Tibiofemoral Slip Velocity in Total Knee Arthroplasty is Design-Invariant but Activity-Dependent.

Tibiofemoral slip velocity is a key contributor to total knee arthroplasty (TKA) component wear, yet few studies have evaluated this quantity in vivo. The aim of the present study was to measure and compare tibiofemoral slip velocities in 3 TKA designs for a range of daily activities. Mobile biplane X-ray imaging was used to measure 6-degree-of-freedom tibiofemoral kinematics and the locations of articular contact in 75 patients implanted with a posterior-stabilized, cruciate-retaining, or medial-stabilized design while each patient performed level walking, step up, step down, sit-to-stand, and stand-to-sit. Using these data, tibiofemoral slip velocity was calculated for the duration of each activity for each TKA design. The pattern of tibiofemoral slip velocity was similar for all 3 TKA designs within each activity but markedly different across the 5 activities tested, with the magnitude of peak slip velocity being significantly higher in level walking (range: 158-211 mm/s) than in all other activities (range: 43-75 mm/s). The pattern of tibiofemoral slip velocity in both the medial and lateral compartments closely resembled the pattern of tibiofemoral (knee) flexion angular velocity, with a strong linear relationship observed between slip velocity and flexion angular velocity (r = 0.81-0.97). Tibiofemoral slip velocity was invariant to TKA design but was significantly affected by activity type. Our measurements of slip velocity and articular contact locations for a wide range of daily activities may be used as inputs in joint simulator testing protocols and computational models developed to estimate TKA component wear.

Agreement between a markerless and a marker-based motion capture systems for balance related quantities.

Balance studies usually focus on quantities describing the global body motion. Assessing such quantities using classical marker-based approach can be tedious and modify the participant's behaviour. The recent development of markerless motion capture methods could bypass the issues related to the use of markers. This work compared dynamic balance related quantities obtained with markers and videos. Sixteen young healthy participants performed four different motor tasks: walking at self-selected speed, balance loss, walking on a narrow beam and countermovement jumps. Their movements were recorded simultaneously by marker-based and markerless motion capture systems. Videos were processed using a commercial markerless pose estimation software, Theia3D. The centre of mass position (CoM) was computed, and the associated extrapolated centre of mass position (XCoM) and whole-body angular momentum (WBAM) were derived. Bland-Altman analysis was performed and root mean square difference (RMSD) and coefficient of correlation were computed to compare the results obtained with marker-based and markerless methods. Bias remained of the magnitude of a few mm for CoM and XCoM positions, and RMSD of CoM and XCoM was around 1 cm. RMSD of the WBAM was less than 10 % of the total amplitude in any direction, and bias was less than 1 %. Results suggest that outcomes of balance studies will be similar whether marker-based or markerless motion capture system are used. Nevertheless, one should be careful when assessing dynamic movements such as jumping, as they displayed the biggest differences (both bias and RMSD), although it is unclear whether these differences are due to errors in markerless or marker-based motion capture system.

Changes in Relative Work of the Lower Extremity and Distal Foot Joints After Total Ankle Replacement: An Exploratory Study.

Ankle osteoarthritis does not only led to lower ankle power generation, but also results in compensatory gait mechanics at the hip and Chopart joints. Much of previous work explored the relative work distribution after total ankle replacement (TAR) either across the lower extremity joints where the foot was modelled as a single rigid unit or across the intrinsic foot joints without considering the more proximal lower limb joints. Therefore, this study aims, for the first time, to combine 3D kinetic lower limb and foot models together to assess changes in the relative joint work distribution across the foot and lower limb joints during level walking before and after patients undergo TAR. We included both patients and healthy control subjects. All patients underwent a three-dimensional gait analysis before and after surgery. Kinetic lower limb and multi-segment foot models were used to quantify all inter-segmental joint works and their relative contributions to the total lower limb work. Patients demonstrated a significant increase in the relative ankle positive joint work contribution and a significant decrease in the relative Chopart positive joint work contribution after TAR. Furthermore, there exists a large effect toward decreases in the relative contribution of the hip negative joint work after TAR. In conclusion, this study seems to corroborate the theoretical rationale that TAR reduces the compensatory strategy in the Chopart and hip joints in patients suffering from end-stage ankle osteoarthritis.

Common modelling assumptions affect the joint moments measured during passive joint mobilizations.

Joint resistance to passive mobilization has already been estimated in-vivo in several studies by measuring the applied forces and moments while manipulating the joint. Nevertheless, in most of the studies, simplified modelling approaches are used to calculate this joint resistance. The impact of these simplifications is still unknown. We propose a protocol that enables a reference 3D inverse dynamics approach to be implemented and compared to common simplified approaches. Eight typically developed children and eight children with cerebral palsy were recruited and underwent a passive testing protocol, while applied forces and moments were measured through a 3D handheld dynamometer, simultaneously to its 3D kinematics and the 3D kinematics of the different segments. Then, passive joint resistance was estimated using the reference 3D inverse dynamics approach and according to 5 simplified approaches found in the literature, i.e. ignoring either the dynamometer kinematics, the measured moments alone or together with the measured tangential forces, the gravity and the inertia of the different segments, or the distal segments kinematics. These simplifications lead to non-negligible differences with respect to the reference 3D inverse dynamics, from 3 to 32% for the ankle, 4 to 34% for the knee and 1 to 58% for the hip depending of the different simplifications. Finally, we recommend a complete 3D kinematics and dynamics modelling to estimate the joint resistance to passive mobilization.

Estimation of two wear factors for total hip arthroplasty: A simulation study based on musculoskeletal modelling.

BACKGROUND: Primary causes of surgical revision after total hip arthroplasty are polyethylene wear and implant loosening. These factors are particularly related to joint friction and thus patients' physical activity. Assessing implant wear over time according to patients' morphology and physical activity level is key to improve follow-up and patients' quality of life. METHODS: An approach initially proposed for tibiofemoral prosthetic wear estimation was adapted to compute two wear factors (force-velocity, directional wear intensity) using a musculoskeletal model. It was applied on 17 participants with total hip arthroplasty to compute joint angular velocity, contact force, sliding velocity, and wear factors during common daily living activities. FINDINGS: Differences were observed between gait, sitting down, and standing up tasks. An incremental increase of both global wear factors (time-integral) was observed during gait from slow to fast speeds (p ≤ 0.01). Interestingly, these two wear factors did not result in same trend for sitting down and standing up tasks. Compared to gait, one cycle of sitting down or standing up tends to induce higher friction-related wear but lower cross-shear-related wear. Depending on the wear factor, significant differences can be found between sitting down and gait at slow speed (p ≤ 0.05), and between sitting down (p ≤ 0.05) or standing up (p ≤ 0.05) and gait at fast speed. Furthermore, depending on the activity, wear can be fostered by joint contact force and/or sliding velocity. INTERPRETATION: This study demonstrated the potential of wear estimation to highlight activities inducing a higher risk of implant wear after total hip arthroplasty from motion capture data.

Can the evaluation of marker placement confidence be used as an indicator of gait kinematic variability?

Introduction: Three-dimensional gait analysis is widely used for the clinical assessment of movement disorders. However, measurement error reduces the reliability of kinematic data and consequently assessment of gait deviations. The identification of high variability is associated with low reliability and those parameters should be ignored or excluded from gait data interpretation. Moreover, marker placement error has been demonstrated to be the biggest source of variability in gait analysis and may be affected by factors intrinsic to the evaluators such as the evaluator's expertise which could be appraised through his/her experience and confidence in marker placement. Objectives: In the present study, we hypothesized that confidence in marker placement is correlated with kinematic variability and could potentially be used as part of a score of reliability. Therefore, we have proposed a questionnaire to evaluate qualitatively the confidence of evaluators in lower-limb marker placement. The primary aim of this study was to evaluate the reliability and validity of the presented questionnaire. The secondary objective was to test a possible relationship between marker placement confidence and kinematics variability. Methods: To do so, test-retest gait data were acquired from two different experimental protocols. One protocol included data from a cohort of 32 pathological and 24 asymptomatic subjects where gait analysis was repeated three times, involving two evaluators. A second protocol included data from a cohort of 8 asymptomatic adults with gait analysis repeated 12 times, per participant, and involving four evaluators with a wider range of experience. Results: Results demonstrated that the questionnaire proposed is valid and reliable to evaluate qualitatively the confidence of evaluators in placing markers. Indeed, confidence scores were correlated with the actual variability of marker placement and revealed the evaluator's experience and the subjects' characteristics. However, no correlation was observed between confidence scores and kinematic variability and the formulated hypothesis was not supported.

Evaluation of lower limb and pelvic marker placement precision among different evaluators and its impact on gait kinematics computed with the Conventional Gait Model.

BACKGROUND: Gait analysis relies on the accurate and precise identification of anatomical landmarks to provide reliable and reproducible data. More specifically, the precision of marker placement among repeated measurements is responsible for increased variability in the output gait data. RESEARCH QUESTION: The objective of this study was to quantify the precision of marker placement on the lower limbs by a test-retest procedure and to investigate its propagation to kinematic data. METHODS: The protocol was tested on a cohort of eight asymptomatic adults involving four evaluators, with different levels of experience. Each evaluator performed, three repeated marker placements for each participant. The standard deviation was used to calculate the precision of the marker placement, the precision of the orientation of the anatomical (segment) coordinate systems, and the precision of the lower limb kinematics. In addition, one-way ANOVA was used to compare the intra-evaluator marker placement precision and kinematic precisions among the different levels of the evaluator's experience. Finally, a Pearson correlation between marker placement precision and kinematic precision was analyzed. RESULTS: Results have shown a precision of skin markers within 10 mm and 12 mm for intra-evaluator and inter-evaluator, respectively. Analysis of kinematic data showed good to moderate reliability for all parameters apart from hip and knee rotation that demonstrated poor intra- and inter-evaluator precision. Inter-trial variability was observed reduced than intra- and inter-evaluator variability. Moreover, experience had a positive impact on kinematic reliability since evaluators with higher experience showed a statistically significant increase in precision for most kinematic parameters. However, no correlation was observed between marker placement precision and kinematic precision which indicates that an error in the placement of one specific marker can be compensated or enhanced, in a non-linear way, by an error in the placement of other markers.

Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint.

BACKGROUND: Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work. METHODS: Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups. RESULTS: The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group. CONCLUSION: Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

A procedure and model for the identification of uni- and biarticular structures passive contribution to inter-segmental dynamics.

Inter-segmental moments come from muscles contractions, but also from passive moments, resulting from the resistance of the periarticular structures. To quantify the passive contribution of uni- and biarticular structures during gait, we propose an innovative procedure and model. 12 typically developed (TD) children and 17 with cerebral palsy (CP) participated in a passive testing protocol. The relaxed lower limb joints were manipulated through full ranges of motion while kinematics and applied forces were simultaneously measured. The relationships between uni-/biarticular passive moments/forces and joint angles/musculo-tendon lengths were modelled by a set of exponential functions. Then, subject specific gait joint angles/musculo-tendon lengths were input into the determined passive models to estimate joint moments and power attributable to passive structures. We found that passive mechanisms contribute substantially in both populations, mainly during push-off and swing phases for hip and knee and push-off for the ankle, with a distinction between uni- and biarticular structures. CP children showed comparable passive mechanisms but larger variability than the TD ones and higher contributions. The proposed procedure and model enable a comprehensive assessment of the passive mechanisms for a subject-specific treatment of the stiffness implying gait disorders by targeting when and how passive forces are impacting gait.

Walking ability of individuals fitted with transfemoral bone-anchored prostheses: A comparative study of gait parameters.

OBJECTIVE: This study presents the walking abilities of participants fitted with transfemoral bone-anchored prostheses using a total of 14 gait parameters. DESIGN: Two-centre retrospective cross-sectional comparative study. SETTING: Research facilities equipped with tridimensional motion capture systems. PARTICIPANTS: Two control arms included eight able-bodied participants arm (54 ± 9 years, 1.75 ± 0.07 m, 76 ± 7 kg) and nine participants fitted with transfemoral socket-suspended prostheses arm (59 ± 9 years, 1.73 ± 0.07 m, 80 ± 16 kg). The intervention arm included nine participants fitted with transfemoral bone-anchored prostheses arm (51 ± 13 years, 1.78 ± 0.09 m, 87.3 ± 16.1 kg). INTERVENTION: Fitting of transfemoral bone-anchored prostheses. MAIN MEASURES: Comparisons were performed for two spatio-temporal, three spatial and nine temporal gait parameters. RESULTS: The cadence and speed of walking were 107 ± 6 steps/min and 1.23 ± 0.19 m/s for the able-bodied participants arm, 88 ± 7 steps/min and 0.87 ± 0.17 m/s for the socket-suspended prosthesis arm, and 96 ± 6 steps/min and 1.03 ± 0.17 m/s for bone-anchored prosthesis arm, respectively. Able-bodied participants and bone-anchored prosthesis arms were comparable in age, height, and body mass index as well as cadence and speed of walking, but the able-bodied participant arm showed a swing phase 31% shorter. Bone-anchored and socket-suspended prostheses arms were comparable for age, height, mass, and body mass index as well as cadence and speed of walking, but the bone-anchored prosthesis arm showed a step width and duration of double support in seconds 65% and 41% shorter, respectively. CONCLUSIONS: Bone-anchored and socket-suspended prostheses restored equally well the gait parameters at a self-selected speed. This benchmark data provides new insights into the walking ability of individuals using transfemoral bionics bone-anchored prostheses.

Comparison between a novel helical and a posterior ankle-foot orthosis on gait in people with unilateral foot drop: a randomised crossover trial.

BACKGROUND: Neuromuscular disease and peripheral neuropathy may cause drop foot with or without evertor weakness. We developed a helical-shaped, non-articulated ankle-foot orthosis (AFO) to provide medial-lateral stability while allowing mobility, to improve gait capacity. Our aim was to evaluate the effect of the helical AFO (hAFO) on functional gait capacity (6-min walk test) in people with peripheral neuropathy or neuromuscular disease (NMD) causing unilateral drop foot and compare with a posterior leaf spring AFO (plsAFO). Secondary aims were to compare functional mobility, 3D kinematic and kinetic gait variables and satisfaction between the AFOs. METHODS: Single centre, randomised crossover trial from January to July 2017 in 20 individuals (14 with peripheral neuropathy and 6 with NMD, 12 females, mean age 55.6 years, SD 15.3); 10 wore the hAFO for the first week and 10 wore the plsAFO before switching for the second week. The 6-min walk test (6MWT), Timed Up and Go (TUG) test and 3D gait analysis were evaluated with the hAFO, the plsAFO and shoes only (noAFO) at inclusion and 1 week after wearing each orthosis. Satisfaction was evaluated with the Quebec user evaluation of satisfaction with assistive technology (QUEST). RESULTS: Median [interquartile range] 6MWT distance was greater with the hAFO (444 m [79]) than the plsAFO (389 m [135], P < 0.001, Hedge's g = 0.6) and noAFO (337 m [91], P < 0.001, g = 0.88). TUG time was shorter with the hAFO (8.1 s [2.8]) than the plsAFO (9.5 s [2.6], P < 0.001, g = - 0.5) and noAFO (10.0 s [2.6]), P < 0.001, g = - 0.6). The plsAFO limited plantarflexion during the loading response (plsAFO - 7.5 deg [6.0] vs. noAFO -13.0 deg [10.0], P = 0.0007, g = - 1.0) but the hAFO did not (- 11.0 deg [5.1] vs. noAFO, P = 0.05, g = - 0.5). Quasi-stiffness was lower for the hAFO than plsAFO (P = 0.009, g = - 0.7). The dimensionless eversion moment was higher (though not significantly) with the hAFO than noAFO. Neither orthosis reduced ankle power (P = 0.34). Median total QUEST score was higher for the hAFO (4.7 [0.7]) than the plsAFO (3.6 [0.8]) (P < 0.001, g = 1.9). CONCLUSIONS: The helical orthosis significantly and considerably improved functional gait performance, did not limit ankle mobility, increased lateral stability, though not significantly, and was associated with greater patient satisfaction than the posterior leaf spring orthosis. Trial registration The trial began before registration was mandatory.

Can a Musculoskeletal Model Adapted to Knee Implant Geometry Improve Prediction of 3D Contact Forces and Moments?

Tibiofemoral contact loads are crucial parameters in the onset and progression of osteoarthrosis. While contact loads are frequently estimated from musculoskeletal models, their customization is often limited to scaling musculoskeletal geometry or adapting muscle lines. Moreover, studies have usually focused on superior-inferior contact force without investigating three-dimensional contact loads. Using experimental data from six patients with instrumented total knee arthroplasty (TKA), this study customized a lower limb musculoskeletal model to consider the positioning and the geometry of the implant at knee level. Static optimization was performed to estimate tibiofemoral contact forces and contact moments as well as musculotendinous forces. Predictions from both a generic and a customized model were compared to the instrumented implant measurements. Both models accurately predict superior-inferior (SI) force and abduction-adduction (AA) moment. Notably, the customization improves prediction of medial-lateral (ML) force and flexion-extension (FE) moments. However, there is subject-dependent variability in the prediction of anterior-posterior (AP) force. The customized models presented here predict loads on all joint axes and in most cases improve prediction. Unexpectedly, this improvement was more limited for patients with more rotated implants, suggesting a need for further model adaptations such as muscle wrapping or redefinition of hip and ankle joint centers and axes.

Comparison between passive knee kinematics during surgery and active knee kinematics during walking: A preliminary study.

Recovery of function is among a patient's main expectations when undergoing total knee arthroplasty (TKA). However, normal gait knee function is not always completely restored, which can affect patient satisfaction and quality of life. Computer-assisted surgery (CAS) allows surgeons to evaluate passive knee kinematics intra-operatively. Understanding associations between knee kinematics measured during surgery and during daily activities, such as walking, could help define criteria for success based on knee function and not only on the correct alignment of the implant or the leg. This preliminary study compared passive knee kinematics measured during surgery with active kinematics measured during walking. Eight patients underwent a treadmill gait analysis using the KneeKG™ system both before surgery and three months afterwards. Knee kinematics were measured during CAS both before and after TKA implantation. The anatomical axes of the KneeKG™ and CAS systems were homogenised using a two-level, multi-body kinematics optimisation with a kinematic chain based on the calibration measured during CAS. A Bland-Altman analysis was performed before and after TKA for adduction-abduction angle, internal-external rotation, and anterior-posterior displacement over the whole gait cycle, at the single stance phase and at the swing phase. Homogenising the anatomical axes between CAS and treadmill gait led to limited median bias and limits of agreement (post-surgery -0.6 ± 3.6 deg, -2.7 ± 3.6 deg, and -0.2 ± 2.4 mm for adduction-abduction, internal-external rotation and anterior-posterior displacement, respectively). At the individual level, correlations between the two systems were mostly weak (R2 < 0.3) over the whole gait cycle, indicating low kinematic consistency between the two measurements. However, correlations were better at the phase level, especially the swing phase. The multiple sources of differences did not enable us to conclude whether they came from anatomical and biomechanical differences or from measurement system errors.

Kinetics influence of multibody kinematics optimisation for soft tissue artefact compensation.

Soft tissue artefact (STA) remains a major source of error in human movement analysis. The multibody kinematics optimisation (MKO) approach is widely stated as a solution to reduce the effects of STA. This study aimed at assessing the influence of the MKO STA-compensation on the errors of estimation of the knee intersegment moments. Experimental data were issued from the CAMS-Knee dataset where six participants with instrumented total knee arthroplasty performed five activities of daily living: gait, downhill walking, stair descent, squat, and sit-to-stand. Kinematics was measured both on the basis of skin markers and a mobile mono-plane fluoroscope, used to obtain the STA-free bone movement. For four different lower limb models and one corresponding to a single-body kinematics optimization (SKO), knee intersegmental moments (estimated using model-derived kinematics and ground reaction force) were compared with an estimate based on the fluoroscope. Considering all participants and activities, mean root mean square differences were the largest along the adduction/abduction axis: of 3.22Nm with a SKO approach, 3.49Nm with the three-DoF knee model, and 7.66Nm, 8.52Nm, and 8.54Nm with the one-DoF knee models. Results showed that adding joint kinematics constraints can increase the estimation errors of the intersegmental moment. These errors came directly from the errors in the estimation of the position of the knee joint centre induced by the constraints. When using a MKO approach, we recommend to analyse carefully joint centre position estimates that do not remain close to the one obtained with a SKO approach.

A Velocity Stretch Reflex Threshold Based on Muscle-Tendon Unit Peak Acceleration to Detect Possible Occurrences of Spasticity during Gait in Children with Cerebral Palsy.

Spasticity might affect gait in children with cerebral palsy. Quantifying its occurrence during locomotion is challenging. One approach is to determine kinematic stretch reflex thresholds, usually on the velocity, during passive assessment and to search for their exceedance during gait. These thresholds are determined through EMG-Onset detection algorithms, which are variable in performance and sensitive to noisy data, and can therefore lack consistency. This study aimed to evaluate the feasibility of determining the velocity stretch reflex threshold from maximal musculotendon acceleration. Eighteen children with CP were recruited and underwent clinical gait analysis and a full instrumented assessment of their soleus, gastrocnemius lateralis, semitendinosus, and rectus femoris spasticity, with EMG, kinematics, and applied forces being measured simultaneously. Using a subject-scaled musculoskeletal model, the acceleration-based stretch reflex velocity thresholds were determined and compared to those based on EMG-Onset determination. Their consistencies according to physiological criteria, i.e., if the timing of the threshold was between the beginning of the stretch and the spastic catch, were evaluated. Finally, two parameters designed to evaluate the occurrence of spasticity during gait, i.e., the proportion of the gait trial time with a gait velocity above the velocity threshold and the number of times the threshold was exceeded, were compared. The proposed method produces velocity stretch reflex thresholds close to the EMG-based ones. For all muscles, no statistical difference was found between the two parameters designed to evaluate the occurrence of spasticity during gait. Contrarily to the EMG-based methods, the proposed method always provides physiologically consistent values, with median electromechanical delays of between 50 and 130 ms. For all subjects, the semitendinosus velocity during gait usually exceeded its stretch reflex threshold, while it was less frequent for the three other muscles. We conclude that a velocity stretch reflex threshold, based on musculotendon acceleration, is a reliable substitute for EMG-based ones.

Accuracy and precision of the measurement of liner orientation of dual mobility cup total hip arthroplasty using ultrasound imaging.

The Dual Mobility Cup (DMC) was created in 1974 to prevent dislocation and decrease wear. However, the movement of the polyethylene liner in vivo remains unclear. The aims of this study were to visualise liner positions and quantify the accuracy of the liner plane orientation for static positions, using ultrasound imaging. DMC reconstruction and angle between cup and liner were evaluated on isolated submerged DMCs by comparing 3D laser scans and ultrasound imaging. Moreover, the abduction and anteversion angles of the liner plane relative to the pelvis orientation were calculated via combined motion analysis and 3D ultrasound imaging on four fresh post-mortem human subjects with implanted DMC. On submerged DMC, the mean angle error between ultrasound imaging and 3D scan was 1.2°. In cadaveric experiments, intra-operator repeatability proved satisfactory, with low range value (lower than 2°) and standard deviation (lower than 1°). The study demonstrates the feasibility of measuring liner orientation on submerged and ex vivo experiments using ultrasound imaging, and is a first step towards in vivo analysis of DMC movement.

Accuracy of a markerless motion capture system in estimating upper extremity kinematics during boxing.

Kinematic analysis of the upper extremity can be useful to assess the performance and skill levels of athletes during combat sports such as boxing. Although marker-based approach is widely used to obtain kinematic data, it is not suitable for "in the field" activities, i.e., when performed outside the laboratory environment. Markerless video-based systems along with deep learning-based pose estimation algorithms show great potential for estimating skeletal kinematics. However, applicability of these systems in assessing upper-limb kinematics remains unexplored in highly dynamic activities. This study aimed to assess kinematics of the upper limb estimated with a markerless motion capture system (2D video cameras along with commercially available pose estimation software Theia3D) compared to those measured with marker-based system during "in the field" boxing. A total of three elite boxers equipped with retroreflective markers were instructed to perform specific sequences of shadow boxing trials. Their movements were simultaneously recorded with 12 optoelectronic and 10 video cameras, providing synchronized data to be processed further for comparison. Comparative assessment showed higher differences in 3D joint center positions at the elbow (more than 3 cm) compared to the shoulder and wrist (<2.5 cm). In the case of joint angles, relatively weaker agreement was observed along internal/external rotation. The shoulder joint revealed better performance across all the joints. Segment velocities displayed good-to-excellent agreement across all the segments. Overall, segment velocities exhibited better performance compared to joint angles. The findings indicate that, given the practicality of markerless motion capture system, it can be a promising alternative to analyze sports-performance.

An analytical model to quantify the impact of the propagation of uncertainty in knee joint angle computation.

Joint kinematics are typically described using Cardan angles or the attitude vector and its projection on the joint axes. Whichever the notation used, the uncertainties present in gait measurements affect the computed kinematics, especially for the knee joint. One notation - the attitude vector - enables the derivation of an analytical model of the propagation of uncertainty. Thus, the objective of this study was to derive this analytical model and assess the propagation of uncertainty in knee joint angle computation. Multi-session gait data acquired from one asymptomatic adult participant was used as reference data (experimental mean curve and standard deviations). Findings showed that an input uncertainty of 5° in the attitude vector and joint axes parameters matched experimental standard deviations. Taking each uncertainty independently, the cross-talk effect could result from uncertainty in the orientation of either the attitude vector (intrinsic variability) or the first joint axis (extrinsic variability). We concluded that the model successfully estimated the propagation of input uncertainties on joint angles and enabled an investigation of how that propagation occurred. The analytical model could be used to a priori estimate the standard deviations of experimental kinematics curves based on expected intrinsic and extrinsic uncertainties.

Decreased Mechanical Work Demand in the Chopart Joint After Total Ankle Replacement.

BACKGROUND: The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR. METHODS: Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work. RESULTS: The contribution of the Ankle joint (P = .007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work (P < .001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR (P = .006). CONCLUSION: The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group.

Automatic gait event detection in pathologic gait using an auto-selection approach among concurrent methods.

BACKGROUND: Accurate gait event detection is crucial to analyze pathological gait data. Existing methods relying on marker trajectories were reported to be sensitive to different gait patterns, which is an inherent characteristic of pathologic gait. RESEARCH QUESTION: We propose a new approach based on auto-selection among different methods, original and taken from the literature. METHODS: The auto-selection approach evaluates the accuracy of the implemented methods for both foot-strike and foot-off on all available events detected by the force platforms, independently, and automatically selects the most accurate one to be used on the whole gait session. Pathological gait data from 272 patients with cerebral palsy and idiopathic toe walking were used retrospectively to evaluate the accuracy of this approach. Three methods previously reported in literature together with original methods developed based on auto-correlation were implemented and constituted our auto-selection approach. The accuracy and precision were compared to a recently reported method based on deep events as it is the method that showed the best performance in literature. RESULTS: Results showed that the proposed approach outperformed all implemented methods used alone, with an accuracy of - 2.0 ms and - 0.9 ms for foot strike and foot-off, respectively. Additionally, more than 99% and 93% of events detected were detected within 20 ms and 10 ms of accuracy, respectively. SIGNIFICANCE: The proposed methodology has demonstrated to improve the accuracy and precision of gait event detection in gait analysis.