Progress on in vivo ankle biomechanics based on dual fluoroscopic imaging technology_Journal of Biomedical Engineering

Authors：

YE Dongqiang ¹ , SUN Xiaole ¹ , ZHANG Cui ^1,2 , ZHANG Shen ¹ , ZHANG Xini ¹ ,  FU Weijie ¹

1. Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, P.R. China;
2. Laboratory of Sports Biomechanics, Sport Science Research Center of Shandong, Jinan 250014, P.R. China;

Corresponding author：

Keywords：

dual fluoroscopic imaging system; in vivo kinematics; ankle; motion analysis

DOI：

10.7507/1001-5515.202006009

Video：

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The technical deficiencies in traditional medical imagining methods limit the study of in vivo ankle biomechanics. A dual fluoroscopic imaging system (DFIS) provides accurate and non-invasive measurements of dynamic and static activities in joints of the body. This approach can be used to quantify the movement in the single bones of the ankle and analyse different morphological and complex bone positions and movement patterns within these organs and has been widely used in the field of image diagnosis and evaluation of clinical biomechanics. This paper reviews the applications of DFIS that were used to measure the in vivo kinematics of the ankle in the field of clinical and sports medicine. The advantages and shortcomings of DFIS in the practical application are summarised. We further put forward effective research programs for understanding the movement as well as injury mechanism of the ankle in vivo, and provide constructive research direction for future study.

Citation： YE Dongqiang, SUN Xiaole, ZHANG Cui, ZHANG Shen, ZHANG Xini, FU Weijie. Progress on in vivo ankle biomechanics based on dual fluoroscopic imaging technology. Journal of Biomedical Engineering, 2021, 38(3): 602-608. doi: 10.7507/1001-5515.202006009 Copy

1.	Kessler S E, Rainbow M J, Lichtwark G A, et al. A direct comparison of biplanar videoradiography and optical motion capture for foot and ankle kinematics. Front Bioeng Biotechnol, 2019, 7: 199.
2.	Belatti D A, Phisitkul P. Economic burden of foot and ankle surgery in the US Medicare population. Foot Ankle Int, 2014, 35(4): 334-340.
3.	Cigoja S, Asmussen M J, Firminger C R, et al. The effects of increased midsole bending stiffness of sport shoes on muscle-tendon unit shortening and shortening velocity: a randomised crossover trial in recreational male runners. Sports Med Open, 2020, 6(1): 9.
4.	Lin C C, Li J D, Lu T W, et al. A model-based tracking method for measuring 3D dynamic joint motion using an alternating biplane X-ray imaging system. Med Phys, 2018, 45(8): 3637-3649.
5.	Zhu G, Wang Z, Yuan C, et al. In vitro study of foot bone kinematics via a custom-made cadaveric gait simulator. J Orthop Surg Res, 2020, 15(1): 346.
6.	Niu K, Anijs T, Sluiter V, et al. In situ comparison of a-mode ultrasound tracking system and skin-mounted markers for measuring kinematics of the lower extremity. J Biomech, 2018, 72: 134-143.
7.	de Asla R J, Wan L, Rubash H E, et al. Six DOF in vivo kinematics of the ankle joint complex: application of a combined dual-orthogonal fluoroscopic and magnetic resonance imaging technique. J Orthop Res, 2006, 24(5): 1019-1027.
8.	张翠, 汤运启, 王少白, 等. 双平面正交荧光透视成像系统在运动医学领域中的应用研究进展. 中国运动医学杂志, 2019, 38(8): 717-725.
9.	Balsdon M, Dombroski C, Bushey K, et al. Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: a biplane fluoroscopy study. Prosthet Orthot Int, 2019, 43(3): 331-338.
10.	Cao S, Wang C, Ma X, et al. In vivo kinematics of functional ankle instability patients and lateral ankle sprain copers during stair descent. J Orthop Res, 2019, 37(8): 1860-1867.
11.	Cao S, Wang C, Zhang G, et al. In vivo kinematics of functional ankle instability patients during the stance phase of walking. Gait Posture, 2019, 73: 262-268.
12.	Cao S, Wang C, Zhang G, et al. Effects of an ankle brace on the in vivo kinematics of patients with chronic ankle instability during walking on an inversion platform. Gait Posture, 2019, 72: 228-233.
13.	Lawrence R L, Ellingson A M, Ludewig P M. Validation of single-plane fluoroscopy and 2D/3D shape-matching for quantifying shoulder complex kinematics. Med Eng Phys, 2018, 52: 69-75.
14.	张翠. 高冲击动作中在体胫股关节 6 自由度运动和软骨接触特征研究. 上海: 上海体育学院, 2020.
15.	Maharaj J N, Kessler S, Rainbow M J, et al. The reliability of foot and ankle bone and joint kinematics measured with biplanar videoradiography and manual scientific rotoscoping. Front Bioeng Biotechnol, 2020, 8: 106.
16.	James C R, Peterson B E, Crim J R, et al. The use of fluoroscopy during direct anterior hip arthroplasty: powerful or misleading?. J Arthroplasty, 2018, 33(6): 1775-1779.
17.	Klemt C, Limmahakhun S, Bounajem G, et al. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J, 2020, 102-B(11): 1505-1510.
18.	Zhou C, Cha T, Wang W, et al. Investigation of alterations in the lumbar disc biomechanics at the adjacent segments after spinal fusion using a combined in vivo and in silico approach. Ann Biomed Eng, 2021, 49(2): 601-616.
19.	Li J S, Tsai T Y, Clancy M M, et al. Weight loss changed gait kinematics in individuals with obesity and knee pain. Gait Posture, 2019, 68: 461-465.
20.	Cross J A, Mchenry B D, Molthen R, et al. Biplane fluoroscopy for hindfoot motion analysis during gait: A model-based evaluation. Med Eng Phys, 2017, 43: 118-123.
21.	Nichols J A, Roach K E, Fiorentino N M, et al. Subject-specific axes of rotation based on talar morphology do not improve predictions of tibiotalar and subtalar joint kinematics. Ann Biomed Eng, 2017, 45(9): 2109-2121.
22.	Nichols J A, Roach K E, Fiorentino N M, et al. Predicting tibiotalar and subtalar joint angles from skin-marker data with dual-fluoroscopy as a reference standard. Gait Posture, 2016, 49: 136-143.
23.	Akinnola O O, Vardakastani V, Kedgley A E. The effect of planar constraint on the definition of the wrist axes of rotation. J Biomech, 2020, 113: 110083.
24.	Arndt A, Westblad P, Winson I, et al. Ankle and subtalar kinematics measured with intracortical pins during the stance phase of walking. Foot Ankle Int, 2004, 25(5): 357-364.
25.	Roach K E, Wang B, Kapron A L, et al. In vivo kinematics of the tibiotalar and subtalar joints in asymptomatic subjects: a high-speed dual fluoroscopy study. J Biomech Eng, 2016, 138(9): 61-69.
26.	Phan C B, Shin G, Lee K M, et al. Skeletal kinematics of the midtarsal joint during walking: midtarsal joint locking revisited. J Biomech, 2019, 95: 109287.
27.	Phan C B, Nguyen D P, Lee K M, et al. Relative movement on the articular surfaces of the tibiotalar and subtalar joints during walking. Bone Joint Res, 2018, 7(8): 501-507.
28.	Koo S, Lee K M, Cha Y J. Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study. Gait Posture, 2015, 42(4): 424-429.
29.	Yamaguchi S, Sasho T, Kato H, et al. Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities. Foot Ankle Int, 2009, 30(4): 361-366.
30.	Hannigan J J, Pollard C D. Differences in running biomechanics between a maximal, traditional, and minimal running shoe. J Sci Med Sport, 2020, 23(1): 15-19.
31.	Peltz C D, Haladik J A, Hoffman S E, et al. Effects of footwear on three-dimensional tibiotalar and subtalar joint motion during running. J Biomech, 2014, 47(11): 2647-2653.
32.	Campbell K J, Wilson K J, Laprade R F, et al. Normative rearfoot motion during barefoot and shod walking using biplane fluoroscopy. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1402-1408.
33.	Nordin A D, Dufek J S. Footwear and footstrike change loading patterns in running. J Sports Sci, 2020, 38(16): 1869-1876.
34.	Hoffman S E, Peltz C D, Haladik J A, et al. Dynamic in-vivo assessment of navicular drop while running in barefoot, minimalist, and motion control footwear conditions. Gait Posture, 2015, 41(3): 825-829.
35.	Benca E, Listabarth S, Flock F, et al. Analysis of running-related injuries: the Vienna study. J Clin Med, 2020, 9(2): 438.
36.	Balsdon M E, Bushey K M, Dombroski C E, et al. Medial longitudinal arch angle presents significant differences between foot types: a biplane fluoroscopy study. J Biomech Eng, 2016, 138(10): 1-6.
37.	Roach K E, Foreman K B, Barg A, et al. Application of High-Speed dual fluoroscopy to study in vivo tibiotalar and subtalar kinematics in patients with chronic ankle instability and asymptomatic control subjects during dynamic activities. Foot Ankle Int, 2017, 38(11): 1236-1248.
38.	Zhang G, Cao S, Wang C, et al. Effect of a semirigid ankle brace on the in vivo kinematics of patients with functional ankle instability during the stance phase of walking. Biomed Res Int, 2019: 4398469.
39.	Fraser J J, Hart J M, Saliba S F, et al. Multisegmented ankle-foot kinematics during gait initiation in ankle sprains and chronic ankle instability. Clin Biomech (Bristol, Avon), 2019, 68: 80-88.
40.	Dewar R A, Arnold G P, WANG W, et al. Comparison of 3 ankle braces in reducing ankle inversion in a basketball rebounding task. Foot (Edinb), 2019, 39: 129-135.
41.	Caravaggi P, Matias A B, Taddei U T, et al. Reliability of medial-longitudinal-arch measures for skin-markers based kinematic analysis. J Biomech, 2019, 88: 180-185.
42.	Su S, Mo Z, Guo J, et al. The effect of arch height and material hardness of personalized insole on correction and tissues of flatfoot. J Healthc Eng, 2017, 2017: 8614341.
43.	Jung D Y, Kim M H, Koh E K, et al. A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Phys Ther Sport, 2011, 12(1): 30-35.

1. Kessler S E, Rainbow M J, Lichtwark G A, et al. A direct comparison of biplanar videoradiography and optical motion capture for foot and ankle kinematics. Front Bioeng Biotechnol, 2019, 7: 199.
2. Belatti D A, Phisitkul P. Economic burden of foot and ankle surgery in the US Medicare population. Foot Ankle Int, 2014, 35(4): 334-340.
3. Cigoja S, Asmussen M J, Firminger C R, et al. The effects of increased midsole bending stiffness of sport shoes on muscle-tendon unit shortening and shortening velocity: a randomised crossover trial in recreational male runners. Sports Med Open, 2020, 6(1): 9.
4. Lin C C, Li J D, Lu T W, et al. A model-based tracking method for measuring 3D dynamic joint motion using an alternating biplane X-ray imaging system. Med Phys, 2018, 45(8): 3637-3649.
5. Zhu G, Wang Z, Yuan C, et al. In vitro study of foot bone kinematics via a custom-made cadaveric gait simulator. J Orthop Surg Res, 2020, 15(1): 346.
6. Niu K, Anijs T, Sluiter V, et al. In situ comparison of a-mode ultrasound tracking system and skin-mounted markers for measuring kinematics of the lower extremity. J Biomech, 2018, 72: 134-143.
7. de Asla R J, Wan L, Rubash H E, et al. Six DOF in vivo kinematics of the ankle joint complex: application of a combined dual-orthogonal fluoroscopic and magnetic resonance imaging technique. J Orthop Res, 2006, 24(5): 1019-1027.
8. 张翠, 汤运启, 王少白, 等. 双平面正交荧光透视成像系统在运动医学领域中的应用研究进展. 中国运动医学杂志, 2019, 38(8): 717-725.
9. Balsdon M, Dombroski C, Bushey K, et al. Hard, soft and off-the-shelf foot orthoses and their effect on the angle of the medial longitudinal arch: a biplane fluoroscopy study. Prosthet Orthot Int, 2019, 43(3): 331-338.
10. Cao S, Wang C, Ma X, et al. In vivo kinematics of functional ankle instability patients and lateral ankle sprain copers during stair descent. J Orthop Res, 2019, 37(8): 1860-1867.
11. Cao S, Wang C, Zhang G, et al. In vivo kinematics of functional ankle instability patients during the stance phase of walking. Gait Posture, 2019, 73: 262-268.
12. Cao S, Wang C, Zhang G, et al. Effects of an ankle brace on the in vivo kinematics of patients with chronic ankle instability during walking on an inversion platform. Gait Posture, 2019, 72: 228-233.
13. Lawrence R L, Ellingson A M, Ludewig P M. Validation of single-plane fluoroscopy and 2D/3D shape-matching for quantifying shoulder complex kinematics. Med Eng Phys, 2018, 52: 69-75.
14. 张翠. 高冲击动作中在体胫股关节 6 自由度运动和软骨接触特征研究. 上海: 上海体育学院, 2020.
15. Maharaj J N, Kessler S, Rainbow M J, et al. The reliability of foot and ankle bone and joint kinematics measured with biplanar videoradiography and manual scientific rotoscoping. Front Bioeng Biotechnol, 2020, 8: 106.
16. James C R, Peterson B E, Crim J R, et al. The use of fluoroscopy during direct anterior hip arthroplasty: powerful or misleading?. J Arthroplasty, 2018, 33(6): 1775-1779.
17. Klemt C, Limmahakhun S, Bounajem G, et al. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J, 2020, 102-B(11): 1505-1510.
18. Zhou C, Cha T, Wang W, et al. Investigation of alterations in the lumbar disc biomechanics at the adjacent segments after spinal fusion using a combined in vivo and in silico approach. Ann Biomed Eng, 2021, 49(2): 601-616.
19. Li J S, Tsai T Y, Clancy M M, et al. Weight loss changed gait kinematics in individuals with obesity and knee pain. Gait Posture, 2019, 68: 461-465.
20. Cross J A, Mchenry B D, Molthen R, et al. Biplane fluoroscopy for hindfoot motion analysis during gait: A model-based evaluation. Med Eng Phys, 2017, 43: 118-123.
21. Nichols J A, Roach K E, Fiorentino N M, et al. Subject-specific axes of rotation based on talar morphology do not improve predictions of tibiotalar and subtalar joint kinematics. Ann Biomed Eng, 2017, 45(9): 2109-2121.
22. Nichols J A, Roach K E, Fiorentino N M, et al. Predicting tibiotalar and subtalar joint angles from skin-marker data with dual-fluoroscopy as a reference standard. Gait Posture, 2016, 49: 136-143.
23. Akinnola O O, Vardakastani V, Kedgley A E. The effect of planar constraint on the definition of the wrist axes of rotation. J Biomech, 2020, 113: 110083.
24. Arndt A, Westblad P, Winson I, et al. Ankle and subtalar kinematics measured with intracortical pins during the stance phase of walking. Foot Ankle Int, 2004, 25(5): 357-364.
25. Roach K E, Wang B, Kapron A L, et al. In vivo kinematics of the tibiotalar and subtalar joints in asymptomatic subjects: a high-speed dual fluoroscopy study. J Biomech Eng, 2016, 138(9): 61-69.
26. Phan C B, Shin G, Lee K M, et al. Skeletal kinematics of the midtarsal joint during walking: midtarsal joint locking revisited. J Biomech, 2019, 95: 109287.
27. Phan C B, Nguyen D P, Lee K M, et al. Relative movement on the articular surfaces of the tibiotalar and subtalar joints during walking. Bone Joint Res, 2018, 7(8): 501-507.
28. Koo S, Lee K M, Cha Y J. Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study. Gait Posture, 2015, 42(4): 424-429.
29. Yamaguchi S, Sasho T, Kato H, et al. Ankle and subtalar kinematics during dorsiflexion-plantarflexion activities. Foot Ankle Int, 2009, 30(4): 361-366.
30. Hannigan J J, Pollard C D. Differences in running biomechanics between a maximal, traditional, and minimal running shoe. J Sci Med Sport, 2020, 23(1): 15-19.
31. Peltz C D, Haladik J A, Hoffman S E, et al. Effects of footwear on three-dimensional tibiotalar and subtalar joint motion during running. J Biomech, 2014, 47(11): 2647-2653.
32. Campbell K J, Wilson K J, Laprade R F, et al. Normative rearfoot motion during barefoot and shod walking using biplane fluoroscopy. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1402-1408.
33. Nordin A D, Dufek J S. Footwear and footstrike change loading patterns in running. J Sports Sci, 2020, 38(16): 1869-1876.
34. Hoffman S E, Peltz C D, Haladik J A, et al. Dynamic in-vivo assessment of navicular drop while running in barefoot, minimalist, and motion control footwear conditions. Gait Posture, 2015, 41(3): 825-829.
35. Benca E, Listabarth S, Flock F, et al. Analysis of running-related injuries: the Vienna study. J Clin Med, 2020, 9(2): 438.
36. Balsdon M E, Bushey K M, Dombroski C E, et al. Medial longitudinal arch angle presents significant differences between foot types: a biplane fluoroscopy study. J Biomech Eng, 2016, 138(10): 1-6.
37. Roach K E, Foreman K B, Barg A, et al. Application of High-Speed dual fluoroscopy to study in vivo tibiotalar and subtalar kinematics in patients with chronic ankle instability and asymptomatic control subjects during dynamic activities. Foot Ankle Int, 2017, 38(11): 1236-1248.
38. Zhang G, Cao S, Wang C, et al. Effect of a semirigid ankle brace on the in vivo kinematics of patients with functional ankle instability during the stance phase of walking. Biomed Res Int, 2019: 4398469.
39. Fraser J J, Hart J M, Saliba S F, et al. Multisegmented ankle-foot kinematics during gait initiation in ankle sprains and chronic ankle instability. Clin Biomech (Bristol, Avon), 2019, 68: 80-88.
40. Dewar R A, Arnold G P, WANG W, et al. Comparison of 3 ankle braces in reducing ankle inversion in a basketball rebounding task. Foot (Edinb), 2019, 39: 129-135.
41. Caravaggi P, Matias A B, Taddei U T, et al. Reliability of medial-longitudinal-arch measures for skin-markers based kinematic analysis. J Biomech, 2019, 88: 180-185.
42. Su S, Mo Z, Guo J, et al. The effect of arch height and material hardness of personalized insole on correction and tissues of flatfoot. J Healthc Eng, 2017, 2017: 8614341.
43. Jung D Y, Kim M H, Koh E K, et al. A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Phys Ther Sport, 2011, 12(1): 30-35.

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