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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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Wakker AM, Verhofstad MHJ, Visser JJ, Van Vledder MG, Van Walsum T. Talus-derived reference coordinate system for 3D calcaneal assessment: A novel approach to improve morphological measurements. J Orthop Res 2024. [PMID: 38711242 DOI: 10.1002/jor.25868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
In 3D-analysis of the calcaneus, a consistent coordinate system aligned with the original anatomical directions is crucial for pre- and postoperative analysis. This importance stems from the calcaneus's key role in weight-bearing and biomechanical alignment. However, defining a reliable coordinate system based solely on fractured or surgically reconstructed calcanei presents significant challenges. Given its anatomical prominence and consistent orientation, the talus offers a potential solution to this challenge. Our work explores the feasibility of talus-derived coordinate systems for 3D-modeling of the calcaneus across its various conditions. Four methods were tested on nonfractured, fractured and surgically reconstructed calcanei, utilizing Principal Component Analysis, anatomical landmarks, bounding box, and an atlas-based approach. The methods were compared with a self-defined calcaneus reference coordinate system. Additionally, the impact of deviation of the coordinate system on morphological measurements was investigated. Among methods for constructing nonfractured calcanei coordinate systems, the atlas-based method displayed the lowest Root Mean Square value in comparison with the reference coordinate system. For morphological measures like Böhler's Angle and the Critical angle of Gissane, the atlas talus-based system closely aligned with ground truth, yielding differences of 0.6° and 1.2°, respectively, compared to larger deviations seen in other talus-based coordinate systems. In conclusion, all tested methods were feasible for creating a talus derived coordinate system. A talus derived coordinate system showed potential, offering benefits for morphological measurements and clinical scenarios involving fractured and surgically reconstructed calcanei. Further research is recommended to assess the impact of these coordinate systems on surgical planning and outcomes.
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Affiliation(s)
- Alexander M Wakker
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacob J Visser
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Theo Van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Behling AV, Welte L, Kelly L, Rainbow MJ. Human in vivo midtarsal and subtalar joint kinematics during walking, running and hopping. J R Soc Interface 2024; 21:20240074. [PMID: 38807524 DOI: 10.1098/rsif.2024.0074] [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: 09/15/2023] [Accepted: 04/08/2024] [Indexed: 05/30/2024] Open
Abstract
The interaction among joints of the midtarsal complex and subtalar joint is important for locomotor function; however, its complexity poses substantial challenges in quantifying the joints' motions. We determine the mobility of these joints across locomotion tasks and investigate the influence of individual talus morphology on their motion. Using highly accurate biplanar videoradiography, three-dimensional bone kinematics were captured during walking, running and hopping. We calculated the axis of rotation of the midtarsal complex and subtalar joint for the landing and push-off phases. A comparison was made between these rotation axes and the morphological subtalar axis. Measurement included total rotation about and the orientation of the rotation axes in the direction of the subtalar joint and its deviation via spatial angles for both phases. The rotation axes of all three bones relative to the talus closely align with the morphological subtalar axis. This suggests that the midtarsal and subtalar joints' motions might be described by one commonly oriented axis. Despite having such an axis, the location of the axes and ranges of motion differed among the bones. Our results provide a novel perspective of healthy foot function across different sagittal plane-dominant locomotion tasks underscoring the importance of quantifying midtarsal complex and subtalar motion while accounting for an individual's talus morphology.
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Affiliation(s)
- Anja-Verena Behling
- School of Human Movement and Nutrition Science, The University of Queensland , Brisbane, Queensland, Australia
- Department of Mechanical and Materials Engineering, Queen's University , Kingston, Ontario, Canada
| | - Lauren Welte
- Mechanical Engineering, University of Alberta , Edmonton, Alberta, Canada
- Biomedical Engineering, University of Alberta , Edmonton, Alberta, Canada
| | - Luke Kelly
- School of Human Movement and Nutrition Science, The University of Queensland , Brisbane, Queensland, Australia
- Griffith Centre of Biomedical & Rehabilitation Engineering, Griffith University , Gold Coast, Queensland, Australia
- School of Health Sciences & Social Work, Griffith University , Gold Coast, Queensland, Australia
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University , Kingston, Ontario, Canada
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Conconi M, Pompili A, Sancisi N, Durante S, Leardini A, Belvedere C. Foot kinematics as a function of ground orientation and weightbearing. J Orthop Res 2024; 42:148-163. [PMID: 37442638 DOI: 10.1002/jor.25661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
The foot is responsible for the bodyweight transfer to the ground, while adapting to different terrains and activities. Despite this fundamental role, the knowledge about the foot bone intrinsic kinematics is still limited. The aim of the study is to provide a quantitative and systematic description of the kinematics of all bones in the foot, considering the full range of dorsi/plantar flexion and pronation/supination of the foot, both in weightbearing and nonweightbearing conditions. Bone kinematics was accurately reconstructed for three specimens from a series of computed tomography scans taken in weightbearing configuration. The ground inclination was imposed through a set of wedges, varying the foot orientation both in the sagittal and coronal planes; the donor body-weight was applied or removed by a cable-rig. A total of 32 scans for each foot were acquired and segmented. Bone kinematics was expressed in terms of anatomical reference systems optimized for the foot kinematic description. Results agree with previous literature where available. However, our analysis reveals that bones such as calcaneus, navicular, intermediate cuneiform, fourth and fifth metatarsal move more during foot pronation than flexion. Weightbearing significantly increase the range of motion of almost all the bone. Cuneiform and metatarsal move more due to weightbearing than in response to ground inclination, showing their role in the load-acceptance phase. The data here reported represent a step toward a deeper understanding of the foot behavior, that may help in the definition of better treatment and medical devices, as well as new biomechanical model of the foot.
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Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Alessandro Pompili
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Stefano Durante
- Area Tecnico Diagnostica Radiologica, IRCCS S. Orsola Malpighi Hospital, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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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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Fallon Verbruggen F, Killen BA, Burssens A, Boey H, Vander Sloten J, Jonkers I. Unique shape variations of hind and midfoot bones in flatfoot subjects-A statistical shape modeling approach. Clin Anat 2023; 36:848-857. [PMID: 36373980 DOI: 10.1002/ca.23969] [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: 07/01/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
Flatfoot deformity is a prevalent hind- and midfoot disorder. Given its complexity, single-plane radiological measurements omit case-specific joint interaction and bone shape variations. Three-dimensional medical imaging assessment using statistical shape models provides a complete approach in characterizing bone shape variations unique to flatfoot condition. This study used statistical shape models to define specific bone shape variations of the subtalar, talonavicular, and calcaneocuboid joints that characterize flatfoot deformity, that differentiate them from healthy controls. Bones of the aforementioned joints were segmented from computed tomography scans of 40 feet. The three-dimensional hindfoot alignment angle categorized the population into 18 flatfoot subjects (≥7° valgus) and 22 controls. Statistical shape models for each joint were defined using the entire study cohort. For each joint, an average weighted shape parameter was calculated for each mode of variation, and then compared between flatfoot and controls. Significance was set at p < 0.05, with values between 0.05 ≤ p < 0.1 considered trending towards significance. The flatfoot population showed a more adducted talar head, inferiorly inclined talar neck, and posteriorly orientated medial subtalar articulation compare to controls, coupled with more navicular eversion, shallower navicular cup, and more prominent navicular tuberosity. The calcaneocuboid joint presented trends of a more adducted calcaneus, more abducted cuboid, narrower calcaneal roof, and less prominent cuboid beak compared to controls. Statistical shape model analysis identified unique shape variations which may enhance understanding and computer-aided models of the intricacies of flatfoot, leading to better diagnosis and, ultimately, surgical treatment.
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Affiliation(s)
- Ferdia Fallon Verbruggen
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Bryce A Killen
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Arne Burssens
- Department of Orthopaedics, UZ Ghent, Ghent, Belgium
| | - Hannelore Boey
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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7
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Biomechanical Implications of Congenital Conditions of the Foot/Ankle. Foot Ankle Clin 2023; 28:27-43. [PMID: 36822687 DOI: 10.1016/j.fcl.2022.10.003] [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] [Indexed: 01/03/2023]
Abstract
Segmental foot and ankle models are often used as part of instrumented gait analysis when planning interventions for complex congenital foot conditions. More than 40 models have been used for clinical analysis, and it is important to understand the technical differences among models. These models have been used to improve clinical planning of pediatric foot conditions including clubfoot, planovalgus, and equinovarus. They have also been used to identify clinically relevant subgroups among pediatric populations, quantify postoperative outcomes, and explain variability in healthy populations.
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Wellenberg RHH, Schallig W, Steenbergen P, Tex PD, Dobbe JGG, Streekstra GJ, Witbreuk MMEH, Buizer AI, Maas M. Assessment of foot deformities in individuals with cerebral palsy using weight-bearing CT. Skeletal Radiol 2022; 52:1313-1320. [PMID: 36585514 DOI: 10.1007/s00256-022-04272-6] [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: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aims of this study were to visualize and quantify relative bone positions in the feet of individuals with cerebral palsy (CP) with a foot deformity and compare bone positions with those of typically developed (TD) controls. MATERIALS AND METHODS Weight-bearing CT images of 14 individuals with CP scheduled for tendon transfer and/or bony surgery and of 20 TD controls were acquired on a Planmed Verity WBCT scanner. Centroids of the navicular and calcaneus with respect to the talus were used to quantify foot deformities. All taluses were aligned and the size and dimensions of the individuals' talus were scaled to correct for differences in bone sizes. In order to visualize and quantify variations in relative bone positions, 95% CI ellipsoids and standard deviations in its principle X-, Y-, and Z-directions were determined. RESULTS In individuals with CP (age 11-17), a large variation in centroid positions was observed compared to data of TD controls. Radiuses of the ellipsoids, representing the standard deviations of the 95% CI in the principle X-, Y-, and Z-directions, were larger in individuals with CP compared to TD controls for both the calcaneus (3.16 vs 1.86 mm, 4.26 vs 2.60 mm, 9.19 vs 3.60 mm) and navicular (4.63 vs 1.55 mm, 5.18 vs 2.10 mm, 16.07 vs 4.16 mm). CONCLUSION By determining centroids of the calcaneus and navicular with respect to the talus on WBCT images, normal and abnormal relative bone positions can be visualized and quantified in individuals with CP with various foot deformities.
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Affiliation(s)
- R H H Wellenberg
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. .,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - W Schallig
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Steenbergen
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P den Tex
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J G G Dobbe
- Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - G J Streekstra
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - M M E H Witbreuk
- Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - A I Buizer
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1118, Amsterdam, The Netherlands.,Orthopedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam UMC, Pediatric Rehabilitation, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - M Maas
- Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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