ArthroMetrix LLC. is dedicated to a better understanding of orthopedic injuries, prevention, treatment and outcome analysis of such injuries. ArthroMetrix developed the 3D Star Exam and the CT Star Exam which are computerized joint laxity testing systems that can measure motion in a subject’s knees during tests that mimic the physical examination done in a clinical setting. With the assistance of 3D modeling ArthroMetrix can provide visual aids that clearly depict the movement within the knee from any angle. In conjuction with the ArthroShare mobile app medical providers and research personel are able to consistantly measure joint movement and monitor patient-reported outcome measures.
Custom software was developed by ArthroMetrix in order to analyze the data collected by the robotic testing devices. Objective knee joint laxity data can be used to more accurately diagnose knee injuries and can aid the surgeon in operative planning or non-operative treatment. Sophisticated 3D visualization software is used for a crisp and clear presentation of the knee joint laxity. 3D modeling enhances the level of visualization enabling the healthcare professional to interpret the knee motion from multiple angles simultaneously.
Arthroshare is a web-based portal for doctors, patients, research professionals and other healthcare professionals designed to streamline and consolidate the collection of patient feedback in order to reliably gauge patient outcomes. With the rise of results-based medicine, Arthroshare provides the healthcare community with a convenient, user-friendly platform optimized for the management and execution of clinical research. The Arthroshare Portal enables clinicians and researchers to easily and reliably connect with patients to regularly collect necessary clinical information while maintaining confidentiality through our secure online portal.
Patients also have the ability to download the Arthroshare Mobile App for both iOS and Android. With the Arthroshare mobile app users now have easy access to securely share their recovery progress with their provider. The app connects users with providers and clinical researchers for the collection of health care survey throughout the course of care. Users can fill out surveys that have been assigned to them by their care provider, exchange secure messages their care provider and share updates about their recovery in a clear and easy-to-use format.
- Subjective Test based on what can be felt by the hands.
- Two dimensional Data (instrumented manual testing devices).
- Can be Inconsistent between Clinicians.
- Can be inconsistent from day to day for a single clinician.
Robotic Knee Story
- Objective Test based on numerical data.
- Precisely Measuring what your hands are feeling.
- Greater Precision.
- Consistent Force Application.
- Removes Examiner Bias..
Robotic Knee Testing 3D Visualization
- Communicate complex mechanisms of the human body.
- Precise presentation of robotic analysis.
- Superior ability to portray joint movement.
- Reveal detailed spatial relationships.
- Enhance anatomy interaction and functions.
- Clearly and concisely view joint translation.
- Simultaneously display multiple viewpoints.
- Specific diagnosis of knee injuries based on manual clinical examination alone has been shown, in many cases, to be inconsistent and/or lacking in accuracy.
- Injuries to the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), or the meniscus are generally diagnosed more consistently and accurately as compared to those involving rotational or combined injuries.
- The ranges in diagnostic accuracy using the manual clinical knee examination have been reported as: medial meniscus tear 75-85%; lateral meniscus tear 58-92%; ACL tear 83%-100% and PCL 96-100% [Jah, Kocabey, Liu, O’Shea, Rubinstein, Terry].
- However, other injuries such as medial collateral ligament (MCL) tears, posterolateral corner (PLC) injuries, or combined injuries have much lower ranges of accuracy [Hughston, LaPrade, LaPrade, Oberlander, Yoon].
- For example, the posterolateral corner of the knee, which is a system of bones, muscles, tendons and ligaments, has an anatomy that can vary from one person to the next. This variation can present difficulties when trying to identify rotational instability and injury patterns [Amis, LaPrade, LaPrade, Ranawat, Ross].
Problems Associated with Manual Examination
- Overall knee joint laxity can feel similar during the manual clinical knee examination as a result of different knee injuries.
- Inconsistent between examiners [Ahlden, Anderson, Ballantyne, Benvenuti, Berry, Boyer, Branch, Kuroda, Lane, Kitamura].
- Inconsistent from day to day [Ahlden, Anderson, Ballantyne, Benvenuti, Berry, Boyer, Branch, Kuroda, Lane, Kitamura].
- Difficult for examiners with smaller hands to perform [Rebman, Draper].
- Difficult to perform on larger patients.
- Can be difficult to test consistently between the right and left legs of a patient [Sernert].
- Can be difficult to perform at an acute stage after injury [Mitsou].
Robotic Knee Testing
- Examiner does not apply the force (force/torque applied by motors)
- Takes away side-to-side variability
- Consistent force between days and between patients
- Constant speed
- Controlled direction
- Quantitative data rather than qualitative
Motion of the tibia relative to the femur is recorded using an electromagnetic system
- High accuracy - 0.48 mm and 0.30 degrees
Six degree of freedom data is reported
- Information about off-axis motions can help in an accurate diagnosis
- Flexibility in how the data from testing can be displayed/analyzed (see Data Analysis Section)
Research And Clinical Plans
All plans include secure encrypted HIPAA compliant security with multiple levels of restricted access to application features and functionality.
Research and University Settings
- Up to 25 users
- 5000 cases per year
- Standard protocols
- Web-bassed support
Clinial Settings Per Provider
- Up to 5 users
- 1500 cases per year
- Standard protocols
- Web-based support
Clinical Settings Unlimited
- Up to 500 users
- Unlimited cases
- Customized protocols
- Web-based support
- Amis AA, Bull AM, Gupte CM, et al (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11:271-81.
- Hughston JC, Jacobson KE (1985) Chronic posterolateral rotary instability of the knee. J Bone Joint Surg Am 67A:351-9.
- Jah AAE, Keyhani S, Zarei R, Moghaddam AK (2005) Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg 71:189-96.
- Kocabey Y, Tetik O, Isbell WM, et al (2004) The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 20:696-700.
- LaPrade RF, Terry GC (1997) Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with the clinical instability. Am J Sports Med 25:433-8.
- LaPrade RF, Hamilton CD, Engebretsen L (1997) Treatment of acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries. Sports Med Arthrosc 5:91-9.
- Liu SH, Osti L, Henry M, Bocchi L (1995) The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br 77:586-8.
- Oberlander MA, Shalvoy RM, Hughston JC (1993) The accuracy of the clinical knee examination documented by arthroscopy. A prospective study. Am J Sports Med 21:773-8.
- O’Shea KJ, Murphy KP, Heekin RD, Herzwurm PJ (1996) The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders. Am J Sports Med 24:164-7.
- Ranawat A, Baker CL, Henry S, Harner CD (2008) Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg 16:506-18.
- Ross G, DeConciliis GP, Choi K, Scheller AD (2004) Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee. J Bone Joint Surg Am 86-A Suppl 2:2-7.
- Rubinstein RA Jr, Shelbourne KD, McCarroll JR, et al (1994) The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med 22:550-7.
- Terry GC, Tagert BE, Young MJ (1995) Reliability of the clinical assessment in predicting the cause of internal derangements of the knee. Arthroscopy 11:568-76.
- Yoon Y-S, Rah J-H, Park H-J (1997) A prospective study of the accuracy of clinical examination evaluated by arthroscopy of the knee. Int Orthop 21:223-7.
- Ahlden M, Kartus J, Ejerhed L, Karlsson J, Sernert N (2009) Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellartendon-bone or ham- string tendon autografts, with special emphasis on comparison over time. Knee Surg Sports Traumatol Arthrosc 17:1117–1124.
- Anderson AF, Lipscomb AB (1989) Preoperative instrumented testing of the anterior and posterior knee laxity. Am J Sports Med 17:387–392.
- Anderson AF, Synder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometer. Am J Sports Med 20:135–140.
- Ballantyne BT, French AK, Helmsoth SL, Kachingwe AF, Soderberg G (1995) Influence of examiner and gender on inter- rater reliability of KT-1000 arthrometer measurements. Phys Ther 75:898–906.
- Benvenuti JF, Valloton JA, Meystre JL, Leyvraz PF (1998) Objective assessment of the anterior tibial translation in Lachman test position. Comparison between three types of measurement. Knee Surg Sports Traumatol Arthrosc 6:215–219.
- Berry J, Kramer K, Binkley GA, Stratford P, Hunter S, Brown K (1999) Error estimate in novices and expert raters for the KT- 1000 arthrometer. J Orthop Sports Phys Ther 29:49–55.
- Boyer P, Djian P, Christel P, Paoletti X, Degeorges R (2004) Fiabilite ́ de l’arthrome`tre KT-1000 pour la mesure de la laxite ́ ante ́rieure du genou. Rev Chir Ortho 90:757–764.
- Branch TB, Mayr HO, Browne JE, Campbell JC, Stoehr A, Jacobs CA (2010) Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination. Arthroscopy 7:997–1004.
- Draper, D.O.; Schulthies, S. A test for eliminating false positive anterior cruciate ligament injury diagnoses. J. Athl. Train. 1993, 28, 355–357.
- Kuroda R, et al. Similarities and differences of diagnostic manual tests for anterior cruciate ligament insufficiency: a global survey and kinematics assessment. Am J Sports Med. 2012;40(1):91–9.
- Lane CG, Warren R, Pearle AD. The pivot shift. J Am Acad Orthop Surg. 2008;16(12):679–88.
- Kitamura N, et al. Biomechanical characteristics of 3 pivot-shift maneuvers for the anterior cruciate ligament-deficient knee: in vivo evaluation with an electromagnetic sensor system. Am J Sports Med. 2013;41(11):2500–6.
- Mitsou, A.; Vallianatos, P. Clinical diagnosis of ruptures of the anterior cruciate ligament: A comparison between the lachman test and the anterior drawer sign. Injury 1988, 19, 427–428.
- Rebman, L.W. Suggestions from the field: Lachman’s test—An alternative method. J. Orthop. Sports Phys. Ther. 1988, 9, 381–382.
- Sernert N, Kartus J, Kohler K, Ejerhed L, Karlsson J (2001) Evaluation of the reproducibility of the KT-1000 arthrometer. Scand J Med Sci Sport 11:120–125.
- Englander Z, Stinton SK, Branch TP. How to predict knee kinematics during an ACL injury. Return to Play in Football – An Evidence Based Approach. Musahl, V., Karlsson, J., Krutsch, W., Mandelbaum, B.R., Espregueira-Mendes, J., d'Hooghe, P.P.R.N. (Eds.). ISBN 978-3-662-55713-6.
- Branch TP, Stinton SK, Sharma A, Lavoie F, Guier C, Neyret P. The impact of bone morphology on the outcome of the pivot shift test: a cohort study. BMC Musculoskeletal Disorders DOI: 10.1186/s12891-017-1798-4.
- Lording T, Stinton SK, Neyret P, Branch TP. Diagnostic findings caused by cutting of the iliotibial tract and anterolateral ligament in an ACL intact knee using a standardized and automated clinical knee examination. Knee Surgery, Sports Traumatology, Arthroscopy 2017;25(4):1161-1169.
- Branch TP, Stinton SK, Hutton WC, Neyret P. The combination of tibial anterior translation and axial rotation into a single biomechanical factor improves the prediction of patient satisfaction over each factor alone in patients with ACL reconstructed knees. Knee Surgery, Sports Traumatology, Arthroscopy 2017;25(4):1038-1047.
- Branch TP, Stinton SK, Browne J, Lording T, deJarnette NK, Hutton WC. A Robotic System for Measuring the Relative Motion Between the Femur and Tiba. In: Rotatory Knee Instability: An Evidence Based Approach. Editors: Jon Karlsson, Ryosuke Kuroda, Volder Musahl, Stefano Zaffagnini. 2016 Springer, New York. ISBN: 978-3-319-32069-4. DOI: 10.1007/978-3-319-32070-0.
- Siebold R, Takada T, Feil S, Dietrich C, Stinton SK, Branch TP. Anatomical “C Shape” double bundle versus single bundle anterior cruciate ligament reconstruction in pre-adolescent children with open growth plates. Knee Surgery, Sports Traumatology, Arthroscopy 2016;24(3):796-806.
- Stinton SK, Siebold R, Freedberg H, Jacobs C, Branch TP. The use of a robotic tibial rotation device and an electromagnetic tracking system to accurately reproduce the clinical dial test. Knee Surgery, Sports Traumatology, Arthroscopy 2016;24(3):815-822.
- Branch TP, Stinton SK, Siebold R, Freedberg HI, Jacobs CA, Hutton WC. Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination. Knee Surgery, Sports Traumatology, Arthroscopy 2017;25(8):2460-2467.
- Branch TP, Lavoie F, Guier C, Branch E, Lording T, Stinton SK, Neyret P. Single bundle ACL reconstruction with and without extra-articular reconstruction: evaluation with robotic lower leg rotation testing and patient satisfaction scores. Knee Surgery, Sports Traumatology, Arthroscopy 2015;23(10):2882-2891.
- Branch TP, Stinton SK, Sternberg M, Hutton W, Lavoie F, Cuier C, Neyret P. Robotic axial lower leg testing: repeatability and reproducibility. Knee Surgery, Sports Traumatology, Arthroscopy 2015;23(10):2892-2899.
- Siebold R, Branch TP, Freedberg HI, Jacobs CA. A matched pairs comparison of single- versus double-bundle anterior cruciate ligament reconstructions, clinical results and manual laxity testing. Knee Surgery, Sports Traumatology, Arthroscopy 2011;19(Suppl 1):S4-S11.
- Branch TP, Siebold R, Freedberg HI, Jacobs CA. Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity. Knee Surgery, Sports Traumatology, Arthroscopy 2011;19:432-440.
- Branch TP, Mayr HO, Browne JE Campbell JC, Stoehr A, Jacobs CA. Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination. Arthroscopy 2010;26(7):997-1004.
- Branch TP, Browne JE, Campbell JD, Siebold R, Freedberg HI, Arendt EA, Lavoie F, Neyret P, Jacobs CA. Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Knee Surgery, Sports Traumatology, Arthroscopy 2010;18:1379-1384.
Presentations at National and International Meetings
- Branch TP. Symposium: Anterolateral ligament-What is the role for its repair or reconstruction in 2017. ISAKOS Biennial meeting 2017, Shanghai, China.
- Branch TP, Stinton SK. Robot assessment of ACL reconstructed knees. ESSKA biennial meeting, Barcelona, Spain. May 2016.
- ACL Study Group March 2016.
- Branch TP, Stinton SK. Changes in tibiofemoral biomechanics as a result of ACL reconstruction can affect patellofemoral kinematics. 2015 Biennial meeting of the International Patellofemoral Study Group. Chicago, IL.
- Branch TP, Stinton SK, Krishnamoorthi K, DeJarnette N, Trigg S. The use of CT robotic knee testing to identify patellar subluxation in a cohort of patients with anterior knee pain. 2015 Biennial meeting of the International Patellofemoral Study Group. Chicago, IL.
- Branch TP, Stinton SK, Krishnamoorthi K. Patellar orientation and tibial rotation 21 post-Fulkerson procedure. 2015 Biennial meeting of the International Patellofemoral Study Group. Chicago, IL.
- Branch TP, Stinton SK. The potential impact of repair of the anterolateral ligament on post ACL-reconstruction uncontrolled internal rotation. Star Paper Session at the 2014 ESSKA Biennial Meeting, Amsterdam.
- Stinton SK, Branch TP. The importance of test-retest reliability and reproducibility over time during objective knee examination. 2014 ESSKA Biennial Meeting, Amsterdam.
- Stinton SK, Branch TP. The importance of a complete clinical knee exam using 3 independent laxity tests. 2014 ESSKA Biennial Meeting, Amsterdam.
- Branch TP, Stinton SK. The potential frequency of anterolateral ligament injuries in at-risk patients in a post ACL-reconstructed population. 2014 ESSKA Biennial Meeting, Amsterdam.
- Branch TP, Stinton SK. Robotic Evaluation of clinically diagnosed posterolateral corner instability. 2014 AANA annual meeting, Hollywood, FL.
- Branch TP, Browne J, Stinton SK. The impact of lateral meniscectomy on rotational stability in the knee. 2014 AANA annual meeting, Hollywood, FL.
- Branch TP, Stinton SK. The AP laxity test, the varus/valgus test and the dial test show no correlation. 2014 AANA annual meeting, Hollywood, FL.
- Browne J, Branch TP, Stinton SK. The Effect of Medial Meniscal Injury on Rotational Instability following ACL Reconstruction. 2014 AANA annual meeting, Hollywood, FL.
- Stinton SK, Browne JE, Jacobs CA, Branch TP. The effect of medial meniscal injury on rotational instability following ACL reconstruction. Highlighted poster at the 2014 AAOS Annual Meeting, New Orleans.
- Browne J, Stinton SK, Branch TP. The impact of lateral meniscectomy on rotational stability in the knee. 2014 ACL study group annual meeting, Capetown, South Africa.
- Branch TP, Stinton SK. Rotational instability and robotic knee testing. 2014 ACL study Group annual meeting, Capetown, South Africa.
- Stinton SK, Trigg S, DeJarnette NK, Cunningham TJ, Branch TP. Reliability of a robotic knee tester during dynamic CT scanning. 2013 ISAKOS biennial meeting, Toronto, Canada.
- Stinton SK, DeJarnette NK, Cunningham TJ, Branch TP. Do tibial rotational characteristics play a role in determining the likelihood of anterior cruciate ligament failure? 2013 ISAKOS biennial meeting, Toronto, Canada.
- Stinton SK, Branch TP, Cunningham TJ, Jacobs CA. The Effect of ACL Graft Selection on in vivo 3D Patellar Kinematics During Robotic Tibial Rotation Using Dynamic CT. 2013 AAOS Annual Meeting in Chicago, IL.
- Stinton SK, DeJarnette NK, Cunningham TJ, Hutton WC, Branch TP. Do Tibial Rotational Characteristics Play a Role in Determining the Likelihood of Anterior Cruciate Ligament Failure? 2013 Orthopaedic Research Society Annual Meeting in San Antonio, TX.
- Stinton SK, Branch TP, Cunningham TJ, Mills T, Albahar A, Jacobs CA. In Vivo 3D Patellar Kinematics During Robotic Tibial Rotation Using Dynamic CT. 2012 ESSKA biennial meeting in Geneva, Switzerland.
- Branch TP, Stinton SK, Cunningham TJ, Jacobs, CA. The Effect of Graft Selection on In Vivo 3D Patellar Kinematics During Robotic Tibial Rotation Using Dynamic CT. 2012 ACL Study group. Jackson Hole, Wyoming.
- Cunningham TJ, Branch TP, Stinton SK, Mills T, Albahar A, Jacobs CA. A robotic in vivo comparison of 3-dimensional patellar kinematics between healthy volunteers and those with patellofemoral pain syndrome using dynamic computed tomography. 2012 Orthopaedic Research Society Annual Meeting. San Francisco.
- Jacobs CA, Branch TP, Cunningham TJ, Stinton SK, Freedberg HI, Browne JE, Wente TM. A robotic in vivo evaluation of loading characteristics of different anterior cruciate ligament reconstructions. 2012 Orthopaedic Research Society Annual Meeting. San Francisco.
- Branch TP, Stinton SK, Cunningham TJ, Freedberg HI, Browne JE, Jacobs CA. Debate: Double Bundle ACL Reconstruction is Superior to Single Bundle. 2011 Emerging Techniques in Orthopedics Conference in Las Vegas, NV.
- Branch TP, Cunningham TJ, Mills T, Albahar A, Stinton SK, Jacobs CA. In Vivo 3D Patellar Kinematics During Robotic Tibial Rotation During Dynamic CT. 2011 International Patellofemoral Study Group Meeting, San Diego, CA.
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