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Introduction Movement quality screening in early-career military populations, like Army Reserve Officers' Training Corps (AROTC) cadets, could decrease the negative impact of musculoskeletal injury observed within the military. Movement quality screening techniques should be valid before being pursued in the field. Normative data describing movement quality of AROTC cadets are also needed. Therefore, the aims of this study were to determine criterion validity of several movement quality assessments and report normative jump-landing kinematics of AROTC cadets. Materials and Methods This cross-sectional research was approved by the Institutional Review Board. As part of a larger study, 20 AROTC cadets (21.3 ± 3.4 years; 1.7 ± 0.1 m; 73.8 ± 14.8 kg) had 3-dimensional (3D) and 2-dimensional (2D) kinematic data collected simultaneously while performing a jump-landing task. Variables of interest were 3D hip and knee sagittal, frontal, and transverse joint angles at maximum knee flexion. An experienced rater calculated sagittal and frontal 2D joint angles at maximum knee flexion. Averages of 2D and 3D angles were calculated to describe normative data and for further data analysis. Bivariate correlations between 3D and 2D variables were used to determine criterion validity. Results Moderate correlations were found between 2D and 3D hip frontal plane angles (P  = .05, r  =−0.33), 2D and 3D knee sagittal plane angles (P  = .04, r  = 0.35), and 2D and 3D knee frontal plane angles (P  = .03, r  = −0.36). Normative values of knee and hip kinematics demonstrated averages of 17.58° of knee adduction, 16.48° of knee external rotation, 11.57° of hip abduction, 10.76° of hip internal rotation, and 103.47° of knee flexion during landings. However, ranges demonstrated that landing patterns vary within AROTC cadets. Conclusions The normative values of 3D jump-landing kinematic data indicate that movement quality varies greatly within AROTC cadets, and some cadets display potentially injurious movements. Therefore, screening movement quality could be beneficial to determine musculoskeletal injury risk in AROTC cadets. Based on the correlations discovered in this study, we recommend the 2D techniques used in this study be researched further as they may serve as alternatives to expensive, timely 3D techniques that could be better utilized in military environments. [ABSTRACT FROM AUTHOR]

Aims: Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies. Methods: In 137 robotic-assisted TKAs, extension and flexion stressed gap laxities and bone resections were measured. The primary outcome was the proportion and magnitude of medial and lateral SPI (gap differential > 2.0 mm) for KA, MA, and FA. Secondary outcomes were the proportion of knees with severe (> 4.0 mm) SPI, and resection thicknesses for each technique, with KA as reference. Results: FA showed significantly lower rates of medial and lateral SPI (2.9% and 2.2%) compared to KA (45.3%; p < 0.001, and 25.5%; p < 0.001) and compared to MA (52.6%; p < 0.001 and 29.9%; p < 0.001). There was no difference in medial and lateral SPI between KA and MA (p = 0.228 and p = 0.417, respectively). FA showed significantly lower rates of severe medial and lateral SPI (0 and 0%) compared to KA (8.0%; p < 0.001 and 7.3%; p = 0.001) and compared to MA (10.2%; p < 0.001 and 4.4%; p = 0.013). There was no difference in severe medial and lateral SPI between KA and MA (p = 0.527 and p = 0.307, respectively). MA resulted in thinner resections than KA in medial extension (mean difference (MD) 1.4 mm, SD 1.9; p < 0.001), medial flexion (MD 1.5 mm, SD 1.8; p < 0.001), and lateral extension (MD 1.1 mm, SD 1.9; p < 0.001). FA resulted in thinner resections than KA in medial extension (MD 1.6 mm, SD 1.4; p < 0.001) and lateral extension (MD 2.0 mm, SD 1.6; p < 0.001), but in thicker medial flexion resections (MD 0.8 mm, SD 1.4; p < 0.001). Conclusion: Mechanical and kinematic alignment (measured resection techniques) result in high rates of SPI. Pre-resection angular and translational adjustments with functional alignment, with typically smaller distal than posterior femoral resection, address this issue. Cite this article: Bone Jt Open 2024;5(8):681–687.

Introduction: Axial malalignment in the coronal plane has been identified as a significant risk factor for knee cartilage damage, leading to osteoarthritis progression. However, the impact of sagittal axial deviation on cartilage damage remains underexplored. Biomechanical studies have suggested that an increased tibial slope leads to altered pressure distribution in the articular cartilage, potentially contributing to cartilage damage. Despite these biomechanical insights, clinical evidence linking increased tibial slope to cartilage damage is lacking. Methods: This retrospective study focuses on patients who underwent surgical cartilage transplantation between January 2016 and July 2023. A total of 108 patients were divided into two groups based on the presence or absence of other pathologies contributing to cartilage damage. Clinical data, including tibial slope measurements from lateral radiographs, were collected. A further subgroup‐matched pair analysis was conducted comparing cases with patellar lesions and healthy knees. Statistical analysis compared tibial slope values between groups and assessed correlations between tibial slope and cartilage lesion grade. Results: Patients without other identifiable pathologies exhibited a significantly higher medial tibial slope compared to those with known causative factors for cartilage damage (p < 0.05). Cartilage damage, particularly in the patellar region, was more prevalent in patients with an increased tibial slope. Patients with patellar lesions had a significant increased slope than healthy controls (p < 0.05). However, there was no significant correlation between cartilage lesion grade and tibial slope. Conclusion: The study identified increased medial tibial slope as a possible independent risk factor for cartilage damage in the knee, especially in the patellar region. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine associations between running economy (RE) and running sagittal plane kinematic and kinetic parameters. Method: A total of 30 male recreational runners (age: 21.21 ± 1.22 yr, VO2max: 54.61 ± 5.42 mL·kg-1·min-1) participated in two separate test sessions. In the first session, the participant's body composition and RE at 10 and 12 km·h-1 were measured. In the second session, measurements were taken for the sagittal plane of hip, knee, and ankle angles and range of motion (ROM), as well as ground reaction force. Results:Moderate correlations were found between lower energy costs at 12 km·h-1 and smaller hip flexion at toe-off (r = 0.373) as well as smaller peak hip flexion during stance (r = 0.397). During the swing phase, lower energy costs at 10 km·h-1 were moderately correlated with smaller peak knee flexion and smaller knee flexion and extension ROM (r = 0.366-0.443). Lower energy costs at 12 km·h-1 were moderately correlated with smaller peak hip and knee flexion as well as knee extension ROM(r = 0.369-0.427). In terms of kinetics, there was a moderate correlation between higher energy costs at 10 km·h-1 and larger peak active force, as well as larger peak braking and propulsion force (r = -0.470-0.488). Lower energy costs at 12 km·h-1 were moderately to largely correlated with smaller peak impact and braking force (r = 0.486 and -0.500, respectively). Regarding the statistical parametric mapping analysis, most outcomes showed associations with RE at 10 km·h-1, including knee flexion (42.5%-65.5%of the gait cycle), ankle plantarflexion (32.5%-36%of the gait cycle), active force (30.5%-35%of the stance phase), and propulsion force (68%-72.5% of the stance phase). Lower energy costs at 12 km·h-1 were correlated with smaller hip flexion (5.5%-12% and 66.5%-74%) and smaller knee flexion (57%-57.5%) during the running gait cycle. Conclusions: This study indicates that biomechanical factors are associated with RE in recreational runners. To design effective training methods to improve RE, coaches and runners should focus on the sagittal plane kinematics of the hip, knee, and ankle, as well as lower vertical and horizontal kinetic parameters. [ABSTRACT FROM AUTHOR]

Clinical information regarding skeletal and dental characteristics is essential for orthodontic diagnosis and treatment planning. Therefore, an evaluation to predict the association between skeletal and dental variables would prove diagnostically invaluable. This study aims to enumerate the prevalence of skeletal and dental classifications in a sample of Malay adult patients, and to determine the association between sagittal skeletal relationship, vertical facial dimension and anteroposterior molar relationship. A retrospective study involving orthodontic study models and lateral cephalograms of 117 Malay patients between 18 and 41 years old (mean age 26.5 ± 5.38) were evaluated for molar relationship (Class I, II or III), ANB angle (skeletal Class I, II or III) and maxillary-mandibular planes (MMP) angle (normo-, hypo- or hyperdivergent). Reassessment was done after two weeks for intra- and inter-examiner reliability. The association between these variables were analyzed with Chi-square test. There was perfect agreement for intra- and inter-examiner reliability with kappa scored 1. A highly statistically significant association between molar relationship and sagittal skeletal pattern (p=0.000), and statistically significant association between sagittal and vertical skeletal pattern (p=0.048) was found. There was no significant association between molar relationship and vertical skeletal pattern (p=0.855). In conclusion, skeletal Class I, molar Class II and normodivergent vertical pattern were the most prevalent among Malaysian Malay adult patients. There was association between sagittal and vertical dimension, and between sagittal and molar relationships. However, there was no association between vertical plane and molar relationships. [ABSTRACT FROM AUTHOR]

Objective: To compare the coronal plane with axial and sagittal planes in opportunistic screening of osteoporosis using computed tomography (CT). Materials and methods: A total of 100 patients aged ≥ 50 years who underwent both lumbar spine CT and dual-energy X-ray absorptiometry within 3 months were included. Osteoporosis was diagnosed based on dual-energy X-ray absorptiometry results. The CT number was measured at the center of the vertebral body in coronal, axial, and sagittal planes. To compare the coronal plane with axial and sagittal planes in diagnosing osteoporosis, the areas under the receiver operating characteristic curve (AUC) were compared and intraclass correlation coefficient (ICC) was calculated. The optimal cutoff values were calculated using Youden's index. Results: The AUC of the coronal plane (0.80; 95% confidence interval [CI], 0.71–0.89) was not significantly different from that of the axial plane (0.78; 95% CI, 0.68–0.87; P = 0.39) and that of the sagittal plane (0.78; 95% CI, 0.69–0.87; P = 0.68). Excellent concordance rates were observed between coronal and axial planes with ICC of 0.95 (95% CI, 0.92–0.96) and between coronal and sagittal planes with ICC of 0.93 (95% CI, 0.85–0.96). The optimal cutoff values for the coronal, axial, and sagittal planes were 110, 112, and 112 HU, respectively. Conclusion: The coronal plane does not significantly differ from axial and sagittal planes in opportunistic screening of osteoporosis. Thus, the coronal plane as well as axial and sagittal planes can be used interchangeably in measuring bone mineral density using CT. [ABSTRACT FROM AUTHOR]

Machine learning (ML) algorithms are crucial within the realm of healthcare applications. However, a comprehensive assessment of the effectiveness of regression algorithms in predicting alterations in lifting movement patterns has not been conducted. This research represents a pilot investigation using regression-based machine learning techniques to forecast alterations in trunk, hip, and knee movements subsequent to a 12-week strength training for people who have low back pain (LBP). The system uses a feature extraction algorithm to calculate the range of motion in the sagittal plane for the knee, trunk, and hip and 12 different regression machine learning algorithms. The results show that Ensemble Tree with LSBoost demonstrated the utmost accuracy in prognosticating trunk movement. Meanwhile, the Ensemble Tree approach, specifically LSBoost, exhibited the highest predictive precision for hip movement. The Gaussian regression with the kernel chosen as exponential returned the highest prediction accuracy for knee movement. These regression models hold the potential to significantly enhance the precision of visualisation of the treatment output for individuals afflicted with LBP. [ABSTRACT FROM AUTHOR]

(1) Background: The most common musculoskeletal pathology among healthcare professionals is neck and/or shoulder pain. The aim of this study was to determine the dominant upper limb functionality concerning the ability to replicate a given movement pattern among employees reporting neck or upper limb pain while using a computer during the COVID-19 pandemic. (2) Methods: The study was conducted from March to April 2021 on a group of 45 medical employees who used a computer workstation for 4 to 6 h of their working time. In the design of this study, three study groups were created: a group of patients with pain syndrome of segment C5/C7 of the spine, a group of patients with shoulder pain syndrome, and a control group of healthy volunteers. (3) Results: The examined groups significantly differed in the correctness of performing the given movement (p = 0.001) and the minimum value of inclination during the exercise session (p = 0.026), as well as the maximum lowering (p = 0.03) in relation to the control group. (4) Conclusions: The VECTIS device can be used to assess the accuracy of reflecting the prescribed movement of the upper limb in rehabilitation programs for patients with cervical spine pain syndrome and shoulder pain syndrome. [ABSTRACT FROM AUTHOR]

Alzheimer’s disease (AD) is a degenerative neuronal brain disorder resulting in memory loss, skills, and cognitive changes. The disorder’s primary diagnostic tests are defined as total brain atrophy and hippocampal atrophy. Early diagnosis is significant, and automatic systems design is necessary for this disorder. Potential biomarkers for AD are described using a hippocampal magnetic resonance imaging volumetry system with certain limitations. For the definite identification of the hippocampus region, pre-processing of the 3D MRI images of AD is necessary. The filtering and histogram-based pre-processing techniques enhance the region of interest, which helps in effectively segmenting the biomarker, the hippocampus. The median and eight histogram clippings are defined to be 98% efficient pre-processing techniques with the comparison of image quality parameters and statistical analysis. Thus an algorithm for pre-processing of the 3D MRI images of stages of AD is designed for the further process of identification. [ABSTRACT FROM AUTHOR]

The InterCriteria decision-making approach, known as InterCriteria analysis (ICrA), was applied here to optimize the experimental protocol when the surface electromyography (EMG) signals of upper arm human muscles are recorded. Ten healthy subjects performed cycling movements in the sagittal plane with and without added weight for ten, six, two, and one second, respectively, for each active phase. The EMG signals from six muscles or parts of muscles, namely m. deltoideus pars clavicularis and pars spinata, m. brachialis, m. anconeus, m. biceps brachii, and m. triceps brachii caput longum, were recorded. ICrA was used on the obtained data to find correlations between the sixteen different phases, eight for elbow flexion and eight for elbow extension. Based on the obtained results, we proposed an optimized experimental protocol (OEP) that omits slower and more difficult tasks while saving crucial data. The optimized protocol consists of seven, instead of ten, tasks and takes three minutes less than the time taken for the full experimental protocol (FEP). The lower number of movements in the OEP could prevent physical and psychical fatigue, discomfort, or even pain in the investigated subjects. In addition, the time to train subjects, as well as the time to process the surface EMG data, can be significantly reduced.

Objective To observe the changes of sagittal plane balances of cervical spine of the patients underwent posterior cervical single open-door expansive laminoplasty, and to provide the imaging evidence for the postoperative rehabilitation training of the patients. Methods A total of 32 patients who underwent posterior cervical single open-door expansive laminoplasty were selected. According to the median value（15.75 mm) of sagittal vertical axis (SVA) distance before operation, the patients were divided into low SVA group and high SVA group，and there were 16 patients in each group. The imaging and clinical data of the patients in two groups before operation and at the last follow-up were retrospectively analyzed. The SVA value, cervical lordosis angle (Cobb angle), and T1 tilt angle (T1s) of the patients at the X-ray lateral view of the cervical spine were detected before operation and at the last follow-up. The postoperative Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) store，and satisfaction score of the patients in two groups were analyzed. Results Compared with before operation, the NDI score of the patients in high SVA group after operation was decreased (P<0.01), the JOA score was increased (P<0.01) . Compared with before operation, the NDI score of the patients in low SVA group was decreased (P<0.01), the JOA score was increased (P<0.01), and the SVA value was increased (P<0.01), while there were no significant differences in the Cobb angle and T1s (P>0.05) . There was no statistically significant difference in the occurrence of axial symptoms of the patients between low SVA group and high SVA group（P>0.05) . Conclusion In the follow-up of at least 2 years after operation, posterior cervical single open-door expansive laminoplasty has the certain effect on the sagittal plane balance of cervical spine of the patients. The main manifestations are tendency of cervical lordosis and anterior shift of the center of gravity, but the overall stability can still be maintained. The patients with high SVA have a higher incidence of axial symptoms after operation. [ABSTRACT FROM AUTHOR]

Hallux valgus is a complex condition understood to involve pathomechanics in all 3 of the cardinal planes. Despite this, the bulk of its historical evaluation has been in the transverse plane, and one might argue that the traditional and more commonly performed univariate and bivariate analyses within the literature do not comprehensively describe the potential interrelationships between the planes during perioperative assessment. Therefore this investigation aimed to evaluate relationships between common radiographic parameters measured in the three cardinal planes by means of a multivariate regression analysis. Serial analyses utilizing the first intermetatarsal angle, hallux valgus angle, tibial sesamoid position, proximal articular set angle, Engel's angle, first metatarsal inclination angle, and the sesamoid rotation angle were performed with varying dependent and independent variables. The tibial sesamoid position (p <.001) and proximal articular set angle (p =.014) were found to be independently associated with the first intermetatarsal angle, while the hallux valgus angle (p =.712), Engel's angle (p =.646), first metatarsal inclination angle (p =.097), and sesamoid rotation angle (p =.099) were not. The tibial sesamoid position (p =.003), proximal articular set angle (p <.001), Engel's angle (p =.006), and sesamoid rotation angle (p =.003) were found to be independently associated with the hallux valgus angle, while the first intermetatarsal angle (p =.712) and first metatarsal inclination angle (p =.400) were not. The first intermetatarsal angle (p <.001), hallux valgus angle (p =.003), and proximal articular set angle (p =.015) were found to be independently associated with the tibial sesamoid position, while Engel's angle (p =.400), the first metatarsal inclination angle (p =.088), and the sesamoid rotation angle (p =.649) were not. These findings appear to question a direct relationship between the first intermetatarsal angle and hallux valgus angle, as well as potentially infer a relationship between the frontal plane with the hallux valgus angle. [ABSTRACT FROM AUTHOR]

The rise in the occurrence of musculoskeletal disorders, such as thoracic hyperkyphosis (THK) or lumbar hypolordosis (LHL), is a result of demographic changes. Exercise therapy is an effective approach that can reduce related disabilities and costs. To ensure successful therapy, an individualized exercise program adapted to the severity of the disorder is expedient. Nevertheless, appropriate classification systems are scarce. This project aimed to develop and evaluate a severity classification focused on exercise therapy for patients with THK or LHL. A multilevel severity classification was developed and evaluated by means of an online survey. Reference limits of spinal shape angles were established by data from video rasterstereography of 201 healthy participants. A mean kyphosis angle of 50.03° and an average lordosis angle of 40.72° were calculated as healthy references. The strength of the multilevel classification consisting of the combination of subjective pain and objective spinal shape factors was confirmed by the survey (70% agreement). In particular, the included pain parameters were considered relevant by 78% of the experts. Even though the results of the survey provide important evidence for further analyses and optimization options of the classification system, the current version is still acceptable as therapeutic support. [ABSTRACT FROM AUTHOR]

Javelin throw gain recognition as an individual sport identity and was counted as a separate event in the Olympic game of 1908 before that it was counted as a part of pentathlon since the first modern Olympic started in the year 1896 at Athens. The present study was conducted 30 (N) female javelin throwers that participated in the national level selected as subjects. The data was collected from the 3rd National Open Javelin Throw Championships 23-24 Octobers, 2021 held at Jawaharlal Nehru Stadium, New Delhi. The researcher utilized free body movement and software tools to capture video footage of athletes throwing javelins. Two cameras were set up at the Sagittal and Frontal planes, respectively, at 2.60m & 3.10m, to capture the athletes' 2D-videoography. The mean values is 5.49 meter for the acceleration path and the mean and standard deviation values of 38.59 meter for the performance values of female javelin throwers this states that there is no significant correlation between the performance and the acceleration. However it was positively correlated. The present study is first of its kind and would add literature for further scope of research in the Indian female javelin throwers. [ABSTRACT FROM AUTHOR]

Machine learning (ML) algorithms are crucial within the realm of healthcare applications. However, a comprehensive assessment of the effectiveness of regression algorithms in predicting alterations in lifting movement patterns has not been conducted. This research represents a pilot investigation using regression-based machine learning techniques to forecast alterations in trunk, hip, and knee movements subsequent to a 12-week strength training for people who have low back pain (LBP). The system uses a feature extraction algorithm to calculate the range of motion in the sagittal plane for the knee, trunk, and hip and 12 different regression machine learning algorithms. The results show that Ensemble Tree with LSBoost demonstrated the utmost accuracy in prognosticating trunk movement. Meanwhile, the Ensemble Tree approach, specifically LSBoost, exhibited the highest predictive precision for hip movement. The Gaussian regression with the kernel chosen as exponential returned the highest prediction accuracy for knee movement. These regression models hold the potential to significantly enhance the precision of visualisation of the treatment output for individuals afflicted with LBP.

Aim of the study: The aim of the study was to assess the relationship between the position of the sacrum, lumbar and thoracic spine and the mobility of the trunk in the sagittal plane in young women and men. Material and methods: 64 students (33 women and 31 men) were studied. The mean age in the study group was 22.94 ± 1.51 years. The following tests were performed on each subject once: measurement of height and weight, assessment of spinal alignment and mobility in the sagittal plane using Zebris Pointer. Results: The results obtained were analyzed using appropriate statistical tools. Statistically significant correlations were obtained: in the alignment of the sacrum in relation to the lumbar spine (strong correlation), in the alignment of the lumbar spine in relation to the thoracic spine and, in the male group only, between the alignment of the thoracic spine and mobility in the direction of flexion in the thoracic segment (moderate correlation). Conclusions: In women, horizontal sacral alignment coexisting with deepened lordosis was most frequently observed. In addition, women were more likely to have a deepened thoracic kyphosis, less range of motion in the direction of thoracic flexion and extension, and greater mobility in the direction of lumbar flexion and extension than men. In men, the vertical alignment of the sacrum was accompanied by a shallowing of the physiological lordosis. In addition, in this group, a decrease in lordosis influenced an increase in movement to flexion in the thoracic spine. When planning a physiotherapy exercise program for a person in whom abnormalities in the alignment of the lumbopelvic complex have been noted, an individual exercise program should be selected. The study should take into account not only the evaluation of the alignment of the lumbosacral spine, but also the mobility of the segments above and below the examined area taking into account intergender differences.

ObjectiveThis study aims to find the optimal arrangement of the Kirschner wire (K-wire) in the sagittal plane for fixation of a pediatric lateral condylar humeral fracture (Milch type II) by using finite element analysis (FEA).MethodsA model of lateral condyle fracture in a 6-year-old boy was developed, and an XYZ coordinate system was established based on this model. The YZ plane was defined as the sagittal plane to investigate the impact of the angle formed by the first and second K-wires on stability. Two configurations were studied for each angle: parallel and divergent. Evaluation indicators included the maximum displacement of the fracture fragment and the maximum von Mises stress in the pins and bone.ResultsThe model with a −60° angle showed the best performance in both evaluation indicators. The parallel and divergent pin configurations had different performances in each group. The displacement results for negative angles were similar, and this result was better than those for positive angles.ConclusionWe successfully created a model of pediatric lateral condyle humerus fracture (Milch type II) and performed K-wire fixation with varying sagittal plane configurations, combined with FEA. Our findings demonstrate that the angle of −60° between the two pins in the sagittal plane provided the highest level of stability, with divergent configurations proving superior to parallel pinning at this angle.

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BACKGROUND: The motion of the knee joint is a three-dimensional motion with three translational degrees of freedom and three rotational degrees of freedom. When the prosthesis is implanted in total knee arthroplasty, the varus angle of the coronal plane, the anteroposterior angle of the sagittal plane and the rotation angle of the axial plane should be fully considered. OBJECTIVE: To summarize the clinical advantages and disadvantages of femoral and tibial prosthesis implantation angle in total knee arthroplasty, so as to provide reference for effective prosthesis implantation in total knee arthroplasty. METHODS: The first author searched the literature on prosthesis implantation in PubMed database and CNKI database by computer. The English key words were “total knee arthroplasty, total knee replacement, femoral, tibial, coronal, sagittal, axial, prosthesis, component, alignment, osteotomy”. The Chinese key words were “total knee arthroplasty, femur, tibia, prosthesis, osteotomy, coronal, sagittal, axial, alignment”. The articles that meet the search terms are preliminarily screened, and the relevant articles related to the review content and the clinical advantages and disadvantages of prosthesis implantation are retained for further detailed analysis, induction and summary. RESULTS AND CONCLUSION: (1) On the coronal plane of the femur, the angle between the mechanical axis of the lower limb and the anatomical axis of the femur is measured through the full-length film of the weight-bearing position of the lower limb as a reference for femoral osteotomy. The 4-6° valgus osteotomy is often taken, and the prosthesis is implanted perpendicular to the mechanical axis. (2) In the sagittal plane of the femur, to obtain good knee flexion function, the 0-3°anteversion osteotomy is often taken and the prosthesis is implanted slightly anteversion. (3) In the axial plane of the femur, although surgical transepicondylar axis is regarded as the rotation center of the distal femur, it is more convenient to refer to posterior condylar axis when using surgical instruments, and the prosthesis is rotated 2-5° outward relative to posterior condylar axis. (4) In the coronal plane of the tibia, to obtain the rectangular space and horizontal joint line in the extended position, the prosthesis should be implanted perpendicular to the mechanical axis of the tibia. (5) In the sagittal plane of the tibia, the polyethylene gasket has a certain retroversion angle, and the prosthesis is often implanted with a retroversion of 0-7°. (6) In the axial plane of the tibia, because the Akagi line is approximately parallel to the anterior and posterior axis of the tibia, the anterior and posterior axis of the prosthesis is often implanted parallel to the Akagi line. [ABSTRACT FROM AUTHOR]

1 An apex posterior angulation of 6.5° exists in the distal quarter of the humeral diaphysis (80% of the length of the humerus). 2 The length of the humerus and absolute distance to the CORA is significantly greater in males than in females. 3 The magnitude of apex posterior angulation and relative location of the CORA is consistent across ages and between sexes. 4 The apex posterior bow has clinical implications regarding plate contour, medullary nailing, and arthroplasty during fracture surgery. An understanding of the sagittal plane morphology of the humerus is relevant during surgical fixation of humeral fractures but is not well described in the literature. The purpose of this study was to better characterize the native sagittal plane morphology of the humerus. 170 patients with uninjured full length lateral humerus radiographs were retrospectively evaluated. The angle between the proximal humeral diaphyseal axis and the distal humeral diaphyseal axis was identified and measured. The proximal axis was defined by two points equidistant from the anterior and posterior cortex 10 mm and 100 mm distal to the metaphyseal flare, and the distal axis by two points at 10 mm and 50 mm proximal to the capitellum/trochlea. The relative location of the center of rotation of angulation (CORA) was calculated as a percentage of humeral length. 114 radiographs were included in the analysis (66 right humeri, 48 left humeri). The average apex posterior angulation was 6.5 +/- 2.9°. The CORA occurred at an average of 80% (SD+/-13%) of the length of the humerus (proximal to distal). Total humeral length and absolute distance to CORA were greater in males compared to females (364 ± 50 mm versus 326 ± 30 mm; p<0.001; 290 ± 68 mm versus 260 ± 48 mm; p=0.003), but there were no significant sex differences with respect to magnitude of the apex posterior angulation (p=0.077) or location of CORA as a percentage of total humeral length (p=0.916). There were no statistically significant associations between age and total humeral length (p=0.056), distance to CORA (p=0.130), location of CORA as percentage of total humeral length (p=0.753), or magnitude of angulation (p=0.075). An apex posterior bow consistently exists in the distal one-quarter of the humerus that is consistent across ages and between sexes. This normal anatomic bow is important to recognize to avoid an extension malreduction and has implications for implant fit and contouring. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to: (i) to analyze the morphometric characteristics of the cervical vertebral column in the sagittal plane; and (ii) compare morphometric methods used for determinating cervical lordosis angle. Materials and Methods: Direct cervical sagittal radiographs of 175 adults were analyzed and cervical lordosis angle was evaluated by Cobb (C2-C7), central cervical lordosis angle, posterior tangent, and Risser & Ferguson methods. In addition, occipitocervical angle (occiput-C2) and cervical vertical tranlation distance were determined to assess upper cervical lordosis and forward head posture, respectively. Results: The measured cervical lordosis angles were differed (p<0.05) depending on the measurement method. There was a strong negative correlation between cervical lordosis angle and occipitocervical angle (r = -0.707), a weak negative correlation between cervical lordosis angle and cervical vertical translation distance (r = -0.253) and a moderate positive correlation between occipitocervical angle and cervical vertical translation distance (r = 0.552). It was observed that an increase of 1 mm in the cervical vertical translation distance caused an increase in the occipitocervical angle about 0.6 degrees. Conclusions: In planning cervical surgery, the balance and alignment of the cervical vertebral column in the sagittal plane should be evaluated in detail. The contour of the cervical vertebral column in the sagittal plane and the limits of cervical lordosis angle are important in the evaluation of cervical pathologies. The obsservations from this study will benefit the understanding of vertebral column morphometry will contribute to the literature in anatomy, physiotherapy, radiology, and cervical regional surgery. [ABSTRACT FROM AUTHOR]

Perturbations in sitting posture, represented by the center of mass (COM) of the upper body, provide critical information for analyzing balance control. While the COM is generally measured by an optical motion capture system, it is not practical. In a previous study, we proposed a method to estimate the COM during standing from a force platform under the feet based on inverted pendulum models. However, it is unclear whether the technique can be applied to the sitting posture. Furthermore, it is also unclear whether two force platforms under the buttocks and the feet would be required if it could be applied. The purpose of this study is to estimate the upper body COM of a subject sitting on a backless seat from one or two force platforms and to validate the estimation accuracy by comparing the results to those from an optical motion capture system. For considering forces acting from the lower limbs, it is necessary to adopt a mechanical model that includes the lower limbs and to use a force platform under the feet in addition to those on the seat. We compared estimation accuracy between the models with and without lower limbs in three conditions: rest sitting, voluntary sway, and seat sway with an electric cart. The result indicated a clear difference between the two models, and the model considering lower limbs had high accuracy. Since the present method is a practical and highly accurate method of sitting posture, it may be applied in the analysis of low back pain and motion sickness.

Background and ObjectivesSchool bag (SB) load causes significant changes in the height and symmetry of the intervertebral discs at each level of the spine from T12-L1 to L5-S1. This study aims to determine the change in the size of the lumbar segment angle at a particularly critical point L3-L4 of the spine in relation to the load of the average weight of SB in healthy male children (students) at standing and after 2-minute gait.Methods47 boys, aged 12.2 ± 0.92 years, underwent photogrammetric measurements in the sagittal plane in statics and dynamics, walking on a laboratory treadmill. Measurements were repeated with the weight of SB with a constant load of 6,251 kg, which represents 13.78% of the average body weight of our sample. The lumbar angle (LA) connecting the point of the big toe, the lumbar point L3-L4 and the processus spinosus C7 was measured. In gait, LA was measured in the phases of the middle support and the initial contact of the heel.ResultsT-test of paired samples was used to estimate the change in LA at standing from 4.953° and walking phases from 6.295° to 7.332° in relation to the unloaded state, and the value of the effect size (ES) indicates that the impact of SB load is significant.ConclusionsCumulatively, microtraumas caused by SB load significantly affect the increase in intervertebral pressure at the L3-L4 point, which is susceptible to degenerative processes and which can be the cause of lumbar syndrome (LS). Preventive measures are needed in order to lighten SB in this population and introduce up to 10% of students' body weight into the safe zone.

BackgroundSpinopelvic motion, the cornerstone of the sagittal balance of the human body, is pivotal in patient-specific total hip arthroplasty.PurposeThis study aims to develop a novel model using back propagation neural network (BPNN) to predict pelvic changes when one sits down, based on standing lateral spinopelvic radiographs.MethodsYoung healthy volunteers were included in the study, 18 spinopelvic parameters were taken, such as pelvic incidence (PI) and so on. First, standing parameters correlated with sitting pelvic tilt (PT) and sacral slope (SS) were identified via Pearson correlation. Then, with these parameters as inputs and sitting PT and SS as outputs, the BPNN prediction network was established. Finally, the prediction results were evaluated by relative error (RE), prediction accuracy (PA), and normalized root mean squared error (NRMSE).ResultsThe study included 145 volunteers of 23.1 ± 2.3 years old (M:F = 51:94). Pearson analysis revealed sitting PT was correlated with six standing measurements and sitting SS with five. The best BPNN model achieved 78.48% and 77.54% accuracy in predicting PT and SS, respectively; As for PI, a constant for pelvic morphology, it was 95.99%.DiscussionIn this study, the BPNN model yielded desirable accuracy in predicting sitting spinopelvic parameters, which provides new insights and tools for characterizing spinopelvic changes throughout the motion cycle.

Non-traumatic spinal pathology is often missed on routine axial imaging of the abdomen and pelvis, particularly when obtained in the acute setting, and is much more readily evaluated on sagittal reformats. The purpose of this pictorial essay is to reinforce the diagnostic utility of reviewing sagittal reformats of the thoracolumbar spine on routine abdominal imaging. We present a structured approach to non-traumatic pathology of the lumbar spine using seven categories of pathology that can be identified on sagittal reformats of the spine on abdomen and pelvis CT. [ABSTRACT FROM AUTHOR]

Background: Sagittal balance in severe androgen insensitivity syndrome (AIS) patient has been difficult to study due to problems with imaging technique. Abnormal sagittal profiles have been frequently observed in AIS patients presenting as cervical kyphosis, thoracic hypokyphosis, and positive sagittal vertical axis (SVA) off set. The significance of these changes is not understood in these patients. The purpose of this study is to assess the sagittal profile of AIS patients before and after surgery. Subjects and Methods: Changes in curve correction in both coronal and sagittal planes before and after surgery. Curve type, Cobb angles, sagittal parameters, and fusion level were analyzed with conventional parameters. Patient outcomes were measured using mobile device friendly Scoliosis Research Society-22 questionnaire online. Results: Fourteen patients were recruited. Average age was 16 years (13–36). Postoperation and final follow-up Cobb angles were reduced to 27°, 26°, and 16° and 29°, 28°, and 16°, respectively. In the sagittal plane, the Cobb angles pre- and postoperation and final follow-up are as follows: Cervical lordosis (36.7, 39.1, and 41.9), thoracic kyphosis (33.1, 35.8, and 39.1), lumbar lordosis (51.1, 45.2, and 54.2), SVA (1.3, 1.6, and 0), pelvic tilt (19, 21, and 18), sacral slope (47, 46, and 55), and pelvic tilt (43.7, 45, and 43.5). “Function”, “satisfaction,” and “mean” were significantly improved over the period, particularly between the last seen visit and before surgery. Conclusions: Abnormal coronal and sagittal parameters and their changes after surgery are reported in AIS patients. Patients expressed significant improvements in their function abilities and satisfied with clinical management, as well as their general quality of life.

Context: The use of a pelvic inclinometer in medical practice to evaluate pelvic inclination angle is speedy, noninvasive, and easy to use. There is currently no goniometer available for objective measurement of innominate bone inclination in standing. In clinical assessment, it is necessary to employ portable, reliable, low-cost, and safe measurement apparatus for the measurement of pelvic inclination. Aims: To assess the inter- and intra-tester reliability of a tripod-mounted pelvic inclinometer and a hand-held inclinometer with smartphone application for measuring the angle of pelvic inclination in the sagittal plane. Study Setting and Design: Design of assessing and measuring reliability of pelvic inclinometer in India. Materials and Methods: A total of 160 individuals aged between 18 and 30 years volunteered to participate in the study. Pelvic inclination angle was measured on both sides using two newly developed pelvic inclinometers in the sagittal plane. One was tripod-mounted wooden arm inclinometer and the other was hand-held inclinometer with smartphone software application. Reliability was assessed for the tripod-mounted pelvic inclinometer apparatus that is based on the idea of measuring pelvic tilts with caliper. Further, reliability was also assessed for hand-held pelvic inclinometer with software application in a mobile cell device. Statistical Analysis Used: Cronbach's alpha (C-alpha) and intraclass correlation coefficient (ICC) were used to test reliability. Results: The intratester reliability of the tripod-mounted wooden arm inclinometer on both left (C-alpha - 0.98; ICC - 0.94) and right sides (C alpha - 0.97; ICC - 0.93) was high. Similar findings were noted with the hand-held inclinometer with smartphone software application, with intrarater reliability being high on both right (C-alpha - 0.98; ICC - 0.95) and left sides (C-alpha - 0.98; ICC - 0.96). Conclusion: Both the newly designed pelvic inclinometers, i.e., tripod-mounted wooden arm inclinometer and hand-held inclinometer with smartphone software application, are reliable and consistent for measuring pelvic inclination in the sagittal plane. [ABSTRACT FROM AUTHOR]

Medical image super-resolution (SR) has mainly been developed for a single image in the literature. However, there is a growing demand for high-resolution, thin-slice medical images. We hypothesized that fusing the two planes of a computed tomography (CT) study and applying the SR model to the third plane could yield high-quality thin-slice SR images. From the same CT study, we collected axial planes of 1 mm and 5 mm in thickness and coronal planes of 5 mm in thickness. Four SR algorithms were then used for SR reconstruction. Quantitative measurements were performed for image quality testing. We also tested the effects of different regions of interest (ROIs). Based on quantitative comparisons, the image quality obtained when the SR models were applied to the sagittal plane was better than that when applying the models to the other planes. The results were statistically significant according to the Wilcoxon signed-rank test. The overall effect of the enhanced deep residual network (EDSR) model was superior to those of the other three resolution-enhancement methods. A maximal ROI containing minimal blank areas was the most appropriate for quantitative measurements. Fusing two series of thick-slice CT images and applying SR models to the third plane can yield high-resolution thin-slice CT images. EDSR provides superior SR performance across all ROI conditions.

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that negatively affect athletes' future performance and return to play. The purpose of this study was to examine the correlation of kinematics and kinetics of changing sagittal plane body position during landing and the risk of non-contact ACL injury. Seven university female (age 19.57 ± 0.79 y, height 164.21 ± 8.11 m, weight 60.43 ± 5.99 kg) athletes playing soccer and handball, and with ≥ two years of training volunteered for this research. Three trunk positions: Lean Forward Landing (LFL), Self-selected Landing (SSL), and Upright Landing (URL)—via double/single-leg landing—were captured by a high-speed VICON motion capture system. A 3 × 2 two-way within-subjects ANOVA and Multiple Bonferroni corrected pairwise were used to test for condition (LFL, SSL, URL) and task (single/double-leg) effects (p ≤   0.05 ). The findings indicated that landing with a deeper knee flexion angle (LFL) would lead to smaller impact forces when compared to upright landing. [ABSTRACT FROM AUTHOR]

The corpus callosum in the interval between the cerebral hemispheres is a plate of white matter, uneven in thickness, in which two surfaces are distinguished - the upper and lower ones, bent according to its lateral profile. The objective of the study was to study the individual variability of location of the lateral and medial longitudinal strips on the upper surface of the corpus callosum, as well as structural features of its lower surface. The material was the brain of men and women (10 specimens each) of the second period of adulthood, who died for the causes not related to the pathology of the central nervous system. After two weeks of fixation in a 10% formalin solution, the brain was prepared by separating the cerebral hemispheres and other parts of the brain from the corpus callosum, resulting in exposure of its upper and lower surface, which was photographed using a digital camera. As evidenced by the obtained data, the width of the trunk of the corpus callosum in men varies from 9 to 16 mm, whereas in women the difference between the minimum (11.0 mm) and the maximum (20.0 mm) values is greater than in men, when in fact there is only small difference of the arithmetic mean value. Thus, we offer to consider the lateral longitudinal strips to be the boundaries of the corpus callosum hemispherical part and the distance between them determines the width of this formation, which in average is 13.0 ± 2.5 mm in men and 14.4 ± 2.7 mm in women. In the meantime, the nature of the individual variability of the width of the corpus callosum trunk in women is more diverse than in men. [ABSTRACT FROM AUTHOR]

As a method for the balance assessment, a steady-state response of a subject standing on the support surface oscillating horizontally back and forth at a single frequency has been studied. While past studies on the method have focused on the kinematic analysis investigating the center of mass (COM) motion, there has no research based on mechanical models. The purpose of this study is to present mechanical models that concisely represent the steady-state response depending on the oscillation frequencies. This study implemented oscillation tests on six healthy subjects at 0.4, 0.6, 0.8, and 1.2 Hz. The steady-state response in the test tended to keep the head stationary in space and to suppress the amplitude of the center of pressure (COP). From the analysis based on a double inverted pendulum model, we found a boundary frequency around 0.7 Hz where the body keeps a straight-line and the head can be stationary without using ankle torque. Additionally, the analysis based on the double inverted pendulum model indicated that the steady-state response below the boundary frequency could be represented by a single inverted pendulum model. From comparing the theoretical feedback gain of the ankle torque for making the head stationary in the single inverted pendulum model, we found that the control strategy of some subjects changed significantly at 0.4 Hz. These findings were consistent with the results of the past studies and may be useful for understanding the steady-state response of the oscillation at constant frequencies.

Background: We hypothesized that when the posterior cruciate ligament (PCL) is found deficient at total knee arthroplasty (TKA), using an anterior-stabilized (AS) tibial insert would provide similar function and survivorship when compared to using a more traditional cruciate-retaining (CR) bearing when the (PCL) is balanced.Methods: A total of 1731 TKAs were performed using the same TKA design. Of them, 868 TKAs had a standard CR insert implanted (CR-S), 480 TKAs used a lipped CR insert (CR-L), and 383 TKAs used an AS insert. If the PCL was considered nonfunctional or absent, an AS bearing was placed. When the PCL was balanced, a CR-S or CR-L bearing was used. Follow-up was performed using the Knee Society scoring system. Kaplan-Meier survivorship was used with failure defined as aseptic loosening.Results: At final follow-up, there were no significant differences in knee flexion, pain, function, or stair scores. Walking scores were significantly lower in the AS group. Posterior instability was higher in the CR-S group, whereas the manipulation rate was highest in the CR-L group (1.7%, 1.3%, and 0% for CR-L, CR-S, and AS groups, respectively). Kaplan-Meier survivorship at 5 years demonstrated no significant difference between the 3 groups (99% 100%, and 99% for CR-S, CR-L, and AS groups, respectively).Conclusion: Using an AS insert provided similar function and 5-year survivorship as compared to using a CR-S and CR-L tibial insert when the PCL was balanced. Using an ultracongruent AS dished tibial component appears to be a reasonable option when the PCL is completely released or found deficient at operation. [ABSTRACT FROM AUTHOR]

Patients with spinal cord injuries cannot move their limbs using their intact muscles. A suitable controller can be used to move their arms by employing the functional electrical stimulation method. In this article, a fuzzy exponential sliding‐mode controller is designed to move a musculoskeletal human arm model to track an optimal trajectory in the sagittal plane. This optimal arm trajectory is obtained by developing a policy for the central nervous system. In order to specify the optimal trajectory between two points, two dynamic and static optimal criteria are applied simultaneously. The first dynamic objective function is defined to minimize the joint torques, and the second static optimization is offered to minimize the muscle forces at each moment. In addition, fuzzy logic is used to tune the sliding‐surface parameter to enable an appropriate tracking performance. Simulation results are evaluated and compared with experimental data for upward and downward movements of the human arm.

Introduction: Human body posture is an individual feature influenced by environmental conditions and the type of performed work. The curvatures change with age, quality and style of life. Civilizational development has led to a sedentary lifestyle, which has an influence on postural defects formation. The aim of this study was to verify the effect of length of time for taxi drivers on spine curvature formation compared to people who adopt a sitting position. Materials and methods: The study comprised 60 subjects: 30 controls and 30 study subjects (taxi drivers), all with work history longer than 10 years. Triplicate measurements of spinal curvatures were taken using the Rippstein Plurimeter in a relaxed position, and results were saved according to the SFTR system. In addition, body height and weight were measured to calculate body mass index (BMI). Results: The average work time in the examined group was 57.7 and the control group 6.8 hours per week. The mean values of thoracic kyphosis and lumbar lordosis in the examined group were 36.3 and 17.9 degrees, respectively, versus 30.3 and 20.8 in the control group. Age and length of service had an impact on the shaping of the spinal curvatures. Greater value of BMI was associated with deeper thoracic kyphosis, but not with shallower lumbar lordosis. Conclusions: Adverse changes in shaping spinal curvatures progress with increasing age and length of the employment performed in the sitting position. Body mass index and body weight above the normal level contribute to deepening thoracic kyphosis.