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

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.

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

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.

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

2020 ◽  
Author(s):  
Andrew Schmidt ◽  
David J. Stockton ◽  
Michael A. Hunt ◽  
Andrew Yung ◽  
Bassam A. Masri ◽  
...  
Keyword(s):  
Contact Area ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Absolute Error ◽  
Detectable Change ◽  
Lower Field ◽  
Open Mri ◽  
Smallest Detectable Change ◽  
Anterior Cruciate ◽  
Centroid Location

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.

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

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.

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

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.

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

2018 ◽  
Vol 46 (7) ◽  
pp. 1566-1574 ◽  
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.

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

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.

Imaging of Noncontact Anterior Cruciate Ligament Injuries and Associated Bone Marrow Contusion Patterns

2021 ◽  
Author(s):  
Lauren Pringle ◽  
Rob Wissman
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Axial Loading ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Concomitant Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Bone Contusions

AbstractAnterior cruciate ligament (ACL) tears are commonly associated with bone contusions. Bone contusions can lend important insight into increased risk for more subtle concurrent injuries based on common injury mechanisms and patterns, as higher energy trauma has been tied to patterns of specific bone contusions and concomitant injuries. Lateral compartment contusions are most common and occur in pivot shift injuries. Medial compartment contusions may represent a contrecoup mechanism after the initial lateral injuries. Patellotibial contusions require axial loading but are also typically seen in conjunction with lateral and medial compartment contusions. The differences in ACL injury mechanics and physiology as shown by imaging contusion patterns can help clinicians better identify and treat the concurrent associated injuries.

scholarly journals Tibiofemoral Cartilage Contact Differences Between Level Walking and Downhill Running

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983616 ◽  
Author(s):  
Berkcan Akpinar ◽  
Eric Thorhauer ◽  
Scott Tashman ◽  
James J. Irrgang ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Contact Area ◽  
Gait Cycle ◽  
Imaging System ◽  
Cartilage Degeneration ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Downhill Running ◽  
Level Walking ◽  
Impact Phase ◽  
The Impact

Background: Some studies have suggested that altered tibiofemoral cartilage contact behavior (arthrokinematics) may contribute to long-term cartilage degeneration, potentially leading to tibiofemoral osteoarthritis. However, few studies have assessed normal tibiofemoral arthrokinematics during dynamic activities. Purpose: To characterize tibiofemoral arthrokinematics during the impact phase of level walking and downhill running. Study Design: Descriptive laboratory study. Methods: Arthrokinematic data were collected on uninjured knees of 44 participants (mean age, 20.7 ± 6.6 years). Using a dynamic stereoradiographic imaging system with superimposed 3-dimensional bone models from computed tomography and magnetic resonance imaging of participant-specific tibiofemoral joints, arthrokinematics were assessed during the first 15% of the gait cycle during level walking and the first 10% of the gait cycle during downhill running. Results: During level walking and downhill running, the medial compartment had a greater cartilage contact area versus the lateral compartment. Both compartments had a significantly less cartilage contact area during running versus walking (medial compartment gait cycle affected: 8%-10%; lateral compartment gait cycle affected: 5%-10%). Further, medial and lateral compartment tibiofemoral contact paths were significantly more posterior and longer during downhill running. Conclusion: There was a decreased tibiofemoral cartilage contact area during downhill running compared with level walking, suggesting that underlying bone morphology may play a key role in determining the size of cartilage contact regions. Clinical Relevance: This study provides the first data characterizing tibiofemoral cartilage contact patterns during level walking and downhill running. These results provide evidence in support of performing biomechanical assessments during both level walking and downhill running to obtain a comprehensive picture of tibiofemoral cartilage behavior after clinical interventions.

Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study

2021 ◽  
pp. 036354652110282
Author(s):  
Niv Marom ◽  
Hamidreza Jahandar ◽  
Thomas J. Fraychineaud ◽  
Zaid A. Zayyad ◽  
Hervé Ouanezar ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Contact Force ◽  
Contact Stress ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
In Vitro Study ◽  
Lateral Compartment ◽  
Lateral Tibial Plateau ◽  
Intact Knee

Background: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. Hypothesis: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. Study Design: Controlled laboratory study. Methods: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. Results: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm ( P < .001) and 6.0 ± 2.6 mm ( P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N ( P = .001) and 17 ± 10 N ( P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa ( P = .005) and by 0.17 ± 0.12 ( P = .006), respectively, at 15° of flexion. Conclusion: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. Clinical Relevance: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.

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