Several methods are used to evaluate knee articulation during movement, such as the Tibio Femoral Contact Point migration or the Instantaneous Centre of Rotation displacement and even the Moment Arm variations during extension. Such evaluation is important in case of Anterior Cruciate Ligament reconstruction or Total Knee Replacement, but unfortunately, it is only available in research settings. We have devised a novel clinical methodology based on serial images of knee movement videofluoroscopy, which are interactively analysed to allow automatic determination of kinematics parameters. The method, called CINARTRO, compares values with the contralateral knee and produces a standard Clinical Document Architecture file ready for Electronic Medical Record systems. To correct the "pin cushion" effect of X ray intensifiers, a 10 mm apart lead spheres phantom was developed. To validate the interactive selection of anatomical points, cadaver limbs were marked with lead markers and compared with points marked on the blind image. Anterior Cruciate Ligament (injured and reconstructed) and contralateral Moment Arms averages of 53mm, 39mm and 43mm respectively were found. Similarly the Total Knee Replacement patient`s Moment Arm was reduced to 33mm. These findings justify the use of our methodology to help clinicians during rehabilitation follow-up.
El objetivo de este trabajo es caracterizar los aspectos tomográficos relevantes en el síndrome de heterotaxia, mediante cuatro pacientes que ejemplifican los hallazgos más frecuentes en esta patología. Situs solitus es la disposición habitual de los órganos y vasos sanguíneos y situs inversus se refiere a la imagen en espejo del situs solitus. Cuando la disposición de los órganos es indeterminada e impredecible y no se corresponde con el situs solitus ni el situs inversus, estamos frente al situs ambiguus o síndrome de heterotaxia, espectro de anomalías poco frecuente en las relaciones de los órganos toracoabdominales. Puede acompañarse de isomerismo derecho o isomerismo izquierdo. Clasificarlo en dos subgrupos es habitualmente difícil, ya que ninguno de estos tiene hallazgos únicos y patognomónicos, sino que existe amplia superposición. Ambos son de mal pronóstico, en los casos de isomerismo izquierdo un 5-10% llegan a la edad adulta, siendo de peor pronóstico los casos de isomerismo derecho, debido a que presentan inmunodepresión secundaria a la asplenia y cardiopatías congénitas más severas. Se debe analizar cada caso de forma individualizada y detallada para establecer el diagnóstico, determinar la asociación lesional y establecer aquellos pacientes que presenten mayor riesgo de complicaciones.
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