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Shin S, Kwak DS, Lee UY. Mobility and anthropometry of the sacroiliac joint: range of motion and morphological characteristics. Biomed Eng Lett 2024; 14:867-876. [PMID: 38946817 PMCID: PMC11208354 DOI: 10.1007/s13534-024-00382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/24/2024] [Accepted: 04/21/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose The sacroiliac joint (SIJ), a synovial joint with irregular surfaces, is crucial for stabilizing the body and facilitating daily activities. However, recent studies have reported that 15-30% of lower back pain can be attributed to instability in the SIJ, a condition collectively referred to as sacroiliac joint dysfunction (SIJD). The aim of this study is to investigate how the morphological characteristics of the auricular surface may influence the SIJ range of motion (ROM) and to examine differences in SIJ ROM between females and males, thereby contributing to the enhancement of SIJD diagnosis and treatment. Methods We measured SIJ ROM using motion-analysis cameras in 24 fresh cadavers of Korean adults (13 males and 11 females). Using three-dimensional renderings of the measured auricular surface, we investigated the correlations between the morphological characteristics of the auricular surface and the ROM of the SIJ. Results The SIJ ROM was between 0.2° and 6.7° and was significantly greater in females (3.58° ± 1.49) compared with males (1.38° ± 1.00). Dividing the participants into high-motion (3.87° ± 1.19) and low-motion (1.13° ± 0.62) groups based on the mean ROM (2.39°) showed no significant differences in any measurements. Additionally, bone defects around the SIJ were identified using computed tomography of the high-motion group. In the low-motion group, calcification between auricular surfaces and bone bridges was observed. Conclusion This suggests that the SIJ ROM is influenced more by the anatomical structures around the SIJ than by the morphological characteristics of the auricular surface.
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Affiliation(s)
- Seonjin Shin
- Department of Biomedicine & Health Science, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - U-Young Lee
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
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Toyohara R, Ohashi T. A literature review of biomechanical studies on physiological and pathological sacroiliac joints: Articular surface structure, joint motion, dysfunction and treatments. Clin Biomech (Bristol, Avon) 2024; 114:106233. [PMID: 38531152 DOI: 10.1016/j.clinbiomech.2024.106233] [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: 12/12/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Sacroiliac joints are affected by mechanical environments; the joints are formed under mechanical stimulation, receive impact of walking between the upper and lower parts of the bodies and can be a cause of pain due to non-physiological loads. However, there are so far very few studies that reviewed biomechanics of physiological and pathological sacroiliac joints. This review article aims to describe the current sacroiliac joint biomechanics. METHODS Previous original papers have been summarized based on three categories: articular surface structure, sacroiliac joint motion and sacroiliac joint dysfunction and treatments. FINDINGS Although the articular surface morphologies vary greatly from individual to individual, many researchers have tried to classify the joints into several types. It has been suggested that the surface morphologies may not change regardless of joint dysfunction, however, the relationship between the joint structure and pain are still unclear. The range of sacroiliac joint motion is demonstrated to be less than 1 mm and there is no difference between physiological and pathological joints. The sacroiliac joint absorbs shock within the pelvis by the joint structures of pelvic morphology, ligaments and fat tissues. The morphology and motion of the sacroiliac joints may be optimized for upright bipedal walking. INTERPRETATION There is no doubt that pelvic mechanical environments affect pain induction and treatment; however, no one has yet provided a concrete explanation. Future research could help develop treatments based on sacroiliac joint biomechanics to support joint function.
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Affiliation(s)
- Ryota Toyohara
- Faculty of Engineering, Hokkaido University, Japan; Creative Research Institution, Hokkaido University, Japan.
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Toyohara R, Hammer N, Ohashi T. Experimental characterization of motion resistance of the sacroiliac joint. Biomed Mater Eng 2024; 35:53-63. [PMID: 37545208 DOI: 10.3233/bme-230041] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND The human sacroiliac joint (SIJ) in vivo is exposed to compressive and shearing stress environment, given the joint lines are almost parallel to the direction of gravity. The SIJ supports efficient bipedal walking. Unexpected or unphysiological, repeated impacts are believed to cause joint misalignment and result in SIJ pain. In the anterior compartment of the SIJ being synovial, the articular surface presents fine irregularities, potentially restricting the motion of the joints. OBJECTIVE To clarify how the SIJ articular surface affects the resistance of the motion under physiological loading. METHODS SIJ surface models were created based on computed tomography data of three patients and subsequently 3D printed. Shear resistance was measured in four directions and three combined positions using a customized setup. In addition, repositionability of SIJs was investigated by unloading a shear force. RESULTS Shear resistance of the SIJ was the highest in the inferior direction. It changed depending on the direction of the shear and the alignment position of the articular surface. CONCLUSION SIJ articular surface morphology is likely designed to accommodate upright bipedal walking. Joint misalignment may in consequence increase the risk of subluxation.
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Affiliation(s)
- Ryota Toyohara
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Niels Hammer
- Division of Clinical and Macroscopic Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (IWU), Chemnitz, Germany
| | - Toshiro Ohashi
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
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Øhrn FD, Engseth LHW, Pripp AH, Röhrl SMH, Schulz A. Dose reduction does not impact the precision of CT-based RSA in tibial implants: a diagnostic accuracy study on precision in a porcine cadaver. Acta Orthop 2023; 94:550-544. [PMID: 37909103 PMCID: PMC10618912 DOI: 10.2340/17453674.2023.24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/08/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is the gold standard for evaluation of migration of implants. CT-RSA has been shown to have precision at the level of RSA in hip, shoulder, and knee joint replacements. We aimed to assess the impact of dose reduction on precision of CT-RSA on tibial implants, comparing it with previously published data on precision of standard dose CT-RSA on tibial implants. MATERIAL AND METHODS We performed a total knee arthroplasty on a porcine knee cadaver, and subsequent CT-RSA with low effective doses (0.02 mSv). We compared the results with previously published CT-RSA data with standard (0.08 mSv) dose. The primary outcome variable was the difference in precision of the maximum total translation (MTT). Secondary variables included ratios of variances and standard deviations, and precision of peripheral point translations, center-of-mass translations, and rotations. A difference of more than 0.1 mm in precision was defined as clinically relevant. Our hypothesis was that precisions of low and standard CT-RSA doses were equal. RESULTS Low dose (mean 0.07, 95% confidence interval [CI] 0.06-0.08) and standard dose CT-RSA (0.08, CI 0.07-0.09) achieve similar precision, with difference in precision of MTT of 0.01, CI 0.00-0.02 mm. The F-statistic (0.99, CI 0.63-1.55) and sdtest (1.05, CI 0.43-2.58) also supported this. CONCLUSION We conclude that the precision of low dose CT-RSA for tibial implants on a porcine cadaver is equal to standard dose CT-RSA. However, these findings should be confirmed in clinical trials.
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Affiliation(s)
- Frank-David Øhrn
- Orthopaedic Department, Kristiansund Hospital, Møre and Romsdal Hospital Trust, Kristiansund; Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science (INB), NTNU Norwegian University of Science and Technology.
| | - Lars H W Engseth
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - Stephan M H Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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Engseth LHW, Schulz A, Pripp AH, Röhrl SMH, Øhrn FD. CT-based migration analysis is more precise than radiostereometric analysis for tibial implants: a phantom study on a porcine cadaver. Acta Orthop 2023; 94:207-214. [PMID: 37114404 PMCID: PMC10141323 DOI: 10.2340/17453674.2023.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is the gold standard for migration analysis, but computed tomography analysis methods (CTRSA) have shown comparable results in other joints. We attempted to validate precision for CT compared with RSA for a tibial implant. MATERIAL AND METHODS RSA and CT were performed on a porcine knee with a tibial implant. Marker-based RSA, model-based RSA (MBRSA), and CT scans from 2 different manufacturers were compared. CT analysis was performed by 2 raters for reliability evaluation. RESULTS 21 double examinations for precision measurements for RSA and CT-based Micromotion Analysis (CTMA) were analysed. Mean (95% confidence interval) precision data for maximum total point motion (MTPM) using marker-based RSA was 0.45 (0.19-0.70) and 0.58 (0.20-0.96) using MBRSA (F-statistic 0.44 [95% CI 0.18-1.1], p = 0.07). Precision data for total translation (TT) for CTMA was 0.08 (0.03-0.12) for the GE scanner and 0.11 (0.04-0.19) for the Siemens scanner (F-statistic 0.37 [0.15-0.91], p = 0.03). When comparing the aforementioned precision for both RSA methods with both CTMA analyses, CTMA was more precise (p < 0.001). The same pattern was seen for other translations and migrations. Mean effective radiation doses were 0.005 mSv (RSA) (0.0048-0.0050) and 0.08 mSv (CT) (0.078-0.080) (p < 0.001). Intra- and interrater reliability were 0.79 (0.75-0.82) and 0.77 (0.72-0.82), respectively. CONCLUSION CTMA is more precise than RSA for migration analysis of a tibial implant, has overall good intra- and interrater reliability but higher effective radiation doses in a porcine cadaver.
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Affiliation(s)
- Lars H W Engseth
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo.
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - Stephan M H Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Frank-David Øhrn
- Orthopaedic Department, Kristiansund Hospital, Møre and Romsdal Hospital Trust, Kristiansund; Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science (INB), NTNU Norwegian University of Science and Technology, Norway
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Toyohara R, Hiramukai T, Kurosawa D, Hammer N, Ohashi T. Numerical analysis of the effects of padded pelvic belts as a treatment for sacroiliac joint dysfunction. Biomed Mater Eng 2022:BME221490. [DOI: 10.3233/bme-221490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND: Pain related to the sacroiliac joint (SIJ) accounts for low back pain in 15%–30% of patients. One of the most common treatment options is the use of pelvic belts. Various types of pelvic belts exist; however, the mechanisms underlying treatment and their effectiveness remain unclear to date. OBJECTIVE: To analyze stress distribution in the pelvis when a pelvic rubber belt or a padded pelvic belt is applied, to assess the effectiveness of treatment from a numerical biomechanical perspective. METHODS: The pressure distribution at the pelvic belts was measured using a device and subsequently modeled with the finite element method of a pelvis with soft tissues. The stress environment when wearing a pelvic belt in a double-leg stance was simulated. RESULTS: With the application of pelvic belts, the innominate bone rotated outward, which was termed an out-flare. This caused the SIJ to compress and cause reduction in sacrotuberous, sacrospinous, interosseous, and posterior sacroiliac ligament loading. Padded pelvic belts decreased the SIJ displacement to a greater extent than in pelvic rubber belts. CONCLUSION: Pelvic belts aid in compressing the SIJ and reduce its mobility.
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Affiliation(s)
| | | | | | - Niels Hammer
- , , Medical University of Graz, , Austria
- , University of Leipzig, , Germany
- , Fraunhofer Institute for Machine Tools and Forming Technology (IWU), , Germany
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Ribeiro RP, Guerrero FG, Camargo EN, Pivotto LR, Aimi MA, Loss JF, Candotti CT. Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT). J Osteopath Med 2021; 121:849-856. [PMID: 34551460 DOI: 10.1515/jom-2021-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/29/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. OBJECTIVES This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). METHODS In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized. RESULTS The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=-0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836). CONCLUSIONS The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.
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Affiliation(s)
- Rafael P Ribeiro
- School of Physical Education, Physiotherapy and Dance (ESEFID), Brazilian Institute of Osteopathy (IBO), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Filipe G Guerrero
- Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo N Camargo
- School of Physical Education, Physiotherapy and Dance (ESEFID), Brazilian Institute of Osteopathy (IBO), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Brazilian Institute of Osteopathy (IBO), Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiza R Pivotto
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Mateus A Aimi
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Jefferson F Loss
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia T Candotti
- School of Physical Education, Physiotherapy and Dance (ESEFID), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Øhrn FD, Lian ØB, Tsukanaka M, Röhrl SM. Early migration of a medially stabilized total knee arthroplasty : a radiostereometric analysis study up to two years. Bone Jt Open 2021; 2:737-744. [PMID: 34493056 PMCID: PMC8479839 DOI: 10.1302/2633-1462.29.bjo-2021-0115.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims Medial pivot (MP) total knee arthroplasties (TKAs) were designed to mimic native knee kinematics with their deep medial congruent fitting of the tibia to the femur almost like a ball-on-socket, and a flat lateral part. GMK Sphere is a novel MP implant. Our primary aim was to study the migration pattern of the tibial tray of this TKA. Methods A total of 31 patients were recruited to this single-group radiostereometric analysis (RSA) study and received a medial pivot GMK Sphere TKA. The distributions of male patients versus female patients and right versus left knees were 21:10 and 17:14, respectively. Mean BMI was 29 kg/m2 (95% confidence interval (CI) 27 to 30) and mean age at surgery was 63 years (95% CI 61 to 66). Maximum total point motions (MTPMs), medial, proximal, and anterior translations and transversal, internal, and varus rotations were calculated at three, 12, and 24 months. Patient-reported outcome measure data were also retrieved. Results MTPMs at three, 12, and 24 months were 1.0 mm (95% CI 0.8 to 1.2), 1.3 mm (95% CI 0.9 to 1.7), and 1.4 mm (0.8 to 2.0), respectively. The Forgotten Joint Score was 79 (95% CI 39 to 95) and Knee Injury and Osteoarthritis Outcome Score obtained at two years was 94 (95% CI 81 to 100), 86 (95% CI 75 to 93), 94 (95% CI 88 to 100), 69 (95% CI 48 to 88), and 81 (95% CI59 to 100) for Pain, Symptoms, Activities of Daily Living, Sport & Recreation, and Quality of Life, respectively. Conclusion In conclusion, we found that the mean increase in MTPM was lower than 0.2 mm between 12 and 24 months and thus apparently stable. Yet the GMK Sphere had higher migration at one and two years than anticipated. Based on current RSA data, we therefore cannot conclude on the long-term performance of the implant, pending further assessment. Cite this article: Bone Jt Open 2021;2(9):737–744.
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Affiliation(s)
- Frank-David Øhrn
- Kristiansund Hospital, Møre and Romsdal Health Trust, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Bjerkestrand Lian
- Kristiansund Hospital, Møre and Romsdal Health Trust, Kristiansund, Norway.,Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan Maximillian Röhrl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Keller MC, Hurschler C, Schwarze M. Experimental evaluation of precision and accuracy of RSA in the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2060-2068. [PMID: 33275168 DOI: 10.1007/s00586-020-06672-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Roentgen stereophotogrammetric analysis is a technique to make accurate assessments of the relative position and orientation of bone structures and implants in vivo. While the precision and accuracy of stereophotogrammetry for hip and knee arthroplasty is well documented, there is insufficient knowledge of the technique's precision and, especially accuracy when applied to rotational movements in the spinal region. METHODS The motion of one cadaver lumbar spine segment (L3/L4) was analyzed in flexion-extension, lateral bending and internal rotation. The specific aim of this study was to examine the precision and accuracy of stereophotogrammetry in a controlled in vitro setting, taking the surrounding soft tissue into account. The second objective of this study was to investigate the effect of different focal spot values of X-ray tubes. RESULTS Overall, the precision of flexion-extension measurements was found to be better when using a 0.6 mm focal spot value rather than 1.2 mm (± 0.056° and ± 0.153°; respectively), and accuracy was also slightly better for the 0.6 mm focal spot value compared to 1.2 mm (- 0.137° and - 0.170°; respectively). The best values for precision and accuracy were obtained in lateral bending for both 0.6 mm and 1.2 mm focal spot values (precision: ± 0.019° and ± 0.015°, respectively; accuracy: - 0.041° and - 0.035°). CONCLUSION In summary, the results suggest stereophotogrammetry to be a highly precise method to analyze motion of the lumbar spine. Since precision and accuracy are better than 0.2° for both focal spot values, the choice between these is of minor clinical relevance.
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Affiliation(s)
- Marie Christina Keller
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Cho HJ, Kwak DS. Movement of the sacroiliac joint: Anatomy, systematic review, and biomechanical considerations. Proc Inst Mech Eng H 2020; 235:357-364. [PMID: 33256545 DOI: 10.1177/0954411920978021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several researchers investigated the anatomy and biomechanics of the sacroiliac joint (SIJ) to understand the relationship between lower back pain and the SIJ. Many studies concluded that the SIJ has little movement; however, some studies using spinopelvic parameters mentioned high change in pelvic incidence (PI). In this study, SIJ movement and PI change reported in previous studies were reviewed according to position and posture changes. Literature on SIJ movement was reviewed by searching through the publication databases. In biomechanical studies, the result of the rotational angle in the sagittal plane was mainly investigated to compare with the results of PI change. From the results of SIJ movement studies, the minimum movement of nutation and count-nutation was 0.01°, and maximum movement was 2.27°. From the results of PI change studies with different positions and movements, the highest change was 9°, and the lowest change was 0°. Movement of the SIJ was limited by its anatomical structure; maximum movement of the SIJ was 9° in a previous study. Therefore, SIJ movement should be studied more intensely as biomechanical perspective to understand its movement.
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Affiliation(s)
- Ho-Jung Cho
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Trunk, pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women. Clin Biomech (Bristol, Avon) 2020; 80:105168. [PMID: 32920251 DOI: 10.1016/j.clinbiomech.2020.105168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test. METHODS In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance. FINDINGS Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (-2.4°, 0.3°) and 1.0° (-0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups. INTERPRETATION Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.
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Ladurner A, Callary SA, Mitra A, Rickman M, Thewlis D, Solomon LB. Radiostereometric Analysis Allows Assessment of the Stability and Inducible Displacement of Pelvic Ring Disruptions during Healing: A Case Series. J Clin Med 2020; 9:jcm9113411. [PMID: 33114372 PMCID: PMC7692147 DOI: 10.3390/jcm9113411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/18/2022] Open
Abstract
There is currently no accurate data on fracture displacement during the rehabilitation of pelvic ring injuries. This study investigated the use of radiostereometric analysis (RSA) in assessing the stability of C1 pelvic ring injuries stabilised with a posterior plate and an anterior external fixator. Six patients, instructed to weight-bear as tolerated after surgery, were reviewed at 2, 4, 6, 12, 26, 52 and 104 weeks. The external fixators were removed at 6 weeks. Outcomes, including the Iowa Pelvic Score (IPS), and complications were recorded. Fracture stability was assessed using measurements on plain radiographs and RSA. All patients progressed to full weight-bearing without support within 6 weeks. At 104 weeks, the IPS was excellent in four patients, good in one patient and fair in one patient. Plain radiographs showed that all fractures were well reduced, and no loss of reduction occurred over time. By contrast, RSA measurements identified displacement in all cases. The maximum three-dimensional (3D) displacement at any time point in each patient ranged from 2 to 10 mm. Two patients with the largest displacement over time had the lowest IPS. RSA also demonstrated displacements above the currently defined normal threshold through the ‘un-injured’ sacroiliac joint in the same two patients, suggesting a subtle C2 injury, missed at initial assessment. This study demonstrates the limitations of plain radiographs in assessing pelvic fracture stability and displacement during healing, and the potential of RSA to monitor more accurately the effects of stabilisation and weight-bearing on fracture stability.
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Affiliation(s)
- Andreas Ladurner
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (A.L.); (S.A.C.); (M.R.)
| | - Stuart A. Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (A.L.); (S.A.C.); (M.R.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Aniruddha Mitra
- Department of Orthopaedics and Trauma, Warrnambool Hospital, Warrnambool, VIC 3280, Australia;
| | - Mark Rickman
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (A.L.); (S.A.C.); (M.R.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Lucian B. Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (A.L.); (S.A.C.); (M.R.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
- Correspondence:
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13
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Challis JH. Quaternions as a solution to determining the angular kinematics of human movement. BMC Biomed Eng 2020; 2:5. [PMID: 32903359 PMCID: PMC7422562 DOI: 10.1186/s42490-020-00039-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
The three-dimensional description of rigid body kinematics is a key step in many studies in biomechanics. There are several options for describing rigid body orientation including Cardan angles, Euler angles, and quaternions; the utility of quaternions will be reviewed and elaborated. The orientation of a rigid body or a joint between rigid bodies can be described by a quaternion which consists of four variables compared with Cardan or Euler angles (which require three variables). A quaternion, q = (q 0, q 1, q 2, q 3), can be considered a rotation (Ω = 2 cos-1(q 0)), about an axis defined by a unit direction vector q 1 / sin Ω 2 q 2 / sin Ω 2 q 3 / sin Ω 2 . The quaternion, compared with Cardan and Euler angles, does not suffer from singularities or Codman's paradox. Three-dimensional angular kinematics are defined on the surface of a unit hypersphere which means numerical procedures for orientation averaging and interpolation must take account of the shape of this surface rather than assuming that Euclidean geometry based procedures are appropriate. Numerical simulations demonstrate the utility of quaternions for averaging three-dimensional orientations. In addition the use of quaternions for the interpolation of three-dimensional orientations, and for determining three-dimensional orientation derivatives is reviewed. The unambiguous nature of defining rigid body orientation in three-dimensions using a quaternion, and its simple averaging and interpolation gives it great utility for the kinematic analysis of human movement.
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Affiliation(s)
- John H Challis
- Biomechanics Laboratory, Pennsylvania State University, University Park, PA 16802 USA
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14
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Finite element analysis of load transition on sacroiliac joint during bipedal walking. Sci Rep 2020; 10:13683. [PMID: 32792529 PMCID: PMC7426964 DOI: 10.1038/s41598-020-70676-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
The sacroiliac joint (SIJ) is burdened with variant loads. However, no methods have allowed to measure objectively how the SIJ deforms during bipedal walking. In this study, in-vivo walking conditions were replicated in a kinematic model combining the finite element method with 3D walking analysis data divided into five phases in order to visualize the load transition on the SIJ and clarify the role of the SIJ. Both models with and without inclusion of the SIJ were investigated. In models with bilateral SIJs, the displacement differed greatly between the sacrum and both hip bones on the SIJ as the boundary. The movements of the sacrum involved a nutation movement in the stance phase and a counter-nutation in the swing phase relative to the ilium. In models without SIJs, the displacement of the pelvis and loads of pelvic ligaments decreased, and the equivalent stress of the SIJs increased compared to the model with SIJs. The walking loads cause distortion of the entire pelvis, and stress concentration at the SIJ are seen due to the morphology of the pelvic ring. However, the SIJs help dissipate the resulting stresses, and the surrounding ligaments are likewise involved in load transmission.
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15
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Parashin S, Gascoyne T, Zarrabian M. A phantom and cadaveric study of radiostereometric analysis in posterior cervical and lumbar spinal fusion. Spine J 2020; 20:1333-1343. [PMID: 32272254 DOI: 10.1016/j.spinee.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Detecting pseudarthrosis following spinal fusion is important for accurate diagnosis and treatment. Current diagnostic measures hold certain drawbacks. Radiostereometric analysis (RSA) is a radiographic technique with the capability to measure intervertebral segment changes and may be a novel way of assessing fusion. PURPOSE The purpose of this work was to measure the accuracy and precision of RSA in instrumented posterior cervical and lumbar spinal fusion for measuring intervertebral movement. Further, to gain surgical practice with RSA in spine and determine optimal bead placements. STUDY DESIGN Artificial bone and cadaveric spine models were used to simulate a 3-level cervical (C3-C6) and a 2-level (L4-S1) lumbosacral posterior spinal fusion to analyze bead placements and to measure RSA accuracy and precision. METHODS Preliminary RSA bead placements were planned and measured in the artificial model. Secondary bead placements were adjusted slightly in the cadaveric model to consider additional fusion scenarios. Bead spread, detectability, and stability were measured to determine optimal placements. Translational and rotational precision of both models were measured. Accuracy was measured in the artificial spine model. Model-based RSA software was used for analysis. RESULTS Optimal bead placements were found to be throughout the lateral mass of C3-C6 and in the spinous process, transverse process, and within the screw canal of L4-S1. Detectability was high among all segments. Spread was greater in L4-S1 than C3-C6 due to bead collinearity along the transverse axis of the cervical vertebrae. Translational and rotational RSA accuracy in cervical and lumbosacral regions ranged between 0.005 to 0.014 mm and 0.058 to 0.208°. Translational and rotational precision measured in the phantom models ranged 0.017 to 0.131 mm and 0.058 to 0.394° in C3-C6, and 0.086 to 0.191 mm and 0.200 to 0.369° in L4-S1. Translational and rotational precision measured in the cadaveric models ranged 0.054 to 0.548 mm and 0.148 to 1.386° in C3-C6, and 0.068 to 0.164 mm and 0.100 to 0.270° in L4-S1. CONCLUSIONS RSA was found to be a feasible radiographic technique in C3-C6 and L4-S1 spinal fusion when measured in artificial and cadaveric models. Optimal bead placements were determined. Bead spread was shown to be better throughout the lumbar region than the cervical region due to anatomical size variations. RSA accuracy and precision were within acceptable RSA criteria. CLINICAL SIGNIFICANCE The results from this work contribute to the accuracy, precision, and bead placements for studying RSA in cervical and lumbar spinal fusions. This work may further support the development of clinical studies to assess spinal fusion by evaluating postoperative intervertebral movement using RSA.
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Affiliation(s)
- Sara Parashin
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9.
| | - Trevor Gascoyne
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9
| | - Mohammad Zarrabian
- Department of Surgery, Faculty of Medicine, AE 101-820 Sherbrook Street, University of Manitoba, Winnipeg, Manitoba, Canada, R3A 1R9
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16
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Author Response to Cibulka. Phys Ther 2020; 100:pzaa047. [PMID: 32242632 DOI: 10.1093/ptj/pzaa047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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17
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Challis JH. Short Communication: Determining the average attitude of a rigid body. J Biomech 2020; 98:109492. [PMID: 31733819 DOI: 10.1016/j.jbiomech.2019.109492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
Three-dimensional angular kinematics exist on the surface of a unit hypersphere, therefore the average attitude cannot always be accurately computed by averaging Cardan angles. This study derives and evaluates a method for determining average body attitude, by exploiting the singular value decomposition of the average of a set of attitude matrices. To test the method 1000 criterion attitudes were determined, and for each attitude 10 noisy attitude matrices generated. The new method and the averaging of Cardan angles extracted from the 10 noisy attitude matrices were evaluated for their ability to estimate the criterion attitude. At low attitude variance the two approaches provided equivalent results, but with increasing attitude variance levels the new procedure was superior. The method provides superior estimates of average attitude compared with averaging Cardan angles, by accounting for the geometric distribution of rigid body attitudes on the surface of a unit hypersphere.
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Affiliation(s)
- John H Challis
- Biomechanics Laboratory, Pennsylvania State University, University Park, USA.
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18
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Casaroli G, Bassani T, Brayda-Bruno M, Luca A, Galbusera F. What do we know about the biomechanics of the sacroiliac joint and of sacropelvic fixation? A literature review. Med Eng Phys 2019; 76:1-12. [PMID: 31866118 DOI: 10.1016/j.medengphy.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this review is to summarize the general knowledge about the biomechanics of the sacroiliac joint and sacropelvic fixation techniques. Additionally, this study aims to support biomechanical investigations in defining experimental protocols as well as numerical modeling of the sacropelvic structures. The sacroiliac joint is characterized by a large variability of shape and ranges of motion among individuals. Although the ligament network and the anatomical features strongly limit the joint movements, sacroiliac displacements and rotations are not negligible. Currently available treatments for sacroiliac joint dysfunction include physical therapy, steroid injections, Radio-frequency ablation of specific neural structures, and open or minimally invasive SIJ fusion. In long posterior construct, the most common solutions are the iliac screws and the S2 alar - iliac screws, whereas for the joint fixation alone, mini - invasive alternative system can be used. Several studies reported the clinical outcomes of the different techniques and investigated the biomechanical stability of the relative construct, but the effect of sacropelvic fixation techniques on the joint flexibility and on the stress generated into the bone is still unknown. In our opinion, more biomechanical analyses on the behavior of the sacroiliac joint may be performed in order to better predict the risk of failure or instability of the joint.
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Affiliation(s)
- Gloria Casaroli
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Marco Brayda-Bruno
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Andrea Luca
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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19
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Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019; 99:1511-1519. [PMID: 31355883 DOI: 10.1093/ptj/pzz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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20
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Van Hauwermeiren L, Verstraete M, Stouthandel MEJ, Van Oevelen A, De Gersem W, Delrue L, Achten E, Adriaens D, Van Hoof T. Joint coordinate system for biomechanical analysis of the sacroiliac joint. J Orthop Res 2019; 37:1101-1109. [PMID: 30839121 DOI: 10.1002/jor.24271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
Sacroiliac joint (SIJ) biomechanics have been described in both in vitro and in vivo studies. A standard for joint coordinate systems has been created by the International Society of Biomechanics for most of the joints in the human body. However, a standardized joint coordinate system for sacroiliac joint motion analysis is currently still lacking. This impedes the comparison across studies and hinders communication among scientists and clinicians. As SIJ motion is reported to be quite limited, a proper standardization and reproducibility of this procedure is essential for the interpretation of future biomechanical SIJ studies. This paper proposes a joint coordinate system for the analysis of sacroiliac joint motion, based on the procedure developed by Grood and Suntay, using semi-automated anatomical landmarks on 3D joint surfaces. This coordinate system offers high inter-rater reliability and aspires to a more intuitive representation of biomechanical data, as it is aligned with SIJ articular surfaces. This study aims to encourage further reflection and debate on biomechanical data representation, in order to facilitate interpretation of SIJ biomechanics and improve communication between researchers and clinicians. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
| | - Matthias Verstraete
- Department of Physical Medicine and Orthopedic Surgery, Ghent University, Ghent, Belgium
| | - Michael E J Stouthandel
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Aline Van Oevelen
- Department of Anatomy and Embryology, Ghent University, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Louke Delrue
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique Adriaens
- Department of Biology (Evolutionary Morphology of Vertebrates), Ghent University, Ghent, Belgium
| | - Tom Van Hoof
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
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21
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Hammer N, Scholze M, Kibsgård T, Klima S, Schleifenbaum S, Seidel T, Werner M, Grunert R. Physiological in vitro sacroiliac joint motion: a study on three-dimensional posterior pelvic ring kinematics. J Anat 2018; 234:346-358. [PMID: 30536830 DOI: 10.1111/joa.12924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 12/28/2022] Open
Abstract
The sacroiliac joint (SIJ) is a well-known source of low back and pelvic pain, of increasing interest for both conservative and surgical treatment. Alterations in the kinematics of the pelvis have been hypothesized as a major cause of SIJ-related pain. However, definitions of both the range and the extent of physiological movement are controversial, and there are no clear baseline data for pathological alterations. The present study combined a novel biomechanical setup allowing for physiological motion of the lumbosacral transition and pelvis without restricting the SIJ movement in vitro, combined with optical image correlation. Six fresh human pelvises (81 ± 10 years, three females, three males) were tested, with bodyweight-adapted loading applied to the fifth lumbar vertebra and both acetabula. Deformation at the lumbopelvises was determined computationally from three-dimensional image correlation data. Sacroiliac joint motion under the loading of 100% bodyweight primarily consisted of a z-axis rotation (0.16°) and an inferior translation of the sacrum relative to the ilium (0.32 mm). Sacroiliac joint flexion-extension rotations were minute (< 0.02°). Corresponding movements of the SIJ were found at the lumbosacral transition, with an anterior translation of L5 relative to the sacrum of -0.97 mm and an inferior translation of 0.11 mm, respectively. Moreover, a flexion of 1.82° was observed at the lumbosacral transition. Within the innominate bone and at the pubic symphysis, small complementary rotations were seen around a vertical axis, accounting for -0.10° and 0.11°, respectively. Other motions were minute and accompanied by large interindividual variation. The present study provides evidence of different SIJ motions than reported previously when exerted by physiological loading. Sacroiliac joint kinematics were in the sub-degree and sub-millimeter range, in line with previous in vivo and in vitro findings, largely limited to the sagittal rotation and an inferior translation of the sacrum relative to the ilium. This given physiological loading scenario underlines the relevance of the lumbosacral transition when considering the overall motion of the lumbopelvis, and how relatively little the other segments contribute to overall motion.
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Affiliation(s)
- Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany.,Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Mario Scholze
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Institute of Materials Science and Engineering, Chemnitz University of Technology, Chemnitz, Germany
| | - Thomas Kibsgård
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Stefan Klima
- Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany.,Orthopaedicus Clinics, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopedic and Trauma Surgery, University Clinics of Leipzig, Germany
| | - Thomas Seidel
- Institute of Cellular and Molecular Physiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Department of Anatomy, University of Leipzig, Germany
| | - Ronny Grunert
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Department of Neurosurgery, University of Leipzig, Leipzig, Germany
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22
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Fraser AN, Tsukanaka M, Fjalestad T, Madsen JE, Röhrl SM. Model-based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty. J Orthop Res 2018; 36:3299-3307. [PMID: 30035319 DOI: 10.1002/jor.24111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
This study aims to validate model-based radiostereometric analysis (RSA) on the glenoid component of reversed total shoulder arthroplasty. We compared two different modalities of model-based RSA, elementary geometrical shapes and reversed engineering. We also explored two different ways to position the patient to obtain different projections of the implant, the hip-position (transversal) and shoulder-position (sagittal). Phantom accuracy was determined by performing nine translations (x, y, z) and five rotations (x, y, z), and expressed as the mean difference between RSA measurements and micrometer values. Precision was measured using 12 double examinations of the phantom and 19 in patients, and expressed as1.96 × standard deviations of the paired differences between double examinations. The accuracy was high for both modalities, but rotation around the symmetrical axis of the implant could not be measured using reversed engineering. Clinical precision ranged from 0.13 to 0.25 mm for translations, and 0.4° to 0.7° for rotations, using reversed engineering. For elementary geometrical shapes, the precision ranged from 0.18 to 0.34 mm for translations, and 0.8° to 1.8° for rotations. The hip-position was abandoned due to poor implant visualization. Model-based RSA on the glenoid component of reversed total shoulder arthroplasty has a high precision and accuracy, comparable to RSA results on hips and knees. Patient positioning is vital for obtaining adequate results. We found that reversed engineering was the more reliable method, and recommend reversed engineering as the method of choice for further clinical RSA investigation of the glenoid component of reversed total shoulder arthroplasty. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3299-3307, 2018.
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Affiliation(s)
- Alexander Nilsskog Fraser
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tore Fjalestad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan E Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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23
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Holm-Glad T, Reigstad O, Tsukanaka M, Røkkum M, Röhrl SM. High precision and accuracy of model-based RSA for analysis of wrist arthroplasty. J Orthop Res 2018; 36:3053-3063. [PMID: 29873422 DOI: 10.1002/jor.24063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/03/2018] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is a method for measuring micromotion in joint arthroplasties. RSA has never been used in total wrist arthroplasties. We evaluated: (i) the precision of model-based RSA in total wrist arthroplasties measured in a phantom model and in patients; (ii) the number of bone markers necessary to ensure the precision; and (iii) the accuracy of model-based RSA in a phantom model. Reverse engineered models of radial and carpal/metacarpal components of two wrist arthroplasties (ReMotion® and Motec®) were obtained by laser scanning. Precision and accuracy of each arthroplasty were analyzed with regards to translation and rotation along the three coordinate axes. Precision was analyzed in 10 phantom and 30 clinical double examinations for each arthroplasty, and was expressed by a repeatability coefficient. The precision of different numbers and configurations of bone markers in the phantom model were compared. Accuracy was tested in a phantom model where the implants were attached to a micrometer, and was defined as the mean difference between measured and true migration. In the phantom model the precision for translations ranged from 0.03 to 0.14 mm and for rotations from 0.18 to 1.52°. In patients the precision for translations ranged from 0.06 to 0.18 mm, and for rotations from 0.32 to 2.18°. Less than four bone markers resulted in inferior precision. Accuracy ranged from -0.06 to 0.04 mm, and from -0.38 to -0.01°. Y-rotations could not be obtained from the Motec® due to rotational symmetry about the longitudinal axis. We conclude that model-based RSA in total wrist arthroplasties is precise, accurate, and feasible to use for clinical evaluation of micromotion in wrist arthroplasties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3053-3063, 2018.
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Affiliation(s)
- Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Feeney DF, Capobianco RA, Montgomery JR, Morreale J, Grabowski AM, Enoka RM. Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking. J Electromyogr Kinesiol 2018; 43:95-103. [PMID: 30267967 DOI: 10.1016/j.jelekin.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 11/18/2022] Open
Abstract
Walking is often compromised in individuals with low back and hip disorders, such as sacroiliac joint dysfunction (SIJD). The disorder involves reduced coactivation of the gluteus maximus and contralateral latissimus dorsi, which together provide joint stability during walking. The purpose of our study was to compare the kinematics and contributions of selected muscles to identified synergies during walking between healthy individuals and those with SIJD. Six women with unilateral SIJD and six age-matched healthy controls walked on a force-measuring treadmill at 1 m/s while we recorded kinematics and the activity of 16 muscles with surface EMG. Non-negative matrix factorization was used to identify patterns of EMG activity (muscle synergies). Individuals with SIJD exhibited less hip extension and lower peak vertical ground reaction forces on the affected side than the unaffected side. In contrast to controls, the SIJD group also displayed a depressed muscle synergy between gluteus maximus on the affected side and the contralateral latissimus dorsi. The results indicate that individuals with SIJD exhibited both reduced activation of gluteus maximus during a loading synergy present in walking and greater asymmetry between legs when walking compared with age-matched controls.
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Affiliation(s)
- Daniel F Feeney
- University of Colorado, Boulder, Department of Integrative Physiology, Neurophysiology of Movement Laboratory, Applied Biomechanics Laboratory, 354 UCB, Boulder, CO 80309, USA.
| | - Robyn A Capobianco
- University of Colorado, Boulder, Department of Integrative Physiology, Neurophysiology of Movement Laboratory, Applied Biomechanics Laboratory, 354 UCB, Boulder, CO 80309, USA.
| | - Jana R Montgomery
- University of Colorado, Boulder, Department of Integrative Physiology, Neurophysiology of Movement Laboratory, Applied Biomechanics Laboratory, 354 UCB, Boulder, CO 80309, USA.
| | - Joseph Morreale
- Center for Spine and Orthopedics, 9005 Grant St, Suite 200, Thornton, CO 80229, USA.
| | - Alena M Grabowski
- University of Colorado, Boulder, Department of Integrative Physiology, Neurophysiology of Movement Laboratory, Applied Biomechanics Laboratory, 354 UCB, Boulder, CO 80309, USA; VA Eastern Colorado Healthcare System, Denver, CO, USA.
| | - Roger M Enoka
- University of Colorado, Boulder, Department of Integrative Physiology, Neurophysiology of Movement Laboratory, Applied Biomechanics Laboratory, 354 UCB, Boulder, CO 80309, USA.
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Kibsgård TJ, Röhrl SM, Røise O, Sturesson B, Stuge B. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clin Biomech (Bristol, Avon) 2017; 47:40-45. [PMID: 28582642 DOI: 10.1016/j.clinbiomech.2017.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 05/05/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Active Straight Leg Raise is a functional test used in the assessment of pelvic girdle pain, and has shown to have good validity, reliability and responsiveness. The Active Straight Leg Raise is considered to examine the patients' ability to transfer load through the pelvis. It has been hypothesized that patients with pelvic girdle pain lack the ability to stabilize the pelvic girdle, probably due to instability or increased movement of the sacroiliac joint. This study examines the movement of the sacroiliac joints during the Active Straight Leg Raise in patients with pelvic girdle pain. METHODS Tantalum markers were inserted in the dorsal sacrum and ilium of 12 patients with long-lasting pelvic girdle pain scheduled for sacroiliac joint fusion surgery. Two to three weeks later movement of the sacroiliac joints during the Active Straight Leg Raise was measured with radiostereometric analysis. FINDINGS Small movements were detected. There was larger movement of the sacroiliac joint of the rested leg's sacroiliac joint compared to the lifted leg's side. A mean backward rotation of 0.8° and inward tilt of 0.3° were seen in the rested leg's sacroiliac joint. INTERPRETATION The movements of the sacroiliac joints during the Active Straight Leg Raise are small. There was a small backward rotation of the innominate bone relative to sacrum on the rested leg's side. Our findings contradict an earlier understanding that a forward rotation of the lifted leg's innominate occur while performing the Active Straight Leg Raise.
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Affiliation(s)
- Thomas J Kibsgård
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Olav Røise
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Bengt Sturesson
- Department of Orthopaedics, Aleris specialistvård, Ängelholm Hospital, Ängelholm, Sweden
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
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Ouweltjes W, Gussekloo S, Spoor C, van Leeuwen J. A new technique using roentgen stereophotogrammetry to measure changes in the spatial conformation of bovine hind claws in response to external loads. Vet J 2016; 208:81-6. [DOI: 10.1016/j.tvjl.2015.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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Adhia DB, Milosavljevic S, Tumilty S, Bussey MD. Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin. ACTA ACUST UNITED AC 2015; 21:100-8. [PMID: 26144685 DOI: 10.1016/j.math.2015.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/30/2015] [Accepted: 06/12/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Innominate kinematic anomalies resulting in low back pain (LBP) of sacroiliac joint (SIJ) origin (SIJ-positive), has always been a topic of contention, owing to difficultly in its evaluation. Recent technique of electromagnetic palpation-digitization has been able to accurately quantify innominate kinematics in healthy individuals. OBJECTIVES The purpose of this study is to determine if participants with LBP of SIJ origin (SIJ-positive) demonstrate significantly different innominate kinematics than participants with LBP of non-SIJ origin (SIJ-negative). DESIGN Single-blinded cross-sectional case-control study. METHOD Participants [n(122)] between the ages of 18 to 50 years, suffering from chronic non-specific LBP (≥3 months) volunteered in the study. An experienced musculoskeletal physiotherapist evaluated and classified participants into either SIJ-positive [n(45)] or SIJ-negative [n(77)] group, using the reference standard pain provocation tests [≥3 positive tests = SIJ-positive]. A research physiotherapist, blinded to clinical groups, conducted the innominate kinematic testing using a valid and reliable electromagnetic palpation-digitization technique, during prone lying incremental hip abduction-external rotation test positions. RESULTS The results of the mixed model regression analyses demonstrated that SIJ-positive participants exhibited significantly different innominate movement patterns and trends of rotation, but not innominate ranges of motion, when compared with SIJ-negative LBP participants. CONCLUSIONS These findings demonstrate association between SIJ pain and altered innominate kinematics, and have led the groundwork for further exploration of clinical measurement, relevance, and management of these potentially important movement observations.
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Affiliation(s)
- Divya Bharatkumar Adhia
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand; School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | | | - Steve Tumilty
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Melanie D Bussey
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
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28
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Kibsgård TJ, Røise O, Sturesson B, Röhrl SM, Stuge B. Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain. Clin Biomech (Bristol, Avon) 2014; 29:406-11. [PMID: 24602677 DOI: 10.1016/j.clinbiomech.2014.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/17/2014] [Accepted: 02/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chamberlain's projections (anterior-posterior X-ray of the pubic symphysis) have been used to diagnose sacroiliac joint mobility during the single-leg stance test. This study examined the movement in the sacroiliac joint during the single-leg stance test with precise radiostereometric analysis. METHODS Under general anesthesia, tantalum markers were inserted into the dorsal sacrum and the ilium of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, a radiostereometric analysis was conducted while the subjects performed a single-leg stance. FINDINGS Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac join, a total of 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint. INTERPRETATION The movement in the sacroiliac joint during the single-leg stance is small and almost undetectable by the precise radiostereometric analysis. A complex movement pattern was seen during the test, with a combination of movements in the two joints. The interpretation of the results of this study is that, the Chamberlain examination likely is inadequate in the examination of sacroiliac joint movement in patients with pelvic girdle pain.
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Affiliation(s)
- Thomas J Kibsgård
- Department of Orthopaedics, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Olav Røise
- Department of Orthopaedics, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
| | - Bengt Sturesson
- Department of Orthopedics, Ängelholm Hospital, Ängelholm, Sweden.
| | - Stephan M Röhrl
- Department of Orthopaedics, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Britt Stuge
- Department of Orthopaedics, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
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Vleeming A, Schuenke MD, Sturesson B, Willard FH. Authors' response to the letter to the editors by Professor M. T. Cibulka: a critical interpretation of sacroiliac joint movement studies. J Anat 2013; 222:391-5. [PMID: 23410076 DOI: 10.1111/joa.12018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012; 221:537-67. [PMID: 22994881 PMCID: PMC3512279 DOI: 10.1111/j.1469-7580.2012.01564.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/28/2022] Open
Abstract
This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure.
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Affiliation(s)
- A Vleeming
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA
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