Robotically Simulated Pivot Shift That Represents the Clinical Exam
| Autor: | Jarrod E Dumpe, Tara F. Nagle, Joel D Kolmodin, Paul Saluan, Robb Colbrunn, Wael K. Barsoum |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Anterior cruciate ligament 0206 medical engineering Pivot shift Clinical exam 02 engineering and technology 03 medical and health sciences 0302 clinical medicine Cadaver medicine Humans Orthopedics and Sports Medicine Tibial rotation Anterior Cruciate Ligament 030203 arthritis & rheumatology Orthodontics Anterior Cruciate Ligament Reconstruction business.industry Biomechanics Robotics musculoskeletal system 020601 biomedical engineering Biomechanical Phenomena surgical procedures operative medicine.anatomical_structure Orthopedic surgery Cadaveric spasm business human activities |
| Zdroj: | Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 37(12) |
| ISSN: | 1554-527X |
| Popis: | A thorough understanding of anterior cruciate ligament (ACL) function and the effects of surgical interventions on knee biomechanics requires robust technologies and simulation paradigms that align with clinical insight. In vitro orthopedic biomechanical testing for the elucidation of ACL integrity doesn't have an established testing paradigm to simulate the clinical pivot shift exam on cadaveric specimens. The study aim was to develop a robotically simulated pivot shift that represents the clinical exam. An orthopedic surgeon performed a pivot shift on an instrumented ACL-deficient cadaver leg to capture 6 degree-of-freedom motion/loads. The same knee was mounted to the robot and the sensitivity of the motion/loading profiles quantified. Three loading profile candidates that generated positive pivot shifts on the instrumented knee were selected and applied to 7 ACL-intact/deficient specimens and resulted in the identification of a profile that was able to induce a positive pivot shift in all ACL-deficient specimens ( p < 0.001). The simulated shifts began at 22 ± 8° and ended at 33 ± 6° of flexion with the average magnitude of the shifts being 12.8 ± 3.2 mm in anterior tibial translation and 17.6 ± 4.3° in external tibial rotation. The establishment and replication of a robotically simulated clinical pivot shift across multiple specimens show the robustness of the loading profile to accommodate anatomical and experimental variability. Further evaluation and refinement should be undertaken to create a useful tool in evaluating ACL function and reconstruction techniques. Statement of clinical significance: Creation and successful demonstration of the simulated clinical pivot shift validates a profile for robotic musculoskeletal simulators to analyze ACL related clinical questions. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2601-2608, 2019. |
| Databáze: | OpenAIRE |
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