ArthroPlanner: a surgical planning solution for acromioplasty
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We present a computer-assisted planning solution “ArthroPlanner” for acromioplasty based on 3D anatomical models, computed tomography and joint kinematic simulations.
In addition to a standard static clinical evaluation (anamnesis, radiological examination), the software provides a dynamic assessment of the shoulder joint by computing in real time the joint kinematics from a database of activities of daily living. During motion, the precise bone resection (location and amount) is computed based on detected subacromial impingements, providing surgeons with precise information about the surgical procedure. Moreover, to improve the subjective reading of medical images, the software provides 3D measurement tools based on anatomical models assisting in the analysis of shoulder morphological features.
We performed an in vivo assessment of the software in a prospective randomized clinical study conducted with 27 patients beneficiating from the planning solution and a control group of 31 patients without planning. Postoperatively, patient’s pain decreased, and the shoulder range of motion and the functional outcomes improved significantly and the rotator cuff healing rate was good for both groups without intergroup differences. The amount of bone resected at surgery was comparable between the groups. The percentage of remaining impingement after surgery was in average reduced to 51% without groups difference.
ArthroPlanner software includes all required materials (images data, 3D models, motion, morphological measurements, etc.) to improve orthopedists’ performance in the surgical planning of acromioplasty. The solution offers a perfect analysis of the patient’s anatomy and the ability to precisely analyze a dynamic mechanism to fully apprehend the patient’s condition and to fulfill his/her expectations. The study however failed to detect any statistically significant difference in clinical outcomes and bone resection between the groups. Short-term clinical and radiological results were excellent in both groups.
KeywordsShoulder Subacromial impingement Acromioplasty 3D surgical planning Kinematics 3D simulations
This study was funded by Fondation Hans Wilsdorf, a nonprofit foundation with no commercial interest in the present study. We would like to thank Camille Laroquais for her help with the 3D reconstruction and postoperative analysis.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving humans
Institutional ethical approval (CCER no. 15-151) was obtained prior to data collection, and the study was registered at ClinicalTrials.gov (NCT02725346). All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- 3.Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228Google Scholar
- 11.Constant C, Murley A (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
- 17.Gerber C, Catanzaro S, Betz M, Ernstbrunner L (2017) Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: a safe adjunct to rotator cuff repair. Arthroscopy. https://doi.org/10.1016/j.arthro.2017.08.255
- 18.Goutallier D, Postel J, Bernageau J, Lavau L, Voisin M (2016) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
- 25.Lippitt S, Harryman D, Matsen F (1993) A practical tool for function evaluation: the simple shoulder test. In: Matsen FAI, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont, pp 501–518Google Scholar
- 29.Moor B, Bouaicha S, Rothenfluh D, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J 95B(7):935–941CrossRefGoogle Scholar
- 32.Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86Google Scholar
- 37.Schneider P, Eberly D (2003) Geometric tools for computer graphics. The Morgan Kaufmann Series in Computer Graphics and Geometric Modeling. Morgan Kaufmann, San FranciscoGoogle Scholar
- 46.Website (Accessed July 2017) PDF3D. https://www.pdf3d.com/
- 47.Website (Accessed July 2017) Qt. https://www.qt.io/
- 48.Website (Accessed July 2017) Visualization toolkit. http://www.vtk.org/
- 49.Wiley A (1991) Superior humeral dislocation. A complication following decompression and debridement for rotator cuff tears. Clin Orthop Relat Res 263:135–141Google Scholar
- 50.Wu G, van der Helm F, Veegerc H, Makhsouse M, Royf PV, Angling C, Nagelsh J, Kardunai A, McQuadej K, Wangk X, Wernerl F, Buchholzm B (2005) ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand. J Biomech 38:981–992CrossRefPubMedGoogle Scholar