Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination.
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ABSTRACT:
SUBMITTER: Branch TP
PROVIDER: S-EPMC5522506 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:BackgroundBiomechanical measurement tools have been developed and widely used to precisely quantify knee anterior-posterior laxity after anterior cruciate ligament (ACL) injury. However, validated objective device to document knee rotational laxity, though being developed by different researchers, are not yet widely used in the daily clinical practice. A new biomechanical device was developed to quantify knee internal and external rotations.MethodsThe reliability of the new biomechanical device which measures knee rotations were tested. Different torques (1-10Nm) were applied by the device to internally and externally rotate human cadaveric knees, which were held in a flexion angle of 30°. The rotations were measured by the device in degrees. There were two independent testers, and each tester carried out three trials. Intra-rater and inter-rater reliability were quantified in terms of intraclass correlation (ICC) coefficient among trials and between testers. The device was verified by the comparison with a computer assisted navigation system. ICC was measured. Mean, standard deviation and 95% confident interval of the difference as well as the root mean square difference were calculated. The correlations were deemed to be reliable if the ICC was above 0.75.ResultsThe intra-rater and inter-rater reliability achieved high correlation for both internal and external rotation, ranged from 0.959 to 0.992. ICC between the proposed meter and the navigation system for both internal and external rotation was 0.78. The mean differences were 2.3° and 2.5° for internal and external rotation respectively.ConclusionsA new knee rotational laxity meter was proposed in this study. Its reliability was verified by showing high correlation among trials. It also showed good correlation to a gold standard of measurement. It might be used to document knee rotational laxity for various purposes, especially after ACL injury, after further validation of the device in human subjects.
| S-EPMC6445399 | biostudies-literature
Project description:Canine hip dysplasia is the most common orthopedic developmental condition in the dog and early hip laxity is the main risk factor. The importance of hip laxity in young animals in the development of hip dysplasia is unanimously recognized among researchers and veterinarians due to its medical applicability in terms of disease control and prevention. In the market, there is some certified hip distractors to promote joint laxity. However, the clinical use of some of these distractors complies with a set of usage rules, that can limit its medical application. In this study was compared the technical quality of radiographs and hip distraction using a certified hip distractor (CertD) and Dis-UTAD in 104 dogs (208 joints). The mean pelvic tilting of 1.5 ± 1.6° and 1.5 ± 1.8° were similar when using the CertD and the Dis-UTAD distractors, respectively (P > 0.05). In the CertD sample, the mean hip distraction index (DI) was 0.46 ± 0.17 and in the Dis-UTAD 0.46 ± 0.16; the mean DI differences was 0.001 ± 0.045, resulting in a non-significant paired t-test (P = 0.65) and a significant intraclass correlation coefficient of 0.96, with the 95% lower limit confidence interval of 0.95 (P < 0.05). The statistical power analysis showed a very low distraction index difference effect size. The results suggest that the statistical reproducibility of CertD hip distraction by the Dis-UTAD and the DI mean differences of 0.001 might be considered without clinical importance. The Dis-UTAD might be considered adequate to promote dog hip laxity.
| S-EPMC7466428 | biostudies-literature
Project description:BackgroundIn the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)-using soft robotic technology and machine learning for fully automated clinical breast examination-is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology.ObjectiveThis study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design.MethodsThis study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks' mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients.ResultsMost respondents (143/155, 92.3%) indicated that they would definitely or probably use R-CBE, with 82.6% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users' perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key.ConclusionsThere is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential.
| S-EPMC10131668 | biostudies-literature
Project description:It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane. Clinical outcomes were evaluated by the Japanese Orthopedic Association score for osteoarthritic knees, Japanese Knee Osteoarthritis Measure, and the New Knee Society Score. The frequency of outliers (>3 degrees) was 10% for the hip-knee-ankle angle, 8% for FCA, 0% for TCA, 19% for sagittal FCA, and 9% for sagittal TCA. The Japanese Orthopedic Association score and Japanese Knee Osteoarthritis Measure were significantly improved postoperatively. The postoperative New Knee Society Score was 67.2% for symptoms, 50.3% for satisfaction, 58.6% for expectation, and 44.1% for function. TKA using an accelerometer-based portable navigation device achieved good results for both lower limb alignment and clinical outcomes.
| S-EPMC6123170 | biostudies-literature
Project description:STRAS (Single access Transluminal Robotic Assistant for Surgeons) is a new robotic system based on the Anubis® platform of Karl Storz for application to intra-luminal surgical procedures. Pre-clinical testing of STRAS has recently permitted to demonstrate major advantages of the system in comparison with classic procedures. Benchmark methods permitting to establish objective criteria for 'expertise' need to be worked out now to effectively train surgeons on this new system in the near future. STRAS consists of three cable-driven sub-systems, one endoscope serving as guide, and two flexible instruments. The flexible instruments have three degrees of freedom and can be teleoperated by a single user via two specially designed master interfaces. In this study, small force sensors sewn into a wearable glove to ergonomically fit the master handles of the robotic system were employed for monitoring the forces applied by an expert and a trainee (complete novice) during all the steps of surgical task execution in a simulator task (4-step-pick-and-drop). Analysis of grip-force profiles is performed sensor by sensor to bring to the fore specific differences in handgrip force profiles in specific sensor locations on anatomically relevant parts of the fingers and hand controlling the master/slave system.
| S-EPMC6848933 | biostudies-literature
Project description:BackgroundRobotic-arm-assisted knee arthroplasty allows for more accurate component positioning and alignment and is associated with better patient-reported outcomes compared to manually performed jig-based knee arthroplasty. However, what is not known is whether the addition of an intra-articular sensor (VerasenseTM) to aid intraoperative balancing of the total knee replacement (TKR) offers improved functional outcomes for the patient. The purpose of this research is to compare the outcomes of patients undergoing a conventional manual knee replacement to those undergoing TKR using robotic-assisted surgery and the VerasenseTM to optimise alignment and balance the knee joint, respectively, and assess the associated cost economics of such technology.Methods and analysisThis randomised controlled trial will include 90 patients with end-stage osteoarthritis of the knee undergoing primary TKR. Patients meeting the inclusion/exclusion criteria that consent to be in the study will be randomised at a ratio of 1:1 to either manual TKR (standard of care) or robotic-arm-assisted TKR with VerasenseTM to aid balancing of the knee. The primary objective will be functional improvement at 6 months following surgery between the two groups. The secondary objectives are to compare changes in knee-specific function, joint awareness, patient expectation and fulfilment, satisfaction, pain, stiffness and functional ability, health-related quality of life, cost-effectiveness, and gait patterns between the two groups. Ethical approval was obtained by the Tyne & Wear South Research Ethics Committee, UK. The study is sponsored by the Newcastle Hospitals NHS Foundation Trust.DiscussionThis study will assess whether the improved accuracy of component positioning using the robotic-arm-assisted surgery and the VerasenseTM to aid balancing of the TKR offers improved outcome relative to standard manual jig-based systems that are currently the standard of care. This will be assessed primarily according to knee-specific function, but several other measures will also be assessed including whether these are cost-effective interventions.Trial registrationInternational Standard Randomised Controlled Trial Number ISRCTN47889316 https://doi.org/10.1186/ISRCTN47889316 . Registered on 25 November 2019 DATE AND VERSION FOR PROTOCOL: ROAM Protocol V1.0 (13-12-2018).
| S-EPMC8783439 | biostudies-literature
Project description:BackgroundNPM1 mutation status can influence prognosis and management in AML. Accordingly, clinical testing (i.e., RT-PCR, NGS and IHC) for mutant NPM1 is increasing in order to detect residual disease in AML, alongside flow cytometry (FC). However, the relationship of the results from RT-PCR to traditional NGS, IHC and FC is not widely known among many practitioners. Herein, we aim to: i) describe the performance of RT-PCR compared to traditional NGS and IHC for the detection of mutant NPM1 in clinical practice, and also compare it to FC, and ii) provide our observations regarding the advantages and disadvantages of each approach in order to inform future clinical testing algorithms.MethodsPeripheral blood and bone marrow samples collected for clinical testing at variable time points during patient management were tested by quantitative, real-time, RT-PCR and results were compared to findings from a Myeloid NGS panel, mutant NPM1 IHC and FC.ResultsRT-PCR showed superior sensitivity compared to NGS, IHC and FC with the main challenge of NGS, IHC and FC being the ability to identify a low disease burden (<0.5% NCN by RT-PCR). Nevertheless, the positive predictive value of NGS, IHC and FC were each ≥ 80% indicating that positive results by those assays are typically associated with RT-PCR positivity. IHC, unlike bulk methods (RT-PCR, NGS and FC), is able provide information regarding cellular/architectural context of disease in biopsies. FC did not identify any NPM1-mutated residual disease not already detected by RT-PCR, NGS or IHC.ConclusionOverall, our findings demonstrate that RT-PCR shows superior sensitivity compared to a traditional Myeloid NGS, suggesting the need for "deep-sequencing" NGS panels for NGS-based monitoring of residual disease in NPM1-mutant AML. IHC provides complementary cytomorphologic information to RT-PCR. Lastly, FC may not be necessary in the setting of post-therapy follow up for NPM1-mutated AML. Together, these findings can help inform future clinical testing algorithms.
| S-EPMC8435844 | biostudies-literature
Project description:Background and purpose - Instability following primary total knee arthroplasty (TKA) is, according to all national registries, one of the major failure mechanisms leading to revision surgery. However, the range of soft-tissue laxity that favors both pain relief and optimal knee function following TKA remains unclear. We reviewed current evidence on the relationship between instrumented knee laxity measured postoperatively and outcome scores following primary TKA. Patients and methods - We conducted a systematic search of PubMed, Embase, and Cochrane databases to identify relevant studies, which were cross-referenced using Web of Science. Results - 14 eligible studies were identified; all were methodologically similar. Both sagittal and coronal laxity measurement were reported; 6 studies reported on measurement in both extension and flexion. In knee extension from 0° to 30° none of 11 studies could establish statistically significant association between laxity and outcome scores. In flexion from 60° to 90° 6 of 9 studies found statistically significant association. Favorable results were reported for posterior cruciate retaining (CR) knees with sagittal laxity between 5 and 10 mm at 75-80° and for knees with medial coronal laxity below 4° in 80-90° of flexion. Interpretation - In order to improve outcome following TKA careful measuring and adjusting of ligament laxity intraoperatively seems important. Future studies using newer outcome scores supplemented by performance-based scores may complement current evidence.
| S-EPMC6367957 | biostudies-literature
Project description:BackgroundDespite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA).MethodsThe present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches.ResultsThe cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge.ConclusionsThe present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.
| S-EPMC5266759 | biostudies-literature
Project description:Studies have identified factors that contribute to functional limitations in people with knee osteoarthritis (OA), including quadriceps femoris muscle weakness, joint laxity, and reports of knee instability. However, little is known about the relationship among these factors or their relative influence on function. The purpose of this study was to investigate self-reported knee instability and its relationships with knee laxity and function in people with medial knee osteoarthritis (OA).Fifty-two individuals with medial knee OA participated in the study.Each participant was classified into 1 of 3 groups based on reports of knee instability. Limb alignment, knee laxity, and quadriceps femoris muscle strength (force-generating capacity) were assessed. Function was measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a stair-climbing test (SCT). Group differences were detected with one-way analyses of variance, and relationships among variables were assessed with the Eta(2) statistic and hierarchical regression analysis.There were no differences in alignment, laxity, or strength among the 3 groups. Self-reported knee instability did not correlate with medial laxity, limb alignment, or quadriceps femoris muscle strength. Individuals reporting worse knee instability scored worse on all subsets of the KOOS. Self-reported knee instability scores significantly contributed to the prediction of all measures of function above that explained by quadriceps femoris muscle force, knee laxity, and alignment. Neither laxity nor alignment contributed to any measure of function.Self-reported knee instability is a factor that is not directly associated with knee laxity and contributes to worse function. Further research is necessary to delineate the factors that contribute to self-reported knee instability and reduced function in this population.
| S-EPMC2599794 | biostudies-literature