The evaluation of the distance between popliteus tendon or LCL footprint and the implant of the TKA using 3D template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Lower Limb ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Lower Limbs ◽  
Popliteus Tendon ◽  
Femoral Bone ◽  
Bone Resection ◽  
Total Knee ◽  
Ct Data ◽  
Formalin Fixed

Abstract Background When the surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injury are worried because those femoral footprints are relatively close to the bone resection lesion. The purpose of this study was to evaluate the distance between PT or LCL footprint and TKA implant using the three-dimensional (3D) template system.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used. All the surrounded soft tissue except the PT and knee ligaments were removed from the limb. Careful dissection of the PT and LCL was performed, and those femoral footprints were detected. Each footprint was periphery marked with a K-wire. CT scanning of the whole lower limb was then performed. The CT data was analyzed with 3D template system. Simulated models of TKA were Journey II BCS and Persona PS. The area of each footprint, and the length between most distal or posterior point of femur and the edge of each footprint were measured. When the implant model was matched to the CT image, the shortest length between each footprint and the bone resection were evaluated.Results The area of PT and LCL footprint were, 38.7±17.7mm 2 , and 58±24.6mm 2 , respectively. The length between most distal or posterior point of femur and the edge of the PT footprint were 10.3±2.4mm, and 14.2±2.8mm, respectively. The length between most distal or posterior point of femur and the edge of the LCL footprint were 16.3±2.3mm, and 15.5±3.3mm, respectively. When simulated the TKA, the shortest length between PT footprint and bone resection lesion of Journey II BCS and Persona PS were, 4.3±2.5mm, and 3.2±2.9mm, respectively. The shortest length between PT footprint and bone resection lesion of Journey II BCS and Persona PS were, 7.2±2.3mm, and 5.6±2.1mm, respectively. PT footprint was suffered by the bone resection of Journey II BCS TKA in 3 knees, and also by the Persona PS’s bone resection in 9 knees.Conclusion The PT and LCL femoral footprint existed close to the femoral bone resection lesion of the TKA. Careful attention is needed not to injure the PT and LCL in the surgical procedures.

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Femoral Bone ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Total Knee ◽  
Resection Area

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Simulation Models ◽  
Ct Scanning ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Resection Area

Abstract Background When surgeons perform TKA, popliteus tendon (PT) and lateral collateral ligament (LCL) iatrogenic injuries are a risk because the femoral attachments are relatively close to the bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model. Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used. All the surrounding soft tissue except the PT, ligaments and meniscus were removed from the knee. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a K-wire. CT scanning was then performed. The data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image, the shortest length between each footprint and the osteotomy area were calculated. Results The area of the PT and LCL footprints was 38.7±17.7mm 2 and 58.0±24.6mm 2 . The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm. The length between these same points and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm. Under TKA simulation, for the Journey II BCS and the Persona PS, the shortest length between the PT footprint and the osteotomy area was 4.3±2.5mm and 3.2±2.9mm, and the shortest length between the LCL footprint and the osteotomy area was 7.2±2.3mm and 5.6±2.1mm. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knee. Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. Careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

scholarly journals Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty

2017 ◽  
Vol 03 (03) ◽  
pp. e110-e112
Author(s):  
Benjamin Rossi ◽  
Narlaka Jayasekera ◽  
Fionnuala Kelly ◽  
Keith Eyres
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Recovery ◽  
Patient Perception ◽  
Femoral Bone ◽  
Bone Resection ◽  
Orthopaedic Literature ◽  
Total Knee ◽  
A Prospective Study ◽  
Revision Tka

AbstractThe aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even ‘well-informed’ patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.

Kinematics Simulation Analysis of a Kind of Pedal Rehabilitation Robot

2014 ◽  
Vol 602-605 ◽  
pp. 848-852
Author(s):  
Wen Long Wang ◽  
Ji Rong Wang
Keyword(s):  
Lower Limb ◽  
Simulation Analysis ◽  
Three Dimensional ◽  
Lower Limbs ◽  
Rehabilitation Robot ◽  
Movement Trajectory ◽  
Three Dimensional Model ◽  
Kinematics Simulation ◽  
Limb Rehabilitation ◽  
Lower Limb Rehabilitation

This paper describes the design of the gait mechanism of pedal lower limb rehabilitation robot based on people’s heel movement trajectory curve in the normal walking. It is established the kinematics mathematical model of a pedal lower limbs rehabilitation robot and the simplified three-dimensional model with Pro/e software, then it is simulated kinematics using ADAMS software. The simulation result is shown that this pedal lower limbs rehabilitation robot can achieve the expected rehabilitation exercise and run smoothly. Kinematics analysis and simulation of pedal rehabilitation robot is provided the necessary theoretical basis and parameters for the study of lower limb rehabilitation machinery.

scholarly journals CONTRACTION OF THE TENSOR FASCIAE LATAE MUSCLE OF THE FASCIA OF THE BROAD THIGH AND FLEXION OF THE KNEE JOINT IN THE RUNNERS

2019 ◽  
Vol 72 (3) ◽  
pp. 318-322
Author(s):  
Rafał Słoniak ◽  
Tomasz Tittinger ◽  
Damian Szczepański ◽  
Tadeusz Szymon Gaździk ◽  
Małgorzata Kulesa-Mrowiecka ◽  
...  
Keyword(s):  
Knee Joint ◽  
Lower Limb ◽  
Mixed Type ◽  
Three Dimensional ◽  
Lower Limbs ◽  
Study Group ◽  
Hip Joints ◽  
Exclusion Criteria ◽  
Post Traumatic ◽  
Tensor Fasciae Latae

Introduction: The illustration of the ranges of bending the limb during the outflow allowed to divide the study group into two parts. In the majority of respondents, the initial flexion prevailed over the final one. The researchers focused on finding the reasons for the advantage of the final bend over the initial one in 30% of the subjects. The aim: The analysis of the dynamic stride under the control of the MVN Biomech system in the bending of the knee joint of the lateral limb, comparing the preparation to the leg (initial bending) and its ending (final) Materials and Methods: 18 right-handed 25 to 35 year old runners were selected after the following exclusion criteria were applied: polyarticular hypermobility, systemic diseases, Rheumatoid arthritis, osteoarthritis, post-traumatic instability. The MVN Biomech system assessed the three-dimensional movements of the joints of the free part of the lower limb and pelvis, and the flexibility of the muscles was subject to physiotherapeutic assessment. Results: In 55% of respondents dominated the pattern in which the initial flexion exceeded by min. 10⁰ final bend in both limbs (decreasing type). The researchers focused on finding the reasons for the smaller difference or the advantage of the final bending on both sides in 30% of respondents (mixed type). The comparison of physiotherapeutic examination results and measurements of MVN Biomech showed functional contractures of the tensor fasciae latea muscles in 5 subjects with a mixed type (83% of subjects with a mixed type). Conclusions: Contraction of the tensor fasciae latae constrained the initial flexion of the knee joint of the lateral limb, and also increased bilateral visitation of the hip joints during the dynamic mixed-type twitch. The remaining muscles of the lower limbs show no statistically significant differences in elasticity compared to the type of the leg.

Optimal Combination of Minimum Degrees of Freedom to be Actuated in the Lower Limbs to Facilitate Arm-Free Paraplegic Standing

2007 ◽  
Vol 129 (6) ◽  
pp. 838-847 ◽  
Author(s):  
Joon-young Kim ◽  
James K. Mills ◽  
Albert H. Vette ◽  
Milos R. Popovic
Keyword(s):  
Lower Limb ◽  
Degrees Of Freedom ◽  
Three Dimensional ◽  
Optimal Combination ◽  
Lower Limbs ◽  
Free Standing ◽  
Joint Torques ◽  
Flexion Extension ◽  
Hip Abduction ◽  
The Individual

Arm-free paraplegic standing via functional electrical stimulation (FES) has drawn much attention in the biomechanical field as it might allow a paraplegic to stand and simultaneously use both arms to perform daily activities. However, current FES systems for standing require that the individual actively regulates balance using one or both arms, thus limiting the practical use of these systems. The purpose of the present study was to show that actuating only six out of 12 degrees of freedom (12-DOFs) in the lower limbs to allow paraplegics to stand freely is theoretically feasible with respect to multibody stability and physiological torque limitations of the lower limb DOF. Specifically, the goal was to determine the optimal combination of the minimum DOF that can be realistically actuated using FES while ensuring stability and able-bodied kinematics during perturbed arm-free standing. The human body was represented by a three-dimensional dynamics model with 12-DOFs in the lower limbs. Nakamura’s method (Nakamura, Y., and Ghodoussi, U., 1989, “Dynamics Computation of Closed-Link Robot Mechanisms With Nonredundant and Redundant Actuators,” IEEE Trans. Rob. Autom., 5(3), pp. 294–302) was applied to estimate the joint torques of the system using experimental motion data from four healthy subjects. The torques were estimated by applying our previous finding that only 6 (6-DOFs) out of 12-DOFs in the lower limbs need to be actuated to facilitate stable standing. Furthermore, it was shown that six cases of 6-DOFs exist, which facilitate stable standing. In order to characterize each of these cases in terms of the torque generation patterns and to identify a potential optimal 6-DOF combination, the joint torques during perturbations in eight different directions were estimated for all six cases of 6-DOFs. The results suggest that the actuation of both ankle flexion∕extension, both knee flexion∕extension, one hip flexion∕extension, and one hip abduction∕adduction DOF will result in the minimum torque requirements to regulate balance during perturbed standing. To facilitate unsupported FES-assisted standing, it is sufficient to actuate only 6-DOFs. An optimal combination of 6-DOFs exists, for which this system can generate able-bodied kinematics while requiring lower limb joint torques that are producible using contemporary FES technology. These findings suggest that FES-assisted arm-free standing of paraplegics is theoretically feasible, even when limited by the fact that muscles actuating specific DOFs are often denervated or difficult to access.

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery

2019 ◽  
Author(s):  
James D. Sires ◽  
Johnathan D. Craik ◽  
Christopher J. Wilson
Keyword(s):  
Polyethylene Wear ◽  
Three Dimensional ◽  
Revision Arthroplasty ◽  
Absolute Difference ◽  
Future Research ◽  
Coronal Alignment ◽  
Bone Resection ◽  
Total Knee ◽  
The Difference ◽  
Preoperative Plan

AbstractAccurate component positioning and planning is vital to prevent malalignment of total knee arthroplasty (TKA) as malalignment is associated with an increased rate of polyethylene wear and revision arthroplasty. The MAKO total knee robotic arm-assisted surgery (Stryker, Kalamazoo, MI) uses a preoperative computed tomography scan of the patient's knee and three-dimensional planning to size and orientate implants prior to bone resection. The aim of this study was to determine the accuracy of the MAKO Total Knee system in achieving the preoperative plan for bone resection and final limb coronal alignment. A series of 45 consecutive cases was performed using the MAKO Total Knee system and Triathlon Total Knee implant (Stryker) between April 2018 and May 2019. The difference between what was planned and what was achieved for bone resection and coronal limb alignment was calculated. A total of 37 patients had their data captured using the MAKO system software. Mean difference from the plan for distal femoral cuts was 0.38mm (0.32) deep/proud, anterior femoral cuts 0.44mm (0.27) deep/proud and tibial cuts 0.37mm (0.30) deep/proud. In total, 99 out of 105 (94.29%) of bone resections were within 1mm of the plan. Mean absolute difference in final limb coronal alignment was 0.78° (0.78), with 78.13% being ≤1.00° of the plan, and 100% being ≤3.00° of the plan. The accuracy in achieving preoperatively planned bone resection and final limb coronal alignment using the MAKO Total Knee system is high. Future research is planned to look at whether this is associated with decreased rates of polyethylene wear and revision arthroplasty.

scholarly journals Vascular 3D Printing with a Novel Biological Tissue Mimicking Resin for Patient-Specific Procedure Simulations in Interventional Radiology: a Feasibility Study

2022 ◽  
Author(s):  
R. Kaufmann ◽  
C. J. Zech ◽  
M. Takes ◽  
P. Brantner ◽  
F. Thieringer ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
3D Printing ◽  
Biological Tissue ◽  
Vascular System ◽  
Three Dimensional ◽  
Case Series ◽  
Ct Scanning ◽  
Patient Specific ◽  
Specific Procedure ◽  
Ct Data

AbstractThree-dimensional (3D) printing of vascular structures is of special interest for procedure simulations in Interventional Radiology, but remains due to the complexity of the vascular system and the lack of biological tissue mimicking 3D printing materials a technical challenge. In this study, the technical feasibility, accuracy, and usability of a recently introduced silicone-like resin were evaluated for endovascular procedure simulations and technically compared to a commonly used standard clear resin. Fifty-four vascular models based on twenty-seven consecutive embolization cases were fabricated from preinterventional CT scans and each model was checked for printing success and accuracy by CT-scanning and digital comparison to its original CT data. Median deltas (Δ) of luminal diameters were 0.35 mm for clear and 0.32 mm for flexible resin (216 measurements in total) with no significant differences (p > 0.05). Printing success was 85.2% for standard clear and 81.5% for the novel flexible resin. In conclusion, vascular 3D printing with silicone-like flexible resin was technically feasible and highly accurate. This is the first and largest consecutive case series of 3D-printed embolizations with a novel biological tissue mimicking material and is a promising next step in patient-specific procedure simulations in Interventional Radiology.

scholarly journals Visualization of walking speed variation-induced synchronized dynamic changes in lower limb joint angles and activity of trunk and lower limb muscles with a newly developed gait analysis system

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880668 ◽  
Author(s):  
Kousei Miura ◽  
Hideki Kadone ◽  
Masao Koda ◽  
Keita Nakayama ◽  
Hiroshi Kumagai ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Hip Joint ◽  
Lower Limb ◽  
Three Dimensional ◽  
Lower Limbs ◽  
Joint Angles ◽  
Dynamic Changes ◽  
Maximum Flexion ◽  
Lower Limb Muscles ◽  
Limb Muscles

Purpose: To evaluate a newly developed system for dynamic analysis of gait kinematics and muscle activity. Methods: We recruited 10 healthy men into this study. Analyses of three-dimensional motion and wireless surface electromyogram (EMG) were integrated to achieve synchronous measurement. The participants walked continuously for 10 min under two conditions: comfortable and quick pace. Outcome measures were joint angles of the lower limbs determined from reflective markers and myoelectric activity of trunk and lower limbs determined from EMG sensors, comparing comfortable and quick gait pace. Results: Lower limb joint angle was significantly greater at the quick pace (maximum flexion of the hip joint: 4.1°, maximum extension of hip joint: 2.3°, and maximum flexion of the knee joint while standing: 7.4°). The period of maximum flexion of the ankle joint during a walking cycle was 2.5% longer at a quick pace. EMG amplitudes of all trunk muscles significantly increased during the period of support by two legs (cervical paraspinal: 55.1%, latissimus dorsi: 31.3%, and erector spinae: 32.6%). EMG amplitudes of quadriceps, femoral biceps, and tibialis anterior increased significantly by 223%, 60.9%, and 67.4%, respectively, between the periods of heel contact and loading response. EMG amplitude of the gastrocnemius significantly increased by 102% during the heel-off period. Conclusion: Our gait analysis synchronizing three-dimensional motion and wireless surface EMG successfully visualized dynamic changes in lower limb joint angles and activity of trunk and lower limb muscles induced by various walking speeds.

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