TY - JOUR A1 - Trepczynski, Adam A1 - Kneifel, Paul A1 - Heyland, Mark A1 - Leskovar, Marko A1 - Moewis, Philippe A1 - Damm, Philipp A1 - Taylor, William R. A1 - Zachow, Stefan A1 - Duda, Georg N. T1 - Impact of the external knee flexion moment on patello-femoral loading derived from in vivo loads and kinematics JF - Frontiers in Bioengineering and Biotechnology N2 - Introduction: Anterior knee pain and other patello-femoral (PF) complications frequently limit the success of total knee arthroplasty as the final treatment of end stage osteoarthritis. However, knowledge about the in-vivo loading conditions at the PF joint remains limited, as no direct measurements are available. We hypothesised that the external knee flexion moment (EFM) is highly predictive of the PF contact forces during activities with substantial flexion of the loaded knee. Materials and methods: Six patients (65–80 years, 67–101 kg) with total knee arthroplasty (TKA) performed two activities of daily living: sit-stand-sit and squat. Tibio-femoral (TF) contact forces were measured in vivo using instrumented tibial components, while synchronously internal TF and PF kinematics were captured with mobile fluoroscopy. The measurements were used to compute PF contact forces using patient specific musculoskeletal models. The relationship between the EFM and the PF contact force was quantified using linear regression. Results: Mean peak TF contact forces of 1.97–3.24 times body weight (BW) were found while peak PF forces reached 1.75 to 3.29 times body weight (BW). The peak EFM ranged from 3.2 to 5.9 %BW times body height, and was a good predictor of the PF contact force (R2 = 0.95 and 0.88 for sit-stand-sit and squat, respectively). Discussion: The novel combination of in vivo TF contact forces and internal patellar kinematics enabled a reliable assessment of PF contact forces. The results of the regression analysis suggest that PF forces can be estimated based solely on the EFM from quantitative gait analysis. Our study also demonstrates the relevance of PF contact forces, which reach magnitudes similar to TF forces during activities of daily living. Y1 - 2024 U6 - https://doi.org/10.3389/fbioe.2024.1473951 SN - 2296-4185 VL - 12/2024 PB - Frontiers Media SA ER - TY - CHAP A1 - Ehlke, Moritz A1 - Heyland, Mark A1 - Märdian, Sven A1 - Duda, Georg A1 - Zachow, Stefan T1 - 3D Assessment of Osteosynthesis based on 2D Radiographs T2 - Proceedings of the Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie (CURAC) N2 - We present a novel method to derive the surface distance of an osteosynthesis plate w.r.t. the patient-specific surface of the distal femur based on postoperative 2D radiographs. In a first step, the implant geometry is used as a calibration object to relate the implant and the individual X-ray images spatially in a virtual X-ray setup. Second, the patient- specific femoral shape and pose are reconstructed by fitting a deformable statistical shape and intensity model (SSIM) to the X-rays. The relative positioning between femur and implant is then assessed in terms of the displacement between the reconstructed 3D shape of the femur and the plate. We believe that the approach presented in this paper constitutes a meaningful tool to elucidate the effect of implant positioning on fracture healing and, ultimately, to derive load recommendations after surgery. KW - 3d-reconstruction from 2d X-rays KW - osteosynthesis follow-up KW - statistical shape and intensity models Y1 - 2015 SP - 317 EP - 321 ER - TY - GEN A1 - Ehlke, Moritz A1 - Heyland, Mark A1 - Märdian, Sven A1 - Duda, Georg A1 - Zachow, Stefan T1 - 3D Assessment of Osteosynthesis based on 2D Radiographs N2 - We present a novel method to derive the surface distance of an osteosynthesis plate w.r.t. the patient-specific surface of the distal femur based on postoperative 2D radiographs. In a first step, the implant geometry is used as a calibration object to relate the implant and the individual X-ray images spatially in a virtual X-ray setup. Second, the patient-specific femoral shape and pose are reconstructed by fitting a deformable statistical shape and intensity model (SSIM) to the X-rays. The relative positioning between femur and implant is then assessed in terms of the displacement between the reconstructed 3D shape of the femur and the plate. We believe that the approach presented in this paper constitutes a meaningful tool to elucidate the effect of implant positioning on fracture healing and, ultimately, to derive load recommendations after surgery. T3 - ZIB-Report - 15-47 KW - 3d-reconstruction from 2d X-rays KW - statistical shape and intensity models KW - osteosynthesis follow-up Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:0297-zib-56217 SN - 1438-0064 ER - TY - CHAP A1 - Ehlke, Moritz A1 - Heyland, Mark A1 - Märdian, Sven A1 - Duda, Georg A1 - Zachow, Stefan T1 - Assessing the relative positioning of an osteosynthesis plate to the patient-specific femoral shape from plain 2D radiographs T2 - Proceedings of the 15th Annual Meeting of CAOS-International (CAOS) N2 - We present a novel method to derive the surface distance of an osteosynthesis plate w.r.t. the patient­specific surface of the distal femur based on 2D X­ray images. Our goal is to study from clinical data, how the plate­to­bone distance affects bone healing. The patient­specific 3D shape of the femur is, however, seldom recorded for cases of femoral osteosynthesis since this typically requires Computed Tomography (CT), which comes at high cost and radiation dose. Our method instead utilizes two postoperative X­ray images to derive the femoral shape and thus can be applied on radiographs that are taken in clinical routine for follow­up. First, the implant geometry is used as a calibration object to relate the implant and the individual X­ray images spatially in a virtual X­ray setup. In a second step, the patient­specific femoral shape and pose are reconstructed in the virtual setup by fitting a deformable statistical shape and intensity model (SSIM) to the images. The relative positioning between femur and implant is then assessed in terms of displacement between the reconstructed 3D shape of the femur and the plate. A preliminary evaluation based on 4 cadaver datasets shows that the method derives the plate­to­bone distance with a mean absolute error of less than 1mm and a maximum error of 4.7 mm compared to ground truth from CT. We believe that the approach presented in this paper constitutes a meaningful tool to elucidate the effect of implant positioning on fracture healing. KW - 3d-­reconstruction from 2d X­rays KW - statistical shape and intensity models KW - fracture fixation of the distal femur KW - pose estimation Y1 - 2015 ER - TY - GEN A1 - Ehlke, Moritz A1 - Heyland, Mark A1 - Märdian, Sven A1 - Duda, Georg A1 - Zachow, Stefan T1 - Assessing the Relative Positioning of an Osteosynthesis Plate to the Patient-Specific Femoral Shape from Plain 2D Radiographs N2 - We present a novel method to derive the surface distance of an osteosynthesis plate w.r.t. the patient­specific surface of the distal femur based on 2D X­ray images. Our goal is to study from clinical data, how the plate­to­bone distance affects bone healing. The patient­specific 3D shape of the femur is, however, seldom recorded for cases of femoral osteosynthesis since this typically requires Computed Tomography (CT), which comes at high cost and radiation dose. Our method instead utilizes two postoperative X­ray images to derive the femoral shape and thus can be applied on radiographs that are taken in clinical routine for follow­up. First, the implant geometry is used as a calibration object to relate the implant and the individual X­ray images spatially in a virtual X­ray setup. In a second step, the patient­specific femoral shape and pose are reconstructed in the virtual setup by fitting a deformable statistical shape and intensity model (SSIM) to the images. The relative positioning between femur and implant is then assessed in terms of displacement between the reconstructed 3D shape of the femur and the plate. A preliminary evaluation based on 4 cadaver datasets shows that the method derives the plate­to­bone distance with a mean absolute error of less than 1mm and a maximum error of 4.7 mm compared to ground truth from CT. We believe that the approach presented in this paper constitutes a meaningful tool to elucidate the effect of implant positioning on fracture healing. T3 - ZIB-Report - 15-21 KW - 3d-­reconstruction from 2d X­rays KW - statistical shape and intensity models KW - fracture fixation of the distal femur KW - pose estimation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:0297-zib-54268 SN - 1438-0064 ER - TY - JOUR A1 - Leskovar, Marko A1 - Heyland, Mark A1 - Trepczynski, Adam A1 - Zachow, Stefan T1 - Comparison of Global and Local Optimization Methods for Intensity-based 2D-3D Registration JF - Computers in Biology and Medicine Y1 - 2025 U6 - https://doi.org/10.1016/j.compbiomed.2024.109574 VL - 186 SP - 109574 PB - Elsevier ER - TY - JOUR A1 - Trepczynski, Adam A1 - Kneifel, Paul A1 - Heyland, Mark A1 - Leskovar, Marko A1 - Moewis, Philippe A1 - Damm, Philipp A1 - Taylor, William R. A1 - Zachow, Stefan A1 - Duda, Georg T1 - Impact of the External Knee Flexion Moment on Patello-Femoral Loading Derived from in vivo Loads and Kinematics JF - Frontiers in Bioengineering and Biotechnology N2 - Anterior knee pain and other patello-femoral (PF) complications frequently limit the success of total knee arthroplasty as the final treatment of end stage osteoarthritis. However, knowledge about the invivo loading conditions at the PF joint remains limited, as no direct measurements are available. We hypothesised that the external knee flexion moment (EFM) is highly predictive of the PF contact forces during activities with substantial flexion of the loaded knee.Six patients (65-80 years, 67-101 kg) with total knee arthroplasty (TKA) performed two activities of daily living: sit-stand-sit and squat. Tibio-femoral (TF) contact forces were measured in vivo using instrumented tibial components, while synchronously internal TF and PF kinematics were captured with mobile fluoroscopy. The measurements were used to compute PF contact forces using patient specific musculoskeletal models. The relationship between the EFM and the PF contact force was quantified using linear regression.Mean peak TF contact forces of 1.97 to 3.24 times body weight (BW) were found while peak PF forces reached 1.75 to 3.29 times body weight (BW). The peak EFM ranged from 3.2 to 5.9 %BW times body height, and was a good predictor of the PF contact force (R^2 = 0.95 and 0.88 for sit-standsit and squat, respectively).The novel combination of in vivo TF contact forces and internal patellar kinematics enabled a reliable assessment of PF contact forces. The results of the regression analysis suggest that PF forces can be estimated based solely on the EFM from quantitative gait analysis. Our study also demonstrates the relevance of PF contact forces, which reach magnitudes similar to TF forces during activities of daily living. Y1 - 2024 U6 - https://doi.org/10.3389/fbioe.2024.1473951 VL - 12 ER - TY - JOUR A1 - Deppe, Dominik A1 - Gabriele, Matteo A1 - Mazzoleni, Manuel Giovanni A1 - Ordas-Bayon, Alejandro A1 - Fidanza, Andrea A1 - Rozhko, Yuriy A1 - Şimşek, Ekin Kaya A1 - Keltz, Eran A1 - Osterhoff, Georg A1 - Damm, Philipp A1 - Duda, Georg N. A1 - Leskovar, Marko A1 - Zachow, Stefan A1 - Trepczynski, Adam A1 - Heyland, Mark T1 - Interobserver Reliability of the Modified Radiographic Union Score (mRUST) for Tibial and Femoral Fractures JF - Journal of Orthopaedic Trauma N2 - OBJECTIVES: To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (femur, tibia) treated with various modalities (nail, plate). METHODS: Design: Retrospective analysis. Setting: Single center academic hospital in Germany. Patient Selection Criteria: Adult patients (≥18 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality. Outcome Measures and Comparisons: Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up time points based on clinical practice. To evaluate interrater reliability, intraclass correlation coefficients were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur/tibia), treatment type (plate/nail fixation), and treatment combinations across locations. RESULTS: A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18–84)) with 1136 follow-up time points were analyzed. Overall interrater reliability for mRUST was good (intraclass correlation coefficient 0.77), consistent across fixation methods (nail/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70–0.74) and lowest for the posterior cortex (0.65–0.74). CONCLUSIONS: The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Y1 - 2025 U6 - https://doi.org/10.1097/BOT.0000000000003032 SN - 0890-5339 VL - 39 IS - 10 SP - 557 EP - 563 ER -