Reliability of Tibiofemoral Contact Area and Centroid Location in an Upright, Open MRI (UO-MRI)

Abstract Background: In biomechanical studies using conventional closed-bore MR, imaging cannot be performed during natural weightbearing which has necessitated simulating weightbearing load on the joint. Upright, open MRI (UO-MRI) allows for joint imaging during natural weightbearing and may have the potential to better characterize the biomechanical effect of tibiofemoral pathology involving soft tissues. However open MRI scanners have lower field strengths than closed-bore scanners, which limits the image quality that can be obtained. Thus, there is a need to establish the reliability of measurements in upright weightbearing postures obtained via the UO-MRI.Methods: Manual segmentation of cartilage regions in contact from participants with prior anterior cruciate ligament (ACL) rupture was performed and centroids of those contact areas were automatically determined for the medial (MC) and lateral (LC) tibiofemoral compartments. To assess reliability, inter-rater, test-retest, and intra-rater reliability were determined by intra-class correlation (ICC3,1), standard error of measurement (SEM), smallest detectable change with 95% confidence (SDC95). Accuracy was assessed by using a high-resolution, 7T MRI as a reference and determined by mean absolute error (MAE).Results: Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the MC demonstrated ICC3,1 values from 0.95-0.99 and 0.98-0.99 respectively, and in the LC from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the MC and 0.95% in the LC. Contact area and centroid location reliability for coronal scans in the MC demonstrated ICC3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the LC from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the MC and 1.41% in the LC. Contact area segmentation was accurate to within a MAE of 11.0 mm2.Conclusions: Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

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Reliability of tibiofemoral contact area and centroid location in upright, open MRI

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03786-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Andrew M. Schmidt ◽

David J. Stockton ◽

Michael A. Hunt ◽

Andrew Yung ◽

Bassam A. Masri ◽

...

Keyword(s):

Contact Area ◽

Soft Tissues ◽

Cruciate Ligament ◽

Lateral Compartment ◽

Medial Compartment ◽

Detectable Change ◽

Lower Field ◽

Open Mri ◽

Smallest Detectable Change ◽

Centroid Location

Abstract Background Imaging cannot be performed during natural weightbearing in biomechanical studies using conventional closed-bore MRI, which has necessitated simulating weightbearing load on the joint. Upright, open MRI (UO-MRI) allows for joint imaging during natural weightbearing and may have the potential to better characterize the biomechanical effect of tibiofemoral pathology involving soft tissues. However open MRI scanners have lower field strengths than closed-bore scanners, which limits the image quality that can be obtained. Thus, there is a need to establish the reliability of measurements in upright weightbearing postures obtained using UO-MRI. Methods Knees of five participants with prior anterior cruciate ligament (ACL) rupture were scanned standing in a 0.5 T upright open MRI scanner using a 3D DESS sequence. Manual segmentation of cartilage regions in contact was performed and centroids of these contact areas were automatically determined for the medial and lateral tibiofemoral compartments. Inter-rater, test-retest, and intra-rater reliability were determined and quantified using intra-class correlation (ICC3,1), standard error of measurement (SEM), and smallest detectable change with 95% confidence (SDC95). Accuracy was assessed by using a high-resolution 7 T MRI as a reference. Results Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the medial compartment had ICC3,1 values from 0.95–0.99 and 0.98–0.99 respectively. In the lateral compartment, contact area and centroid location reliability ICC3,1 values ranged from 0.83–0.91 and 0.95–1.00 respectively. The smallest detectable change in contact area was 1.28% in the medial compartment and 0.95% in the lateral compartment. Contact area and centroid location reliability for coronal scans in the medial compartment had ICC3,1 values from 0.90–0.98 and 0.98–1.00 respectively, and in the lateral compartment ICC3,1 ranged from 0.76–0.94 and 0.93–1.00 respectively. The smallest detectable change in contact area was 0.65% in the medial compartment and 1.41% in the lateral compartment. Contact area was accurate to within a mean absolute error of 11.0 mm2. Conclusions Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

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Reliability of Tibiofemoral Contact Area and Centroid Location in Upright, Open MRI

10.21203/rs.2.22418/v4 ◽

2020 ◽

Author(s):

Andrew Schmidt ◽

David J. Stockton ◽

Michael A. Hunt ◽

Andrew Yung ◽

Bassam A. Masri ◽

...

Keyword(s):

Contact Area ◽

Soft Tissues ◽

Cruciate Ligament ◽

Lateral Compartment ◽

Medial Compartment ◽

Detectable Change ◽

Lower Field ◽

Open Mri ◽

Smallest Detectable Change ◽

Centroid Location

Abstract Background:Imaging cannot be performed during natural weightbearing in biomechanical studies using conventional closed-bore MRI, which has necessitated simulating weightbearing load on the joint. Upright, open MRI (UO-MRI) allows for joint imaging during natural weightbearing and may have the potential to better characterize the biomechanical effect of tibiofemoral pathology involving soft tissues. However open MRI scanners have lower field strengths than closed-bore scanners, which limits the image quality that can be obtained. Thus, there is a need to establish the reliability of measurements in upright weightbearing postures obtained using UO-MRI.Methods:Knees of five participants with prior anterior cruciate ligament (ACL) rupture were scanned standing in a 0.5T upright open MRI scanner using a 3D DESS sequence. Manual segmentation of cartilage regions in contact was performed and centroids of these contact areas were automatically determined for the medial and lateral tibiofemoral compartments. Inter-rater, test-retest, and intra-rater reliability were determined and quantified using intra-class correlation (ICC3,1), standard error of measurement (SEM), and smallest detectable change with 95% confidence (SDC95). Accuracy was assessed by using a high-resolution 7T MRI as a reference.Results:Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the medial compartment had ICC3,1 values from 0.95-0.99 and 0.98-0.99 respectively. In the lateral compartment, contact area and centroid location reliability ICC3,1 values ranged from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the medial compartment and 0.95% in the lateral compartment. Contact area and centroid location reliability for coronal scans in the medial compartment had ICC3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the lateral compartment ICC3,1 ranged from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the medial compartment and 1.41% in the lateral compartment. Contact area was accurate to within a mean absolute error of 11.0 mm2.Conclusions:Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

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Reliability of Tibiofemoral Contact Area and Centroid Location in an Upright, Open MRI (UO-MRI)

10.21203/rs.2.22418/v2 ◽

2020 ◽

Author(s):

Andrew Schmidt ◽

David J. Stockton ◽

Michael A. Hunt ◽

Andrew Yung ◽

Bassam A. Masri ◽

...

Keyword(s):

Measurement Error ◽

Contact Area ◽

Joint Mechanics ◽

Detectable Change ◽

Intra Class Correlation ◽

Open Mri ◽

Smallest Detectable Change ◽

Knee Joint Mechanics ◽

Standard Error Of Measurement ◽

Centroid Location

Abstract Background: Biomechanical studies are often performed using conventional closed-bore MR, which has necessitated simulating weightbearing load on the joint. The clinical applicability of these biomechanical findings is unclear because of the limitations of simulating weightbearing. Upright, open MRI (UO-MRI) can be used to assess knee joint mechanics, in particular contact area and centroid location. However, it is not clear how reliably measurements of contact area and centroid location can be made in upright weightbearing postures. Methods: Manual segmentation of cartilage regions in contact was performed and centroids of those contact areas were automatically determined for the medial (MC) and lateral (LC) tibiofemoral compartments. To assess reliability, inter-rater, test-retest, and intra-rater reliability were determined by intra-class correlation (ICC 3,1 ), standard error of measurement (SEM), smallest detectable change with 95% confidence (SDC 95 ). Accuracy was assessed by using a high-resolution, 7T MRI as a reference and determined by measurement error (%). Results: Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the MC demonstrated ICC 3,1 values from 0.95-0.99 and 0.98-0.99 respectively, and in the LC from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the MC and 0.95% in the LC. Contact area and centroid location reliability for coronal scans in the MC demonstrated ICC 3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the LC from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the MC and 1.41% in the LC. Contact area segmentation was accurate to within 4.81% measurement error. Conclusions: Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability and accuracy within 5%. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

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Reliability of Tibiofemoral Contact Area and Centroid Location in an Upright, Open MRI (UO-MRI)

10.21203/rs.2.22418/v1 ◽

2020 ◽

Author(s):

Andrew Schmidt ◽

David J. Stockton ◽

Michael A. Hunt ◽

Andrew Yung ◽

Bassam A. Masri ◽

...

Keyword(s):

Measurement Error ◽

Contact Area ◽

Joint Mechanics ◽

Detectable Change ◽

Intra Class Correlation ◽

Open Mri ◽

Smallest Detectable Change ◽

Knee Joint Mechanics ◽

Standard Error Of Measurement ◽

Centroid Location

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Tibiofemoral contact and alignment in patients with anterior cruciate ligament rupture treated nonoperatively versus reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.103b9.bjj-2020-1955.r1 ◽

2021 ◽

Vol 103-B (9) ◽

pp. 1505-1513

Author(s):

David J. Stockton ◽

Andrew M. Schmidt ◽

Andrew Yung ◽

Jane Desrochers ◽

Honglin Zhang ◽

...

Keyword(s):

Acl Reconstruction ◽

Contact Area ◽

Cruciate Ligament ◽

Acl Injury ◽

Acl Rupture ◽

Healthy Controls ◽

The Mean ◽

Anterior Cruciate ◽

Time Since Injury ◽

Centroid Location

Aims Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters. Methods An upright, open MRI was used to directly measure tibiofemoral contact area, centroid location, and alignment in 18 individuals with unilateral ACL rupture within the last five years. Eight participants had been treated nonoperatively and ten had ACL reconstruction performed within one year of injury. All participants were high-functioning and had returned to sport or recreational activities. Healthy contralateral knees served as controls. Participants were imaged in a standing posture with knees fully extended. Results Participants’ mean age was 28.4 years (SD 7.3), the mean time since injury was 2.7 years (SD 1.6), and the mean International Knee Documentation Subjective Knee Form score was 84.4 (SD 13.5). ACL injury was associated with a 10% increase (p = 0.001) in contact area, controlling for compartment, sex, posture, age, body mass, and time since injury. ACL injury was associated with a 5.2% more posteriorly translated medial centroid (p = 0.001), equivalent to a 2.6 mm posterior translation on a representative tibia with mean posteroanterior width of 49.4 mm. Relative to the femur, the tibiae of ACL ruptured knees were 2.3 mm more anteriorly translated (p = 0.003) and 2.6° less externally rotated (p = 0.010) than healthy controls. ACL reconstruction was not associated with an improvement in any measure. Conclusion ACL rupture was associated with an increased contact area, posteriorly translated medial centroid, anterior tibial translation, and reduced tibial external rotation in full extension. These changes were present 2.7 years post-injury regardless of ACL reconstruction status. Cite this article: Bone Joint J 2021;103-B(9):1505–1513.

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Anterior Cruciate Ligament Reconstruction Affects Tibiofemoral Joint Congruency During Dynamic Functional Movement

The American Journal of Sports Medicine ◽

10.1177/0363546518764675 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1566-1574 ◽

Cited By ~ 4

Author(s):

Kanto Nagai ◽

Tom Gale ◽

James J. Irrgang ◽

Scott Tashman ◽

Freddie H. Fu ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Subchondral Bone ◽

Contact Area ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Lateral Compartment ◽

Patient Specific ◽

Cruciate Ligament Reconstruction ◽

Joint Congruency ◽

Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) has been shown to alter kinematics, which may influence dynamic tibiofemoral joint congruency (a measure of how well the bone surfaces fit together). This may lead to abnormal loading of cartilage and joint degeneration. However, joint congruency after ACLR has never been investigated. Hypotheses: The ACLR knee will be more congruent than the contralateral uninjured knee, and dynamic congruency will increase over time after ACLR. Side-to-side differences (SSD) in dynamic congruency will be related to cartilage contact location/area and subchondral bone curvatures. Study Design: Descriptive laboratory study. Methods: The authors examined 43 patients who underwent unilateral ACLR. At 6 months and 24 months after ACLR, patients performed downhill running on a treadmill while synchronized biplane radiographs were acquired at 150 images per second. Dynamic tibiofemoral kinematic values were determined by use of a validated volumetric model-based tracking process that matched patient-specific bone models, obtained from computed tomography, to biplane radiographs. Patient-specific cartilage models, obtained from magnetic resonance imaging, were registered to tracked bone models and used to calculate dynamic cartilage contact regions. Principle curvatures of the subchondral bone surfaces under each cartilage contact area were calculated to determine joint congruency. Repeated-measures analysis of variance was used to test the differences. Multiple linear regression was used to identify associations between SSD in congruency index, cartilage contact area, contact location, and global curvatures of femoral or tibial subchondral bone. Results: Lateral compartment congruency in the ACLR knee was greater than in the contralateral knee ( P < .001 at 6 months and P = .010 at 24 months). From 6 to 24 months after surgery, dynamic congruency decreased in the medial compartment ( P = .002) and increased in the lateral compartment ( P = .007) in the ACLR knee. In the lateral compartment, SSD in joint congruency was related to contact location and femur global curvature, and in the medial compartment, SSD in joint congruency was related to contact area. Conclusion: ACLR appears to affect dynamic joint congruency. SSD in joint congruency was associated with changes in contact location, contact area, and femoral bony curvature. Clinical Relevance: Alterations in tibiofemoral contact location, contact area, and bone shape affect dynamic joint congruency, potentially contributing to long-term degeneration after ACLR.

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The Irreducible Knee Dislocation

The Journal of Knee Surgery ◽

10.1055/s-0039-1698749 ◽

2019 ◽

Vol 33 (04) ◽

pp. 328-334

Author(s):

Shahbaz S. Malik ◽

Peter B. MacDonald

Keyword(s):

Soft Tissues ◽

Case Reports ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Knee Dislocation ◽

Small Subset ◽

Ligament Injuries ◽

Small Series ◽

Anterior Cruciate ◽

Knee Dislocations

AbstractIrreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is posterolateral, which can be challenging to diagnose both clinically and on plain radiographs. Vascular injury is uncommon and closed reduction is seldom possible due to medial femoral condyle buttonholing through soft tissues requiring open or arthroscopic reduction. Ligament injuries mostly include medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Literature has numerous case reports with a couple of small series giving short- to mid-term outcomes of posterolateral knee dislocations. There is, however, no consensus on management of ligament injuries with case reports showing good outcomes in early or delayed ligament reconstruction. This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations.

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A Comparative Study of the Length Patterns of Anterior Cruciate Ligament Reconstructions in the Dog and Man

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632634 ◽

2000 ◽

Vol 13 (02) ◽

pp. 73-77 ◽

Cited By ~ 7

Author(s):

J. T. Andrish ◽

M. L. Olmstead ◽

Helen Kambic ◽

A. Shah ◽

M. P. Palmisano

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissues ◽

Cruciate Ligament ◽

Statistical Significance ◽

Full Extension ◽

Cranial Cruciate Ligament ◽

Custom Made ◽

Fresh Frozen ◽

Anterior Cruciate ◽

Over The Top

SummaryTo measure the change of length patterns of nine different simulated anterior cruciate ligament (ACL) reconstructions in the canine and human knee.Six fresh-frozen canine cadaver knees and six fresh-frozen human cadaver knees were used in this study. All of the soft tissues were removed from each cadaver knee, leaving the menisci, collateral ligaments and cruciate ligaments intact. After fixation of the femur to a custom-made frame, the ACL was excised. Three tunnels were made each at the ACL origin and insertion, making possible nine reconstruction combinations. A modified intra-articular technique was used to measure change of length, in mm, of each ACL reconstruction through a range of motion of 0 degrees (full extension) to 135 degrees of flexion. A rankorder list of reconstruction combinations was determined. The most isometric combination was determined for the canine and human knees, and trends in length patterns were also evaluated in both species relative to femoral and tibial position. Statistical significance was determined by ANOVA.A combination joining a point caudal to the ACL origin (over-the-top) and anterior on the tibial insertion was found to be the most isometric combination in both the canine and human. The trends in change of length patterns across all reconstruction combinations were similar in the dog and man. Isometry was improved as the reconstruction was placed further posterior on the femur and anterior on the tibia. Conclusions: The canine knee is an appropriate animal model for the study of isometry of the human ACL and its reconstructions.The length patterns of nine simulated Anterior Cruciate Ligament (ACL) reconstructions were determined in the dog and man. In both species, the most isometric reconstruction was one joining points corresponding to a position at the posterior edge of the intercondylar roof of the femur (over-thetop) with a position anterior on the ACL insertion. For the sake of clarity the term anterior cruciate ligament has been used, throughout, for both species, instead of the cranial cruciate ligament (CCL) in the dog. Also knee has been used in place of stifle for the dog.

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Biomechanical Evaluation of Different Techniques in Double Bundle Anterior Cruciate Ligament Reconstruction Using Finite Element Analysis

Journal of Biomimetics Biomaterials and Tissue Engineering ◽

10.4028/www.scientific.net/jbbte.13.55 ◽

2012 ◽

Vol 13 ◽

pp. 55-68 ◽

Cited By ~ 4

Author(s):

Rong Ying Huang ◽

Hong Guang Zheng ◽

Qiang Xu

Keyword(s):

Finite Element ◽

Anterior Cruciate Ligament ◽

Soft Tissues ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Double Bundle ◽

Rotational Stability ◽

Single Bundle ◽

Element Analysis ◽

Anterior Cruciate

Anterior cruciate ligament injuries commonly in traffic accident, sports activities and extreme sports. Anterior cruciate ligament reconstruction is a common practice to help the patients restore the knee stability. However, there is no previous comparison study of single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction with respect to biomechanical characteristics such as rotational stability, force and stress inside the ligament and grafts, stresses inside the soft tissues. In this study, we developed a pair of three-dimensional finite element models of a lower extremity including femur, tibia, fibula, cartilage, meniscus, and four major ligaments at 0°，25°，60° and 80°of knee flexion. Based on the intact models, single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction models were also developed. Then, the anterior tibial translations, the forces and stresses inside the ACL and ACL replacements, as well as the stresses inside the menisci, femoral and tibial cartilage were predicted under a combined rotatory load of 10Nm valgus moment and 5 Nm internal torque, respectively using finite element analysis. The rotational stability, ligament forces and stresses in the menisci, femoral and tibial cartilage following double bundle augmentation were superior to the other reconstruction techniques, while there is little advantage in ligament stress compared to that of the single bundle reconstruction. We conclude that double-femoral double-tibial tunnel reconstruction may have advantages with regard to biomechanical characteristics such as rotational stability, force inside the ligament and grafts, stresses inside the soft tissues.

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