Comparison of three formal methods used to estimate the functional axis of rotation: an extensive in-vivo analysis performed on the knee joint

Investigation of Characteristic Motion Patterns of the Knee Joint During a Weightbearing Flexion

This study aimed to develop and validate a novel flexion axis concept by calculating the points on femoral condyles that could maintain constant heights during knee flexion. Twenty-two knees of 22 healthy subjects were investigated when performing a weightbearing single leg lunge. The knee positions were captured using a validated dual fluoroscopic image system. The points on sagittal planes of the femoral condyles that had minimal changes in heights from the tibial plane along the flexion path were calculated. It was found that the points do formulate a medial-lateral flexion axis that was defined as the iso-height axis (IHA). The six degrees of freedom (6DOF) kinematics data calculated using the IHA were compared with those calculated using the conventional transepicondylar axis and geometrical center axis. The IHA measured minimal changes in proximal-distal translations and varus-valgus rotations along the flexion path, indicating that the IHA may have interesting clinical implications. Therefore, identifying the IHA could provide an alternative physiological reference for improvement of contemporary knee surgeries, such as ligament reconstruction and knee replacement surgeries that are aimed to reproduce normal knee kinematics and medial/lateral soft tissue tensions during knee flexion.

Measurement error associated with gait cycle selection in treadmill running at various speeds

A common approach in the biomechanical analysis of running technique is to average data from several gait cycles to compute a 'representative mean.' However, the impact of the quantity and selection of gait cycles on biomechanical measures is not well understood. We examined the effects of gait cycle selection on kinematic data by: (i) comparing representative means calculated from varying numbers of gait cycles to 'global' means from the entire capture period; and (ii) comparing representative means from varying numbers of gait cycles sampled from different parts of the capture period. We used a public dataset (n = 28) of lower limb kinematics captured during a 30-second period of treadmill running at three speeds (2.5 m s^-1, 3.5 m s^-1 and 4.5 m s^-1). 'Ground truth' values were determined by averaging data across all collected strides and compared to representative means calculated from random samples (1,000 samples) of n (range = 5-30) consecutive gait cycles. We also compared representative means calculated from n (range = 5-15) consecutive gait cycles randomly sampled (1,000 samples) from within the same data capture period. The mean, variance and range of the absolute error of the representative mean compared to the 'ground truth' mean progressively reduced across all speeds as the number of gait cycles used increased. Similar magnitudes of 'error' were observed between the 2.5 m s^-1 and 3.5 m s^-1 speeds at comparable gait cycle numbers -where the maximum errors were < 1.5 degrees even with a small number of gait cycles (i.e., 5-10). At the 4.5 m s^-1 speed, maximum errors typically exceeded 2-4 degrees when a lower number of gait cycles were used. Subsequently, a higher number of gait cycles (i.e., 25-30) was required to achieve low errors (i.e., 1-2 degrees) at the 4.5 m s^-1 speed. The mean, variance and range of absolute error of representative means calculated from different parts of the capture period was consistent irrespective of the number of gait cycles used. The error between representative means was low (i.e., < 1.5 degrees) and consistent across the different number of gait cycles at the 2.5 m s^-1 and 3.5 m s^-1 speeds, and consistent but larger (i.e., up to 2-4 degrees) at the 4.5 m s^-1 speed. Our findings suggest that selecting as many gait cycles as possible from a treadmill running bout will minimise potential 'error.' Analysing a small sample (i.e., 5-10 cycles) will typically result in minimal 'error' (i.e., < 2 degrees), particularly at lower speeds (i.e., 2.5 m s^-1 and 3.5 m s^-1). Researchers and clinicians should consider the balance between practicalities of collecting and analysing a smaller number of gait cycles against the potential 'error' when determining their methodological approach. Irrespective of the number of gait cycles used, we recommend that the potential 'error' introduced by the choice of gait cycle number be considered when interpreting the magnitude of effects in treadmill-based running studies.

Comparison between Helical Axis and SARA Approaches for the Estimation of Functional Joint Axes on Multi-Body Modeling Data

Functional methods usually allow for a flexible and accurate representation of joint kinematics and are increasingly implemented both for clinical and biomechanics research purposes. This paper presents a quantitative comparison between two widely adopted methods for functional axis estimation, that is, the helical axis theory and the symmetrical axis of rotation approach (SARA). To this purpose, a multi-body model was developed to simulate the lower limb of a subject. This model was designed to reproduce different motion patterns, that is, by selecting the active degrees of freedom of the simulated ankle joint. Thanks to virtual markers attached to each segment, the multi-body model was used to generate simulated motion capture data that were then analyzed by instantaneous helical axes and SARA algorithms. To achieve a synthetic representation of joint kinematics, a mean helical axis and an average SARA functional axis were estimated, along with dispersion parameters and rms distance data that were used to quantitatively assess the performance of each method. The sensitivity of each algorithm to different combinations of range and speed of motion, scattering of marker clusters, sampling rate, and additive noise on markers’ trajectories, was finally evaluated.

Three-dimensional color map: a novel tool to locate the surgical transepicondylar axis

Background

Accurate localization of the surgical transepicondylar axis (sTEA) in total knee arthroplasty (TKA), the most reliable anatomical reference for femoral rotation, has long been a challenge, primarily because it is intractable to locate the center of the sulcus of the medial epicondyle. This study aimed to introduce and verify a novel method to locate the sTEA more precisely.

Methods

This study included 26 adult femoral specimens and 80 adult patients with computed tomography (CT) scan data. Three dimensions (3D) models based on CT scans of the distal femurs were reconstructed with Mimics and imported into Geomagic Studio. The 3D color map method was applied to locate the sTEA. To further verify the accuracy of the method, the identified sTEA was transferred to the femoral specimens and compared with the points identified by the total station machine. We further compared the recognition rate of sTEA between 3D color map method and two-dimensional (2D) CT slices method. The repeatability of this novel method was also evaluated.

Results

The 3D color map method located the centers of the sulcus of the medial epicondyle and the most prominent point of the lateral epicondyle of all the femoral specimens, which were further identified and confirmed by patient-specific guide plates and total station machine on femoral specimens. The 3D color map method achieved a recognition rate of up to 96.23%, while the recognition rate of the 2D CT slices method was only 68.87%. The repeatability of this objective method was excellent.

Conclusions

The results of this study indicated that the 3D color map method could be used to accurately and objectively locate the sTEA, with high repeatability and recognition rate. However, the proposed novel method requires further validation in clinical applications.

A Cluster-based Model Using Functional Methods Requires Less Operator Experience for Reliable Gait Analysis: A Preliminary Study of Intra- and Inter-assessor Reliability

Reliability of three-dimensional gait analysis is important for repetitive assessments in clinical or research studies. In this paper, we hypothesized that a Strathclyde Functional Cluster Model (SFCM) in which all the joint centers and flexion axes were determined by functional methods, could improve the reliability of joint kinematics within and between operators' sessions compared to an anatomical model, Plug-in Gait (PiG). A preliminary study of intra- and inter-assessor reliability of the SFCM was been analyzed and compared to the PiG. One able-bodied participant performed eight sessions measured by four operators who have different experience level on the two models. Intra- and inter-operator reliability of the SFCM and PiG were assessed using the intraclass correlation coefficient (ICC) and standard deviation (SD). Results showed that the SFCM generated smaller SD and greater ICC values for all joint variables compared to the PiG in the inter-operator condition, suggesting that functional methods could improve the inter-operator reliability. Moreover, the intra-operator ICC results indicated that the SFCM performance was less influenced by operator experience compared to the PiG. In conclusion, as the model requires less palpation of ALs, it would benefit the users who have less experience in practical use.

Technical note: sensitivity analysis of the SCoRE and SARA methods for determining rotational axes during tibiofemoral movements using optical motion capture

Purpose

The first aim was to report the sensitivity of calculated tibiofemoral movements for the choice of placement of the set of femoral markers. The second aim was to report the influence of accuracy of the motion captured positions of the markers on the calculated tibiofemoral movements.

Methods

Tibiofemoral kinematics during single leg hops for distance were calculated. For the first aim, an experiment was conducted in which four different setups of the femoral markers were used to calculated tibiofemoral movements. For the second aim, an experiment was conducted in which all raw marker positions were mathematically moved independently with the known Vicon position error with a distance and in a random direction in each frame, repeated a hundred times. Each time, the tibiofemoral movements were calculated.

Results

The first experiment yields that the standard deviation of the calculated anterior tibia translation between marker setups was 0.88 mm and the standard deviation of the external tibia rotation between marker setups was 0.76 degrees. The second experiment yields that the standard deviation was 0.76 mm for anterior tibia translation and 0.38 degrees for external tibia rotation.

Conclusion

A combined standard deviation of both experiments revealed that transients in anterior tibia translation less than 2.32 mm and external tibia rotations less than 1.70 degrees should be taken with caution. These results are 19.42% of the range of the anterior tibia translation and 13.51% of the rotation range during the jump task. The marker setup should be chosen carefully.