Virtual reality techniques. Application to anatomic visualization and orthopaedics training

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends

Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.

DICOM 3D viewers, virtual reality or 3D printing - a pilot usability study for assessing the preference of orthopedic surgeons

As standard practice in orthopedic surgery, the information gathered by analyzing Computer Tomography (CT) 2D images is used for patient diagnosis and planning surgery. Lately, these virtual slices are the input for generating 3D virtual models using DICOM viewers, facilitating spatial orientation, and diagnosis. Virtual Reality (VR) and 3D printing (3DP) technologies are also reported for use in anatomy visualization, medical training, and diagnosis. However, it has not been yet investigated whether the surgeons consider that the advantages offered by 3DP and VR outweigh their development efforts. Moreover, no comparative evaluation for understanding surgeon's preference in using these investigation tools has been performed so far. Therefore, in this paper, a pilot usability test was conducted for collecting surgeons' opinions. 3D models of knee, hip and foot were displayed using DICOM 3D viewer, two VR environments and as 3D-printed replicas. These tools adequacy for diagnosis was comparatively assessed in three cases scenarios, the time for completing the diagnosis tasks was recorded and questionnaires filled in. The time for preparing the models for VR and 3DP, the resources needed and the associated costs were presented in order to provide surgeons with the whole context. Results showed a preference in using desktop DICOM viewer with 3D capabilities along with the information provided by Unity-based VR solution for visualizing the virtual model from various angles challenging to analyze on the computer screen. 3D-printed replicas were considered more useful for physically simulating the surgery than for diagnosis. For the VR and 3DP models, the lack of information on bone quality was considered an important drawback. The following order of using the tools was preferred: DICOM viewer, followed by Unity VR and 3DP.

Current Status of Simulation-based Training Tools in Orthopedic Surgery: A Systematic Review

OBJECTIVE

To conduct a systematic review of orthopedic training and assessment simulators with reference to their level of evidence (LoE) and level of recommendation.

DESIGN

Medline and EMBASE library databases were searched for English language articles published between 1980 and 2016, describing orthopedic simulators or validation studies of these models. All studies were assessed for LoE, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education.

RESULTS

A total of 76 articles describing orthopedic simulators met the inclusion criteria, 47 of which described at least 1 validation study. The most commonly identified models (n = 34) and validation studies (n = 26) were for knee arthroscopy. Construct validation was the most frequent validation study attempted by authors. In all, 62% (47 of 76) of the simulator studies described arthroscopy simulators, which also contained validation studies with the highest LoE.

CONCLUSIONS

Orthopedic simulators are increasingly being subjected to validation studies, although the LoE of such studies generally remain low. There remains a lack of focus on nontechnical skills and on cost analyses of orthopedic simulators.

Construct Validity for a Cost-effective Arthroscopic Surgery Simulator for Resident Education

INTRODUCTION

Arthroscopy is one of the most challenging surgical skills to assess and teach. Although basic psychomotor arthroscopic skills, such as triangulation and object manipulation, are incorporated into many simulation exercises, they are not always individually taught or objectively evaluated. In addition, arthroscopic instruments, arthroscopy cameras, and the cadaver or joint models necessary for practice are costly.

METHODS

A low-cost arthroscopic simulator was created to practice triangulation, probing, horizon changes, suture management, and object manipulation. The simulator materials were purchased exclusively from national hardware stores with a total cost averaging $79. The universal serial bus (USB) camera is included in the total cost. Three residency programs accredited by the Accreditation Council for Graduate Medical Education were tested on the simulator. Replica boards were created at each institution. Participants included medical students (20), residents (46), and attending physicians (9).

RESULTS

Construct validity-the ability to differentiate between novice, intermediate, and senior level participants-was obtained. On all tasks, junior residents scored at a statistically significant lower rate than senior residents and attending physicians.

CONCLUSIONS

This cost-effective arthroscopic surgical simulator objectively demonstrated that attending physicians and senior residents performed at a higher level than junior residents and novice medical students. The results of this study demonstrate that this simulator could be an important training tool for resident education.

Arthroscopic skills assessment and use of box model for training in arthroscopic surgery using Sawbones - "FAST" workstation

PURPOSE

Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules.

METHODS

Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES "FAST" arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; "Novice", "Beginner", "Intermediate" and "Advanced" based on previous arthroscopy experience, for analyses of performance.

RESULTS

The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice - 166 s, Beginner - 135.5 s, Intermediate - 100 s, Advance - 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks.

CONCLUSION

Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions.

Evaluating Simulation in Training for Arthroscopic Knee Surgery: A Systematic Review of the Literature

PURPOSE

To evaluate the reported outcomes for measuring the effectiveness of simulation during knee arthroscopy training and determine the consistency of reporting and validation of simulation used in knee arthroscopy training.

METHODS

Four databases (MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials) were screened for studies involving knee arthroscopy simulation training. Inclusion and exclusion criteria were applied to the searched studies, and a quality assessment was completed for included studies. The reviewers searched the references list in each of the eligible studies to identify other relevant studies that was not captured by our search strategy.

RESULTS

We identified 13 eligible studies. The mean number of participants per study was 24 (range: 9 to 42 participants). The 3 most commonly reported surgical skills were the mean time to perform the task (100%), the visualization and probing tasks (77%), and the number of cartilage collisions with measurement of the surgical force (46%). The most commonly described measurement instruments included the Simulation Built-In Scoring System (54%), motion analysis system (23%), and Basic Arthroscopic Knee Skill Scoring System global rating scale (15%). The most frequently reported type of validity for the simulator was construct validity (54%) and concurrent validity (31%). Moreover, construct validity (69%) and concurrent validity (54%) were the most commonly reported type of validity for the measurement instrument.

CONCLUSIONS

There is significant variation in reported learning outcomes and measurement instruments for evaluating the effectiveness of knee arthroscopic simulation-based education. Despite this, time to perform a task was the most commonly reported skill-evaluating outcome of simulation. The included studies in this review were of variable strength in terms of their evidence and methodologic quality. This study highlights the need for consistent outcome reporting after arthroscopic simulation training.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I, II, and IV studies.

Sawbones laboratory in orthopedic surgical training

Sawbones are artificial bones designed to simulate the bone architecture, as well as the bone’s physical properties. The incorporation of sawbones simulation laboratories in many orthopedic training programs has provided the residents with flexibility in learning and scheduling that align with their working hour limitations. This review paper deliberates the organization of sawbones simulation in orthopedic surgical training to enhance trainee’s future learning. In addition, it explores the implications of sawbones simulation in orthopedic surgical teaching and evaluation. It scrutinizes the suitability of practicing on sawbones at the simulation laboratory to improve orthopedic trainee’s learning. This will be followed with recommendations for future enhancement of sawbones simulation-based learning in orthopedic surgical training.

Imaging of temporomandibular joint: approach by direct volume rendering

BACKGROUND

The purpose of this study was to conduct a morphological analysis of the temporomandibular joint, a highly specialized synovial joint that permits movement and function of the mandible.

MATERIALS AND METHODS

We have studied the temporom-andibular joint anatomy, directly on the living, from 3D images obtained by medical imaging Computed Tomography and Nuclear Magnetic Resonance acquisition, and subsequent re-engineering techniques 3D Surface Rendering and Volume Rendering. Data were analysed with the goal of being able to isolate, identify and distinguish the anatomical structures of the joint, and get the largest possible number of information utilizing software for post-processing work.

RESULTS

It was possible to reproduce anatomy of the skeletal structures, as well as through acquisitions of Magnetic Resonance Imaging; it was also possible to visualize the vascular, muscular, ligamentous and tendinous components of the articular complex, and also the capsule and the fibrous cartilaginous disc. We managed the Surface Rendering and Volume Rendering, not only to obtain three-dimensional images for colour and for resolution comparable to the usual anatomical preparations, but also a considerable number of anatomical, minuter details, zooming, rotating and cutting the same images with linking, graduating the colour, transparency and opacity from time to time.

CONCLUSION

These results are encouraging to stimulate further studies in other anatomical districts.

Variation in joint stressing magnitudes during knee arthroscopy

PURPOSE

When performing knee arthroscopy, joint stressing is essential to increase the operative joint space. Adequate training of joint stressing is important, since high stressing forces can damage knee ligaments, and low stressing might not give sufficient operative space. As forces are difficult to transfer since they cannot be seen, simulators might be suited to train joint stressing as they can visualise the amount of applied stress. This requires the joint stressing thresholds to be validated. The purpose of this study was to measure the variation in the maximum joint stressing forces applied by various surgeons in vivo in a human population and based on that derive thresholds for safe stressing.

METHODS

From studies on ligament failure properties, we inferred a theoretical maximum stressing force of 78 N. Twenty-one patients were included, and knee arthroscopies were performed by five experienced surgeons. Forces solely performed in the varus and in valgus direction were measured. A load sensor was mounted on a belt, which was rotated along the hip to measure both varus and valgus stressing. The measurements started as soon as the interior of the knee joint was visualised using joint stressing.

RESULTS

The average maximum stressing force was 60 N (SD = 28 N). The mean first frame force was 47 N (SD = 34 N). No significant differences were found between varus and valgus stressing.

CONCLUSION

Since variation in stressing forces is high, offering training cases on simulators where the complete range of stressing forces can be experienced is recommended. Abiding to safety levels is essential to increase patient safety.

Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator

BACKGROUND

Several virtual reality simulators have been developed to assist orthopaedic surgeons in acquiring the skills necessary to perform arthroscopic surgery. The purpose of this study was to assess the construct validity of the ArthroSim virtual reality arthroscopy simulator by evaluating whether skills acquired through increased experience in the operating room lead to improved performance on the simulator.

METHODS

Using the simulator, six postgraduate year-1 orthopaedic residents were compared with six postgraduate year-5 residents and with six community-based orthopaedic surgeons when performing diagnostic arthroscopy. The time to perform the procedure was recorded. To ensure that subjects did not sacrifice the quality of the procedure to complete the task in a shorter time, the simulator was programmed to provide a completeness score that indicated whether the surgeon accurately performed all of the steps of diagnostic arthroscopy in the correct sequence.

RESULTS

The mean time to perform the procedure by each group was 610 seconds for community-based orthopaedic surgeons, 745 seconds for postgraduate year-5 residents, and 1028 seconds for postgraduate year-1 residents. Both the postgraduate year-5 residents and the community-based orthopaedic surgeons performed the procedure in significantly less time (p = 0.006) than the postgraduate year-1 residents. There was a trend toward significance (p = 0.055) in time to complete the procedure when the postgraduate year-5 residents were compared with the community-based orthopaedic surgeons. The mean level of completeness as assigned by the simulator for each group was 85% for the community-based orthopaedic surgeons, 79% for the postgraduate year-5 residents, and 71% for the postgraduate year-1 residents. As expected, these differences were not significant, indicating that the three groups had achieved an acceptable level of consistency in their performance of the procedure.

CONCLUSIONS

Higher levels of surgeon experience resulted in improved efficiency when performing diagnostic knee arthroscopy on the simulator. Further validation studies utilizing the simulator are currently under way and the additional simulated tasks of arthroscopic meniscectomy, meniscal repair, microfracture, and loose body removal are being developed.

Objective structured assessment of technical skill in upper extremity surgery

PURPOSE

Objective assessment of technical skills in hand surgery has been lacking. This article reports on an Objective Structured Assessment of Technical Skills format of a multiple bench-station evaluation of orthopedic surgery residents' technical skills for 3 common upper extremity surgeries.

METHODS

Twenty-seven residents (6 postgraduate year [PGY] 2, 8 PGY 3, 8 PGY 4, and 5 PGY 5) participated in the examination. Each resident performed surgery on a cadaveric specimen at 3 stations, trigger finger release (TFR), open carpal tunnel release, and distal radius fracture fixation. A board-certified hand surgeon evaluated trainee performance at each station, using a procedure-specific detailed checklist, a validated global rating scale, and pass/fail assessment. A resident post-testing evaluation was collected.

RESULTS

Construct validity with correlation between year in training and detailed checklist scores was demonstrated for TFR and carpal tunnel release; between year in training and global rating scores for TFR and distal radius fracture fixation; and between year in training and pass/fail assessment for TFR. Criterion validity was demonstrated by the correlation between global rating scale scores, detailed checklist scores, and pass/fail assessment for TFR, carpal tunnel release, and distal radius fracture fixation. Time to complete the surgery was not correlated with surgical performance. Residents rated the multiple-station Objective Structured Assessment of Technical Skills format as highly educational.

CONCLUSIONS

This study reports that a surgeon's ability to release a trigger finger does not correlate specifically to his or her ability to perform a carpal tunnel release or to perform plate fixation of a radius fracture. The results of this study would indicate that, for 3 different surgical simulations representing procedures of varying complexity, assessments by a single assessment tool is not adequate. To completely understand a resident's abilities, assessment by checklist (understanding the steps of the surgery), global rating scales (assessment of basic surgical skills in light of lesser or greater complexity surgeries), and pass/fail assessment (examination of adverse events) are all necessary components.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

Three-dimensional reconstruction of paracentesis approach in transjugular intrahepatic portosystemic shunt

To establish a digital transjugular intrahepatic portosystemic shunt (TIPS) model and provide morphological data for radiological diagnosis and interventional radiology to reduce portal vein pressure, 400 serial sectional images from the internal jugular vein superior margin to the lower edge of the liver were chosen from the Chinese Visible Human dataset. Surface and volume reconstructions were performed using 3D-DOCTOR 3.5 software on an ordinary personal computer. Volume and surface renderings were employed to perform data segmentation and image edge detection for reconstruction of the internal jugular vein, brachiocephalic vein, superior vena cava, heart, inferior vena cava, hepatic vein, and portal vein for computerized 3D reconstruction of the TIPS pathway and construction of a 3D visible model of different structures along it. The model can also display pathway and distribution characteristics and interactively show the spatial structural relationships between intrahepatic venous lines from any position and angle, plus complete data acquisition for any range and angle for 3D reconstruction with stereopsis and measurements using any visualization platform. The digital reconstruction of the TIPS pathway correctly reflected the complicated anatomic structural characteristics and spatial adjacency relationships between intrahepatic venous lines, providing a reference 3D morphology for image diagnostics and interventional TIPS therapy.

Virtual reality in orthopaedics: is it a reality?

BACKGROUND

Virtual reality (VR) simulation has been a requirement for airline and military pilots for decades and is only now being integrated into surgical training programs. Thus far, orthopaedic training programs have been slow to adopt VR training.

QUESTIONS/PURPOSES

We therefore asked (1) how VR has worked for other surgical specialties; (2) what VR solutions are available for orthopaedics; and (3) should VR simulation become part of the orthopaedic curriculum?

METHODS

An informal literature review was performed, searching for orthopaedically-oriented VR surgical simulators and comparing this to the number of programs available for general surgery teaching programs. An in-depth review of a VR simulator for knee arthroscopy is also presented. WHERE ARE WE NOW?: The number of papers specific to orthopaedics and VR is limited. VR is used effectively in other specialties, especially general surgery. VR simulators are readily available for shoulder and knee arthroscopy but not as well incorporated into training curricula. WHERE DO WE NEED TO GO?: VR technology is available today for training programs. Integration of VR into the orthopaedic curriculum will save time in the OR, reduce operative errors, and improve the resident's overall educational experience. The public will expect their surgeons to train on these simulators. HOW DO WE GET THERE?: Orthopaedic training programs should take advantage of the commercially available VR simulators for orthopaedic procedures and incorporate them into their training curricula. This effort could be led by the American Academy of Orthopaedic Surgeons (AAOS) and the American Board of Orthopaedic Surgery (ABOS), two of the primary sponsors of a major study in the effectiveness of VR simulators for knee arthroscopy.

A novel modeling framework for multilayered soft tissue deformation in virtual orthopedic surgery

Realistic modeling of soft tissue deformation is crucial to virtual orthopedic surgery, especially orthopedic trauma surgery which involves layered heterogeneous soft tissues. In this paper, a novel modeling framework for multilayered soft tissue deformation is proposed in order to facilitate the development of orthopedic surgery simulators. We construct our deformable model according to the layered structure of real human organs, and this results in a multilayered model. The division of layers is based on the segmented Chinese Visible Human (CVH) dataset. This enhances the realism and accuracy in the simulation. For the sake of efficiency, we employ 3D mass-spring system to our multilayered model. The nonlinear passive biomechanical properties of skin and skeletal muscle are achieved by introducing a bilinear elasticity scheme to the springs in the mass-spring system. To efficiently and accurately reproduce the biomechanical properties of certain human tissues, an optimization approach is employed in configuring the parameters of the springs. Experimental data from biomechanics literatures are used as benchmarking references. With the employment of Physics Processing Unit (PPU) and high quality volume visualization, our framework is developed into an interactive and intuitive platform for virtual surgery training systems. Several experiments demonstrate the feasibility of the proposed framework in providing interactive and realistic deformation for orthopedic surgery simulation.

Effect of a virtual reality interface on the learning curve and on the accuracy of a surgical planner for total hip replacement

The aim of this study is to evaluate the performance of a non-conventional input and output device (virtual reality) in a total hip replacement surgical planner. A test was performed asking five users to position a cup in a defined position. Every user performed the task using three different hardware configurations: (I) conventional mouse and monitor, (II) mouse and auto-stereoscopic monitor, and (III) 12-DOF tracker (haptic device) and auto-stereoscopic monitor. The results were evaluated in terms of root mean square error of the obtained position with respect to the target one and in terms of learning curve. The results showed that the examined VR technology does not show a sufficient positioning accuracy to be considered for clinical assessment.

The development of an objective model to assess arthroscopic performance

BACKGROUND

Many residency and fellowship programs have cadaver laboratories to teach and practice arthroscopic skills. However, there is currently no validated method of evaluating arthroscopic skill in this setting. The purpose of the present study was to develop and validate an objective model for evaluating basic arthroscopic proficiency on a cadaver knee in a bioskills laboratory.

METHODS

Two measures from the educational literature were adapted for use specifically for arthroscopy: a task-specific checklist and a global rating scale were combined to create the Basic Arthroscopic Knee Skill Scoring System. Fifty-nine residents, three sports medicine fellows, and six sports medicine fellowship-trained attending surgeons were recruited. After completing a demographic survey, including the postgraduate year and number of knee and shoulder arthroscopies performed, each subject performed a diagnostic knee arthroscopy and a partial meniscectomy on a cadaver knee while being assessed by a single evaluator using the Basic Arthroscopic Knee Skill Scoring System.

RESULTS

There was a strong positive correlation between global rating scale scores and both the postgraduate year (r = 0.93, p < 0.01) and the ranked number of knee arthroscopies performed (r = 0.88, p < 0.01). These scores detected significant differences between postgraduate years 1 and 2, and years 4 and 5 at the p <or= 0.01 level and between years 2 and 3 at the p <or= 0.05 level. Task-specific checklist scores were moderately correlated with both postgraduate year (r = 0.73, p < 0.01) and ranked number of knee arthroscopies performed (r = 0.64, p < 0.01). These scores detected significant differences only between postgraduate year-1 and year-2 residents at the p <or= 0.01 level, indicating that these skills are acquired early in training.

CONCLUSION

The Basic Arthroscopic Knee Skill Scoring System can capture and differentiate levels of arthroscopic skill and was validated to objectively evaluate basic arthroscopic proficiency in a bioskills laboratory. This model will allow benchmarks of surgical skill to be created for each level of residency training and individual progress to be monitored over time.

Evaluation of skills in arthroscopic training based on trajectory and force data

Objective evaluation of surgical skills is essential for an arthroscopic training system. We asked whether a quantitative assessment of arthroscopic skills using scores, time to completion, instrument tip trajectory data, and force data was valid. We presumed more experienced surgeons would perform better on a simulated arthroscopic procedure than novices, therefore validating the quantitative assessment. Surgical trainees (n = 12), orthopaedic residents (n = 12), and experienced arthroscopic surgeons (n = 6) were tested on a Sawbones knee simulator. Subjects performed a joint inspection and probing task and a partial meniscectomy task. The trajectory data were measured using an electromagnetic motion tracking system and the force data were measured using a force sensor. The experienced group performed both tasks with higher scores and more quickly than the less experienced groups. The path length of the probe and the scissors was substantially shorter and the probe velocity was considerably faster in the experienced group. The trainee group applied substantially stronger forces to the joint during the joint inspection and probing task. Our data suggest a performance assessment using an electromagnetic motion tracking system and a force sensor provides an objective means of evaluating surgical skills in an arthroscopic training system.

Virtual 3D planning of acetabular fracture reduction

Displaced acetabular fractures are best treated with open reduction to achieve anatomic reduction and maximize the chance of a good functional outcome. Because of the anatomic complexity and often limited visualization, fracture reduction can be difficult. Virtual planning software can allow the surgeon to understand the fracture morphology and to rehearse reduction maneuvers. The purpose of this study was to determine the effect of a novel virtual fracture reduction module on time and accuracy of reduction. Four acetabular fracture patterns were created in synthetic pelves, which were implanted with fiducial markers and were registered with CT scan. Ten surgeons used virtual fracture reduction software or conventional 2D planning methods and immediately reduced the fractures blindly in a viscous gel medium. 3D imaging was again performed and the accuracy of reduction was assessed. The average malreduction was significantly improved following planning with the virtual software compared to the standard technique. The time taken for reduction was also significantly less for two of the four fracture patterns. Virtual software may be useful for visualizing and planning treatment of fractures of the acetabulum, potentially leading to more accurate and efficient reductions, and may also be an effective educational tool.

Volume rendering based on magnetic resonance imaging: advances in understanding the three-dimensional anatomy of the human knee

The choice of medical imaging techniques, for the purpose of the present work aimed at studying the anatomy of the knee, derives from the increasing use of images in diagnostics, research and teaching, and the subsequent importance that these methods are gaining within the scientific community. Medical systems using virtual reality techniques also offer a good alternative to traditional methods, and are considered among the most important tools in the areas of research and teaching. In our work we have shown some possible uses of three-dimensional imaging for the study of the morphology of the normal human knee, and its clinical applications. We used the direct volume rendering technique, and created a data set of images and animations to allow us to visualize the single structures of the human knee in three dimensions. Direct volume rendering makes use of specific algorithms to transform conventional two-dimensional magnetic resonance imaging sets of slices into see-through volume data set images. It is a technique which does not require the construction of intermediate geometric representations, and has the advantage of allowing the visualization of a single image of the full data set, using semi-transparent mapping. Digital images of human structures, and in particular of the knee, offer important information about anatomical structures and their relationships, and are of great value in the planning of surgical procedures. On this basis we studied seven volunteers with an average age of 25 years, who underwent magnetic resonance imaging. After elaboration of the data through post-processing, we analysed the structure of the knee in detail. The aim of our investigation was the three-dimensional image, in order to comprehend better the interactions between anatomical structures. We believe that these results, applied to living subjects, widen the frontiers in the areas of teaching, diagnostics, therapy and scientific research.