ReviewHuman movement analysis using stereophotogrammetry: Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics
Introduction
Human movement analysis using stereophotogrammetric measurements and rigid body modelling requires the definition of systems of axes associated with each bony segment incorporated in the model. The systems of axes defined from body-surface marker positions are referred to here as marker cluster technical frames (CTF), while those defined from anatomical landmark (AL) positions are referred to as anatomical frames (AF). The differences of the features of the CTFs and the AFs have been described in the first paper of this series [1]. A major issue in human movement analysis is the identification of ALs and the reconstruction of their position in a selected set of axes, namely the AL calibration [1], [2], [3]. ALs can be either internal or subcutaneous and in general the determination of their location lacks accuracy and precision. This affects AF position and orientation precision and, consequently, the estimation and interpretation of joint kinematics and kinetics.
This paper reviews the information available in the literature regarding the precision and accuracy of the determination of the location of both internal and palpable ALs, and thus have the relevant AFs, as well as the sensitivity of joint kinematics variables to AF precision and accuracy. Given the relevance of AF axes determination in allowing the correct interpretation of joint kinematics, definitions of AFs aimed at reducing joint kinematics sensitivity to AL uncertainty are also discussed.
Section snippets
Determination of subcutaneous palpable AL locations
The incorrect location of subcutaneous bony ALs through palpation can be caused by three main factors: (1) the palpable ALs are not points but surfaces, sometimes large and irregular; (2) a soft tissue layer of variable thickness and composition covers the ALs; (3) the identification of the location of the ALs depends on which palpation procedure was used.
White et al. [4] first reported on the repeatability of the determination in vitro of pelvic and lower limb AL positions. Problems associated
Determination of internal AL locations: hip and knee joint centres
Those ALs not representing palpable bony prominences are referred to as ‘internal’. Among the lower limb internal ALs, the geometric centres of the femoral head and of the acetabulum are used the most. In human movement analysis, the corresponding articular surface areas are assumed to have spherical shapes and a common centre, therefore the hip is assumed to be a ball-and-socket joint. The accuracy and precision with which the hip joint centre (HJC) location is estimated are crucial for error
Determination of AF position and orientation
The knowledge of the AL positions in the relevant CTF allows for the definition of AFs and the determination of their orientation. A precise determination of AF orientation is crucial for joint kinematics reliability. Della Croce et al. [7] used the AF definitions proposed by Cappozzo et al. [3], which are in accordance with general standard directions of reference axes [45]. The experimental data reported in [7] provided observations of the AF position vectors and orientation matrices, and
Joint kinematics sensitivity to erroneous determination of AL location and AF orientation
Given the crucial role of the HJC in locomotion analysis, the effects of the erroneous determination of its location have been investigated more than those of other AL locations [13], [16]. Kadaba et al. [13] observed the effects on joint kinematics when the HJC position was made to vary analytically over a 20 mm range in all directions. They observed an offset in joint kinematics curves but not an effect on the relevant patterns throughout the gait cycle. Stagni et al. [16] extended the
Reduction of AL uncertainty effects on joint kinematics
As reported in the previous section, only a limited number of studies dealt with the effect of incorrect definition of joint axes, and therefore of AL location uncertainty, on joint kinematics description. Moreover, the conclusions of those studies were limited to a “warning” to the biomechanical community about using information regarding the minor angles of joint kinematics data. The problem can be approached in two ways: (1) reducing the uncertainty of the AL position determination and/or
Conclusion
The studies reviewed in this paper have given quantitative descriptions of the precision of AL position determination and its effects on joint kinematics. Although following different approaches, these have consistently shown that reliability and interpretability of joint kinematics are largely dependent on the precision of the determination of AF orientation. The non-linear nature of this dependency renders the effects on joint kinematics unpredictable. Reduction of these errors can be
Acknowledgement
This review work was carried out under the sponsorship of the Ministero dell’Istruzione, dell’Università e della Ricerca and of the authors’ Institutions.
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