:::

A Point Cluster Method for In

T. P. Andriacchi
Vivo Motion Analysis: Applied to
E. J. Alexander
a Study of Knee Kinematics
A new method fo; deriving limb segment motion from markers placed on the skin is
M. K. Toney described. The method provides a basis for determining the artifact associated with
nonrigid body movement of points placed on the skin. The method is based on a
cluster of points uniformly distributed on the limb segment. Each point is assigned
C. Dyrby an arbitrary mass. The center of mass and the inertia tensor of this cluster of points
are calculated. The eigenvalues and eigenvectors of the inertia tensor are used to
define a coordinate system in the cluster as well as to provide d basis for evaluating
J. Sum non-rigid body movement. The eigenvalues of the inertia tensor remain invariant if
the segment is behaving as a rigid body, thereby providing a basis for determining
Mechanical Engineering!
variations for nonrigid body movement. The method was tested in a simulation model
Functional Restoration,
where systematic and random errors were introduced into a fixed cluster of points.
Stanford University,
The simulation demonstrated that the error due to nonrigid body movement could be
Terman 546,
substantially reduced. The method was also evaluated in a group of ten normal
Stanford, CA 94305-3030
subjects during walking. The results for knee rotation and translation obtained from
the point cluster method compared favorably to results previously obtained from
normal subjects with intra-cortical pins placed into the femur and tibia. The resulting
methodology described in this paper provides a unique approach to the measurement
of in vivo motion using skin-based marker systems.

Introduction
Knee movement during normal function involves a complex
set of coupled translations and rotations. The movement of the
knee is dependent on the type of activity, the muscle firing
patterns as well as the passive anatomy of the knee joint. A
knowledge of the in vivo movement of the knee is important
for understanding normal function as well as addressing clinical
problems. For example, it has been well established that follow­
ing rupture to the anterior cruciate ligament of the knee joint,
there is an increase in the anterior translation of the tibia demon­
strated during clinical testing. However, the relationship be­
tween passive clinical instability and dynamic instability re­
mains unclear. There is a need for improved methods of in vivo
testing that can be used to assess the complete six-degree-of­
freedom movement of the knee joint.
The most frequently used method for measuring human
movement involves placing markers or fixtures on the skin sur­
face of the segment being analyzed. The movement of the mark­
ers or fixtures is typically used to infer the underlying relative
movement between two adjacent segments (e'-g., knee joint)
with the goal of precisely defining the movement of the joint.
Skin movement relative to the underlying bone is a primary
factor limiting the resolution of detailed joint movement using
skin-based systems (Holden et aI., 1997). The scope and clini­
cal relevance of in vivo measurement of human motion would
be substantially improved if reliable measurements of skeletal
movement could be obtained from skin-based marker systems.
Spoor and Veldpas ( 1980) have described a technique using
a minimum mean square error approach that lessens the effect
of deformation between any two time steps, time 1 to time 2.
This method assumes the markers are fixed to a segment that
moves as a rigid body between any two time steps. This assump­
tion limits the scope of application for this method, since mark-
COnlributed by the Bioengineering Division for publication in the JOURNAL
OF BIOMECHANICAL ENGINEERING. Manuscript received by the Bioengineering
Division September 24. 1997; revised manuscript received July 22, 1998. Associ­
ate Technical Editor: R. C. Haul.
ers placed directly on skin will experience non-rigid body move­
ment. Another approach, described by Cappello et al. (1996),
used a cluster of points to correct for deformation in the limb
segment by a double calibration technique. The cluster of points
is recorded in full extension and in full flexion; the body is
assumed to deform linearly between these two positions. This
linearity assumption, along with the assumption that the dy­
namic deformation that will be recorded during an actual activ­
ity is equivalent to the static deformation, limit the applicability
of this technique. As yet none of these methods provide an
absolute standard to identify nonrigid body movement of the
limb segment.
Skeletal movement can be measured using alternative ap­
proaches to a skin-based marker system. These approaches in­
clude stereoradiography (Jonsson and Karrholm, 1993), bone
pins (LaFortune et aI., 1992; Murphy, 1990; Reinschmidt et aI.,
1995), external fixation devices (Cappozza et aI., 1996) or
single plane fluoroscopic techniques (Sati et aI., 1996; Banks
and Hodge, 1996; Stein et aI., 1993; Stiehl et aI., 1995). All of
these methods are invasive or expose the test subject to radia­
tion. Therefore, the wide spread applicability of these methods
is limited.
Recently a new approach using a cluster of points has been
described (Andriacchi et aI., 1994; Andriacchi and Toney,
1995), which has the potential to address the nonrigid body
movement of the limb segment in a systematic manner. The
method has been summarized in general terms and tested against
results from two subjects wearing Ilizarov devices. However,
the details of the methodology were not fully described.
The purpose of this paper is to present the details of a new
method based on a point cluster technique (PCT) to reduce the
nonrigid body motion artifacts during in vivo human motion
testing and to evaluate its applicability to in vivo testing. The
PCT method was combined with an optimization approach and
tested using a simulation model. The in vivo study was designed
to evaluate the PCT method and to compare with a previously
reported study (La Fortune et aI., 1992) on the three-dimen­
sional kinematics of the human knee during walking acquired
using intra-cortical traction pins in the femur and tibia.

Journal of Biomechanical Engineering Copyright © 1998 by ASME DECEMBER 1998, Vol. 120 / 743

•
.--------------------­ ---------­ ----­
Analytical Methods
Point Cluster Equations. The PCT is based on a cluster
of points unifonnly distributed on the limb segment. Each point
(i) is assigned an arbitrary mass m(t), , which can be varied at
each time step. The center of mass and the inertia tensor of
the cluster of points are calculated as described below. The
eigenvalues and the eigenvectors of the inertia tensor arc the
principal moments of inertia and the principle axes of the point
cluster. The eigenvectors establish a transformation between the
segment and the global coordinate system. The eigenvalues are
invariant to movement if the segment is behaving as a rigid
body. If the eigenvalues change from their value in the rest
position, then the segment where the markers are placed has
deviated from rigid body movement. By adjusting the individual
weighting m(t), of each point, the artifact due to nonrigid body
movement can be reduced.
The point cluster technique was implemented by placing a
group of markers (n > 3) on a limb segment. At any time t,
denote the location of marker i in the global coordinate system
by G(t)" where
g(t),,x]
G(t), = g(t)"y i=I ... n
[ g(t),.,
Each point G(t), was arbitrarily assigned a mass m(t)i' The
mass serves as a weighting factor, which can be adjusted to
minimize changes in eigenvalues. The center of mass C (t) of
the points is given by
C(t) = 2:j-) G(t), . m(t),
2:;'~1 m(t),
At time t, the location of G (t), is given by
G(t), = C(t) + R(t)· L(t)i i = I ... n
where R(t) is the orientation matrix, and L(t), is the location
of the points in a local coordinate system.
To define the orientation matrix R(t) and local coordinate
system in the cluster, the points G(t), were translated to a
coordinate system located at the mass center C (t) as follows:
P(t)i = G(t)i - C(t) i = I ... n
The inertia tensor I(t) for the discrete cluster points was given
by
We can now define the local coordinates L (I), for each of the
points by
L(/), = RT(t)'(G(t); .. C(t» i = I ... n (7)
R(t) is orthogonal since it is constructed from three orthogonal
eigenvectors as shown in Eq (6).
Optimization Method and Simulation Study. In conjunc­
tion with the point cluster method describe above, there is the
potential to enhance the ability to isolate rigid body motion
using optimization techniques. The eigenvalues form a basis for
an optimization technique since they remain invariant if the
segment moves as a rigid body. The mass weighting factors
m (t), can be assigned a unit value if the cluster segment moves
primarily as a rigid body. Typically, markers placed on the skin
will undergo both rigid body motion and motion due to the skin
deformation, If nonrigid body movement occurs, the eigenval­
ues will change from their values in the rest position (to). An
algorithm was developed to minimize the eigenvalue changes
by redistributing the weight factors m(t), at each time step. The
algorithm begins by calculating the sum of the squares of the
three eigenvalues (Eigenvalue norm) for times to and t, as
(1) ! 2
A o = \10'0)' +
2 2
O'nh + (\"h and
A, = leA,); + (As)~ + (As)~ (8)
As previously noted, the mass m(/)i was used as a weighting
factor to reduce variations in eigenvalues. The eigenvalue norms
A, and Ao were written as a function of each cluster point mass
m(tJi' Each Ao and A., was calculated from Eg. (5) as a function
of the mass distribution m (t,); using Eqs. (1) - ( 4 ) to establish
(2) the matrix given in Eq. (5). Thus the difference between A,
and A o expressed in Eq. (8) could be calculated in terms of
the n cluster point masses (m(t,),) for each time step f,. This
difference was implicitly defined as a function F(mU,» in the
(3)
following form:
F(m(tJ" ., . , m(t,)n) = (A, ~ A o )2 (9)
A mass distribution for n cluster points m(tJi~ln at each time
step ts that minimized F(m(t,),) was solved numerically. Min­
imizing F(m(tJ,) took the form of a nonlinear minimization
(4) of n unknowns m(ts)i for i = I .. n, which was solved at each
time step. For computational efficiency the mass distribution
was defined in terms of a single distribution parameter E. The
parameter E was calculated by redefining the mass distribution

L P"x' Pi,y . [ -m(t),] L Pix' P,.,· [ -m(t)i]

i=l

L Piy' p",' [ -m(t)i 1

(5)
;=1

L P'.x· Pi.,' [-m(t);]

i-I

The eigenvectors E; of I(t) were used to form the transforma­ such that the point with the largest displacement from the rest
tion matrix R(t) as follows: position in the local coordinate system will have the lowest
weight factor. Note that for rigid body movement each point
(6)
would have zero displacement from its rest position. E was
where the three eigenvectors have the form calculated by first determining the displacement 6L( t s )' of each
point (i) relative to its position in the reference position L(t,),
e(t»),x] at time to as
E(t») = e(t»).y j = 1,2,3
[ (10)
e (t) ),l
The local coordinate L(U, at time step t, for each point was
Associated with each of these eigenvectors is an eigenvalue calculated using Eq. (7). The relative movement (nonrigid body
'A(t»),j = 1,2,3. movement) of each coordinate relative to the rest position (at

744 I Vol. 120, DECEMBER 1998 Transactions of the ASME

 time = to) is given by f?L (ts ). ). A trial redistribution of m(t)i
was calculated such that the point with the largest displacement
from the reference position (max (!::,.L(tS)i) was assigned the
lowest weighting factor and the remaining distribution was de­
termined by the following:
Thus, the mass distribution was expressed in terms of a single
parameter E. The problem of minimizing F(m(ts)J, ... , m(t,)n)
for n variables was reduced to minimizing
F (m. ( E( ts ) U < tol
Equation ( II) provides the initial trial solution to minimize
F(m(t.')i)' F(mU,)i) is then minimized with respect tOE using
the Levenberg-Marquardt technique (Levenberg, 1944; Mar­
quardt, 1963) to within a nonzero convergence tolerance given
as tol in Eq. (12). The parameter E is determined for each time
step to provide a redistribution of the weighting parameters
m(t)i that will minimize the effect of markers contributing to
the non-rigid body motion. . algorithm. Thus, the cluster method provided a substantial im­
Simulation Study. To test the algorithm, error was intro­
duced into a fixed cluster of eight points (Fig. I) in the form
of both random and systematic error. Eight points were selected
to replicate the number of markers used for the in vivo study.
The random error represented the error primarily due to digitiza­
tion noise associated with the optoelectronic system. The ran­
dom noise assigned to each cluster point coordinate had a mag­
nitude ranging between 0 and 5 mm. The systematic error was
assigned to a subset of the cluster points to represent the move­
ment of skin or underlying muscle during contraction. The sys­
tematic error was assigned in the longitudinal direction of the
cluster to represent skin movement tangential to the surface of
the segment. Four of the eight cluster points were assigned an
error that increased from 0 and 6 cm over 20 time steps. The
corrected and uncorrected cluster position was compared in
terms of position of the cluster center of mass and orientation.
In addition, the error in the position of a trial point not included
in the cluster was used to evaluate error correction. Calculations
were based on setting tol = 0.1 in Eq. (12).
, ., ,
""
" , ~, '
,.
A a protocol approved by the Institution Review Board. The aver­
. ~ Non-optimized
Optimized~
E Random
~1II 20b:.on-OPlim.iz.ed .
~~ \ B
~i3 ." ..... '... ~OptJmlzed
&~
Simulation Results. The systematic error introduced into
four of the eight cluster points was linearly increased over 20
time steps while the random error was applied to all eight cluster
points (Fig. 1 (A». Eight markers were selected to match our
in vivo model. The error was calculated as the distance that
each cluster point moved from its initial position. As the system­
atic error for some of the cluster points increased to 6 cm, the
change in the eigenvalue norm (Fig. I(B» approached a 20
percent increase from the initial rest position. In spite of the
large error in half of the cluster points, the mass center error was
approximately 3 cm at its maximum. The error in the location of
(12) the trial point provides an important evaluation of the influence
of the cluster point errors because its calculation is based on
the position of the mass center as well as the angular position
determined from the eigenvectors as given by Eq. (7). This is
the type of calculation that is ultimately used to locate the
location anatomical coordinate system fixed in the underlying
bone when the cluster method is applied to in vivo movement
studies. Again, in spite of the large error in four of the eight
cluster points, the calculation of the trial point error was less
than 3.5 cm prior to the application of the mass optimization
provement in the calculation of the location of the trial point
without employing the optimization algorithm. In fact, if one
anticipates cluster point error on the order of 2 cm or less, the
cluster point algorithm can be used quite efficiently without the
introduction of the optimization algorithm. However, if nonrigid
body movement becomes large, the redistribution mass algo­
rithm substantially reduces the error in the location of the mass
center as well as the ultimate calculation of the trial point posi­
tion. By minimizing the change in the eigenvalue norm, one
can achieve a substantial improvement in the systematic error
associated with simulated skin movement. While the simulation
study provided the only absolute test of the algorithm's ability
to correct for nonrigid body motion in cluster points, it remained
difficult to assess the applicability of this analytical technique
to true in vivo testing. Therefore, an in vivo study was conducted
to examine the applicability of point cluster methodology to its
intended goal, in vivo testing.
In Vivo Tests. The in vivo testing protocol was designed
to follow the protocol described by LaFortune et aL (1992)
with several exceptions. In that study, five healthy male subjects
were tested while walking with intracortical pins placed in the
femur and tibia to quantify six-degree-of-freedom movement
of the knee joint. In the present study, five male subjects and
five female subjects were also tested during level walking using
,- --:-_--, age age of the population was 31.7 ::'::: 10.5 years, the weight
was 574 ::'::: 120.9 N, and the height was 1.7 ::'::: 0.1 m. For
t Systematic
Error
analysis, a single trial was randomly selected from six trials
acquired on each patient.
~
Error
Trial Point
Instrumentation. Reflective markers on the limb segment
l-

W
II .....
o· t were tracked using a four camera video-based motion measure­
'''< +
Clusler /1>_ 5
ment system (GaitLink TM, Computerized Functional Testing
Corporation, Chicago, IL). The cameras were positioned in an
Points
arc approximately 1.5 m from the center of the measurement
volume on one side of a 10m walkway. A modified direct linear

~
transform technique (Hatze, 1988) was used to reconstruct the
I three-dimensional locations of the markers. The transform pa­
Non'optimized .
~ •• Optimized
0
L 1 2
~_~ _
._J _
E
rameters were calculated using 88 markers in known locations,
/ \"c,­ chosen to span the volume of interest completely.
The system accuracy was tested using a rigid test device
TimuStl:lp fabricated to represent the thigh, shank segment and knee joint.
The test device knee could be flexed at predetermined angles.
Fig. 1 The simUlation study involved introducing random and systematic Markers were placed on this device, then data were acquired
error into a fixed set of eight cluster points (E). The systematic error in while the device was rolled along the walkway. From these
four cluster points was linearly increased with time (A). The errors
(dashed line) in eigenvalue, mass center, and trial points increased with
tests, root mean square angular errors of 0.3, 0.6, and 1.0 deg
increasing systematic error. Following optimization (solid tine), there were measured for flexion, adduction, and internal rotation at
was substantial error reduction in each parameter. the knee respectively. For translational errors, the lateral, ante-

Journal of Biomechanical Engineering DECEMBER 1998, Vol. 120 / 745

• ---------------
rior, and superior rms errors were 1.5, 1.5, and 1.0 mm, respec­
tively.
Subjects and Protocol. The motion of the knee joint was
quantified in terms of flexion, rotation, and displacement. A total
of 16 markers were placed on the leg. Eight markers defined the
thigh and eight defined the shank cluster system. The selection
of the number of markers was based on the spacing between
markers required for tracking using the video-based optoelec­
tronic system. To describe the motion of the underlying bones
in terms of the global coordinate system, a subset of the markers
in the point cluster were referenced to bony landmarks on the
femur and tibia (Fig. 2). Techniques described by Hoppenfeld
and Huton (1976) and Benedetti and CappozZQ (1994) were
used to locate these bony landmarks. The anatomic coordinate
system used was similar to that described by LaFortune et al.
( 1992) with the exception of the origin of the femoral coordi­
nate system. For the thigh segment, a coordinate system was
located in the femoral condyles. The thigh's medial-lateral axis
(Fig. 3) runs through the trans-epicondylar line (a line drawn
between the medial-lateral femoral epicondyles). The midpoint
of this axis is the origin. The inferior-superior axis runs parallel
to the long axis of the femur, passing through the midpoint of the
trans-epicondylar line. The anterior-posterior axis is the cross
product of the medial-lateral and inferior-superior axes. The
final position of the inferior-superior axis is made orthogonal
to the anterior-posterior and medial-lateral axis. For the shank
segment, the tibial coordinate system begins with the medial­
lateral axis running through the most medial and lateral edges
of the tibial plateau. The inferior-superior axis is perpendicular
to the medial-lateral axis passing through the tibial eminence.
The anterior-posterior axis is the cross product of the medial­
lateral and inferior-superior axes. The results from the level
walking studies were compared to the results from LaFortune
obtained with intracortical pins placed in the femur and tibia.
In Vivo Results. Average curves were calculated for the
three rotational (Fig. 4) and translational (Fig. 5) components
of displacement. The temporal pattern of the curves was com­
pared to data reported by LaFortune. In addition, maximum
ranges of peak-to-peak displacements were compared (Table
I). The flexion-extension motion was quite reproducible and
consistent with LaFortune's measurements. It should be noted
Yf
Tibial
the rotation' since this point was offset from the center of rotation
Anatomic
of the knee. The anterior-posterior displacement showed the
System
largest range of movement as well as some unique characteris­
Yt
Fig. 2 An illustration of the cluster point distribution, cluster coordinate,
and anatomical systems
746 I Vol. 120, DECEMBER 1998
---- ----------
Trans-epicondylar
Reference 1\1/111/111/1111/1
- Reference
used in
LaFortune et al
Fig. 3 The location of the femoral reference point used to define AP
motion of the femur with respect to the fixed tibial system. The point
used in the study reported by LaFortune et al. (1992) is illustrated for
comparison.
that for the purposes of this paper, motion of the femur has
been described with respect to a fixed tibial system. Thus, in
comparing the results to LaFortune, the axes were reversed. The
abduction-adduction motion showed a pattern with minimal
changes during stance phase with the femur adducting slightly
during swing phase. The patterns were quite comparable with
that described by LaFortune. Similarly, the internal-external
rotation motion showed the femur internally rotated at heel
strike with external rotation taking place to approximately ter­
minal extension. As the knee flexed during swing phase, the
femur again internally rotated.
The translations between the results derived from the point
cluster and those described by LaFortune also show comparable
patterns of movement during level walking (Fig. 5). It should
be noted that the displacements were calculated on the basis of
the movement of the transepicondylar reference point relative
to a fixed tibial system. This point differed slightly from that
defined by LaFortune's femoral reference point described as
located at the deepest point of the intercondylar fossa (Fig. 3).
In addition, LaFortune normalized the position of this point to
zero at heel strike. In the present study, the data were not
normalized. The average curves of axial displacement showed
'similar characteristics to those reported by LaFortune but were
offset due to the effect of normalization. The medial-lateral
displacement showed the least amount of movement during
walking and probably reflects the coupled displacement due to
tics. In general, the maximum anterior position of the femur on
the tibia occurs during swing phase. At heel strike, the femur
assumes the maximum posterior position and moves anteriorly
to terminal extension. This pattern was common to all subjects.
The eigenvalue changes (as a percent change from the refer­
ence) for the averaged curves of the ten subjects illustrated in
Figs. 4 and 5 ranged from 4.7 to 7.4 percent for the thigh
segment and 2.8 to 6.9 percent for the shank segment (Table
2). The eigenvalue change provided a basis for determining the
quality of the calculation throughout stance phase. As illustrated
in Fig. 6, the eigenvalue norms for the thigh and shank varied
throughout stance and swing phase. Typically, the thigh seg-
Transactions of the ASME
 70 There are several observations that can be derived from the
60
simulation study. The cluster method provides a substantial
LaFortune et al
correction in the location of the origin of a cluster coordinate
c: iii 50 (1992) system (mass center) as well as the orientation axes (eigenvec­
';o( e 40
QI
and PCT '- tors) of the cluster system. Even with large errors introduced
.! g' 30 into half of the cluster points, the ultimate calculation of an
11.0
- 20 arbitrary trial point was substantially improved even prior to
10 the application of the optimization algorithm (Fig. 1). Thus, ip
situations where cluster points are strategically located such that
skin movement is minimized, the point cluster system can be
-10
efficiently used without the recruitment of the optimization al­
gorithm. While the mass redistribution algorithm can substan­
c tially improve the calculation of the mass center location and
o
n
:::l

cluster orientation, it substantially increases computational de­

mands. The mass optimization algorithm involves a nonlinear
"tl

"tl
optimization at each time step. Convergence, numerical condi­
c:iilc:( 5 LaFortune et al
o CIl tioning, and the appropriate selection of the optimization algo­
+if (1992)~ PCT
.Bel
o CIl
~e.c:
--. - --- . - -- . . -- ­
O+-------==----------/ll-----~__::l=_­
rithm are important considerations. At this point, the algorithm
was not selected for efficiency, but rather to demonstrate and
o evaluate the analytical procedure associated with the point clus­
~ ter. The ultimate evaluation of this type of methodology must
:::l -5

"tl

.c
c:(
-1

LaFortune et al
(1992)

1 - LaFortune et al
(1992) I #
, ... . ..

... ... . ... .... #

#
#
..
..
.. ..
o
-1 1
Stance Swing
LaFortune et al
Toe

Heel

Strike
Off

Ei'ii (1992)
~~ f ..
Fig. 4 A comparison of averaged rotation of the femur with respect to c:CIl..l
-; 0 "~-¥--=------.I---4,-----"-",,,,,---,,,,,,;i<I--''''-­
the tibia. The measurements derived from the skin-based PCT markers E
(solid line) had comparable temporal patterns (location of maxima and
minima) to those obtained with intracortical pins (LaFortune et al., 1992).
Note that LaFortune's results were inverted to a fixed tibial frame.
.CIl
u

lc;
i:3 'C -1
..I CIl
:!:!
ment showed greater error during swing phase than during
stance phase (Fig. 6).
-2
Discussion
The point cluster method in this paper addresses the problem
of deriving limb segment motion from markers placed on the -.!2
..
skin. The method provides a basis for determining the artifact E"
u.s
-c: LaFortune at a/I
associated with nonrigid body movement in a manner that per­ (1992)
c:c:(
CIl
mits an improvement in the approximation to the rigid portion E
of the segment movement.
The results of the simulation study provided an important
.
u
CIl

"ii ..
III 0
basis to evaluate the point cluster methodology as well as the c'i:CIl
optimization algorithm against an absolute standard. The sys­ a. ...
c:(:g
tematic error introduced into the cluster was designed to repre­ a.
sent skin movement associated with a portion of the cluster Stance Swing
segment moving on a contracting muscle or any other source
Heel Toe
of skin surface movement. The random noise was designed to be Strike Off
associated with the influence of the optoelectronic measurement
systems typically used to acquire the movement of markers in Fig. 5 A comparison of averaged translation of the femur with respect
three-dimensional space. These errors were selected to replicate to the tibia. The translation is based on the displacement of the femoral
reference point (Fig. 3) with respect to a fixed tibial system. Note LaFor­
what is anticipated from in vivo studies (Cappozzo et aI., 1996; tune used a different reference point (Fig. 3) and normalized translation
Maslen and Ackland, 1994; Holden et aI., 1997; LaFortune et to zero at high strike. LaFortune's results were converted to a fixed tibial
aI., 1992). system.

Journal of Biomechanical Engineering DECEMBER 1998, Vol. 120 I 747

-I
Table 1 A comparison of the maximum rotational and translational mo­ 80
tion between measurements obtained with the point cluster method and 70
those reported by LaFortune. The peak values were defined as shown 60
in Figs. 4 and 5. 1

\
50

MAXIMUM MINlMUM DIFFERENCE 1:-;- 40

I I I I o GI
Adduction
PCT
5.69
Lafortune
6.4
PCT
-5.18
Lafortune
1.2
PCT
10.87
I Lafortune
5.2 'xClIO!e 3D
20
-ClI
(Degrees) (4.84) (2.0) (3.10) NA
u.e. 10
0

IntemalRot 11.46 9.4 -4.59 -5.0 16.05 14.4 -10

(Degrees) (3.70) (2.7) (3.35) (1.6)

Lateral 0.34 NA -1.00 NA 1.34 0.56

(em) (0.46) NA (0.41) NA (0.28)

Anterior 1.40 0.36 -1.07 1.43 2.47 1.79

(em) (0.60) (0.18) (0.46) (0.37) HeBI

Strike
Toe
Oft

Axial 4.\l 0.70 2.13 -0.32 1.98 1.02 Fig. 6 An illustration of the temporal change in the eigenvalue norm
(em) (0.63) (0.38) (0.71) (0.29)
dUring the gait cycle

be determined through in vivo studies. However, absolute evalu­
ation even in highly controlled in vivo studies is difficult. Even
a study with rigid pins fixed into a rigid portion of the segment
such as bone will have errors associated with the instrumenta­
tion. Thus, any physical study will have unknown errors that
will contaminate the absolute analytical evaluation of the ap­
proach. At present, the best physical. data availa.ble, for eval.ua­
tion of the methodology are reported m a study With mtracortlcal
pins placed in the femur and the tibia (LaFortune et aI., 1992).
While there are limitations to direct comparisons between pa­
tients measured in LaFortune's study compared to those mea­
sured in this study, a comparison of the similarities of the results
as well as a physical interpretation of the results provides an
important basis for understanding the in vivo application .of this
methodology. There has been a paucity of in vivo testmg re­
ported with similar methods (Spoor and Veldpaus, 1980; Cap­
pello et aI., 1996).
Comparison of this approach to the work of either Spoor
and Valdpaus or Capello et al. is problematic. The Spoor and
Valdpaus work provided only a detailed description of their
approach; no results of computer simulations or in vivo testing
were presented. The work of Cappello et al. do not provide the
mathematics of their technique; results were limited to a single
individual performing a cycling activity. The results of the in
vivo comparison to previous studies where intracortical pins
were placed also demonstrated that the point cluster method
produces a reasonable approximation to in vivo knee joint move­
ment. The internal rotation calculations were quite comparable.
The differences in the anterior-posterior displacement patterns
Table 2 The average and standard deviation (sd.) of the percent eigen­
value norms change from the reference position for the thigh and shank
segments over one walking cycle. The eigenvalue changes provide a
metric for each segment's deviation from rigid body motion. Also shown
are the demographic measurements for each subject.
% Eigenvalye Cbunge •
can be attributed to a number of factors. These factors include
the precise definition of the transepicondylar reference point,
the differences in gait that may be associated with patients
walldng with the intracortical pins versus those walking nor­
mally as well as possible differences in axis locations.
The physical interpretation of the anterior-posterior position
of the femur with respect to the tibia provides some interesting
insights into the relative tibiofemoral contact movement over
the gait cycle. At heel strike the results of this study demonstrate
that the tibia is anteriorly displaced with respect to the femur.
This finding is reasonable in the context of the loads that occur
at heel strike. Typically, as the foot strikes the ground there is
an anteriorly directed force at the heel. Simultaneously at heel
strike, the quadriceps are firing, which will also produce an
anterior force on the tibia with the knee at full extension. As
the knee goes past midstance phase it again reaches extension
prior to toe-off. The results of this study demonstrate that the
tibia displaces posteriorly with respect to the femur during this
portion of the gait cycle. This finding is again reasonable consid­
ering that at this time in the gait cycle the quadriceps are not
firing and the external forces are tending to push the tibia poste­
riorly as the weight is transferring to the contralateral limb.
These two points in the walking cycle with the knee at full
extension produced extreme differences in the anterior-posterior
position of the transepicondylar reference point. These findings
provide a basis for the dynamic evaluation of anterior-posterior
stability of the knee joint. In addition, it points out the impor­
tance of relating knee kinematics to the particular dynamic func­
tion when attempting to describe tibiofemoral kinematics.
There are practical limitations of PCT. In practice, having
this overabundance of markers on each segment can lead to
difficulties in tracking and labeling the individual markers. Ad­
ditionally, care must be taken in marker placement to ensure
the markers are positioned such that the point clusters are not
symmetric; that is, the cluster of markers possess no axes of

rotational symmetry. This can lead to the calculation of the

Subject Age Sex Height Weight Thigh Shank
principal axes becoming indetenninate, causing the governing
Code Years M. Kg. , Mean % sd Mean %
'd equations to become ill conditioned. However, given the precau­
Iaoj 59 1.55 54 4.8 2.0 3.5 27 tions of the PCT described here, it provides a unique approach
laom 30 1.60 48 5.6 2.7 2.8 1.7 to the measurement of in vivo motion using skin-based marker
lanw 26 m 168 68 6.6 2.7 3.9 2.8
laon 29 f 1.57
systems.
50 4.7 19 3.9 16
laov 24 f 1.52 54 7.4 2.6 6.9 18
lapy 23 m 1.83 71 6.4 3.2 4.0 1.7
laqq 25 f 160 47 5.5 2.8 4.8 2.8
Acknowledgments
laqu 32 m 1.70 64 6.1 2.7 4.9 2.2 This study was supported by: NIH Grant ORA #97021021:
larb 37 m 1.78 69 4.6 1.9 2.9 16
lare 32 m 1.85 82 5.9 3.9 4.7
"A New Technique for the Analysis of Human Movement";
18
NIAMS/NIH Grant 2 ROl-AR-20701-16Al: "Biomechanical
.. Calculated using (A. - ~)I ~ from Equation 10 averaged over one walking cycle ..
Study of Total Knee Replacement"; NIAMS/NIH Grant 2 ROl-

748 I Vol. 120, DECEMBER 1998 Transactions of the ASME

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a


AR39421-05A2: "Anterior Cruciate Ligament-Functional
Biomechanics.' ,
References
Andriacchi, T. P., Sen, K., Toney, M. K., and Yoder, D., 1994, "New develop­
ments in musculoskeletal functional testing," Proc. Canadian Soc. ofBiomechan­
ics, VIIIth Biennial Conf.. pp. 12-13.
Andriacchi, T. P., and Toney, M. K., 1995, "In Vivo Measurement of Six­
Degrees-of-Freedom Knee Movement During Functional Testing," in: Trans. 41
Ann. Meet. Orth. Res. Soc., Orlando, FL, p. 698.
Banks, S. A., and Hodge, W. A., 1996, "Accurate measurement of three-dimen­
sional knee replacement kinematics using single-plane fluoroscopy," IEEE Trans.
Biomed. Eng., 43(6), 638-649.
Benedetti, M. G., and Cappozza, A., 1994, "Anatomical landmark definition
and identification in computer aided movement analysis in a rehabilitation context
II (Internal Report)," Universita Degli Studi La Sapienza, 1-31.
Cappello, A., Cappozza, A., La Palombara, P. F., Leardini, A., and Bertani,
A., 1996, "Skin artifact compensation by double calibration in bone motion
reconstruction," Paper No. 2.6.3-2, presented at the 18th Annual Int. Conf. of
the IEEE Engineering in Medicine and Biology Society.
Cappozza, A., Catani, E, Leardini, A., Benedetti, M. G., and Della Croce, U.,
1996, "Position and orientation in space of bones during movement: experimental
artifacts," Clinical Biomechanics, II, 90-100.
Dyrby, C. 0., Toney, M. K., and Andriacchi, T. P., 1997, "Relation between
knee flexion and tibial-femoral rotation duri"ng activities involving deep flexion,"
Gait and Posture, 5, 179.
Hatze, H., 1988, "Higb-precision three-dimensional photogrammetric calibra­
tion and object space reconstruction using a modified DLT-approach," J. Biome­
chanics, 21,533-538.
Holden, J. P., Orsini, J. A., Siegel, K. L., Kepple, T. M., Gerber, L. H., and
Stanhope, S. J., 1997, "Surface movement errors in shank kinematics and knee
kinetics during gait," Gait and Posture, 3,217-227.
Journal of Biomechanical Engineering
a !
,---._------ - -.--- ------- ------~----
Hoppenfeld, S., and Huton, R., 1976, "Physical examination of the knee,"
Physical Examination of the Spine and Extremities, 171-196.
Jonsson, H., and Karrholm, J., 1994, "Tlu'ee-dimensional knee joint movements
during a step-up: evaluation after anterior cruciate ligament rupture," J. Or/hop.
Res., 12(6), 769-779.
LaFortune, M. A., Cavanagh,P. R., Sommer, H. J., and Kalenak, A., 1992,
"Three dimensional kinematics of the human knee during walking," J. Biome­
chanics, 25, 347-357.
Levenberg, K., 1944, "A method for the solution of certain problems in least
squares," Quart. ApI. Math., 2, 164-168.
Marquardt, D., 1963, "An algorithm for least-squares estimation of nonlinear
parameters," SIAM J. Appl. Math., 11,431-441.
Maslen, B. A., and Ackland, T. R., 1994, "Radiographic study of skin displace­
ment errors in the foot and ankle during standing," Clinical Biomechanics, 9,
291-296.
Murphy, M. C, 1990, "Geometry and the Kinematics of the Normal Human
Knee," Ph.D. thesis, Massachusetts Institute of Technology, Cambridge, MA.
Reinschmidt, c., van den Bogert, A. J., Lundberg, A., Murphy, N., and Nigg,
B. M., 1995, "Tibiofemoral and calcaneus-tibia motion during running: skin vs.
bone markers," in: Conference Proceedings. American Society of Biomechanics,
Stanford, 41-42.
Sati, A., de Guise, J. A., Larouche, S., and Drouin, G., 1996, "Quantitative
assessment of skin-bone movement at the knee," The Knee, 3, 121-138.
Spoor, C. W., and Veldpaus, E E., 1980, "Rigid body motion calculated from
spatial co-ordinates of markers," J. Biomechanics, 13,391-393.
Stein, L. A., Endicott, A. N., Sampalis, J. S., Kaplow, M. A., Patel, M. D., and
. Mitchell, N. S., 1993, "Motion of the patella during walking: A video digital­
fluoroscopic study in healthy volunteers," Amer. 1. Roentgenology, 161, 618­
620.
Stiehl, J. B., Komistek, R. D., Dennis, D. A., Paxson, R. D., and Hoff, W, A.,
1995, "Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee
arthroplasty," 1. Bone Joint Surg. Br.. 77, 884-889.
DECEMBER 1998, Vol. 120 / 749
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