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Rasheed B, Bjelland Ø, Dalen AF, Schaarschmidt U, Schaathun HG, Pedersen MD, Steinert M, Bye RT. Intraoperative identification of patient-specific elastic modulus of the meniscus during arthroscopy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 254:108269. [PMID: 38861877 DOI: 10.1016/j.cmpb.2024.108269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative meniscus tissue has been associated with a lower elastic modulus and can lead to the development of arthrosis. Safe intraoperative measurement of in vivo elastic modulus of the human meniscus could contribute to a better understanding of meniscus health, and for developing surgical simulators where novice surgeons can learn to distinguish healthy from degenerative meniscus tissue. Such measurement can also support intraoperative decision-making by providing a quantitative measure of the meniscus health condition. The objective of this study is to demonstrate a method for intraoperative identification of meniscus elastic modulus during arthroscopic probing using an adaptive observer method. METHODS Ex vivo arthroscopic examinations were performed on five cadaveric knees to estimate the elastic modulus of the anterior, mid-body, and posterior regions of lateral and medial menisci. Real-time intraoperative force-displacement data was obtained and utilized for modulus estimation through an adaptive observer method. For the validation of arthroscopic elastic moduli, an inverse parameter identification approach using optimization, based on biomechanical indentation tests and finite element analyses, was employed. Experimental force-displacement data in various anatomical locations were measured through indentation. An iterative optimization algorithm was employed to optimize elastic moduli and Poisson's ratios by comparing experimental force values at maximum displacement with the corresponding force values from linear elastic region-specific finite element models. Finally, the estimated elastic modulus values obtained from ex vivo arthroscopy were compared against optimized values using a paired t-test. RESULTS The elastic moduli obtained from ex vivo arthroscopy and optimization showcased subject specificity in material properties. Additionally, the results emphasized anatomical and regional specificity within the menisci. The anterior region of the medial menisci exhibited the highest elastic modulus among the anatomical locations studied (9.97±3.20MPa from arthroscopy and 5.05±1.97MPa from finite element-based inverse parameter identification). The paired t-test results indicated no statistically significant difference between the elastic moduli obtained from arthroscopy and inverse parameter identification, suggesting the feasibility of stiffness estimation using arthroscopic examination. CONCLUSIONS This study has demonstrated the feasibility of intraoperative identification of patient-specific elastic modulus for meniscus tissue during arthroscopy.
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Affiliation(s)
- Bismi Rasheed
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway; Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway.
| | - Øystein Bjelland
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway; Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway
| | - Andreas F Dalen
- Å lesund Biomechanics Lab, Department of Research and Innovation, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway; Department of Orthopaedic Surgery, Møre and Romsdal Hospital Trust, Å lesund, 6017, Norway
| | - Ute Schaarschmidt
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
| | - Hans Georg Schaathun
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
| | - Morten D Pedersen
- Department of Engineering Cybernetics, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Martin Steinert
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, Trondheim, 7491, Norway
| | - Robin T Bye
- Cyber-Physical Systems Laboratory, Department of ICT and Natural Sciences, Norwegian University of Science and Technology, Å lesund, 6025, Norway
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Gurun E, Ozturk M, Bozduman O. How should meniscus tissue stiffness be measured, what are the correct parameters? Acad Radiol 2024; 31:3716-3717. [PMID: 39153962 DOI: 10.1016/j.acra.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Enes Gurun
- Department of Radiology, Samsun University Faculty of Medicine, SAMSUN.
| | - Mesut Ozturk
- Department of Radiology, Samsun University Faculty of Medicine, SAMSUN.
| | - Omer Bozduman
- Department of Orthopedics and Traumatology, Memorial Antalya Hospital, ANTALYA.
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Ye R, Xiong HH, Liu X, Yang JX, Guo JD, Qiu JW. The Impact of Different Regions of Interest on Shear Wave Elastography Assessment of the Meniscus in the Knee Joint. Acad Radiol 2024; 31:3306-3314. [PMID: 38429187 DOI: 10.1016/j.acra.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
RATIONALE AND OBJECTIVES To investigate the impact of different regions of interest (ROI) on the assessment of shear wave elastography (SWE) in evaluating the meniscus of the knee joint. MATERIALS AND METHODS After ethical approval, a total of 141 participants were enrolled in this prospective study from February to October 2023. SWE was utilized to evaluate the anterior horn of the lateral meniscus (LM) and medial meniscus (MM), using two different ROIs (ROI-Small and ROI-Trace) to measure the elastic mean value (Emean) and elastic maximum value (Emax). The differences in elasticity values between the normal menisci and torn menisci were compared, and the impact of different ROI selection methods on the diagnostic performance of elastic parameters in the torn menisci was assessed using receiver operating characteristic (ROC) curves. RESULTS In Emean comparison, only MM in the tear group showed higher ROI-S than ROI-T. When comparing Emax, all ROI-T values were higher than the ROI-S values, and this difference was statistically significant. Different sizes of ROI did not significantly impact the diagnostic performance of Emean in LM and MM, nor the diagnostic effectiveness of Emax in LM. However, only the area under the curve (AUC) of MM for Emax in both ROI-S and ROI-T showed a statistically significant difference. CONCLUSION The shear wave elasticity values and diagnostic performance may vary depending on the ROI settings. Therefore, it is recommended to use a 2 mm diameter ROI placed at the central position of the meniscus, with Emean as the elasticity index.
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Affiliation(s)
- Ran Ye
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, No.6001 Beihuan Road, Futian District, Shenzhen 518000, China; Graduate School, Guangzhou Medical University, Guangzhou 510000, China.
| | - Hua-Hua Xiong
- Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen 518000, China
| | - Xiao Liu
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Jun-Xing Yang
- Department of Orthopedics, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Jian-Dong Guo
- Department of Radiology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Jian-Wen Qiu
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, No.6001 Beihuan Road, Futian District, Shenzhen 518000, China
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Dag N, Sinanoglu MS. Evaluation of meniscal elasticity using shear wave elastography in obese children and adolescents: a preliminary cross-sectional study. Pediatr Radiol 2024; 54:293-298. [PMID: 38153540 DOI: 10.1007/s00247-023-05836-x] [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: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Musculoskeletal problems such as pain, joint pathology, increased risk of fracture, and the development of structural deformities are common in childhood obesity. Increased mechanical stress on the knee joint leads to degenerative changes in the cartilage and meniscus. Meniscal elasticity values increase in meniscal degeneration. Shear wave elastography (SWE) is an ultrasound-based imaging technique based on the principle of measuring tissue elasticity. OBJECTIVE We aimed to investigate the changes in meniscal stiffness and thickness that can be caused by obesity in children and adolescents using SWE. MATERIALS AND METHODS In this prospective cross-sectional study, the menisci of obese (n=44) and age- and sex-matched healthy weight (n=44) children and adolescents were assessed by SWE. Meniscal elasticity was measured in kPa on the coronal plane. Independent samples t-test was used to compare meniscal elasticity values between groups. Additionally, Pearson's correlation test was used to examine the relationships between elasticity values and age, height, weight, and body mass index (BMI). RESULTS Meniscal elasticity values were significantly higher in the obese group than in the control group (P<0.001). In both groups, there was no significant difference in meniscal stiffness between the boys and girls or between the right and left sides. In the obese group, there were weak and moderate positive correlations between meniscal elasticity values and age, weight, and BMI (P<0.05). There was no significant difference in meniscal thickness between the obese and control groups. CONCLUSION Meniscal stiffness is increased in obese children and adolescents.
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Affiliation(s)
- Nurullah Dag
- Department of Radiology, Malatya Training and Research Hospital, Ozalper Mah, Turgut Ozal Bulvari, Yesilyurt, Malatya, 44330, Turkey.
| | - Muhammed S Sinanoglu
- Department of Pediatrics, Malatya Training and Research Hospital, Malatya, Turkey
- Department of Pediatrics, Malatya Turgut Ozal University, Malatya, Turkey
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Ye R, Xiong H, Liu X, Yang J, Guo J, Qiu J. Assessment of Knee Menisci in Healthy Adults Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2859-2866. [PMID: 37661827 DOI: 10.1002/jum.16326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES The aim of this study was to explore the application value of shear wave elastography in healthy adults with knee meniscus. METHODS One hundred adult subjects who underwent health checkups at our hospital from December 2022 to February 2023 were selected as research participants. Shear wave elastography was used to evaluate the periphery of the lateral and medial meniscus in both knees. To assess the mean differences in Young's modulus values between male and female groups, a one-way analysis of variance (ANOVA) and independent samples t-test were conducted. In addition, a Pearson correlation coefficient test was used to analyze the correlation between the elastic values of the meniscus and age, height, weight, and body mass index (BMI). RESULTS There were no significant differences in elastic values between the lateral meniscus of the left and right sides or between the medial meniscus of the left and right sides within the same gender group (P > .05). Stiffness values of the medial meniscus were higher in each gender group than those of the lateral meniscus (P < .01). Additionally, males demonstrated higher stiffness values than females (P < .01). As age increased, the Young's modulus of the meniscus increased significantly (r > .75, P < .01). CONCLUSION Shear wave elastography can serve as an adjunctive tool to aid in the assessment of knee meniscal elasticity.
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Affiliation(s)
- Ran Ye
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
- Guaduate School, Guangzhou Medical University, Guangzhou, China
| | - Huahua Xiong
- Department of Ultrasound, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiao Liu
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Junxing Yang
- Department of Orthopedics, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiandong Guo
- Department of Radiology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jianwen Qiu
- Department of Physical Examination, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
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Gurun E, Akdulum I, Akyuz M, Tokgoz N, Ozhan Oktar S. Shear Wave Elastography Evaluation of Meniscus Degeneration with Magnetic Resonance Imaging Correlation. Acad Radiol 2021; 28:1383-1388. [PMID: 33402299 DOI: 10.1016/j.acra.2020.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES The objective of the study was to assess the diagnostic efficiency of shear wave elastography in the grading of meniscal degeneration compared to magnetic resonance imaging (MRI) as a reference standard. MATERIALS AND METHODS Fifty patients were included in the study (who had bilateral knee MRI). Tissue elasticity was measured in the coronal plane from the meniscus body in kilopascal. Nonparametric testing (Mann-Whitney U) was utilized to assess the differences between mean elasticity of the meniscus tissue, gender. The inter-intraobserver agreement was determined by the intraclass correlation coefficient. The correlations between the mean elasticity of the meniscus versus age, height, and body mass index were calculated via the "Pearson Correlation Coefficient Test." The relationship between MRI meniscal degeneration grading and elastography elasticity module was determined via the "Spearman Correlation Test." A p value less than 0.05 was considered statistically significant. RESULTS İnter-intraobserver intraclass correlation coefficient of the lateral and medial meniscus mean stiffness values were good or excellent (>0.8). A statistically significant increase in stiffness of meniscus tissue was observed with an increase in age (p = 0.003 for medial menisci, 0.006 for lateral menisci). Tissue stiffness was higher in the medial meniscus than the lateral meniscus (p < 0.001). A positive correlation was observed between the MRI meniscal degeneration grade and tissue stiffness (p < 0.05). Additionally, mean stiffness values from lateral and medial menisci were higher in the group with degeneration (p < 0.0001). CONCLUSION Meniscus stiffness is increased with aging. There was a statistically significant positive correlation between meniscal stiffness and degeneration grading in MRI.
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Affiliation(s)
- Enes Gurun
- Department of Radiology, Gazi University Hospital, Ankara, Turkey.
| | - Ismail Akdulum
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Melih Akyuz
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Nil Tokgoz
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
| | - Suna Ozhan Oktar
- Department of Radiology, Gazi University Hospital, Ankara, Turkey
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