A new semi-automated measurement technique based on X-ray pictures for ankle morphometry

Knowledge of human joint morphology is important in orthopaedic surgery and in prosthesis design. The literature on quantitative morphological analysis of the ankle joint is particularly scarce. A semi-automated radiographic measurement method was developed to collect morphological measures of the ankle joint. The method was based on standard lateral and antero-posterior X-ray pictures of the ankle joint. These were then scanned and analysed by means of specialized software designed for the purpose, which requires minimal operator contribution. Accuracy of the method was experimentally assessed by in vitro direct measurements. Intra- and inter-operator variability was also tested. Accuracy was assessed to be within 1mm for most measurements. Repeatability was not affected by operator skill and was within 2mm. The newly proposed method was applied successfully on 15 male adult subjects and relevant results are reported. The method allows ankle morphology to be analysed in a large number of subjects providing reliable data for anthropometric statistics.     

A probabilistic method to estimate gait kinetics in the absence of ground reaction force measurements

Human joint torques during gait are usually computed using inverse dynamics. This method requires a skeletal model, kinematics and measured ground reaction forces and moments (GRFM). Measuring GRFM is however only possible in a controlled environment. This paper introduces a probabilistic method based on probabilistic principal component analysis to estimate the joint torques for healthy gait without measured GRFM. A gait dataset of 23 subjects was obtained containing kinematics, measured GRFM and joint torques from inverse dynamics in order to obtain a probabilistic model. This model was then used to estimate the joint torques of other subjects without measured GRFM. Only kinematics, a skeletal model and timing of gait events are needed. Estimation only takes 0.28 ms per time instant. Using cross-validation, the resulting root mean square estimation errors for the lower-limb joint torques are found to be approximately 0.1 Nm/kg, which is 6–18% of the range of the ground truth joint torques. Estimated joint torque and GRFM errors are up to two times smaller than model-based state-of-the-art methods. Model-free artificial neural networks can achieve lower errors than our method, but are less repeatable, do not contain uncertainty information on the estimates and are difficult to use in situations which are not in the learning set. In contrast, our method performs well in a new situation where the walking speed is higher than in the learning dataset. The method can for example be used to estimate the kinetics during overground walking without force plates, during treadmill walking without (separate) force plates and during ambulatory measurements.     

A novel functional calibration method for real-time elbow joint angles estimation with magnetic-inertial sensors

Magnetic-inertial measurement units (MIMUs) are often used to measure the joint angles between two body segments. To obtain anatomically meaningful joint angles, each MIMU must be computationally aligned (i.e., calibrated) with the anatomical rotation axes. In this paper, a novel four-step functional calibration method is presented for the elbow joint, which relies on a two-degrees-of-freedom elbow model. In each step, subjects are asked to perform a simple task involving either one-dimensional motions around some anatomical axes or a static posture. The proposed method was implemented on a fully portable wearable system, which, after calibration, was capable of estimating the elbow joint angles in real time. Fifteen subjects participated in a multi-session experiment that was designed to assess accuracy, repeatability and robustness of the proposed method. When compared against an optical motion capture system (OMCS), the proposed wearable system showed an accuracy of about 4° along each degree of freedom. The proposed calibration method was tested against different MIMU mountings, multiple repetitions and non-strict observance of the calibration protocol and proved to be robust against these factors. Compared to previous works, the proposed method does not require the wearer to maintain specific arm postures while performing the calibration motions, and therefore it is more robust and better suited for real-world applications.     

In vivo tests of an improved method for functional location of the subtalar joint axis

The subtalar joint is important in frontal plane movement and posture of the hindfoot. Abnormal subtalar joint moments caused by muscle forces and the ground reaction force acting on the foot are thought to play a role in various foot deformities. Calculating joint moments typically requires knowledge of the location of the joint axis; however, location of the subtalar axis from measured movement is difficult because the talus cannot be tracked using skin-mounted markers. The accuracy of a novel technique for locating the subtalar axis was assessed in vivo using magnetic resonance imaging. The method was also tested with skin-mounted markers and video motion analysis. The technique involves applying forces to the foot that cause pure subtalar joint motion (with negligible talocrural joint motion), and then using helical axis decomposition of the resulting tibiocalcaneal motion. The resulting subtalar axis estimates differed by 6° on average from the true best-fit subtalar axes in the MRI tests. Motion was found to have been applied primarily about the subtalar joint with an average of only 3° of talocrural joint motion. The proposed method provides a potential means for obtaining subject-specific subtalar axis estimates which can then be used in inverse dynamic analyses and subject-specific musculoskeletal models.     

A new non-orthogonal decomposition method to determine effective torques for three-dimensional joint rotation

This paper describes a new non-orthogonal decomposition method to determine effective torques for three-dimensional (3D) joint rotation. A rotation about a joint coordinate axis (e.g. shoulder internal/external rotation) cannot be explained only by the torque about the joint coordinate axis because the joint coordinate axes usually deviate from the principal axes of inertia of the entire kinematic chain distal to the joint. Instead of decomposing torques into three orthogonal joint coordinate axes, our new method decomposes torques into three "non-orthogonal effective axes" that are determined in such a way that a torque about each effective axis produces a joint rotation only about one of the joint coordinate axes. To demonstrate the validity of this new method, a simple internal/external rotation of the upper arm with the elbow flexed at 90 degrees was analyzed by both orthogonal and non-orthogonal decomposition methods. The results showed that only the non-orthogonal decomposition method could explain the cause-effect mechanism whereby three angular accelerations at the shoulder joint are produced by the gravity torque, resultant joint torque, and interaction torque. The proposed method would be helpful for biomechanics and motor control researchers to investigate the manner in which the central nervous system coordinates the gravity torque, resultant joint torque, and interaction torque to control 3D joint rotations.     

In vivo determination of the anatomical axes of the ankle joint complex: An optimization approach

This study investigates the feasibility of a subject-specific three-dimensional model of the ankle joint complex for kinematic and dynamic analysis of movement. The ankle joint complex was modelled as a three-segment system, connected by two ideal highe joints: the talocrural and the subtalar joint. A mathematical formulation was developed to express the three-dimensional translation and rotation between the foot and shank segments as a function of the two joint angles, and 12 model parameters describing the locations of the joint axes. An optimization method was used to fit the model parameters to three-dimensional kinematic data of foot and shank markers, obtained during test movements throughout the entire physiological range of motion of the ankle joint. The movement of the talus segment, which cannot be measured non-invasively, is not necessary for the analysis.

This optimization method was used to determine the position and orientation of the joint axes in 14 normal subjects. After optimization, the discrepancy between the best fitting model and actual marker kinematics was between 1 and 3 mm for all subjects. The predicted inclination of the subtalar joint axis from the horizontal plane was 37.4±2.7°, and the medial deviation was 18.0±16.2°. The lateral side of the talucrural axis was directed slightly posteriorly (6.8±8.1°), and inclined downward by 7.0±5.4°. These results are similar to previously reported typical results from anatomical, in vitro, studies. Reproducibility was evaluated by repeated testing of one subject, which resulted in variations of about one-fifth of the standard deviation within the group, the inclination of the subtalar joint axis was significantly correlated to the arch height and a radiographic ‘tarsal index’. It is concluded that this optimization method provides the opportunity to incorporate inter-individual anatomical differences into kinematic and dynamic analysis of the ankle joint complex. This allows a more functional interpretation of kinematic data, and more realistic estimates of internal forces.     

Analysis of forearm rotational motion using biplane fluoroscopic intensity-based 2D–3D matching

Measuring three-dimensional (3D) forearm rotational motion is difficult. We aimed to develop and validate a new method for analyzing 3D forearm rotational motion. We proposed biplane fluoroscopic intensity-based 2D–3D matching, which employs automatic registration processing using the evolutionary optimization strategy. Biplane fluoroscopy was conducted for forearm rotation at 12.5 frames per second along with computed tomography (CT) at one static position. An arm phantom was embedded with eight stainless steel spheres (diameter, 1.5 mm), and forearm rotational motion measurements using the proposed method were compared with those using radiostereometric analysis, which is considered the ground truth. As for the time resolution analysis, we measured radiohumeral joint motion in a patient with posterolateral rotatory instability and compared the 2D–3D matching method with the simulated multiple CT method, which uses CTs at multiple positions and interpolates between the positions. Rotation errors of the radius and ulna between these two methods were 0.31 ± 0.35° and 0.32 ± 0.33°, respectively, translation errors were 0.43 ± 0.35 mm and 0.29 ± 0.25 mm, respectively. Although the 2D–3D method could detect joint dislocation, the multiple CT method could not detect quick motion during joint dislocation. The proposed method enabled high temporal- and spatial-resolution motion analyses with low radiation exposure. Moreover, it enabled the detection of a sudden motion, such as joint dislocation, and may contribute to 3D motion analysis, including joint dislocation, which currently cannot be analyzed using conventional methods.     

Justification of triaxial goniometer for the measurement of joint rotation

The modified triaxial goniometer was designed based on the gyroscopic concept. This device is capable of measuring the joint three-dimensional angular motion corresponding to a specific set of Eulerian angles. Since the angular measurement by this device is not sequence dependent, it is convenient to provide unique motion patterns of the joint from one position to another. The joint rotational axes are oriented based on identifiable bony landmarks which provide a convenient visualization of the anatomical motion involved. The error caused by the exoskeletal attachment of the instrument can be theoretically corrected. Considering all factors in joint functional evaluation, the triaxial goniometer is a useful and effective method to provide simple real time three-dimensional angular motion measurements.     

A method of calculating physiologically relevant joint reaction forces during forward dynamic simulations of movement from an existing knee model

In the commonly used SIMM software, which includes a complete musculoskeletal model of the lower limbs, the reaction forces at the knee are computed. These reaction forces represent the bone-on-bone contact forces and the soft tissue forces (e.g. ligaments) other than muscles acting at the joint. In the knee model integrated into this software, a patellotibial joint rather than a patellofemoral joint is defined, and a force acting along the direction of the patellar ligament is not included. Although this knee model results in valid kinematics and muscle moment arms, the reaction forces at the knee calculated do not represent physiologic knee joint reaction forces. Hence our objectives were to develop a method of calculating physiologic knee joint reaction forces using the knee model incorporated into the SIMM software and to demonstrate the differences in the forces returned by SIMM and the physiologic forces in an example. Our method converts the anatomically fictional patellotibial joint into a patellofemoral joint and computes the force in an inextensible patellar ligament. In our example, the rectus femoris was fully excited isometrically, with the knee and hip flexed to 90 degrees . The resulting SIMM tibiofemoral joint reaction force was primarily shear, because the quadriceps force was applied to the tibia via the fictional patellotibial joint. In contrast the physiologic tibiofemoral joint reaction force was primarily compression, because the quadriceps force was applied through the patellar ligament. This result illustrates that the physiologic knee joint reaction forces are profoundly different than the forces returned by SIMM. However physiologic knee joint reaction forces can be computed with postprocessing of SIMM results.     

A global optimization method for prediction of muscle forces of human musculoskeletal system

Inverse dynamic optimization is a popular method for predicting muscle and joint reaction forces within human musculoskeletal joints. However, the traditional formulation of the optimization method does not include the joint reaction moment in the moment equilibrium equation, potentially violating the equilibrium conditions of the joint. Consequently, the predicted muscle and joint reaction forces are coordinate system-dependent. This paper presents an improved optimization method for the prediction of muscle forces and joint reaction forces. In this method, the location of the rotation center of the joint is used as an optimization variable, and the moment equilibrium equation is formulated with respect to the joint rotation center to represent an accurate moment constraint condition. The predicted muscle and joint reaction forces are independent of the joint coordinate system. The new optimization method was used to predict muscle forces of an elbow joint. The results demonstrated that the joint rotation center location varied with applied loading conditions. The predicted muscle and joint reaction forces were different from those predicted by using the traditional optimization method. The results further demonstrated that the improved optimization method converged to a minimum for the objective function that is smaller than that reached by using the traditional optimization method. Therefore, the joint rotation center location should be involved as a variable in an inverse dynamic optimization method for predicting muscle and joint reaction forces within human musculoskeletal joints.     

The use of basis functions in modelling joint articular surfaces: application to the knee joint

This article introduces a new method to represent bone surface geometry for simulations of joint contact. The method uses the inner product of two basis functions to provide a mathematical representation of the joint surfaces. This method guarantees a continuous transition in the direction of the surface normals, an important property for computation of joint contact. Our formulation handles experimental data that are not evenly distributed, a common characteristic of digitized data of musculoskeletal morphologies. The method makes it possible to represent highly curved surfaces, which are encountered in many anatomical structures. The accuracy of this method is demonstrated by modeling the human knee joint. The mean relative percentage error in the representation of the patellar track surface was 0.25% (range 0-1.56%) which corresponded to an absolute error of 0.17mm (range 0-0.16mm).     

Cluster-based upper body marker models for three-dimensional kinematic analysis: Comparison with an anatomical model and reliability analysis

Quantifying angular joint kinematics of the upper body is a useful method for assessing upper limb function. Joint angles are commonly obtained via motion capture, tracking markers placed on anatomical landmarks. This method is associated with limitations including administrative burden, soft tissue artifacts, and intra- and inter-tester variability. An alternative method involves the tracking of rigid marker clusters affixed to body segments, calibrated relative to anatomical landmarks or known joint angles. The accuracy and reliability of applying this cluster method to the upper body has, however, not been comprehensively explored. Our objective was to compare three different upper body cluster models with an anatomical model, with respect to joint angles and reliability. Non-disabled participants performed two standardized functional upper limb tasks with anatomical and cluster markers applied concurrently. Joint angle curves obtained via the marker clusters with three different calibration methods were compared to those from an anatomical model, and between-session reliability was assessed for all models. The cluster models produced joint angle curves which were comparable to and highly correlated with those from the anatomical model, but exhibited notable offsets and differences in sensitivity for some degrees of freedom. Between-session reliability was comparable between all models, and good for most degrees of freedom. Overall, the cluster models produced reliable joint angles that, however, cannot be used interchangeably with anatomical model outputs to calculate kinematic metrics. Cluster models appear to be an adequate, and possibly advantageous alternative to anatomical models when the objective is to assess trends in movement behavior.     

A computer vision based method for 3D posture estimation of symmetrical lifting

Work-related musculoskeletal disorders (WMSD) are commonly observed among the workers involved in material handling tasks such as lifting. To improve work place safety, it is necessary to assess musculoskeletal and biomechanical risk exposures associated with these tasks. Such an assessment has been mainly conducted using surface marker-based methods, which is time consuming and tedious. During the past decade, computer vision based pose estimation techniques have gained an increasing interest and may be a viable alternative for surface marker-based human movement analysis. The aim of this study is to develop and validate a computer vision based marker-less motion capture method to assess 3D joint kinematics of lifting tasks. Twelve subjects performing three types of symmetrical lifting tasks were filmed from two views using optical cameras. The joints kinematics were calculated by the proposed computer vision based motion capture method as well as a surface marker-based motion capture method. The joint kinematics estimated from the computer vision based method were practically comparable to the joint kinematics obtained by the surface marker-based method. The mean and standard deviation of the difference between the joint angles estimated by the computer vision based method and these obtained by the surface marker-based method was 2.31 ± 4.00°. One potential application of the proposed computer vision based marker-less method is to noninvasively assess 3D joint kinematics of industrial tasks such as lifting.     

Can one angle be simply subtracted from another to determine range of motion in three-dimensional motion analysis?

To determine the range of motion of a joint between an initial orientation and a final orientation, it is convenient to subtract initial joint angles from final joint angles, a method referred to as the vectorial approach. However, for three-dimensional movements, the vectorial approach is not mathematically correct. To determine the joint range of motion, the rotation matrix between the two orientations should be calculated, and angles describing the range of motion should be extracted from this matrix, a method referred to as the matrical approach. As the matrical approach is less straightforward to implement, it is of interest to identify situations in which the vectorial approach leads to insubstantial errors. In this study, the vectorial approach was compared to the matrical approach, and theoretical justification was given for situations in which the vectorial approach can reasonably be used. The main findings are that the vectorial approach can be used if (1) the motion is planar (Woltring HJ. 1994. 3-D attitude representation of human joints: a standardization proposal. J Biomech 27(12): 1399–1414), (2) the angles between the final and the initial orientation are small (Woltring HJ. 1991. Representation and calculation of 3-D joint movement. Hum Mov Sci 10(5): 603–616), (3) the angles between the initial orientation of the distal segment and the proximal segment are small and finally (4) when only one large angle occurs between the initial orientation of the distal segment and the proximal segment and the angle sequence is chosen in such a way that this large angle occurs on the first axis of rotation. These findings provide specific criteria to consider when choosing the angle sequence to use for movement analysis.     

In vivo measurement of the dynamic 3-D kinematics of the ovine stifle joint

The ovine stifle joint is a promising animal model for investigation of joint mechanobiology. A method for in vivo measurement of dynamic 3-D kinematics of the ovine stifle joint is described (accuracy: 0.36 +/- 0.39 mm). Inter-subject variability in kinematics is greater than both intra-subject and inter-session variability. For future studies in which joint kinematics are measured prior to and following controlled orthopaedic interventions, pooling of data should be avoided and each subject should act as its own control.     

Getting in shape: Reconstructing three-dimensional long-track speed skating kinematics by comparing several body pose reconstruction techniques

In gait studies body pose reconstruction (BPR) techniques have been widely explored, but no previous protocols have been developed for speed skating, while the peculiarities of the skating posture and technique do not automatically allow for the transfer of the results of those explorations to kinematic skating data. The aim of this paper is to determine the best procedure for body pose reconstruction and inverse dynamics of speed skating, and to what extend this choice influences the estimation of joint power. The results show that an eight body segment model together with a global optimization method with revolute joint in the knee and in the lumbosacral joint, while keeping the other joints spherical, would be the most realistic model to use for the inverse kinematics in speed skating. To determine joint power, this method should be combined with a least-square error method for the inverse dynamics. Reporting on the BPR technique and the inverse dynamic method is crucial to enable comparison between studies. Our data showed an underestimation of up to 74% in mean joint power when no optimization procedure was applied for BPR and an underestimation of up to 31% in mean joint power when a bottom-up inverse dynamics method was chosen instead of a least square error approach. Although these results are aimed at speed skating, reporting on the BPR procedure and the inverse dynamics method, together with setting a golden standard should be common practice in all human movement research to allow comparison between studies.     

Determining the location of hip joint centre: application of a conchoid's shape to the acetabular cartilage surface of magnetic resonance images

Preoperative planning, or intraoperative navigation of hip surgery, including joint-preserving procedures such as osteotomy or joint-replacing procedures such as total arthroplasty, needs to be performed with a high degree of accuracy to ensure a successful outcome. The ability to precisely localise the hip joint rotation centre may prove to be very useful in this context. The human hip joint has been shown to be a conchoid shape, and therefore the accurate location of the hip joint centre (HJC) cannot be computed simply as the centre of a sphere. This study describes a method for determining the HJC by applying a conchoid shape to the acetabular cartilage surface of magnetic resonance images, in order to increase the accuracy of the HJC location which had previously been calculated by a functional method using reconstructed three-dimensional surface bony models. By approximating a conchoid shape to the acetabulum, it was possible to compensate for HJC calculation errors.     

Globographic visualisation of three dimensional joint angles

Three different methods for describing three dimensional joint angles are commonly used in biomechanics. The joint coordinate system and Cardan/Euler angles are conceptually quite different but are known to represent the same underlying mathematics. More recently the globographic method has been suggested as an alternative and this has proved particularly attractive for the shoulder joint. All three methods can be implemented in a number of ways leading to a choice of angle definitions. Very recently Rab has demonstrated that the globographic method is equivalent to one implementation of the joint coordinate system. This paper presents a rigorous analysis of the three different methods and proves their mathematical equivalence. The well known sequence dependence of Cardan/Euler is presented as equivalent to configuration dependence of the joint coordinate system and orientation dependence of globographic angles. The precise definition of different angle sets can be easily visualised using the globographic method using analogues of longitude, latitude and surface bearings with which most users will already be familiar. The method implicitly requires one axis of the moving segment to be identified as its principal axis and this can be extremely useful in helping define the most appropriate angle set to describe the orientation of any particular joint. Using this technique different angle sets are considered to be most appropriate for different joints and examples of this for the hip, knee, ankle, pelvis and axial skeleton are outlined.     

Pilon 骨折的分型与治疗进展

本文回顾了Pilon骨折的诊断、分型及治疗发展,Pilon骨折特点是高能量损伤累及踝关节负重关节面的胫骨远端骨折,常伴有腓骨骨折和下胫腓关节分离。20世纪中期Pilon骨折被认为无法通过内固定进行治疗,公认的方法是通过骨牵引使关节早期模造获得关节功能的恢复。20世纪后期随着AO理论的深入研究,学术界广泛认同所有关节内骨折的理想治疗方法是解剖复位、坚强固定和早期活动。此后,随着内固定技术的发展及骨科BO理论的出现,目前普遍认为Pilon骨折的治疗应遵循的原则是:1.寻求骨折稳固和软组织完整之间的一种平衡;2.不以牺牲局部软组织血供来强求达到坚强固定。     

Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb

Measurements of human strength can be important during analyses of physical activities. Such measurements have often taken the form of the maximum voluntary torque at a single joint angle and angular velocity. However, the available strength varies substantially with joint position and velocity. When examining dynamic activities, strength measurements should account for these variations. A model is presented of maximum voluntary joint torque as a function of joint angle and angular velocity. The model is based on well-known physiological relationships between muscle force and length and between muscle force and velocity and was tested by fitting it to maximum voluntary joint torque data from six different exertions in the lower limb. Isometric, concentric and eccentric maximum voluntary contractions were collected during hip extension, hip flexion, knee extension, knee flexion, ankle plantar flexion and dorsiflexion. Model parameters are reported for each of these exertion directions by gender and age group. This model provides an efficient method by which strength variations with joint angle and angular velocity may be incorporated into comparisons between joint torques calculated by inverse dynamics and the maximum available joint torques.