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Berumen-Nafarrate E, Ramos-Moctezuma IR, Sigala-González LR, Quintana-Trejo FN, Tonche-Ramos JJ, Portillo-Ortiz NK, Cañedo-Figueroa CE, Aguirre-Madrid A. Mobile App for Enhanced Anterior Cruciate Ligament (ACL) Assessment in Conscious Subjects: "Pivot-Shift Meter". J Pers Med 2024; 14:651. [PMID: 38929873 PMCID: PMC11204776 DOI: 10.3390/jpm14060651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by introducing a machine learning classification algorithm integrated into a mobile application, leveraging smartphones' built-in inertial sensors for dynamic rotational stability assessment during knee examinations. Orthopedic specialists conducted knee evaluations on a cohort of 52 subjects, yielding valuable insights. Quantitative analyses, employing the Intraclass Correlation Coefficient (ICC), demonstrated robust agreement in both intraobserver and interobserver assessments. Specifically, ICC values of 0.94 reflected strong concordance in the timing between maneuvers, while signal amplitude exhibited consistency, with the ICC ranging from 0.71 to 0.66. The introduced machine learning algorithms proved effective, accurately classifying 90% of cases exhibiting joint hypermobility. These quantifiable results underscore the algorithm's reliability in assessing knee stability. This study emphasizes the practicality and effectiveness of implementing machine learning algorithms within a mobile application, showcasing its potential as a valuable tool for categorizing signals captured by smartphone inertial sensors during the pivot-shift test.
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Affiliation(s)
- Edmundo Berumen-Nafarrate
- Star Medica Chihuahua Hospital, Perif. de la Juventud 6103, Fracc. El Saucito, Chihuahua 31110, Mexico
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Ivan Rene Ramos-Moctezuma
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Luis Raúl Sigala-González
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Fatima Norely Quintana-Trejo
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Jesus Javier Tonche-Ramos
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Nadia Karina Portillo-Ortiz
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Carlos Eduardo Cañedo-Figueroa
- Faculty of Medicine and Biomedical Sciences, University Autonomous of Chihuahua (UACH), Chihuahua 31110, Mexico; (I.R.R.-M.); (L.R.S.-G.); (F.N.Q.-T.); (J.J.T.-R.); (N.K.P.-O.); (C.E.C.-F.)
| | - Arturo Aguirre-Madrid
- Department of Orthopedic Surgery, Star Medica Chihuahua Hospital, Perif. de la Juventud 6103, Fracc. El Saucito, Chihuahua 31110, Mexico;
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Martinez-Cano JP, Familiari F, Vinagre G, Moatshe G, Gomez-Sierra MA, Marín Fermín T. Instrument-based anterolateral rotatory laxity assessment of the knee has a high intra-observer and inter-observer reliability: a systematic review. J ISAKOS 2024; 9:221-226. [PMID: 37495018 DOI: 10.1016/j.jisako.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
IMPORTANCE A reliable evaluation of anterolateral rotatory instability in the anterior cruciate ligament (ACL) deficient knee is important to help surgeons determine which patients might need concurrent anterolateral augmentation procedures. OBJECTIVE The purpose of this study was to systematically review studies that assess the intra-observer and inter-observer reliability of instruments used to measure anterolateral rotatory laxity of the knee. EVIDENCE REVIEW A comprehensive literature review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, using PubMed, Embase, Scopus, and Google Scholar databases for original, English-language studies evaluating the reliability of objective or instrument-based anterolateral rotatory laxity of the knee until October 31, 2022. Reliability data were extracted from text, tables, and figures. FINDINGS Twelve studies, with patients between the ages of 14-63 years, were included. The instruments used to measure anterolateral rotatory knee laxity included inertial sensors (n = 9), magnetic resonance imaging (n = 1), and navigation systems (n = 2). The global intra-observer intraclass correlation coefficient for these devices was between 0.63 and 0.97, and the global inter-observer reliability was between 0.63 and 0.99. CONCLUSION AND RELEVANCE Instrument-based anterolateral rotatory knee laxity assessment has moderate to good intra- and inter-observer reliability. Evaluating anterolateral instability in ACL-deficient knees with these devices could help in decision-making when considering anterolateral augmentation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Juan Pablo Martinez-Cano
- Departamento de Ortopedia, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali 760032, Colombia; Universidad Icesi, Calle 18 No. 122-135, Cali 760031, Colombia.
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy.
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery and Traumatology, Complexo Hospitalar do Médio Ave, Porto 4761-917, Portugal; Department of Orthopaedic Surgery and Traumatology, Hospital Lusíadas, Porto 4050-115, Portugal.
| | - Gilbert Moatshe
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo 0806, Norway; Orthopaedic Clinic, Oslo University Hospital and University of Oslo, Oslo 0369, Norway.
| | - Maria Antonia Gomez-Sierra
- Departamento de Ortopedia, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali 760032, Colombia; Universidad Icesi, Calle 18 No. 122-135, Cali 760031, Colombia
| | - Theodorakys Marín Fermín
- Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, 29222, Doha, Qatar.
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Dadoo S, Ozbek EA, Nukuto K, Runer A, Keeling LE, Grandberg C, Kuroda R, Zaffagnini S, Karlsson J, Hughes JD, Irrgang JJ, Musahl V. What it takes to have a high-grade pivot shift-focus on bony morphology. Knee Surg Sports Traumatol Arthrosc 2023; 31:4080-4089. [PMID: 37410122 DOI: 10.1007/s00167-023-07472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury. METHODS All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs. RESULTS Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s2 (range: 4.9-52.0 m/s2). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = - 0.29, p = 0.041), lateral tibial plateau (r = - 0.28, p = 0.042), and lateral femoral condyle (r = - 0.29, p = 0.037), and a decreased LTAD (r = - 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s2 for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury. CONCLUSION Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Emre Anil Ozbek
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopedic Surgery and Traumatology, University of Ankara, Ankara, Turkey
| | - Koji Nukuto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Armin Runer
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Laura E Keeling
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Camila Grandberg
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica, Istituto Orthopedico Rizzoli, Bologna, Italy
| | - Jon Karlsson
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonathan D Hughes
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - James J Irrgang
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Keitsch M, Reiter A, Strahl A, Frosch KH, Berger-Groch J, Priemel M. Apps in Clinical Practice: Usage Behaviour of Trauma Surgeons and Radiologists in Northern Germany. Int J Telemed Appl 2023; 2023:3930820. [PMID: 37564895 PMCID: PMC10412380 DOI: 10.1155/2023/3930820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Apps, in general, are an integral part of our daily lives. To investigate the current usage behaviour of trauma surgeons and radiologists regarding medical apps in clinical practice and to find out if and how the current range of medical apps can be improved, we surveyed trauma surgeons and radiologists in northern Germany. Material and Methods. An online questionnaire was sent to 100 trauma surgeons and 100 radiologists in northern Germany. Participants were asked about the frequency of their use of medical apps in clinical practice, which apps were used most often, how useful participants thought apps were, and in which area they would like to see improvements. The most frequently mentioned apps were finally analyzed. Results The survey study showed that 87.4% of the trauma surgeons and 67.4% of the radiologists use medical apps on a regular basis at work. It also revealed that trauma surgeons used medical apps much more often than radiologists and that young doctors were more likely to rely on medical apps than chief physicians. 80.0% of the participants would pay at least 5 euros for a medical app. Trauma surgeons see the greatest need for support in their daily work from medical apps in the area of treatment, while radiologists seek more support in the area of classification. Conclusion The study underscored the broad acceptance of medical apps in everyday clinical practice. As the physicians are willing to spend money and stated a general interest and need for further developments, there is high potential for the future. This trial is registered with DRKS00026766.
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Affiliation(s)
- Marie Keitsch
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
- Department of Trauma Surgery and Orthopeadics, Pediatric Orthopeadics, Agaplesion Diakonieklinikum Rotenburg, Elise-Averdieck-Str. 17, 27356 Rotenburg (Wümme), Germany
| | - Alonja Reiter
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
| | - André Strahl
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
- Department of Trauma Surgery, Orthopeadics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany
| | - Josephine Berger-Groch
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
- Department of Trauma and Orthopeadic Surgery, Katharinenhospital Klinikum Stuttgart, Kriegsbergstr. 60 70714 Stuttgart, Germany
| | - Matthias Priemel
- Department of Trauma and Orthopeadic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52 20246 Hamburg, Germany
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Soudé G, De Villeneuve Bargemon JB, Khakha R, Pithioux M, Argenson JN, Ollivier M, Jacquet C. Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees. J Exp Orthop 2023; 10:6. [PMID: 36695976 PMCID: PMC9877253 DOI: 10.1186/s40634-023-00570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient-knees. Because of the high inter-observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. METHODS Twelve ACL-injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). RESULTS The intra-observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter-observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. CONCLUSION The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. LEVEL OF EVIDENCE Level IV, case series, pilot study.
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Affiliation(s)
- Guillaume Soudé
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Jean-Baptiste De Villeneuve Bargemon
- Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France ,International Wrist Center, Bizet Clinic, Paris, France
| | - Raghbir Khakha
- grid.420545.20000 0004 0489 3985Guys and St Thomas Hospitals, London, UK
| | - Martine Pithioux
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Jean-Noël Argenson
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Matthieu Ollivier
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Christophe Jacquet
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
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Gibbs CM, Hughes JD, Popchak AJ, Chiba D, Winkler PW, Lesniak BP, Anderst WJ, Musahl V. Preoperative quantitative pivot shift does not correlate with in vivo kinematics following ACL reconstruction with or without lateral extraarticular tenodesis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07232-8. [PMID: 36394585 DOI: 10.1007/s00167-022-07232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Quantitative pivot shift (QPS) testing using PIVOT technology can detect high- and low-grade rotatory knee instability following anterior cruciate ligament injury or reconstruction (ACLR). The aim of this project was to determine if preoperative QPS correlates with postoperative knee kinematics in the operative and contralateral, healthy extremity following ACLR with or without lateral extraarticular tenodesis (LET) using a highly precise in vivo analysis system. A positive correlation between preoperative QPS and postoperative tibial translation and rotation following ACLR with or without LET in the operative and healthy, contralateral extremity was hypothesized. METHODS Twenty patients with ACL injury and high-grade rotatory knee instability were randomized to undergo anatomic ACLR with or without LET as part of a prospective randomized trial. At 6 and 12 months postoperatively, in vivo kinematic data were collected using dynamic biplanar radiography superimposed with high-resolution computed tomography scans of patients' knees during downhill running. Total anterior-posterior (AP) tibial translation and internal-external tibial rotation were measured during the gait cycle. Spearman's rho was calculated for preoperative QPS and postoperative kinematics. RESULTS In the contralateral, healthy extremity, a significant positive correlation was seen between preoperative QPS and total AP tibial translation at 12 months postoperatively (rs = 0.6, p < 0.05). There were no additional significant correlations observed between preoperative QPS and postoperative knee kinematics at 6 and 12 months postoperatively in the operative and contralateral, healthy extremity for combined isolated ACLR and ACLR with LET patients as well as isolated ACLR patients or ACLR with LET patients analyzed separately. DISCUSSION The main finding of this study was that there was a significant positive correlation between preoperative QPS and total AP tibial translation at 12 months postoperatively in the contralateral, healthy extremity. There were no significant correlations between preoperative QPS and postoperative in vivo kinematics at 6 and 12 months following ACLR with or without LET. This suggests that QPS as measured with PIVOT technology does correlate with healthy in vivo knee kinematics, but QPS does not correlate with in vivo kinematics following ACLR with or without LET.
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Affiliation(s)
- Christopher M Gibbs
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.
| | - Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daisuke Chiba
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Philipp W Winkler
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA.,Department for Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Bryson P Lesniak
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
| | - William J Anderst
- Biodynamics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave #1010, Pittsburgh, PA, USA
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The Use of Mobile Applications for the Diagnosis and Treatment of Tumors in Orthopaedic Oncology - a Systematic Review. J Med Syst 2021; 45:99. [PMID: 34628540 PMCID: PMC8502123 DOI: 10.1007/s10916-021-01774-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022]
Abstract
The use of smartphone apps is an essential part of everyday life. Mobile applications offer enormous opportunities for dealing with challenges in public health, and their number increases every day. This paper aims to review the existing literature on mobile applications in orthopaedic oncology and to summarize the current mobile applications for musculoskeletal tumors. A systematic literature review was conducted regarding articles on mobile applications in orthopaedic and trauma surgery. The focus was on identifying mobile applications that can be used in the treatment of patients with musculoskeletal tumors. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality. In addition, the Apple App Store and Google Play Store were searched for suitable mobile applications. Ninety-one articles describing a mobile application in orthopaedic and trauma surgery were identified. Three articles focused on a mobile application for musculoskeletal tumors. Additionally, seven mobile applications were available in the App/Play Stores dealing with bone or soft tissue tumors in orthopaedic oncology without corresponding scientific articles. Increasing numbers of mobile applications are being developed in orthopaedic and trauma surgery. Currently, only three scientific articles on mobile applications in orthopaedic oncology are present, yet several more applications are available without scientific medical evaluation. Since mobile applications can facilitate the everyday life of orthopaedic and trauma surgeons, it is worthwhile to be aware of new developments in this field. A regular scientific evaluation of the subject is important in order to classify the significance of these applications.
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Jacquet C, Pioger C, Seil R, Khakha R, Parratte S, Steltzlen C, Argenson JN, Pujol N, Ollivier M. Incidence and Risk Factors for Residual High-Grade Pivot Shift After ACL Reconstruction With or Without a Lateral Extra-articular Tenodesis. Orthop J Sports Med 2021; 9:23259671211003590. [PMID: 33997078 PMCID: PMC8113945 DOI: 10.1177/23259671211003590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background Residual rotatory knee laxity at midterm follow-up after isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR with lateral extra-articular tenodesis (LET) remains an issue. Purpose/Hypothesis To evaluate the outcomes of ACLR with or without additional LET at a minimum 2-year follow-up in patients with preoperative high-grade pivot shift (PS). Our hypothesis was that the addition of LET would decrease the risk of secondary meniscal injury and the presence of residual high-grade PS at follow-up. Study Design Cohort study; Level of evidence, 3. Methods A retrospective analysis performed at 3 sports medicine centers identified 266 study patients; all had a high-grade PS (grade 2 or 3) preoperatively and underwent isolated ACLR with or without LET. Four different ACLR techniques were used: single-strand quadrupled semitendinosus (ST4) ACLR without LET (ST4 group; n = 55), ST4 with anatomic LET (ST4+LET group; n = 77), bone-patellar tendon and modified Lemaire LET (BTB+LET group; n = 43), and quadriceps tendon and modified Lemaire LET (QT+LET group; n = 91). At follow-up, we evaluated for the presence of high-grade (grade ≥2) PS. Preoperative meniscal tears and their treatment were recorded. Results Overall, 185 (69.5%) patients had at least 1 meniscal tear at index surgery. The mean follow-up period was 44.3 months; 47 (17.7%) patients had a new meniscal tear and 64 (24%) patients had a high-grade PS at follow-up. Compared with meniscal repair, significant predictors for high-grade PS at follow-up were meniscectomy (odds ratio [OR] = 2.65 [95% CI, 1.19-5.63]; P = .02) and nonrepair of preoperative meniscal tear (OR = 3.26 [95% CI, 1.27-9.43]; P = .007). The appearance of a new symptomatic meniscal tear was the strongest significant predictor of high-grade PS at follow-up (OR = 4.31 [95% CI, 2.31-8.06]; P < .001). No significant correlation was observed between the addition of LET and the presence of high-grade PS at follow-up. Conclusion In the current study, 1 in 4 patients with high-grade PS before ACLR with or without LET was at risk of residual rotatory knee laxity at mean 44-month follow-up, regardless of the technique used. Repairing a pre-existing meniscal lesion was more effective than performing LET to decrease the presence of a high-grade PS at follow-up.
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Affiliation(s)
- Christophe Jacquet
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Charles Pioger
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Romain Seil
- Orthopaedic Department, CH Luxembourg, Luxembourg
| | - Raghbir Khakha
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | | | - Camille Steltzlen
- Orthopaedic Department CH Mignot, rue de Versailles, Le Chesnay, France
| | - Jean-Noel Argenson
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Nicolas Pujol
- Orthopaedic Department CH Mignot, rue de Versailles, Le Chesnay, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
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9
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Kim JE, Kim DH, Lee JI, Choi HG, Jung YS, Lee SH, Lee YS. Difference of preoperative varus-valgus stress radiograph is effective for the correction accuracy in the preoperative planning during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:1035-1044. [PMID: 32462268 DOI: 10.1007/s00167-020-06076-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to evaluate (1) the efficacy of varus-valgus stress radiographs to adjust the preoperative soft-tissue imbalance and (2) ascertain whether varus-valgus stress radiographs are effective for the correction accuracy in the preoperative planning of the opening wedge high tibial osteotomy (OWHTO). METHODS From February 2017 to December 2018, a total of 121 consecutive knees that underwent bi-planar OWHTO were enrolled in this retrospective analysis. Preoperative planning was performed using a weight-bearing line (WBL). Target WBL was determined according to the status of the medial compartments such as cartilage, meniscus, and preoperative arthritic grade. Preoperative varus-valgus stress radiographs were used to assess the preoperative mediolateral ligament imbalance. The final target correction length of the opening gap was determined by subtracting the difference between the varus-valgus stress radiographs (VVD). All patients were divided into two groups according to the preoperatively planned correction degree: (group A), smaller than average; (group B), larger than average. Patients were also divided into two other groups (VVD adjusted and neglected groups). RESULTS Groups A and B were 56 and 54 knees, respectively. The preoperatively planned correction lengths of the opening gap were 9.33 ± 1.5 and 14.16 ± 3.96 mm, respectively (p < 0.01). Mean values of the VVD were 0.85 ± 0.72, and 1.27 ± 1.78 mm, respectively (p < 0.01). Correction errors were 2.17 ± 2.06 and 3.52 ± 2.16%, respectively (p < 0.01). Planned and final correction degrees were also significantly larger (p < 0.01, and p < 0.01, respectively), because the preoperative WBL ratio was significantly smaller in the VVD adjusted group (p < 0.01). CONCLUSION The VVD values could reproduce the preoperative soft-tissue imbalance and it was more prominent as the correction degree increased. The strategy of subtracting the VVD as assumed soft-tissue imbalance in the preoperative planning worked well for the correction accuracy during OWHTO. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- Ji Eui Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Jae Ik Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Han Gyeol Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - You Sun Jung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sang Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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10
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Napier RJ, Feller JA, Devitt BM, McClelland JA, Webster KE, Thrush CSJ, Whitehead TS. Is the KiRA Device Useful in Quantifying the Pivot Shift in Anterior Cruciate Ligament-Deficient Knees? Orthop J Sports Med 2021; 9:2325967120977869. [PMID: 33553458 PMCID: PMC7841684 DOI: 10.1177/2325967120977869] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Various technologies have been developed to quantify the pivot shift, as it is regarded as a key indicator of anterolateral rotatory laxity of the knee. Purpose: To determine the usefulness of a commercially available triaxial accelerometer (Kinematic Rapid Assessment [KiRA]) in numerically quantifying the pivot shift in patients under anesthesia with an anterior cruciate ligament (ACL)–deficient knee. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Both knees of 50 patients (26 male [mean age, 30.4 years], 24 female [mean age, 26.6 years]) under anesthesia were assessed immediately before unilateral ACL reconstruction by an orthopaedic fellow and 1 of 3 experienced knee surgeons. The pivot-shift grade and 2 KiRA outputs (range of acceleration and slope of acceleration change) were compared. Results: The surgeon and fellow recorded the same pivot-shift grade for 45 of 50 patients (90%). Data from the 5 patients with no agreement and 1 patient with extreme outlying data were excluded from subsequent analysis. Using the KiRA range and slope data, the surgeon identified the injured knee in 74% and 76% of patients, respectively, while the fellow’s rate of injured knee identification was 74% and 80%, respectively. A correlation could be found only between pivot-shift grade and surgeon-derived range data (ρ = 0.40; P < .01) but not slope data or any fellow-derived outputs. Using the surgeon-derived range data, there was a significant difference between a grade 3 pivot (>5 m/s2) and a grade 1 or 2 pivot (<5 m/s2) (P = .01). Conclusion: Although a correlation between KiRA output data and pivot-shift grade was found when the device was used by an experienced surgeon, there was no correlation when used by a well-trained but less experienced orthopaedic fellow. Furthermore, the KiRA output data identified the ACL-deficient knee correctly in only 74% of patients. Although a threshold acceleration range value could be identified, above which the value was associated with a grade 3 pivot shift, this was dependent on the examiner, and distinction between other grades could not be made.
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Affiliation(s)
- Richard J Napier
- Orthopaedic Research Unit, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Brian M Devitt
- OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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