Mechanically-induced osteophyte in the rat knee.

OBJECTIVES: Osteophytes are common anatomical signs of advanced osteoarthritis. It remains unclear whether they develop from physio-molecular, and/or mechanical stimuli. This study examined the effects of mechanical impact on the knee joint periosteum leading to osteophyte formation. DESIGN: Eighteen mature rats received one single impact load of 53 N (30 MPa) to the periosteum of the experimental medial femoral condyles. Contralateral knees were used as controls. Animals were sacrificed at 24 h, 3, 6 and 9 weeks post-impact. Distal femurs were harvested and prepared for histology. Hematoxylin and Eosin, and Masson's trichrome stained slides were examined by light microscopy. Nuclear density was quantified to assess the tissue reaction. RESULTS: 24 h: The synovium membrane, fibrous and cambium periosteum were damaged. Blood infiltration pooled in the impacted medial collateral ligament (MCL) region. Week 3: A cartilaginous tissue spur, chondrophyte, was found in every rat at the impacted site of the MCL. Chondrophytes were composed of fibrocartilage and cartilage matrix, with signs of cartilage mineralization and remodelling activity. Week 6: Chondrophytes presented signs of more advanced mineralisation, recognized as osteophytes. Week 9: Osteophytes appeared to be more mineralized with almost no cartilage tissue. CONCLUSIONS: Osteophytes can be induced with a single mechanical impact applied to the periosteum in rat knees. These data indicate that a moderate trauma to the periosteal layer of the joint may play a role in osteophyte development.

The influence of osteophyte depiction in CT for patient-specific guided hip resurfacing procedures.

PURPOSE: An accurate fit of a patient-specific instrument guide during an intervention is one of the critical factors affecting accuracy of the surgical procedure. In this study, we investigated how well osteophytes, which are abnormal bone growths that form along joints, are depicted in clinical preoperative CT scans and estimated the influence of such depiction errors on the intraoperative accuracy of the guide. METHODS: In 34 hip resurfacing patients, 227 osteophyte surface points on the anterior aspect of the femoral neck were collected intraoperatively, using an optoelectronic navigation system. These points were registered to a preoperative CT scan of the patient, and distances between collected points and segmented virtual bone surface, as well as Hounsfield units for these points, were determined. We simulated the registration error of a patient-specific guide, using a modified registration algorithm, to test placement on the anterior aspect of the femoral neck without removing any osteophytes. This error was then applied to the surgical plan of the femoral central-pin position and orientation for evaluation. RESULTS: The average distance between the collected points and the segmented surface was 2.6 mm. We estimated the average error for the entrance point of the central-pin to be 0.7 mm in the distal direction and 3.2 mm in the anterior direction. The average orientation error was 2.8° in anteversion. CONCLUSIONS: The depiction of osteophytes in clinical preoperative CT scans for proximal femurs can be unreliable and can possibly result in significant intraoperative instrument alignment errors during image-guided surgeries.

Wide-angle ITER-prototype tangential infrared and visible viewing system for DIII-D.

An imaging system with a wide-angle tangential view of the full poloidal cross-section of the tokamak in simultaneous infrared and visible light has been installed on DIII-D. The optical train includes three polished stainless steel mirrors in vacuum, which view the tokamak through an aperture in the first mirror, similar to the design concept proposed for ITER. A dichroic beam splitter outside the vacuum separates visible and infrared (IR) light. Spatial calibration is accomplished by warping a CAD-rendered image to align with landmarks in a data image. The IR camera provides scrape-off layer heat flux profile deposition features in diverted and inner-wall-limited plasmas, such as heat flux reduction in pumped radiative divertor shots. Demonstration of the system to date includes observation of fast-ion losses to the outer wall during neutral beam injection, and shows reduced peak wall heat loading with disruption mitigation by injection of a massive gas puff.

Analyzing shoulder translation with navigation technology.

PURPOSE: Asymmetric stress imposed on the shoulder can lead to anterior shoulder instability in young athletes who perform repetitive overhead motions. A common treatment, surgical anterior capsule tightening, assumes that the instability is caused by abnormal anterior laxity. This study investigated the possibility that one element of overall imbalance, posterior capsular tightness, could be an underlying reason for shoulder instability. Surgical navigation technology, which is more accurate than whole-body motion-capture systems, was used to study anterior translational motions. METHOD: The study was used four cadaver shoulders, with the scapula and rotator cuff muscles intact. Opto-electronic surgical navigation localization devices were mounted on the scapula and humerus to accurately capture positions and orientations. The shoulders were passively moved through 7 motions, 5 of simple angulation and 2 combinations of clinical interest. Each motion was repeated in 4 different soft-tissue states: rotator cuff intact, capsule intact, and surgically induced capsular tightnesses of 5 and 10mm. RESULTS: The shoulders had significantly greater anterior translation when the posterior capsule was artificially tightened (p < 0.05); this was particularly in movements that combined abduction with internal or external rotation, which are typical overhead sports motions. Overall translation was indifferent to whether the shoulders were intact or dissected down to the capsule, as was translation during flexion was indifferent to dissection state (p > 0.95). CONCLUSION: Surgical navigation technology can easily be used to analyze cadaveric shoulder motion, with opportunities for adaptation to anesthetized patients. Results suggest that the inverse of artificial tightening, such as surgical release of the posterior capsule, may be an effective minimally invasive treatment of chronic shoulder dislocation subsequent to sports motions.

Cartilage collagen matrix reorientation and displacement in response to surface loading.

An investigation of collagen fiber reorientation, as well as fluid and matrix movement of equine articular cartilage and subchondral bone under compressive mechanical loads, was undertaken using small angle X-ray scattering measurements and optical microscopy. Small angle X-ray scattering measurements were made on healthy and diseased samples of equine articular cartilage and subchondral bone mounted in a mechanical testing apparatus on station ID18F of ESRF, Grenoble, together with fiber orientation analysis using polarized light and displacement measurements of the cartilage matrix and fluid using tracers. At surface pressures of up to approximately 1.5 MPa, there was reversible compression of the tangential surface fibers and immediately subjacent zone. As load increased, deformation in these zones reached a maximum and then reorientation propagated to the radial deep zone. Between surface pressures of 4.8 MPa and 6.0 MPa, fiber orientation above the tide mark rotated 10 deg from the radial direction, with an overall loss of alignment. With further increase in load, the fibers "crimped" as shown by the appearance of subsidiary peaks approximately +/-10 deg either side of the principal fiber orientation direction. Failure at higher loads was characterized by a radial split in the deep cartilage, which propagated along the tide mark while the surface zone remained intact. In lesions, the fiber organization was disrupted and the initial response to load was consistent with early rupture of fibers, but the matrix relaxed to an organization very similar to that of the unloaded tissue. Tracer measurements revealed anisotropic solid and fluid displacement, which depended strongly on depth within the tissue.

Computer-assisted distraction osteogenesis by Ilizarov's method.

BACKGROUND: The Taylor spatial frame is a fixation device used to implement the Ilizarov method of bone deformity correction to gradually distract an osteotomized bone at regular intervals, according to a prescribed schedule. METHODS: We modify conventional technique by: (a) preoperatively planning a virtual three-dimensional (3D) correction; (b) basing the correction on the actual location of the frame with respect to the anatomy, immediately compensating for frame mounting errors; and (c) calculating the correction based on 3D CT data rather than measurements from radiographs. We have performed a laboratory study using plastic phantoms, and a pilot clinical study involving five patients. RESULTS: In 20 tibial phantom experiments, we achieved average correction errors of < 2 degrees total rotation and < 0.5 mm total lengthening. We observed clinically acceptable corrections with no complications in our pilot clinical study. CONCLUSIONS: Our method achieved high accuracy and precision in a laboratory setting, and produced acceptable outcomes in a pilot clinical study.

Dynamic simulation of a displacement-controlled total knee replacement wear tester.

This paper presents a dynamic finite element method (FEM) model of a commercial displacement-controlled total knee replacement (TKR) wear tester. The first goal of the study was to validate the model, which included both the wear tester and the TKR components. Convergence simulations and experimental testing were performed. These included a novel experimental determination of the coefficient of friction and an evaluation of predicted joint contact areas by comparing simulation results with experimental data collected using pressure-sensitive film. The second goal of this study was to develop a procedure for implementing force-based testing protocols on a displacement-controlled TKR wear tester. A standard force-based cyclic wear-testing protocol was simulated using the FEM model and resulting displacement waveforms were extracted. These were used as control inputs to the physical wear tester and an experimental wear test was performed. Reaction loads on the tibial components were measured and compared with the simulated results. The model was capable of accurately predicting the tibial loads throughout the test cycle, verifying the model's contact mechanics. The study demonstrated the use of computational modelling to convert a force-based testing protocol into displacement-based control parameters for use in a displacement-controlled mechanical testing system.

Spectrin maintains the lateral order in phosphatidylserine monolayers.

We investigate the effect of the skeletal protein spectrin on the lateral order in dipalmitoyl phosphatidylserine monolayers spread on aqueous surfaces using grazing incidence X-ray diffraction. Without spectrin, the condensed lipid monolayer exhibits two-dimensional hexagonal packing, characterized by monotonic decrease in the d-spacing and increase in the degree of order with increasing surface pressure between 17 and 36 mN/m. Addition of spectrin to the aqueous subphase at high pressures preserves the monolayers structural parameters unchanged from 36 to 25 mN/m. These results demonstrate for the first time that spectrin could participate in sustaining the two-dimensional order in lipid domains through a direct interaction with phosphatidylserine species.

Validation of a new surgical procedure for percutaneous scaphoid fixation using intra-operative ultrasound.

A new technique for percutaneous fixation of non-displaced scaphoid fractures is described. The technique used pre-operative planning from computed tomography images, registration to intra-operatively acquired three-dimensional ultrasound images, and intra-operative guidance using an optical tracking system. Two stand-alone software applications were developed. The first one was used to determine the surgical plan pre-operatively and the second one was used to guide the surgeon during screw insertion. Laboratory validation of the technique included measurements of the inter-operator and intra-operator variability in the outcome of scaphoid fixation using the proposed procedure, and also included comparison of the performance of this procedure with the conventional percutaneous fixation technique using fluoroscopy. The results showed that the tight accuracy requirements of percutaneous scaphoid fixation were met and that the consistency was superior to the conventional technique.

A navigation system for shoulder arthroscopic surgery.

The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively, optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks.

Two-dimensional order in mammalian pre-ocular tear film.

We report a grazing incidence x-ray diffraction (GIXD) investigation of the surface lipid layer of the pre-ocular tear film. For the first time we demonstrate the existence of 2D order over a wide range of surface pressures in this system, with typical spicing of 3.75A and 4.16A independent of the monolayer surface pressure. Analogous lipid ordering is also found in an artificial lipid mixture of the major lipid components of the tear film, suggesting that the 2D ordering is set by generic lipid-lipid interactions. Fluorescence microscopy of the natural and artificial tear film mixture reveals the co-existence of a dilute and a much more condensed phase in the amphiphilic lipid matrix over the pressure range of 15-45mN/m investigated by GIXD, plus an additional structure due to the much more hydrophobic part of the mixture. This evidence supports the previous hypothesis that tear film has a layered structure.

Regional variations of collagen orientation in normal and diseased articular cartilage and subchondral bone determined using small angle X-ray scattering (SAXS).

OBJECTIVE: To determine regional differences in the orientation of collagen in the articular cartilage of the equine metacarpophalangeal joint as well as describing cartilage orientation in lesions using small angle X-ray scattering (SAXS). DESIGN: SAXS diffraction patterns were taken at the European Synchrotron Radiation Facility (ESRF), with increasing depth into cartilage and bone cross sections. Results for healthy samples were taken at different regions along the joint which receive different loads and differences in collagen orientation were determined. Results were also taken from diseased samples and the collagen orientation changes from that of healthy samples observed. RESULTS: Regions subject to low loads show a lower degree of orientation and regions exposed to the highest loads possess oriented collagen fibres especially in the radial layer. In early lesions the orientations of the collagen fibres are disrupted. Subchondral bone fibres are twisted in regions where the joint receives shear forces. Changes in fibre orientation are also observed in the calcified cartilage even in regions where the cartilage is intact. In more advanced lesions where there is loss of cartilage the fibres in the calcified layer are realigned tangential to the surface. CONCLUSIONS: Regional variations in collagen arrangement show that the highly ordered layers of the articular cartilage are the most important elements in supporting high variable loads. In lesions changes occur in the deep tissue whilst the overlying cartilage appeared normal. We therefore suggest that the interface region is a key element in the early stages of the disease.

Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome is a prevalent condition in young people. While it is widely believed that abnormal patellar tracking plays a role in the development of patellofemoral pain syndrome, this link has not been established. The purpose of this cross-sectional case-control study was to test the hypothesis that patterns of patellar spin, tilt, and lateral translation make it possible to distinguish individuals with patellofemoral pain syndrome and clinical evidence of patellar malalignment from those with patellofemoral pain syndrome and no clinical evidence of malalignment and from individuals with no knee problems. METHODS: Three-dimensional patellofemoral joint kinematics in one knee of each of sixty volunteers (twenty in each group described above) were assessed with use of a new, validated magnetic resonance imaging-based method. Static low-resolution scans of the loaded knee were acquired at five different angles of knee flexion (ranging between -4 degrees and 60 degrees). High-resolution geometric models of the patella, femur, and tibia and associated coordinate axes were registered to the bone positions on the low-resolution scans to determine the patellar motion as a function of knee flexion angle. Hierarchical modeling was used to identify group differences in patterns of patellar spin, tilt, and lateral translation. RESULTS: No differences in the overall pattern of patellar motion were observed among groups (p>0.08 for all global maximum likelihood ratio tests). Features of patellar spin and tilt patterns varied greatly between subjects across all three groups, and no significant group differences were detected. At 19 degrees of knee flexion, the patellae in the group with patellofemoral pain and clinical evidence of malalignment were positioned an average of 2.25 mm more laterally than the patellae in the control group, and this difference was marginally significant (p=0.049). Other features of the pattern of lateral translation did not differ, and large overlaps in values were observed across all groups. CONCLUSIONS: It cannot be determined from our cross-sectional study whether the more lateral position of the patella in the group with clinical evidence of malalignment preceded or followed the onset of symptoms. It is clear from the data that an individual with patellofemoral pain syndrome cannot be distinguished from a control subject by examining patterns of spin, tilt, or lateral translation of the patella, even when clinical evidence of mechanical abnormality was observed.

Needle artifact localization in 3T MR images.

This work explores an image-based approach for localizing needles during MRI-guided interventions, for the purpose of tracking and navigation. Susceptibility artifacts for several needles of varying thickness were imaged, in phantoms, using a 3 tesla MRI system, under a variety of conditions. The relationship between the true needle positions and the locations of artifacts within the images, determined both by manual and automatic segmentation methods, have been quantified and are presented here.

Computer-assisted guidewire insertion for hip fracture fixation.

OBJECTIVE: : This study was designed to test in a laboratory setting a novel computer-assisted fluoroscopic technique and a conventional fluoroscopic technique for open reduction and internal fixation (ORIF) of hip fractures. Our hypothesis is that a novel computer-assisted fluoroscopic technique will achieve acceptable guidewire placement in one pass, with decreased fluoroscopic time and with accuracy and precision better than conventional technique. DESIGN: Prospective, randomized trials. SETTING: Laboratory. PARTICIPANTS: Thirty, Sawbone, femur phantoms. INTERVENTION: Dynamic hip screw guidewires were inserted into 15 femur phantoms under fluoroscopic guidance by using computer-assisted fluoroscopic ORIF technique, and 15 femurs were inserted by using a conventional fluoroscopic-assisted ORIF technique. MAIN OUTCOME MEASUREMENTS: Ideal guidewire placement was defined as the center of the femoral head, 5 mm from the apical bone edge on anteroposterior and lateral views. Accuracy was measured as distance to ideal placement, and the number of passes and fluoroscopic time were noted for each trial. RESULTS: The computer-assisted technique achieved an average guidewire placement that was as accurate as the conventional technique in fewer passes, 1.1 +/- 0.2 (mean +/- standard deviation) compared with 2.4 +/- 1.1 (P < 0.0001), respectively, and with fewer fluoroscopic images, 2 +/- 0 compared with 13.5 +/- 3 (P < 0.0002), respectively. Guidewire placement in both groups was within the tip-apex distance defined by Baumgaertner et al. CONCLUSIONS: The computer-assisted technique was significantly more accurate and precise than conventional technique. It also required fewer drill tracks through the femur and exposed the patient and the surgical team to significantly less ionizing radiation.

An estimation/correction algorithm for detecting bone edges in CT images.

The normal direction of the bone contour in computed tomography (CT) images provides important anatomical information and can guide segmentation algorithms. Since various bones in CT images have different sizes, and the intensity values of bone pixels are generally nonuniform and noisy, estimation of the normal direction using a single scale is not reliable. We propose a multiscale approach to estimate the normal direction of bone edges. The reliability of the estimation is calculated from the estimated results and, after re-scaling, the reliability is used to further correct the normal direction. The optimal scale at each point is obtained while estimating the normal direction; this scale is then used in a simple edge detector. Our experimental results have shown that use of this estimated/corrected normal direction improves the segmentation quality by decreasing the number of unexpected edges and discontinuities (gaps) of real contours. The corrected normal direction could also be used in postprocessing to delete false edges. Our segmentation algorithm is automatic, and its performance is evaluated on CT images of the human pelvis, leg, and wrist.

Magnetic resonance imaging for in vivo assessment of three-dimensional patellar tracking.

We have developed a non-invasive measurement technique which can ultimately be used to quantify three-dimensional patellar kinematics of human subjects for a range of static positions of loaded flexion and assessed its accuracy. Knee models obtained by segmenting and reconstructing one high-resolution scan of the knee were registered to bone outlines obtained by segmenting fast, low-resolution scans of the knee in static loaded flexion. We compared patellar tracking measurements made using the new method to measurements made using Roentgen stereophotogrammetric analysis in three cadaver knee specimens loaded through a range of flexion in a test rig. The error in patellar spin and tilt measurements was less than 1.02 degrees and the error in lateral patellar shift was 0.88 mm. Sagittal plane scans provided more accurate final measurements of patellar spin and tilt, whereas axial plane scans provided more accurate measurements of lateral translation and patellar flexion. Halving the number of slices did not increase measurement error significantly, which suggests that scan times can be reduced without reducing accuracy significantly. The method is particularly useful for multiple measurements on the same subject because the high-resolution bone-models need only be created once; thus, the potential variability in coordinate axes assignment and model segmentation during subsequent measurements is removed.

Computer-assisted deformity correction using the ilizarov method.

The Taylor spatial frame is a fixation device used to implement the Ilizarov method of bone deformity correction to gradually distract an osteotomized bone at regular intervals, according to a prescribed schedule. We improve the accuracy of Ilizarov's method of osteogenesis by preoperatively planning the correction, intraoperatively measuring the location of the frame relative to the patient, and computing the final shape of the frame. In four of five tibial phantom experiments, we were able to achieve correction errors of less than 2 degrees of total rotation. We also demonstrate how registration uncertainty can be propagated through the planned transformation to visualize the range of possible correction outcomes. Our method is an improvement over an existing computer-assisted technique (Iyun et al.) in that the surgeon has the same flexibility as in the conventional technique when fixating the frame to the patient.

A point-selection algorithm based on spatial-stiffness analysis of rigid registration.

OBJECTIVE: We propose a model of shape-based registration that leads to a task-specific algorithm for preoperatively selecting a set of model registration points. MATERIALS AND METHODS: We performed five sets of computer simulations using registration points generated by our algorithm and two noise amplification index (NAI) algorithms on the basis of the research of Simon 20. We used several different bone surface models (distal radius, proximal femur and tibia) computed from CT images of patient volunteers. The number of registration points used varied between 6 and 30. RESULTS: Our algorithm was faster than the NAI-based algorithms by factors of approximately 4 and 200. It had equal or better performance in terms of target registration error (TRE) when compared with the other algorithms. Our simulations also showed that point selection can have a large effect on TRE behavior; in particular, poor point selection does not necessarily decrease TRE as more registration points are added. CONCLUSIONS: Our point-selection algorithm produces model registration points with similar or better TRE behavior than the NAI-based algorithms we tested, and it does so with significantly less computation time.

Accurate assessment of patellar tracking using fiducial and intensity-based fluoroscopic techniques.

Accuracies of a point-based and an intensity-based fluoroscopic methods of assessing patella tracking were determined by comparing the pattern of patellar motion with respect to orientation (flexion, internal rotation, and lateral tilt) and translation (lateral, proximal, and anterior) with the pattern of patellar motion measured using Roentgen stereophotogrammetric analysis in three cadaver knee specimens. Each pose in the patellar motion could be obtained from single as well as multiple calibrated fluoroscopic images. The errors using the intensity-based method were slightly higher than those of the point-based method, but they appear to be sufficiently low to detect clinically significant differences in patellar kinematics.