Frank C. Kolo

Assessment of Congruence and Impingement of the Hip Joint in Professional Ballet Dancers: A Motion Capture Study

Background: Early hip osteoarthritis in dancers could be explained by femoroacetabular impingements. However, there is a lack of validated noninvasive methods and dynamic studies to ascertain impingement during motion. Moreover, it is unknown whether the femoral head and acetabulum are congruent in typical dancing positions. Hypothesis: The practice of some dancing movements could cause a loss of hip joint congruence and recurrent impingements, which could lead to early osteoarthritis. Study Design: Descriptive laboratory study. Methods: Eleven pairs of female dancer’s hips were motion captured with an optical tracking system while performing 6 different dancing movements. The resulting computed motions were applied to patient-specific hip joint 3-dimensional models based on magnetic resonance images. While visualizing the dancer’s hip in motion, the authors detected impingements using computer-assisted techniques. The range of motion and congruence of the hip joint were also quantified in those 6 recorded dancing movements. Results: The frequency of impingement and subluxation varied with the type of movement. Four dancing movements (développé à la seconde, grand écart facial, grand écart latéral, and grand plié) seem to induce significant stress in the hip joint, according to the observed high frequency of impingement and amount of subluxation. The femoroacetabular translations were high (range, 0.93 to 6.35 mm). For almost all movements, the computed zones of impingement were mainly located in the superior or posterosuperior quadrant of the acetabulum, which was relevant with respect to radiologically diagnosed damaged zones in the labrum. All dancers’ hips were morphologically normal. Conclusion: Impingements and subluxations are frequently observed in typical ballet movements, causing cartilage hypercompression. These movements should be limited in frequency. Clinical Relevance: The present study indicates that some dancing movements could damage the hip joint, which could lead to early osteoarthritis.

Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis: A randomized, double‐blind, placebo‐controlled clinical trial at a single center

OBJECTIVE To evaluate the symptomatic effects of highly purified chondroitin 4 and chondroitin 6 sulfate (CS) therapy in patients with osteoarthritis (OA) of the hand. METHODS This investigator-initiated, single-center, randomized, double-blind, placebo-controlled clinical trial included 162 symptomatic patients with radiographic evidence of hand OA (American College of Rheumatology criteria). Inclusion criteria included patients assessment of global spontaneous hand pain of at least 40 mm on a 0-100-mm visual analog scale (VAS) and functional impairment of at least 6 (0-30 scale) on the Functional Index for Hand OA (FIHOA) in the most symptomatic hand. Patients received either 800 mg of CS (n = 80 patients) or placebo (n = 82 patients) once daily for 6 months and were analyzed in an intent-to-treat approach. The two primary outcomes were the change in the patients assessment of global spontaneous hand pain and in hand function (by FIHOA score) from baseline to month 6. Secondary outcomes were improvement in grip strength, duration of morning stiffness, acetaminophen consumption, and the investigators global impression of treatment efficacy. RESULTS There was a significantly more pronounced decrease in the patients global assessment of hand pain in the CS group than in the placebo group (difference VAS scores -8.7 mm; P = 0.016). Hand function improved significantly more in the CS group than in the placebo group (difference in FIHOA scores -2.14; P = 0.008). There was a statistically significant between-group difference in favor of CS for the duration of morning stiffness and for the investigators global impression of treatment efficacy. Changes in grip strength, acetaminophen consumption, and safety end points were not significantly different between the two groups. CONCLUSION This study demonstrates that CS improves hand pain and function in patients with symptomatic OA of the hand and shows a good safety profile.

A patient-specific measurement technique to model shoulder joint kinematics.

BACKGROUND Measuring dynamic in vivo shoulder kinematics is crucial to better understanding numerous pathologies. Motion capture systems using skin-mounted markers offer good solutions for non-invasive assessment of shoulder kinematics during dynamic movement. However, none of the current motion capture techniques have been used to study translation values at the joint, which is crucial to assess shoulder instability. The aim of the present study was to develop a dedicated patient-specific measurement technique based on motion capture and magnetic resonance imaging (MRI) to determine shoulder kinematics accurately. HYPOTHESIS Estimation of both rotations and translations at the shoulder joint using motion capture is feasible thanks to a patient-specific kinematic chain of the shoulder complex reconstructed from MRI data. MATERIALS AND METHODS We implemented a patient-specific kinematic chain model of the shoulder complex with loose constraints on joint translation. To assess the effectiveness of the technique, six subjects underwent data acquisition simultaneously with fluoroscopy and motion capture during flexion and empty-can abduction. The reference 3D shoulder kinematics was reconstructed from fluoroscopy and compared to that obtained from the new technique using skin markers. RESULTS Root mean square errors (RMSE) for shoulder orientation were within 4° (mean range: 2.0°-3.4°) for each anatomical axis and each motion. For glenohumeral translations, maximum RMSE for flexion was 3.7mm and 3.5mm for empty-can abduction (mean range: 1.9-3.3mm). Although the translation errors were significant, the computed patterns of humeral translation showed good agreement with published data. DISCUSSION To our knowledge, this study is the first attempt to calculate both rotations and translations at the shoulder joint based on skin-mounted markers. Results were encouraging and can serve as reference for future developments. The proposed technique could provide valuable kinematic data for the study of shoulder pathologies. LEVEL OF EVIDENCE Basic Science Study.

Kinematics of the shoulder joint in tennis players

OBJECTIVES Shoulder pain and injury are common in tennis players. The precise causes for such pain remain unclear. Impingement at critical tennis positions and glenohumeral instability have never been dynamically evaluated in vivo. The purpose of this study was to evaluate the different types of impingement and stability during tennis movements. DESIGN Laboratory study. METHODS Type and frequency of impingement as well as percentage of subluxation were evaluated in 10 tennis players through a novel dedicated patient-specific measurement technique based on optical motion capture and Magnetic Resonance Imaging (MRI). RESULTS All volunteers, nine male and one female, had a clinically functional rotator cuff. MRI revealed 11 rotator cuff lesions in six subjects and six labral lesions in five subjects. Lateral subacromial, anterior subacromial, internal anterosuperior, and internal posterosuperior impingements were observed in four, three, two and seven subjects, respectively. No instability could be demonstrated in this population. CONCLUSIONS Tennis players presented frequent radiographic signs of structural lesions that could mainly be related to posterosuperior impingements due to repetitive abnormal motion contacts. This is the first study demonstrating that a dynamic and precise motion analysis of the entire kinematic chain of the shoulder is possible through a non-invasive method of investigation. This premier kinematic observation offers novel insights into the analysis of shoulder impingement and instability that could, with future studies, be generalized to other shoulder pathologies and sports. This original method may open new horizons leading to improvement in impingement comprehension.

Analysis of hip range of motion in everyday life: a pilot study

Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the “normal hip” in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction.

Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study.

Abstract Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation. Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography. Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values. While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder.

A new tear pattern of the rotator cuff and its treatment: Fosbury flop tears.

PURPOSE The purpose of this report is to describe a new full-thickness tear pattern of the posterosuperior rotator cuff with reversal healing. We describe the specific radiologic signs associated with this tear pattern and the arthroscopic rotator cuff repair technique. MATERIALS AND METHODS A prospective radiologic and clinical study collected all patients with a magnetic resonance imaging arthrogram that underwent an arthroscopic rotator cuff repair over a 1 year period. RESULTS Among 97 patients, five demonstrated a tear of the posterosuperior rotator cuff with reversal healing. Characteristic radiographic findings included a thicker tendon than normal, the presence of a stump and accumulation of liquid in the superior-medial part of the subacromial bursa, and adhesions between the supraspinatus tendon and the wall of the subacromial bursa. CONCLUSION Avulsion of the posterosuperior rotator cuff with reversal healing on its bursal-side is a less common condition. This type of lesion and distinct radiographic signs that can be recognized to facilitate anatomic repair of the rotator cuff. LEVEL OF EVIDENCE Level IV.

An orthopaedic surgeon's guide to ultrasound imaging of the healthy, pathological and postoperative shoulder

Ultrasound (US) imaging is an efficient, easy to use and inexpensive tool allowing for facilitated diagnosis and management of the painful shoulder. It remains primarily used by radiologists and rheumatologists, despite having shown excellent diagnostic accuracy when used by different medical specialities in their office-based consultation. It also has advantages over other imaging modalities in the evaluation of the postoperative shoulder for rotator cuff integrity and correct anchor and suture placement, as well as rotator cuff analysis following arthroplasty. Integration of US imaging into the orthopaedic surgeons toolbox can be aided by a basic understanding of US principles, accompanied by a guide outlining basic techniques for evaluation of the healthy, pathological and postoperative shoulder as well as US-guided treatment possibilities.

ArthroPlanner: a surgical planning solution for acromioplasty

PurposeWe present a computer-assisted planning solution “ArthroPlanner” for acromioplasty based on 3D anatomical models, computed tomography and joint kinematic simulations.MethodsIn addition to a standard static clinical evaluation (anamnesis, radiological examination), the software provides a dynamic assessment of the shoulder joint by computing in real time the joint kinematics from a database of activities of daily living. During motion, the precise bone resection (location and amount) is computed based on detected subacromial impingements, providing surgeons with precise information about the surgical procedure. Moreover, to improve the subjective reading of medical images, the software provides 3D measurement tools based on anatomical models assisting in the analysis of shoulder morphological features.ResultsWe performed an in vivo assessment of the software in a prospective randomized clinical study conducted with 27 patients beneficiating from the planning solution and a control group of 31 patients without planning. Postoperatively, patient’s pain decreased, and the shoulder range of motion and the functional outcomes improved significantly and the rotator cuff healing rate was good for both groups without intergroup differences. The amount of bone resected at surgery was comparable between the groups. The percentage of remaining impingement after surgery was in average reduced to 51% without groups difference.ConclusionsArthroPlanner software includes all required materials (images data, 3D models, motion, morphological measurements, etc.) to improve orthopedists’ performance in the surgical planning of acromioplasty. The solution offers a perfect analysis of the patient’s anatomy and the ability to precisely analyze a dynamic mechanism to fully apprehend the patient’s condition and to fulfill his/her expectations. The study however failed to detect any statistically significant difference in clinical outcomes and bone resection between the groups. Short-term clinical and radiological results were excellent in both groups.

Multi-body optimization with subject-specific knee models: performance at high knee flexion angles

Abstract When estimating knee kinematics from skin markers and stereophotogrammetry, multi-body optimization (MBO) has provided promising results for reducing soft tissue artefacts (STA), but can still be improved. The goal of this study was to assess the performance of MBO with subject-specific knee models at high knee flexion angles (up to 110°) against knee joint kinematics measured by magnetic resonance imaging. Eight subjects were recruited. MBO with subject-specific knee models was more effective in compensating STA compared to no kinematic and spherical constraints, in particular for joint displacements. Moreover, it seems to be more reliable over large ranges of knee flexion angle. The ranges of root mean square errors for knee rotations/displacements were 3.0°–9.2°/1.3–3.5 mm for subject-specific knee models, 6.8°–8.7°/6.0–12.4 mm without kinematic constraint and 7.1°–9.8°/4.9–12.5 mm for spherical constraints.