1
|
Horsak B, Durstberger S, Krondorfer P, Thajer A, Greber-Platzer S, Kranzl A. Which method should we use to determine the hip joint center location in individuals with a high amount of soft tissue? Clin Biomech (Bristol, Avon) 2024; 115:106254. [PMID: 38669918 DOI: 10.1016/j.clinbiomech.2024.106254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This study investigated the most accurate method for estimating the hip joint center position in clinical 3D gait analysis for young individuals with high amounts of soft tissue. We compared position estimates of five regression-based and two functional methods to the hip joint center position obtained through 3D free-hand ultrasound. METHODS For this purpose, the data of 14 overweight or obese individuals with a mean age of 13.6 (SD 2.1 yrs) and a BMI of 36.5 (SD 7.1 kg/m2, range 26-52 kg/m2) who underwent standard clinical 3D gait analysis were used. The data of each participant were processed with five regression-based and two functional methods and compared to the hip joint center identified via 3D free-hand ultrasound. FINDINGS The absolute location errors to 3D free-hand ultrasound for each anatomical plane and the Euclidean distances served as outcomes next to their effects on gait variables. The data suggest that regression-based methods are preferable to functional methods in this population, as the latter demonstrated the highest variability in accuracy with large errors for some individuals. INTERPRETATION Based on our findings we recommend using the regression method presented by Hara et al. due to its superior overall accuracy of <9 mm on average in all planes and the lowest impact on kinematic and kinetic output variables. We do not recommend using the Harrington equations (single and multiple) in populations with high amounts of soft tissue as they require pelvic depth as input, which can be massively biased when a lot of soft tissue is present around the pelvis.
Collapse
Affiliation(s)
- Brian Horsak
- Center for Digital Health and Social Innovation, St. Pölten University of Applied Sciences, Campus-Platz 1, St. Pölten 3100, Austria; Institute of Health Sciences, St. Pölten University of Applied Sciences, Campus-Platz 1, St. Pölten 3100, Austria.
| | - Sebastian Durstberger
- FH Campus Wien - University of Applied Sciences, Department Health Sciences, Favoritenstrasse 226, 1100 Vienna, Austria; Orthopaedic Hospital Speising, Laboratory of Gait and Movement Analysis, Speisinger Str. 109, Vienna 1130, Austria
| | - Philipp Krondorfer
- Center for Digital Health and Social Innovation, St. Pölten University of Applied Sciences, Campus-Platz 1, St. Pölten 3100, Austria
| | - Alexandra Thajer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Guertel 18-20, Vienna 1090, Austria
| | - Susanne Greber-Platzer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Guertel 18-20, Vienna 1090, Austria
| | - Andreas Kranzl
- Orthopaedic Hospital Speising, Laboratory of Gait and Movement Analysis, Speisinger Str. 109, Vienna 1130, Austria
| |
Collapse
|
2
|
Dranetz J, Chen S, Choi H. Impact of model geometry and joint center locations on inverse kinematic/dynamic predictions: A comparative study of sexually dimorphic models. J Biomech 2024; 169:112147. [PMID: 38768542 DOI: 10.1016/j.jbiomech.2024.112147] [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: 11/06/2023] [Revised: 03/14/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
This work illustrates the sensitivity of demographically characteristic body segment inertial properties and subject-specific customization on model performance. One characteristic demographic, gender, and one subject-specific characteristic, hip joint center location, were represented with musculoskeletal modeling to evaluate how design decisions may alter model outputs. Generic sexually dimorphic musculoskeletal models were developed from the commonly used Rajagopal model using male and female data adapted by Dumas et al. Hip joint centers of these models were adjusted based on functional joint center testing. The kinematics and dynamics of 40 gait cycles from four subjects are predicted using these models. Two-way analysis of variance (ANOVA) was performed on the continuous time series data using statistical parametric mapping (SPM) to assess changes in kinematics/dynamics due to either choice in model (Rajagopal vs Dumas) or whether joint center adjustment was performed. The SPM based two-way ANOVA of the inverse dynamics found that differences in the Rajagopal and Dumas models resulted in significant differences in sagittal plane moments during swing (0.115 ± 0.032 Nm/kg difference in mean hip flexion moment during initial swing and a 0.077 ± 0.041 Nm/kg difference in mean hip extension moment during terminal swing), and differences between the models with and without hip joint center adjustment resulted in significant differences in hip flexion and abduction moments during stance (0.217 ± 0.055 Nm/kg increased mean hip abductive moment). By comparing the outputs of these differently constructed models with each other, the study finds that dynamic predictions of stance are sensitive to positioning of joint centers, and dynamic predictions of swing are more sensitive to segment mass/inertial properties.
Collapse
Affiliation(s)
- Joseph Dranetz
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, United States.
| | - Shuo Chen
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, United States.
| | - Hwan Choi
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, United States.
| |
Collapse
|
3
|
Martinez L, Lalevée M, Poirier T, Brunel H, Matsoukis J, Van Driessche S, Billuart F. Influence of Skin Marker Positioning and Their Combinations on Hip Joint Center Estimation Using the Functional Method. Bioengineering (Basel) 2024; 11:297. [PMID: 38534571 DOI: 10.3390/bioengineering11030297] [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: 02/12/2024] [Revised: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
Accurate estimation of hip joint center (HJC) position is crucial during gait analysis. HJC is obtained with predictive or functional methods. But in the functional method, there is no consensus on where to place the skin markers and which combination to use. The objective of this study was to analyze how different combinations of skin markers affect the estimation of HJC position relative to predictive methods. Forty-one healthy volunteers were included in this study; thirteen markers were placed on the pelvis and hip of each subject's lower limbs. Various marker combinations were used to determine the HJC position based on ten calibration movement trials, captured by a motion capture system. The estimated HJC position for each combination was evaluated by focusing on the range and standard deviation of the mean norm values of HJC and the mean X, Y, Z coordinates of HJC for each limb. The combinations that produced the best estimates incorporated the markers on the pelvis and on proximal and easily identifiable muscles, with results close to predictive methods. The combination that excluded the markers on the pelvis was not robust in estimating the HJC position.
Collapse
Affiliation(s)
- Lucas Martinez
- Unité de Recherche ERPHAN, UR 20201, UVSQ, 92380 Garches, France
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-Kinésithérapie Saint Michel, 68 rue du Commerce, 75015 Paris, France
| | - Matthieu Lalevée
- CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, 76821 Mont-Saint-Aignan, France
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000 Rouen, France
| | - Thomas Poirier
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-Kinésithérapie Saint Michel, 68 rue du Commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-Kinésithérapie Saint Michel, 68 rue du Commerce, 75015 Paris, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP24, 76083 Le Havre CEDEX, France
| | - Stéphane Van Driessche
- Polyclinique Sainte Marguerite, 5 Avenue de la Font Sainte-Marguerite, 89000 Auxerre, France
| | - Fabien Billuart
- Unité de Recherche ERPHAN, UR 20201, UVSQ, 92380 Garches, France
- Université de Versailles-Saint-Quentin-en-Yvelines, UFR Simone Veil-Santé, 20 Avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France
| |
Collapse
|
4
|
Sado N, Edagawa T, Fujimori T, Hashimoto S, Okamoto Y, Nakajima T. Hip and lumbosacral joint centre locations in asian population: Biases produced by existing regression equations and development of new equations. J Biomech 2024; 162:111866. [PMID: 37976688 DOI: 10.1016/j.jbiomech.2023.111866] [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: 07/24/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
The hip and lumbosacral joint centre (HJC and LSJC) predictions are required to analyse the lumbo-pelvic-hip dynamics during various human motions. Some HJC and LSJC regression equations based on pelvic dimension have been developed; however, the pre-existing methods need to be re-evaluated, and methodological reconsideration may improve the regression methods. Here we show that pre-existing methods produce biased predictions of the LSJC and HJC in 23 male and 24 female Japanese adults, and that the biases in the LSJC differ between sexes, using magnetic resonance imaging (MRI) around the pelvis. Compared with directly measured locations on MRI, the pre-existing regression equations predict LSJC to be more posterior in males and more inferior and posterior in females, and HJC to be more medial in both sexes. The better pre-existing regression equation for LSJC height differs between sexes, with pelvic-width-base better in males and pelvic-depth-base better in females, respectively. We suggest the unsuitability of pre-existing methods to our dataset consisting of Japanese adults and the importance of considering sex differences in regression methods. We propose regression equations to predict HJC and LSJC, considering soft-tissue thickness, sex differences, and a height-directional measure, using least absolute shrinkage and selection operator regression. We validate them using leave-one-out cross-validation (LOOCV). LOOCV shows that our model produces negligible biases and smaller absolute errors than the pre-existing regressions; in particular, the anteroposterior absolute error for LSJC is less than half that of the pre-existing regression. Our regression equation can be a powerful solution for accurate motion analysis.
Collapse
Affiliation(s)
- Natsuki Sado
- Institute of Health and Sports Science, University of Tsukuba, Tsukuba, Japan.
| | - Takeshi Edagawa
- Graduate School of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Toshihide Fujimori
- Graduate School of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shogo Hashimoto
- Graduate School of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | | | | |
Collapse
|
5
|
Henry A, Benner C, Easwaran A, Veerapalli L, Gaddy D, Suva LJ, Robbins AB. Predictive estimation of ovine hip joint centers: A regression approach. J Biomech 2023; 161:111861. [PMID: 37952489 DOI: 10.1016/j.jbiomech.2023.111861] [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: 03/08/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
Estimation of the hip joint center in ovine biomechanical analysis is often overlooked or estimated using a marker on the greater trochanter which can result in large errors that propagate through subsequent analyses. The purpose of this study was to develop a novel method of estimating the hip joint centers in sheep to facilitate more accurate analysis of ovine biomechanics. CT scans from 16 sheep of varying ages, weight, sex, and phenotypes were acquired and the data was used to calculate the known hip joint center by sphere fitting the femoral head. Anatomical measurements and additional subject information were used to create a variety of regression models to estimate the hip joint centers in absence of CT data. The best regression equation created utilized markers placed on the tuber coxae and tuber ischii of the pelvis and resulted in a mean 3D Euclidean distance error of 6.43 ± 2.22 mm (mean ± standard deviation) between the known and estimated hip joint center. The regression models produced allow for more detailed, accurate and robust analysis of sheep biomechanics.
Collapse
Affiliation(s)
- Aaron Henry
- Department of Multidisciplinary Engineering, College of Engineering, Texas A&M University, United States of America.
| | - Carson Benner
- J. Mike Walker '66 Department of Mechanical Engineering, College of Engineering, Texas A&M University, United States of America.
| | - Anish Easwaran
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, United States of America.
| | - Likhitha Veerapalli
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, United States of America.
| | - Dana Gaddy
- Department of Veterinary Integrative Biosciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, United States of America.
| | - Larry J Suva
- Department of Veterinary Physiology & Pharmacology, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, United States of America.
| | - Andrew B Robbins
- Department of Multidisciplinary Engineering, College of Engineering, Texas A&M University, United States of America; J. Mike Walker '66 Department of Mechanical Engineering, College of Engineering, Texas A&M University, United States of America; School of Engineering Medicine, Texas A&M University, United States of America.
| |
Collapse
|
6
|
Boekesteijn RJ, van de Ven MPF, Wilders LM, Bisseling P, Groen BE, Smulders K. The effect of functional calibration methods on gait kinematics in adolescents with idiopathic rotational deformity of the femur. Clin Biomech (Bristol, Avon) 2023; 107:106028. [PMID: 37331152 DOI: 10.1016/j.clinbiomech.2023.106028] [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: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Due to anatomical deviations, assumptions of the conventional calibration method for gait analysis may be violated in individuals with rotational deformities of the femur. Functional calibration methods were compared with conventional methods in this group for 1) localization of the hip joint center and orientation of the knee axis, and 2) gait kinematics. METHODS Twenty-four adolescents with idiopathic rotational deformity of the femur underwent gait analysis and a CT scan. During standing, distance between hip joint centers and knee axis orientation were compared between calibration methods, with CT serving as reference for hip joint center estimation. Gait kinematics were compared using statistical parametric mapping. FINDINGS The conventional calibration method estimated the hip joint center closer to the CT reference (4±12 mm more lateral) than the functional calibration method (26 ± 20 mm more lateral). Orientation of the knee joint axis was 2.6° less internal in the functional calibration method. During gait, statistical parametric mapping revealed significantly more hip flexion, less external hip rotation during the swing phase, less knee varus-valgus motion, and larger knee flexion angles when applying the functional method. INTERPRETATION Functional calibration methods were less accurate in determining the hip joint center location than the conventional calibration method and resulted in a knee joint axis that was less internally rotated. Importantly, there was less knee joint angle crosstalk during gait when using the functional method. Although differences between methods on gait kinematics were within clinically acceptable limits for the sagittal plane, relatively larger differences on transversal hip kinematics may hold clinical importance.
Collapse
Affiliation(s)
- Ramon J Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | - Lise M Wilders
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Pepijn Bisseling
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Brenda E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Lewis CL, Uemura K, Atkins PR, Lenz AL, Fiorentino NM, Aoki SK, Anderson AE. Patients with cam-type femoroacetabular impingement demonstrate increased change in bone-to-bone distance during walking: A dual fluoroscopy study. J Orthop Res 2023; 41:161-169. [PMID: 35325481 PMCID: PMC9508282 DOI: 10.1002/jor.25332] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Cam-type femoroacetabular impingement (FAI) syndrome is a painful, structural hip disorder. Herein, we investigated hip joint mechanics through in vivo, dynamic measurement of the bone-to-bone distance between the femoral head and acetabulum in patients with cam FAI syndrome and morphologically screened controls. We hypothesized that individuals with cam FAI syndrome would have larger changes in bone-to-bone distance compared to the control group, which we would interpret as altered joint mechanics as signified by greater movement of the femoral head as it articulates within the acetabulum. Seven patients with cam FAI syndrome and 11 asymptomatic individuals with typical morphology underwent dual fluoroscopy imaging during level and inclined walking (upward slope). The change in bone-to-bone distance between femoral and acetabular bone surfaces was evaluated for five anatomical regions of the acetabulum at each timepoint of gait. Linear regression analysis of the bone-to-bone distance considered two within-subject factors (activity and region) and one between-subjects factor (group). Across activities, the change in minimum bone-to-bone distance was 1.38-2.54 mm for the cam FAI group and 1.16-1.84 mm for controls. In all regions except the anterior-superior region, the change in bone-to-bone distance was larger in the cam group than the control group (p ≤ 0.024). An effect of activity was detected only in the posterior-superior region where larger changes were noted during level walking than incline walking. Statement of clinical significance: Patients with cam FAI syndrome exhibit altered hip joint mechanics during the low-demand activity of walking; these alterations could affect load transmission, and contribute to pain, tissue damage, and osteoarthritis.
Collapse
Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Niccolo M Fiorentino
- Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
8
|
Schuring LL, Mozingo JD, Lenz AL, Uemura K, Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Anderson AE. Acetabular labrum and cartilage contact mechanics during pivoting and walking tasks in individuals with cam femoroacetabular impingement syndrome. J Biomech 2023; 146:111424. [PMID: 36603366 PMCID: PMC9869780 DOI: 10.1016/j.jbiomech.2022.111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities. Previous in silico studies have employed generalized model geometry or kinematics to simulate impingement between the femur and acetabulum, which may not accurately capture the interplay between morphology and motion. In this study, we utilized models with participant-specific bone and articular soft tissue anatomy and kinematics measured by dual-fluoroscopy to compare hip contact mechanics of cam FAIS patients to controls during four activities of daily living (internal/external pivoting and level/incline walking). Averaged across the gait cycle during incline walking, patients displayed increased strain in the anterior joint (labrum strain: p-value = 0.038, patients: 11.7 ± 6.7 %, controls: 5.0 ± 3.6 %; cartilage strain: p-value = 0.029, patients: 9.1 ± 3.3 %, controls: 4.2 ± 2.3). Patients also exhibited increased average anterior cartilage strains during external pivoting (p-value = 0.039; patients: 13.0 ± 9.2 %, controls: 3.9 ± 3.2 %]). No significant differences between patient and control contact area and strain were found for level walking and internal pivoting. Our study provides new insights into the biomechanics of cam FAIS, including spatiotemporal hip joint contact mechanics during activities of daily living.
Collapse
Affiliation(s)
- Lindsay L Schuring
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Joseph D Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
| | - Niccolo M Fiorentino
- Mechanical Engineering Department, University of Vermont, Burlington, VT 05405, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Andrew E Anderson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA.
| |
Collapse
|
9
|
Salami F, Götze M, Campos S, Leboucher J, Hagmann S, Wolf SI. Estimation of a midfoot joint center in typically developed adults using functional calibration methods. Gait Posture 2022; 97:203-209. [PMID: 35988436 DOI: 10.1016/j.gaitpost.2022.08.013] [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: 03/31/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are detailed findings on hip and knee joint parameters determined via functional calibration methods for use in instrumented 3D-gait analysis but these methods have not yet been addressed to the foot. RESEARCH QUESTION Are functional calibration methods feasible for determining foot joint parameters and may they help for clinical interpretation of foot deformities? METHODS Rigid segments were formed by markers on forefoot and hindfoot via a least square method. The position of the midfoot joint articulating both foot segments was then determined via a functional calibration motion. This two-stage procedure was applied on a cohort of 17 typically developed adults and one subject with severe planovalgus foot deformity for determining the location of the midfoot joint and kinematics of hindfoot and forefoot. RESULTS The position of the midfoot joint center could be estimated in the typically developed cohort and also in the demonstration case with planovalgus foot deformity. Depending on the choice of marker set for hindfoot and forefoot, the position of the joint center varied in the anatomic midfoot region with most robust results when addressing the marker on the navicular to the hindfoot. CONCLUSION The presented method for joint center determination within the foot and the characteristic results of the foot joint angles appear promising for typically developed feet. However, further validation of the method is needed for application in clinical context.
Collapse
Affiliation(s)
- Firooz Salami
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Götze
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sarah Campos
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julien Leboucher
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastién Hagmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
10
|
Mozingo JD, Schuring LL, Mortensen AJ, Anderson AE, Aoki SK. Effect of Patient Positioning on Measurement of the Anterior Center-Edge Angle on False-Profile Radiographs and Its 3-Dimensional Mapping to the Acetabular Rim. Orthop J Sports Med 2022; 10:23259671211073834. [PMID: 35141341 PMCID: PMC8819774 DOI: 10.1177/23259671211073834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The anterior center-edge angle (ACEA) is used to quantify anterior coverage of the femoral head by the acetabulum. However, its measurement has not been evaluated in a manner consistent with routine use, and the precise 3-dimensional (3D) anatomic location where it measures coverage is not known. Purpose: To determine the effect of patient positioning on ACEA measurement reliability, magnitude, and 3D location. Study Design: Descriptive laboratory study. Methods: Included were 18 adults; 7 participants had cam morphology and femoroacetabular impingement syndrome, and 11 participants had no radiographic evidence of hip abnormalities and no history of hip pain or injuries. Ultimately, 3D femur and pelvis models were generated from computed tomography images. Radiographs were generated with the models in different degrees of pelvic rotation, tilt, and obliquity relative to the standard false-profile view. The ACEA was measured by 2 raters by selecting the location of the bone edge on each radiograph. Selections were projected onto the pelvis model and expressed as a clockface location on the acetabular rim. The clockface was mirrored on left hips to allow a direct comparison of locations between hips. Interrater and intrarater reliability were quantified via the intraclass correlation coefficient (ICC). The effect of position on ACEA measurements and clockface locations was determined via linear regression. Results: Intrarater and interrater reliability were excellent (ICC ≥0.97 for all). For every degree increase in rotation, tilt, and obliquity, the ACEA changed by +0.53°, +0.93°, and –0.04°, respectively. The mean clockface location (hour:minute:second) in the false-profile view was 2:09:32 ± 0:12:00 and changed by +0:02:08, –0:00:35, and –0:00:05 for every degree increase in rotation, tilt, and obliquity, respectively. Conclusion: ACEA measurements were reliable even with differences in patient positioning. Rotation and tilt were associated with notable changes in ACEA measurements. ACEA bone edge measurements mapped to the anterosuperior acetabular rim, typically in proximity to the anterior inferior iliac spine. Mapped location was most sensitive to rotation. Clinical Relevance: Pelvic rotation and tilt affected ACEA measurements, which could alter the clinical classification and treatment of borderline abnormalities. Rotation in particular must be well controlled during patient imaging to preserve measurement reliability and accuracy and to describe coverage from the intended 3D rim location.
Collapse
Affiliation(s)
- Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Lindsay L. Schuring
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
11
|
Wellsandt E, Kallman T, Golightly Y, Podsiadlo D, Dudley A, Vas S, Michaud K, Tao M, Sajja B, Manzer M. Knee joint unloading and daily physical activity associate with cartilage T2 relaxation times 1 month after ACL injury. J Orthop Res 2022; 40:138-149. [PMID: 33783030 PMCID: PMC8478972 DOI: 10.1002/jor.25034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is prevalent after anterior cruciate ligament (ACL) injury, but mechanismsunderlying its development are poorly understood. The purpose of this study was to determine if gait biomechanics and daily physical activity (PA) associate with cartilage T2 relaxation times, a marker of collagen organization and water content, 1 month after ACL injury. Twenty-seven participants (15-35 years old) without chondral lesions completed magnetic resonance imaging, three-dimensional gait analysis, and 1 week of PA accelerometry. Interlimb differences and ratios were calculated for gait biomechanics and T2 relaxation times, respectively. Multiple linear regression models adjusted for age, sex, and concomitant meniscus injury were used to determine the association between gait biomechanics and PA with T2 relaxation times, respectively. Altered knee adduction moment (KAM) impulse, less knee flexion excursion (kEXC) and higher daily step counts accounted for 35.8%-65.8% of T2 relaxation time variation in the weightbearing and posterior cartilage of the medial and lateral compartment (all p ≤ .011). KAM impulse was the strongest factor for T2 relaxation times in all models (all p ≤ .001). Lower KAM impulse associated with longer T2 relaxation times in the injured medial compartment (β = -.720 to -.901) and shorter T2 relaxation in the lateral compartment (β = .713 to .956). At 1 month after ACL injury, altered KAM impulse, less kEXC, and higher PA associated with longer T2 relaxation times, which may indicate poorer cartilage health. Statement of Clinical Significance: Gait biomechanics and daily PA are modifiable targets that may improve cartilage health acutely after ACL injury and slow progression to OA.
Collapse
Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tyler Kallman
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yvonne Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Podsiadlo
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Dudley
- Department of Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Stephanie Vas
- Department of Clinical Diagnostic and Therapeutic Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA,Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Matthew Tao
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Balasrinivasa Sajja
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Manzer
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
12
|
Öztürk O, Salami F, Musagara AR, Demirbüken İ, Polat MG, Wolf SI, Götze M. Functional hip joint centre determination in children with cerebral palsy. Gait Posture 2021; 90:185-189. [PMID: 34500219 DOI: 10.1016/j.gaitpost.2021.08.021] [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: 12/18/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although functional methods determining the hip joint center (HJC) are becoming increasingly popular, no systematic investigation has been conducted yet to assess the reliability of functional hip joint calibration in patients with cerebral palsy (CP). RESEARCH QUESTION What is the most reliable way to conduct functional calibration motions for estimating HJC location in children with CP and movement disorders? METHODS Twenty-two patients with CP were included in the study. A marker set for Plug-in Gait with additional cluster markers was used. Two functional calibration movements, including a new movement, were proposed and tested with one and three repetitions each. Functional HJCs were determined using the SCoRE approach and compared to results obtained by applying the conventional regression method for assessing face validity. RESULTS The choice of calibration movement had significant impact on SCoRE residuals and HJC location. Increasingly repeating calibration movements did not improve results. A modified star movement by allowing the toes to tip the ground provided the most reliable data and is feasible for children with GMFCS level I-III. The feasibility of the method is further improved by analyzing hip motion in the contralateral stance limb and, among the calibration movements, gave the most precise HJC estimation. SIGNIFICANCE Type and performance of the functional calibration movement is one key factor for determining a robust HJC. Analyzing the data in the stance leg via the modified star motion yielded robust and reasonable results for the HJC location, which should be validated in further studies that include imaging methods. Using one repetition instead of three seems promising in terms of feasibility for patients with movement disorder.
Collapse
Affiliation(s)
- Orhan Öztürk
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Firooz Salami
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Arik Rehani Musagara
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - İlkşan Demirbüken
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - M Gülden Polat
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Sebastian I Wolf
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany.
| | - Marco Götze
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| |
Collapse
|
13
|
Ye D, Sun X, Zhang C, Zhang S, Zhang X, Wang S, Fu W. In Vivo Foot and Ankle Kinematics During Activities Measured by Using a Dual Fluoroscopic Imaging System: A Narrative Review. Front Bioeng Biotechnol 2021; 9:693806. [PMID: 34350162 PMCID: PMC8327092 DOI: 10.3389/fbioe.2021.693806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022] Open
Abstract
Foot and ankle joints are complicated anatomical structures that combine the tibiotalar and subtalar joints. They play an extremely important role in walking, running, jumping and other dynamic activities of the human body. The in vivo kinematic analysis of the foot and ankle helps deeply understand the movement characteristics of these structures, as well as identify abnormal joint movements and treat related diseases. However, the technical deficiencies of traditional medical imaging methods limit studies on in vivo foot and ankle biomechanics. During the last decade, the dual fluoroscopic imaging system (DFIS) has enabled the accurate and noninvasive measurements of the dynamic and static activities in the joints of the body. Thus, this method can be utilised to quantify the movement in the single bones of the foot and ankle and analyse different morphological joints and complex bone positions and movement patterns within these organs. Moreover, it has been widely used in the field of image diagnosis and clinical biomechanics evaluation. The integration of existing single DFIS studies has great methodological reference value for future research on the foot and ankle. Therefore, this review evaluated existing studies that applied DFIS to measure the in vivo kinematics of the foot and ankle during various activities in healthy and pathologic populations. The difference between DFIS and traditional biomechanical measurement methods was shown. The advantages and shortcomings of DFIS in practical application were further elucidated, and effective theoretical support and constructive research direction for future studies on the human foot and ankle were provided.
Collapse
Affiliation(s)
- Dongqiang Ye
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xiaole Sun
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Cui Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Shandong Institute of Sport Science, Jinan, China
| | - Shen Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xini Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
14
|
The Missing Link: Defining the Functional Parameters of Pelvic and Acetabular Alignment. J Am Acad Orthop Surg 2021; 29:446-451. [PMID: 32826661 DOI: 10.5435/jaaos-d-20-00400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed to define the three-dimensional functional alignment of the pelvis, proximal femur, and acetabulum during postural and physical activities. METHODS Thirty volunteers aged 40 years or greater were recruited. Reflective markers placed on bony prominences on the pelvis and lower extremities were tracked using a 12-camera motion analysis system. Measurements were obtained for various postures (ie, supine, standing, and sitting) and activities (ie, walking and ascending/descending stairs). RESULTS Significant pelvic motion occurred only in the sagittal plane. The mean posterior inclinations of the pelvis were 15°, 18°, and 51° in the supine, standing, and sitting positions, respectively. These corresponded to acetabular anteversion/inclination angles of 26°/44°, 28°/45°, and 55°/55°, respectively. For activities, the mean posterior inclinations of the pelvis were 19°, 19°, and 20° during walking and ascending and descending stairs, respectively. These corresponded to acetabular anteversion/inclination angles of 29°/45°, 29°/45°, and 30°/46°, respectively. DISCUSSION The functional parameters for pelvic and acetabular alignment were defined. Further research is needed to understand the extent to which these normal parameters are altered in the setting of hip and/or spinal degenerative disease to guide acetabular implant placement.
Collapse
|
15
|
Roach KE, Foreman KB, MacWilliams BA, Karpos K, Nichols J, Anderson AE. The modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model provides clinically acceptable measurements of ankle and midfoot angles: A dual fluoroscopy study. Gait Posture 2021; 85:258-265. [PMID: 33626450 PMCID: PMC8085108 DOI: 10.1016/j.gaitpost.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 09/28/2020] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several multi-segment foot models have been developed to evaluate foot and ankle motion using skin-marker motion analysis. However, few multi-segment models have been evaluated against a reference standard to establish kinematic accuracy. RESEARCH QUESTION How accurately do skin-markers estimate foot and ankle motion for the modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model when compared against the reference standard, dual fluoroscopy (DF), during gait, in asymptomatic participants? METHODS Five participants walked overground as full-body skin-marker trajectory data and DF images of the foot and shank were simultaneously acquired. Using the mSHCG model, ankle and midfoot angles were calculated throughout stance for both motion analysis techniques. Statistical parametric mapping assessed differences in joint angles and marker positions between skin-marker and DF motion analysis techniques. Paired t tests, and linear regression models were used to compare joint angles and range of motion (ROM) calculated from the two techniques. RESULTS In the coronal plane, the skin-marker model significantly overestimated ROM (p = 0.028). Further, the DF model midfoot ROM was significantly positively related to differences between DF and skin-marker midfoot angles (p = 0.035, adjusted R2 = 0.76). In the sagittal plane, skin-markers underestimated ankle angles by as much as 7.26°, while midfoot angles were overestimated by as much as 9.01°. However, DF and skin-marker joint angles were not significantly different over stance. Skin-markers on the tibia, calcaneus, and fifth metatarsal had significantly different positions than the DF markers along the direction of walking for isolated portions that were less than 10 % of stance. Euclidean distances between DF and skin-markers positions were less than 9.36 mm. SIGNIFICANCE As the accuracy of the mSHCG model was formerly unknown, the results of this study provide ranges of confidence for key angles calculated by this model.
Collapse
Affiliation(s)
- Koren E. Roach
- Department of Radiology and Biomedical Imaging, 185 Berry St., Suite 350, San Francisco, CA 94107,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108
| | - Bruce A. MacWilliams
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Motion Analysis Center, Shriners Hospitals for Children, 1275 Fairfax Rd., Salt Lake City, UT 84103, USA
| | - Kostantino Karpos
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physics, Arizona State University, 550 E Tyler Drive Tempe, AZ 85287
| | - Jennifer Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108,Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
| |
Collapse
|
16
|
Focusing on functional knee parameter determination to develop a better clinical gait analysis protocol. Gait Posture 2021; 84:127-136. [PMID: 33316686 DOI: 10.1016/j.gaitpost.2020.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Attempts to improve protocol standards of marker-based clinical gait analysis (CGA) have been one of the main focuses of research to enhance robustness and reliability outcomes since the 1990s. Determining joint centres and axes constitutes an important aspect of those protocols. Although the hip joint is more prominent in such studies, knee joint center (KJC) and axis (KJA) directly affect all outcomes. RESEARCH QUESTION What recommendations arise from the study of the scientific literature for determining knee joint parameters (KJP) for protocols of CGA? METHODS A systematic, electronic search was conducted on November 2018 using three databases with the keyword combination ("functional approach" OR "functional method" OR "functional calibration") AND ("hip joint" OR "knee joint" OR "ankle joint") and analyzed by four reviewers. Given the existence of a recent review about the hip joint and the lack of material about the ankle joint, only papers about the knee joint were kept. The references cited in the selected papers were also screened in the final round of the search for these publications. The quality of the selected papers was assessed and aspects regarding accuracy, repeatability, and feasibility were thoroughly considered to allow for a comparison between studies. Technical aspects, such as marker set choice, KJP determination techniques, demographics, and functional movements, were also included. RESULTS Thirty-one papers were included and on average received a rating of about 75 % according to the quality scale used. The results showed that functional methods are superior or equivalent to predictive methods to estimate the KJA, while a regression method was slightly better for KJC prediction. SIGNIFICANCE Calibration methods should be applied to CGA whenever feasibility is reached. No study to date has focused on evaluating the in vivo RoM required to obtain reliable and repeatable results and future work should aim in this direction.
Collapse
|
17
|
Atkins PR, Hananouchi T, Anderson AE, Aoki SK. Inclusion of the Acetabular Labrum Reduces Simulated Range of Motion of the Hip Compared With Bone Contact Models. Arthrosc Sports Med Rehabil 2020; 2:e779-e787. [PMID: 33376992 PMCID: PMC7754612 DOI: 10.1016/j.asmr.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine whether inclusion of the acetabular labrum affects the maximum range of motion (ROM) during simulation of the flexion–adduction–internal rotation impingement examination. Methods Three-dimensional surface reconstructions of the femur, hemi-pelvis, and labrum from computed tomography arthrography images of 19 participants were used to simulate maximum ROM during the flexion–adduction–internal rotation examination. Simulations were conducted for positions between 70° and 110° flexion and 0° and 20° adduction at 10° increments to measure maximum internal rotation and the position of contact between the femur and acetabular rim (bone-to-bone) or the femur and labrum (bone-to-labrum). Internal rotation angles and clock-face position values were compared between the 2 contact scenarios for each position. Results The ROM in the bone-to-labrum contact model was significantly less than that of the bone-to-bone contact model for all evaluated positions (P ≤ .001, except at 110° flexion and 20° adduction, P = .114). The inclusion of the labrum reduced internal rotation by a median [interquartile range] of 18 [15, 25]° while altering the position of contact on the acetabular clock-face by –0:01 [–0:27, 0:16]. The variability in contact location for the bone-to-labrum contact scenario was nearly double that of the bone-to-bone contact scenario, as indicated by the interquartile range. Conclusions Inclusion of the anatomy of the acetabular labrum in collision models used to simulate impingement examinations reduced the internal rotation ROM by approximately 20° and increased variability in the location of contact relative to the acetabular rim. Clinical Relevance While standard bone-to-bone contact ROM simulations may be informative with respect to the relative change in ROM based on a surgical intervention (e.g., pre- and post-osteochondroplasty for cam-type femoroacetabular impingement), they may not accurately represent the clinical ROM of the joint or the kinematic position at which damage may occur due to shape mismatch between the femur and acetabulum.
Collapse
Affiliation(s)
- Penny R. Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
| | - Takehito Hananouchi
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Medical Engineering Laboratory, Department of Mechanical Engineering, Osaka Sangyo University, Daito, Osaka, Japan
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Address correspondence to Stephen K. Aoki, University of Utah Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108.
| |
Collapse
|
18
|
Meng L, Millar L, Child C, Buis A. A Cluster-based Model Using Functional Methods Requires Less Operator Experience for Reliable Gait Analysis: A Preliminary Study of Intra- and Inter-assessor Reliability. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3154-3157. [PMID: 33018674 DOI: 10.1109/embc44109.2020.9176611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reliability of three-dimensional gait analysis is important for repetitive assessments in clinical or research studies. In this paper, we hypothesized that a Strathclyde Functional Cluster Model (SFCM) in which all the joint centers and flexion axes were determined by functional methods, could improve the reliability of joint kinematics within and between operators' sessions compared to an anatomical model, Plug-in Gait (PiG). A preliminary study of intra- and inter-assessor reliability of the SFCM was been analyzed and compared to the PiG. One able-bodied participant performed eight sessions measured by four operators who have different experience level on the two models. Intra- and inter-operator reliability of the SFCM and PiG were assessed using the intraclass correlation coefficient (ICC) and standard deviation (SD). Results showed that the SFCM generated smaller SD and greater ICC values for all joint variables compared to the PiG in the inter-operator condition, suggesting that functional methods could improve the inter-operator reliability. Moreover, the intra-operator ICC results indicated that the SFCM performance was less influenced by operator experience compared to the PiG. In conclusion, as the model requires less palpation of ALs, it would benefit the users who have less experience in practical use.
Collapse
|
19
|
An Enhanced Planar Linked Segment Model for Predicting Lumbar Spine Loads during Symmetric Lifting Tasks. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present technical note aimed at enriching the planar linked segment model originally proposed by Chaffin with the prediction of the moment arm and of the orientation of the line of action of the back extensor muscles during symmetric lifting tasks. The prediction equations proposed by van Dieen and de Looze for their single equivalent muscle model were used for such a purpose. Their prediction was based on the thorax-to-pelvis flexion angle as computed from 3D video-based motion capture. In order to make these prediction equations compliant with a two-dimensional analysis, the planar angle formed by the segment joining L5/S1 to the shoulder with the longitudinal axis of the pelvis was introduced. This newly computed planar trunk flexion angle was used to feed van Dieen and de Looze’s equations, comparing the results with the original model. A full-body Plug-in-Gait model relative to 10 subjects performing manual lifting activities using a stoop and a squat technique was used for model validation. A strong association was found between the proposed planar trunk flexion angle and that used by van Dieen and de Looze (r = 0.970). A strong association and a high level of agreement were found between the back extensor muscle moment arm (r = 0.965; bias < 0.001 m; upper limit of agreement (LOA) = 0.002 m; lower LOA < 0.001 m) and the orientation of the line of action (r = 0.970; bias = 2.8°; upper LOA = 5.3°; lower LOA = 0.2°) as computed using the two methods. For both the considered variables, the prediction error fell within the model sensitivity.
Collapse
|
20
|
Kolz CW, Sulkar HJ, Aliaj K, Tashjian RZ, Chalmers PN, Qiu Y, Zhang Y, Foreman KB, Anderson AE, Henninger HB. Reliable interpretation of scapular kinematics depends on coordinate system definition. Gait Posture 2020; 81:183-190. [PMID: 32758918 PMCID: PMC7484087 DOI: 10.1016/j.gaitpost.2020.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interpretation of shoulder motion across studies has been complicated due to the use of numerous scapular coordinate systems in the literature. Currently, there are no simple means by which to compare scapular kinematics between coordinate system definitions when data from only one coordinate system is known. RESEARCH QUESTION How do scapular kinematics vary based on the choice of coordinate system and can average rotation matrices be used to accurately convert kinematics between scapular local coordinate systems? METHODS Average rotation matrices derived from anatomic landmarks of 51 cadaver scapulae (29 M/22 F; 59 ± 13 yrs; 26R/25 L; 171 ± 11 cm; 70 ± 19 kg; 23.7 ± 5.5 kg/m2) were generated between three common scapular coordinate systems. Absolute angle of rotation was used to determine if anatomical variability within the cadaver population influenced the matrices. To quantify the predictive capability to convert kinematics between the three coordinate systems, the average rotation matrices were applied to scapulothoracic motion data collected from 19 human subjects (10 M/9 F; 43 ± 17 yrs; 19R; 173 ± 9 cm; 71 ± 16 kg; 23.6 ± 4.5 kg/m2) using biplane fluoroscopy. Root mean squared error (RMSE) was used to compare kinematics from an original coordinate system to the kinematics expressed in each alternative coordinate system. RESULTS The choice of scapular coordinate system resulted in mean differences in scapulothoracic rotation of up to 23°, with overall different shapes and/or magnitudes of the curves. A single average rotation matrix between any two coordinate systems achieved accurate conversion of scapulothoracic kinematics to within 4° of RMSE of the known solution. The average rotation matrices were independent of sex, side, decomposition sequence, and motion. SIGNIFICANCE Scapulothoracic kinematic representations vary in shape and magnitude based solely on the choice of local coordinate system. The results of this study enhance interpretability and reproducibility in expressing scapulothoracic motion data between laboratories by providing a simple means to convert data between common coordinate systems. This is necessitated by the variety of available motion analysis techniques and their respective scapular landmark definitions.
Collapse
Affiliation(s)
- Christopher W Kolz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Hema J Sulkar
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Klevis Aliaj
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | - Yuqing Qiu
- Department of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Department of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.
| |
Collapse
|
21
|
Validity of Using Automated Two-Dimensional Video Analysis to Measure Continuous Sagittal Plane Running Kinematics. Ann Biomed Eng 2020; 49:455-468. [PMID: 32705424 DOI: 10.1007/s10439-020-02569-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
Two-dimensional video analysis is commonly used to assess kinematics when three-dimensional motion capture is unavailable. However, videos are often assessed using manual digitization, which limits the ability to extract outcomes that require continuous data. Here, we introduced a method to collect continuous kinematic data in 2D using an inexpensive camera and an open-source automated marker tracking program. We tested the validity of this method by comparing 2D video analysis to 3D motion capture for measuring sagittal-plane running kinematics. Twenty uninjured participants ran on a treadmill for 1-min while lower extremity kinematics were collected simultaneously in 3D using a motion capture system and in 2D using a single digital camera, both at 120 Hz. Knee, ankle, and foot angle at contact, peak knee flexion, knee flexion excursion, and knee-ankle flexion vector coding variability were computed using both the 3D and 2D kinematic data, and were compared using intraclass correlation coefficients and Bland-Altman plots. The agreement between collection methods was excellent for foot angle at contact and knee flexion excursion, good for ankle and knee angle at contact and knee-ankle vector coding variability, and moderate for peak knee flexion. However, Bland-Altman plots revealed significant differences between the 2D and 3D collection methods, which varied across study participants. These low-cost methods could be useful for collecting continuous sagittal plane running kinematics in non-laboratory settings.
Collapse
|
22
|
Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 PMCID: PMC7405358 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
Collapse
Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
| |
Collapse
|
23
|
Bennett HJ, Valenzuela KA, Fleenor K, Weinhandl JT. A Normative Database of Hip and Knee Joint Biomechanics During Dynamic Tasks Using Four Functional Methods With Three Functional Calibration Tasks. J Biomech Eng 2020; 142:958437. [PMID: 31513696 DOI: 10.1115/1.4044503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Although predicted hip joint center (HJC) locations are known to vary widely between functional methods, no previous investigation has detailed functional method-dependent hip and knee biomechanics. The purpose of this study was to define a normative database of hip joint biomechanics during dynamic movements based upon functional HJC methods and calibration tasks. Thirty healthy young adults performed arc, star arc, and two-sided calibration tasks. Motion capture and ground reaction forces were collected during walking, running, and single-leg landings (SLLs). Two sphere-fit (geometric and algebraic) and two coordinate transformation techniques were implemented using each calibration (12 total method-calibration combinations). Surprisingly, the geometric fit-two-sided model placed the HJC at the midline of the pelvis and above the iliac spines, and thus was removed from analyses. A database of triplanar hip and knee kinematics and hip moments and powers was constructed using the mean of all subjects for the eleven method-calibration combinations. A nested analysis of variance approach compared calibration [method] peak hip kinematics and kinetics. Most method differences existed between geometric fit and coordinate transformations (58 of 84 total). No arc-star arc differences were found. Thirty-two differences were found between the two-sided and arc/star arc calibrations. This database of functional method based hip and knee biomechanics serves as an important reference point for interstudy comparisons. Overall, this study illustrates that functional HJC method can dramatically impact hip biomechanics and should be explicitly detailed in future work.
Collapse
Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, 2016 Student Recreation Center, Norfolk, VA 23529
| | - Kevin A Valenzuela
- Department of Kinesiology, HHS2-203, California State University Long Beach, Long Beach, CA 90840
| | - Kristina Fleenor
- Department of Human Movement Sciences, Old Dominion University, 2016 Student Recreation Center, Norfolk, VA 23529
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 322 HPER Building, 1914 Andy Holt Avenue, Knoxville, TN 37996-2700
| |
Collapse
|
24
|
Lenz AL, Nichols JA, Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis: An in Vivo Dual-Fluoroscopy Imaging Study. J Bone Joint Surg Am 2020; 102:600-608. [PMID: 32079879 PMCID: PMC7289138 DOI: 10.2106/jbjs.19.01132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle. METHODS Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured. RESULTS During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°). CONCLUSIONS A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. CLINICAL RELEVANCE Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.
Collapse
Affiliation(s)
- Amy L. Lenz
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Jennifer A. Nichols
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Koren E. Roach
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Radiology, University of California-San Francisco, San Francisco, California
| | - K. Bo Foreman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Alexej Barg
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Charles L. Saltzman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Email address for A.E. Anderson:
| |
Collapse
|
25
|
Atkins PR, Fiorentino NM, Hartle JA, Aoki SK, Peters CL, Foreman KB, Anderson AE. In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study. J Orthop Res 2020; 38:823-833. [PMID: 31693209 PMCID: PMC7301904 DOI: 10.1002/jor.24509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) may alter the kinematic function of the hip, resulting in pain and tissue damage. Previous motion analysis studies of FAIS have employed skin markers, which are prone to soft tissue artifact and inaccurate calculation of the hip joint center. This may explain why the evidence linking FAIS with deleterious kinematics is contradictory. The purpose of this study was to employ dual fluoroscopy (DF) to quantify in vivo kinematics of patients with cam FAIS relative to asymptomatic, morphologically normal control participants during various activities. Eleven asymptomatic, morphologically normal controls and seven patients with cam FAIS were imaged with DF during standing, level walking, incline walking, and functional range of motion activities. Model-based tracking calculated the kinematic position of the hip by registering projections of three-dimensional computed tomography models with DF images. Patients with FAIS stood with their hip extended (mean [95% confidence interval], -2.2 [-7.4, 3.1]°, flexion positive), whereas controls were flexed (5.3 [2.6, 8.0]°; p = 0.013). Male patients with cam FAIS had less peak internal rotation than the male control participants during self-selected speed level-walking (-0.2 [-6.5, 6.1]° vs. -9.8 [-12.2, -7.3]°; p = 0.007) and less anterior pelvic tilt at heel-strike of incline (5°) walking (3.4 [-1.0, -7.9]° vs. 9.8 [6.4, 13.2]°; p = 0.032). Even during submaximal range of motion activities, such as incline walking, patients may alter pelvic motion to avoid positions that approximate the cam lesion and the acetabular labrum. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:823-833, 2020.
Collapse
Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA
| | - Joseph A. Hartle
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA
| | - Andrew. E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
| |
Collapse
|
26
|
Effects of the soft tissue artefact on the hip joint kinematics during unrestricted activities of daily living. J Biomech 2020; 104:109717. [PMID: 32234246 DOI: 10.1016/j.jbiomech.2020.109717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 12/25/2019] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Abstract
Soft tissue artefact (STA) affects the kinematics retrieved with skin marker-based motion capture, and thus influences the outcomes of biomechanical models that rely on such kinematics. In order to be compensated for, the effects of STA must be characterized across a broad sample population and for different motion activities. In this study, the error introduced by STA on the kinematics of the hip joint and of its individual components, and on the location of the hip joint center (HJC) was quantified for fifteen THA subjects during overground gait, stair descent, chair rise and putting on socks. The error due to STA was computed as the difference between the kinematics measured with motion capture and those measured simultaneously with moving fluoroscopy, a STA-free X-ray technique. The main significant effects of STA were: underestimation of the hip range of motion for all four activities, underestimation of the flexion especially during phases of the motion with higher flexion, overestimation of the internal rotation, and lateral misplacement of the HJC mostly due to the functional calibration. The thigh contributed more to the STA error than the pelvis. The STA error of the thigh appeared to be correlated with the hip flexion angles, with a varying degree of linearity depending on the activity and on the phase of the motion cycle. Future kinematic-driven STA compensation models should take into account the non-linearity of the STA error and its dependency of the phase of the motion cycle.
Collapse
|
27
|
Do Your Routine Radiographs to Diagnose Cam Femoroacetabular Impingement Visualize the Region of the Femoral Head-Neck Junction You Intended? Arthroscopy 2019; 35:1796-1806. [PMID: 31072720 DOI: 10.1016/j.arthro.2018.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/13/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To use computer models and image analysis to identify the position on the head-neck junction visualized in 10 radiographic views used to quantify cam morphology. METHODS We generated 97 surface models of the proximal femur from computed tomography scans of 59 control femurs and 38 femurs with cam morphology-a flattening or convexity at the femoral head-neck junction. Each model was transformed to a position that represents the anteroposterior, Meyer lateral, 45° Dunn, modified false-profile, Espié frog-leg, modified 45° Dunn, frog-leg lateral, cross-table, 90° Dunn, and false-profile views. The position on the head-neck junction visualized from each view was identified on the surfaces. This position was then quantified by a clock face generated on the plane of the head-neck junction, in which the 12-o'clock position indicated the superior head-neck junction and the 3-o'clock position indicated the anterior head-neck junction. The mean visualized clock-face position was calculated for all subjects. Analysis was repeated to account for variability in femoral version. A general linear model with repeated measures was used to compare each radiographic view and anteversion angle. RESULTS Each radiographic view provided visualization of the mean clock-face position as follows: anteroposterior view, 12:01; Meyer lateral view, 1:08; 45° Dunn view, 1:40; modified false-profile view, 2:01; Espié frog-leg view, 2:14; modified 45° Dunn view, 2:35; frog-leg lateral view, 2:45; cross-table view, 3:00; 90° Dunn view, 3:13; and false-profile view, 3:44. Each view visualized a different position on the clock face (all P < .001). Increasing simulated femoral anteversion by 10° changed the visualized position of the head-neck junction to a more clockwise position (range, 0:07 to 0:29; all P < .001), whereas decreasing anteversion by 10° visualized a more counterclockwise position (range, -0:23 to -0:08; all P < .001). CONCLUSIONS Ten common radiographic views used to identify cam morphology visualized different clock-face positions of the head-neck junction. Our data will help clinicians to understand the position of the head-neck junction visualized for each radiographic view and make educated decisions in the selection of radiographs acquired in the clinic. CLINICAL RELEVANCE Our findings will aid clinicians in choosing a set of radiographs to capture cam morphology in the assessment of patients with hip pain.
Collapse
|
28
|
Evaluation of functional methods of joint centre determination for quasi-planar movement. PLoS One 2019; 14:e0210807. [PMID: 30653613 PMCID: PMC6336381 DOI: 10.1371/journal.pone.0210807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
Abstract
Functional methods identify joint centres as the centre of rotation (CoR) of two adjacent movements during an ad-hoc movement. The methods have been used for functionally determining hip joint centre in gait analysis and have revealed advantages compared to predictive regression techniques. However, the current implementation of functional methods hinders its application in clinical use when subjects have difficulties performing multi-plane movements over the required range. In this study, we systematically investigated whether functional methods can be used to localise the CoR during a quasi-planar movement. The effects of the following factors were analysed: the algorithms, the range and speed of the movement, marker cluster location, marker cluster size and distance to the joint centre. A mechanical linkage was used in our study to isolate the factors of interest and give insight to variation in implementation of functional methods. Our results showed the algorithms and cluster locations significantly affected the estimate results. For all algorithms, a significantly positive relationship between CoR errors and the distance of proximal cluster coordinate location to the joint centre along the medial-lateral direction was observed while the distal marker clusters were best located as close as possible to the joint centre. By optimising the analytical and experimental factors, the transformation algorithms achieved a root mean square error (RMSE) of 5.3 mm while the sphere fitting methods yielded the best estimation with an RMSE of 2.6 mm. The transformation algorithms performed better in presence of random noise and simulated soft tissue artefacts.
Collapse
|
29
|
Which Two-dimensional Radiographic Measurements of Cam Femoroacetabular Impingement Best Describe the Three-dimensional Shape of the Proximal Femur? Clin Orthop Relat Res 2019; 477:242-253. [PMID: 30179924 PMCID: PMC6345307 DOI: 10.1097/corr.0000000000000462] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many two-dimensional (2-D) radiographic views are used to help diagnose cam femoroacetabular impingement (FAI), but there is little consensus as to which view or combination of views is most effective at visualizing the magnitude and extent of the cam lesion (ie, severity). Previous studies have used a single image from a sequence of CT or MR images to serve as a reference standard with which to evaluate the ability of 2-D radiographic views and associated measurements to describe the severity of the cam lesion. However, single images from CT or MRI data may fail to capture the apex of the cam lesion. Thus, it may be more appropriate to use measurements of three-dimensional (3-D) surface reconstructions from CT or MRI data to serve as an anatomic reference standard when evaluating radiographic views and associated measurements used in the diagnosis of cam FAI. QUESTIONS/PURPOSES The purpose of this study was to use digitally reconstructed radiographs and 3-D statistical shape modeling to (1) determine the correlation between 2-D radiographic measurements of cam FAI and 3-D metrics of proximal femoral shape; and 2) identify the combination of radiographic measurements from plain film projections that were most effective at predicting the 3-D shape of the proximal femur. METHODS This study leveraged previously acquired CT images of the femur from a convenience sample of 37 patients (34 males; mean age, 27 years, range, 16-47 years; mean body mass index [BMI], 24.6 kg/m, range, 19.0-30.2 kg/m) diagnosed with cam FAI imaged between February 2005 and January 2016. Patients were diagnosed with cam FAI based on a culmination of clinical examinations, history of hip pain, and imaging findings. The control group consisted of 59 morphologically normal control participants (36 males; mean age, 29 years, range, 15-55 years; mean BMI, 24.4 kg/m, range, 16.3-38.6 kg/m) imaged between April 2008 and September 2014. Of these controls, 30 were cadaveric femurs and 29 were living participants. All controls were screened for evidence of femoral deformities using radiographs. In addition, living control participants had no history of hip pain or previous surgery to the hip or lower limbs. CT images were acquired for each participant and the surface of the proximal femur was segmented and reconstructed. Surfaces were input to our statistical shape modeling pipeline, which objectively calculated 3-D shape scores that described the overall shape of the entire proximal femur and of the region of the femur where the cam lesion is typically located. Digital reconstructions for eight plain film views (AP, Meyer lateral, 45° Dunn, modified 45° Dunn, frog-leg lateral, Espié frog-leg, 90° Dunn, and cross-table lateral) were generated from CT data. For each view, measurements of the α angle and head-neck offset were obtained by two researchers (intraobserver correlation coefficients of 0.80-0.94 for the α angle and 0.42-0.80 for the head-neck offset measurements). The relationships between radiographic measurements from each view and the 3-D shape scores (for the entire proximal femur and for the region specific to the cam lesion) were assessed with linear correlation. Additionally, partial least squares regression was used to determine which combination of views and measurements was the most effective at predicting 3-D shape scores. RESULTS Three-dimensional shape scores were most strongly correlated with α angle on the cross-table view when considering the entire proximal femur (r = -0.568; p < 0.001) and on the Meyer lateral view when considering the region of the cam lesion (r = -0.669; p < 0.001). Partial least squares regression demonstrated that measurements from the Meyer lateral and 90° Dunn radiographs produced the optimized regression model for predicting shape scores for the proximal femur (R = 0.405, root mean squared error of prediction [RMSEP] = 1.549) and the region of the cam lesion (R = 0.525, RMSEP = 1.150). Interestingly, views with larger differences in the α angle and head-neck offset between control and cam FAI groups did not have the strongest correlations with 3-D shape. CONCLUSIONS Considered together, radiographic measurements from the Meyer lateral and 90° Dunn views provided the most effective predictions of 3-D shape of the proximal femur and the region of the cam lesion as determined using shape modeling metrics. CLINICAL RELEVANCE Our results suggest that clinicians should consider using the Meyer lateral and 90° Dunn views to evaluate patients in whom cam FAI is suspected. However, the α angle and head-neck offset measurements from these and other plain film views could describe no more than half of the overall variation in the shape of the proximal femur and cam lesion. Thus, caution should be exercised when evaluating femoral head anatomy using the α angle and head-neck offset measurements from plain film radiographs. Given these findings, we believe there is merit in pursuing research that aims to develop the framework necessary to integrate statistical shape modeling into clinical evaluation, because this could aid in the diagnosis of cam FAI.
Collapse
|
30
|
Kingston DC, Acker SM. Representing fine-wire EMG with surface EMG in three thigh muscles during high knee flexion movements. J Electromyogr Kinesiol 2018; 43:55-61. [DOI: 10.1016/j.jelekin.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 08/26/2018] [Indexed: 11/27/2022] Open
|
31
|
A normative database of hip and knee joint biomechanics during dynamic tasks using anatomical regression prediction methods. J Biomech 2018; 81:122-131. [DOI: 10.1016/j.jbiomech.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022]
|
32
|
Uemura K, Atkins PR, Maas SA, Peters CL, Anderson AE. Three-dimensional femoral head coverage in the standing position represents that measured in vivo during gait. Clin Anat 2018; 31:1177-1183. [PMID: 30117200 DOI: 10.1002/ca.23262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
Individuals with over- or under-covered hips may develop hip osteoarthritis. Femoral head coverage is typically evaluated using radiographs, and/or computed tomography (CT) or magnetic resonance images obtained supine. Yet, these static assessments of coverage may not provide accurate information regarding the dynamic, three-dimensional (3-D) relationship between the femoral head and acetabulum. The objectives of this study were to: (1) quantify total and regional 3-D femoral head coverage in a standing position and during gait, and (2) quantify the relationship between 3-D femoral head coverage in standing to that measured during gait. The kinematic position of the hip during standing and gait was measured in vivo for 11 asymptomatic morphologically normal subjects using dual fluoroscopy and model-based tracking of 3-D CT models. Percent coverage in the standing position and during gait was measured overall and on a regional basis (anterior, superior, posterior, inferior). Coverage in standing was correlated with that measured during gait. For total coverage, very little change in coverage occurred during gait (range: 35.0-36.7%; mean: 36.2%). Coverage at each time point of gait strongly correlated with coverage during standing (r = 0.929-0.989). The regions thought to play an important role in weight bearing (i.e. anterior, superior, posterior) were significantly correlated with coverage in standing during the stance phase. Our results suggest that coverage measured in a standing position is a good surrogate for coverage measured during gait. Clin. Anat. 31:1177-1183, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Musculoskeletal Research Laboratories, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA
| | - Christopher L Peters
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Andrew E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Department of Physical Therapy, University of Utah, Dumke Health Professions Building, 520 Wakara Way, Suite 240, Salt Lake City, Utah, 84108, USA
| |
Collapse
|
33
|
Modified False-Profile Radiograph of the Hip Provides Better Visualization of the Anterosuperior Femoral Head-Neck Junction. Arthroscopy 2018; 34:1236-1243. [PMID: 29289395 DOI: 10.1016/j.arthro.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to quantify the amount of internal femur rotation required to visualize the 12 to 3 o'clock positions of the femoral head-neck junction as seen on the false-profile radiograph. METHODS Computed tomography (CT) images of the femur were retrospectively reviewed from control subjects and cam femoroacetabular impingement (FAI) patients. Using an automatically determined clockface, the positions between 12 and 3 o'clock were determined. The optimal femoral rotation angle to visualize each clockface position on the femoral head-neck junction was calculated based on the CT surface data. RESULTS Fifty-nine control subjects and 38 cam FAI patients were evaluated for this study. The mean (95% confidence interval) internal femur rotation needed to optimally visualize the clockface positions of the femoral head-neck junction on the modified false-profile radiograph were 0.9° (0.8°-1.0°) for 3:00, 10.3° (10.0°-10.6°) for 2:30, 21.6° (21.0°-22.1°) for 2:00, 34.3° (33.6°-35.1°) for 1:30, 49.6° (48.6°-50.4°) for 1:00, 68.4° (67.7°-69.0°) for 12:30, and 90.1° (89.9°-90.4°) for 12:00. CONCLUSIONS Internal femur rotation of 35° during the false-profile radiograph may better visualize the femoral head-neck junction in the anterosuperior (1 to 2 o'clock) region commonly associated with the cam lesion. From this view, rotation angles between 0° and 90° can be used to visualize other regions of the anterosuperior femoral head-neck junction. CLINICAL RELEVANCE The internal rotation of the affected femur for a modified false-profile radiograph may provide a new radiographic view that can be used to quantify anterosuperior femoral head-neck morphology.
Collapse
|
34
|
Uemura K, Atkins PR, Fiorentino NM, Anderson AE. Hip rotation during standing and dynamic activities and the compensatory effect of femoral anteversion: An in-vivo analysis of asymptomatic young adults using three-dimensional computed tomography models and dual fluoroscopy. Gait Posture 2018; 61:276-281. [PMID: 29413797 PMCID: PMC6599491 DOI: 10.1016/j.gaitpost.2018.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals are thought to compensate for femoral anteversion by altering hip rotation. However, the relationship between hip rotation in a neutral position (i.e. static rotation) and dynamic hip rotation is poorly understood, as is the relationship between anteversion and hip rotation. RESEARCH OBJECTIVE Herein, anteversion and in-vivo hip rotation during standing, walking, and pivoting were measured in eleven asymptomatic, morphologically normal, young adults using three-dimensional computed tomography models and dual fluoroscopy. METHODS Using correlation analyses, we: 1) determined the relationship between hip rotation in the static position to that measured during dynamic activities, and 2) evaluated the association between femoral anteversion and hip rotation during dynamic activities. Hip rotation was calculated while standing (static-rotation), throughout gait, as a mean during gait (mean gait rotation), and as a mean (mid-pivot rotation), maximum (max-rotation) and minimum (min-rotation) during pivoting. RESULTS Static-rotation (mean ± standard deviation; 11.3° ± 7.3°) and mean gait rotation (7.8° ± 4.7°) were positively correlated (r = 0.679, p = 0.022). Likewise, static-rotation was strongly correlated with mid-pivot rotation (r = 0.837, p = 0.001), max-rotation (r = 0.754, p = 0.007), and min-rotation (r = 0.835, p = 0.001). Strong positive correlations were found between anteversion and hip internal rotation during all of the stance phase (0-60% gait) and during mid- and terminal-swing (86-100% gait) (all r > 0.607, p < 0.05). CONCLUSIONS Our results suggest that the static position may be used cautiously to express the neutral rotational position of the femur for dynamic movements. Further, our results indicate that femoral anteversion is compensated for by altering hip rotation. As such, both anteversion and hip rotation may be important to consider when diagnosing hip pathology and planning for surgical procedures.
Collapse
Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA.
| | - Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA.
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
| |
Collapse
|
35
|
Horsak B, Schwab C, Clemens C, Baca A, Greber-Platzer S, Kreissl A, Kranzl A. Is the reliability of 3D kinematics of young obese participants dependent on the hip joint center localization method used? Gait Posture 2018; 59:65-70. [PMID: 28992613 DOI: 10.1016/j.gaitpost.2017.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate if the test-retest reliability for three-dimensional (3D) gait kinematics in a young obese population is affected by using either a predictive (Davis) or a functional (SCoRE) hip joint center (HJC) localization approach. A secondary goal was to analyze how consistent both methods perform in estimating the HJC position. A convenience sample of ten participants, two females and eight males with an age-based body mass index (BMI) above the 97th percentile (mean±SD: 34.2±3.9kg/m2) was recruited. Participants underwent two 3D gait analysis sessions separated by a minimum of one day and a maximum of seven days. The standard error of measurement (SEM) and the root mean square error (RMSE) of key kinematic parameters along with the root mean square deviation (RMSD) of the entire waveforms were used to analyze the test-retest reliability. To get an estimate of the consistency of both HJC localization methods, the HJC positions determined by both methods were compared to each other. SEM, RMSE, and RMSD results indicate that the HJC position estimations between both methods are not different and demonstrate moderate to good reliability to estimate joint kinematics. With respect to the localization of the HJC, notable inconsistencies ranging from 0 to 5.4cm were observed. In conclusion, both approaches appear equally reliable. However, the inconsistent HJC estimation points out, that accuracy seems to be a big issue in these methods. Future research should attend to this matter.
Collapse
Affiliation(s)
- Brian Horsak
- St. Pölten University of Applied Sciences, Department of Physiotherapy, Austria.
| | - Caterine Schwab
- St. Pölten University of Applied Sciences, Department of Physiotherapy, Austria
| | - Christoph Clemens
- University of Vienna, Department of Biomechanics, Kinesiology and Applied Computer Science, Austria
| | - Arnold Baca
- University of Vienna, Department of Biomechanics, Kinesiology and Applied Computer Science, Austria
| | | | - Alexandra Kreissl
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Austria
| | - Andreas Kranzl
- Orthopaedic Hospital Vienna-Speising, Laboratory of Gait and Movement Analysis, Austria
| |
Collapse
|
36
|
Roach KE, Wang B, Kapron AL, Fiorentino NM, Saltzman CL, Bo Foreman K, Anderson AE. In Vivo Kinematics of the Tibiotalar and Subtalar Joints in Asymptomatic Subjects: A High-Speed Dual Fluoroscopy Study. J Biomech Eng 2017; 138:2539410. [PMID: 27455417 DOI: 10.1115/1.4034263] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/08/2022]
Abstract
Measurements of joint kinematics are essential to understand the pathomechanics of ankle disease and the effects of treatment. Traditional motion capture techniques do not provide measurements of independent tibiotalar and subtalar joint motion. In this study, high-speed dual fluoroscopy images of ten asymptomatic adults were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of each bone and dual fluoroscopy images were used to quantify in vivo kinematics for the tibiotalar and subtalar joints. Dynamic tibiotalar and subtalar mean joint angles often exhibited opposing trends during captured stance. During both speeds of walking, the tibiotalar joint had significantly greater dorsi/plantarflexion (D/P) angular ROM than the subtalar joint while the subtalar joint demonstrated greater inversion/eversion (In/Ev) and internal/external rotation (IR/ER) than the tibiotalar joint. During balanced heel-rise, only D/P and In/Ev were significantly different between the tibiotalar and subtalar joints. Translational ROM in the anterior/posterior (AP) direction was significantly greater in the subtalar than the tibiotalar joint during walking at 0.5 m/s. Overall, our results support the long-held belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. However, the subtalar joint provided considerable D/P rotation, and the tibiotalar joint rotated about all three axes, which, along with translational motion, suggests that each joint undergoes complex, 3D motion.
Collapse
|
37
|
Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Application of High-Speed Dual Fluoroscopy to Study In Vivo Tibiotalar and Subtalar Kinematics in Patients With Chronic Ankle Instability and Asymptomatic Control Subjects During Dynamic Activities. Foot Ankle Int 2017; 38:1236-1248. [PMID: 28800713 PMCID: PMC5914166 DOI: 10.1177/1071100717723128] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abnormal angular and translational (ie, kinematic) motion at the tibiotalar and subtalar joints is believed to cause osteoarthritis in patients with chronic ankle instability (CAI). METHODS In this preliminary study the investigators quantified and compared in vivo tibiotalar and subtalar kinematics in 4 patients with CAI (3 women) and 10 control subjects (5 men) using dual fluoroscopy during a balanced, single-leg heel-rise and treadmill walking at 0.5 and 1.0 m/s. RESULTS During balanced heel-rise, 69%, 54%, and 66% of mean CAI tibiotalar internal rotation/external rotation (IR/ER), subtalar inversion/eversion, and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 0.5-m/s gait, 50% and 60% of mean CAI tibiotalar dorsi/plantarflexion and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 1.0-m/s gait, 62%, 65%, and 73% of mean CAI subtalar dorsi/plantarflexion, inversion/eversion, and IR/ER, respectively, were outside the 95% confidence intervals of control subjects. Patients with CAI exhibited less tibiotalar and subtalar translational motion during gait; no clear differences in translations were noted during balanced heel-rise. CONCLUSION Overall, the balanced heel-rise activity exposed more tibiotalar and subtalar kinematic variation between patients with CAI and control subjects. Therefore, weight-bearing activities involving large range of motion, balance, and stability may be best for studying kinematic adaptations in patients with CAI. CLINICAL RELEVANCE These preliminary results suggest that patients with CAI require more tibiotalar external rotation, subtalar eversion, and subtalar external rotation during weight-bearing stability exercises, all with less overall joint translation.
Collapse
Affiliation(s)
- Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
- Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA
| |
Collapse
|
38
|
Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. In Vivo Measurements of the Ischiofemoral Space in Recreationally Active Participants During Dynamic Activities: A High-Speed Dual Fluoroscopy Study. Am J Sports Med 2017; 45:2901-2910. [PMID: 28682639 PMCID: PMC6599761 DOI: 10.1177/0363546517712990] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is a dynamic process, but its diagnosis is often based on static, supine images. PURPOSE To couple 3-dimensional (3D) computed tomography (CT) models with dual fluoroscopy (DF) images to quantify in vivo hip motion and the ischiofemoral space (IFS) in asymptomatic participants during weightbearing activities and evaluate the relationship of dynamic measurements with sex, hip kinematics, and the IFS measured from axial magnetic resonance imaging (MRI). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Eleven young, asymptomatic adults (5 female) were recruited. 3D reconstructions of the femur and pelvis were generated from MRI and CT. The axial and 3D IFS were measured from supine MRI. In vivo hip motion during weightbearing activities was quantified using DF. The bone-to-bone distance between the lesser trochanter and ischium was measured dynamically. The minimum and maximum IFS were determined and evaluated against hip joint angles using a linear mixed-effects model. RESULTS The minimum IFS occurred during external rotation for 10 of 11 participants. The IFS measured from axial MRI (mean, 23.7 mm [95% CI, 19.9-27.9]) was significantly greater than the minimum IFS observed during external rotation (mean, 10.8 mm [95% CI, 8.3-13.7]; P < .001), level walking (mean, 15.5 mm [95% CI, 11.4-19.7]; P = .007), and incline walking (mean, 15.8 mm [95% CI, 11.6-20.1]; P = .004) but not for standing. The IFS was reduced with extension (β = 0.66), adduction (β = 0.22), and external rotation (β = 0.21) ( P < .001 for all) during the dynamic activities observed. The IFS was smaller in female than male participants for standing (mean, 20.9 mm [95% CI, 19.3-22.3] vs 30.4 mm [95% CI, 27.2-33.8], respectively; P = .034), level walking (mean, 8.8 mm [95% CI, 7.5-9.9] vs 21.1 mm [95% CI, 18.7-23.6], respectively; P = .001), and incline walking (mean, 9.1 mm [95% CI, 7.4-10.8] vs 21.3 mm [95% CI, 18.8-24.1], respectively; P = .003). Joint angles between the sexes were not significantly different for any of the dynamic positions of interest. CONCLUSION The minimum IFS during dynamic activities was smaller than axial MRI measurements. Compared with male participants, the IFS in female participants was reduced during standing and walking, despite a lack of kinematic differences between the sexes. The relationship between the IFS and hip joint angles suggests that the hip should be placed into greater extension, adduction, and external rotation in clinical examinations and imaging, as the IFS measured from static images, especially in a neutral orientation, may not accurately represent the minimum IFS during dynamic motion. Nevertheless, this statement must be interpreted with caution, as only asymptomatic participants were analyzed herein.
Collapse
Affiliation(s)
- Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Travis G. Maak
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S Central Campus Drive Rm 3750, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way Suite 240, Salt Lake City, UT 84108, USA
| |
Collapse
|
39
|
Valentin S, Peham C, Zsoldos R, Licka T. A sphere fitting approach to determine the hip joint centre of the horse. COMPARATIVE EXERCISE PHYSIOLOGY 2017. [DOI: 10.3920/cep160039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Accurate identification of the hip joint centre (HJC) is crucial for the correct estimation of knee and hip joint loads and kinematics, which is particularly relevant in orthopaedic surgery and musculoskeletal modelling. Several methods have been described for calculation of the HJC in humans, however, no studies have used these methods in the horse despite a similar need for improved evaluation of hip joint biomechanics in rehabilitation and musculoskeletal modelling. This preliminary study uses the commonly used functional method (least-squares sphere fit) to determine the HJC in three equid cadavers. Bone pins with reflective markers attached were drilled into the tuber coxae (TC), tuber ischium (TI), tuber sacrale (TS), greater trochanter (GT), third trochanter (TT) and lateral femoral condyle (FC) of the uppermost limb of the cadavers positioned in lateral recumbency. Three repetitions of passive movements consisting of pro-and retraction, ab- and adduction and circumduction were performed. The HJC was calculated using a least-squares sphere fitting method and presented as a distance from the TC based on a percentage of the TC to TI vector magnitude. Mean (± standard deviation) of the HJC is located 52.4% (± 3.9) caudally, 0.2% (± 6.5) dorsally, and 19.8% (± 4.2) medially from the TC. This study is the first to quantify the HJC in horses ex vivo using a functional method. Further work (in vivo and imaging) is required to validate the findings of the present study.
Collapse
Affiliation(s)
- S. Valentin
- Institute for Clinical Exercise & Health Science, School of Science and Sport, University of the West of Scotland, Hamilton ML3 0JB, United Kingdom
| | - C. Peham
- Equine Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - R.R. Zsoldos
- Working Group Animal Breeding, Department of Sustainable Agricultural Systems, University of Natural Resources and Life Sciences Vienna, Gregor-Mendel-Straße 33, 1180 Vienna, Austria
| | - T.F. Licka
- Equine Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
- Large Animal Hospital, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin EH25 9RG, United Kingdom
| |
Collapse
|
40
|
Fiorentino NM, Atkins PR, Kutschke MJ, Goebel JM, Foreman KB, Anderson AE. Soft tissue artifact causes significant errors in the calculation of joint angles and range of motion at the hip. Gait Posture 2017; 55:184-190. [PMID: 28475981 PMCID: PMC9840870 DOI: 10.1016/j.gaitpost.2017.03.033] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
Soft tissue movement between reflective skin markers and underlying bone induces errors in gait analysis. These errors are known as soft tissue artifact (STA). Prior studies have not examined how STA affects hip joint angles and range of motion (ROM) during dynamic activities. Herein, we: 1) measured STA of skin markers on the pelvis and thigh during walking, hip abduction and hip rotation, 2) quantified errors in tracking the thigh, pelvis and hip joint angles/ROM, and 3) determined whether model constraints on hip joint degrees of freedom mitigated errors. Eleven asymptomatic young adults were imaged simultaneously with retroreflective skin markers (SM) and dual fluoroscopy (DF), an X-ray technique with sub-millimeter and sub-degree accuracy. STA, defined as the range of SM positions in the DF-measured bone anatomical frame, varied based on marker location, activity and subject. Considering all skin markers and activities, mean STA ranged from 0.3cm to 5.4cm. STA caused the hip joint angle tracked with SM to be 1.9° more extended, 0.6° more adducted, and 5.8° more internally rotated than the hip tracked with DF. ROM was reduced for SM measurements relative to DF, with the largest difference of 21.8° about the internal-external axis during hip rotation. Constraining the model did not consistently reduce angle errors. Our results indicate STA causes substantial errors, particularly for markers tracking the femur and during hip internal-external rotation. This study establishes the need for future research to develop methods minimizing STA of markers on the thigh and pelvis.
Collapse
Affiliation(s)
- Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J. Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Justine M. Goebel
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Corresponding author at: University of Utah Orthopaedics, 590 Wakara Way, RM A-100, Salt Lake City, UT, 84108, USA., (A.E. Anderson)
| |
Collapse
|
41
|
Fiorentino NM, Atkins PR, Kutschke MJ, Foreman KB, Anderson AE. In-vivo quantification of dynamic hip joint center errors and soft tissue artifact. Gait Posture 2016; 50:246-251. [PMID: 27693944 PMCID: PMC5119549 DOI: 10.1016/j.gaitpost.2016.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
Hip joint center (HJC) measurement error can adversely affect predictions from biomechanical models. Soft tissue artifact (STA) may exacerbate HJC errors during dynamic motions. We quantified HJC error and the effect of STA in 11 young, asymptomatic adults during six activities. Subjects were imaged simultaneously with reflective skin markers (SM) and dual fluoroscopy (DF), an x-ray based technique with submillimeter accuracy that does not suffer from STA. Five HJCs were defined from locations of SM using three predictive (i.e., based on regression) and two functional methods; these calculations were repeated using the DF solutions. Hip joint center motion was analyzed during six degrees-of-freedom (default) and three degrees-of-freedom hip joint kinematics. The position of the DF-measured femoral head center (FHC), served as the reference to calculate HJC error. The effect of STA was quantified with mean absolute deviation. HJC errors were (mean±SD) 16.6±8.4mm and 11.7±11.0mm using SM and DF solutions, respectively. HJC errors from SM measurements were all significantly different from the FHC in at least one anatomical direction during multiple activities. The mean absolute deviation of SM-based HJCs was 2.8±0.7mm, which was greater than that for the FHC (0.6±0.1mm), suggesting that STA caused approximately 2.2mm of spurious HJC motion. Constraining the hip joint to three degrees-of-freedom led to approximately 3.1mm of spurious HJC motion. Our results indicate that STA-induced motion of the HJC contributes to the overall error, but inaccuracies inherent with predictive and functional methods appear to be a larger source of error.
Collapse
Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
| |
Collapse
|