly greater than the minimum IFS observed during external rotation (mean, 10.8 mm [95% CI, 8.3-13.7]; P < .001), level walking (mean, 15.5 mm [95% CI, 11.4-19.7]; P = .007), and incline walking (mean, 15.8 mm [95% CI, 11.6-20.1]; P = .004) but not for standing. The IFS was reduced with extension (β = 0.66), adduction (β = 0.22), and external rotation (β = 0.21) ( P < .001 for all) during the dynamic activities observed. The IFS was smaller in female than male participants for standing (mean, 20.9 mm [95% CI, 19.3-22.3] vs 30.4 mm [95% CI, 27.2-33.8], respectively; P = .034), level walking (mean, 8.8 mm [95% CI, 7.5-9.9] vs 21.1 mm [95% CI, 18.7-23.6], respectively; P = .001), and incline walking (mean, 9.1 mm [95% CI, 7.4-10.8] vs 21.3 mm [95% CI, 18.8-24.1], respectively; P = .003). Joint angles between the sexes were not significantly different for any of the dynamic positions of interest. CONCLUSION The minimum IFS during dynamic activities was smaller than axial MRI measurements. Compared with male participants, the IFS in female participants was reduced during standing and walking, despite a lack of kinematic differences between the sexes. The relationship between the IFS and hip joint angles suggests that the hip should be placed into greater extension, adduction, and external rotation in clinical examinations and imaging, as the IFS measured from static images, especially in a neutral orientation, may not accurately represent the minimum IFS during dynamic motion. Nevertheless, this statement must be interpreted with caution, as only asymptomatic participants were analyzed herein.
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Affiliation(s)
- Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Travis G. Maak
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S Central Campus Drive Rm 3750, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way Suite 240, Salt Lake City, UT 84108, USA
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Geiger SM, Reich E, Böttcher P, Grund S, Hagen J. Validation of biplane high‐speed fluoroscopy combined with two different noninvasive tracking methodologies for measuring
in vivo
distal limb kinematics of the horse. Equine Vet J 2017; 50:261-269. [DOI: 10.1111/evj.12717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Geiger
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine Leipzig University Leipzig Germany
| | - E. Reich
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine Leipzig University Leipzig Germany
| | - P. Böttcher
- Small Animal Clinic Department of Veterinary Medicine Freie Universität Berlin Berlin Germany
| | - S. Grund
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine Leipzig University Leipzig Germany
| | - J. Hagen
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine Leipzig University Leipzig Germany
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Marquez-Lara A, Stone AV, Luo TD, Parker BR, Sharma A, Freehill MT. Top 50 cited journal articles on overhead throwing athletes: a bibliographic analysis. JSES OPEN ACCESS 2017; 1:55-62. [PMID: 30675541 PMCID: PMC6340857 DOI: 10.1016/j.jses.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The frequency of citations for a journal article is a reflection of its academic impact. The purpose of this study was to identify and characterize the top 50 cited journal articles related to overhead throwing athletes in the published literature. Methods The Web of Science database was searched on January 18, 2016, using the terms "throwing athlete," "baseball," and "pitcher" to identify the top 50 cited articles related to overhead throwing athletes using the all-database function. The type of study, country of origin, publishing journal, and year published were reviewed for each article. Results The top 50 articles identified were cited between 95 and 471 times and were published in 13 journals between 1969 and 2011. Most of the articles were small case series or nonsystematic literature reviews. The shoulder was the most common body region studied in the top 50 articles (33 of 50 [66%]). Among original studies (n = 43), there was a good representation of surgical management of shoulder and elbow pathology in overhead athletes (9 of 43 [20.9%]); however, most of the articles reported on shoulder and elbow kinematics (19 of 43 [44.2%]) and pathoanatomy (15 of 43 [34.9%]). Conclusion The greater prevalence of nonsurgical articles may reflect a continued effort to better understand the different pathologies specific to overhead throwing athletes. An understanding of the variable content and quality of frequently cited articles on overhead throwing athletes may serve as a stepping stone for future studies to advance the diagnosis and management of complex elbow and shoulder injuries in these high functional individuals.
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Affiliation(s)
- Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - T David Luo
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Benjamin R Parker
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Aman Sharma
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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83
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Weiss M, Reich E, Grund S, Mülling CKW, Geiger SM. Validation of 2 noninvasive, markerless reconstruction techniques in biplane high-speed fluoroscopy for 3-dimensional research of bovine distal limb kinematics. J Dairy Sci 2017; 100:8372-8384. [PMID: 28780107 DOI: 10.3168/jds.2017-12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/28/2017] [Indexed: 11/19/2022]
Abstract
Lameness severely impairs cattle's locomotion, and it is among the most important threats to animal welfare, performance, and productivity in the modern dairy industry. However, insight into the pathological alterations of claw biomechanics leading to lameness and an understanding of the biomechanics behind development of claw lesions causing lameness are limited. Biplane high-speed fluoroscopic kinematography is a new approach for the analysis of skeletal motion. Biplane high-speed videos in combination with bone scans can be used for 3-dimensional (3D) animations of bones moving in 3D space. The gold standard, marker-based animation, requires implantation of radio-opaque markers into bones, which impairs the practicability for lameness research in live animals. Therefore, the purpose of this study was to evaluate the comparative accuracy of 2 noninvasive, markerless animation techniques (semi-automatic and manual) in 3D animation of the bovine distal limb. Tantalum markers were implanted into each of the distal, middle, and proximal phalanges of 5 isolated bovine distal forelimbs, and biplane high-speed x-ray videos of each limb were recorded to capture the simulation of one step. The limbs were scanned by computed tomography to create bone models of the 6 digital bones, and 3D animation of the bones' movements were subsequently reconstructed using the marker-based, the semi-automatic, and the manual animation techniques. Manual animation translational bias and precision varied from 0.63 ± 0.26 mm to 0.80 ± 0.49 mm, and rotational bias and precision ranged from 2.41 ± 1.43° to 6.75 ± 4.67°. Semi-automatic translational values for bias and precision ranged from 1.26 ± 1.28 mm to 2.75 ± 2.17 mm, and rotational values varied from 3.81 ± 2.78° to 11.7 ± 8.11°. In our study, we demonstrated the successful application of biplane high-speed fluoroscopic kinematography to gait analysis of bovine distal limb. Using the manual animation technique, kinematics can be measured with sub-millimeter accuracy without the need for invasive marker implantation.
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Affiliation(s)
- M Weiss
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 43, D-04103 Leipzig, Germany
| | - E Reich
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 43, D-04103 Leipzig, Germany
| | - S Grund
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 43, D-04103 Leipzig, Germany
| | - C K W Mülling
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 43, D-04103 Leipzig, Germany
| | - S M Geiger
- Institute of Veterinary Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 43, D-04103 Leipzig, Germany.
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84
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Rapp EA, Richardson RT, Russo SA, Rose WC, Richards JG. A comparison of two non-invasive methods for measuring scapular orientation in functional positions. J Biomech 2017; 61:269-274. [DOI: 10.1016/j.jbiomech.2017.07.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
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85
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Kahan LG, Guertler C, Blatnik JA, Lake SP. Validation of Single C-Arm Fluoroscopic Technique for Measuring In Vivo Abdominal Wall Deformation. J Biomech Eng 2017; 139:2633404. [DOI: 10.1115/1.4037073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 11/08/2022]
Abstract
Hernia meshes significantly reduce the recurrence rates in hernia repair. It is known that they affect the abdominal wall postimplantation, yet the understanding of in vivo mechanics in the mesh placement area is lacking. We established a single C-arm biplane fluoroscopic system to study strains at the interface between the mesh and repaired abdominal tissues. We aimed to validate this system for future porcine hernia repair studies. Custom matlab programs were written to correct for pincushion distortion, and direct linear transformation (DLT) reconstructed objects in 3D. Using a custom biplane-trough setup, image sets were acquired throughout the calibrated volume to evaluate a radio-opaque test piece with known distances between adjacent beads. Distances were measured postprocessing and compared to known measurements. Repeatability testing was conducted by taking image sets of the test piece in a fixed location to determine system movement. The error in areal stretch tracking was evaluated by imaging a square plate with fixed radio-opaque beads and using matlab programs to compare the measured areal stretch to known bead positions. Minor differences between measured and known distances in the test piece were not statistically different, and the system yielded a 0.01 mm bias in the XY plane and a precision of 0.61 mm. The measured areal stretch was 0.996, which was not significantly different than the expected value of 1. In addition, preliminary stretch data for a hernia mesh in a porcine model demonstrated technique feasibility to measure in vivo porcine abdominal mechanics.
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Affiliation(s)
- Lindsey G. Kahan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Charlotte Guertler
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130 e-mail:
| | - Jeffrey A. Blatnik
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Spencer P. Lake
- Mem. ASME Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Orthopaedic Surgery, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130 e-mail:
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Subject-Specific Axes of Rotation Based on Talar Morphology Do Not Improve Predictions of Tibiotalar and Subtalar Joint Kinematics. Ann Biomed Eng 2017. [PMID: 28639171 DOI: 10.1007/s10439-017-1874-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Use of subject-specific axes of rotation may improve predictions generated by kinematic models, especially for joints with complex anatomy, such as the tibiotalar and subtalar joints of the ankle. The objective of this study was twofold. First, we compared the axes of rotation between generic and subject-specific ankle models for ten control subjects. Second, we quantified the accuracy of generic and subject-specific models for predicting tibiotalar and subtalar joint motion during level walking using inverse kinematics. Here, tibiotalar and subtalar joint kinematics measured in vivo by dual-fluoroscopy served as the reference standard. The generic model was based on a cadaver study, while the subject-specific models were derived from each subject's talus reconstructed from computed tomography images. The subject-specific and generic axes of rotation were significantly different. The average angle between the modeled axes was 12.9° ± 4.3° and 24.4° ± 5.9° at the tibiotalar and subtalar joints, respectively. However, predictions from both models did not agree well with dynamic dual-fluoroscopy data, where errors ranged from 1.0° to 8.9° and 0.6° to 7.6° for the generic and subject-specific models, respectively. Our results suggest that methods that rely on talar morphology to define subject-specific axes may be inadequate for accurately predicting tibiotalar and subtalar joint kinematics.
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87
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Anderst W, Rynearson B, West T, Donaldson W, Lee J. Dynamic in vivo 3D atlantoaxial spine kinematics during upright rotation. J Biomech 2017; 60:110-115. [PMID: 28662932 DOI: 10.1016/j.jbiomech.2017.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
Abstract
Diagnosing dysfunctional atlantoaxial motion is challenging given limitations of current diagnostic imaging techniques. Three-dimensional imaging during upright functional motion may be useful in identifying dynamic instability not apparent on static imaging. Abnormal atlantoaxial motion has been linked to numerous pathologies including whiplash, cervicogenic headaches, C2 fractures, and rheumatoid arthritis. However, normal C1/C2 rotational kinematics under dynamic physiologic loading have not been previously reported owing to imaging difficulties. The objective of this study was to determine dynamic three-dimensional in vivo C1/C2 kinematics during upright axial rotation. Twenty young healthy adults performed full head rotation while seated within a biplane X-ray system while radiographs were collected at 30 images per second. Six degree-of-freedom kinematics were determined for C1 and C2 via a validated volumetric model-based tracking process. The maximum global head rotation (to one side) was 73.6±8.3°, whereas maximum C1 rotation relative to C2 was 36.8±6.7°. The relationship between C1/C2 rotation and head rotation was linear through midrange motion (±20° head rotation from neutral) in a nearly 1:1 ratio. Coupled rotation between C1 and C2 included 4.5±3.1° of flexion and 6.4±8.2° of extension, and 9.8±3.8° of contralateral bending. Translational motion of C1 relative to C2 was 7.8±1.5mm ipsilaterally, 2.2±1.2mm inferiorly, and 3.3±1.0mm posteriorly. We believe this is the first study describing 3D dynamic atlantoaxial kinematics under true physiologic conditions in healthy subjects. C1/C2 rotation accounts for approximately half of total head axial rotation. Additionally, C1 undergoes coupled flexion/extension and contralateral bending, in addition to inferior, lateral and posterior translation.
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Affiliation(s)
- William Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, United States.
| | - Bryan Rynearson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Tyler West
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - William Donaldson
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
| | - Joon Lee
- University of Pittsburgh, Department of Orthopaedic Surgery, United States
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88
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Fiorentino NM, Atkins PR, Kutschke MJ, Goebel JM, Foreman KB, Anderson AE. Soft tissue artifact causes significant errors in the calculation of joint angles and range of motion at the hip. Gait Posture 2017; 55:184-190. [PMID: 28475981 PMCID: PMC9840870 DOI: 10.1016/j.gaitpost.2017.03.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
Soft tissue movement between reflective skin markers and underlying bone induces errors in gait analysis. These errors are known as soft tissue artifact (STA). Prior studies have not examined how STA affects hip joint angles and range of motion (ROM) during dynamic activities. Herein, we: 1) measured STA of skin markers on the pelvis and thigh during walking, hip abduction and hip rotation, 2) quantified errors in tracking the thigh, pelvis and hip joint angles/ROM, and 3) determined whether model constraints on hip joint degrees of freedom mitigated errors. Eleven asymptomatic young adults were imaged simultaneously with retroreflective skin markers (SM) and dual fluoroscopy (DF), an X-ray technique with sub-millimeter and sub-degree accuracy. STA, defined as the range of SM positions in the DF-measured bone anatomical frame, varied based on marker location, activity and subject. Considering all skin markers and activities, mean STA ranged from 0.3cm to 5.4cm. STA caused the hip joint angle tracked with SM to be 1.9° more extended, 0.6° more adducted, and 5.8° more internally rotated than the hip tracked with DF. ROM was reduced for SM measurements relative to DF, with the largest difference of 21.8° about the internal-external axis during hip rotation. Constraining the model did not consistently reduce angle errors. Our results indicate STA causes substantial errors, particularly for markers tracking the femur and during hip internal-external rotation. This study establishes the need for future research to develop methods minimizing STA of markers on the thigh and pelvis.
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Affiliation(s)
- Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J. Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Justine M. Goebel
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Corresponding author at: University of Utah Orthopaedics, 590 Wakara Way, RM A-100, Salt Lake City, UT, 84108, USA., (A.E. Anderson)
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89
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Baumer TG, Dischler J, Mende V, Zauel R, van Holsbeeck M, Siegal DS, Divine G, Moutzouros V, Bey MJ. Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes. J Shoulder Elbow Surg 2017; 26:1064-1072. [PMID: 28131679 PMCID: PMC5438772 DOI: 10.1016/j.jse.2016.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of asymptomatic rotator cuff tears has been reported to range from 15% to 39%, but the influence of asymptomatic rotator cuff pathology on shoulder function is not well understood. This study assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. METHODS A clinical ultrasound examination was performed in 46 asymptomatic volunteers (age: 60.3 ± 7.5 years) with normal shoulder function to document the condition of their rotator cuff. The ultrasound imaging identified the participants as healthy (n = 14) or pathologic (n = 32). Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex (Biodex Medical Systems, Inc., Shirley, NY, USA), and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores. RESULTS Compared with healthy volunteers, those with rotator cuff pathology had significantly less abduction (P = .050) and elevation (P = .041) strength, their humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). No significant differences were detected in the Western Ontario Rotator Cuff Index, visual analog scale, range of motion, or acromiohumeral distance. CONCLUSIONS The differences observed between the healthy volunteers and those with asymptomatic rotator cuff pathology lend insight into the changes in joint mechanics, shoulder strength, and conventional clinical outcomes associated with the early stages of rotator cuff pathology. Furthermore, these findings suggest a plausible mechanical progression of kinematic and strength changes associated with the development of rotator cuff pathology.
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Affiliation(s)
- Timothy G Baumer
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA.
| | - Jack Dischler
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Veronica Mende
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Daniel S Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA
| | - George Divine
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, MI, USA
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90
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Wu W, Lee PVS, Ackland DC. The sensitivity of shoulder muscle and joint force predictions to changes in joint kinematics: A Monte-Carlo analysis. Gait Posture 2017; 54:87-92. [PMID: 28279851 DOI: 10.1016/j.gaitpost.2017.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/19/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
Kinematics of the shoulder girdle obtained from non-invasive measurement systems such as video motion analysis, accelerometers and magnetic tracking sensors has been shown to be adversely affected by instrumentation measurement errors and skin motion artefact. The degree to which musculoskeletal model calculations of shoulder muscle and joint loading are influenced by variations in joint kinematics is currently not well understood. A three-dimensional musculoskeletal model of the upper limb was used to evaluate the sensitivity of shoulder muscle and joint force. Monte-Carlo analyses were performed by randomly perturbing scapular and humeral joint coordinates during abduction and flexion. Muscle and joint force calculations were generally most sensitive to changes in the kinematics of the humerus in elevation and of the scapula in medial-lateral rotation, and were least sensitive to changes in humerus plane of elevation and scapula protraction-retraction. Overall model sensitivity was greater during abduction than flexion, and the influence of specific kinematics perturbations varied from muscle to muscle. In general, muscles that generated greater force, such as the middle deltoid and subscapularis, were more sensitive to changes in shoulder kinematics. This study suggests that musculoskeletal model sensitivity to changes in kinematics is task-specific, and varies depending on the plane of motion. Calculations of shoulder muscle and joint function depend on reliable humeral and scapula motion data, particularly that of humeral elevation and scapula medial-lateral rotation. The findings in this study have implications for the use of kinematic data in musculoskeletal model development and simulations.
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Affiliation(s)
- Wen Wu
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
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91
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Dynamic measurements of cervical neural foramina during neck movements in asymptomatic young volunteers. Surg Radiol Anat 2017; 39:1069-1078. [DOI: 10.1007/s00276-017-1847-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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92
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Anderst WJ, Aucie Y. Three-dimensional intervertebral range of motion in the cervical spine: Does the method of calculation matter? Med Eng Phys 2017; 41:109-115. [PMID: 28126422 DOI: 10.1016/j.medengphy.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 09/02/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
Intervertebral range of motion (ROM) is commonly calculated using ordered rotations or projection angles. Ordered rotations are sequence-dependent, and projection angles are dependent upon on which orientation vectors are projected. This study assessed the effect of calculation method on intervertebral ROM in the subaxial cervical spine (C3-C7) during in vivo dynamic, three-dimensional, functional movement. Biplane radiographs were collected at 30 images per second while 29 participants performed full ROM flexion/extension, axial rotation and lateral bending movements of their cervical spine. In vivo bone motion was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking technique. Intervertebral rotations were calculated using six Cardan angle sequences and two projection angle combinations. Within-subject comparisons revealed significant differences in intervertebral ROM among calculation methods (all p<0.002). Group mean ROM differences were small, but significantly different among calculation methods (p<0.001). A resampling technique demonstrated that as group size increases, the differences between calculation methods decreases substantially. It is concluded that the method used to calculate intervertebral rotations of the sub-axial cervical spine can significantly affect within-subject and between group comparisons of intervertebral ROM.
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Affiliation(s)
- William J Anderst
- Department of Orthopaedic Surgery, Biodynamics Lab, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA.
| | - Yashar Aucie
- Department of Bioengineering, University of Pittsburgh, USA
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93
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Kim DS, Lee B, Banks SA, Hong K, Jang YH. Comparison of dynamics in 3D glenohumeral position between primary dislocated shoulders and contralateral healthy shoulders. J Orthop 2017; 14:195-200. [PMID: 28123261 DOI: 10.1016/j.jor.2016.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUNDS After shoulder dislocation, kinematic changes in shoulder, including translation of the humeral head, ensue. There have been many attempts to measure these changes using motion measurement techniques, but in vivo three-dimensional (3D) glenohumeral changes have not been appreciated until now. The purpose of this study was to measure and analyze changes in glenohumeral translation in patients with shoulder dislocation and compare these changes with healthy shoulder. METHODS We included 20 subjects who had suffered shoulder dislocation for first time, and 3D models of their humerus and scapula were obtained using computed tomography and fluoroscopic images during scapular plane abduction and external rotation of shoulder with elbow flexed at 90° and arm abducted at 90°. We measured the superior/inferior (SI) and anterior/posterior (AP) translations for both shoulders. RESULTS No statistically significant difference between healthy and dislocated shoulders was detected in SI translation for scapular plane abduction with increasing elevation angles. In AP translation, the humeral head was located 2.29 mm more anteriorly in the dislocated shoulder than in the healthy shoulder. However, no statistically significant difference was seen. For internal to external rotation, the angle of the rotated arm had an effect on AP translation. However, no statistically significant difference was detected. In the apprehension test, there was no significant difference in the mean value of AP translation. CONCLUSION Compared with the contralateral healthy shoulder, changes in glenohumeral translation during in vivo movement after shoulder dislocation were found to be non-significant.
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Affiliation(s)
- Doo Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Gangwon, South Korea
| | - Bonggun Lee
- Department of Orthopedic Surgery, Hanyang University, Seoul, South Korea
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611-6250, USA
| | - Kyungjin Hong
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Gangwon, South Korea
| | - Young Hwan Jang
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Gangwon, South Korea
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94
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Nicholson KF, Richardson RT, Miller F, Richards JG. Determining 3D scapular orientation with scapula models and biplane 2D images. Med Eng Phys 2017; 41:103-108. [PMID: 28126419 DOI: 10.1016/j.medengphy.2017.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 08/18/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
This study evaluated a strategy for identifying 3D scapulothoracic orientation using bilateral X-ray scans and 3D scapula models. Both subject-specific scapula models and a scaled general model were utilized. 3D scapulothoracic orientations obtained from X-rays were compared to motion capture data. "Subjects" consisted of a skeletal model of a human torso and ten real bone scapulae. Retroreflective markers were placed on the scapulae and a three-marker triad was placed on the trunk. Marker positions were recorded using an eight camera motion capture system. A biplane X-ray system from EOS Imaging was used to collect two orthogonal 2D images of the skeleton and markers. Custom software was created for the 3D to 2D matching process. The results indicated that the matched orientations compared favorably to motion capture orientations, with RMSE errors ranging from 3.1° to 5.5° and a mean error of 3.9° The proposed strategy was shown to be accurate for both subject-specific models and a scaled general model.
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Affiliation(s)
- Kristen F Nicholson
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
| | - R Tyler Richardson
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
| | - Freeman Miller
- Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
| | - James G Richards
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
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95
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Mahato NK, Montuelle S, Goubeaux C, Cotton J, Williams S, Thomas J, Clark BC. Quantification of intervertebral displacement with a novel MRI-based modeling technique: Assessing measurement bias and reliability with a porcine spine model. Magn Reson Imaging 2016; 38:77-86. [PMID: 28027908 DOI: 10.1016/j.mri.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to develop a novel magnetic resonance imaging (MRI)-based modeling technique for measuring intervertebral displacements. Here, we present the measurement bias and reliability of the developmental work using a porcine spine model. Porcine lumbar vertebral segments were fitted in a custom-built apparatus placed within an externally calibrated imaging volume of an open-MRI scanner. The apparatus allowed movement of the vertebrae through pre-assigned magnitudes of sagittal and coronal translation and rotation. The induced displacements were imaged with static (T1) and fast dynamic (2D HYCE S) pulse sequences. These images were imported into animation software, in which these images formed a background 'scene'. Three-dimensional models of vertebrae were created using static axial scans from the specimen and then transferred into the animation environment. In the animation environment, the user manually moved the models (rotoscoping) to perform model-to-'scene' matching to fit the models to their image silhouettes and assigned anatomical joint axes to the motion-segments. The animation protocol quantified the experimental translation and rotation displacements between the vertebral models. Accuracy of the technique was calculated as 'bias' using a linear mixed effects model, average percentage error and root mean square errors. Between-session reliability was examined by computing intra-class correlation coefficients (ICC) and the coefficient of variations (CV). For translation trials, a constant bias (β0) of 0.35 (±0.11) mm was detected for the 2D HYCE S sequence (p=0.01). The model did not demonstrate significant additional bias with each mm increase in experimental translation (β1Displacement=0.01mm; p=0.69). Using the T1 sequence for the same assessments did not significantly change the bias (p>0.05). ICC values for the T1 and 2D HYCE S pulse sequences were 0.98 and 0.97, respectively. For rotation trials, a constant bias (β0) of 0.62 (±0.12)° was detected for the 2D HYCE S sequence (p<0.01). The model also demonstrated an additional bias (β1Displacement) of 0.05° with each degree increase in the experimental rotation (p<0.01). Using T1 sequence for the same assessments did not significantly change the bias (p>0.05). ICC values for the T1 and 2D HYCE S pulse sequences were recorded 0.97 and 0.91, respectively. This novel quasi-static approach to quantifying intervertebral relationship demonstrates a reasonable degree of accuracy and reliability using the model-to-image matching technique with both static and dynamic sequences in a porcine model. Future work is required to explore multi-planar assessment of real-time spine motion and to examine the reliability of our approach in humans.
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Affiliation(s)
- Niladri K Mahato
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - Stephane Montuelle
- Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - Craig Goubeaux
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Mechanical Engineering, Ohio University, Athens, OH 45701, United States.
| | - John Cotton
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Mechanical Engineering, Ohio University, Athens, OH 45701, United States.
| | - Susan Williams
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States.
| | - James Thomas
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States; School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH 45701, United States.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, United States; Department of Biomedical Sciences, Ohio University, Athens, OH 45701, United States; Department of Geriatric Medicine, Ohio University, Athens, OH 45701, United States.
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96
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Zhao KD, Ben-Abraham EI, Magnuson DJ, Camp JJ, Berglund LJ, An KN, Bronfort G, Gay RE. Effect of Off-Axis Fluoroscopy Imaging on Two-Dimensional Kinematics in the Lumbar Spine: A Dynamic In Vitro Validation Study. J Biomech Eng 2016; 138:054502. [PMID: 26974192 DOI: 10.1115/1.4032995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Indexed: 01/07/2023]
Abstract
Spine intersegmental motion parameters and the resultant regional patterns may be useful for biomechanical classification of low back pain (LBP) as well as assessing the appropriate intervention strategy. Because of its availability and reasonable cost, two-dimensional (2D) fluoroscopy has great potential as a diagnostic and evaluative tool. However, the technique of quantifying intervertebral motion in the lumbar spine must be validated, and the sensitivity assessed. The purpose of this investigation was to (1) compare synchronous fluoroscopic and optoelectronic measures of intervertebral rotations during dynamic flexion-extension movements in vitro and (2) assess the effect of C-arm rotation to simulate off-axis patient alignment on intervertebral kinematics measures. Six cadaveric lumbar-sacrum specimens were dissected, and active marker optoelectronic sensors were rigidly attached to the bodies of L2-S1. Fluoroscopic sequences and optoelectronic kinematic data (0.15-mm linear, 0.17-0.20 deg rotational, accuracy) were obtained simultaneously. After images were obtained in a true sagittal plane, the image receptor was rotated in 5 deg increments (posterior oblique angulations) from 5 deg to 15 deg. Quantitative motion analysis (qma) software was used to determine the intersegmental rotations from the fluoroscopic images. The mean absolute rotation differences between optoelectronic values and dynamic fluoroscopic values were less than 0.5 deg for all the motion segments at each off-axis fluoroscopic rotation and were not significantly different (P > 0.05) for any of the off-axis rotations of the fluoroscope. Small misalignments of the lumbar spine relative to the fluoroscope did not introduce measurement variation in relative segmental rotations greater than that observed when the spine and fluoroscope were perpendicular to each other, suggesting that fluoroscopic measures of relative segmental rotation during flexion-extension are likely robust, even when patient alignment is not perfect.
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97
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Rathi S, Taylor NF, Green RA. The effect of in vivo rotator cuff muscle contraction on glenohumeral joint translation: An ultrasonographic and electromyographic study. J Biomech 2016; 49:3840-3847. [DOI: 10.1016/j.jbiomech.2016.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/22/2022]
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98
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Longitudinal Study of the Six Degrees of Freedom Cervical Spine Range of Motion During Dynamic Flexion, Extension, and Rotation After Single-level Anterior Arthrodesis. Spine (Phila Pa 1976) 2016; 41:E1319-E1327. [PMID: 27831986 PMCID: PMC5119762 DOI: 10.1097/brs.0000000000001629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A longitudinal study using biplane radiography to measure in vivo intervertebral range of motion (ROM) during dynamic flexion/extension, and rotation. OBJECTIVE To longitudinally compare intervertebral maximal ROM and midrange motion in asymptomatic control subjects and single-level arthrodesis patients. SUMMARY OF BACKGROUND DATA In vitro studies consistently report that adjacent segment maximal ROM increases superior and inferior to cervical arthrodesis. Previous in vivo results have been conflicting, indicating that maximal ROM may or may not increase superior and/or inferior to the arthrodesis. There are no previous reports of midrange motion in arthrodesis patients and similar-aged controls. METHODS Eight single-level (C5/C6) anterior arthrodesis patients (tested 7 ± 1 months and 28 ± 6 months postsurgery) and six asymptomatic control subjects (tested twice, 58 ± 6 months apart) performed dynamic full ROM flexion/extension and axial rotation whereas biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral position from each pair of radiographs with submillimeter accuracy. The intervertebral maximal ROM and midrange motion in flexion/extension, rotation, lateral bending, and anterior-posterior translation were compared between test dates and between groups. RESULTS Adjacent segment maximal ROM did not increase over time during flexion/extension, or rotation movements. Adjacent segment maximal rotational ROM was not significantly greater in arthrodesis patients than in corresponding motion segments of similar-aged controls. C4/C5 adjacent segment rotation during the midrange of head motion and maximal anterior-posterior translation were significantly greater in arthrodesis patients than in the corresponding motion segment in controls on the second test date. CONCLUSION C5/C6 arthrodesis appears to significantly affect midrange, but not end-range, adjacent segment motions. The effects of arthrodesis on adjacent segment motion may be best evaluated by longitudinal studies that compare maximal and midrange adjacent segment motion to corresponding motion segments of similar-aged controls to determine if the adjacent segment motion is truly excessive. LEVEL OF EVIDENCE 3.
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99
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Irvine JN, Arner JW, Thorhauer E, Abebe ES, D'Auria J, Schreiber VM, Harner CD, Tashman S. Is There a Difference in Graft Motion for Bone-Tendon-Bone and Hamstring Autograft ACL Reconstruction at 6 Weeks and 1 Year? Am J Sports Med 2016; 44:2599-2607. [PMID: 27411358 DOI: 10.1177/0363546516651436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone-patellar tendon-bone (BTB) grafts are generally believed to heal more quickly than soft tissue grafts after anterior cruciate ligament (ACL) reconstruction, but little is known about the time course of healing or motion of the grafts within the bone tunnels. HYPOTHESIS Graft-tunnel motion will be greater in hamstring (HS) grafts compared with BTB grafts and will be less at 1 year than at 6 weeks. STUDY DESIGN Controlled laboratory study. METHODS Twelve patients underwent anatomic single-bundle ACL reconstruction using HS or BTB autografts (6 per group) with six 0.8-mm tantalum beads embedded in each graft. Dynamic stereo x-ray images were collected at 6 weeks and 1 year during treadmill walking and stair descent and at 1 year during treadmill running. Tibiofemoral kinematics and bead positions were evaluated. Graft-tunnel motion was based on bead range of motion during the loading response phase (first 10%) of the gait cycle. RESULTS During treadmill walking, there was no difference in femoral tunnel or tibial tunnel motion between BTB or HS grafts at 6 weeks (BTB vs HS: 2.00 ± 1.05 vs 1.25 ± 0.67 mm [femoral tunnel]; 1.20 ± 0.63 vs 1.27 ± 0.71 mm [tibial tunnel]), or 1 year (BTB vs HS: 1.62 ± 0.76 vs 1.08 ± 0.26 mm [femoral tunnel]; 1.58 ± 0.75 vs 1.68 ± 0.53 mm [tibial tunnel]). During stair descent, there was no difference in femoral or tibial tunnel motion between BTB and HS grafts at 6 weeks or 1 year. With running, there was no difference between graft types at 1 year. For all results, P values were > .05. Knee kinematics were consistent with the literature. CONCLUSION During walking and stair descent, ACL reconstruction using suspensory fixation yielded no difference between graft types in femoral or tibial tunnel motion at 6 weeks or 1 year. All subjects were asymptomatic with knee kinematics similar to that of the literature. The significance of persistent, small (1 to 3 mm) movements at 1 year for healing or graft performance is unknown. CLINICAL RELEVANCE These study results may have significant implications for graft choice, rehabilitation strategies, and timing for return to sports.
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Affiliation(s)
- James N Irvine
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Eric Thorhauer
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Ermias S Abebe
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer D'Auria
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Verena M Schreiber
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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100
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Fiorentino NM, Atkins PR, Kutschke MJ, Foreman KB, Anderson AE. In-vivo quantification of dynamic hip joint center errors and soft tissue artifact. Gait Posture 2016; 50:246-251. [PMID: 27693944 PMCID: PMC5119549 DOI: 10.1016/j.gaitpost.2016.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
Hip joint center (HJC) measurement error can adversely affect predictions from biomechanical models. Soft tissue artifact (STA) may exacerbate HJC errors during dynamic motions. We quantified HJC error and the effect of STA in 11 young, asymptomatic adults during six activities. Subjects were imaged simultaneously with reflective skin markers (SM) and dual fluoroscopy (DF), an x-ray based technique with submillimeter accuracy that does not suffer from STA. Five HJCs were defined from locations of SM using three predictive (i.e., based on regression) and two functional methods; these calculations were repeated using the DF solutions. Hip joint center motion was analyzed during six degrees-of-freedom (default) and three degrees-of-freedom hip joint kinematics. The position of the DF-measured femoral head center (FHC), served as the reference to calculate HJC error. The effect of STA was quantified with mean absolute deviation. HJC errors were (mean±SD) 16.6±8.4mm and 11.7±11.0mm using SM and DF solutions, respectively. HJC errors from SM measurements were all significantly different from the FHC in at least one anatomical direction during multiple activities. The mean absolute deviation of SM-based HJCs was 2.8±0.7mm, which was greater than that for the FHC (0.6±0.1mm), suggesting that STA caused approximately 2.2mm of spurious HJC motion. Constraining the hip joint to three degrees-of-freedom led to approximately 3.1mm of spurious HJC motion. Our results indicate that STA-induced motion of the HJC contributes to the overall error, but inaccuracies inherent with predictive and functional methods appear to be a larger source of error.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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