Anatomical frame identification and reconstruction for repeatable lower limb joint kinematics estimates

The quantitative description of joint mechanics during movement requires the reconstruction of the position and orientation of selected anatomical axes with respect to a laboratory reference frame. These anatomical axes are identified through an ad hoc anatomical calibration procedure and their position and orientation are reconstructed relative to bone-embedded frames normally derived from photogrammetric marker positions and used to describe movement. The repeatability of anatomical calibration, both within and between subjects, is crucial for kinematic and kinetic end results. This paper illustrates an anatomical calibration approach, which does not require anatomical landmark manual palpation, described in the literature to be prone to great indeterminacy. This approach allows for the estimate of subject-specific bone morphology and automatic anatomical frame identification. The experimental procedure consists of digitization through photogrammetry of superficial points selected over the areas of the bone covered with a thin layer of soft tissue. Information concerning the location of internal anatomical landmarks, such as a joint center obtained using a functional approach, may also be added. The data thus acquired are matched with the digital model of a deformable template bone. Consequently, the repeatability of pelvis, knee and hip joint angles is determined. Five volunteers, each of whom performed five walking trials, and six operators, with no specific knowledge of anatomy, participated in the study. Descriptive statistics analysis was performed during upright posture, showing a limited dispersion of all angles (less than 3 deg) except for hip and knee internal-external rotation (6 deg and 9 deg, respectively). During level walking, the ratio of inter-operator and inter-trial error and an absolute subject-specific repeatability were assessed. For pelvic and hip angles, and knee flexion-extension the inter-operator error was equal to the inter-trial error-the absolute error ranging from 0.1 deg to 0.9 deg. Knee internal-external rotation and ab-adduction showed, on average, inter-operator errors, which were 8% and 28% greater than the relevant inter-trial errors, respectively. The absolute error was in the range 0.9-2.9 deg.