Biomechanical analysis of temporomandibular joint dynamics based on real-time magnetic resonance imaging.

AIM: The traditional hinge axis theory of temporomandibular joint (TMJ) dynamics is increasingly being replaced by the theory of instantaneous centers of rotation (ICR). Typically, ICR determinations are based on theoretical calculations or three-dimensional approximations of finite element models. MATERIALS AND METHODS: With the advent of real-time magnetic resonance imaging (MRI), natural physiologic movements of the TMJ may be visualized with 15 frames per second. The present study employs real-time MRI to analyze the TMJ biomechanics of healthy volunteers during mandibular movements, with a special emphasis on horizontal condylar inclination (HCI) and ICR pathways. The Wilcoxon rank sum test was used to comparatively analyze ICR pathways of mandibular opening and closure. RESULTS: Mean HCI was 34.8 degrees (± 11.3 degrees) and mean mandibular rotation was 26.6 degrees (± 7.2 degrees). Within a mandibular motion of 10 to 30 degrees, the resulting x- and y-translation during opening and closure of the mandible differed significantly (10 to 20 degrees, x: P = 0.02 and y: P < 0.01; 20 to 30 degrees, x: P < 0.001 and y: P = 0.01). Rotation of both 0 to 10 degrees and > 30 degrees showed no significant differences in x- and y-translation. Near occlusion movements differed only for y-translation (P < 0.01). CONCLUSION: Real-time MRI facilitates the direct recording of TMJ structures during physiologic mandibular movements. The present findings support the theory of ICR. Statistics confirmed that opening and closure of the mandible follow different ICR pathways, which might be due to muscular activity discrepancies during different movement directions. ICR pathways were similar within maximum interincisal distance (MID) and near occlusion (NO), which might be explained by limited extensibility of tissue fibers (MID) and tooth contact (NO), respectively.

An interaction model for predicting brace migration and validation through walking experiment.

Brace migration undermines therapeutic efficacy, which is traditionally evaluated through walking experiments. This study developed an interaction model that considered the instantaneous center of rotation (ICR) misalignment to predict migration. The model was validated by walking experiment. Results show a strong positive correlation for four-linkage (FL) (r = 0.952, p < 0.01, root mean squared error (RMSE) = 0.53 mm) and spur gear (SG) (r = 0.898, p < 0.01, RMSE = 1.35 mm) mechanisms. The FL exhibits lower migration than SG (p < 0.05). In conclusion, the interaction model accurately predicts migration, emphasizing the influence of mechanism on migration.

Instantaneous center of rotation in the canine femorotibial joint: Ex vivo assessment of a tool to evaluate joint stabilization surgeries.

Cranial cruciate ligament rupture is a common cause of femorotibial joint instability in the dog. Numerous techniques including several tibial osteotomies have been described for stabilization, but there is no current consensus on the best method. The instantaneous center of rotation (ICR) can aid investigations of pathological joint movement, but its use is problematic in the femorotibial joint due to combined rotation and translation during flexion and extension. Using fluoroscopic images from an earlier cadaveric study of canine joint stability, an interpolation method was used to create repeatable rotational steps across joint situations, followed by least squares approximation of the ICR. The ICR in intact joints was located mid-condyle but displaced significantly (P < 0.001) proximally following cranial cruciate ligament transection and medial meniscal release. Individual joints appear to respond differently to destabilization. Triple tibial osteotomy partially restored ICR location during early movement from flexion to extension. Joint instability significantly altered the proportions of rolling and gliding movement at the joint surface (P < 0.02), which triple tibial osteotomy partially improved. While triple tibial osteotomy restores joint stability ex vivo and clinically, normal biomechanics of the joint are not restored. The methods described here may prove useful for comparison of osteotomy techniques for stabilization of the cranial cruciate ligament deficient femorotibial joint in dogs.

The effect of cervical intervertebral disc degeneration on the motion path of instantaneous center of rotation at degenerated and adjacent segments: A finite element analysis.

BACKGROUND: The motion path of instantaneous center of rotation (ICR) is a crucial kinematic parameter to dynamically characterize cervical spine intervertebral patterns of motion; however, few studies have evaluated the effect of cervical disc degeneration (CDD) on ICR motion path. The purpose of this study was to investigate the effect of CDD on the ICR motion path of degenerated and adjacent segments. METHOD: A validated nonlinear three-dimensional finite element (FE) model of a healthy adult cervical spine was used. Progressive degeneration was simulated with six FE models by modifying intervertebral disc height and material properties, anterior osteophyte size, and degree of endplate sclerosis at the C5-C6 level. All models were subjected to a pure moment of 1 Nm and a compressive follower load of 73.6 N to simulate physical motion. ICR motion paths were compared among different models. RESULTS: The normal FE model results were consistent with those of previous studies. In degenerative models, average ICR motion paths shifted significantly anterior at the degenerated segment (ß = 0.27 mm; 95% CI: 0.22, 0.32) and posterior at the proximal adjacent segment (ß = -0.09 mm; 95% CI: -0.15, -0.02) than those of the normal model. CONCLUSION: CDD significantly affected ICR motion paths at the degenerated and proximal adjacent segments. The changes at adjacent segments may be a result of compensatory mechanisms to maintain the balance of the cervical spine. Surgical treatment planning should take into account the restoration of ICR motion path to normal. These findings could provide a basis for prosthesis design and clinical practice.

Intuitive assessment of modeled lumbar spinal motion by clustering and visualization of finite helical axes.

A variety of medical imaging procedures, cadaver experiments, and computer models have been utilized to capture, depict, and understand the motion of the human lumbar spine. Particular interest lies in assessing the relative movement between two adjacent vertebrae, which can be represented by a temporal evolution of finite helical axes (FHA). Mathematically, this FHA evolution constitutes a seven-dimensional quantity: one dimension for the time, two for the (normalized) direction vector, another two for the (unique) position vector, as well as one for each the angle of rotation around and the amount of translation along the axis. Predominantly in the literature, however, movements are assumed to take place in certain physiological planes on which FHA are projected. The resulting three-dimensional quantity - the so-called centrode - is easily presentable but leaves out substantial pieces of available data. Here, we investigate and assess several possibilities to visualize subsets of FHA data of increasing dimensionality. Finally, we utilize an agglomerative hierarchical clustering algorithm and propose a novel visualization technique, namely the quiver principal axis plot (QPAP), to depict the entirety of information inherent to hundreds or thousands of FHA. The QPAP method is applied to flexion-extension, lateral bending, and axial rotation movements of a lumbar spine within both a reduced model as well as a complex upper body system.

The Differences Among Kinematic Parameters for Evaluating the Quality of Intervertebral Motion of the Cervical Spine in Clinical and Experimental Studies: Concepts, Research and Measurement Techniques. A Literature Review.

BACKGROUND: The center of rotation (COR), instantaneous center of rotation (ICR), instantaneous axis of rotation, instantaneous helical axis, finite helical axis, and helical axis of motion are important kinematic parameters for evaluating the quality of intervertebral motion of the cervical spine (QIMC). These parameters embody different concepts and are calculated using various methods. In this review, the distinctions and connections between these kinematic parameters are analyzed according to the concepts, research, and measurement techniques to provide a theoretic basis for future research and new research directions. METHODS: The PubMed/MEDLINE databases were searched for studies published in English related to the concepts, research, and calculation of these parameters. The included studies were classified according to the different research or calculation methods, and the proportion of each study type was calculated and analyzed. RESULTS: Forty articles were selected. The methods for analyzing the QIMC include in vivo and in vitro studies and finite element analysis. The primary methods for calculating these parameters include the method of perpendicular bisectors and the finite helical axis method. CONCLUSIONS: COR was the simplest but not the most accurate parameter to evaluate the QIMC. Conversely, instantaneous helical axis/helical axis of motion were the most accurate, but relatively complex parameters to evaluate the QIMC. ICR showed dynamic changes during flexion-extension motion, but not the three-dimensional kinematic motion of the cervical spine. These parameters were equivalent only in certain situations but cannot be substituted for each other in the clinic. A dynamic radiographic in vivo study was the most convenient and frequently used research method to calculate COR, but failed to describe the dynamic movement. The method of perpendicular bisectors was widely used to calculate the COR or ICR. Therefore, a combination of new research and calculation methods to simply and effectively evaluate the QIMC requires further investigation.

Clinical Relevance of Cervical Kinematic Quality Parameters in Planar Movement.

Comprehending cervical spinal motion underlies the understanding of the mechanisms of cervical disorders. We aimed to better define the clinical relevance of cervical spine kinematics, focusing on quality parameters describing cervical spine planar motion. The most common study focuses were kinematic quality parameters after cervical arthroplasty and in normal subjects, patients with cervical degeneration, and patients with cervical deformities. Kinematic quality parameters are important for cervical degeneration prevention, being detected sooner than differences on imaging examinations and being significantly related to the degree of cervical degeneration. Kinematic quality parameters are effective for evaluating the changes of cervical motion pattern after cervical fusion and non-fusion, assessing operative and adjacent segments in the early stages, and predicting adjacent segment degeneration. However, owing to current research limitations, and controversy about the changes of kinematic quality parameters after different surgical procedures, current assessments are limited to cervical spine flexion and extension. Different osteotomy methods of cervical deformity have different effects on cervical motion patterns and quality parameters. Choosing the most effective surgical method remains a challenge and kinematic quality parameters in cervical deformity are important future research topics. This review highlights the instantaneous center of rotation, the center of rotation, and the instantaneous axis of rotation as being important kinematic quality parameters of cervical spinal motion. These can be used to detect abnormal cervical mobility, to diagnose cervical degeneration, to design disc protheses, and to evaluate surgical effects earlier than other methods. Owing to limitations of research methods there is variation in the way parameters are defined by various researchers. No uniform standard exists for defining degenerative motion quality parameters in normal asymptomatic, degenerative, and postoperative patients. Therefore, further study is required. New study techniques and defining kinematic quality parameters in normal subjects will clarify the definitions of these parameters, enhancing their future clinical usefulness.

Establishing a common instantaneous center of rotation for the metatarso-phalangeal and metatarso-sesamoid joints: a theoretical geometric model based on specific morphometrics.

BACKGROUND: Previous research has identified separate sagittal plane instantaneous centers of rotation for the metatarso-phalangeal and metatarso-sesamoid joints, but surprisingly, it does not appear that any have integrated the distinctive morphological characteristics of all three joints and their respective axes into a model that collectively unifies their functional motions. Since all joint motion is defined by its centers of rotation, establishing this in a complicated multi-dimensional structure such as the metatarso-phalangeal-sesamoid joint complex is fundamental to understanding its functionality and subsequent structural failures such as hallux abducto valgus and hallux rigidus. METHODS: Based on a hypothesis that it is possible to develop an instantaneous center of rotation common to all four osseous structures, specific morphometrics were selected from a sequential series of 0.5-mm sagittal plane C-T sections in one representative cadaver specimen randomly selected from a cohort of nine, seven which were obtained from the Body Donation Program, Department of Anatomy, University of California, San Diego School of Medicine, and two which were in the possession of one author (MD). All mature skeletal specimens appeared grossly normal, shared similar morphological features, and displayed no evidence of prior trauma, deformity, or surgery. Specific C-T sections isolated the sagittal plane characteristics of the inter-sesamoidal ridge and each sesamoid groove, and criteria for establishing theoretical sesamoid contact points were established. From these data, a geometric model was developed which, to be accurate, had to closely mimic all physical and spatial characteristics specific to each bone, account for individual variations and pathological states, and be consistent with previously established metatarso-phalangeal joint functional motion. RESULTS: Sequential sagittal plane C-T sections dissected the metatarsal head from medial to lateral and, at approximately midway through the metatarsal head, the circular nature of the inter-sesamoidal ridge (crista) was isolated; other C-T sections defined, respectively, the elliptical characteristics of the tibial (medial) and fibular (lateral) sesamoid grooves in each specimen. A general plane model representing the most basic form of the joint was developed, and its center of rotation was established with a series of tangential and normal lines. Simplified tibial sesamoid and fibular plane models were developed next which, when combined, permitted the development of a spherical model with three separate contact points. Based on the morphometrics of each sesamoid groove and a more distally positioned tibial sesamoid, the model was modified to accurately define the center of rotation and one distinctive sagittal plane geometric and functional characteristic of each groove. CONCLUSION: Consistent with our hypothesis, this theoretical geometric model illustrates how it is possible to define an instantaneous center of rotation common to all three joints while simultaneously accounting for morphometric and spatial variability. This should provide additional insight into metatarso-phalangeal-sesamoid joint complex functionality and the physical characteristics that contribute to its failure.

Instantaneous centers of rotation for lumbar segmental extension in vivo.

The study aimed to map instantaneous centers of rotation (ICRs) of lumbar motion segments during a functional lifting task and examine differences across segments and variations caused by magnitude of weight lifted. Eleven healthy participants lifted loads of three different magnitudes (4.5, 9, and 13.5kg) from a trunk-flexed (~75°) to an upright position, while being imaged by a dynamic stereo X-ray (DSX) system. Tracked lumbar vertebral (L2-S1) motion data were processed into highly accurate 6DOF intervertebral (L2L3, L3L4, L4L5, L5S1) kinematics. ICRs were computed using the finite helical axis method. Effects of segment level and load magnitude on the anterior-posterior (AP) and superior-inferior (SI) ICR migration ranges were assessed with a mixed-effects model. Further, ICRs were averaged to a single center of rotation (COR) to assess segment-specific differences in COR AP- and SI-coordinates. The AP range was found to be significantly larger for L2L3 compared to L3L4 (p=0.02), L4L5 and L5S1 (p<0.001). Average ICR SI location was relatively higher - near the superior endplate of the inferior vertebra - for L4L5 and L5SI compared to L2L3 and L3L4 (p≤0.001) - located between the mid-transverse plane and superior endplate of the inferior vertebra - but differences were not significant amongst themselves (p>0.9). Load magnitude had a significant effect only on the SI component of ICR migration range (13.5kg>9kg and 4.5kg; p=0.049 and 0.017 respectively). The reported segment-specific ICR data exemplify improved input parameters for lumbar spine biomechanical models and design of disc replacements, and base-line references for potential diagnostic applications.

Postero-lateral disc prosthesis combined with a unilateral facet replacement device maintains quantity and quality of motion at a single lumbar level.

BACKGROUND: Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent. PURPOSE: The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels. STUDY DESIGN: In-vitro study using human cadaveric lumbar spines. METHODS: Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions. RESULTS: Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space. CONCLUSION: Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level.

METODOLOGÍA PARA DIMENSIONAMIENTO DE MECANISMO POLICÉNTRICO DE RODILLA UTILIZANDO ANÁLISIS DE MARCHA Y ALGORITMOS GENÉTICOS / METHODOLOGY TO GAUGE A FOUR-BAR LINKAGE PROSTHETIC KNEE MECHANISM BASED ON GAIT ANALYSIS AND GENETIC ALGORITHMS

El objetivo de esta investigación es desarrollar una metodología para dimensionar un mecanismo policéntrico de rodilla de 4 barras para máxima estabilidad. Basado en el hecho de que la estabilidad del mecanismo durante la respuesta a la carga depende de la posición del centro instantáneo de rotación (CIR) respecto la fuerza de reacción del piso (FRP) durante la fase de apoyo, se desarrolló una plataforma de cómputo que representa el movimiento real de la pierna, el vector FRP y el mecanismo con su CIR. Para obtener los datos de entrada a la plataforma, se realizó un análisis de marcha a una paciente con amputación transfemoral unilateral, obteniendo la FRP, el ángulo de flexo-extensión de rodilla y la cinemática de los miembros inferiores. Por otra parte, a través de los algoritmos genéticos (AGs), se obtienen las dimensiones y configuración de los eslabones del mecanismo requeridas para iterar con la plataforma en la cual, comparando la ubicación de la FRP respecto al CIR en el plano sagital, se determinan las dimensiones funcionales adecuadas. El mecanismo se dimensionó exitosamente utilizando la metodología desarrollada, garantizando estabilidad de la rodilla después del contacto inicial y flexión voluntaria antes del despegue de punta.

This research was aimed to develop a methodology for establishing the proper dimensions of a four-bar linkage prosthetic knee mechanism for maximum stability. Based on the fact that the stability of a four-bar knee during load-bearing is determined by the location of the instantaneous center of rotation (ICR) with respect to the ground reaction force (GRF) vector, a computational platform was developed to simulate the movement of the leg, the GRF vector and the position of the ICR of the mechanism. On one hand, a gait analysis was carried out on a subject with unilateral transfemoral amputation, from which the GRF, the knee flexion-extension angle and the kinematics of the lower limbs were determined. On the other hand, genetic algorithms (GAs) technique provided the dimensions and mechanism links configuration required to iterate with the platform on which, comparing the location of the GRF and the ICR in the sagittal plane, the functional dimensions of the mechanism were obtained. The polycentric knee mechanism was gauged successfully by ensuring knee stability during the initial contact and load response as well as the ability to initiate voluntary flexion toward late stance before the toe-off.