Abstract
In this work, we proved for the first time the feasibility of using high-refresh-rate 3D ultrasound (US) also known as 4D US imaging to create a volumetric atlas of the knee anterior compartment for an autonomous robotic platform for knee arthroscopy. A dataset of 42 4D US sequences (including 94 US volumes) and 25 MRI volumes was collected from seven volunteers, in several leg positions simulating the surgical scenario of knee arthroscopy. MRI-US volume pairs were manually registered, and the knee structures of interest identified on the US volumes. The resulting atlas comprised the femur, tibia and patella surfaces, patellar tendon, femoral cartilage, the anterior parts of the menisci and the ACL, for knee angles between 0 and 90 degrees flexion. The inter-operator reproducibility of the registrations was calculated as the norm of the difference in the translation and the rotation values selected by two experienced orthopaedic surgeons and resulted to be on average of 4.42 mm ± 1.89 mm SD and 7.77 degrees ± 2.80 degrees SD, respectively. A new metric was introduced to measure the overlap of the US volume located at the position selected from the first and the second experts and the agreement resulted to be on average of 87% ± 3 SD. The US scanning protocol adopted could be considered compatible with the arthroscopy procedure, as proved through six cadaver studies. These preliminary results show that 4D US is an excellent candidate for automatic image-based guidance in knee arthroscopy.
Highlights
Knee arthroscopy is the most common minimally invasive surgery (MIS) to diagnose and treat intra-articular knee disorders [1]
The preliminary results show that 4D US holds the potential to provide guidance for a knee arthroscopy robotic system, currently being investigated by our research group. 3D/4D US imaging was used to create a volumetric knee atlas of the anterior knee compartment, for different knee angles between 0 degrees and 90 degrees knee flexion
Several possible realistic knee arthroscopy scenarios were simulated under both static and dynamic conditions and proved to be compatible with all the arthroscopy procedures tested during cadaver experiments
Summary
Knee arthroscopy is the most common minimally invasive surgery (MIS) to diagnose and treat intra-articular knee disorders [1]. The surgeon inspects the knee joint looking for abnormal areas through the arthroscope view displayed on a screen, whilst manipulating (e.g. holding and flexing) the leg to increase the intra-articular space allowing the arthroscope to reach the knee tissues. This procedure is complex, mostly due to the 2D limited field of view provided by the arthroscope, the strong hand-eye coordination required and poor ergonomics. It may lead to unintended injuries to the patient and/or postoperative complications [2], [3]
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