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Valente G, Grenno G, Dal Fabbro G, Zaffagnini S, Taddei F. Medial and lateral knee contact forces during walking, stair ascent and stair descent are more affected by contact locations than tibiofemoral alignment in knee osteoarthritis patients with varus malalignment. Front Bioeng Biotechnol 2023; 11:1254661. [PMID: 37731759 PMCID: PMC10507691 DOI: 10.3389/fbioe.2023.1254661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction: Knee OA progression is related to medial knee contact forces, which can be altered by anatomical parameters of tibiofemoral alignment and contact point locations. There is limited and controversial literature on medial-lateral force distribution and the effect of anatomical parameters, especially in motor activities different from walking. We analyzed the effect of tibiofemoral alignment and contact point locations on knee contact forces, and the medial-lateral force distribution in knee OA subjects with varus malalignment during walking, stair ascending and stair descending. Methods: Fifty-one knee OA subjects with varus malalignment underwent weight-bearing radiographs and motion capture during walking, stair ascending and stair descending. We created a set of four musculoskeletal models per subject with increasing level of personalization, and calculated medial and lateral knee contact forces. To analyze the effect of the anatomical parameters, statistically-significant differences in knee contact forces among models were evaluated. Then, to analyze the force distribution, the medial-to-total contact force ratios were calculated from the fully-informed models. In addition, a multiple regression analysis was performed to evaluate correlations between forces and anatomical parameters. Results: The anatomical parameters significantly affected the knee contact forces. However, the contact points decreased medial forces and increased lateral forces and led to more marked variations compared to tibiofemoral alignment, which produced an opposite effect. The forces were less medially-distributed during stair negotiation, with medial-to-total ratios below 50% at force peaks. The anatomical parameters explained 30%-67% of the variability in the knee forces, where the medial contact points were the best predictors of medial contact forces. Discussion: Including personalized locations of contact points is crucial when analyzing knee contact forces in subjects with varus malalignment, and especially the medial contact points have a major effect on the forces rather than tibiofemoral alignment. Remarkably, the medial-lateral force distribution depends on the motor activity, where stair ascending and descending show increased lateral forces that lead to less medially-distributed loads compared to walking.
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Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulia Grenno
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Guitteny S, Aissaoui R, Dumas R. Can a Musculoskeletal Model Adapted to Knee Implant Geometry Improve Prediction of 3D Contact Forces and Moments? Ann Biomed Eng 2023:10.1007/s10439-023-03216-y. [PMID: 37101092 DOI: 10.1007/s10439-023-03216-y] [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: 01/09/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023]
Abstract
Tibiofemoral contact loads are crucial parameters in the onset and progression of osteoarthrosis. While contact loads are frequently estimated from musculoskeletal models, their customization is often limited to scaling musculoskeletal geometry or adapting muscle lines. Moreover, studies have usually focused on superior-inferior contact force without investigating three-dimensional contact loads. Using experimental data from six patients with instrumented total knee arthroplasty (TKA), this study customized a lower limb musculoskeletal model to consider the positioning and the geometry of the implant at knee level. Static optimization was performed to estimate tibiofemoral contact forces and contact moments as well as musculotendinous forces. Predictions from both a generic and a customized model were compared to the instrumented implant measurements. Both models accurately predict superior-inferior (SI) force and abduction-adduction (AA) moment. Notably, the customization improves prediction of medial-lateral (ML) force and flexion-extension (FE) moments. However, there is subject-dependent variability in the prediction of anterior-posterior (AP) force. The customized models presented here predict loads on all joint axes and in most cases improve prediction. Unexpectedly, this improvement was more limited for patients with more rotated implants, suggesting a need for further model adaptations such as muscle wrapping or redefinition of hip and ankle joint centers and axes.
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Affiliation(s)
- Sacha Guitteny
- Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, 69622, Lyon, France
| | - Rachid Aissaoui
- Laboratoire de Recherche en Imagerie Et Orthopédie (LIO), Département Génie des Systèmes, Ecole de Technologie Supérieure, Montréal, Canada
| | - Raphael Dumas
- Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, 69622, Lyon, France.
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Zhang L, Liu G, Yan Y, Han B, Li H, Ma J, Wang X. A subject-specific musculoskeletal model to predict the tibiofemoral contact forces during daily living activities. Comput Methods Biomech Biomed Engin 2022; 26:972-985. [PMID: 35852103 DOI: 10.1080/10255842.2022.2101889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Accurate prediction of tibiofemoral contact force (TFCF) during daily living activities is significant for understanding the initiation, progression, and treatment of knee osteoarthritis (KOA). However, the diversity of target activities, prediction accuracy, and computational efficiency of the current musculoskeletal simulations need to be further improved. In this study, a subject-specific musculoskeletal model considered the tibiofemoral alignment, medial-lateral contact locations, secondary tibiofemoral and all patellofemoral motions, and knee ligaments was proposed to predict the TFCFs during the five daily activities (normal walking, sit-to-stand, stand-to-sit, stair ascent, and stair descent) in OpenSim software. The standing lower-limbs-full-length radiograph, local radiograph of knee joint, motion capture data, and force plate data of eighteen subjects were acquired as the input data of the musculoskeletal model. The results showed good agreements of TFCFs between the predictions based on our proposed musculoskeletal model and the in-vivo measurements based on instrumented knee implants during the five daily activities (RMSE: 0.16 ∼ 0.31 BW, R2: 0.88 ∼ 0.97, M: -0.11 ∼ -0.02, P: 0.03 ∼ 0.10, and C: 0.04 ∼ 0.14). Additionally, the order of the peak total and lateral TFCFs from low to high was normal walking, stair ascent and stand-to-sit, and stair descent and sit-to-stand (P < 0.05), and the peak medial TFCF was stand-to-sit, sit-to-stand, normal walking, stair ascent and stair descent (P < 0.05). The outcomes of this study are valuable for further understanding the knee biomechanics during daily living activities and providing theoretical guidance for the treatments of KOA.
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Affiliation(s)
- Li Zhang
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, P.R. China
| | - Geng Liu
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, P.R. China
| | - Yuzhou Yan
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, P.R. China
| | - Bing Han
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, P.R. China
| | - Hui Li
- Joint Surgery Department, Xi’an Hong-hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, P.R. China
| | - Jianbing Ma
- Joint Surgery Department, Xi’an Hong-hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, P.R. China
| | - Xupeng Wang
- Department of Industrial Design, School of Art and Design, Xi’an University of Technology, Xi’an, P.R. China
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Manal K, Buchanan TS. An Efficient One-Step Moment Balancing Algorithm for Computing Medial and Lateral Knee Compartment Contact Forces. J Biomech Eng 2022; 144:1120495. [PMID: 34549259 DOI: 10.1115/1.4052494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 11/08/2022]
Abstract
The knee adduction moment is associated with the progression of knee osteoarthritis (OA). The adduction moment reflects the net effect of muscles, passive tissues and bone-on-bone contact forces. Medial compartment OA is more common than lateral and therefore our ability to correctly partition bone-on-bones forces across the medial and lateral compartments is key to understanding mechanical factors associated with the onset and progression of knee OA. In this technical brief we present an efficient one-step moment balancing algorithm linking the sagittal and frontal planes in the determination of musculotendon forces. Novel to the one-step approach is the introduction of a penalty function limiting total compressive force from acting in the lateral compartment when the internal moment is net abduction (i.e., external knee adduction). Medial and lateral knee contact forces were computed using the one-step moment balancing algorithm for 10 subjects walking at a self-selected pace and compared to values determined using a well-established two-step frontal moment balancing approach. Overall, average peak differences in magnitude and timing were small and the ensemble-averaged contact force profiles were similar between methods. The only statistical difference was slightly larger (0.2 BWs) peak medial contact force for the one-step method during the first half of stance, however these differences are small relative to peak values and would not likely alter interpretation of the data. The 1-step moment balancing method is a more efficient methodology for computing medial and lateral knee contact forces that can be used in place of two-step frontal plane moment balancing.
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Affiliation(s)
- Kurt Manal
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 S. College Ave, Room 148, Newark, DE 19713; Department of Biomechanics and Movement Science, University of Delaware, Newark, DE 19713; Department of Biomedical Engineering, University of Delaware, Newark, DE 19713
| | - Thomas S Buchanan
- Department of Biomechanics and Movement Science, University of Delaware, Newark, DE 19713; Department of Biomedical Engineering, University of Delaware, Newark, DE 19713; Department of Mechanical Engineering, University of Delaware, Newark, DE 19713
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Münch M, Barth T, Studt A, Dehoust J, Seide K, Hartel M, Frosch KH. Stresses and deformations of an osteosynthesis plate in a lateral tibia plateau fracture. BIOMED ENG-BIOMED TE 2022; 67:43-52. [PMID: 34995435 DOI: 10.1515/bmt-2021-0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022]
Abstract
This study has the aim to investigate the strain and stress in an anterolateral locking plate applied for the fixation of a lateral split fracture. To simulate a complex fracture situation, three segments were separated. With a FEM analysis, representative places for strain and stress measurement were determined. A locked osteosynthesis plate was instrumented with strain gauges and tested on a fractured and a non-fractured Saw Bone model. To simulate different loading situations, four different points of force application, from the center of the condyles to a 15 mm posterior position, were used with a medial-lateral load distribution of 60:40. The simulations as well as the biomechanical tests demonstrated that two deformations dominate the load on the plate: a bending into posterior direction and a bulging of the plate head. Shifting the point of application to the posterior direction resulted in increasing maximum stress, from 1.16 to 6.32 MPa (FEM analysis) and from 3.04 to 7.00 MPa (biomechanical study), respectively. Furthermore, the comparison of the non-fractured and fractured models showed an increase in maximum stress by the factor 2.06-2.2 (biomechanical investigation) and 1.5-3.3 (FEM analysis), respectively.
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Affiliation(s)
- Matthias Münch
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Tobias Barth
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Institute for Integrated Circuits, Technical University Hamburg, Hamburg, Germany
| | - Annika Studt
- Institute for Sport Science, University of Giessen, Giessen, Germany
| | - Julius Dehoust
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Klaus Seide
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Maximilian Hartel
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hunt KD, Dunevant SE, Yohler RM, Carlson KJ. Femoral Bicondylar Angles among Dry-Habitat Chimpanzees ( Pan troglodytes schweinfurthii) Resemble Those of Humans: Implications for Knee Function, Australopith Sexual Dimorphism, and the Evolution of Bipedalism. JOURNAL OF ANTHROPOLOGICAL RESEARCH 2021. [DOI: 10.1086/715398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Knee loading in OA subjects is correlated to flexion and adduction moments and to contact point locations. Sci Rep 2021; 11:8594. [PMID: 33883591 PMCID: PMC8060429 DOI: 10.1038/s41598-021-87978-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
This study evaluated the association of contact point locations with the knee medial and lateral contact force (Fmed, Flat) alterations in OA and healthy subjects. A musculoskeletal model of the lower limb with subject-specific tibiofemoral contact point trajectories was used to estimate the Fmed and Flat in ten healthy and twelve OA subjects during treadmill gait. Regression analyses were performed to evaluate the correlation of the contact point locations, knee adduction moment (KAM), knee flexion moment (KFM), frontal plane alignment, and gait speed with the Fmed and Flat. Medial contact point locations in the medial–lateral direction showed a poor correlation with the Fmed in OA (R2 = 0.13, p = 0.01) and healthy (R2 = 0.24, p = 0.001) subjects. Anterior–posterior location of the contact points also showed a poor correlation with the Fmed of OA subjects (R2 = 0.32, p < 0.001). Across all subjects, KAM and KFM remained the best predictors of the Fmed and Flat, respectively (R2 between 0.62 and 0.69). Results suggest different mechanisms of contact force distribution in OA joints. The variations in the location of the contact points participate partially to explains the Fmed variations in OA subjects together with the KFM and KAM.
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Accuracy of the tibiofemoral contact forces estimated by a subject-specific musculoskeletal model with fluoroscopy-based contact point trajectories. J Biomech 2020; 113:110117. [PMID: 33197692 DOI: 10.1016/j.jbiomech.2020.110117] [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: 01/30/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
Accurate estimation of the tibiofemoral contact forces relies on exact kinematics and joint geometry. Subject-specific kinematic constraints representing contact point trajectories derived from fluoroscopic measurements during lunge are introduced in a musculoskeletal model of the lower limb and compared to generic kinematic constraints. The medial, lateral, and total contact forces during gait and squat are validated using the data of four patients with an instrumented prosthesis. The accuracy of the estimated contact forces (both with subject-specific and generic kinematic constraints) remains close to the level reported in the literature. The mean root mean square errors range from 0.32 to 0.52 body weights for gait and from 0.27 to 0.72 body weights for squat. The impact of the subject-specific contact point trajectories is not found substantial or consistent between patients and tasks. Indeed, the kinematics of the total knee prostheses remains close to the kinematics of a hinge joint and the contact point locations remain generally centred at 20 mm from the tibia centreline (close to the constant value defined in the generic constraints). The contact point trajectories are also suspected to differ between tasks (lunge vs. gait and squat). While the contact point trajectories have been reported to be sensitive model parameters, no clear improvement of the contact force accuracy is demonstrated on patients with instrumented prosthesis. The introduction (as kinematic constraints) of fluoroscopy-based contact point trajectories may be considered in cases where these trajectories are significantly altered, as reported for osteoarthritis patients.
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Dumas R, Moissenet F, Cheze L. Fluoroscopy-based subject-specific knee joint constraints for the estimation of prosthesis kinematics and contact velocities during gait. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- R. Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon, France
| | - F. Moissenet
- Kinesiology Laboratory, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - L. Cheze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon, France
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Clinical application of three-dimensional printing-assisted arthroscopic reconstruction of medial patellofemoral ligament to treat recurrent patellar dislocation in adolescents. Asian J Surg 2020; 43:1191-1193. [PMID: 32994113 DOI: 10.1016/j.asjsur.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
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Zeighami A, Dumas R, Bleau J, Lavoie F, Guise JD, Aissaoui R. A method for quantitative evaluation of a valgus knee orthosis using biplane x-ray images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4815-4818. [PMID: 33019068 DOI: 10.1109/embc44109.2020.9176337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Knee orthoses are designed to reestablish the normal kinematics of the knee joint. However, the data on the effectiveness of them on modifying the internal joint kinematics are scarce. The aim of this study was to develop a method to allow accurate comparison of the knee contact kinematics in osteoarthritic (OA) subjects with and without wearing a valgus knee orthosis using imaging techniques. Biplane x-ray images of a subject (68 yrs., female, 1.70 m, 89 kg, left knee) was recorded during a weight-bearing squat at five positions. The same squat trial was repeated while wearing the orthosis. The 3D models of the knee were reconstructed from the biplane x-rays and the joint kinematics as well as the tibiofemoral contact point locations and bone-to-bone distance were compared at each posture. This could be seen as a proof of concept for the use of contact point locations as a parameter for evaluating the effectiveness of knee orthoses.Clinical Relevance- Joint kinematics derived from the skin markers suffer from low accuracy. The real impact of the knee orthoses on the skeleton takes vigorous techniques, which allows detecting the subtle kinematics changes directly at the joint level.
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Nolte D, Ko ST, Bull AM, Kedgley AE. Reconstruction of the lower limb bones from digitised anatomical landmarks using statistical shape modelling. Gait Posture 2020; 77:269-275. [PMID: 32092603 PMCID: PMC7090904 DOI: 10.1016/j.gaitpost.2020.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone shapes strongly influence force and moment predictions of kinematic and musculoskeletal models used in motion analysis. The precise determination of joint reference frames is essential for accurate predictions. Since clinical motion analysis typically does not include medical imaging, from which bone shapes may be obtained, scaling methods using reference subjects to create subject-specific bone geometries are widely used. RESEARCH QUESTION This study investigated if lower limb bone shape predictions from skin-based measurements, utilising an underlying statistical shape model (SSM) that corrects for soft tissue artefacts in digitisation, can be used to improve conventional linear scaling methods of bone geometries. METHODS SSMs created from 35 healthy adult femurs and tibiae/fibulae were used to reconstruct bone shapes by minimising the distance between anatomical landmarks on the models and those digitised in the motion laboratory or on medical images. Soft tissue artefacts were quantified from magnetic resonance images and then used to predict distances between landmarks digitised on the skin surface and bone. Reconstruction results were compared to linearly scaled models by measuring root mean squared distances to segmented surfaces, calculating differences of commonly used anatomical measures and the errors in the prediction of the hip joint centre. RESULTS SSM reconstructed surface predictions from varying landmark sets from skin and bone landmarks were more accurate compared to linear scaling methods (2.60-2.95 mm vs. 3.66-3.87 mm median error; p < 0.05). No significant differences were found between SSM reconstructions from bony landmarks and SSM reconstructions from digitised landmarks obtained in the motion lab and therefore reconstructions using skin landmarks are as accurate as reconstructions from landmarks obtained from medical images. SIGNIFICANCE These results indicate that SSM reconstructions can be used to increase the accuracy in obtaining bone shapes from surface digitised experimental data acquired in motion lab environments.
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