Knee最新文献 - Book学术

A machine learning approach using gait parameters to cluster TKA subjects into stable and unstable joints for discovery analysis

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-11 DOI: 10.1016/j.knee.2025.02.018

Erica M. Ramirez, Kathrin Ebinger , Denis Nam, Christopher Ferrigno, Markus A. Wimmer

Background

Patient-reported joint instability after total knee arthroplasty (TKA) is difficult to quantify objectively. Here, we apply machine learning to cluster TKA subjects using nine literature-proposed gait parameters as knee instability predictors and explore cluster reliability and consistency with self-organizing map (SOM) and k-means computation.

Methods

Subjects with TKA were retrieved from a data repository, supplemented by TKA patients with self-reported knee instability. Healthy elderly subjects, serving as control group for gait features, were added as well. All subjects have undergone identical gait analysis testing. Gait parameters (in singularity or combination) were used to cluster subjects using SOM and k-means and to identify the best split. Once clustered, comparisons between groups were performed.

Results

From all gait parameter combinations tried across the 91 TKA subjects, dynamic joint stiffness (DJS) was the single parameter that gave high reliability, was reasonably consistent, and singularly clustered all but one of the known unstable subjects. This TKA cluster, which contained 11 presumably unstable subjects, showed higher DJS (0.57) than the cluster containing the remaining TKA subjects (0.23). Interestingly, the latter had a DJS similar to that of the 34 healthy subjects (0.24). Additionally, during swing, the cluster with the presumably unstable subjects exhibited lower antero-posterior motion with a higher-than-normal biceps/rectus femoris activity ratio.

Conclusion

Using machine learning, DJS emerged as the most powerful variable to cluster TKA subjects into presumably stable and unstable groups based on gait. Future hypothesis driven, prospective research has to verify the observations made in this retrospective discovery work.

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引用次数: 0

Differences in functional recovery after unilateral versus bilateral total knee arthroplasty

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-11 DOI: 10.1016/j.knee.2025.02.016

Seung Jun Lee , Jun Hwan Choi , Bo Ryun Kim , Yong-Geun Park , So Young Lee , Hyun Jung Lee , Wooseong Jeong

Background

Understanding functional changes between unilateral and simultaneous bilateral total knee arthroplasty (TKA) patients remains limited. The purpose of this study was to investigate the differences in recovery times between unilateral and bilateral TKA.

Methods

We retrospectively recruited patients who met the eligibility criteria. All patients engaged in a standard rehabilitation program and completed both self-reported questionnaires and performance-based physical function tests preoperatively, at 6 and 12 weeks postoperatively.

Results

A total of 838 patients were included in this study. Those who underwent bilateral TKA (n = 281) were younger than those opting for unilateral TKA (n = 557), with no significant differences in baseline health status observed between the two groups. Both groups showed continuous improvements in pain, function, and performance-based physical functions from preoperatively to 12 weeks postoperatively. Notably, stiffness did not significantly improve from the preoperative to 6 weeks postoperatively and the stair-climbing test (SCT) showed delayed recovery, with deterioration at 6 weeks but subsequent improvement at 12 weeks in bilateral TKA group. Similarly, the recovery rate in the 6-min walking test (6MWT) was initially slow for the bilateral TKA group during the first 6 weeks, but later accelerated. Significant interactions between time and group were observed in the timed-up-and-go test, 6MWT, and SCT.

Conclusion

Patients who underwent bilateral TKA showed distinct recovery patterns, suggesting the need for tailored rehabilitation approaches compared those who underwent unilateral surgery. These findings underscore the need to provide patients with information about potential differences in recovery patterns based on their chosen surgical approach prior to surgery.

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引用次数: 0

Detailed anatomy of the meniscotibial ligament and clock face position of meniscal attachments in the tibia

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-08 DOI: 10.1016/j.knee.2025.02.022

Keiichi Yoshida , Mitsuaki Kubota , Haruka Kaneko , Jun Tomura , Jun Shiozawa , Youngji Kim , Shinnosuke Hada , Yoshitomo Saita , Muneaki Ishijima

Background

The meniscotibial ligament (MTL) is linked to meniscal extrusion that leads to knee osteoarthritis. There have been some reports on surgical treatment of MTL, however, the precise anatomy of the MTL attachment remains unclear. This study aimed to investigate the detailed anatomy of the attachment and to propose a method of clock face position.

Methods

Twenty knees of embalmed cadavers were included. Imaginary clock face positions were drawn on the tibial joint surface, with the anterior side defined as 12 o’clock, the posterior side as 6 o’clock, the medial side as 3 o’clock, and the lateral side as 9 o’clock. The MTL attachments to the tibial rim were then analyzed at 1-h intervals.

Results

All medial MTL and lateral MTL attachments at the 7 o’clock position were attached to the wall. MTL attachments on the articular surface were observed in certain cases at the 9 o’clock, 10 o’clock, and 11 o’clock positions. The medial MTL attachment was furthest from the articular surface at the 1 o’clock position and closest at the 4 o’clock position. The lateral MTL attachment was furthest at the 7 o’clock and closest at the 11 o’clock positions.

Conclusions

We revealed the detailed anatomy of the MTL and defined a novel method of clock face position. The medial MTL was not attached to the articular surface, whereas the lateral MTL was more anteriorly attached to the articular surface. These findings may facilitate the development of more accurate surgical techniques.

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引用次数: 0

Is leukocyte scintigraphy recommended in periprosthetic knee infection diagnosis? A retrospective study of 92 total knee arthroplasties

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-05 DOI: 10.1016/j.knee.2025.02.005

Maria Pia Neri , Mirco Lo Presti , Davide Pellicanò , Marco Minerba , Monica Cosentino , Cosimo Vasco , Ludovica Solito , Gabrio Goracci , Stefano Zaffagnini

Purpose

The aim of this study was to assess in vitro labelled leukocyte scintigraphy (LS) diagnostic accuracy in periprosthetic knee infection diagnosis.

Methods

This is a retrospective study that includes all patients with total knee arthroplasty (TKA) who performed LS before undergoing revision surgery for septic or aseptic loosening of the implant in our department from January of 2011 to March of 2023.

The 2018 International Consensus Meeting (ICM) and 2021 European Bone and Joint Infection Society (EBJS) periprosthetic joint infection (PJI) definitions were employed to define infected and not infected patients.

Results

92 TKAs were included in this study. This was the LS diagnostic performance according to the 2018 ICM PJI definition: sensitivity 89%, specificity 80%, positive predictive value (PPV) 80%, negative predictive value (NPV) 89%, positive likelihood ratio (LR + ) 4.46, negative likelihood ratio (LR-) 0.14. According to 2021 EBJS PJI definition: sensitivity 91%, specificity 80%, PPV 76%, NPV 92%, LR + 4.43, LR- 0.12.

Conclusion

Previously published studies on LS diagnostic performance report very variable results, probably due to the different and subjective PJI diagnostic criteria employed by each article. This is one of the first studies to employ the most recent PJI definitions and to demonstrate that LS may have a higher specificity and PPV than previously estimated. Therefore it represents a valid instrument in PJI diagnosis.

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引用次数: 0

Posterior tibial slope after total knee arthroplasty is not reproducible or consistent

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-04 DOI: 10.1016/j.knee.2025.01.006

Ekin Barış Demir, Fatih Barça, Mert Uçak, Halis Atıl Atilla, Mutlu Akdoğan, Yalım Ateş

Background

Our aim was to compare posterior tibial slope (PTS) values, distribution, deviation from manufacturer’s recommended value and restoration of this value in total knee arthroplasty (TKA) with tibial component placement using intramedullary (IM) and extramedullary (EM) methods, and to analyze factors affecting these values.

Methods

A total of 151 knees operated with Zimmer-Biomet NexGen® LPS Fixed Bearing Knee TKA between 2022 and 2024 were retrospectively investigated. Knees were grouped by method of tibial component placement (IM or EM). Pre-operative descriptive data, postoperative PTS, scatteredness of PTS, difference between pre-operative and postoperative PTS, deviation from 7° which was claimed by the manufacturer and rate of outliers were compared between groups. Factors that might affect postoperative PTS in the EM group were analyzed.

Results

Ninety-five knees (62.9%) in the EM group and 56 knees (37.1%) in the IM group were analyzed. Mean PTS decreased from 8.8 ± 3.5° to 6.7 ± 2.7° (P < 0.001) in the EM group, and from 10 ± 4.1° to 4.9 ± 2.6° (P < 0.001) in the IM group. Postoperative PTS was significantly lower in the IM group (P < 0.001). Mean deviation from 7° claimed by the manufacturer was 2.4 ± 1.4° for the EM group and 2.8 ± 1.8° for the IM group (P = 0.14). In 15 of 151 patients (9.9%), postoperative PTS was above 10°. Linear regression analysis revealed a moderate effect of pre-operative PTS and weight in the EM group.

Conclusions

Although not statistically significant, the EM method is closer to the manufacturer’s recommendation for sagittal alignment. However, both groups had a wide range of PTS and a large number of outliers. Both methods are not reliable in terms of PTS reproducibility and consistency.

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引用次数: 0

Comparison of predictive models for knee pain and analysis of individual and physical activity variables using interpretable machine learning

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-04 DOI: 10.1016/j.knee.2025.02.006

Jun-hee Kim

Background

Knee pain is associated with not only individual factors such as age and obesity but also physical activity factors such as occupational activities and exercise, which has a significant impact on the lives of adults and the elderly.

Objectives

The purpose of this study was to construct a model for predicting knee pain using individual and physical activity variables and to determine the relationship between knee pain and individual and physical activity variables.

Design

Observational study.

Methods

A total of 19 variables related to individual and physical activity were used to create a knee pain prediction model. Model composition variables were selected using recursive feature elimination with cross validation. The performance of the model was evaluated using test data, and the relationship between knee pain and predictor variables was analyzed using SHapley Additive exPlanations (SHAP).

Results

The CatBoost model showed the highest performance. And, activity limitation was identified as the most influential predictor, followed by weekly physical activity, body image, weight change, occupational type, age, BMI, and housing type.

Conclusion

Knee pain prediction models built with individual and physical activity variables can exhibit relatively high predictive performance, and interpretable machine learning models can provide valuable insight into the complex relationships between individual and physical activity variables and knee pain.

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引用次数: 0

Periarticular injection versus placebo in total knee arthroplasty with intrathecal morphine

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-03 DOI: 10.1016/j.knee.2025.02.004

Daniel J. Lombardo , Teresa Potter , Gregory Tocks , Aaron J. Johnson , Jeremy A. Ross , William A. Jiranek , Gregory J. Golladay

Introduction

Periarticular injection (PAI) is one part of total knee arthroplasty (TKA) multimodal analgesia protocols. PAI combined with neuraxial anesthesia including intrathecal morphine (ITM) has not been previously investigated. This study prospectively compares PAI to placebo injection in patients undergoing TKA under spinal anesthesia with ITM.

Methods

We performed a prospective, double-blinded randomized controlled trial comparing immediate postoperative outcomes after TKA. All patients received combined spinal-epidural (CSE) anesthesia with ITM and multimodal analgesia. The study group received a standardized PAI with 0.5% ropivacaine, clonidine, ketorolac, and epinephrine, while the control group received PAI with saline. Exclusion criteria were revision surgery, inability to receive epidural anesthesia or PAI, patients taking greater than 80 morphine milligram equivalents (MME) daily prior to surgery, and lack of patient consent to participate in the study.

Results

Sixty-four patients enrolled and completed the study from 2015 to 2021. Thirty-four were randomized to the study group and 30 to the control. There was no difference in mean total postoperative opioid consumption between PAI (125.49 MME) and control (138.80 MME); (p = 0.556). There was also no difference in opioid requirements at 0–24 and 24–48 h between PAI (58.87 and 70.57 MME), and control (70.57 and 69.72 MME); (p = 0.308 and p = 0.556).

Conclusion

This study, while underpowered, demonstrates that PAI does not significantly decrease opioid consumption after TKA compared to placebo injection when utilizing ITM spinal anesthesia. When ITM is used, PAI may be reasonably be excluded from the protocol without affecting opioid requirements.

引言关节周围注射（PAI）是全膝关节置换术（TKA）多模式镇痛方案的一部分。PAI 与神经轴麻醉（包括鞘内吗啡 (ITM)）的结合此前尚未进行过研究。我们进行了一项前瞻性双盲随机对照试验，比较了 TKA 术后的即时疗效。所有患者都接受了带 ITM 的脊髓硬膜外联合麻醉（CSE）和多模式镇痛。研究组使用 0.5% 罗哌卡因、氯尼丁、酮咯酸和肾上腺素进行标准化 PAI，对照组使用生理盐水进行 PAI。排除标准为翻修手术、无法接受硬膜外麻醉或PAI、术前每日服用超过80吗啡毫克当量（MME）的患者，以及未征得患者同意参与研究的患者。34人被随机分配到研究组，30人被随机分配到对照组。PAI 组（125.49 MME）和对照组（138.80 MME）的术后阿片类药物平均总用量没有差异；（P = 0.556）。结论本研究虽然效力不足，但表明在使用 ITM 脊髓麻醉时，与安慰剂注射相比，PAI 不会显著减少 TKA 术后的阿片类药物消耗量。在使用 ITM 时，可以合理地将 PAI 排除在方案之外，而不会影响阿片类药物的需求。

{"title":"Periarticular injection versus placebo in total knee arthroplasty with intrathecal morphine","authors":"Daniel J. Lombardo , Teresa Potter , Gregory Tocks , Aaron J. Johnson , Jeremy A. Ross , William A. Jiranek , Gregory J. Golladay","doi":"10.1016/j.knee.2025.02.004","DOIUrl":"10.1016/j.knee.2025.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Periarticular injection (PAI) is one part of total knee arthroplasty (TKA) multimodal analgesia protocols. PAI combined with neuraxial anesthesia including intrathecal morphine (ITM) has not been previously investigated. This study prospectively compares PAI to placebo injection in patients undergoing TKA under spinal anesthesia with ITM.</div></div><div><h3>Methods</h3><div>We performed a prospective, double-blinded randomized controlled trial comparing immediate postoperative outcomes after TKA. All patients received combined spinal-epidural (CSE) anesthesia with ITM and multimodal analgesia. The study group received a standardized PAI with 0.5% ropivacaine, clonidine, ketorolac, and epinephrine, while the control group received PAI with saline. Exclusion criteria were revision surgery, inability to receive epidural anesthesia or PAI, patients taking greater than 80 morphine milligram equivalents (MME) daily prior to surgery, and lack of patient consent to participate in the study.</div></div><div><h3>Results</h3><div>Sixty-four patients enrolled and completed the study from 2015 to 2021. Thirty-four were randomized to the study group and 30 to the control. There was no difference in mean total postoperative opioid consumption between PAI (125.49 MME) and control (138.80 MME); (<em>p</em> = 0.556). There was also no difference in opioid requirements at 0–24 and 24–48 h between PAI (58.87 and 70.57 MME), and control (70.57 and 69.72 MME); (<em>p</em> = 0.308 and <em>p</em> = 0.556).</div></div><div><h3>Conclusion</h3><div>This study, while underpowered, demonstrates that PAI does not significantly decrease opioid consumption after TKA compared to placebo injection when utilizing ITM spinal anesthesia. When ITM is used, PAI may be reasonably be excluded from the protocol without affecting opioid requirements.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 122-127"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The length of the popliteus on sagittal views correlates with high tibiofemoral rotations and patellar instability 矢状切面上腘绳肌的长度与胫股骨高度旋转和髌骨不稳定性有关

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-03 DOI: 10.1016/j.knee.2025.02.003

Shelby T. Desroches , Nancy Park , David B. Frumberg , John P. Fulkerson , Johannes M. Sieberer

Purpose

This study evaluates the relationship between tibiofemoral rotation and the length of the popliteus on sagittal views to assess if there are significant length differences in the popliteus with different degrees of rotation.

Methods

MRIs were analyzed from two age-sex-matched cohorts: patellofemoral instability (PFI) patients and controls. Tibiofemoral rotation was measured by recording the angle between the femoral and tibial condylar lines. The popliteus length was measured by subtracting the distance from the popliteus sulcus to the femoral condyle and the sulcus to the posterior tibia on sagittal slices. Interrater reliability was calculated using intraclass correlation coefficients (ICC), a regression analysis described relationships between the metrics, and a Mann-Whitney U test compared median differences between cohorts. A significance level of 0.05 was used for all analyses.

Results

There were statistically significant positive relationships between rotation and length overall (

r^{2}

= 0.49, p < 0.001), for the patient group (

r^{2}

= 0.35, p < 0.001) and for the control group (

r^{2}

= 0.52, p < 0.001). There was a significant difference between the PFI and control group for the rotation (p < 0.001) and length (p = 0.002). In total, seventy knees were included, 35 patients and 35 controls. The ICC for the rotation and length measurements were 0.87 (CI: 0.77–0.93) and 0.94 (CI: 0.89–0.97) respectively.

Conclusion

This study identified increased popliteus length associated with increased external tibiofemoral rotation as seen in patella instability patients. These findings demonstrate a further need to investigate the implications of advancing the popliteus for treatment of high tibiofemoral rotations.

目的本研究评估了矢状切面上胫骨股骨旋转与腘绳肌长度之间的关系，以评估不同旋转程度的腘绳肌是否存在显著的长度差异。方法分析了两个年龄性别匹配的组群：髌骨股骨不稳（PFI）患者和对照组的 MRI 图像。通过记录股骨髁线和胫骨髁线之间的角度来测量胫骨股骨旋转。腘绳肌长度的测量方法是在矢状切片上减去腘绳肌沟到股骨髁的距离和腘绳肌沟到胫骨后端的距离。使用类内相关系数（ICC）计算相互之间的可靠性，回归分析描述指标之间的关系，曼-惠特尼U检验比较组群之间的中位数差异。所有分析的显著性水平均为 0.05。结果总体而言，旋转和长度之间存在显著的正相关关系（r2 = 0.49，p < 0.001），患者组（r2 = 0.35，p < 0.001）和对照组（r2 = 0.52，p < 0.001）也是如此。在旋转（p <0.001）和长度（p = 0.002）方面，PFI 组与对照组存在明显差异。总共纳入了 70 个膝关节，其中 35 个是患者，35 个是对照组。旋转和长度测量的 ICC 分别为 0.87（CI：0.77-0.93）和 0.94（CI：0.89-0.97）。这些发现表明，有必要进一步研究推进腘绳肌对治疗胫骨股骨高度旋转的影响。

{"title":"The length of the popliteus on sagittal views correlates with high tibiofemoral rotations and patellar instability","authors":"Shelby T. Desroches , Nancy Park , David B. Frumberg , John P. Fulkerson , Johannes M. Sieberer","doi":"10.1016/j.knee.2025.02.003","DOIUrl":"10.1016/j.knee.2025.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the relationship between tibiofemoral rotation and the length of the popliteus on sagittal views to assess if there are significant length differences in the popliteus with different degrees of rotation.</div></div><div><h3>Methods</h3><div>MRIs were analyzed from two age-sex-matched cohorts: patellofemoral instability (PFI) patients and controls. Tibiofemoral rotation was measured by recording the angle between the femoral and tibial condylar lines. The popliteus length was measured by subtracting the distance from the popliteus sulcus to the femoral condyle and the sulcus to the posterior tibia on sagittal slices. Interrater reliability was calculated using intraclass correlation coefficients (ICC), a regression analysis described relationships between the metrics, and a Mann-Whitney <em>U</em> test compared median differences between cohorts. A significance level of 0.05 was used for all analyses.</div></div><div><h3>Results</h3><div>There were statistically significant positive relationships between rotation and length overall (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.49, <em>p</em> < 0.001), for the patient group (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.35, <em>p</em> < 0.001) and for the control group (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.52, <em>p</em> < 0.001). There was a significant difference between the PFI and control group for the rotation (<em>p</em> < 0.001) and length (<em>p</em> = 0.002). In total, seventy knees were included, 35 patients and 35 controls. The ICC for the rotation and length measurements were 0.87 (CI: 0.77–0.93) and 0.94 (CI: 0.89–0.97) respectively.</div></div><div><h3>Conclusion</h3><div>This study identified increased popliteus length associated with increased external tibiofemoral rotation as seen in patella instability patients. These findings demonstrate a further need to investigate the implications of advancing the popliteus for treatment of high tibiofemoral rotations.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 128-135"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-03 DOI: 10.1016/j.knee.2025.02.013

Dominic Cullen , Peter Thompson , David Johnson , Claudia Lindner

Background

Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs.

Methods

We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.

Results

The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°.

Conclusion

The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.

{"title":"An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs","authors":"Dominic Cullen , Peter Thompson , David Johnson , Claudia Lindner","doi":"10.1016/j.knee.2025.02.013","DOIUrl":"10.1016/j.knee.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs.</div></div><div><h3>Methods</h3><div>We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.</div></div><div><h3>Results</h3><div>The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°.</div></div><div><h3>Conclusion</h3><div>The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 99-110"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Deep learning for tibial plateau fracture detection and classification

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-03-01 DOI: 10.1016/j.knee.2025.02.001

N. van der Gaast , P. Bagave , N. Assink , S. Broos , R.L. Jaarsma , M.J.R. Edwards , E. Hermans , F.F.A. IJpma , A.Y. Ding , J.N. Doornberg , J.H.F. Oosterhoff , the Machine Learning Consortium

Background

Deep learning (DL) has been shown to be successful in interpreting radiographs and aiding in fracture detection and classification. However, no study has aimed to develop a computer vision model for tibia plateau fractures using the Schatzker classification. Therefore, this study aims to develop a deep learning model for (1) detection of tibial plateau fractures and (2) classification according to the Schatzker classification.

Methods

A multicenter approach was performed for the collection of radiographs of patients with tibia plateau fractures. Both anteroposterior and lateral images were uploaded into an annotation software and manually labelled and annotated. The dataset was balanced for optimizing model development and split into a training set and a test set. We trained two convolutional neural networks (GoogleNet and ResNet) for the detection and classification of tibia plateau fractures following the Schatzker classification.

Results

A total of 1506 knee radiographs from 753 patients, including 368 tibial plateau fractures and 385 healthy knees, were used to create the algorithm. The GoogleNet algorithm demonstrated high sensitivity (92.7%) but intermediate accuracy (70.4%) and positive predictive value (64.4%) in detecting tibial plateau fractures, indicating reliable detection of fractured cases. It exhibited limited success in accurately classifying fractures according to the Schatzker system, achieving an accuracy of only 34.6% and a sensitivity of 32.1%.

Conclusion

This study shows that detection of tibial plateau fractures is a task that a DL algorithm can grasp; further refinement is necessary to enhance their accuracy in fracture classification. Computer vision models might improve using different classification systems, as the current Schatzker classification suffers from a low interobserver agreement on conventional radiographs.

{"title":"Deep learning for tibial plateau fracture detection and classification","authors":"N. van der Gaast , P. Bagave , N. Assink , S. Broos , R.L. Jaarsma , M.J.R. Edwards , E. Hermans , F.F.A. IJpma , A.Y. Ding , J.N. Doornberg , J.H.F. Oosterhoff , the Machine Learning Consortium","doi":"10.1016/j.knee.2025.02.001","DOIUrl":"10.1016/j.knee.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Deep learning (DL) has been shown to be successful in interpreting radiographs and aiding in fracture detection and classification. However, no study has aimed to develop a computer vision model for tibia plateau fractures using the Schatzker classification. Therefore, this study aims to develop a deep learning model for (1) detection of tibial plateau fractures and (2) classification according to the Schatzker classification.</div></div><div><h3>Methods</h3><div>A multicenter approach was performed for the collection of radiographs of patients with tibia plateau fractures. Both anteroposterior and lateral images were uploaded into an annotation software and manually labelled and annotated. The dataset was balanced for optimizing model development and split into a training set and a test set. We trained two convolutional neural networks (GoogleNet and ResNet) for the detection and classification of tibia plateau fractures following the Schatzker classification.</div></div><div><h3>Results</h3><div>A total of 1506 knee radiographs from 753 patients, including 368 tibial plateau fractures and 385 healthy knees, were used to create the algorithm. The GoogleNet algorithm demonstrated high sensitivity (92.7%) but intermediate accuracy (70.4%) and positive predictive value (64.4%) in detecting tibial plateau fractures, indicating reliable detection of fractured cases. It exhibited limited success in accurately classifying fractures according to the Schatzker system, achieving an accuracy of only 34.6% and a sensitivity of 32.1%.</div></div><div><h3>Conclusion</h3><div>This study shows that detection of tibial plateau fractures is a task that a DL algorithm can grasp; further refinement is necessary to enhance their accuracy in fracture classification. Computer vision models might improve using different classification systems, as the current Schatzker classification suffers from a low interobserver agreement on conventional radiographs.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 81-89"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0