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du Toit C, Dima R, Papernick S, Jonnalagadda M, Tessier D, Fenster A, Lalone E. Three-dimensional ultrasound to investigate synovitis in first carpometacarpal osteoarthritis: A feasibility study. Med Phys 2024; 51:1092-1104. [PMID: 37493097 DOI: 10.1002/mp.16640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Synovitis is one of the defining characteristics of osteoarthritis (OA) in the carpometacarpal (CMC1) joint of the thumb. Quantitative characterization of synovial volume is important for furthering our understanding of CMC1 OA disease progression, treatment response, and monitoring strategies. In previous studies, three-dimensional ultrasound (3-D US) has demonstrated the feasibility of being a point-of-care system for monitoring knee OA. However, 3-D US has not been tested on the smaller joints of the hand, which presents unique physiological and imaging challenges. PURPOSE To develop and validate a novel application of 3-D US to monitor soft-tissue characteristics of OA in a CMC1 OA patient population compared to the current gold standard, magnetic resonance imaging (MRI). METHODS A motorized submerged transducer moving assembly was designed for this device specifically for imaging the joints of the hands and wrist. The device used a linear 3-D scanning approach, where a 14L5 2-D transducer was translated over the region of interest. Two imaging phantoms were used to test the linear and volumetric measurement accuracy of the 3-D US device. To evaluate the accuracy of the reconstructed 3-D US geometry, a multilayer monofilament string-grid phantom (10 mm square grid) was scanned. To validate the volumetric measurement capabilities of the system, a simulated synovial tissue phantom with an embedded synovial effusion was fabricated and imaged. Ten CMC1 OA patients were imaged by our 3-D US and a 3.0 T MRI system to compare synovial volumes. The synovial volumes were manually segmented by two raters on the 2D slices of the 3D US reconstruction and MR images, to assess the accuracy and precision of the device for determining synovial tissue volumes. The Standard Error of Measurement and Minimal Detectable Change was used to assess the precision and sensitivity of the volume measurements. Paired sample t-tests were used to assess statistical significance. Additionally, rater reliability was assessed using Intra-Class Correlation (ICC) coefficients. RESULTS The largest percent difference observed between the known physical volume of synovial extrusion in the phantom and the volume measured by our 3D US was 1.1% (p-value = 0.03). The mean volume difference between the 3-D US and the gold standard MRI was 1.78% (p-value = 0.48). The 3-D US synovial tissue volume measurements had a Standard Error Measurement (SEm ) of 11.21 mm3 and a Minimal Detectible Change (MDC) of 31.06 mm3 , while the MRI synovial tissue volume measurements had an SEM of 16.82 mm3 and an MDC of 46.63 mm3 . Excellent inter- and intra-rater reliability (ICCs = 0.94-0.99) observed across all imaging modalities and raters. CONCLUSION Our results indicate the feasibility of applying 3-D US technology to provide accurate and precise CMC1 synovial tissue volume measurements, similar to MRI volume measurements. Lower MDC and SEm values for 3-D US volume measurements indicate that it is a precise measurement tool to assess synovial volume and that it is sensitive to variation between volume segmentations. The application of this imaging technique to monitor OA pathogenesis and treatment response over time at the patient's bedside should be thoroughly investigated in future studies.
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Affiliation(s)
- Carla du Toit
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Robert Dima
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Samuel Papernick
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - David Tessier
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Emily Lalone
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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Straatman L, Norman E, Knowles N, Walton D, Suh N, Lalone E. Use it or lose it: The relationship between two image-based biomarkers in better understanding osteoarthritis progression in the wrist. J Biomech 2023; 161:111849. [PMID: 37931557 DOI: 10.1016/j.jbiomech.2023.111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/01/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
Bone tissue is influenced by its mechanical environment and adapts in response to its mechanical load. This is supported by studies analyzing bone adaptation in the knee and hip. Changes to the bone have also been found to precede cartilage degeneration in diseases such as osteoarthritis (OA). Our objective was to demonstrate the relationship between joint contact and bone density in the wrists of healthy adults. Static CT scans with a calibration phantom were taken to obtain measures of bone mineral density (vBMD) in 3 normalized depths; 0 - 2.5, 2.5 - 5, and 5 - 7.5 mm. Participants underwent a four-dimensional CT scan (4DCT) while performing maximum wrist extension to maximum wrist flexion. 3D bone models of the distal radius, scaphoid, and lunate were made, and analyzed vBMD and joint contact area (JCA) in the radiolunate (RL) and radioscaphoid (RS) joints separately. Correlation coefficients were calculated where vBMD was the dependent variable, and kinematic JCA throughout every 10 degrees of motion were the independent variables. Statistically significant independent variables associated with vBMD were assessed using a regression model and were entered in steps; (1) significant correlations, (2) sex, and (3) age.An increase in vBMD was significantly, positively associated with an increase in JCa. Notably, in the deeper regions (5 - 7.5 mm) of the radius that is primarily composed of trabecular bone. Sex contributed to the variance in vBMD, while age did not. Subchondral bone changes are influenced by wrist position, demonstrating that the wrist serves to bear load similar to the knee and hip.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Science, Western University, Canada; Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada.
| | - Elizabeth Norman
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
| | - Nikolas Knowles
- Kinesiology and Health Science, University of Waterloo, Canada
| | - David Walton
- Department of Physical Therapy, Western University, Canada
| | - Nina Suh
- Department of Orthopedics, Emory University, United States
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
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Norman E, Mistry MR, Lalone E, Suh N. A Kinematic Analysis of Wrist and Carpal Function Using Four-Dimensional Computed Tomography Technology: A Dynamic Perspective. J Hand Surg Am 2023:S0363-5023(23)00386-6. [PMID: 37598324 DOI: 10.1016/j.jhsa.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE An emerging imaging modality, four-dimensional computed tomography, can provide dynamic evaluation of carpal motion, which allows for a better understanding of how the carpals work together to achieve range of motion. The objective of this work was to examine kinematic motion of the carpus through a flexion/extension arc of motion using four-dimensional computed tomography. METHODS A convenience sample of 20 uninjured participants underwent a four-dimensional computed tomography scanning protocol through a complete arc of flexion/extension motion. Kinematic changes in motion were quantified using helical axes motion data for each carpal. Rotation angles were compared between bones to identify differences in kinematic motion between bones. RESULTS The bones within the proximal carpal row, the lunate, scaphoid, and triquetrum, rotate significantly to differing magnitudes at the ends of motion (40° of flexion and 40° of extension). The scaphoid rotates to the highest magnitude, followed by the triquetrum, and lastly, the lunate. The distal carpal row bones rotate to similar magnitudes throughout the entire range of motion. CONCLUSIONS This work describes the kinematics of the carpals throughout dynamic in vivo flexion and extension. CLINICAL RELEVANCE This study adds to an understanding of wrist mechanics and the possible clinical implications of pathological deviation from baseline kinematics.
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Affiliation(s)
- Elizabeth Norman
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Manisha R Mistry
- Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Nina Suh
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada; Department of Orthopaedics, Emory University, Atlanta, GA.
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Straatman L, Knowles N, Suh N, Walton D, Lalone E. The Utility of Quantitative CT (QCT) to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People with Pain Following Wrist Trauma. J Biomech Eng 2022; 144:1131490. [PMID: 35044448 DOI: 10.1115/1.4053594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n=5 post-trauma; n=5 healthy) underwent bilateral CT scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral vBMD was studied at three depths from the subchondral surface (0 to 2.5, 2.5 to 5, 5 to 7.5mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bone, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Sciences, Western University; Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre, Western University, Rm. EC1458, 1201 Western Rd.London, Ontario N6G 1H1
| | | | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre; Schulich School of Medicine and Dentistry, Western University
| | - David Walton
- Department of Health and Rehabilitation Sciences, Western University; School of Physical Therapy, Western University
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre
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Tanashi A, Haddara R, Haddara MM, Ferreira L, Lalone E. A method for measuring in vivo finger kinematics using electromagnetic tracking. Comput Methods Biomech Biomed Engin 2021; 25:1276-1287. [PMID: 34821518 DOI: 10.1080/10255842.2021.2007375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Accurate in vivo measurement of finger joint kinematics is important for evaluation of treatment methods, implant designs, and for the development and validation of computer models of the hand. The main objective of this project was to develop a standardized finger kinematic measurement system employing electromagnetic (EM) tracking to measure in vivo finger motion pathways. A landmark digitization protocol was developed and used in vivo, in a biomechanical study using EM trackers secured to the finger segments. In vivo results for finger flexion/extension showed no significant differences between EM and goniometer results, 5°±3°; p = 0.735.
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Affiliation(s)
- Ahmed Tanashi
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Raneem Haddara
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Mohammad M Haddara
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Louis Ferreira
- School of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Western University, London, Ontario, Canada.,Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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Ranota P, Seltser A, Suh N, Grewal R, MacDermid JC, Lalone E. The Effect of Malunited Scaphoid Fractures on Joint Congruency. J Hand Surg Am 2021; 46:1024.e1-1024.e8. [PMID: 33875280 DOI: 10.1016/j.jhsa.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/11/2020] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Although the consequences of scaphoid nonunion have been well-established, the implications of malunions are not well-known. To date, malunions have mainly been studied with 2-dimensional imaging. The objective of this study was to employ 3-dimensional computed tomography (CT) imaging and inter-bone distance mapping to determine the implications of a scaphoid malunion on 3-dimensional joint surface area (JSA) (a measure of joint contact area) at an average of 7 ± 2 years (range, 4-12 years) after fracture. METHODS In 14 subjects with previous unilateral, malunited scaphoid fractures, we measured the 3-dimensional JSA using reconstructed CT bone models of the carpus. The JSA was compared within each individual, comparing images of the wrist collected at the time of fracture (baseline) and 7 years later (follow-up CT scans). RESULTS There was a significant increase in the measured JSA (reduced joint space) at the scaphotrapezial (23% increase) and scaphocapitate (13% increase) joints when the baseline and follow-up scans of the wrist were compared. An increased JSA indicates that the 2 opposing surfaces are closer in contact and have a reduced joint spacing reflective of degenerative changes. However, participants in this study showed no radiographic signs of degenerative changes in the wrists at midterm follow-up. CONCLUSIONS An increase in JSA was found in patients with a malunited scaphoid in the scaphotrapezial and scaphocapitate joints of the wrist an average of 7 years after injury, but these joint changes were not evident in measured radiographic signs of arthritis. CLINICAL RELEVANCE As early as 4 years after injury, the 3-dimensional JSA is significantly increased at the scaphocapitate and scaphotrapezial joints. Future work is needed to determine the implication of this increased in 3-dimensional JSA on the underlying subchondral bone, and to observe these patients for longer to determine whether degenerative changes develop.
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Affiliation(s)
- Puneet Ranota
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, Ontario, Canada
| | - Anna Seltser
- Department of Hand Surgery and Microsurgery Unit, Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Ramat Gan, Israel
| | - Nina Suh
- Department of Surgery, The University of Western Ontario, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| | - Ruby Grewal
- Department of Surgery, The University of Western Ontario, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| | - Joy C MacDermid
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, Ontario, Canada; Department of Surgery, The University of Western Ontario, Ontario, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, Ontario, Canada.
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Riddle M, MacDermid J, Robinson S, Szekeres M, Ferreira L, Lalone E. Evaluation of individual finger forces during activities of daily living in healthy individuals and those with hand arthritis. J Hand Ther 2021; 33:188-197. [PMID: 32446531 DOI: 10.1016/j.jht.2020.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Measuring finger forces during activities of daily living and how these forces change for individuals with pathologies such as arthritis is valuable to our understanding of hand function. PURPOSE OF THE STUDY The purpose of this study was to determine the forces of individual fingers during the performance of daily activities in healthy participants and determine the envelope of these applied forces. METHODS This is a cross-sectional study investigating twenty-five healthy participants (12 female: 22-65 years old and 13 male: 20-53 years old) and participants with osteoarthritis (12 female: 52-79 years old and 9 male: 64-79 years old) examined at one time point. The force sensors were calibrated for each individual using a load cell to provide force output in Newtons. Each participant performed 19 activities of daily living two times. Force was plotted over time for each task, and the maximum force in each finger during that task was evaluated. RESULTS The range of applied forces was 1.4 ± 0.6 N to 34.8 ± 1.6 N for healthy participants and 2.3 ± 1.0 N to 30.7 ± 3.7 N for those with osteoarthritis. DISCUSSION Sensors allowed for real-time monitoring of finger forces during tasks of daily life. This provides the opportunity to isolate hand grips based on finger recruitment and provide information about the magnitude of forces during the activity. CONCLUSION Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions.
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Affiliation(s)
| | - Joy MacDermid
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, ON, Canada; Department of Physical Therapy, The University of Western Ontario, London, ON, Canada
| | | | - Mike Szekeres
- Department of Physical Therapy, The University of Western Ontario, London, ON, Canada
| | - Louis Ferreira
- School of Biomedical Engineering, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, ON, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada
| | - Emily Lalone
- School of Biomedical Engineering, London, ON, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, London, ON, Canada
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Robinson S, Straatman L, Lee TY, Suh N, Lalone E. Evaluation of Four-Dimensional Computed Tomography as a Technique for Quantifying Carpal Motion. J Biomech Eng 2021; 143:1098186. [PMID: 33564841 DOI: 10.1115/1.4050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 11/08/2022]
Abstract
Delayed diagnosis of dynamic carpal instability often occurs because early changes in bone alignment and movement are difficult to detect and manifest mainly during a dynamic/functional task. Current diagnostic tools are only able to examine the carpal bones under static or sequential-static conditions. Four-dimensional (three dimensions + time) computed tomography (4DCT) enables quantification of carpal mechanics through 3D volume sequences of the wrist in motion. A comprehensive understanding of carpal mechanics is needed to define normal function and structure and provide targets for treatment of carpal injuries. In this study, measurements of scaphoid translation and joint congruency were taken by creating models from the CT scans of the carpals in extreme frames of motion, registering those models to the neutral position, transforming the models into a local coordinate system, and using software to calculate the joint surface areas (JSA). Results indicated that the centroid of the scaphoid translated 6.4 ± 1.3 mm and extended from extreme radial to extreme ulnar deviation. Results are consistent with the literature. An additional study was performed to measure the responsiveness of the 4DCT technique presented. Bone models from each frame of motion for radio ulnar deviation (RUD) and flexion extension (FE) were created and distinct differences between their JSA were measured qualitatively and quantitatively. The results show that there was statistically significantly different JSA within carpal joints between RUD and FE. These studies provide the first step in developing the methodology when using 4DCT scanning to measure subtle abnormalities in the wrist.
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Affiliation(s)
- Sydney Robinson
- School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada
| | - Lauren Straatman
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada; Graduate Program of Health and Rehabilitation Science, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Ting-Yim Lee
- Robarts Research Institute, 100 Perth Dr, London, ON N6A 5K8, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Department of Medical Biophysics, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada; Schulich School of Medicine and Dentistry,Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada
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Bobos P, MacDermid J, Ziebart C, Boutsikari E, Lalone E, Ferreira L, Grewal R. Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: a cross-sectional survey. BMJ Open 2021; 11:e041935. [PMID: 33483445 PMCID: PMC7831706 DOI: 10.1136/bmjopen-2020-041935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this survey was to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection (JP) programmes in people with hand arthritis. DESIGN Cross-sectional survey. SETTING Tertiary clinic. PARTICIPANTS Patients with hand arthritis: osteoarthritis, rheumatoid arthritis, psoriatic arthritis and other forms of arthritis. PRIMARY AND SECONDARY OUTCOME MEASURES This study used a survey among people with hand arthritis. Descriptive statistics and percentages were reported for all the data about the barriers, facilitators and preferences around JP. RESULTS A total of 192 patients consented to participate. Most of the patients (82%) were unaware of JP. Factors that may act as barriers to participation and were regarded as 'a very big concern' were: cost of the programme (44%), time of offering the programme (39%), work commitments (36%) and having a centre/clinic close to the house (28%). Factors that may act as facilitators and rated as 'extremely helpful' were: research that shows that JP works (26%) and having the centre/clinic close to the house (25%). An online format for JP was the most preferred option (54%). Half (46%) preferred a timeframe of 1 hour, three times per week and 44% preferred a 2-hour programme, for three times per week. CONCLUSIONS Awareness of the potential benefits of JP, and prior experience with JP programme were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: cost, work commitments, distance from home to clinic and times that the intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP programmes.
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Affiliation(s)
- Pavlos Bobos
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Christina Ziebart
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Eleni Boutsikari
- Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Emily Lalone
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Louis Ferreira
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
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Thom ML, Willmore K, Surugiu A, Lalone E, Burkhart TA. Females Are Not Proportionally Smaller Males: Relationships Between Radius Anthropometrics and Their Sex Differences. Hand (N Y) 2020; 15:850-857. [PMID: 30819017 PMCID: PMC7850245 DOI: 10.1177/1558944719831239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Distal radius fracture reduction by internal fixation is most commonly achieved using volar locking plates (VLPs). Many standard VLP designs make little point contact with radius anatomy, and most postsurgical complications following fixation are attributed to poor implant fit. Sex differences may require consideration in implant design, as females more commonly require VLP removal. Therefore, the purpose of this research was to determine whether the relationships between measures of radius shape are proportional between the sexes. Methods: Three-dimensional radius bone geometries were created from 40 male and 34 female (mean age = 72.04 years) forearm computed tomographic scans in Mimics (Materialise NV, Leuven, Belgium). Eleven measures of radius shape were collected from each scan. Principal components analysis was performed on these measures to determine which shape variables account for the greatest differences in radius shape among individuals and between the sexes. Results: Principal component scores representing isometric radius size separated the sexes. Six anthropometric measures significantly correlated with isometric radius size for all specimens, whereas 3 and 1 measures significantly correlated with isometric radius size in males and females, respectively. Conclusions: Anthropometrics of male and female radii vary by different proportions. Using anthropometrics from both sexes to create a single implant system may not result in optimal patient fit for either sex.
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Affiliation(s)
| | | | | | | | - Timothy A. Burkhart
- Western University, London, ON, Canada,Timothy A. Burkhart, Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Road, London, ON, Canada N6A 3K7.
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Holland S, Straatman L, MacDermid J, Sinden K, Lalone E. The development of a novel grip motion analysis technique using the Dartfish movement analysis software to evaluate hand movements during activities of daily living. Med Eng Phys 2020; 85:104-112. [PMID: 33081957 DOI: 10.1016/j.medengphy.2020.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
Individuals with hand osteoarthritis (OA) have impairments in grip strength and range of motion (ROM). Obtaining quantitative joint angle measures of the hand is difficult. Without a complete understanding of the kinematics of the hand, the assessment of hand OA when performing activities of daily living (ADL) and recreational activities is not fully understood. The objectives of this study were to establish a simple measurement technique (Grip Configuration Model) describing an individual's grip ROM using the Dartfish Movement Analysis Software, and compare the joint angle measures during maximum flexion/extension and five ADL in people with/without hand OA. Forty participants (20 without hand OA, 20 with hand OA) thumb CMC and MCP, and index MCP and PIP joint angles were evaluated for each activity using the Dartfish Software and Grip Configuration Model. Significant limitations of 17.2% (p < 0.001) and 12.7% (p = 0.01) were seen in the group with hand OA for maximum flexion/extension, respectively. The spray bottle task demonstrated a significant difference of 14.7% (p = 0.001) between the two test groups. Measurements using the Dartfish Software were compared against a manual goniometer and electromagnetic tracking system. This study demonstrated the weakened ROM in individuals with hand OA is translated to ADL and how the Grip Configuration Model simplifies the evaluation of how people grasp objects.
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Affiliation(s)
- Sara Holland
- Musculoskeletal Biomechanics Laboratory, Department of Mechanical and Materials Engineering at Western University, London, ON, Canada.
| | | | - Joy MacDermid
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care Centre, London, ON, Canada.
| | - Kathryn Sinden
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada.
| | - Emily Lalone
- Musculoskeletal Biomechanics Laboratory, Department of Mechanical and Materials Engineering at Western University, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care Centre, London, ON, Canada.
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Vincent JI, MacDermid JC, King GJW, Grewal R, Lalone E. Establishing the psychometric properties of 2 self-reported outcome measures of elbow pain and function: A systematic review. J Hand Ther 2020; 32:222-232. [PMID: 30587433 DOI: 10.1016/j.jht.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons-elbow form (pASES-e) are 2 patient-reported outcome measures (PROMs) commonly used to assess pain and disability arising from elbow disorders. PURPOSE OF THE STUDY To systematically review and summarize the quality and content of the evidence that is available on the psychometric properties of the PREE and pASES-e. METHODS We systematically searched the online databases PubMed, EMBASE, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, UptoDate, ProQuest Dissertations & Theses, and Google Scholar. Ninety-one articles were retrieved, and after screening, 9 were included in the final analysis. Data extraction and quality appraisal was performed by 2 independent raters. Descriptive synthesis of the reviewed studies was completed. RESULTS Seven of the 9 studies had a quality score of 75% or higher. Agreement between the raters was good (kappa, 0.81). Both the PROMs did not demonstrate any floor and ceiling effects except for the satisfaction subscale of the pASES-e. Factor analysis revealed multidimensionality in the function subscale for both the PROMs. Construct validity was good with correlations above 0.70. Both were highly reliable with interclass correlation coefficient of >0.90. They were also highly responsive with an effect size and standardized response mean above 1. The minimal clinical important difference was not estimated for either measures. DISCUSSION This study concluded that strong clinical measurement properties exist for both the PREE and the pASES-e. We identified gaps in the current evidence for both the ASES-e and the PREE. Future studies need to calculate clinically important estimates like MCID, SEM, and others; and provide clear and specific conclusions. CONCLUSION The PREE and pASES-e have been established to be valid, reliable, and sensitive to change in both clinical and research settings based on high-quality evidence.
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Affiliation(s)
- Joshua I Vincent
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; Lifemark Health Corp., Toronto, Ontario, Canada.
| | - Joy C MacDermid
- University of Western Ontario, School of Physical Therapy, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Graham J W King
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada
| | - Ruby Grewal
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada
| | - Emily Lalone
- Faculty of Engineering, University of Western Ontario, London, Ontario, Canada
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Gray RJ, Thom M, Riddle M, Suh N, Burkhart T, Lalone E. Image-Based Comparison Between the Bilateral Symmetry of the Distal Radii Through Established Measures. J Hand Surg Am 2019; 44:966-972. [PMID: 31311681 DOI: 10.1016/j.jhsa.2019.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 02/20/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Anthropometric assessment of bony structures in the body is important for preoperative computer-aided surgery, implant design, finite element modeling, and biomechanical studies investigating joint structure and function. The use of the contralateral limb in surgery and clinical practice relies on the assumption that the right and left limbs of an individual are symmetric. Therefore, the purpose of this study was to quantify the bilateral symmetry of the bony structures of the distal radius using 3-dimensional (3D) computed tomography. METHODS We collected computed tomography images of 37 paired, fresh-frozen, healthy cadaveric male upper limbs (aged 75.4 ± 8.3 years). Three-dimensional reconstructed models were created using semiautomatic segmentation. Using the 3D models, we measured 3D radial inclination, 3D volar tilt, 3D radial height, medial volar cortical angle, middle volar cortical angle, and lateral volar cortical angle and compared them between sides. RESULTS There were no statistically significant differences measured between right and left distal radius in 37 paired wrists. Mean radial height was 12.81 mm (SD, 1.74 mm) on the left and 12.88 mm (SD, 1.72 mm) on the right. Mean volar tilt was 10.74° (SD, 3.74°) and 10.77° (SD, 3.19°) and radial inclination was 24.05° (SD, 2.63°) and 24.18° (SD, 3.41°) on the left and right, respectively. Mean volar cortical angle across the radius was 140.9° (SD, 7.9°) on the left and 140.1° (SD, 7.9°) on the right. CONCLUSIONS Direct bilateral comparison of the distal radius and wrist joints is useful to predict normal anatomy of the injured radius, because bilateral similarities exist. CLINICAL RELEVANCE This article provides a comprehensive list of measurements of the distal radius compared bilaterally using a 3D model. From this study, we found that the contralateral radius can be used as a benchmark with which to compare fracture reduction and to manage malunions during the preoperative planning of corrective osteotomies. It can also be used to define normal anatomy.
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Affiliation(s)
- Robert J Gray
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Mitchell Thom
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Michael Riddle
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Nina Suh
- Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, University of Western Ontario, Ontario, Canada
| | - Timothy Burkhart
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada.
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Wegmann K, Knowles N, Lalone E, Müller LP, Athwal GS, King GJW. Computed Tomography Analysis of the Radial Notch of the Ulna. J Hand Surg Am 2019; 44:794.e1-794.e8. [PMID: 30502012 DOI: 10.1016/j.jhsa.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 08/19/2018] [Accepted: 10/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The anatomy of the radial head and capitellum has been extensively studied; however, the anatomy of the radial notch of the ulna (RNU) has received little attention. This imaging-based anatomic study characterizes the morphology of the RNU. METHODS Ninety-eight cadaveric arms (57 male, 72 ± 14 y) were imaged with computed tomography, and 3-dimensional reconstructions of the proximal ulna were constructed. The anteroposterior and proximal-distal dimensions of the RNU as well as the radius of curvature at standardized levels were measured in 2-mm increments. The orientation of the RNU was also determined. RESULTS The proximal-distal and anteroposterior dimensions of the RNU were 12 ± 2 mm (range, 7-16 mm) and 18 ± 3 mm (range, 12-24 mm), respectively. The average radius of curvature of the RNU was 15 ± 0 mm (range, 15-16 mm). The radius of curvature did not change significantly when comparing the proximal and distal aspect of the RNU. The RNU was rotated 33° ± 2° (range, 31° to 38°) externally relative to the transverse plane of the ulna. The average depth of the RNU at its deepest point was 2.2 ± 0.4 mm (range, 1.5-2.7 mm). The depth decreased from proximal to distal, being most shallow distally. The depth changed by an increase of the radius of curvature, as well as by rotation in the frontal plane. CONCLUSIONS The RNU anatomy was variable, generally extending laterally from proximal to distal. This suggests that a radial head implant should taper from proximal to distal to optimize contact at the RNU. CLINICAL RELEVANCE The present study investigates the detailed anatomy of the radial notch of the ulna using computed tomography scans. The data might help improve the design of prosthetic components.
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Affiliation(s)
- Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Nikolas Knowles
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Emily Lalone
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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15
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Riddle M, MacDermid-Watts K, Holland S, MacDermid JC, Lalone E, Ferreira L. Wearable strain gauge-based technology measures manual tactile forces during the activities of daily living. J Rehabil Assist Technol Eng 2019; 5:2055668318793587. [PMID: 31191951 PMCID: PMC6531800 DOI: 10.1177/2055668318793587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Current methods of determining applied forces in the hand rely on grip dynamometers or force-measurement gloves which are limited in their ability to isolate individual finger forces and interfere with the sense of touch. The objective of this study was to develop an improved force measurement system that could be used during various activities of daily living. Methods Custom-made strain gauge sensors were secured to the fingernail of four fingers and two middle phalanges and calibrated to measure hand forces in eight healthy individuals during five activities of daily living. Results These sensors were capable of measuring forces as small as 0.17 N and did not saturate at high force tasks around 15 N, which is within the envelope of forces experienced during daily life. Preliminary data demonstrate the ability of these tactile sensors to reliably distinguish which fingers/segments were used in various tasks. Conclusions Until now, there has been no method for real-time unobtrusive monitoring of force exposure during the tasks of daily life. The system used in this study provides a new type of low-cost wearable technology to monitor forces in the hands without interfering with the contact surface of the hand.
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Affiliation(s)
- Michael Riddle
- School of Biomedical Engineering, The University of Western Ontario, Ontario, Canada
| | - Kevin MacDermid-Watts
- Department of Mechanical and Materials Engineering, The University of Western Ontario, Ontario, Canada
| | - Sara Holland
- Department of Mechanical and Materials Engineering, The University of Western Ontario, Ontario, Canada
| | - Joy C MacDermid
- Department of Physical Therapy, The University of Western Ontario, Ontario, Canada
| | - Emily Lalone
- School of Biomedical Engineering, The University of Western Ontario, Ontario, Canada.,Department of Mechanical and Materials Engineering, The University of Western Ontario, Ontario, Canada
| | - Louis Ferreira
- Department of Mechanical and Materials Engineering, The University of Western Ontario, Ontario, Canada.,Department of Surgery, Schulich School of Medicine and Dentistry, Ontario, Canada
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Gammon B, Lalone E, Nishiwaki M, Willing R, Johnson J, King GJW. The Effect of Dorsal Angulation on Distal Radioulnar Joint Arthrokinematics Measured Using Intercartilage Distance. J Wrist Surg 2019; 8:10-17. [PMID: 30723596 PMCID: PMC6358445 DOI: 10.1055/s-0038-1667303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
Background The effects of dorsal angulation deformity on in vitro distal radioulnar joint (DRUJ) contact patterns are not well understood. Purpose The purpose of this study was to utilize intercartilage distance to examine the effects of forearm rotation angle, distal radius deformity, and triangular fibrocartilage complex (TFCC) sectioning on DRUJ contact area and centroid position. Methods An adjustable implant permitted the creation of simulated intact state and dorsal angulation deformities of 10, 20, and 30 degrees. Three-dimensional cartilage models of the distal radius and ulna were created using computed tomography data. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. Results DRUJ contact area was highest between 10 and 30 degrees of supination. TFCC sectioning caused a significant decrease in contact area with a mean reduction of 11 ± 7 mm 2 between the TFCC intact and sectioned conditions across all variables. The position of the contact centroid moved volarly and proximally with supination for all variables. Deformity had a significant effect on the location of the contact centroid along the volar-dorsal plane. Conclusion Contact area in the DRUJ was maximal between 10 and 30 degrees of supination during the conditions tested. There was a significant effect of simulated TFCC rupture on contact area in the DRUJ, with a mean contact reduction of 11 ± 7 mm 2 after sectioning. Increasing dorsal angulation caused the contact centroid to move progressively more volar in the sigmoid notch.
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Affiliation(s)
- Braden Gammon
- Division of Orthopedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - Masao Nishiwaki
- Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki-ku, Kawasaki, Japan
| | - Ryan Willing
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - James Johnson
- Department of Mechanical and Materials Engineering, Lawson Health Research Institute, London, Ontario, Canada
| | - Graham J. W. King
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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Wu K, Padmore C, Lalone E, Suh N. An Anthropometric Assessment of the Proximal Hamate Autograft for Scaphoid Proximal Pole Reconstruction. J Hand Surg Am 2019; 44:60.e1-60.e8. [PMID: 29934078 DOI: 10.1016/j.jhsa.2018.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/04/2018] [Accepted: 04/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Fragmentation of the scaphoid proximal pole secondary to avascular necrosis presents a difficult reconstructive problem. This anthropometric study assesses the utility of the ipsilateral proximal hamate for complete osteochondral scaphoid proximal pole reconstruction. METHODS Twenty-nine cadaveric specimens underwent computed tomography scanning and 3-dimensional reconstruction of the carpus and distal radius. Scaphoid height was measured and a third of its height was used to simulate resection of the proximal scaphoid pole and extent of hamate autograft required. The proximal scaphoid and hamate were divided into 6 sections, and compared using an iterative point-to-point distance algorithm. Average distance between the scaphoid and the hamate surfaces was determined. An interbone algorithm was used to assess radioscaphoid joint congruency and articular contact surface of the native scaphoid compared with the scaphoid reconstructed with hamate autograft. RESULTS The mean height of scaphoid proximal pole excision and proximal hamate autograft height was 9.3 mm. Comparing the morphology of the native scaphoid and hamate autografts, the absolute distances were the largest in the volar radioscaphoid, dorsal radioscaphoid, and dorsal scaphocapitate segments. Without osteotomy, the hamate autograft may cause impaction in the dorsal-radial aspect of the distal radius. The hamate autograft also shifted the articular contact point of the radioscaphoid joint toward the dorsal-radial position. Nine hamate autografts were classified as poor-fitting. Poor-fitting specimens had a greater radial styloid to distal radioulnar joint distance. These specimens also had wider hamates and scaphoids in the radial-ulnar dimension and wider scaphoids in the volar-dorsal dimension. Lunate type did not correspond to anthropometric fit. CONCLUSIONS The proximal hamate osteochondral graft was poor fitting in 31% of cases (9 of 29 specimens). Wrists with radial-ulnar hamate width less than 10 mm, radial-ulnar scaphoid width less than 10 mm, and volar-dorsal scaphoid width less than 16 mm demonstrate better anthropometric fit. CLINICAL RELEVANCE This study provides an anthropometric assessment of the recently described proximal hamate autograft, a new bone graft option for proximal scaphoid pole reconstruction.
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Affiliation(s)
- Kitty Wu
- Department of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care, London, Ontario, Canada
| | - Clare Padmore
- Department of Biomedical Engineering, Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Emily Lalone
- Department of Biomedical Engineering, Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- Department of Surgery, Western University, Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
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Fonseca MDCR, Elui VMC, Lalone E, da Silva NC, Barbosa RI, Marcolino AM, Ricci FPFM, MacDermid JC. Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties. Syst Rev 2018; 7:175. [PMID: 30368253 PMCID: PMC6204279 DOI: 10.1186/s13643-018-0836-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. METHODS This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. RESULTS Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. CONCLUSIONS Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.
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Affiliation(s)
- Marisa de Cássia Registro Fonseca
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP Brazil
- Clinical Research, Hand and Upper Limb Centre, St Joseph’s Health Centre, Western University, London, ON Canada
| | - Valéria Meireles Carril Elui
- Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP Brazil
| | - Emily Lalone
- Clinical Research, Hand and Upper Limb Centre, St Joseph’s Health Centre, Western University, London, ON Canada
| | | | - Rafael Inácio Barbosa
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Araranguá, SC Brazil
| | - Alexandre Márcio Marcolino
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Araranguá, SC Brazil
| | | | - Joy C. MacDermid
- Clinical Research, Hand and Upper Limb Centre, St Joseph’s Health Centre, Western University, London, ON Canada
- Rehabilitation Science, School of Rehabilitation, McMaster University, Hamilton, ON Canada
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Lalone E, MacDermid J, Grewal R, King G. Patient Reported Pain and Disability Following a Distal Radius Fracture: A Prospective Study. Open Orthop J 2017; 11:589-599. [PMID: 28979578 PMCID: PMC5620403 DOI: 10.2174/1874325001711010589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fractures of the distal radius are common. Few studies investigating the extended long term outcomes of participants following a distal radius fracture (especially beyond 2 years) and they have relied on subjective measures or single objective tests to measure participant's final outcome. OBJECTIVES The objective of this study was to describe the pain and disability in long-term follow-up of participants after a distal radius fracture. Participants who had previously participated in a prospective study, where baseline and standardized one-year follow-up were performed, were contacted to volunteer to participate in this follow-up (FU) study. Sixty-five participants (17 males, 48 females) with an average age of 57 (SD 13) years at the time of injury and 67 (SD 13 years) at follow-up were evaluated at an average of 11(SD 6) years (range 2-20 years). RESULTS The majority of patients (85%) participants reported no change or had less pain and disability (PRWE) (<5 point difference) at their long-term follow-up compared to their one year PRWE scores. One year PRWE scores were found to be predictive (19.1%) of the variability in long term PRWE score (p=0.02). Age, gender, and mechanism of fall were not significant predictors of worsened outcome. CONCLUSION The majority of people that are experiencing no or low patient reported pain and disability one year following a DRF can expect to retain their positive outcome 10-20 years later. This study did not identify how to predict worsened outcome.
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Affiliation(s)
- Emily Lalone
- Western Univeristy - Mechanical and Materials Engineering, 1151 Richmond Street, London, Ontario N6A 5B9, Canada
| | - Joy MacDermid
- McMaster University - School of Rehabilitation Science, Rm 429, IAHS Victoria, Hamilton, Ontario L8S 1C7, Canada
| | - Ruby Grewal
- The University of Western Ontario - Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Center 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Graham King
- Roth
- McFarlane Hand and Upper Limb Centre - Orthopedic Surgery, London, Ontario, Canada
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Szekeres M, MacDermid JC, Birmingham T, Grewal R, Lalone E. The Effect of Therapeutic Whirlpool and Hot Packs on Hand Volume During Rehabilitation After Distal Radius Fracture: A Blinded Randomized Controlled Trial. Hand (N Y) 2017; 12:265-271. [PMID: 28453348 PMCID: PMC5480660 DOI: 10.1177/1558944716661992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Edema is a possibility with all heating modalities due to the increase in local blood flow caused by vasodilation. Despite the frequent application of superficial heat modalities, their relative effect on hand volume has not been determined for the upper extremity. The objective of this study was to compare the immediate effects of hot packs and whirlpool on hand volume for patients with distal radius fracture (DRF) and to determine whether any changes in volume between these modalities were still present 30 minutes after heat application. Finally, to determine whether there were any differences in volume change between groups after 3 repeated therapy visits. METHODS Sixty patients with clinically healed DRFs were divided into 2 groups. Half received therapeutic whirlpool at each therapy visit, and the other half received a moist hot pack treatment for 3 consecutive visits. Hand volume was measured before heat, after heat, and at the end of each 30-minute therapy session. RESULTS There was a significant difference between groups immediately after heat application, as patients in the whirlpool group experienced an initial volume increase greater than those who received a hot pack. When remeasured after a hand therapy session approximately 30 minutes later, this group difference in volume change was no longer significant. The overall change in volume from enrollment in the study to completion of the study 3 weeks later was not statistically different between groups. CONCLUSION Whirlpool is a potential consideration when selecting a heat modality for patients with DRF.
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Affiliation(s)
- Mike Szekeres
- Western University, London, Ontario, Canada,St. Joseph’s Health Care London, Ontario, Canada,Mike Szekeres, Clinical Research Lab, Roth McFarlane Hand & Upper Limb Centre, St. Joseph’s Health Care London, Ontario, Canada N6A 4V6.
| | - Joy C. MacDermid
- Western University, London, Ontario, Canada,St. Joseph’s Health Care London, Ontario, Canada
| | | | - Ruby Grewal
- Western University, London, Ontario, Canada,St. Joseph’s Health Care London, Ontario, Canada
| | - Emily Lalone
- St. Joseph’s Health Care London, Ontario, Canada
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Desai SJ, Lalone E, Athwal GS, Ferreira LM, Johnson JA, King GJW. Hemiarthroplasty of the elbow: the effect of implant size on joint congruency. J Shoulder Elbow Surg 2016; 25:297-303. [PMID: 26700555 DOI: 10.1016/j.jse.2015.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal humeral hemiarthroplasty is a treatment option for elbow joint disease that predominantly affects the distal humerus, including distal humerus fractures, nonunions, and avascular necrosis. The effect of hemiarthroplasty implants on joint contact has not been reported. The purpose of this in vitro study was to quantify the effects of hemiarthroplasty and implant size on ulnohumeral joint congruency. METHODS Five fresh frozen cadaveric upper extremities were mounted to a custom elbow testing system. Active and passive motion were performed in dependent, horizontal, varus, and valgus positions. A registration and interbone distance algorithm was used to quantify ulnohumeral joint congruency throughout elbow flexion. RESULTS The optimally sized hemiarthroplasty implant demonstrated the greatest joint congruency with the ulna, followed by the oversized implant, then the undersized implant. Joint congruency was greater during active vs. passive flexion, indicating that the elbow joint is more reduced in active flexion than in passive flexion. CONCLUSION This study demonstrates that undersized distal humeral hemiarthroplasty implants have the lowest joint congruency compared with an optimally sized or oversized implant.
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Affiliation(s)
- Sagar J Desai
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Emily Lalone
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - George S Athwal
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Louis M Ferreira
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery and Mechanical and Materials Engineering, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - James A Johnson
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery and Mechanical and Materials Engineering, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Graham J W King
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada.
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Affiliation(s)
- Celine Yeung
- Anatomy and Cell BiologyWestern UniversityLondonONCanada
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Sabo MT, Shannon HL, Deluce S, Lalone E, Ferreira LM, Johnson JA, King GJW. Capitellar excision and hemiarthroplasty affects elbow kinematics and stability. J Shoulder Elbow Surg 2012; 21:1024-1031.e4. [PMID: 21816633 DOI: 10.1016/j.jse.2011.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 03/25/2011] [Accepted: 04/18/2011] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Capitellar hemiarthroplasty is proposed as a reconstructive option for isolated capitellar deficiency, but there is limited data on its effect on elbow biomechanics. This study assessed the effect of capitellar excision with and without replacement on elbow kinematics and stability, and evaluated 2 different implant surface shapes. MATERIALS AND METHODS Ten cadaveric arms were tested with an upper extremity joint simulator. Each arm underwent computer tomography scanning for implant sizing and computer-assisted implantation. Kinematic data were obtained using an electromagnetic tracking system during elbow flexion, with the arm oriented in the valgus, varus, and vertical positions. Implants were placed through an extended lateral epicondylar osteotomy using computer-assisted techniques. A repeated-measures design compared 2 implants (anatomical and spherical) to the native capitellum control and capitellar excision states. Outcomes were maximum varus-valgus laxity and rotation of the ulna with respect to the humerus. RESULTS Excision of the capitellum increased the varus-valgus laxity up to 3.1° in active elbow flexion, with the forearm in pronation but not in supination. Both capitellar implant designs maintained normal varus-valgus laxity in both active and passive elbow flexion. Excision of the capitellum increased external ulnar rotation during active flexion in the vertical and valgus positions up to 1.5°, while both implants restored normal ulnar rotation. The kinematics and stability of the elbows were similar for both implant designs. CONCLUSION The capitellum appears to have a role as a valgus and external rotational stabilizer of the ulnohumeral joint. This instability was corrected by both designs of capitellar hemiarthroplasty.
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Affiliation(s)
- Marlis T Sabo
- Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada
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Rafehi S, Lalone E, Johnson M, King GJW, Athwal GS. An anatomic study of coronoid cartilage thickness with special reference to fractures. J Shoulder Elbow Surg 2012; 21:961-8. [PMID: 21885303 DOI: 10.1016/j.jse.2011.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current coronoid fracture classification systems are based on fragment size and configuration using plain radiographs and/or computed tomography (CT). During surgery, coronoid fracture fragments appear much larger than anticipated because cartilage is radiolucent and therefore not accounted for with preoperative imaging. The purpose of this imaging study was to quantify the articular cartilage thickness of the coronoid, with reference to coronoid fractures. MATERIALS AND METHODS Twenty-four cadaveric ulnae were dissected, imaged with CT, and analyzed by use of image analysis software. Thirteen identifiable landmarks were chosen on the coronoid, olecranon, and proximal radioulnar joint to measure articular cartilage thickness. Intraobserver reliability and interobserver reliability were determined. RESULTS Cartilage thickness was highest at the coronoid tip, with a mean of 3.0 mm (range, 1.7-4.6 mm). Cartilage thickness at the tip correlated inversely with age (P < .01) and correlated strongly with overall ulnar height and ulnar length (P < .05). All measurements had excellent intraobserver and interobserver reliability. CONCLUSION The thickness of cartilage on the coronoid tip is not inconsequential. The results of this study indicate that a 2-mm coronoid tip fracture on CT scan may actually appear to be a mean of 5 mm thick when viewed at the time of surgery. Clinically, this is important because it may alter the classification, the decision to treat, or the type of fixation used. Importantly, biomechanical cadaveric studies assessing coronoid injuries have incorporated cartilage thickness into coronoid size measurements when creating simulated fractures; therefore, it is critical that the conclusions of such biomechanical studies be scrutinized with regard to their clinical recommendations. Surgeons should be aware of these discrepancies.
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Affiliation(s)
- Samah Rafehi
- Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada
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Sabo MT, Shannon H, De Luce S, Lalone E, Ferreira LM, Johnson JA, King GJW. Elbow kinematics after radiocapitellar arthroplasty. J Hand Surg Am 2012; 37:1024-32. [PMID: 22480501 DOI: 10.1016/j.jhsa.2012.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/12/2012] [Accepted: 02/14/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Radiocapitellar arthroplasty has been proposed as a reconstructive option for combined radial head and capitellar deficiency. The purpose of this study was to assess the impact of radiocapitellar replacement on elbow kinematics. We hypothesized that with the medial collateral ligament (MCL) intact, radiocapitellar arthroplasty would replicate normal kinematics, and that a radiocapitellar arthroplasty would more closely approximate normal kinematics than an elbow with a deficient lateral column or with a deficient MCL. METHODS We tested 7 cadaveric arms in an upper extremity joint simulator. Each arm underwent computed tomographic scanning to aid implant size selection and computer-assisted implant insertion. We obtained kinematic data using an electromagnetic tracking system during elbow flexion. The capitellar and radial head implants were placed through an extended lateral epicondylar osteotomy. We sectioned the anterior bundle of the MCL, leaving the flexor-pronator mass intact. Outcomes of interest were varus-valgus and rotational kinematics of the ulnohumeral joint. RESULTS The radiocapitellar arthroplasty showed no difference in kinematics compared with the postosteotomy control. The MCL-deficient elbow showed more valgus angulation and more external ulnar rotation than the control or radiocapitellar arthroplasty in the pronated, valgus loaded position. The deficient lateral column demonstrated increased external ulnar rotation kinematics during active elbow flexion. CONCLUSIONS Radiocapitellar arthroplasty can restore normal elbow kinematics with the MCL intact. If the MCL is deficient, radiocapitellar arthroplasty does not restore normal kinematics. CLINICAL RELEVANCE Radiocapitellar arthroplasty should be considered in cases of lateral column deficiency because it maintains normal elbow kinematics during active motion. Whereas radiocapitellar arthroplasty improves the stability of the MCL-deficient elbow with deficiency of the lateral column, reconstruction of the MCL may further improve normal kinematics.
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Affiliation(s)
- M T Sabo
- St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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