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Aiyangar AK, Zheng L, Tashman S, Anderst WJ, Zhang X. Capturing Three-Dimensional In Vivo Lumbar Intervertebral Joint Kinematics Using Dynamic Stereo-X-Ray Imaging. J Biomech Eng 2013; 136:011004. [DOI: 10.1115/1.4025793] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Indexed: 11/08/2022]
Abstract
Availability of accurate three-dimensional (3D) kinematics of lumbar vertebrae is necessary to understand normal and pathological biomechanics of the lumbar spine. Due to the technical challenges of imaging the lumbar spine motion in vivo, it has been difficult to obtain comprehensive, 3D lumbar kinematics during dynamic functional tasks. The present study demonstrates a recently developed technique to acquire true 3D lumbar vertebral kinematics, in vivo, during a functional load-lifting task. The technique uses a high-speed dynamic stereo-radiography (DSX) system coupled with a volumetric model-based bone tracking procedure. Eight asymptomatic male participants performed weight-lifting tasks, while dynamic X-ray images of their lumbar spines were acquired at 30 fps. A custom-designed radiation attenuator reduced the radiation white-out effect and enhanced the image quality. High resolution CT scans of participants' lumbar spines were obtained to create 3D bone models, which were used to track the X-ray images via a volumetric bone tracking procedure. Continuous 3D intervertebral kinematics from the second lumbar vertebra (L2) to the sacrum (S1) were derived. Results revealed motions occurring simultaneously in all the segments. Differences in contributions to overall lumbar motion from individual segments, particularly L2–L3, L3–L4, and L4–L5, were not statistically significant. However, a reduced contribution from the L5–S1 segment was observed. Segmental extension was nominally linear in the middle range (20%–80%) of motion during the lifting task, but exhibited nonlinear behavior at the beginning and end of the motion. L5–S1 extension exhibited the greatest nonlinearity and variability across participants. Substantial AP translations occurred in all segments (5.0 ± 0.3 mm) and exhibited more scatter and deviation from a nominally linear path compared to segmental extension. Maximum out-of-plane rotations (<1.91 deg) and translations (<0.94 mm) were small compared to the dominant motion in the sagittal plane. The demonstrated success in capturing continuous 3D in vivo lumbar intervertebral kinematics during functional tasks affords the possibility to create a baseline data set for evaluating the lumbar spinal function. The technique can be used to address the gaps in knowledge of lumbar kinematics, to improve the accuracy of the kinematic input into biomechanical models, and to support development of new disk replacement designs more closely replicating the natural lumbar biomechanics.
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Affiliation(s)
- Ameet K. Aiyangar
- EMPA (Swiss Federal Laboratories for Materials Science and Research), Mechanical Systems Engineering (Lab 304), Ueberlandstrasse 129, Duebendorf 8400, Switzerland
- Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203 e-mail:
| | - Liying Zheng
- Department of Orthopaedic Surgery, Musculoskeletal Modeling Laboratory, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203 e-mail:
| | - Scott Tashman
- Department of Orthopaedic Surgery, Department of Bioengineering, Orthopaedic Biodynamics Laboratory, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203 e-mail:
| | - William J. Anderst
- Department of Orthopaedic Surgery, Orthopaedic Biodynamics Laboratory, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203 e-mail:
| | - Xudong Zhang
- Department of Orthopaedic Surgery, Department of Bioengineering, Department of Mechanical Engineering and Materials Science, Musculoskeletal Modeling Laboratory, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203 e-mail:
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152
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Leng S, Zhao K, Qu M, An KN, Berger R, McCollough CH. Dynamic CT technique for assessment of wrist joint instabilities. Med Phys 2013; 38 Suppl 1:S50. [PMID: 21978117 DOI: 10.1118/1.3577759] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop a 4D [three-dimensional (3D) + time] CT technique to capture high spatial and temporal resolution images of wrist joint motion so that dynamic joint instabilities can be detected before the development of static joint instability and onset of osteoarthritis (OA). METHODS A cadaveric wrist was mounted onto a custom motion simulator and scanned with a dual source CT scanner during radial-ulnar deviation. A dynamic 4D CT technique was utilized to reconstruct images at 20 equidistant time points from one motion cycle. 3D images of carpal bones were generated using volume rendering techniques (VRT) at each of the 20 time points and then 4D movies were generated to depict the dynamic joint motion. The same cadaveric wrist was also scanned after cutting all portions of the scapholunate interosseus ligament to simulate scapholunate joint instability. Image quality were assessed on an ordinal scale (1-4, 4 being excellent) by three experienced orthopedic surgeons (specialized in hand surgery) by scoring 2D axial images. Dynamic instability was evaluated by the same surgeons by comparing the two 4D movies of joint motion. Finally, dose reduction was investigated using the cadaveric wrist by scanning at different dose levels to determine the lowest radiation dose that did not substantially alter diagnostic image quality. RESULTS The mean image quality scores for dynamic and static CT images were 3.7 and 4.0, respectively. The carpal bones, distal radius and ulna, and joint spaces were clearly delineated in the 3D VRT images, without motion blurring or banding artifacts, at all time points during the motion cycle. Appropriate viewing angles could be interactively selected to view any articulating structure using different 3D processing techniques. The motion of each carpal bone and the relative motion among the carpal bones were easily observed in the 4D movies. Joint instability was correctly and easily detected in the scan performed after the ligament was cut by observing the relative motion between the scaphoid and lunate bones. Diagnostic capability was not sacrificed with a volume CT dose index (CTDI(vol)) as low as 18 mGy for the whole scan, with estimated skin dose of approximately 33 mGy, which is much lower than the threshold for transient skin erythema (2000 mGy). CONCLUSIONS The proposed dynamic 4D CT imaging technique generated high spatial and high temporal resolution images without requiring periodic joint motion. Preliminary results from this cadaveric study demonstrate the feasibility of detecting joint instability using this technique.
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Affiliation(s)
- Shuai Leng
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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153
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Clinical applications of musculoskeletal modelling for the shoulder and upper limb. Med Biol Eng Comput 2013; 51:953-63. [PMID: 23873010 DOI: 10.1007/s11517-013-1099-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
Musculoskeletal models have been developed to estimate internal loading on the human skeleton, which cannot directly be measured in vivo, from external measurements like kinematics and external forces. Such models of the shoulder and upper extremity have been used for a variety of purposes, ranging from understanding basic shoulder biomechanics to assisting in preoperative planning. In this review, we provide an overview of the most commonly used large-scale shoulder and upper extremity models and categorise the applications of these models according to the type of questions their users aimed to answer. We found that the most explored feature of a model is the possibility to predict the effect of a structural adaptation on functional outcome, for instance, to simulate a tendon transfer preoperatively. Recent studies have focused on minimising the mismatch in morphology between the model, often derived from cadaver studies, and the subject that is analysed. However, only a subset of the parameters that describe the model's geometry and, perhaps most importantly, the musculotendon properties can be obtained in vivo. Because most parameters are somehow interrelated, the others should be scaled to prevent inconsistencies in the model's structure, but it is not known exactly how. Although considerable effort is put into adding complexity to models, for example, by making them subject-specific, we have found little evidence of their superiority over current models. The current trend in development towards individualised, more complex models needs to be justified by demonstrating their ability to answer questions that cannot already be answered by existing models.
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154
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Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. Coracohumeral Distances and Correlation to Arm Rotation: An In Vivo 3-Dimensional Biplane Fluoroscopy Study. Orthop J Sports Med 2013; 1:2325967113496059. [PMID: 26535235 PMCID: PMC4555485 DOI: 10.1177/2325967113496059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears. Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation. Study Design: Descriptive laboratory study. Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured. Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index. Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices. Clinical Relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.
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Affiliation(s)
- John P Brunkhorst
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - J Erik Giphart
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA
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155
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Wilson DR, McWalter EJ, Johnston JD. The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Rheum Dis Clin North Am 2013; 39:21-44. [PMID: 23312409 DOI: 10.1016/j.rdc.2012.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanics play a role in the initiation and progression of osteoarthritis. However, our understanding of which mechanical parameters are most important, and what their impact is on the disease, is limited by the challenge of measuring the most important mechanical quantities in living subjects. Consequently, comprehensive statements cannot be made about how mechanics should be modified to prevent, slow or arrest osteoarthritis. Our current understanding is based largely on studies of deviations from normal mechanics caused by malalignment, injury, and deformity. Some treatments for osteoarthritis focus on correcting mechanics, but there appears to be scope for more mechanically based interventions.
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Affiliation(s)
- David R Wilson
- Department of Orthopaedics, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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156
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Pierrart J, Lefèvre-Colau MM, Skalli W, Vuillemin V, Masmejean EH, Cuénod CA, Gregory TM. New dynamic three-dimensional MRI technique for shoulder kinematic analysis. J Magn Reson Imaging 2013; 39:729-34. [PMID: 23723138 DOI: 10.1002/jmri.24204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To establish a new imaging technique using dynamic MRI three-dimensional (3D) volumetric acquisition in real-time, on six normal shoulders for the analysis of the 3D shoulder kinematics during continuous motion. MATERIALS AND METHODS At first, a standard static acquisition was performed. Then, fast images were obtained with a multi-slice 3D balanced gradient echo sequence to get a real time series during the initial phase of shoulder abduction. Subsequently, the images were reconstructed; registered and the translational patterns of the humeral head relative to the glenoid and the size of the subacromial space were calculated. Additionally, the intraobserver reproducibility was tested. RESULTS The maximal abduction was on average 43° (30° to 60°) and the mean width of the subacromial space was 7.7 mm (SD: ±1.2 mm). Difference between extreme values and average values was low, respectively 2.5 mm on X-axis, 2 mm on Y-axis, 1.4 mm for the width of the subacromial space and 1.2° for the measure of the glenohumeral abduction. CONCLUSION This study reported a dynamic MRI protocol for the monitoring of shoulder 3D kinematics during continuous movement. The results suggest that there is no superior shift of the humeral head during the first phase of abduction.
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Affiliation(s)
- Jérôme Pierrart
- Laboratory of Biomechanics, Arts et métiers ParisTech, France.; Orthopaedic Surgery and traumatology, European Hospital Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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157
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Anderst WJ, Donaldson WF, Lee JY, Kang JD. Subject-specific inverse dynamics of the head and cervical spine during in vivo dynamic flexion-extension. J Biomech Eng 2013; 135:61007-8. [PMID: 23699719 DOI: 10.1115/1.4023524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/29/2013] [Indexed: 11/08/2022]
Abstract
The effects of degeneration and surgery on cervical spine mechanics are commonly evaluated through in vitro testing and finite element models derived from these tests. The objectives of the current study were to estimate the load applied to the C2 vertebra during in vivo functional flexion-extension and to evaluate the effects of anterior cervical arthrodesis on spine kinetics. Spine and head kinematics from 16 subjects (six arthrodesis patients and ten asymptomatic controls) were determined during functional flexion-extension using dynamic stereo X-ray and conventional reflective markers. Subject-specific inverse dynamics models, including three flexor muscles and four extensor muscles attached to the skull, estimated the force applied to C2. Total force applied to C2 was not significantly different between arthrodesis and control groups at any 10 deg increment of head flexion-extension (all p values ≥ 0.937). Forces applied to C2 were smallest in the neutral position, increased slowly with flexion, and increased rapidly with extension. Muscle moment arms changed significantly during flexion-extension, and were dependent upon the direction of head motion. The results suggest that in vitro protocols and finite element models that apply constant loads to C2 do not accurately represent in vivo cervical spine kinetics.
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Affiliation(s)
- William J Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15203, USA.
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158
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Motion path of the instant center of rotation in the cervical spine during in vivo dynamic flexion-extension: implications for artificial disc design and evaluation of motion quality after arthrodesis. Spine (Phila Pa 1976) 2013; 38:E594-601. [PMID: 23429677 PMCID: PMC3656913 DOI: 10.1097/brs.0b013e31828ca5c7] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case-control. OBJECTIVE To characterize the motion path of the instant center of rotation (ICR) at each cervical motion segment from C2 to C7 during dynamic flexion-extension in asymptomatic subjects. To compare ICR paths in asymptomatic subjects and patients with single-level arthrodesis. SUMMARY OF BACKGROUND DATA The ICR has been proposed as an alternative to range of motion (ROM) for evaluating the quality of spine movement and for identifying abnormal midrange kinematics. The motion path of the ICR during dynamic motion has not been reported. METHODS Twenty asymptomatic controls, 12 C5-C6, and 5 C6-C7 patients with arthrodesis performed full ROM flexion-extension, while biplane radiographs were obtained at 30 Hz. A previously validated tracking process determined 3-dimensional vertebral position with submillimeter accuracy. The finite helical axis method was used to calculate the ICR between adjacent vertebrae. A linear mixed-model analysis identified differences in the ICR path among motion segments and between controls and patients with arthrodesis. RESULTS From C2-C3 to C6-C7, the mean ICR location moved superior for each successive motion segment (P < 0.001). The anterior-posterior change in ICR location per degree of flexion-extension decreased from the C2-C3 motion segment to the C6-C7 motion segment (P < 0.001). Asymptomatic subject variability (95% confidence interval) in the ICR location averaged ± 1.2 mm in the superior-inferior direction and ± 1.9 mm in the anterior-posterior direction over all motion segments and flexion-extension angles. Asymptomatic and arthrodesis groups were not significantly different in terms of average ICR position (all P ≥ 0.091) or in terms of the change in ICR location per degree of flexion-extension (all P ≥ 0.249). CONCLUSION To replicate asymptomatic in vivo cervical motion, disc replacements should account for level-specific differences in the location and motion path of ICR. Single-level anterior arthrodesis does not seem to affect cervical motion quality during flexion-extension. LEVEL OF EVIDENCE 4.
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159
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Anderst WJ, Donaldson WF, Lee JY, Kang JD. Cervical motion segment percent contributions to flexion-extension during continuous functional movement in control subjects and arthrodesis patients. Spine (Phila Pa 1976) 2013; 38:E533-9. [PMID: 23370681 PMCID: PMC3686971 DOI: 10.1097/brs.0b013e318289378d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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
STUDY DESIGN Case control study. OBJECTIVE To quantify precisely and compare intervertebral segmental contributions to cervical spine flexion-extension during continuous, functional flexion-extension in asymptomatic subjects with patients who underwent single-level anterior arthrodesis. SUMMARY OF BACKGROUND DATA Segmental contributions to cervical flexion-extension have traditionally been determined using single images collected at full flexion and full extension. These calculations neglect midrange motion and assume that percent contributions to motion remain constant throughout the entire flexion-extension range of motion (ROM). METHODS Six patients with single-level (C5-C6) anterior arthrodesis and 18 asymptomatic control subjects performed flexion-extension while biplane radiographs were collected at 30 images per second. A previously validated tracking process determined 3-dimensional vertebral position with submillimeter accuracy during continuous flexion-extension. Mixed-effects models of segmental percent contribution to C2-C7 flexion-extension were developed to identify differences in percent contribution within each motion segment, among motion segments, and between controls and patients who underwent arthrodesis over the full ROM. RESULTS The C2-C3, C3-C4, and C4-C5 motion segments made their maximum contributions during the midrange of motion. The C5-C6 and C6-C7 motion segments, in contrast, made their maximum contributions near the start and end of the ROM. Arthrodesis patients' contribution from the C4-C5 motion segment increased significantly over the range of motion from 30% to 95% of the total flexion-extension ROM (average increased contribution of 5.1%) and arthrodesis patients' contribution from the C6-C7 motion segment increased significantly over the entire flexion-extension ROM (average increased percentage contribution of 8.9%) in comparison to controls. CONCLUSION Cervical motion segment contributions to flexion-extension change significantly during the flexion-extension motion. The largest change in percent contribution to motion, relative to controls, occurs at the C6-C7 motion segment, over the entire ROM, suggesting a potential mechanical mechanism for the clinical observation of increased incidence of adjacent segment degeneration at C6-C7 rather than at C4-C5 after C5-C6 arthrodesis.
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Affiliation(s)
- William J Anderst
- From the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
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160
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Teeter MG, Seslija P, Milner JS, Nikolov HN, Yuan X, Naudie DDR, Holdsworth DW. Quantification ofin vivoimplant wear in total knee replacement from dynamic single plane radiography. Phys Med Biol 2013; 58:2751-67. [DOI: 10.1088/0031-9155/58/9/2751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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161
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Anderst WJ, Donaldson WF, Lee JY, Kang JD. Cervical spine intervertebral kinematics with respect to the head are different during flexion and extension motions. J Biomech 2013; 46:1471-5. [PMID: 23540377 DOI: 10.1016/j.jbiomech.2013.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/24/2013] [Accepted: 03/03/2013] [Indexed: 12/01/2022]
Abstract
Previous dynamic imaging studies of the cervical spine have focused entirely on intervertebral kinematics while neglecting to investigate the relationship between head motion and intervertebral motion. Specifically, it is unknown if the relationship between head and intervertebral kinematics is affected by movement direction. We tested the hypothesis that there would be no difference in sagittal plane intervertebral angles at identical head orientations during the flexion and extension movements. Nineteen asymptomatic subjects performed continuous head flexion-extension movements while biplane radiographs were collected at 30 images per second. A previously validated model-based volumetric tracking process determined three-dimensional vertebral position with sub-millimeter accuracy throughout the flexion-extension motion. Head movement was recorded at 60 Hz using conventional motion analysis and reflective markers. Intervertebral angles were determined at identical head orientations during the flexion and extension movements. Cervical motion segments were in a more extended orientation during flexion and in a more flexed orientation during extension for any given head orientation. The results suggest that static radiographs cannot accurately represent vertebral orientation during dynamic motion. Further, data should be collected during both flexion and extension movements when investigating intervertebral kinematics with respect to global head orientation. Also, in vitro protocols that use intervertebral total range of motion as validation criteria may be improved by assessing model fidelity using continuous intervertebral kinematics in flexion and in extension. Finally, musculoskeletal models of the head and cervical spine should account for the direction of head motion when determining muscle moment arms because vertebral orientations (and therefore muscle attachment sites) are dependent on the direction of head motion.
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Affiliation(s)
- William J Anderst
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA.
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162
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Anderst WJ, Lee JY, Donaldson WF, Kang JD. Six-degrees-of-freedom cervical spine range of motion during dynamic flexion-extension after single-level anterior arthrodesis: comparison with asymptomatic control subjects. J Bone Joint Surg Am 2013; 95:497-506. [PMID: 23515984 PMCID: PMC3748975 DOI: 10.2106/jbjs.k.01733] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The etiology of adjacent-segment disease following cervical spine arthrodesis remains controversial. The objective of the current study was to evaluate cervical intervertebral range of motion during dynamic flexion-extension in patients who had undergone a single-level arthrodesis and in asymptomatic control subjects. METHODS Ten patients who had undergone a single-level (C5/C6) anterior arthrodesis and twenty asymptomatic control subjects performed continuous full range-of-motion flexion-extension while biplane radiographs were collected at thirty images per second. A previously validated tracking process determined three-dimensional vertebral position on each pair of radiographs with submillimeter accuracy. Six-degrees-of-freedom kinematics between adjacent vertebrae were calculated throughout the entire flexion-extension movement cycle over multiple trials for each participant. Cervical kinematics were also calculated from images collected during static full flexion and static full extension. RESULTS The C4/C5 motion segment moved through a larger extension range of motion and a smaller flexion range of motion in the subjects with the arthrodesis than in the controls. The extension difference between the arthrodesis and control groups was 3.8° (95% CI [confidence interval], 0.9° to 6.6°; p = 0.011) and the flexion difference was -2.9° (95% CI, -5.3° to -0.5°; p = 0.019). Adjacent-segment posterior translation was greater in the arthrodesis group than in the controls, with a C4/C5 difference of 0.8 mm (95% CI, 0.0 to 1.6 mm) and a C6/C7 difference of 0.4 mm (95% CI, 0.0 to 0.8 mm; p = 0.016). Translation range of motion and rotation range of motion were consistently larger when measured on images collected during dynamic functional movement as opposed to images collected at static full flexion or full extension. The upper 95% CI limit for anterior-posterior translation range of motion was 3.45 mm at C3/C4 and C4/C5, but only 2.3 mm at C6/C7. CONCLUSIONS C5/C6 arthrodesis does not affect the total range of motion in adjacent vertebral segments, but it does alter the distribution of adjacent-segment motion toward more extension and less flexion superior to the arthrodesis and more posterior translation superior and inferior to the arthrodesis during in vivo functional loading. Range of motion measured from static full-flexion and full-extension images underestimates dynamic range of motion. Clinical evaluation of excessive anterior-posterior translation should take into account the cervical vertebral level.
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Affiliation(s)
- William J. Anderst
- Department of Orthopaedic Surgery, Orthopaedics Biodynamics Laboratory, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203. E-mail address:
| | - Joon Y. Lee
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213
| | - William F. Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213
| | - James D. Kang
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213
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Giphart JE, Brunkhorst JP, Horn NH, Shelburne KB, Torry MR, Millett PJ. Effect of plane of arm elevation on glenohumeral kinematics: a normative biplane fluoroscopy study. J Bone Joint Surg Am 2013; 95:238-45. [PMID: 23389787 DOI: 10.2106/jbjs.j.01875] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding glenohumeral motion in normal and pathologic states requires the precise measurement of shoulder kinematics. The effect of the plane of arm elevation on glenohumeral translations and rotations remains largely unknown. The purpose of this study was to measure the three-dimensional glenohumeral translations and rotations during arm elevation in healthy subjects. METHODS Eight male subjects performed scaption and forward flexion, and five subjects (three men and two women) performed abduction, inside a dynamic biplane fluoroscopy system. Bone geometries were extracted from computed tomography images and used to determine the three-dimensional position and orientation of the humerus and scapula in individual frames. Descriptive statistics were determined for glenohumeral joint rotations and translations, and linear regressions were performed to calculate the scapulohumeral rhythm ratio. RESULTS The scapulohumeral rhythm ratio was 2.0 ± 0.4:1 for abduction, 1.6 ± 0.5:1 for scaption, and 1.1 ± 0.3:1 for forward flexion, with the ratio for forward flexion being significantly lower than that for abduction (p = 0.002). Humeral head excursion was largest in abduction (5.1 ± 1.1 mm) and smallest in scaption (2.4 ± 0.6 mm) (p < 0.001). The direction of translation, as determined by the linear regression slope, was more inferior during abduction (-2.1 ± 1.8 mm/90°) compared with forward flexion (0.1 ± 10.9 mm/90°) (p = 0.024). CONCLUSIONS Scapulohumeral rhythm significantly decreased as the plane of arm elevation moved in an anterior arc from abduction to forward flexion. The amount of physiologic glenohumeral excursion varied significantly with the plane of elevation, was smallest for scaption, and showed inconsistent patterns across subjects with the exception of consistent inferior translation during abduction.
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Affiliation(s)
- J Erik Giphart
- Department of BioMedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA
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Henak CR, Anderson AE, Weiss JA. Subject-specific analysis of joint contact mechanics: application to the study of osteoarthritis and surgical planning. J Biomech Eng 2013; 135:021003. [PMID: 23445048 PMCID: PMC3705883 DOI: 10.1115/1.4023386] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/03/2013] [Accepted: 01/18/2013] [Indexed: 11/08/2022]
Abstract
Advances in computational mechanics, constitutive modeling, and techniques for subject-specific modeling have opened the door to patient-specific simulation of the relationships between joint mechanics and osteoarthritis (OA), as well as patient-specific preoperative planning. This article reviews the application of computational biomechanics to the simulation of joint contact mechanics as relevant to the study of OA. This review begins with background regarding OA and the mechanical causes of OA in the context of simulations of joint mechanics. The broad range of technical considerations in creating validated subject-specific whole joint models is discussed. The types of computational models available for the study of joint mechanics are reviewed. The types of constitutive models that are available for articular cartilage are reviewed, with special attention to choosing an appropriate constitutive model for the application at hand. Issues related to model generation are discussed, including acquisition of model geometry from volumetric image data and specific considerations for acquisition of computed tomography and magnetic resonance imaging data. Approaches to model validation are reviewed. The areas of parametric analysis, factorial design, and probabilistic analysis are reviewed in the context of simulations of joint contact mechanics. Following the review of technical considerations, the article details insights that have been obtained from computational models of joint mechanics for normal joints; patient populations; the study of specific aspects of joint mechanics relevant to OA, such as congruency and instability; and preoperative planning. Finally, future directions for research and application are summarized.
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Affiliation(s)
- Corinne R. Henak
- Department of Bioengineering,University of Utah,Salt Lake City, UT 84112;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT 84112
| | - Andrew E. Anderson
- Department of Bioengineering,University of Utah,Salt Lake City, UT;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT;Department of Orthopaedics,University of Utah,Salt Lake City, UT 84108;Department of Physical Therapy,University of Utah,Salt Lake City, UT 84108
| | - Jeffrey A. Weiss
- Department of Bioengineering,University of Utah,Salt Lake City, UT 84108;Scientific Computing and Imaging Institute,University of Utah,Salt Lake City, UT 84108;Department of Orthopaedics,University of Utah,Salt Lake City, UT 84108e-mail:
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Baillargeon E, Anderst WJ. Sensitivity, reliability and accuracy of the instant center of rotation calculation in the cervical spine during in vivo dynamic flexion-extension. J Biomech 2013; 46:670-6. [PMID: 23317757 DOI: 10.1016/j.jbiomech.2012.11.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/07/2012] [Accepted: 11/24/2012] [Indexed: 12/13/2022]
Abstract
The instant center of rotation (ICR) has been proposed as an alternative to range of motion (ROM) for evaluating the quality, rather than the quantity, of cervical spine movement. The purpose of the present study was to assess the sensitivity, reliability and accuracy of cervical spine ICR path calculations obtained during dynamic in vivo movement. The reliability and sensitivity of in vivo cervical spine ICR calculations were assessed by evaluating the effects of movement direction (flexion versus extension), rotation step size, filter frequency, and motion tracking error. The accuracy of the ICR path calculations was assessed through a simulation experiment that replicated in vivo movement of cervical vertebrae. The in vivo assessment included 20 asymptomatic subjects who performed continuous head flexion-extension movements while biplane radiographs were collected at 30 frames per second. In vivo motion of C2 through C7 cervical vertebrae was tracked with sub-millimeter accuracy using a volumetric model-based tracking technique. The finite helical axis method was used to determine ICRs between each pair of adjacent vertebra. The in vivo results indicate ICR path is not different during the flexion movement and the extension movement. In vivo, the path of the ICR can reliably be characterized within 0.5mm in the SI and 1.0mm in the AP direction. The inter-subject variability in ICR location averaged ±1.2mm in the SI direction and ±2.2mm in the AP direction. The computational experiment estimated the in vivo accuracy in ICR location was between 1.1mm and 3.1mm.
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166
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Tersi L, Barré A, Fantozzi S, Stagni R. In vitro quantification of the performance of model-based mono-planar and bi-planar fluoroscopy for 3D joint kinematics estimation. Med Biol Eng Comput 2012; 51:257-65. [DOI: 10.1007/s11517-012-0987-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
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Giphart JE, van der Meijden OAJ, Millett PJ. The effects of arm elevation on the 3-dimensional acromiohumeral distance: a biplane fluoroscopy study with normative data. J Shoulder Elbow Surg 2012; 21:1593-600. [PMID: 22361718 DOI: 10.1016/j.jse.2011.11.023] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Narrowing of the subacromial space has been implicated in several shoulder pathologies. However, the location of the minimum distance points during clinical testing has not been defined. We sought to measure the in vivo minimum distance and location of the minimum distance points on the acromion and proximal humerus during arm elevation. METHODS Eight healthy male subjects (mean age, 30 years) underwent a dynamic in vivo biplane fluoroscopy assessment of scaption and forward elevation. For each frame, the 3-dimensional position and orientation of the humerus and scapula were determined, and the acromiohumeral distance (AHD) was measured as the shortest distance between the acromion and proximal humerus. RESULTS The minimum AHD was 2.6 ± 0.8 mm during scaption and 1.8 ± 1.2 mm during forward flexion at elevation angles of 83° ± 13° and 97° ± 23°, respectively. The minimum distance point was located on the articular surface of the humeral head from the neutral arm position until 34° ± 8° for scaption and 36° ± 6° for forward flexion. Upon further elevation, the minimum distance point was located within the footprint of the supraspinatus muscle until 72° ± 12° for scaption and 65° ± 8° for forward flexion. At greater elevation angles, the minimum distance points were between the acromion and the proximal humeral shaft, distal from the greater tuberosity. CONCLUSIONS The shortest AHD was at approximately 90° of arm elevation. The AHD was no longer measured intra-articularly or within the supraspinatus footprint above approximately 70° of arm elevation.
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Affiliation(s)
- J Erik Giphart
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, CO 81657, USA
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Haque MA, Anderst W, Tashman S, Marai GE. Hierarchical model-based tracking of cervical vertebrae from dynamic biplane radiographs. Med Eng Phys 2012; 35:994-1004. [PMID: 23122602 DOI: 10.1016/j.medengphy.2012.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 09/14/2012] [Accepted: 09/22/2012] [Indexed: 11/30/2022]
Abstract
We present a novel approach for automatically, accurately and reliably determining the 3D motion of the cervical spine from a series of stereo or biplane radiographic images. These images could be acquired through a variety of different imaging hardware configurations. We follow a hierarchical, anatomically-aware, multi-bone approach that takes into account the complex structure of cervical vertebrae and inter-vertebrae overlapping, as well as the temporal coherence in the imaging series. These significant innovations improve the speed, accuracy, reliability and flexibility of the tracking process. Evaluation on cervical data shows that the approach is as accurate (average precision 0.3 mm and 1°) as the expert human-operator driven method that was previously state of the art. However, unlike the previously used method, the hierarchical approach is automatic and robust; even in the presence of implanted hardware. Therefore, the method has solid potential for clinical use to evaluate the effectiveness of surgical interventions.
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Affiliation(s)
- Md Abedul Haque
- University of Pittsburgh, Department of Computer Science, Pittsburgh, PA, USA.
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Seslija P, Teeter MG, Yuan X, Naudie DDR, Bourne RB, MacDonald SJ, Peters TM, Holdsworth DW. Measurement of joint kinematics using a conventional clinical single-perspective flat-panel radiography system. Med Phys 2012; 39:6090-103. [DOI: 10.1118/1.4752205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Passive and dynamic shoulder rotation range in uninjured and previously injured overhead throwing athletes and the effect of shoulder taping. PM R 2012; 4:111-6. [PMID: 22373460 DOI: 10.1016/j.pmrj.2011.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 10/10/2011] [Accepted: 11/25/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate: (1) the passive and dynamic shoulder internal (IR) and external (ER) rotation range of motion (ROM) of 2 groups of asymptomatic overhead throwing athletes: one group who had never experienced shoulder symptoms and another who had shoulder symptoms >12 months ago, (2) the effect of taping on the passive and dynamic IR-ER ROM in both these groups. DESIGN A within-subject repeated measures analysis of variance design to determine the differences in passive and dynamic shoulder rotation range and the effect of shoulder taping on the rotation range in a group of uninjured and previously injured overhead throwing athletes. SETTING Academic institution sports medicine setting. PARTICIPANTS Twenty-six overhead throwing collegiate athletes: 17 with no history of shoulder injury and 9 with previous shoulder injury. METHODS Passive shoulder ROM was measured with a goniometer with the subject in the supine position. To measure dynamic ROM, the subjects sat on a chair and threw a handball into a net. An 8-camera Vicon Motion Capture system recorded markers placed on the upper limb and trunk. Dynamic ROM was calculated with inverse kinematics by using OpenSim. MAIN OUTCOME MEASUREMENT Shoulder IR-ER ROM. RESULTS Dynamic IR-ER ROM was significantly greater than passive IR-ER ROM (P < .0001). There was no difference in passive IR-ER ROM between the uninjured and previously injured overhead throwing athletes. However, there was a significant difference in the total dynamic IR-ER ROM, whereby the overhead throwing athletes who had never experienced shoulder symptoms had less IR-ER ROM than the previously injured group (173.9° versus 196.9°, respectively; P = .049). Taping the shoulder increased the passive ROM in both groups of subjects (P < .001), increased the dynamic IR-ER ROM in the uninjured subjects, but decreased the dynamic IR-ER ROM in the previously injured subjects, although this was not statistically significant (P = .07). CONCLUSIONS Passive IR-ER ROM is a poor indication of dynamic shoulder function. Athletes who have had a previous shoulder injury demonstrate a greater dynamic IR-ER ROM than athletes who have never had a shoulder injury. Shoulder taping decreased the dynamic range of the previously injured athlete, so that it was nearer the dynamic range of the uninjured athlete. Shoulder taping might provide increased protection for the injured athlete by decreasing the dynamic IR-ER ROM and by facilitating better shoulder and scapular muscle control. Further studies are necessary to demonstrate whether this finding is clinically significant.
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171
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Chu Y, Akins J, Lovalekar M, Tashman S, Lephart S, Sell T. Validation of a video-based motion analysis technique in 3-D dynamic scapular kinematic measurements. J Biomech 2012; 45:2462-6. [PMID: 22898626 DOI: 10.1016/j.jbiomech.2012.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 06/16/2012] [Accepted: 06/24/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Yungchien Chu
- Neuromuscular Research Laboratory, University of Pittsburgh, 3830 South Water St. Pittsburgh, PA 15203, USA
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172
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Zakani S, Venne G, Smith EJ, Bicknell R, Ellis RE. Analyzing shoulder translation with navigation technology. Int J Comput Assist Radiol Surg 2012; 7:853-60. [PMID: 22855410 DOI: 10.1007/s11548-012-0782-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Asymmetric stress imposed on the shoulder can lead to anterior shoulder instability in young athletes who perform repetitive overhead motions. A common treatment, surgical anterior capsule tightening, assumes that the instability is caused by abnormal anterior laxity. This study investigated the possibility that one element of overall imbalance, posterior capsular tightness, could be an underlying reason for shoulder instability. Surgical navigation technology, which is more accurate than whole-body motion-capture systems, was used to study anterior translational motions. METHOD The study was used four cadaver shoulders, with the scapula and rotator cuff muscles intact. Opto-electronic surgical navigation localization devices were mounted on the scapula and humerus to accurately capture positions and orientations. The shoulders were passively moved through 7 motions, 5 of simple angulation and 2 combinations of clinical interest. Each motion was repeated in 4 different soft-tissue states: rotator cuff intact, capsule intact, and surgically induced capsular tightnesses of 5 and 10mm. RESULTS The shoulders had significantly greater anterior translation when the posterior capsule was artificially tightened (p < 0.05); this was particularly in movements that combined abduction with internal or external rotation, which are typical overhead sports motions. Overall translation was indifferent to whether the shoulders were intact or dissected down to the capsule, as was translation during flexion was indifferent to dissection state (p > 0.95). CONCLUSION Surgical navigation technology can easily be used to analyze cadaveric shoulder motion, with opportunities for adaptation to anesthetized patients. Results suggest that the inverse of artificial tightening, such as surgical release of the posterior capsule, may be an effective minimally invasive treatment of chronic shoulder dislocation subsequent to sports motions.
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Affiliation(s)
- S Zakani
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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Miranda DL, Schwartz JB, Loomis AC, Brainerd EL, Fleming BC, Crisco JJ. Static and dynamic error of a biplanar videoradiography system using marker-based and markerless tracking techniques. J Biomech Eng 2012; 133:121002. [PMID: 22206419 DOI: 10.1115/1.4005471] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of biplanar videoradiography technology has become increasingly popular for evaluating joint function in vivo. Two fundamentally different methods are currently employed to reconstruct 3D bone motions captured using this technology. Marker-based tracking requires at least three radio-opaque markers to be implanted in the bone of interest. Markerless tracking makes use of algorithms designed to match 3D bone shapes to biplanar videoradiography data. In order to reliably quantify in vivo bone motion, the systematic error of these tracking techniques should be evaluated. Herein, we present new markerless tracking software that makes use of modern GPU technology, describe a versatile method for quantifying the systematic error of a biplanar videoradiography motion capture system using independent gold standard instrumentation, and evaluate the systematic error of the W.M. Keck XROMM Facility's biplanar videoradiography system using both marker-based and markerless tracking algorithms under static and dynamic motion conditions. A polycarbonate flag embedded with 12 radio-opaque markers was used to evaluate the systematic error of the marker-based tracking algorithm. Three human cadaveric bones (distal femur, distal radius, and distal ulna) were used to evaluate the systematic error of the markerless tracking algorithm. The systematic error was evaluated by comparing motions to independent gold standard instrumentation. Static motions were compared to high accuracy linear and rotary stages while dynamic motions were compared to a high accuracy angular displacement transducer. Marker-based tracking was shown to effectively track motion to within 0.1 mm and 0.1 deg under static and dynamic conditions. Furthermore, the presented results indicate that markerless tracking can be used to effectively track rapid bone motions to within 0.15 deg for the distal aspects of the femur, radius, and ulna. Both marker-based and markerless tracking techniques were in excellent agreement with the gold standard instrumentation for both static and dynamic testing protocols. Future research will employ these techniques to quantify in vivo joint motion for high-speed upper and lower extremity impacts such as jumping, landing, and hammering.
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Affiliation(s)
- Daniel L Miranda
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
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Lalone EA, Peters TM, King GW, Johnson JA. Accuracy assessment of an imaging technique to examine ulnohumeral joint congruency during elbow flexion. ACTA ACUST UNITED AC 2012; 17:142-52. [DOI: 10.3109/10929088.2012.673638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goyal K, Tashman S, Wang JH, Li K, Zhang X, Harner C. In vivo analysis of the isolated posterior cruciate ligament-deficient knee during functional activities. Am J Sports Med 2012; 40:777-85. [PMID: 22328708 DOI: 10.1177/0363546511435783] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients with isolated posterior cruciate ligament (PCL) injuries have minimal symptoms, and nonoperative treatment is recommended. However, over time, these patients can develop significant degenerative changes in their knees. Historically, PCL laxity is graded by nonweightbearing anteroposterior measuring techniques that do not reproduce the true, dynamic weightbearing conditions in the injured knee. The purpose of this study was to determine the patholaxity in patients with isolated PCL deficiency during functional weightbearing activities (running, walking, and stair ascent). HYPOTHESIS Patients with unilateral, isolated PCL deficiency will demonstrate dynamic anteroposterior and rotational instability in their affected knees during functional activities of level running and stair ascent compared with their unaffected, contralateral knees. STUDY DESIGN Controlled laboratory study. METHODS Nine asymptomatic patients with isolated grade II PCL injury underwent Dynamic Stereo X-Ray (DSX) of both knees during level running and stair ascent. Three-dimensional reconstructions of the patients' bilateral distal femurs and proximal tibias were created from high-resolution computed tomography (CT) scans. Three-dimensional joint kinematics were determined using a model-based tracking approach to align the radiographic images with CT-derived bone models. The resulting tibiofemoral rotations and translations for the PCL-deficient and PCL-intact knees were then compared. RESULTS During level running, the tibia of the PCL-deficient knee was approximately 2 mm posteriorly subluxated and had an anterior velocity relative to the femur approximately 40 mm/s greater than the contralateral, uninjured knee; however, this was only during the swing phase. No significant differences were found during the stance phase of running. During stair ascent, the tibia of the PCL-deficient knee was approximately 4 mm posteriorly subluxated compared with the intact limb during the terminal swing phase and early stance phase. Between foot strike and the time of peak ground-reaction force (GRF), the tibia of the PCL-deficient knee translated anteriorly relative to the femur with velocities 3 to 4 times greater than in the intact limb. Level walking was also evaluated in 3 patients, but no differences were seen, and it was not tested in the remaining 6 patients. CONCLUSION Changes in knee kinematics due to isolated PCL injuries were highly activity dependent. During running, small differences were identified only during the swing phase when the knee was unloaded. However, during stair ascent, significant differences extended from the late swing into early stance phase. During the swing phase of stair ascent, the tibia in the PCL-deficient joint subluxated posteriorly. Then, as load was transferred to the ascending limb, the tibia reduced anteriorly with high velocity relative to the femur. The resulting shear motion may expose the loaded joint to abnormal and potentially damaging forces. CLINICAL RELEVANCE During functional activities, patients with isolated PCL injuries experience significant knee instability that cannot be identified by standard nonweightbearing static laxity measurements. The finding that different activities create different degrees of instability may have important implications for rehabilitation and activity limitations for PCL-deficient individuals.
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Affiliation(s)
- Kanu Goyal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Shapiro LM, Gold GE. MRI of weight bearing and movement. Osteoarthritis Cartilage 2012; 20:69-78. [PMID: 22138286 PMCID: PMC3260416 DOI: 10.1016/j.joca.2011.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/12/2011] [Accepted: 11/04/2011] [Indexed: 02/02/2023]
Abstract
Conventional, static magnetic resonance imaging (MRI) is able to provide a vast amount of information regarding the anatomy and pathology of the musculoskeletal system. However, patients, especially those whose pain is position dependent or elucidated by movement, may benefit from more advanced imaging techniques that allow for the acquisition of functional information. This manuscript reviews a variety of advancements in MRI techniques that are used to image the musculoskeletal system dynamically, while in motion or under load. The methodologies, advantages and drawbacks of stress MRI, cine-phase contrast MRI and real-time MRI are discussed as each has helped to advance the field by providing a scientific basis for understanding normal and pathological musculoskeletal anatomy and function. Advancements in dynamic MR imaging will certainly lead to improvements in the understanding, prevention, diagnosis and treatment of musculoskeletal disorders. It is difficult to anticipate that dynamic MRI will replace conventional MRI, however, dynamic MRI may provide additional valuable information to findings of conventional MRI.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Radiology, Grant Building Room S068B, Stanford, CA 94305
| | - Garry E. Gold
- Department of Radiology, Grant Building Room S068B, Stanford, CA 94305
- Department of Bioengineering, Grant Building Room S068B, Stanford, CA 94305
- Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Zhu Z, Massimini DF, Wang G, Warner JJP, Li G. The accuracy and repeatability of an automatic 2D-3D fluoroscopic image-model registration technique for determining shoulder joint kinematics. Med Eng Phys 2012; 34:1303-9. [PMID: 22285714 DOI: 10.1016/j.medengphy.2011.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/05/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022]
Abstract
Fluoroscopic imaging, using single plane or dual plane images, has grown in popularity to measure dynamic in vivo human shoulder joint kinematics. However, no study has quantified the difference in spatial positional accuracy between single and dual plane image-model registration applied to the shoulder joint. In this paper, an automatic 2D-3D image-model registration technique was validated for accuracy and repeatability with single and dual plane fluoroscopic images. Accuracy was assessed in a cadaver model, kinematics found using the automatic registration technique were compared to those found using radiostereometric analysis. The in vivo repeatability of the automatic registration technique was assessed during the dynamic abduction motion of four human subjects. The in vitro data indicated that the error in spatial positional accuracy of the humerus and the scapula was less than 0.30mm in translation and less than 0.58° in rotation using dual plane images. Single plane accuracy was satisfactory for in-plane motion variables, but out-of-plane motion variables on average were approximately 8 times less accurate. The in vivo test indicated that the repeatability of the automatic 2D-3D image-model registration was 0.50mm in translation and 1.04° in rotation using dual images. For a single plane technique, the repeatability was 3.31mm in translation and 2.46° in rotation for measuring shoulder joint kinematics. The data demonstrate that accurate and repeatable shoulder joint kinematics can be obtained using dual plane fluoroscopic images with an automatic 2D-3D image-model registration technique; and that out-of-plane motion variables are less accurate than in-plane motion variables using a single plane technique.
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Affiliation(s)
- Zhonglin Zhu
- Department of Biomedical Engineering, Tsinghua University, Beijing, China.
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Giphart JE, Elser F, Dewing CB, Torry MR, Millett PJ. The long head of the biceps tendon has minimal effect on in vivo glenohumeral kinematics: a biplane fluoroscopy study. Am J Sports Med 2012; 40:202-12. [PMID: 21965188 DOI: 10.1177/0363546511423629] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The in vivo stabilizing role of the long head of the biceps tendon (LHB) is poorly understood. While cadaveric studies report that the loaded LHB constrains translations in all directions, clinical data suggest that there is no clinically demonstrable alteration in glenohumeral position after LHB tenodesis or tenotomy. The purpose of this study was to investigate potential alterations in glenohumeral kinematics after LHB tenodesis during 3 dynamic in vivo motions using a biplane fluoroscopy system. HYPOTHESIS Our hypothesis was that there would be no difference in glenohumeral translations greater than 1.0 mm between shoulders after biceps tenodesis and healthy contralateral shoulders. STUDY DESIGN Controlled laboratory study. METHODS Five patients who underwent unilateral, open subpectoral tenodesis performed abduction, a simulated late cocking phase of a throw, and simulated lifting with both their tenodesed shoulder and their contralateral healthy shoulder inside a biplane fluoroscopy system. Dynamic 3-dimensional glenohumeral positions and electromyography activity of the biceps brachii muscle were determined and compared. RESULTS Significant glenohumeral translations occurred in both shoulders for abduction (3.4 mm inferiorly; P < .01) and simulated late cocking (2.6 mm anteriorly; P < .01). The mean difference for each motion in glenohumeral position between the tenodesed and the contralateral healthy shoulders was always less than 1.0 mm. The tenodesed shoulders were more anterior (centered) during abduction (0.7 mm; P < .01) and for the eccentric phase of the simulated late cocking motion (0.9 mm; P < .02). No significant differences were found during the simulated lifting motion and in the superior-inferior direction. CONCLUSION The effect of biceps tenodesis on glenohumeral position during the motions studied in vivo was minimal compared with physiological translations and interpatient variability. CLINICAL RELEVANCE Our findings demonstrated that LHB tenodesis does not dramatically alter glenohumeral position during dynamic motions, suggesting the risk for clinically significant alterations in glenohumeral kinematics after tenodesis is low in otherwise intact shoulders.
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Affiliation(s)
- J Erik Giphart
- Steadman Philippon Research Institute, Vail, CO 81657, USA.
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Myers CA, Torry MR, Shelburne KB, Giphart JE, LaPrade RF, Woo SLY, Steadman JR. In vivo tibiofemoral kinematics during 4 functional tasks of increasing demand using biplane fluoroscopy. Am J Sports Med 2012; 40:170-8. [PMID: 21997729 DOI: 10.1177/0363546511423746] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) has been well defined as the main passive restraint to anterior tibial translation (ATT) in the knee and plays an important role in rotational stability. However, it is unknown how closely the ACL and other passive and active structures of the knee constrain translations and rotations across a set of functional activities of increasing demand on the quadriceps. HYPOTHESIS Anterior tibial translation and internal rotation of the tibia relative to the femur would increase as the demand on the quadriceps increased. STUDY DESIGN Controlled laboratory study. METHODS The in vivo 3-dimensional knee kinematics of 10 adult female patients (height, 167.8 ± 7.1 cm; body mass, 57 ± 4 kg; body mass index [BMI], 24.8 ± 1.7 kg/m(2); age, 29.7 ± 7.9 years) was measured using biplane fluoroscopy while patients completed 4 functional tasks. The tasks included an unloaded knee extension in which the patient slowly extended the knee from 90° to 0° of flexion in 2 seconds; walking at a constant pace of 90 steps per minute; a maximum effort isometric knee extension with the knee at 70° of flexion; and landing from a height of 40 cm in which the patient stepped off a box, landed, and immediately performed a maximum effort vertical jump. RESULTS Landing (5.6 ± 1.9 mm) produced significantly greater peak ATT than walking (3.1 ± 2.2 mm) and unweighted full extension (2.6 ± 2.1 mm) (P < .01), but there was no difference between landing and a maximum isometric contraction (5.0 ± 1.9 mm). While there was no significant difference in peak internal rotation between landing (19.4° ± 5.7°), maximum isometric contraction (15.9° ± 6.7°), and unweighted full knee extension (14.5° ± 7.7°), each produced significantly greater internal rotation than walking (3.9° ± 4.2°) (P < .001). Knee extension torque significantly increased for each task (P < .01): unweighted knee extension (4.7 ± 1.2 N·m), walking (36.5 ± 7.9 N·m), maximum isometric knee extension (105.1 ± 8.2 N·m), and landing (140.2 ± 26.2 N·m). CONCLUSION Anterior tibial translations significantly increased as demand on the quadriceps and external loading increased. Internal rotation was not significantly different between landing, isometric contraction, and unweighted knee extension. Additionally, ATT and internal rotation from each motion were within the normal range, and no excessive amounts of translation or rotation were observed. CLINICAL RELEVANCE This study demonstrated that while ATT will increase as demand on the quadriceps and external loading increases, the knee is able to effectively constrain ATT and internal rotation. This suggests that the healthy knee has a safe envelope of function that is tightly controlled even though task demand is elevated.
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Affiliation(s)
- Casey A Myers
- Biomechanics Research Laboratory, Steadman Philippon Research Institute, Vail, Colorado, USA
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180
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Bey MJ, Peltz CD, Ciarelli K, Kline SK, Divine GW, van Holsbeeck M, Muh S, Kolowich PA, Lock TR, Moutzouros V. In vivo shoulder function after surgical repair of a torn rotator cuff: glenohumeral joint mechanics, shoulder strength, clinical outcomes, and their interaction. Am J Sports Med 2011; 39:2117-29. [PMID: 21737834 PMCID: PMC4601100 DOI: 10.1177/0363546511412164] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. HYPOTHESIS Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. STUDY DESIGN Controlled laboratory study and Case series; Level of evidence, 4. METHODS Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. RESULTS Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients' repaired shoulder was positioned more superiorly on the glenoid than both the patients' contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients' repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. CONCLUSION Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. CLINICAL RELEVANCE The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function.
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Affiliation(s)
- Michael J. Bey
- Bone and Joint Center, Henry Ford Hospital, Detroit, Michigan
,Address correspondence to Michael J. Bey, PhD, Bone and Joint Center, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202 ()
| | | | | | | | - George W. Divine
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | | | - Stephanie Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | | | - Terrence R. Lock
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
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Ackland DC, Keynejad F, Pandy MG. Future trends in the use of X-ray fluoroscopy for the measurement and modelling of joint motion. Proc Inst Mech Eng H 2011; 225:1136-48. [DOI: 10.1177/0954411911422840] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Knowledge of three-dimensional skeletal kinematics during functional activities such as walking, is required for accurate modelling of joint motion and loading, and is important in identifying the effects of injury and disease. For example, accurate measurement of joint kinematics is essential in understanding the pathogenesis of osteoarthritis and its symptoms and for developing strategies to alleviate joint pain. Bi-plane X-ray fluoroscopy has the capacity to accurately and non-invasively measure human joint motion in vivo. Joint kinematics obtained using bi-plane X-ray fluoroscopy will aid in the development of more complex musculoskeletal models, which may be used to assess joint function and disease and plan surgical interventions and post-operative rehabilitation strategies. At present, however, commercial C-arm systems constrain the motion of the subject within the imaging field of view, thus precluding recording of motions such as overground gait. These fluoroscopy systems also operate at low frame rates and therefore cannot accurately capture high-speed joint motion during tasks such as running and throwing. In the future, bi-plane fluoroscopy systems may include computer-controlled tracking for the measurement of joint kinematics over entire cycles of overground gait without constraining motion of the subject. High-speed cameras will facilitate measurement of high-impulse joint motions, and computationally efficient pose-estimation software may provide a fast and fully automated process for quantification of natural joint motion.
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Affiliation(s)
- D C Ackland
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - F Keynejad
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
| | - M G Pandy
- Department of Mechanical Engineering, University of Melbourne, Melbourne, Australia
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Kaptein BL, Shelburne KB, Torry MR, Erik Giphart J. A comparison of calibration methods for stereo fluoroscopic imaging systems. J Biomech 2011; 44:2511-5. [DOI: 10.1016/j.jbiomech.2011.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 07/01/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
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Myers CA, Torry MR, Peterson DS, Shelburne KB, Giphart JE, Krong JP, Woo SLY, Steadman JR. Measurements of tibiofemoral kinematics during soft and stiff drop landings using biplane fluoroscopy. Am J Sports Med 2011; 39:1714-22. [PMID: 21602566 PMCID: PMC4167636 DOI: 10.1177/0363546511404922] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous laboratory studies of landing have defined landing techniques in terms of soft or stiff landings according to the degree of maximal knee flexion angle attained during the landing phase and the relative magnitude of the ground-reaction force. Current anterior cruciate ligament injury prevention programs are instructing athletes to land softly to avoid excessive strain on the anterior cruciate ligament. PURPOSE This study was undertaken to measure, describe, and compare tibiofemoral rotations and translations of soft and stiff landings in healthy individuals using biplane fluoroscopy. STUDY DESIGN Controlled laboratory study. METHODS The in vivo, lower extremity, 3-dimensional knee kinematics of 16 healthy adults (6 male and 10 female) instructed to land softly and stiffly in different trials were collected in biplane fluoroscopy as they performed the landing from a height of 40 cm. RESULTS Average and maximum relative anterior tibial translation (average, 2.8 ± 1.2 mm vs 3.0 ± 1.4 mm; maximum, 4.7 ± 1.6 mm vs 4.4 ± 0.8 mm), internal/external rotation (average, 3.7° ± 5.1° vs 2.7° ± 4.3°; maximum, 5.6° ± 5.5° vs 4.9° ± 4.7°), and varus/valgus (average, 0.2° ± 1.2° vs 0.2° ± 1.0°; maximum, 1.7° ± 1.2° vs 1.6° ± 0.9°) were all similar between soft and stiff landings, respectively. The peak vertical ground-reaction force was significantly larger for stiff landings than for soft landings (2.60 ± 1.32 body weight vs 1.63 ± 0.73; P < .001). The knee flexion angle total range of motion from the minimum angle at contact to the maximum angle at peak knee flexion was significantly greater for soft landings than for stiff (55.4° ± 8.8° vs 36.8° ± 11.1°; P < .01). CONCLUSION Stiff landings, as defined by significantly lower knee flexion angles and significantly greater peak ground-reaction forces, do not result in larger amounts of anterior tibial translation or knee rotation in either varus/valgus or internal/external rotation in healthy individuals. CLINICAL RELEVANCE In healthy knees, the musculature and soft tissues of the knee are able to maintain translations and rotations within a small, safe range during controlled landing tasks of differing demand. The knee kinematics of this healthy population will serve as a comparison for injured knees in future studies. It should be stressed that because the authors did not compare how the loads were distributed over the soft tissues of the knee between the 2 landing styles, the larger ground-reaction forces and more extended knee position observed during stiff landings should still be considered dangerous to the anterior cruciate ligament and other structures of the lower extremities, particularly in competitive settings where movements are often unanticipated.
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Affiliation(s)
- Casey A. Myers
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado.,Department of Mechanical and Materials Engineering, The University of Denver, Denver, Colorado
| | - Michael R. Torry
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado.,School of Kinesiology and Recreation, Illinois State University, Normal, Illinois
| | - Daniel S. Peterson
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado
| | - Kevin B. Shelburne
- Department of Mechanical and Materials Engineering, The University of Denver, Denver, Colorado
| | - J. Erik Giphart
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado
| | - Jacob P. Krong
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado
| | - Savio L-Y. Woo
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J. Richard Steadman
- Biomechanics Research Department, Steadman Philippon Research Institute, Vail, Colorado.,Address correspondence to J. Richard Steadman, MD, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657 ()
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Validation of a noninvasive technique to precisely measure in vivo three-dimensional cervical spine movement. Spine (Phila Pa 1976) 2011; 36:E393-400. [PMID: 21372650 PMCID: PMC3077907 DOI: 10.1097/brs.0b013e31820b7e2f] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo validation during functional loading. OBJECTIVE To determine the accuracy and repeatability of a model-based tracking technique that combines subject-specific computed tomographic (CT) models and high-speed biplane x-ray images to measure three-dimensional (3D) in vivo cervical spine motion. SUMMARY OF BACKGROUND DATA Accurate 3D spine motion is difficult to obtain in vivo during physiological loading because of the inability to directly attach measurement equipment to individual vertebrae. Previous measurement systems were limited by two-dimensional (2D) results and/or their need for manual identification of anatomical landmarks, precipitating unreliable and inaccurate results. All previous techniques lack the ability to capture true 3D motion during dynamic functional loading. METHODS Three subjects had 1.0-mm-diameter tantalum beads implanted into their fused and adjacent vertebrae during anterior cervical discectomy and fusion surgery. High-resolution CT scans were obtained after surgery and used to create subject-specific 3D models of each cervical vertebra. Biplane x-ray images were collected at 30 frames per second while the subjects performed flexion/extension and axial rotation movements 6 months after surgery. Individual bone motion, intervertebral kinematics, and arthrokinematics derived from dynamic radiostereophotogrammetric analysis served as a gold standard to evaluate the accuracy of the model-based tracking technique. RESULTS Individual bones were tracked with an average precision of 0.19 and 0.33 mm in nonfused and fused bones, respectively. Precision in measuring 3D joint kinematics in fused and adjacent segments averaged 0.4 mm for translations and 1.1° for rotations, while anterior and posterior disc height above and below the fusion were measured with a precision ranging between 0.2 and 0.4 mm. The variability in 3D joint kinematics associated with tracking the same trial repeatedly was 0.02 mm in translation and 0.06° in rotation. CONCLUSION The 3D cervical spine motion can be precisely measured in vivo with submillimeter accuracy during functional loading without the need for bead implantation. Fusion instrumentation did not diminish the accuracy of kinematic and arthrokinematic results. The semiautomated model-based tracking technique has excellent repeatability.
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185
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Massimini DF, Warner JJ, Li G. Non-invasive determination of coupled motion of the scapula and humerus—An in-vitro validation. J Biomech 2011; 44:408-12. [DOI: 10.1016/j.jbiomech.2010.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/10/2010] [Accepted: 10/07/2010] [Indexed: 11/26/2022]
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Martin DE, Greco NJ, Klatt BA, Wright VJ, Anderst WJ, Tashman S. Model-based tracking of the hip: implications for novel analyses of hip pathology. J Arthroplasty 2011; 26:88-97. [PMID: 20347253 DOI: 10.1016/j.arth.2009.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 12/03/2009] [Indexed: 02/01/2023] Open
Abstract
This study investigated the efficacy of a combined high-speed, biplane radiography and model-based tracking technique to study hip joint kinematics and arthrokinematics. Comparing model-based tracking to the gold standard of radiostereometric analysis using implanted metal beads, joint translation was measured with a bias of 0.2 mm and a precision of 0.3 mm, whereas joint rotation was measured with a bias of 0.2° and a precision of 0.8°. A novel measure of hip arthrokinematics characterizing the region of closest contact in the anterosuperior acetabulum was measured with a bias of 0.9% and a precision of 2.5%. Model-based tracking of the hip thus provides the opportunity to noninvasively study hip pathologic conditions such as osteoarthritis and femoroacetabular impingement with great accuracy.
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Affiliation(s)
- Daniel E Martin
- University of Pittsburgh Medical Center Department of Orthopedic Surgery, Pittsburgh, Pennsylvania, USA
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187
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Effect of posture on acromiohumeral distance with arm elevation in subjects with and without rotator cuff disease using ultrasonography. J Orthop Sports Phys Ther 2010; 40:633-40. [PMID: 20710092 DOI: 10.2519/jospt.2010.3155] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study. OBJECTIVES To examine the effects of altering posture on the subacromial space (SAS) in subjects with rotator cuff disease and subjects without shoulder pain. BACKGROUND Poor upper quadrant posture has been linked to altered scapular mechanics, which has been theorized to excessively reduce SAS. However, no study has examined the direct effects of altering upper quadrant posture on SAS. We hypothesized that upright posture would increase and slouched posture would decrease the SAS, as compared to a normal posture, when measured both with the shoulder at rest along the side of the trunk and when maintained in 45° of active shoulder abduction. METHODS Participants included 2 groups: the subjects with shoulder pain and rotator cuff disease, as diagnosed via magnetic resonance imaging (n = 31), and control subjects without shoulder pain (n = 29). The SAS was imaged with ultrasound using a 7.5-MHz linear transducer placed in the coronal plane over the posterior to midportion of the acromion. The SAS was measured on ultrasound images using the acromiohumeral distance (AHD), defined as the shortest distance between the acromion and the humerus. The AHD was measured in 2 trials at 2 arm angles (at rest along the trunk and at 45° of active abduction) and across 3 postures (normal, slouched, and upright), and averaged for data analysis. RESULTS Two mixed-model analyses of variance, 1 for each arm angle, were used to compare AHD across postures and between groups. There was no interaction between group and posture, and no significant main effect of group for either arm position. There was no significant main effect of posture for the arm at rest (P = .26); however, there was a significant main effect of posture on AHD at the 45° abduction arm angle (P = .0002), with a significantly greater AHD in upright posture (mean AHD, 9.8 mm), as compared to normal posture (mean AHD, 8.6 mm). CONCLUSION The effect of posture on SAS, as measured by the 2-dimensional AHD using ultrasound of the posterior to middle aspect of the SAS, is small. The AHD increased with upright posture by 1.2 mm compared to normal posture, when the arm was in 45° active abduction.
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188
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Gatesy SM, Baier DB, Jenkins FA, Dial KP. Scientific rotoscoping: a morphology-based method of 3-D motion analysis and visualization. ACTA ACUST UNITED AC 2010; 313:244-61. [PMID: 20084664 DOI: 10.1002/jez.588] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Three-dimensional skeletal movement is often impossible to accurately quantify from external markers. X-ray imaging more directly visualizes moving bones, but extracting 3-D kinematic data is notoriously difficult from a single perspective. Stereophotogrammetry is extremely powerful if bi-planar fluoroscopy is available, yet implantation of three radio-opaque markers in each segment of interest may be impractical. Herein we introduce scientific rotoscoping (SR), a new method of motion analysis that uses articulated bone models to simultaneously animate and quantify moving skeletons without markers. The three-step process is described using examples from our work on pigeon flight and alligator walking. First, the experimental scene is reconstructed in 3-D using commercial animation software so that frames of undistorted fluoroscopic and standard video can be viewed in their correct spatial context through calibrated virtual cameras. Second, polygonal models of relevant bones are created from CT or laser scans and rearticulated into a hierarchical marionette controlled by virtual joints. Third, the marionette is registered to video images by adjusting each of its degrees of freedom over a sequence of frames. SR outputs high-resolution 3-D kinematic data for multiple, unmarked bones and anatomically accurate animations that can be rendered from any perspective. Rather than generating moving stick figures abstracted from the coordinates of independent surface points, SR is a morphology-based method of motion analysis deeply rooted in osteological and arthrological data.
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Affiliation(s)
- Stephen M Gatesy
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island 02912, USA.
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189
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Brainerd EL, Baier DB, Gatesy SM, Hedrick TL, Metzger KA, Gilbert SL, Crisco JJ. X-ray reconstruction of moving morphology (XROMM): precision, accuracy and applications in comparative biomechanics research. ACTA ACUST UNITED AC 2010; 313:262-79. [PMID: 20095029 DOI: 10.1002/jez.589] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
X-Ray Reconstruction of Moving Morphology (XROMM) comprises a set of 3D X-ray motion analysis techniques that merge motion data from in vivo X-ray videos with skeletal morphology data from bone scans into precise and accurate animations of 3D bones moving in 3D space. XROMM methods include: (1) manual alignment (registration) of bone models to video sequences, i.e., Scientific Rotoscoping; (2) computer vision-based autoregistration of bone models to biplanar X-ray videos; and (3) marker-based registration of bone models to biplanar X-ray videos. Here, we describe a novel set of X-ray hardware, software, and workflows for marker-based XROMM. Refurbished C-arm fluoroscopes retrofitted with high-speed video cameras offer a relatively inexpensive X-ray hardware solution for comparative biomechanics research. Precision for our biplanar C-arm hardware and analysis software, measured as the standard deviation of pairwise distances between 1 mm tantalum markers embedded in rigid objects, was found to be +/-0.046 mm under optimal conditions and +/-0.084 mm under actual in vivo recording conditions. Mean error in measurement of a known distance between two beads was within the 0.01 mm fabrication tolerance of the test object, and mean absolute error was 0.037 mm. Animating 3D bone models from sets of marker positions (XROMM animation) makes it possible to study skeletal kinematics in the context of detailed bone morphology. The biplanar fluoroscopy hardware and computational methods described here should make XROMM an accessible and useful addition to the available technologies for studying the form, function, and evolution of vertebrate animals.
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Affiliation(s)
- Elizabeth L Brainerd
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island 02912, USA.
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190
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McDonald CP, Bachison CC, Chang V, Bartol SW, Bey MJ. Three-dimensional dynamic in vivo motion of the cervical spine: assessment of measurement accuracy and preliminary findings. Spine J 2010; 10:497-504. [PMID: 20359957 DOI: 10.1016/j.spinee.2010.02.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/18/2010] [Accepted: 02/18/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous research has quantified cervical spine motion with conventional measurement techniques (eg, cadaveric studies, motion capture systems, and fluoroscopy), but these techniques were not designed to accurately measure three-dimensional (3D) dynamic cervical spine motion under in vivo conditions. PURPOSE The purposes of this study were to characterize the accuracy of model-based tracking for measuring 3D dynamic cervical spine kinematics and to demonstrate its in vivo application. STUDY DESIGN Through accuracy assessment and application of technique, in vivo cervical spine motion was measured. METHODS The accuracy of model-based tracking for measuring cervical spine motion was determined in an in vitro experiment. Tantalum beads were implanted into the vertebrae of an ovine specimen, and biplane X-ray images were acquired as the specimen's neck was manually moved through neck extension and axial neck rotation. The 3D position and orientation of each cervical vertebra were determined from the biplane X-ray images using model-based tracking. For comparison, the position and orientation of each vertebra were also determined by tracking the position of the implanted beads with dynamic radiostereometric analysis. To demonstrate in vivo application of this technique, biplane X-ray images were acquired as a human subject performed two motion tasks: neck extension and axial neck rotation. The positions and orientations of each cervical vertebra were determined with model-based tracking. Cervical spine motion was reported with standard kinematic descriptions of translation and rotation. RESULTS The in vitro validation demonstrated that model-based tracking is accurate to within +/-0.6 mm and +/-0.6 degrees for measuring cervical spine motion. For the in vivo application, there were significant rotations about all three anatomical axes for both the neck extension and axial neck rotation motion tasks. CONCLUSIONS Model-based tracking is an accurate technique for measuring in vivo, 3D, dynamic cervical spine motion. Preliminary data acquired using this technique are in agreement with previous studies. It is anticipated that this experimental approach will enhance our understanding of cervical spine motion under normal and pathologic conditions.
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Affiliation(s)
- Colin P McDonald
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI 48202, USA.
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191
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Assessment of Internal and External Prosthesis Kinematics during Strenuous Activities Using Dynamic Roentgen Stereophotogrammetric Analysis. ACTA ACUST UNITED AC 2010. [DOI: 10.1097/jpo.0b013e3181cca7bb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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192
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San Juan JG, Karduna AR. Measuring humeral head translation using fluoroscopy: A validation study. J Biomech 2010; 43:771-4. [DOI: 10.1016/j.jbiomech.2009.10.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 10/13/2009] [Accepted: 10/16/2009] [Indexed: 10/20/2022]
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Scarvell JM, Pickering MR, Smith PN. New registration algorithm for determining 3D knee kinematics using CT and single-plane fluoroscopy with improved out-of-plane translation accuracy. J Orthop Res 2010; 28:334-40. [PMID: 19798739 DOI: 10.1002/jor.21003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To understand the kinematic effects of surgery, arthroplasty or conservative treatments, a noninvasive system to capture accurate 3D imaging of functional activities in prospective, controlled studies is required. To provide such a technique, a new algorithm was developed to register 3D CT data of normal bones to the same bones in a 2D fluoroscopy frame. The algorithm produces a digitally reconstructed radiograph (DRR) from the CT data and then filters this to produce an edge-enhanced image. The resulting image is then registered with an edge-enhanced version of the fluoroscopy frame using a new similarity measure called Cross-Correlation Residual Entropy (CCRE). The system was evaluated by implanting tantalum beads into three cadaveric knees to act as fiducial markers. The knees were flexed between 0 degrees and 70 degrees , and single-plane fluoroscopy data of the knees were acquired. CT data of the femur and tibia were then individually registered to the fluoroscopy images. No significant measurement bias was observed, and the standard deviation of the error in bead positions was 0.38 mm for in-plane translation and 0.42 degrees for rotation. To determine the accuracy of the registration algorithm for out-of-plane translations, fluoroscopy frames were scaled in size by fixed increments; the average standard deviation of the errors for out-of-plane translation was 0.65 mm. The ability to obtain such accurate 3D motion data from a noninvasive technique will enable prospective, longitudinal, and controlled studies of reconstruction surgery, and conservative management of joint pathologies.
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Affiliation(s)
- Jennifer M Scarvell
- Trauma and Orthopaedic Research Unit, Building 6, Level 1, Canberra Hospital, P.O. Box 11, Woden ACT 2606, Australia.
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194
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Kedgley AE, Dunning CE. An alternative definition of the scapular coordinate system for use with RSA. J Biomech 2010; 43:1527-31. [PMID: 20181341 DOI: 10.1016/j.jbiomech.2010.01.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/14/2010] [Accepted: 01/17/2010] [Indexed: 11/19/2022]
Abstract
When performing radiostereometric analysis (RSA), computed tomography scans are often taken to obtain the landmarks used to create anatomical coordinate systems (CSs) for quantifying joint kinematics. Different conventions for defining CSs lead to an inability to compare results among studies. The International Society of Biomechanics (ISB) has proposed a set of CSs; however, the landmarks needed to create the recommended scapular CS require the entire scapula to be scanned, thereby also exposing breast and other tissues to radiation. The main purpose of this work was to investigate an alternate definition of the CS that has repeatably attainable landmarks and axes as close as possible to those recommended by the ISB, while limiting the portion of the scapula requiring scanning. Intra- and inter-investigator variabilities of landmark digitization were quantified in one model of a scapula and one cadaveric specimen. Based on the variability of the digitizations, an alternative CS was defined. The differences between the ISB and alternative CSs were evaluated on 11 cadaveric specimens. Beaded biplanar RSA was performed on the glenohumeral joint model in 15 different configurations and the resulting kinematics were calculated for each set of landmark digitizations using both sets of coordinate systems. While the kinematic angles obtained using the alternative CS were statistically different from those obtained using the ISB standard, these differences were small (on the order of 5 degrees) and therefore considered to be of little clinical significance. In all likelihood, the benefits of decreasing radiation exposure outweigh these differences in angles.
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Affiliation(s)
- Angela E Kedgley
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
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195
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Scanlan SF, Chaudhari AMW, Dyrby CO, Andriacchi TP. Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees. J Biomech 2010; 43:1817-22. [PMID: 20181339 DOI: 10.1016/j.jbiomech.2010.02.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 02/05/2010] [Accepted: 02/09/2010] [Indexed: 11/26/2022]
Abstract
This study tested the hypotheses that in patients with a successful anterior cruciate ligament (ACL) reconstruction, the internal-external rotation, varus-valgus, and knee flexion position of reconstructed knees would be different from uninjured contralateral knees during walking. Twenty-six subjects with unilateral ACL reconstructions (avg 31 years, 1.7 m, 68 kg, 15 female, 24 months past reconstruction) and no other history of serious lower limb injury walked at a self-selected speed in the gait laboratory, with the uninjured contralateral knee as a matched control. Kinematic measurements of tibiofemoral motion were made using a previously-described point-cluster technique. Repeated-measures ANOVA (alpha=0.017) was used to compare ACL-reconstructed knees to their contralateral knees at four distinct points during the stance phase of walking. An offset towards external tibial rotation in ACL-reconstructed knees was maintained over all time points (95%CI 2.3+/-1.3 degrees ). Twenty-two out of twenty-six individuals experienced an average external tibial rotation offset throughout stance phase. Varus-valgus rotation and knee flexion were not significantly different between reconstructed and contralateral knees. These findings show that differences in tibial rotation during walking exist in ACL reconstructed knees compared to healthy contralateral knees, providing a potential explanation why these patients are at higher risk of knee osteoarthritis in the long-term.
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Affiliation(s)
- Sean F Scanlan
- Biomechanical Engineering, Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
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196
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Bey MJ, Kline SK, Zauel R, Kolowich PA, Lock TR. In Vivo Measurement of Glenohumeral Joint Contact Patterns. EURASIP JOURNAL ON ADVANCES IN SIGNAL PROCESSING 2010; 2010:162136. [PMID: 21546990 PMCID: PMC3086287 DOI: 10.1155/2010/162136] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics.
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Affiliation(s)
- Michael J Bey
- Department of Orthopaedic Surgery, Bone and Joint Center, Henry Ford Hospital, 2799 W. Grand Blvd., E&R 2015, Detroit, MI 48202, USA
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197
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Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 2009; 25:1240-8. [PMID: 19896045 DOI: 10.1016/j.arthro.2009.06.007] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to (1) assess the inter-rater reliability and validity of 2 clinical assessment methods of categorizing scapular dyskinesis and (2) quantify the frequency of asymmetry of bilateral scapular motion in injured and uninjured shoulders by use of 3-dimensional (3D) kinematic analysis. METHODS We evaluated 56 subjects, 35 with shoulder injury and 21 with no symptoms. Two blinded evaluators categorized the scapular motion of all subjects to determine inter-rater reliability using 2 observational methods ("yes/no" and "4 type") to evaluate scapular dyskinesis. Subjects were also instrumented with electromagnetic receivers to assess bilateral 3D scapular kinematics to determine the presence of dyskinesis and establish criterion validity of the 2 methods. RESULTS The inter-rater percent agreement and the degree of this agreement as measured by kappa statistic showed that the yes/no method produced a higher inter-rater percent agreement (79%, kappa = 0.40) than the 4-type method (61%, kappa = 0.44). The yes/no method had a higher sensitivity (76%) and positive predictive value (74%) when compared with the 3D criterion. A chi(2) analysis found significantly more multiple-plane asymmetries in symptomatic subjects (54%) in flexion compared with asymptomatic subjects (14%) (P = .002). CONCLUSIONS The yes/no method allows multiple-plane asymmetries to be considered in clinical assessment and therefore renders this a good screening tool for the presence of scapular dyskinesis. Kinematic analysis shows that asymmetries are common in symptomatic and asymptomatic populations. Testing in flexion showed a higher frequency of multiple-plane scapular asymmetries in the symptomatic group. CLINICAL RELEVANCE Identification of scapular dyskinesis is a key component of the shoulder examination. The clinician's ability to establish the presence or absence of scapular dyskinesis by observation is enhanced using a simple yes/no method especially when testing subjects in shoulder forward flexion. Although scapular asymmetries appear to be a prevalent finding, dyskinesis in the presence of shoulder symptoms should be considered a potential factor contributing to the dysfunction in the presence of shoulder symptoms should be considered a potential factor contributing to the dysfunction.
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Affiliation(s)
- Tim L Uhl
- Division of Athletic Training, University of Kentucky, Lexington, Kentucky 40536, USA.
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198
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Shoulder bony landmarks location using the EOS® low-dose stereoradiography system: a reproducibility study. Surg Radiol Anat 2009; 32:153-8. [DOI: 10.1007/s00276-009-0566-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/19/2009] [Indexed: 10/20/2022]
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199
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Fregly BJ. Design of Optimal Treatments for Neuromusculoskeletal Disorders using Patient-Specific Multibody Dynamic Models. INTERNATIONAL JOURNAL FOR COMPUTATIONAL VISION AND BIOMECHANICS 2009; 2:145-155. [PMID: 21785529 PMCID: PMC3141573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Disorders of the human neuromusculoskeletal system such as osteoarthritis, stroke, cerebral palsy, and paraplegia significantly affect mobility and result in a decreased quality of life. Surgical and rehabilitation treatment planning for these disorders is based primarily on static anatomic measurements and dynamic functional measurements filtered through clinical experience. While this subjective treatment planning approach works well in many cases, it does not predict accurate functional outcome in many others. This paper presents a vision for how patient-specific multibody dynamic models can serve as the foundation for an objective treatment planning approach that identifies optimal treatments and treatment parameters on an individual patient basis. First, a computational paradigm is presented for constructing patient-specific multibody dynamic models. This paradigm involves a combination of patient-specific skeletal models, muscle-tendon models, neural control models, and articular contact models, with the complexity of the complete model being dictated by the requirements of the clinical problem being addressed. Next, three clinical applications are presented to illustrate how such models could be used in the treatment design process. One application involves the design of patient-specific gait modification strategies for knee osteoarthritis rehabilitation, a second involves the selection of optimal patient-specific surgical parameters for a particular knee osteoarthritis surgery, and the third involves the design of patient-specific muscle stimulation patterns for stroke rehabilitation. The paper concludes by discussing important challenges that need to be overcome to turn this vision into reality.
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Affiliation(s)
- Benjamin J Fregly
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL
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200
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Accuracy of a CT-based bone contour registration method to measure relative bone motions in the hindfoot. J Biomech 2009; 42:686-91. [DOI: 10.1016/j.jbiomech.2009.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 01/08/2009] [Accepted: 01/10/2009] [Indexed: 12/26/2022]
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