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Postolka B, Killen BA, Boey H, Malaquias TM, Natsakis T, Clockaerts S, Misselyn D, Coudyzer W, Vander Sloten J, Jonkers I. Hindfoot kinematics and kinetics - A combined in vivo and in silico analysis approach. Gait Posture 2024; 112:8-15. [PMID: 38723393 DOI: 10.1016/j.gaitpost.2024.04.023] [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: 12/01/2023] [Revised: 03/13/2024] [Accepted: 04/23/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND The complex anatomical structure of the foot-ankle imposes challenges to accurately quantify detailed hindfoot kinematics and estimate musculoskeletal loading parameters. Most systems used to capture or estimate dynamic joint function oversimplify the anatomical structure by reducing its complexity. RESEARCH QUESTION Can four dimensional computed tomography (4D CT) imaging in combination with an innovative foot manipulator capture in vivo hindfoot kinematics during a simulated stance phase of walking and can talocrural and subtalar articular joint mechanics be estimated based on a detailed in silico musculoskeletal foot-ankle model. METHODS A foot manipulator imposed plantar/dorsiflexion and inversion/eversion representing a healthy stance phase of gait in 12 healthy participants while simultaneously acquiring 4D CT images. Participant-specific 3D hindfoot rotations and translations were calculated based on bone-specific anatomical coordinate systems. Articular cartilage contact area and contact pressure of the talocrural and subtalar joints were estimated using an extended foot-ankle model updated with an elastic foundation contact model upon prescribing the participant-specific rotations measured in the 4D CT measurement. RESULTS Plantar/dorsiflexion predominantly occurred at the talocrural joint (RoM 15.9±3.9°), while inversion/eversion (RoM 5.9±3.9°) occurred mostly at the subtalar joint, with the contact area being larger at the subtalar than at the talocrural joint. Contact pressure was evenly distributed between the talocrural and subtalar joint at the beginning of the simulated stance phase but was then redistributed from the talocrural to the subtalar joint with increasing dorsiflexion. SIGNIFICANCE In a clinical case study, the healthy participants were compared with four patients after surgically treaded intra-articular calcaneal fracture. The proposed workflow was able to detect small but meaningful differences in hindfoot kinematics and kinetics, indicative of remaining hindfoot pathomechanics that may influence the onset and progression of degenerative joint diseases.
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Affiliation(s)
- Barbara Postolka
- KU Leuven, Department of Movement Sciences, Human Movement Biomechanics Research Group, Tervuursevest 101, Leuven 3001, Belgium.
| | - Bryce A Killen
- KU Leuven, Department of Movement Sciences, Human Movement Biomechanics Research Group, Tervuursevest 101, Leuven 3001, Belgium
| | - Hannelore Boey
- KU Leuven, Department of Movement Sciences, Human Movement Biomechanics Research Group, Tervuursevest 101, Leuven 3001, Belgium; KU Leuven, Department of Mechanical Engineering, Biomechanics Section, Celestijnenlaan 300C, Leuven 3001, Belgium
| | - Tiago M Malaquias
- KU Leuven, Department of Mechanical Engineering, Biomechanics Section, Celestijnenlaan 300C, Leuven 3001, Belgium
| | - Tassos Natsakis
- KU Leuven, Department of Mechanical Engineering, Biomechanics Section, Celestijnenlaan 300C, Leuven 3001, Belgium; Technical University of Cluj-Napoca, Department of Automation, Dorobantilor 71-73, Cluj-Napoca 400268, Romania
| | - Stefan Clockaerts
- Holy Heart Hospital Lier, Department of Orthopaedic Surgery and Traumatology, Mechelsesteenweg 24, Lier 2500, Belgium
| | - Dominique Misselyn
- UZ Leuven, Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
| | | | - Jos Vander Sloten
- KU Leuven, Department of Mechanical Engineering, Biomechanics Section, Celestijnenlaan 300C, Leuven 3001, Belgium
| | - Ilse Jonkers
- KU Leuven, Department of Movement Sciences, Human Movement Biomechanics Research Group, Tervuursevest 101, Leuven 3001, Belgium
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Brand A, Alexander N, Bauer L, Böhm H, Stief F, van Drongelen S, Wolf SI, Trinler U. [An update on clinical gait analysis : Current developments and applications]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:494-502. [PMID: 38847874 DOI: 10.1007/s00132-024-04516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/29/2024]
Abstract
The objective acquisition and assessment of joint movements and loads using instrumented gait analysis has become an established tool in clinical diagnostics. In particular, marker-based 3D gait analyses make use of an increasingly comprehensive database for the assessment of orthopaedic or neurological questions. Based on this data and medical-scientific experience, increasingly reliable approaches and evaluation strategies are emerging, which also draw on methods from artificial intelligence and musculoskeletal modelling. This article focusses on marker-based gait analyses of the lower extremity (hip, knee, foot) and how these can be used in a clinically relevant way using current methods, e.g. for determining indications or optimization of surgical planning. Finally, current developments and applications by using alternative methods from sensor technology and optical motion capture will be briefly discussed.
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Affiliation(s)
- Andreas Brand
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
- Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Nathalie Alexander
- Labor für Bewegungsanalyse, Ostschweizer Kinderspital, St. Gallen, Schweiz
| | - Leandra Bauer
- Experimentelle Orthopädie, Universitätsklinikum Jena, Campus Eisenberg, Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - Harald Böhm
- Orthopädische Kinderklinik, Behandlungszentrum Aschau gGmbH, Aschau im Chiemgau, Deutschland
- Fakultät Ingenieurwissenschaften und Gesundheit, Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Hildesheim, Deutschland
| | - Felix Stief
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main, Deutschland
- BG Service- und Rehabilitationszentrum, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Forschungsbereich für Arthrose, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Sebastian I Wolf
- Klinik für Orthopädie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Setliff JC, Paulus PF, Yamamoto T, Yang S, Hogan MV, Anderst WJ. Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking. Med Eng Phys 2024; 126:104151. [PMID: 38621840 DOI: 10.1016/j.medengphy.2024.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.
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Affiliation(s)
- Joshua C Setliff
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
| | - Paige F Paulus
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tetsuya Yamamoto
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumeng Yang
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Foot and Ankle Injury Research [F.A.I.R] Group, USA
| | - William J Anderst
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Caravelli S, Bragonzoni L, Zinno R, Vocale E, Pinelli E, Barone G, Vara G, Di Paolo S, Zaffagnini S, Mosca M. In Vivo Total Ankle Arthroplasty Kinematic Evaluation: A Prospective Radiostereometric Analysis. Biomedicines 2024; 12:705. [PMID: 38672061 PMCID: PMC11048208 DOI: 10.3390/biomedicines12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Ankle osteoarthritis (OA) represents a significant social burden and is one of the main causes of chronic disability in a rapidly growing part of the world's population. Total ankle arthroplasty (TAA) has become increasingly popular despite the poor results obtained with the first dedicated designs. The purpose of this paper was to evaluate the ankle kinematics, in vivo and under weight-bearing conditions, of a TAA through a dynamic model-based radiostereometric analysis (MB-RSA). The clinical evaluation was performed by administering the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and Short Form-36 questionnaires. The kinematic evaluation was conducted through MB-RSA during the execution of an open kinetic chain and a closed kinetic chain motor task. Double radiographic images of the ankle joint were processed using dedicated software to obtain a 3D reconstruction of the ankle prosthetic components' motion. Eighteen patients (five females) completed the clinical and instrumental preoperative and postoperative evaluations (age 59.1 ± 10.3). All clinical scores showed a marked improvement (p < 0.005). During the closed kinetic chain motor tasks, the ankle showed a total range of motion (ROM) in dorsi-plantarflexion of 19.84°. The parameters in varus-valgus were recorded. Physiological motion can be achieved in TAA, characterized by a wide range of motion and coupling of movements on the three planes. The results of the present work may help to understand the real movement of a widespread TAA model and possibly to improve future designs and instrumentation.
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Affiliation(s)
- Silvio Caravelli
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
| | - Laura Bragonzoni
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Raffaele Zinno
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Emanuele Vocale
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
| | - Erika Pinelli
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Giuseppe Barone
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Giulio Vara
- U.O. Radiodiagnostica, Ospedale Umberto I, 48022 Lugo, BO, Italy;
| | - Stefano Di Paolo
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy;
| | - Massimiliano Mosca
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
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5
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Paulus P, Gale T, Setliff J, Yamamoto T, Yang S, Brown J, Munsch M, Hogan M, Anderst W. Ankle and subtalar joint axes of rotation and center of rotation during walking and running in healthy individuals measured using dynamic biplane radiography. J Biomech 2023; 160:111837. [PMID: 37837836 PMCID: PMC11006825 DOI: 10.1016/j.jbiomech.2023.111837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/07/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
The goal of this study was to determine how foot type and activity level affect ankle and hindfoot motion. Dynamic biplane radiography and a validated volumetric registration process was used to measure ankle and hindfoot motion of 20 healthy adults during walking and running. The helical axes of motion (HAM) during stance were calculated at the tibiotalar and subtalar joints. The intersection of each HAM and the rotation plane of interest defined the tibiotalar and subtalar centers of rotation (COR). Correlations between foot type and hindfoot kinematics were calculated using Pearson's correlations. The effect of activity, phase of gait, and dominant vs. non-dominant limb on HAM and COR were evaluated using linear mixed effects models. Activity and phase of gait influenced the superior location of the tibiotalar (p < 0.041) and subtalar (p < 0.044) CORs. Activity and gait phase affected tibiotalar (p < 0.049) and subtalar (p < 0.044) HAM direction during gait. Both HAM orientation and COR location changed with activity and phase of gait. These ankle and hindfoot kinematics have implications for total ankle replacement design and musculoskeletal models that estimate force and moment generating capabilities of muscles.
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Affiliation(s)
- Paige Paulus
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
| | - Tom Gale
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Joshua Setliff
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Tetsuya Yamamoto
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumeng Yang
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Jessica Brown
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Maria Munsch
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - MaCalus Hogan
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA; Foot and Ankle Injury Research [F.A.I.R] Group, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Anderst
- University of Pittsburgh, Department of Orthopaedic Surgery, Pittsburgh, PA, USA
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6
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Peterson AC, Kruger KM, Lenz AL. Automatic anatomical foot and ankle coordinate toolbox. Front Bioeng Biotechnol 2023; 11:1255464. [PMID: 38026875 PMCID: PMC10644787 DOI: 10.3389/fbioe.2023.1255464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Accurate analysis of bone position and orientation in foot and ankle studies relies on anatomical coordinate systems (ACS). Reliable ACSs are necessary for many biomechanical and clinical studies, especially those including weightbearing computed tomography and biplane fluoroscopy. Existing ACS approaches suffer from limitations such as manual input, oversimplifications, or non-physiological methods. To address these shortcomings, we introduce the Automatic Anatomical Foot and Ankle Coordinate Toolbox (AAFACT), a MATLAB-based toolbox that automates the calculation of ACSs for the major fourteen foot and ankle bones. In this manuscript, we present the development and evaluation of AAFACT, aiming to provide a standardized coordinate system toolbox for foot and ankle studies. The AAFACT was evaluated using a dataset of fifty-six models from seven pathological groups: asymptomatic, osteoarthritis, pilon fracture, progressive collapsing foot deformity, clubfoot, Charcot Marie Tooth, and cavovarus. Three analyses were conducted to assess the reliability of AAFACT. Firstly, ACSs were compared between automatically and manually segmented bone models to assess consistency. Secondly, ACSs were compared between individual bones and group mean bones to assess within-population precision. Lastly, ACSs were compared between the overall mean bone and group mean bones to assess the overall accuracy of anatomical representation. Statistical analyses, including statistical shape modeling, were performed to evaluate the reliability, accuracy, and precision of AAFACT. The comparison between automatically and manually segmented bone models showed consistency between the calculated ACSs. Additionally, the comparison between individual bones and group mean bones, as well as the comparison between the overall mean bone and group mean bones, revealed accurate and precise ACSs calculations. The AAFACT offers a practical and reliable solution for foot and ankle studies in clinical and engineering settings. It accommodates various foot and ankle pathologies while accounting for bone morphology and orientation. The automated calculation of ACSs eliminates the limitations associated with manual input and non-physiological methods. The evaluation results demonstrate the robustness and consistency of AAFACT, making it a valuable tool for researchers and clinicians. The standardized coordinate system provided by AAFACT enhances comparability between studies and facilitates advancements in foot and ankle research.
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Affiliation(s)
- Andrew C. Peterson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
| | - Karen M. Kruger
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States
- Motion Analysis Center, Shriners Children’s, Chicago, IL, United States
| | - Amy L. Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
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Tavana S, Clark JN, Hong CC, Newell N, Calder JD, Hansen U. In vivo evaluation of ankle kinematics and tibiotalar joint contact strains using digital volume correlation and 3 T clinical MRI. Clin Biomech (Bristol, Avon) 2023; 107:106032. [PMID: 37348206 DOI: 10.1016/j.clinbiomech.2023.106032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND In vivo evaluation of ankle joint biomechanics is key to investigating the effect of injuries on the mechanics of the joint and evaluating the effectiveness of treatments. The objectives of this study were to 1) investigate the kinematics and contact strains of the ankle joint and 2) to investigate the correlation between the tibiotalar joint contact strains and the prevalence of osteochondral lesions of the talus distribution. METHODS Eight healthy human ankle joints were subjected to compressive load and 3 T MRIs were obtained before and after applying load. The MR images in combination with digital volume correlation enabled non-invasive measurement of ankle joint kinematics and tibiotalar joint contact strains in three dimensions. FINDINGS The total translation of the calcaneus was smaller (0.48 ± 0.15 mm, p < 0.05) than the distal tibia (0.93 ± 0.16 mm) and the talus (1.03 ± 0.26 mm). These movements can produce compressive and shear joint contact strains (approaching 9%), which can cause development of lesions on joints. 87.5% of peak tensile, compressive, and shear strains in the tibiotalar joint took place in the medial and lateral zones. INTERPRETATION The findings suggested that ankle bones translate independently from each other, and in some cases in opposite directions. These findings help explain the distribution of osteochondral lesions of the talus which have previously been observed to be in medial and lateral regions of the talar dome in 90% of cases. They also provide a reason for the central region of talar dome being less susceptible to developing osteochondral lesions.
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Affiliation(s)
- Saman Tavana
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK.
| | - Jeffrey N Clark
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Choon Chiet Hong
- Fortius Clinic, 17 Fitzhardinge St, London W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, Singapore
| | - Nicolas Newell
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - James D Calder
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK; Fortius Clinic, 17 Fitzhardinge St, London W1H 6EQ, UK
| | - Ulrich Hansen
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
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Hulleck AA, Menoth Mohan D, Abdallah N, El Rich M, Khalaf K. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:901331. [PMID: 36590154 PMCID: PMC9800936 DOI: 10.3389/fmedt.2022.901331] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait. Research objective This study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms. Methods A comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included. Results and significance Clinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges.
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Affiliation(s)
- Abdul Aziz Hulleck
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dhanya Menoth Mohan
- School of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, Australia
| | - Nada Abdallah
- Weill Cornell Medicine, New York City, NY, United States
| | - Marwan El Rich
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates,Health Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates,Correspondence: Kinda Khalaf
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Lin SH, Hung LW, Kuo MY, Lin CC, Lu HY, Weng PL, Fan CL, Kuo CC, Lu TW. Effects of lateral instability on ankle coupled motions in vivo using 3D fluoroscopy. J Orthop Res 2022; 41:1076-1087. [PMID: 36121190 DOI: 10.1002/jor.25448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Lateral ankle instability (LAI) compromises the normal kinematics of the ankle, affecting activities of daily living. In vitro kinematics of ankles with LAI during single-plane motions are available, but the active control stability of these motions remains unclear. The current study measured the 3D ankle kinematics during unresisted single-plane motion tests using a bi-plane fluoroscope with a CT model-based 2D/3D registration method in 12 patients with LAI and 14 healthy peers. The coupling of the kinematic components at the talocrural and subtalar joints was quantified by the path difference between the forward and return paths of the coupled motion. Significantly increased path differences were found in the subtalar dorsiflexion/plantarflexion and inversion/eversion components during internal/external rotation tests (p < 0.05). During inversion/eversion, significantly reduced tibiocalcaneal ranges of motion and the path differences in the talocrural and subtalar dorsiflexion/plantarflexion components were noted (p < 0.05). The current results suggest that chronic LAI had compromised control stability at the subtalar joint during internal/external rotation tests and a conservative motion control strategy with significantly reduced ranges of motion to maintain good control of out-of-plane motion components in response to direct challenges of the anterior talofibular ligament during inversion/eversion tests. The current results also suggest that, compared to kinematic patterns of individual components, the path difference of the coupled motion may serve as a better measure of the motion control stability of the ankle in differentiating LAI from healthy controls.
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Affiliation(s)
- Shang-His Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Surgery, Division of Plastic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Cheng-Chung Lin
- Department of Electrical Engineering, Fu-Jen Catholic University, Taipei, Taiwan
| | - Hsin-Yi Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Ling Weng
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chia-Ling Fan
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Orthopedic Surgery, School of Medicine, China Medical University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
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Wang W, Tsai TY, Zhang C, Lin J, Dai W, Zhang M, Potthast W, Liu Y, Wang S. Comparison of instantaneous knee kinematics during walking and running. Gait Posture 2022; 97:8-12. [PMID: 35843009 DOI: 10.1016/j.gaitpost.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate measurements of in-vivo knee joint kinematics are essential to elucidate healthy knee motion and the changes that accompany injury and repair. Although numerous experimental measurements have been reported, the accurate non-invasive analysis of in-vivo knee kinematics remains a challenge in biomechanics. RESEARCH QUESTION The study objective was to investigate in-vivo knee kinematics before, at, and after contact during walking and running using a combined high-speed dual fluoroscopic imaging system (DFIS) and magnetic resonance (MR) imaging technique. METHODS Three-dimensional (3D) knee models of ten participants were created using MR images. Knee kinematics during walking and running were determined using high-speed DFIS. The 3D knee models were then related to fluoroscopic images to obtain in-vivo six-degrees-of-freedom knee kinematics. RESULTS Before contact knee flexion, external femoral rotation, and proximal-distal distance were 11.9°, 3.4°, and 1.0 mm greater during running compared to walking, respectively. Similar differences were observed at initial contact (9.9°, 7.9°, and 0.9 mm, respectively) and after contact (6.4°, 2.2°, and 0.8 mm, respectively). Posterior femoral translation at initial contact was also increased during running compared to walking. SIGNIFICANCE This study demonstrated accurate instantaneous in-vivo knee kinematic characteristics that may further the understanding of the intrinsic biomechanics of the knee during gait.
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Affiliation(s)
- Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne 50933, Germany
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Cui Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Jinpeng Lin
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Wei Dai
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne 50933, Germany
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
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11
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Baggaley M, Derrick TR, Edwards WB. Sensitivity of Internal Tibial Forces and Moments to Static Optimization Moment Constraints At the Subtalar and Ankle Joints. J Biomech Eng 2022; 145:1143324. [PMID: 35864788 DOI: 10.1115/1.4055036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/08/2022]
Abstract
We examined the sensitivity of internal tibial forces and moments during running to different subtalar/ankle moment constraints in a static optimization routine. Seventeen participants ran at 2.20, 3.33, and 4.17 ms-1 while force and motion data were collected. Ankle joint contact force was estimated using inverse-dynamics-based static optimization. Three sets of joint moment constraints were tested. All sets included the flexion-extension and abduction-adduction moments at the hip and the flexion-extension moment at the knee, but differed in the constraints used at the subtalar/ankle: 1) flexion-extension at the ankle (Sag), 2) flexion-extension and inversion-eversion at ankle (Sag+Front), and 3) flexion-extension at the ankle and supination-pronation at the subtalar (Sag+SubT). Internal tibial forces and moments were quantified at the distal one-third of the tibia, by ensuring static equilibrium with applied forces and moments. No interaction was observed between running speed and constraint for internal tibial forces or moments. Sag+SubT resulted in larger internal mediolateral force (+41%), frontal (+79%), and transverse (+29%) plane moments, compared to Sag and Sag+Front. Internal axial force was greatest in Sag+Front, compared to Sag and Sag+SubT (+37%). Faster running speeds resulted in greater internal tibial forces and moments in all directions (=+6%). Internal tibial forces and moments at the distal one-third of the tibia were sensitive to the subtalar and ankle joint moment constraints used in the static optimization routine, independent of running speed.
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Affiliation(s)
- Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada T2N 1N4
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, 0111L Forker, 534 Wallace Rd, Ames, IA, 50011-4008
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada T2N 1N4
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12
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Lenz AL, Lisonbee RJ, Peterson AC, Roach KE, Foreman KB, Barg A, Anderson AE. Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study. Foot Ankle Int 2022; 43:818-829. [PMID: 35293257 PMCID: PMC9980879 DOI: 10.1177/10711007221078001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In vivo measurements of tibiotalar and subtalar joint motion following TAR are unavailable. Using biplane fluoroscopy, we tested the hypothesis that the prosthetic tibiotalar joint and adjacent subtalar joint would demonstrate kinematic and range of motion differences compared to the contralateral untreated limb, and control participants. METHODS Six patients of 41 identified candidates that all underwent unilateral Zimmer TAR (5.4 ± 1.9 years prior) and 6 control participants were imaged with biplane fluoroscopy during overground walking and a double heel-rise activity. Computed tomography scans were acquired; images were segmented and processed to serve as input for model-based tracking of the biplane fluoroscopy data. Measurements included tibiotalar and subtalar kinematics for the TAR, untreated contralateral, and control limbs. Statistical parametric mapping quantified differences in kinematics throughout overground walking and the double heel-rise activity. RESULTS Patients with this TAR performed walking and heel-rise activities symmetrically with no significant kinematic differences at the tibiotalar and subtalar joints between limbs. Compared to control participants, patients exhibited reduced dorsi/plantarflexion range of motion that corresponded to decreased peak dorsiflexion, but only in the late stance phase of walking. This reduction in tibiotalar dorsi/plantarflexion range of motion in the TAR group became more apparent with double heel-rise activity. CONCLUSION Patients with a Zimmer TAR had symmetric kinematics during activities of walking and double heel-rise, but they did exhibit minor compensations in tibiotalar kinematics as compared to controls. CLINICAL RELEVANCE The lack of significant kinematic compensation at the subtalar joint may explain why secondary subtalar osteoarthritis is reported as being relatively uncommon in patients with some TAR designs.
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Affiliation(s)
- Amy L. Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Rich J. Lisonbee
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Koren E. Roach
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, USA
| | - K. Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany,Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Hamburg, Germany
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA,Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, UT, USA
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13
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Martinelli N, Bergamini AN, Burssens A, Toschi F, Kerkhoffs GMMJ, Victor J, Sansone V. Does the Foot and Ankle Alignment Impact the Patellofemoral Pain Syndrome? A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11082245. [PMID: 35456337 PMCID: PMC9027883 DOI: 10.3390/jcm11082245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: A convincing association between the foot and ankle alignment (FAA) and patellofemoral pain syndrome (PFPS) remains debatable in the literature. Therefore, all studies investigating the role of FAA in patients with PFPS were systematically reviewed. Methods: A systematic literature search was performed on the databases PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were all studies investigating static and/or dynamic FAA factors and PFPS. Studies with less than 20 patients or with patellofemoral osteoarthritis were excluded. The quality assessment was based on Cochrane study criteria, and the maximum score was set at eight. Results: Of 2246 articles, only 13 case-control studies were eligible. Considering static FAA factors, two studies found an association with rearfoot eversion and one with rearfoot inversion. While examining dynamic FAA characteristics, one study found an association with rearfoot eversion range of motion and three with gait kinematics. No further associations were reported. The quality assessment mean score was 5.5 (SD = 0.97) corresponding to moderate quality. Conclusions: In contrast to our expectations, a limited number of studies were founded supporting an association between FAA and PFPS. At present, the quality of the literature is still poor and conflicting, thus the need for further studies to determine any association between FAA and PFPS.
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Affiliation(s)
- Nicolò Martinelli
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (N.M.); (F.T.); (V.S.)
| | - Alberto Nicolò Bergamini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-339-399-6047
| | - Arne Burssens
- Department of Human Structure and Repair, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.B.); (J.V.)
| | - Filippo Toschi
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (N.M.); (F.T.); (V.S.)
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Meibergdreeg 9, 1105 Amsterdam, The Netherlands;
| | - Jan Victor
- Department of Human Structure and Repair, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.B.); (J.V.)
| | - Valerio Sansone
- IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (N.M.); (F.T.); (V.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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14
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Montefiori E, Fiifi Hayford C, Mazzà C. Variations of lower-limb joint kinematics associated with the use of different ankle joint models. J Biomech 2022; 136:111072. [DOI: 10.1016/j.jbiomech.2022.111072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
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15
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Perez MT, Owen JR, Wayne JS. Computational analysis of the clinical presentation of a ligamentous Lisfranc injury. J Orthop Res 2021; 39:2725-2731. [PMID: 33620124 DOI: 10.1002/jor.25013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 02/04/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023]
Abstract
Lisfranc injuries in the midfoot disrupt key arches of the foot which, if left untreated, can progress to pain, dysfunction, and arthritis. A clinical challenge is that 30-40% of Lisfranc injuries are missed in initial evaluations. The objective of this study was to explore different conditions of limb loading that could influence the biomechanics of the Lisfranc joint in a validated computational model. A computational model was created using SolidWorks software to represent the bones and soft tissues of the lower leg and foot. The model was compared to a cadaveric study of healthy and injured Lisfranc joints. The model was then used to simulate weight-bearing radiographs and evaluate how muscle activity and foot position impacted the diastasis of the Lisfranc joint, a key indicator used to diagnose Lisfranc injuries. The computational model was within one standard deviation of the cadaveric study in all measurements for the healthy and injured foot. When simulating weight-bearing radiographs, the presence of muscle activity or inversion/eversion resulted in less joint separation for the model with ligamentous Lisfranc injuries. While previous research has noted that weight-bearing radiographs provide better conditions to assess Lisfranc injuries than nonweight-bearing, this study suggests that in weight-bearing radiographs both altering the position of the foot, possibly due to pain, and the active contraction of the extrinsic flexor muscles can obfuscate indications of a Lisfranc injury.
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Affiliation(s)
- M Tyler Perez
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John R Owen
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer S Wayne
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Orthopaedic Research Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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16
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Ye D, Sun X, Zhang C, Zhang S, Zhang X, Wang S, Fu W. In Vivo Foot and Ankle Kinematics During Activities Measured by Using a Dual Fluoroscopic Imaging System: A Narrative Review. Front Bioeng Biotechnol 2021; 9:693806. [PMID: 34350162 PMCID: PMC8327092 DOI: 10.3389/fbioe.2021.693806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022] Open
Abstract
Foot and ankle joints are complicated anatomical structures that combine the tibiotalar and subtalar joints. They play an extremely important role in walking, running, jumping and other dynamic activities of the human body. The in vivo kinematic analysis of the foot and ankle helps deeply understand the movement characteristics of these structures, as well as identify abnormal joint movements and treat related diseases. However, the technical deficiencies of traditional medical imaging methods limit studies on in vivo foot and ankle biomechanics. During the last decade, the dual fluoroscopic imaging system (DFIS) has enabled the accurate and noninvasive measurements of the dynamic and static activities in the joints of the body. Thus, this method can be utilised to quantify the movement in the single bones of the foot and ankle and analyse different morphological joints and complex bone positions and movement patterns within these organs. Moreover, it has been widely used in the field of image diagnosis and clinical biomechanics evaluation. The integration of existing single DFIS studies has great methodological reference value for future research on the foot and ankle. Therefore, this review evaluated existing studies that applied DFIS to measure the in vivo kinematics of the foot and ankle during various activities in healthy and pathologic populations. The difference between DFIS and traditional biomechanical measurement methods was shown. The advantages and shortcomings of DFIS in practical application were further elucidated, and effective theoretical support and constructive research direction for future studies on the human foot and ankle were provided.
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Affiliation(s)
- Dongqiang Ye
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xiaole Sun
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Cui Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Shandong Institute of Sport Science, Jinan, China
| | - Shen Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Xini Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shaobai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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17
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Lenz AL, Strobel MA, Anderson AM, Fial AV, MacWilliams BA, Krzak JJ, Kruger KM. Assignment of local coordinate systems and methods to calculate tibiotalar and subtalar kinematics: A systematic review. J Biomech 2021; 120:110344. [PMID: 33744722 DOI: 10.1016/j.jbiomech.2021.110344] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022]
Abstract
The introduction of biplane fluoroscopy has created the ability to evaluate in vivo motion, enabling six degree-of-freedom measurement of the tibiotalar and subtalar joints. Although the International Society of Biomechanics defines a standard method of assigning local coordinate systems for the ankle joint complex, standards for the tibiotalar and subtalar joints are lacking. The objective of this systematic review was to summarize and appraise the existing literature that (1) defined coordinate systems for the tibia, talus, and/or calcaneus or (2) assigned kinematic definitions for the tibiotalar and/or subtalar joints. A systematic literature search was developed with search results limited to English Language from 2006 through 2020. Articles were screened by two independent reviewers based on title and abstract. Methodological quality was evaluated using a modified assessment tool. Following screening, 52 articles were identified as having met inclusion criteria. Methodological assessment of these articles varied in quality from 61 to 97. Included articles adopted primary methods for defining coordinate systems that included: (1) anatomical coordinate system (ACS) based on individual bone landmarks and/or geometric shapes, (2) orthogonal principal axes, and (3) interactive closest point (ICP) registration. Common methods for calculating kinematics included: (1) joint coordinate system (JCS) to calculate rotation and translation, (2) Cardan/Euler sequences, and (3) inclination and deviation angles for helical angles. The methods each have strengths and weaknesses. This summarized knowledge should provide the basis for the foot and ankle biomechanics community to create an accepted standard for calculating and reporting tibiotalar and subtalar kinematics.
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Affiliation(s)
- Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States
| | - Marisa A Strobel
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Abigail M Anderson
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Alissa V Fial
- Research & Instruction Services, Marquette University, 1355 W. Wisconsin Ave, Milwaukee, WI 53201, United States
| | - Bruce A MacWilliams
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States; Motion Analysis Center, Shriners Hospitals for Children-Salt Lake City, 1275 Fairfax Rd., Salt Lake City, UT 84103, United States
| | - Joseph J Krzak
- Physical Therapy Program, Midwestern University, 555 31st St., Downers Grove, IL 60515, United States; Motion Analysis Center, Shriners Hospitals for Children-Chicago, 2211 N Oak Park Ave, Chicago, IL 60707, United States
| | - Karen M Kruger
- Department of Biomedical Engineering, Marquette University, 1515 W Wisconsin Ave, Milwaukee, WI 53233, United States; Motion Analysis Center, Shriners Hospitals for Children-Chicago, 2211 N Oak Park Ave, Chicago, IL 60707, United States.
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18
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Roach KE, Foreman KB, MacWilliams BA, Karpos K, Nichols J, Anderson AE. The modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model provides clinically acceptable measurements of ankle and midfoot angles: A dual fluoroscopy study. Gait Posture 2021; 85:258-265. [PMID: 33626450 PMCID: PMC8085108 DOI: 10.1016/j.gaitpost.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 09/28/2020] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several multi-segment foot models have been developed to evaluate foot and ankle motion using skin-marker motion analysis. However, few multi-segment models have been evaluated against a reference standard to establish kinematic accuracy. RESEARCH QUESTION How accurately do skin-markers estimate foot and ankle motion for the modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model when compared against the reference standard, dual fluoroscopy (DF), during gait, in asymptomatic participants? METHODS Five participants walked overground as full-body skin-marker trajectory data and DF images of the foot and shank were simultaneously acquired. Using the mSHCG model, ankle and midfoot angles were calculated throughout stance for both motion analysis techniques. Statistical parametric mapping assessed differences in joint angles and marker positions between skin-marker and DF motion analysis techniques. Paired t tests, and linear regression models were used to compare joint angles and range of motion (ROM) calculated from the two techniques. RESULTS In the coronal plane, the skin-marker model significantly overestimated ROM (p = 0.028). Further, the DF model midfoot ROM was significantly positively related to differences between DF and skin-marker midfoot angles (p = 0.035, adjusted R2 = 0.76). In the sagittal plane, skin-markers underestimated ankle angles by as much as 7.26°, while midfoot angles were overestimated by as much as 9.01°. However, DF and skin-marker joint angles were not significantly different over stance. Skin-markers on the tibia, calcaneus, and fifth metatarsal had significantly different positions than the DF markers along the direction of walking for isolated portions that were less than 10 % of stance. Euclidean distances between DF and skin-markers positions were less than 9.36 mm. SIGNIFICANCE As the accuracy of the mSHCG model was formerly unknown, the results of this study provide ranges of confidence for key angles calculated by this model.
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Affiliation(s)
- Koren E. Roach
- Department of Radiology and Biomedical Imaging, 185 Berry St., Suite 350, San Francisco, CA 94107,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108
| | - Bruce A. MacWilliams
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Motion Analysis Center, Shriners Hospitals for Children, 1275 Fairfax Rd., Salt Lake City, UT 84103, USA
| | - Kostantino Karpos
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physics, Arizona State University, 550 E Tyler Drive Tempe, AZ 85287
| | - Jennifer Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108,Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
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19
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Yang S, Canton SP, Hogan MV, Anderst W. Healthy ankle and hindfoot kinematics during gait: Sex differences, asymmetry and coupled motion revealed through dynamic biplane radiography. J Biomech 2021; 116:110220. [PMID: 33422727 PMCID: PMC7878402 DOI: 10.1016/j.jbiomech.2020.110220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/02/2020] [Accepted: 12/25/2020] [Indexed: 12/25/2022]
Abstract
The aims of this study were to compare male versus female and dominant versus non-dominant kinematics in the ankle and hindfoot, and to characterize coupled motion between the subtalar and tibiotalar joints during the support phase of gait. Twenty healthy adults walked on a laboratory walkway while synchronized biplane radiographs of the ankle and hindfoot were collected at 100 frames/s. A validated tracking technique was used to measure tibiotalar and subtalar kinematics. Differences between male and female range of motion (ROM) were observed only in tibiotalar (AP and ML) and subtalar (ML) translation (all differences<1 mm and all p < 0.04). Statistical parametric mapping identified differences between kinematics waveforms of males and females in tibiotalar translation (AP and ML) and eversion, and subtalar ML translation. No differences between dominant and non-dominant sides were observed in ROM or kinematics waveforms. The average absolute side-to-side difference in the kinematics waveforms was 4.1° and 1.5 mm or less for all rotations and translations, respectively. Tibiotalar plantarflexion was coupled to subtalar inversion and eversion during the impact and push-off phases of stance (r = 0.90 and r = 0.87, respectively). This data may serve as a guide for evaluating ankle kinematics waveforms, ROM, symmetry, and restoration of healthy coupled motion after surgical intervention or rehabilitation. The observed kinematics differences between males and females may predispose females to higher rates of ankle and knee injury and suggest sex-dependent ankle reconstruction techniques may be beneficial.
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Affiliation(s)
- Shumeng Yang
- Department of Bioengineering, University of Pittsburgh, United States
| | | | - MaCalus V Hogan
- Department of Bioengineering, University of Pittsburgh, United States; University of Pittsburgh School of Medicine, United States; Department of Orthopaedic Surgery, University of Pittsburgh, United States; Foot and Ankle Injury Research [F.A.I.R] Group, United States
| | - William Anderst
- University of Pittsburgh School of Medicine, United States; Department of Orthopaedic Surgery, University of Pittsburgh, United States
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20
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Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 PMCID: PMC7405358 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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21
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Blair DJ, Barg A, Foreman KB, Anderson AE, Lenz AL. Methodology for Measurement of in vivo Tibiotalar Kinematics After Total Ankle Replacement Using Dual Fluoroscopy. Front Bioeng Biotechnol 2020; 8:375. [PMID: 32432091 PMCID: PMC7214754 DOI: 10.3389/fbioe.2020.00375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Biomechanical data could improve our clinical understanding of failures in total ankle replacement (TAR) patients, leading to better surgical approaches and implant designs. Kinematics of the prosthetic tibiotalar joint in TAR patients have yet to be measured using dual fluoroscopy. With dual fluoroscopy, computed tomography (CT) images are acquired to track bone motion. One challenge with this approach is dealing with metal artifact in the CT images that distorts implant visualization and the surrounding bone to implant interfaces. The aim of this study was to develop a methodology to measure in vivo TAR kinematics using inputs of computer-aided design (CAD) models, dual fluoroscopy and CT imaging with metal artifact reduction. To develop this methodology, we created a hybrid three-dimensional (3D) model that contained both: (1) the segmented bone; and (2) the CAD models of the TAR components. We evaluated a patient following total ankle replacement to demonstrate feasibility. The patient performed a self-selected overground walk during which dual fluoroscopy images were collected at 200 Hz. In vivo tracking verifications were performed during overground walking using a distance calculation between the implant articular surfaces to evaluate the model-based tracking 3D solution. Tracking verification indicated realistic alignment of the hybrid models with an evenly distributed distance map pattern during the trial. Articular surface distance calculations were reported as an average of 1.3 mm gap during the entirety of overground walking. The successful implementation of our new tracking methodology with a hybrid model presents a new approach to evaluate in vivo TAR kinematics. Measurements of in vivo kinematics could improve our clinical understanding of failures in TAR patients, leading to better long-term surgical outcomes.
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Affiliation(s)
- Dylan J Blair
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Alexej Barg
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
| | - K Bo Foreman
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Amy L Lenz
- Orthopaedic Research Laboratory, Department of Orthpaedics, University of Utah, Salt Lake City, UT, United States
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22
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Lenz AL, Nichols JA, Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Compensatory Motion of the Subtalar Joint Following Tibiotalar Arthrodesis: An in Vivo Dual-Fluoroscopy Imaging Study. J Bone Joint Surg Am 2020; 102:600-608. [PMID: 32079879 PMCID: PMC7289138 DOI: 10.2106/jbjs.19.01132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibiotalar arthrodesis is a common treatment for end-stage tibiotalar osteoarthritis, and is associated with a long-term risk of concomitant subtalar osteoarthritis. It has been clinically hypothesized that subtalar osteoarthritis following tibiotalar arthrodesis is the product of compensatory subtalar joint hypermobility. However, in vivo measurements of subtalar joint motion following tibiotalar arthrodesis have not been quantified. Using dual-fluoroscopy motion capture, we tested the hypothesis that the subtalar joint of the limb with a tibiotalar arthrodesis would demonstrate differences in kinematics and increased range of motion compared with the subtalar joint of the contralateral, asymptomatic, untreated ankle. METHODS Ten asymptomatic patients who had undergone unilateral tibiotalar arthrodesis at a mean (and standard deviation) of 4.0 ± 1.8 years previously were evaluated during overground walking and a double heel-rise task. The evaluation involved markerless tracking with use of dual fluoroscopy integrated with 3-dimensional computed tomography, which allowed for dynamic measurements of subtalar and tibiotalar dorsiflexion-plantar flexion, inversion-eversion, and internal-external rotation. Range of motion, stance time, swing time, step length, and step width were also measured. RESULTS During the early stance phase of walking, the subtalar joint of the limb that had been treated with arthrodesis was plantar flexed (-4.7° ± 3.3°), whereas the subtalar joint of the untreated limb was dorsiflexed (4.6° ± 2.2°). Also, during the early stance phase of walking, eversion of the subtalar joint of the surgically treated limb (0.2° ± 2.3°) was less than that of the untreated limb (4.5° ± 3.2°). During double heel-rise, the treated limb exhibited increased peak subtalar plantar flexion (-7.1° ± 4.1°) compared with the untreated limb (0.2° ± 1.8°). CONCLUSIONS A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. CLINICAL RELEVANCE Significant subtalar joint plantar flexion compensations appear to occur following tibiotalar arthrodesis. We found an increase in subtalar plantar flexion and considered the potential relationship of this finding with the increased rate of subtalar osteoarthritis that occurs following ankle arthrodesis.
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Affiliation(s)
- Amy L. Lenz
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Jennifer A. Nichols
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Koren E. Roach
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Department of Radiology, University of California-San Francisco, San Francisco, California
| | - K. Bo Foreman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Alexej Barg
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Charles L. Saltzman
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Departments of Orthopaedics (A.L.L., J.A.N., K.E.R., A.B., C.L.S., and A.E.A.), Physical Therapy & Athletic Training (K.B.F. and A.E.A.), and Bioengineering and Biomedical Imaging (K.E.R. and A.E.A.), and the Scientific Computing & Imaging Institute (A.E.A.), University of Utah, Salt Lake City, Utah,Email address for A.E. Anderson:
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23
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Maharaj JN, Kessler S, Rainbow MJ, D'Andrea SE, Konow N, Kelly LA, Lichtwark GA. The Reliability of Foot and Ankle Bone and Joint Kinematics Measured With Biplanar Videoradiography and Manual Scientific Rotoscoping. Front Bioeng Biotechnol 2020; 8:106. [PMID: 32211386 PMCID: PMC7075816 DOI: 10.3389/fbioe.2020.00106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Abstract
The intricate motion of the small bones of the feet are critical for its diverse function. Accurately measuring the 3-dimensional (3D) motion of these bones has attracted much attention over the years and until recently, was limited to invasive techniques or quantification of functional segments using multi-segment foot models. Biplanar videoradiography and model-based scientific rotoscoping offers an exciting alternative that allows us to focus on the intricate motion of individual bones in the foot. However, scientific rotoscoping, the process of rotating and translating a 3D bone model so that it aligns with the captured x-ray images, is either semi- or completely manual and it is unknown how much human error affects tracking results. Thus, the aim of this study was to quantify the inter- and intra-operator reliability of manually rotoscoping in vivo bone motion of the tibia, talus, and calcaneus during running. Three-dimensional CT bone volumes and high-speed biplanar videoradiography images of the foot were acquired on six participants. The six-degree-of-freedom motions of the tibia, talus, and calcaneus were determined using a manual markerless registration algorithm. Two operators performed the tracking, and additionally, the first operator re-tracked all bones, to test for intra-operator effects. Mean RMS errors were 1.86 mm and 1.90° for intra-operator comparisons and 2.30 mm and 2.60° for inter-operator comparisons across all bones and planes. The moderate to strong similarity values indicate that tracking bones and joint kinematics between sessions and operators is reliable for running. These errors are likely acceptable for defining gross joint angles. However, this magnitude of error may limit the capacity to perform advanced analyses of joint interactions, particularly those that require precise (sub-millimeter) estimates of bone position and orientation. Optimizing the view and image quality of the biplanar videoradiography system as well as the automated tracking algorithms for rotoscoping bones in the foot are required to reduce these errors and the time burden associated with the manual processing.
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Affiliation(s)
- Jayishni N Maharaj
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah Kessler
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Susan E D'Andrea
- Department of Orthopaedics, Brown University, Providence, RI, United States.,Department of Kinesiology, The University of Rhode Island, Kingston, RI, United States
| | - Nicolai Konow
- Department of Biological Science, University of Massachusetts, Lowell, MA, United States
| | - Luke A Kelly
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Glen A Lichtwark
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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Validation and application of dynamic biplane radiography to study in vivo ankle joint kinematics during high-demand activities. J Biomech 2020; 103:109696. [PMID: 32139098 DOI: 10.1016/j.jbiomech.2020.109696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 12/26/2022]
Abstract
Ankle ligament injuries are the most common musculoskeletal injury in physically active populations. Failure to restore native kinematics post-injury often leads to long-term consequences including chronic instability and arthritis. Using traditional motion capture, it is difficult to distinguish independent motions of the tibiotalar and subtalar joints to assess the effects of injury, surgical repair, and rehabilitation on ankle joint complex (AJC) kinematics. Therefore, the aims of this study were to determine the accuracy of dynamic biplane radiography for determining in vivo AJC kinematics and arthrokinematics, and to identify sport-related movements that require the largest AJC range of motion (ROM) during support. Two subjects had three to five 1.0 mm diameter tantalum beads implanted into the tibia, fibula, talus, and calcaneus during lateral ankle ligament repair. Six months after surgery, the subjects executed seven movements while biplane radiographs were collected. Bone motion was tracked using radiostereophotogrammetric analysis (RSA) as a "gold standard", and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs. Over all movements, the average tibiotalar, subtalar and tibiofibular RMS errors were 0.5 mm ± 0.2 mm, 0.8 mm ± 0.5 mm and 0.8 mm ± 0.3 mm in translation and 1.4° ± 0.4°, 1.5° ± 0.5° and 1.7° ± 0.6° in rotation, respectively. Tibiotalar joint space was determined with an average precision of 0.5 mm. ROM results indicate that jumping and a forward-to-backward push-off movement are the best of the seven sport-related movements evaluated for eliciting full ROM kinematics.
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25
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Cao S, Wang C, Zhang G, Ma X, Wang X, Huang J, Zhang C, Wang K. In vivo kinematics of functional ankle instability patients during the stance phase of walking. Gait Posture 2019; 73:262-268. [PMID: 31382233 DOI: 10.1016/j.gaitpost.2019.07.377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous studies showed functional ankle instability (FAI) patients have morphological ligamentous abnormality, despite having no apparent joint laxity. RESEARCH QUESTION Whether tibiotalar and subtalar joints hypermobility exists in FAI patients during stance phase of walking, remains controversial. METHODS Ten unilateral FAI patients, ten unilateral lateral ankle sprain (LAS) copers and ten healthy controls were included. A dual fluoroscopy imaging system was utilized to capture the fluoroscopic images of tibiotalar and subtalar joint during the stance phase of walking. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint excursions about six degrees of freedom were compared among the three groups. The correlations between range of motion and Cumberland Ankle Instability Tool (CAIT) scores were assessed utilizing the Spearman's correlation coefficient (r). RESULTS During the stance phase, the FAI patients and LAS copers showed larger tibiotalar anterior/posterior translation than the healthy controls (FAI patients, p = .013; LAS copers, p = .002). The FAI patients also showed significantly larger lateral/medial translation (p = .035) and inversion/eversion rotation (p = .003) of subtalar joints than healthy controls. By contrast, the subtalar joints of the LAS copers were not different from those of the healthy controls in the lateral/medial translation (p = .459) and inversion/eversion rotation (p = .091). CAIT scores were negatively correlated with range of motion. SIGNIFICANCE During the stance phase of walking, FAI patients showed significantly larger hypermobility of subtalar joints than healthy controls, contrary to the LAS copers. These findings justify the utilization of dual fluoroscopy imaging system to detect joint hypermobility in FAI patients. Treatment for FAI patients may require stabilization of the subtalar joint.
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Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Gonghao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
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Montefiori E, Modenese L, Di Marco R, Magni-Manzoni S, Malattia C, Petrarca M, Ronchetti A, de Horatio LT, van Dijkhuizen P, Wang A, Wesarg S, Viceconti M, Mazzà C. An image-based kinematic model of the tibiotalar and subtalar joints and its application to gait analysis in children with Juvenile Idiopathic Arthritis. J Biomech 2019; 85:27-36. [DOI: 10.1016/j.jbiomech.2018.12.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 10/06/2018] [Accepted: 12/28/2018] [Indexed: 01/08/2023]
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Lin CC, Li JD, Lu TW, Kuo MY, Kuo CC, Hsu HC. A model-based tracking method for measuring 3D dynamic joint motion using an alternating biplane x-ray imaging system. Med Phys 2018; 45:3637-3649. [PMID: 29889983 DOI: 10.1002/mp.13042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSES To propose a new model-based tracking method for measuring three-dimensional (3D) dynamic joint kinematics using a clinical alternating biplane x-ray imaging system; and to quantify in vitro its errors in measuring ankle and knee motions at different motion speeds. METHODS A new model-based tracking method based on motion component partition and interpolation (MCPI) was developed for measuring 3D dynamic joint kinematics based on a clinical alternating biplane x-ray imaging system. Two detectors of the biplane imaging system placed perpendicular to each other were operated to collect alternating fluoroscopic images of the targeted joint during tasks. The CT data of the joint were also acquired for the reconstruction of volumetric and surface models of each of the associated bones. The CT-based models of the bones were first registered to the alternating images using a model-to-single-plane fluoroscopic image registration method, and the resulting bone poses were then refined using a two-level optimization with motion component partition and model vertex trajectory interpolation. The MCPI method was evaluated in vitro for measurement errors for an ankle and a knee specimen moving at different speeds against a standard reference provided by a highly accurate motion capture system. The positional and rotational errors of the measured bone poses were quantified in terms of the bias, precision, and root-mean-squared errors (RMSE), as well as the mean target registration error (mTRE), a final mTRE less than 2.5 mm indicating a successful registration. RESULTS The new method was found to have RMSE of bone pose measurements of less than 0.18 mm for translations and 0.72° for rotations for the ankle, and 0.33 mm and 0.74° for the knee with a high successful registration rate (>97%), and did not appear to be affected by joint motion speeds. Given the same alternating fluoroscopic images, the MCPI method outperformed the typical biplane analysis method assuming zero time offset between the two fluoroscopic views. The differences in performance between the methods were increased with increased joint motion speed. With the accurate bone pose data, the new method enabled talocrural, subtalar, and tibiofemoral kinematics measurements with submillimeter and subdegree accuracy, except for an RMSE of 1.04° for the internal/external rotation of the talocrural joint. CONCLUSIONS A new model-based tracking method based on MCPI has been developed for measuring dynamic joint motions using an alternating biplane x-ray imaging system widely available in medical centers. The MCPI method has been demonstrated in vitro to be highly accurate in determining the 3D kinematics of the bones of both the ankle joint complex and the knee. The current results suggest that the MCPI method would be an effective approach for measuring in vivo 3D kinematics of dynamic joint motion in a clinical setting equipped with an alternating biplane x-ray imaging system.
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Affiliation(s)
- Cheng-Chung Lin
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Jia-Da Li
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, 10051, Taiwan
- Department of Orthopaedic Surgery, College of Medicine, National Taiwan University, Taipei, 10051, Taiwan
| | - Mei-Ying Kuo
- Department of Physical Therapy, China Medical University, Taichung, 40402, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, 40447, Taiwan
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Roach KE, Foreman KB, Barg A, Saltzman CL, Anderson AE. Application of High-Speed Dual Fluoroscopy to Study In Vivo Tibiotalar and Subtalar Kinematics in Patients With Chronic Ankle Instability and Asymptomatic Control Subjects During Dynamic Activities. Foot Ankle Int 2017; 38:1236-1248. [PMID: 28800713 PMCID: PMC5914166 DOI: 10.1177/1071100717723128] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abnormal angular and translational (ie, kinematic) motion at the tibiotalar and subtalar joints is believed to cause osteoarthritis in patients with chronic ankle instability (CAI). METHODS In this preliminary study the investigators quantified and compared in vivo tibiotalar and subtalar kinematics in 4 patients with CAI (3 women) and 10 control subjects (5 men) using dual fluoroscopy during a balanced, single-leg heel-rise and treadmill walking at 0.5 and 1.0 m/s. RESULTS During balanced heel-rise, 69%, 54%, and 66% of mean CAI tibiotalar internal rotation/external rotation (IR/ER), subtalar inversion/eversion, and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 0.5-m/s gait, 50% and 60% of mean CAI tibiotalar dorsi/plantarflexion and subtalar IR/ER angles, respectively, were outside the 95% confidence intervals of control subjects. During 1.0-m/s gait, 62%, 65%, and 73% of mean CAI subtalar dorsi/plantarflexion, inversion/eversion, and IR/ER, respectively, were outside the 95% confidence intervals of control subjects. Patients with CAI exhibited less tibiotalar and subtalar translational motion during gait; no clear differences in translations were noted during balanced heel-rise. CONCLUSION Overall, the balanced heel-rise activity exposed more tibiotalar and subtalar kinematic variation between patients with CAI and control subjects. Therefore, weight-bearing activities involving large range of motion, balance, and stability may be best for studying kinematic adaptations in patients with CAI. CLINICAL RELEVANCE These preliminary results suggest that patients with CAI require more tibiotalar external rotation, subtalar eversion, and subtalar external rotation during weight-bearing stability exercises, all with less overall joint translation.
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Affiliation(s)
- Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
- Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA
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Subject-Specific Axes of Rotation Based on Talar Morphology Do Not Improve Predictions of Tibiotalar and Subtalar Joint Kinematics. Ann Biomed Eng 2017. [PMID: 28639171 DOI: 10.1007/s10439-017-1874-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Use of subject-specific axes of rotation may improve predictions generated by kinematic models, especially for joints with complex anatomy, such as the tibiotalar and subtalar joints of the ankle. The objective of this study was twofold. First, we compared the axes of rotation between generic and subject-specific ankle models for ten control subjects. Second, we quantified the accuracy of generic and subject-specific models for predicting tibiotalar and subtalar joint motion during level walking using inverse kinematics. Here, tibiotalar and subtalar joint kinematics measured in vivo by dual-fluoroscopy served as the reference standard. The generic model was based on a cadaver study, while the subject-specific models were derived from each subject's talus reconstructed from computed tomography images. The subject-specific and generic axes of rotation were significantly different. The average angle between the modeled axes was 12.9° ± 4.3° and 24.4° ± 5.9° at the tibiotalar and subtalar joints, respectively. However, predictions from both models did not agree well with dynamic dual-fluoroscopy data, where errors ranged from 1.0° to 8.9° and 0.6° to 7.6° for the generic and subject-specific models, respectively. Our results suggest that methods that rely on talar morphology to define subject-specific axes may be inadequate for accurately predicting tibiotalar and subtalar joint kinematics.
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Nozaki S, Watanabe K, Katayose M. Three-dimensional morphometric analysis of the talus: implication for variations in kinematics of the subtalar joint. Surg Radiol Anat 2017; 39:1097-1106. [DOI: 10.1007/s00276-017-1851-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
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31
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Nichols JA, Roach KE, Fiorentino NM, Anderson AE. Predicting tibiotalar and subtalar joint angles from skin-marker data with dual-fluoroscopy as a reference standard. Gait Posture 2016; 49:136-143. [PMID: 27414041 PMCID: PMC5810542 DOI: 10.1016/j.gaitpost.2016.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 02/02/2023]
Abstract
Evidence suggests that the tibiotalar and subtalar joints provide near six degree-of-freedom (DOF) motion. Yet, kinematic models frequently assume one DOF at each of these joints. In this study, we quantified the accuracy of kinematic models to predict joint angles at the tibiotalar and subtalar joints from skin-marker data. Models included 1 or 3 DOF at each joint. Ten asymptomatic subjects, screened for deformities, performed 1.0m/s treadmill walking and a balanced, single-leg heel-rise. Tibiotalar and subtalar joint angles calculated by inverse kinematics for the 1 and 3 DOF models were compared to those measured directly in vivo using dual-fluoroscopy. Results demonstrated that, for each activity, the average error in tibiotalar joint angles predicted by the 1 DOF model were significantly smaller than those predicted by the 3 DOF model for inversion/eversion and internal/external rotation. In contrast, neither model consistently demonstrated smaller errors when predicting subtalar joint angles. Additionally, neither model could accurately predict discrete angles for the tibiotalar and subtalar joints on a per-subject basis. Differences between model predictions and dual-fluoroscopy measurements were highly variable across subjects, with joint angle errors in at least one rotation direction surpassing 10° for 9 out of 10 subjects. Our results suggest that both the 1 and 3 DOF models can predict trends in tibiotalar joint angles on a limited basis. However, as currently implemented, neither model can predict discrete tibiotalar or subtalar joint angles for individual subjects. Inclusion of subject-specific attributes may improve the accuracy of these models.
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Affiliation(s)
- Jennifer A. Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240 Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Correspondence address: Andrew E. Anderson, PhD, University of Utah, Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, 590 Wakara Way, Salt Lake City, UT 84108, +1 801 587-5208
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