Quantitative assessment of the accuracy for three interpolation techniques in kinematic analysis of human movement

Marker obstruction during human movement analyses requires interpolation to reconstruct missing kinematic data. This investigation quantifies errors associated with three interpolation techniques and varying interpolated durations. Right ulnar styloid kinematics from 13 participants performing manual wheelchair ramp ascent were reconstructed using linear, cubic spline and local coordinate system (LCS) interpolation from 11–90% of one propulsive cycle. Elbow angles (flexion/extension and pronation/supination) were calculated using real and reconstructed kinematics. Reconstructed kinematics produced maximum elbow flexion/extension errors of 37.1 (linear), 23.4 (spline) and 9.3 (LCS) degrees. Reconstruction errors are unavoidable [minimum errors of 6.7 mm (LCS); 0.29 mm (spline); 0.42 mm (linear)], emphasising careful motion capture system setup must be performed to minimise data interpolation. For the observed movement, LCS-based interpolation (average error of 14.3 mm; correlation of 0.976 for elbow flexion/extension) was most suitable for reconstructing durations longer than 200 ms. Spline interpolation was superior for shorter durations.     

Muscle activity in rapid multi-degree-of-freedom elbow movements: solutions from a musculoskeletal model

The activity of certain muscles that cross the elbow joint complex (EJC) are affected by forearm position and forearm movement during elbow flexion/extension. To investigate whether these changes are based on the musculoskeletal geometry of the joint, a three-dimensional musculotendinoskeletal computer model of the EJC was used to estimate individual muscle activity in multi-degree-of-freedom (df) rapid (ballistic) elbow movements. It is hypothesized that this model could reproduce the major features of elbow muscle activity during multi-df elbow movements using dynamic optimal control theory, given a minimum-time performance criterion. Results from the model are presented and verified with experimental kinematic and electromyographic data from movements that involved both one-df elbow flexion/extension and two-df flexion/extension with forearm pronation/supination. The model demonstrated how the activity of particular muscles is affected by both forearm position and movement, as measured in these experiments and as previously reported by others. These changes were most evident in the flexor muscles and least evident in the extensor muscles. The model also indicated that, for specific one- and two-df movements, activating a muscle that is antagonistic or noncontributory to the movement could reduce the movement time. The major features of muscle activity in multi-df elbow movements appear to be highly dependent on the joint's musculoskeletal geometry and are not strictly based on neural influences or neuroanatomical substrates. Received: 9 May 1997 / Accepted in revised form: 8 December 1998     

Positioning of the Human Forearm in Tracking Movements and Their Reproduction under Conditions of Limited Visual Control

In 14 healthy persons, we studied movements of the forearm with its positioning on a target level. A double trapezium was used as the command trajectory (flexion in the elbow joint from the state of full extension, 0°, with positioning on the level of 50 or 60° and further flexion to the 100° angle, and a similar reverse movement). We compared (i) tracking movements, when the subject tried to adequately reproduce the movement of the target along the command trajectory visualized on the monitor screen and obtained visual information about the performed movement (shifts of the second light point in time/joint angle coordinates), and (ii) reproduction of these movements under conditions of limitation of the visual feedback (when there was no information about the performed movement). Parameters of the tracking movements and of their reproductions (delays of initiation of the movement phases as compared with the command signal, durations of these phases, and angle velocities of the forearm movement), as well as the quality of positioning after oppositely directed movements, were compared. Positioning on the target level performed under proprioceptive control (when visual control was limited) was accompanied by systematic errors, whose sign in most test series performed by most subjects coincided with the direction of the preceding movement phase. The pattern of signs of systematic positioning errors after movements of opposite directions was quite individual (typical of a given subject) and demonstrated no dependence on the value of the extensor loading. Averaged intragroup systematic errors of positioning after movement phase 1 (flexion to the target level) and phase 3 (extension to the same level) under conditions of a minimum extensor loading (0.5-1.0 N · m) were 2.57° and 2.52°, respectively. When the loading was substantial (3.6-6.0 N · m), the respective errors were 3.85° and 3.48°. The nonlinear properties of muscle stretch receptors in the elbow flexors and extensors (responsible for the significant dependence of the parameters of afferent signals produced in these receptors on the movement prehistory) are considered the primary reason for systematic errors when positioning is performed exclusively under proprioceptive control. The influence of alpha-gamma co-activation in active muscles on the characteristics of the above signals is discussed.     

Feasibility of using EMG driven neuromusculoskeletal model for prediction of dynamic movement of the elbow.

Neuromusculoskeletal (NMS) modeling is a valuable tool in orthopaedic biomechanics and motor control research. To evaluate the feasibility of using electromyographic (EMG) signals with NMS modeling to estimate individual muscle force during dynamic movement, an EMG driven NMS model of the elbow was developed. The model incorporates dynamical equation of motion of the forearm, musculoskeletal geometry and musculotendon modeling of four prime elbow flexors and three prime elbow extensors. It was first calibrated to two normal subjects by determining the subject-specific musculotendon parameters using computational optimization to minimize the root mean square difference between the predicted and measured maximum isometric flexion and extension torque at nine elbow positions (0-120 degrees of flexion with an increment of 15 degrees ). Once calibrated, the model was used to predict the elbow joint trajectories for three flexion/extension tasks by processing the EMG signals picked up by both surface and fine electrodes using two different EMG-to-activation processing schemes reported in the literature without involving any trajectory fitting procedures. It appeared that both schemes interpreted the EMG somewhat consistently but their prediction accuracy varied among testing protocols. In general, the model succeeded in predicting the elbow flexion trajectory in the moderate loading condition but over-drove the flexion trajectory under unloaded condition. The predicted trajectories of the elbow extension were noted to be continuous but the general shape did not fit very well with the measured one. Estimation of muscle activation based on EMG was believed to be the major source of uncertainty within the EMG driven model. It was especially so apparently when fine wire EMG signal is involved primarily. In spite of such limitation, we demonstrated the potential of using EMG driven neuromusculoskeletal modeling for non-invasive prediction of individual muscle forces during dynamic movement under certain conditions.     

A new model to predict in vivo human knee kinematics under physiological-like muscle activation

Although a number of approaches have attempted to model knee kinematics, rarely have they been validated against in vivo data in a larger subject cohort. Here, we assess the feasibility of four-bar linkage mechanisms in addressing knee kinematics and propose a new approach that is capable of accounting for lengthening characteristics of the ligaments, including possible laxity, as well as the internal/external rotation of the joint. MR scans of the knee joints of 12 healthy volunteers were taken at flexion angles of 0 degrees , 30 degrees and 90 degrees under both passive and active muscle conditions. By reconstructing the surfaces at each position, the accuracy of the four-bar linkage mechanism was assessed for every possible combination of points within each cruciate ligament attachment area. The specific set of parameters that minimized the deviation between the predictions and the in vivo pose was derived, producing a mean error of 1.8 and 2.5 on the medial and 1.7 and 2.4mm on the lateral side at 30 degrees and 90 degrees flexion, respectively, for passive motion, significantly improving on the models that did not consider internal/external rotation. For active flexion, mean medial errors were 3.3 and 4.7 mm and lateral errors 3.4 and 4.8 mm. Using this best parameter set, a generic predictive model was created and assessed against the known in vivo positions, producing a maximum average error of 4.9 mm at 90 degrees flexion. The accuracy achieved shows that kinematics may be accurately reconstructed for subject specific musculoskeletal models to allow a better understanding of the load distribution within the knee.     

Measuring the sensitivity of total knee replacement kinematics and laxity to soft tissue imbalances

Ligament balancing during total knee replacement (TKR) is receiving increased attention due to its influence on resulting joint kinematics and laxity. We employed a novel in vitro technique to measure the kinematics and laxity of TKR implants during gait, and measured how these characteristics are influenced by implant shape and soft tissue balancing, simulated using virtual ligaments. Compared with virtual ligaments that were equally balanced in flexion and extension, the largest changes in stance-phase tibiofemoral AP and IE kinematics occurred when the virtual ligaments were simulated to be tighter in extension (tibia offset 1.0 ± 0.1 mm posterior and 3.6 ± 0.1° externally rotated). Virtual ligaments which were tight in flexion caused the largest swing-phase changes in AP kinematics (tibia offset 2.3 ± 0.2 mm), whereas ligaments which were tight in extension caused the largest swing-phase changes in IE kinematics (4.2 ± 0.1° externally rotated). When AP and IE loads were superimposed upon normal gait loads, incremental changes in AP and IE kinematics occurred (similar to laxity testing); and these incremental changes were smallest for joints with virtual ligaments that were tight in extension (in both the stance and swing phases). Two different implant designs (symmetric versus medially congruent) exhibited different kinematics and sensitivities to superimposed loads, but demonstrated similar responses to changes in ligament balancing. Our results demonstrate the potential for pre-clinical testing of implants using joint motion simulators with virtual soft tissues to better understand how ligament balancing affects implant motion.     

Role of agonist and antagonist muscle strength in performance of rapid movements

Six subjects performed rapid self-terminated elbow movements under different mechanical conditions prior to, and 5 weeks after an elbow extensor strengthening programme. Despite the large difference in the strengths of elbow flexors and extensors, the pretest did not demonstrate significant differences between the movement time of flexion and extension movements performed under the same mechanical conditions. The results obtained in the posttest demonstrated a decrease in movement time (i.e. an increase in movement speed) in both elbow flexion and extension movements under some mechanical conditions. In addition, flexion movements demonstrated a relative increase in the acceleration time (acceleration time as a proportion of the movement time). It was concluded that the strength of both the agonist and antagonist muscles was important for the performance of rapid movements. Stronger agonists could increase the acceleration of the limb being moved, while stronger antagonists could facilitate the arrest of the limb movement in a shorter time, providing a longer time for acceleration.     

Forelimb Kinematics of Rats Using XROMM,with Implications for Small Eutherians and Their Fossil Relatives

The earliest eutherian mammals were small-bodied locomotor generalists with a forelimb morphology that strongly resembles that of extant rats. Understanding the kinematics of the humerus, radius, and ulna of extant rats can inform and constrain hypotheses concerning typical posture and mobility in early eutherian forelimbs. The locomotion of Rattus norvegicus has been extensively studied, but the three-dimensional kinematics of the bones themselves remains under-explored. Here, for the first time, we use markerless XROMM (Scientific Rotoscoping) to explore the three-dimensional long bone movements in Rattus norvegicus during a normal, symmetrical gait (walking). Our data show a basic kinematic profile that agrees with previous studies on rats and other small therians: rats maintain a crouched forelimb posture throughout the step cycle, and the ulna is confined to flexion/extension in a parasagittal plane. However, our three-dimensional data illuminate long-axis rotation (LAR) movements for both the humerus and the radius for the first time. Medial LAR of the humerus throughout stance maintains an adducted elbow with a caudally-facing olecranon process, which in turn maintains a cranially-directed manus orientation (pronation). The radius also shows significant LAR correlated with manus pronation and supination. Moreover, we report that elbow flexion and manus orientation are correlated in R. norvegicus: as the elbow angle becomes more acute, manus supination increases. Our data also suggest that manus pronation and orientation in R. norvegicus rely on a divided system of labor between the ulna and radius. Given that the radius follows the flexion and extension trajectory of the ulna, it must rotate at the elbow (on the capitulum) so that during the stance phase its distal end lies medial to ulna, ensuring that the manus remains pronated while the forelimb is supporting the body. We suggest that forelimb posture and kinematics in Juramaia, Eomaia, and other basal eutherians were grossly similar to those of rats, and that humerus and radius LAR may have always played a significant role in forelimb and manus posture in small eutherian mammals.     

Phase-dependence of elbow muscle coactivation in front crawl swimming

Propulsion in swimming is achieved by complex sculling movements with elbow quasi-fixed on the antero-posterior axis to transmit forces from the hand and the forearm to the body. The purpose of this study was to investigate how elbow muscle coactivation was influenced by the front crawl stroke phases. Ten international level male swimmers performed a 200-m front crawl race-pace bout. Sagittal views were digitized frame by frame to determine the stroke phases (aquatic elbow flexion and extension, aerial elbow flexion and extension). Surface electromyograms (EMG) of the right biceps brachii and triceps brachii were recorded and processed using the integrated EMG to calculate a coactivation index (CI) for each phase. A significant effect of the phases on the CI was revealed with highest levels of coactivation during the aquatic elbow flexion and the aerial elbow extension. Swimmers stabilize the elbow joint to overcome drag during the aquatic phase, and act as a brake at the end of the recovery to replace the arm for the next stroke. The CI can provide insight into the magnitude of mechanical constraints supported by a given joint, in particular during a complex movement.     

How effective are added constraints in improving TKR kinematics?

Newer designs of total knee arthroplasty (TKA), through the use of added degrees of constraint, attempt to provide a "guided motion" to restore more normal and predictable kinematics. Two such design philosophies are the posterior stabilised (PS) using a cam-post and the medial pivot (MP) concepts. Knee kinematics of 12 patients with a PS TKA, 13 subjects with a MP TKA and 10 normal subjects were compared. For kinematic assessment, patients underwent fluoroscopic assessment of the knee during a step-up exercise and deep knee bend. Fluoroscopic images were corrected for distortion and assessed using 3D model fitting to determine relative 3D motion, and a 2D method to measure the patellar tendon angle (PTA) as function of knee flexion. For the PS design the cam-post mechanism engaged between 70 degrees and 100 degrees flexion. Between extension and 50 degrees there was forward motion of the contact points. Beyond 60 degrees both condyles rolled moved posteriorly. The majority of the external rotation of the femur occurred between 50 degrees and 80 degrees . The PTA was lower than normal in extension and higher than normal in flexion. The MP exhibited no anterior movement throughout the rage of motion. The medial condyle moved minimally. The lateral contact point moved posteriorly from extension to flexion. The femur rotated externally throughout the range of flexion analysed. The PTA was similar to normal from extension to mid flexion and then higher than normal beyond to high flexion. The PS design fails to fully restrain paradoxical anterior movement and although the cam engages, it does not contribute significantly to overall rollback. The MP knee does not show significant anterior movement, the medial pivot concept appears to achieve near normal kinematics from extension to 50 degrees of knee flexion. However, the results show that at high flexion this design does not achieve normal knee kinematics.     

In-vivo measurement of dynamic joint motion using high speed biplane radiography and CT: application to canine ACL deficiency

Dynamic assessment of three-dimensional (3D) skeletal kinematics is essential for understanding normal joint function as well as the effects of injury or disease. This paper presents a novel technique for measuring in-vivo skeletal kinematics that combines data collected from high-speed biplane radiography and static computed tomography (CT). The goals of the present study were to demonstrate that highly precise measurements can be obtained during dynamic movement studies employing high frame-rate biplane video-radiography, to develop a method for expressing joint kinematics in an anatomically relevant coordinate system and to demonstrate the application of this technique by calculating canine tibio-femoral kinematics during dynamic motion. The method consists of four components: the generation and acquisition of high frame rate biplane radiographs, identification and 3D tracking of implanted bone markers, CT-based coordinate system determination, and kinematic analysis routines for determining joint motion in anatomically based coordinates. Results from dynamic tracking of markers inserted in a phantom object showed the system bias was insignificant (-0.02 mm). The average precision in tracking implanted markers in-vivo was 0.064 mm for the distance between markers and 0.31 degree for the angles between markers. Across-trial standard deviations for tibio-femoral translations were similar for all three motion directions, averaging 0.14 mm (range 0.08 to 0.20 mm). Variability in tibio-femoral rotations was more dependent on rotation axis, with across-trial standard deviations averaging 1.71 degrees for flexion/extension, 0.90 degree for internal/external rotation, and 0.40 degree for varus/valgus rotation. Advantages of this technique over traditional motion analysis methods include the elimination of skin motion artifacts, improved tracking precision and the ability to present results in a consistent anatomical reference frame.     

Reproduction of tracking movements and target positioning of the forearm in humans in the absence of visual control

In 17 healthy volunteers, we studied movements of the forearm, which included episodes of positioning on the target level. The trajectory of the non-ballistic (relatively slow) movement looked like a double trapezium (flexion of the elbow joint from the state of full extension, 0 deg, positioning on the 50 deg level, further flexion to the limit angle of 100 deg, and a similar reverse sequence). The command trajectory and the trajectory of the realized movement were visualized with movements of cursors on a monitor in time/joint angle coordinates. We compared parameters of the tracking movements (in the presence of visual feedback) and their blindfold reproduction (with the complete absence of visual control). It was found that blindfold reproduction movements differ from sample tracking movements and their reproduction with partial limitation of visual control [16] in higher peak velocities and shorter durations, i.e., a trend toward conversion of such movements into ballistic ones was observed. Under conditions of elimination of visual control, movements that led to positioning were mostly hypermetric, i.e., positioning was usually accompanied by positive systematic errors (whose sign coincided with the direction of the preceding movement phase). The mean intragroup value of the systematic error of the first positioning (after flexion to the target level) was +6.73 ± 1.15 deg, while the respective mean for the second positioning (after extension to the same level) was +4.00 ± 1.31 deg. The nonlinear properties of stretch receptors of muscles whose activity provides the formation of a proprioceptive estimate of the joint angle are considered the crucial reason for systematic errors of blindfold positioning.Neirofiziologiya/Neurophysiology, Vol. 36, Nos. 5/6, pp. 393–404, September–December, 2004.This revised version was published online in April 2005 with a corrected cover date and copyright year.     

Cineradiographic study of forelimb movements during quadrupedal walking in the brown lemur (Eulemur fulvus, Primates: Lemuridae)

Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.     

The effect of tendon loading on in-vitro carpal kinematics of the wrist joint

Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on carpal kinematics in-vitro.A cyclic movement was imposed on 7 cadaveric forearms while the carpal kinematics were acquired by a 4-dimensional rotational X-ray imaging system. The extensor- and flexor tendons were loaded with constant force springs of 50 N, respectively. The measurements were repeated without a load on the tendons. The effect of loading on the kinematics was tested statistically by using a linear mixed model.During flexion and extension, the proximal carpal bones were more extended with tendon loading. The lunate was on the average 2.0° (p=0.012) more extended. With tendon loading the distal carpal bones were more ulnary deviated at each angle of wrist motion. The capitate was on the average 2.4° (p=0.004) more ulnary deviated.During radioulnar deviation, the proximal carpal bones were more radially deviated with the lunate 0.7° more into radial deviation with tendon loading (p<0.001). Conversely, the bones of distal row were more flexed and supinated with the capitate 1.5° more into flexion (p=0.025) and 1.0° more into supination (p=0.011).In conclusion, the application of a constant load onto the flexor and extensor tendons in cadaver experiments has a small but statistically significant effect on the carpal kinematics during flexion–extension and radioulnar deviation.     

Shoulder,elbow, and wrist joint angle excursions vary by gesture during touchscreen interaction

Repeated gesturing on touchscreen computing devices has become part of professional, personal, or school use by persons of all ages. Few studies have compared kinematics among joint motions and gestures during touchscreen interaction. We aimed to quantify the relative contributions of the shoulder, elbow and wrist to completion of several gestures to aid understanding of touchscreen ergonomics. Joint angles of the shoulder, elbow, and wrist were recorded for 22 seated participants while they interacted with a 10.1″ tablet computer held on an easel. Joint excursions at the shoulder, elbow, and wrist were all on average ≤20° during touchscreen interaction. The greatest excursion measured was shoulder rotation for swipe right with a mean of 15.5(±6.0)°. Index finger tap on a touchscreen was completed by participants with less than 5° of mean joint excursion at the shoulder, elbow and wrist. Tap, pinch and stretch gestures demonstrated significantly more wrist flexion/extension (p < 0.05) than shoulder flexion/extension, ab/adduction and rotation. Also, swipe left, right and up involved more shoulder rotation (p < 0.05) than wrist flexion/extension. These results suggest that when gestures are repeated frequently, the relative risk of overuse injury at the shoulder, elbow, or wrist may depend on the gesture being repeated.     

Effects of gleno-humeral joint centre mislocation on gleno-humeral kinematics and kinetics

The gleno-humeral (GH) rotation centre is typically estimated using predictive or functional methods, however these methods may lead to location errors. This study aimed at determining a location error threshold above which statistically significant changes in the values of kinematic and kinetic GH parameters occur. The secondary aims were to quantify the effects of the direction of mislocation (X, Y or Z axis) of the GH rotation centre on GH kinematic and kinetic parameters.

Shoulder flexion and abduction movements of 11 healthy volunteers were recorded using a standard motion capture system (Vicon, Oxford Metrics Ltd, Oxford, UK), then GH kinematic and kinetic parameters were computed. The true position of the GH rotation centre was determined using a low dose x-ray scanner (EOS? imaging, France) and this position was transferred to the motion data. GH angles and moments were re-computed for each position of the GH rotation centre after errors of up to ± 20?mm were added in increments of ± 5?mm to each axis. The three-dimensional error range was 5?mm to 34.65?mm.

GH joint angle and moment values were significantly altered from 10?mm of three-dimensional error, and from 5?mm of error on individual axes. However, errors on the longitudinal and antero-posterior axes only caused very small alterations of GH joint angle and moment values respectively. Future research should develop methods of GH rotation centre estimation that produce three-dimensional location errors of less than 10?mm to reduce error propagation on GH kinematics and kinetics.     

A reproducible method for studying three-dimensional knee kinematics

The methods used in movement analysis often rely on the definition of joint coordinate systems permitting three-dimensional (3D) kinematics. The first aim of this research project was to present a functional and postural method (FP method) to define a bone-embedded anatomical frame (BAF) on the femur and tibia, and, subsequently, a knee joint coordinate system. The repeatability of the proposed method was also assessed. Using FP method to define the BAFs, 4 kinematic parameters (flexion/extension, abduction/adduction, tibial internal/external rotation, and antero-posterior translation) were computed for 15 subjects walking on a treadmill. The repeatability for all four kinematic parameters was then assessed, using intra- and inter-observer settings. After pooling the results for all observers, the mean repeatability value ranged between 0.4 degrees and 0.8 degrees for rotation angles and between 0.8 and 2.2 mm for translation.     

Ambulatory measurement of 3D knee joint angle

Three-dimensional measurement of joint motion is a promising tool for clinical evaluation and therapeutic treatment comparisons. Although many devices exist for joints kinematics assessment, there is a need for a system that could be used in routine practice. Such a system should be accurate, ambulatory, and easy to use. The combination of gyroscopes and accelerometers (i.e., inertial measurement unit) has proven to be suitable for unrestrained measurement of orientation during a short period of time (i.e., few minutes). However, due to their inability to detect horizontal reference, inertial-based systems generally fail to measure differential orientation, a prerequisite for computing the three-dimentional knee joint angle recommended by the Internal Society of Biomechanics (ISB). A simple method based on a leg movement is proposed here to align two inertial measurement units fixed on the thigh and shank segments. Based on the combination of the former alignment and a fusion algorithm, the three-dimensional knee joint angle is measured and compared with a magnetic motion capture system during walking. The proposed system is suitable to measure the absolute knee flexion/extension and abduction/adduction angles with mean (SD) offset errors of -1 degree (1 degree ) and 0 degrees (0.6 degrees ) and mean (SD) root mean square (RMS) errors of 1.5 degrees (0.4 degrees ) and 1.7 degrees (0.5 degrees ). The system is also suitable for the relative measurement of knee internal/external rotation (mean (SD) offset error of 3.4 degrees (2.7 degrees )) with a mean (SD) RMS error of 1.6 degrees (0.5 degrees ). The method described in this paper can be easily adapted in order to measure other joint angular displacements such as elbow or ankle.     

Non-invasive assessment of soft-tissue artifact and its effect on knee joint kinematics during functional activity

The soft-tissue interface between skin-mounted markers and the underlying bones poses a major limitation to accurate, non-invasive measurement of joint kinematics. The aim of this study was twofold: first, to quantify lower limb soft-tissue artifact in young healthy subjects during functional activity; and second, to determine the effect of soft-tissue artifact on the calculation of knee joint kinematics. Subject-specific bone models generated from magnetic resonance imaging (MRI) were used in conjunction with X-ray images obtained from single-plane fluoroscopy to determine three-dimensional knee joint kinematics for four separate tasks: open-chain knee flexion, hip axial rotation, level walking, and a step-up. Knee joint kinematics was derived using the anatomical frames from the MRI-based, 3D bone models together with the data from video motion capture and X-ray fluoroscopy. Soft-tissue artifact was defined as the degree of movement of each marker in the anteroposterior, proximodistal and mediolateral directions of the corresponding anatomical frame. A number of different skin-marker clusters (total of 180) were used to calculate knee joint rotations, and the results were compared against those obtained from fluoroscopy. Although a consistent pattern of soft-tissue artifact was found for each task across all subjects, the magnitudes of soft-tissue artifact were subject-, task- and location-dependent. Soft-tissue artifact for the thigh markers was substantially greater than that for the shank markers. Markers positioned in the vicinity of the knee joint showed considerable movement, with root mean square errors as high as 29.3 mm. The maximum root mean square errors for calculating knee joint rotations occurred for the open-chain knee flexion task and were 24.3°, 17.8° and 14.5° for flexion, internal–external rotation and abduction–adduction, respectively. The present results on soft-tissue artifact, based on fluoroscopic measurements in healthy adult subjects, may be helpful in developing location- and direction-specific weighting factors for use in global optimization algorithms aimed at minimizing the effects of soft-tissue artifact on calculations of knee joint rotations.