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The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity

The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity
The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity
The assessment of knee joint laxity is clinically important but its quantification remains elusive. Calibrated, low dosage fluoroscopy, combined with registered surfaces and controlled external loading may offer possible solutions for quantifying relative tibio-femoral motion without soft tissue artefact, even in native joints. The aim of this study was to determine the accuracy of registration using CT and MRI derived 3D bone models, as well as metallic implants, to 2D single-plane fluoroscopic datasets, to assess their suitability for examining knee joint laxity. Four cadaveric knees and one knee implant were positioned using a micromanipulator. After fluoroscopy, the accuracy of registering each surface to the 2D fluoroscopic images was determined by comparison against known translations from the micromanipulator measurements. Dynamic measurements were also performed to assess the relative tibio-femoral error. For CT and MRI derived 3D femur and tibia models during static testing, the in-plane error was 0.4 mm and 0.9 mm, and out-of-plane error 2.6 mm and 9.3 mm respectively. For metallic implants, the in-plane error was 0.2 mm and out-of-plane error 1.5 mm. The relative tibio-femoral error during dynamic measurements was 0.9 mm, 1.2 mm and 0.7 mm in-plane, and 3.9 mm, 10.4 mm and 2.5 mm out-of-plane for CT and MRI based models and metallic implants respectively. The rotational errors ranged from 0.5° to 1.9° for CT, 0.5–4.3° for MRI and 0.1–0.8° for metallic implants. The results of this study indicate that single-plane fluoroscopic analysis can provide accurate information in the investigation of knee joint laxity, but should be limited to static or quasi-static evaluations when assessing native bones, where possible. With this knowledge of registration accuracy, targeted approaches for the determination of tibio-femoral laxity could now determine objective in vivo measures for the identification of ligament reconstruction candidates as well as improve our understanding of the consequences of knee joint instability in TKA.
knee, fluoroscopy, laxity, ct, mri, model registration
1350-4533
1427-1432
Moewis, P.
9e97e918-0605-4ad5-a760-e296ed40cde4
Wolterbeek, N.
6b95c1a0-cfd0-4d35-b5b8-3b1e58005028
Diederichs, G.
70ab0ad5-845f-4938-bb3e-e6650fae1ba5
Valstar, E.
7db53a4b-9b83-48ec-a864-ba1ffbbef501
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77
Moewis, P.
9e97e918-0605-4ad5-a760-e296ed40cde4
Wolterbeek, N.
6b95c1a0-cfd0-4d35-b5b8-3b1e58005028
Diederichs, G.
70ab0ad5-845f-4938-bb3e-e6650fae1ba5
Valstar, E.
7db53a4b-9b83-48ec-a864-ba1ffbbef501
Heller, M.O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Taylor, W.R.
4f1cd2b0-4963-4b10-bbde-da586c069e77

Moewis, P., Wolterbeek, N., Diederichs, G., Valstar, E., Heller, M.O. and Taylor, W.R. (2012) The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity. Medical Engineering & Physics, 34 (10), 1427-1432. (doi:10.1016/j.medengphy.2012.01.007,). (PMID:22342557)

Record type: Article

Abstract

The assessment of knee joint laxity is clinically important but its quantification remains elusive. Calibrated, low dosage fluoroscopy, combined with registered surfaces and controlled external loading may offer possible solutions for quantifying relative tibio-femoral motion without soft tissue artefact, even in native joints. The aim of this study was to determine the accuracy of registration using CT and MRI derived 3D bone models, as well as metallic implants, to 2D single-plane fluoroscopic datasets, to assess their suitability for examining knee joint laxity. Four cadaveric knees and one knee implant were positioned using a micromanipulator. After fluoroscopy, the accuracy of registering each surface to the 2D fluoroscopic images was determined by comparison against known translations from the micromanipulator measurements. Dynamic measurements were also performed to assess the relative tibio-femoral error. For CT and MRI derived 3D femur and tibia models during static testing, the in-plane error was 0.4 mm and 0.9 mm, and out-of-plane error 2.6 mm and 9.3 mm respectively. For metallic implants, the in-plane error was 0.2 mm and out-of-plane error 1.5 mm. The relative tibio-femoral error during dynamic measurements was 0.9 mm, 1.2 mm and 0.7 mm in-plane, and 3.9 mm, 10.4 mm and 2.5 mm out-of-plane for CT and MRI based models and metallic implants respectively. The rotational errors ranged from 0.5° to 1.9° for CT, 0.5–4.3° for MRI and 0.1–0.8° for metallic implants. The results of this study indicate that single-plane fluoroscopic analysis can provide accurate information in the investigation of knee joint laxity, but should be limited to static or quasi-static evaluations when assessing native bones, where possible. With this knowledge of registration accuracy, targeted approaches for the determination of tibio-femoral laxity could now determine objective in vivo measures for the identification of ligament reconstruction candidates as well as improve our understanding of the consequences of knee joint instability in TKA.

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More information

Published date: December 2012
Keywords: knee, fluoroscopy, laxity, ct, mri, model registration
Organisations: Bioengineering Group

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Local EPrints ID: 348537
URI: https://eprints.soton.ac.uk/id/eprint/348537
ISSN: 1350-4533
PURE UUID: 5b50892f-41dc-4ea8-9c38-75d11d80827d
ORCID for M.O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 15 Feb 2013 09:42
Last modified: 20 Jul 2019 00:41

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Contributors

Author: P. Moewis
Author: N. Wolterbeek
Author: G. Diederichs
Author: E. Valstar
Author: M.O. Heller ORCID iD
Author: W.R. Taylor

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