Software Applications

  • Amir Ata Rahnemai-Azar
  • Justin W. Arner
  • Jan-Hendrik Naendrup
  • Volker MusahlEmail author


Rapid advances in computer science and related technologies in the last decades have resulted in the increased application in different fields of medicine. In particular, sophistication of smartphones and computer tablets has provided opportunities for a wide range of clinicians and researchers to utilize these technologies in their everyday practice. In the field of orthopedics, several software products are being developed that are increasingly being used for purposes such as kinematic tracking, educational materials, rehabilitation aids, outcome tools, data registry, telemedicine tools, image processing programs, and clinical evaluations. Some of these products might significantly help clinicians by providing insight to patients’ injury state and planning treatment procedures. This chapter presents principles of the development, reliability, and feasibility of these software products in clinical practice to aid in the care of patients.


Software ACL Pivot shift test Rotatory instability 


  1. 1.
    Ahlden M, Araujo P, Hoshino Y, Samuelsson K, Middleton KK, Nagamune K, Karlsson J, Musahl V (2012) Clinical grading of the pivot shift test correlates best with tibial acceleration. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20(4):708–712CrossRefGoogle Scholar
  2. 2.
    Araujo PH, Ahlden M, Hoshino Y, Muller B, Moloney G, Fu FH, Musahl V (2012) Comparison of three non-invasive quantitative measurement systems for the pivot shift test. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20(4):692–697CrossRefGoogle Scholar
  3. 3.
    Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD (2010) Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 18(9):1269–1276CrossRefGoogle Scholar
  4. 4.
    Berruto M, Uboldi F, Gala L, Marelli B, Albisetti W (2013) Is triaxial accelerometer reliable in the evaluation and grading of knee pivot-shift phenomenon? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 21(4):981–985CrossRefGoogle Scholar
  5. 5.
    Blank E, Lappan C, Belmont PJ Jr, Machen MS, Ficke J, Pope R, Owens BD (2011) Early analysis of the United States Army’s telemedicine orthopaedic consultation program. J Surg Orthop Adv 20(1):50–55PubMedGoogle Scholar
  6. 6.
    Borgstrom PH, Markolf KL, Wang Y, Xu X, Yang PR, Joshi NB, Yeranosian MG, Petrigliano FA, Hame SL, Kaiser WJ, McAllister DR (2015) Use of inertial sensors to predict pivot-shift grade and diagnose an ACL injury during preoperative testing. Am J Sports Med 43(4):857–864CrossRefPubMedGoogle Scholar
  7. 7.
    Boruff JT, Storie D (2014) Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. J Med Libr Assoc 102(1):22–30CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bull AM, Earnshaw PH, Smith A, Katchburian MV, Hassan AN, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg 84(7):1075–1081CrossRefGoogle Scholar
  9. 9.
    Daruwalla ZJ, Wong KL, Thambiah J (2014) The application of telemedicine in orthopedic surgery in Singapore: a pilot study on a secure, mobile telehealth application and messaging platform. JMIR Mhealth Uhealth 2(2):e28CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Debandi A, Maeyama A, Hoshino Y, Asai S, Goto B, Smolinski P, Fu FH (2013) The effect of tunnel placement on rotational stability after ACL reconstruction: evaluation with use of triaxial accelerometry in a porcine model. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 21(3):589–595CrossRefGoogle Scholar
  11. 11.
    Duncan SF, Hendawi TK, Sperling J, Kakinoki R, Hartsock L (2015) iPhone and iPad use in orthopedic surgery. Ochsner J 15(1):52–57PubMedPubMedCentralGoogle Scholar
  12. 12.
    Franko OI (2011) Smartphone apps for orthopaedic surgeons. Clin Orthop Relat Res 469(7):2042–2048CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fujii M, Sasaki Y, Araki D, Furumatsu T, Miyazawa S, Ozaki T, Linde-Rosen M, Smolinski P, Fu FH (2014) Evaluation of the semitendinosus tendon graft shift in the bone tunnel: an experimental study. Knee Surg Sports Traumatol Arthrosc. 2014 Dec 4. pp.1–5. [Epub ahead of print] PubMed PMID: 25472684Google Scholar
  14. 14.
    Gomoll AH, O’Toole RV, Czarnecki J, Warner JJ (2007) Surgical experience correlates with performance on a virtual reality simulator for shoulder arthroscopy. Am J Sports Med 35(6):883–888CrossRefPubMedGoogle Scholar
  15. 15.
    Good DW, Lui DF, Leonard M, Morris S, McElwain JP (2012) Skype: a tool for functional assessment in orthopaedic research. J Telemed Telecare 18(2):94–98CrossRefPubMedGoogle Scholar
  16. 16.
    Hammel R, Kovalski N, Zimmerman DR (2010) Mobile telephone-based remote orthopedic consultation. AJR Am J Roentgenol 195(4):W307CrossRefPubMedGoogle Scholar
  17. 17.
    Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 1(3–4):226–234CrossRefGoogle Scholar
  18. 18.
    Henn RF 3rd, Shah N, Warner JJ, Gomoll AH (2013) Shoulder arthroscopy simulator training improves shoulder arthroscopy performance in a cadaveric model. Arthrosc J Arthroscopic Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 29(6):982–985CrossRefGoogle Scholar
  19. 19.
    Hoshino Y, Araujo P, Ahlden M, Moore CG, Kuroda R, Zaffagnini S, Karlsson J, Fu FH, Musahl V (2012) Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20(4):732–736CrossRefGoogle Scholar
  20. 20.
    Hoshino Y, Araujo P, Ahlden M, Samuelsson K, Muller B, Hofbauer M, Wolf MR, Irrgang JJ, Fu FH, Musahl V (2013) Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 21(4):975–980CrossRefGoogle Scholar
  21. 21.
    Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M, Muratsu H, Yoshiya S, Kurosaka M (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35(7):1098–1104CrossRefPubMedGoogle Scholar
  22. 22.
    Hoshino Y, Musahl V, Irrgang JJ, Lopomo N, Zaffagnini S, Karlsson J, Kuroda R, Fu F (2015) Quantitative evaluation of the Pivot shift test, relationship to clinical pivot shift grade. Paper presented at the American Orthopaedic Society for Sports Medicine, OrlandoGoogle Scholar
  23. 23.
    Iriuchishima T, Ryu K, Aizawa S, Fu FH (2016) The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24:254–259CrossRefGoogle Scholar
  24. 24.
    Jackson WF, Khan T, Alvand A, Al-Ali S, Gill HS, Price AJ, Rees JL (2012) Learning and retaining simulated arthroscopic meniscal repair skills. J Bone Joint Surg Am 94(17):e132CrossRefPubMedGoogle Scholar
  25. 25.
    Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75(5):594–599CrossRefPubMedGoogle Scholar
  26. 26.
    Kim JG, Chang MH, Lim HC, Bae JH, Lee SY, Ahn JH, Wang JH (2015) An in vivo 3D computed tomographic analysis of femoral tunnel geometry and aperture morphology between rigid and flexible systems in double-bundle anterior cruciate ligament reconstruction using the transportal technique. Arthrosc J Arthroscopic Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31(7):1318–1329CrossRefGoogle Scholar
  27. 27.
    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634CrossRefPubMedGoogle Scholar
  28. 28.
    Lane CG, Warren RF, Stanford FC, Kendoff D, Pearle AD (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 16(5):487–492CrossRefGoogle Scholar
  29. 29.
    Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S (2012) Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20(4):713–717CrossRefGoogle Scholar
  30. 30.
    Lopomo N, Zaffagnini S, Signorelli C, Bignozzi S, Giordano G, Marcheggiani Muccioli GM, Visani A (2012) An original clinical methodology for non-invasive assessment of pivot-shift test. Comput Methods Biomech Biomed Engin 15(12):1323–1328CrossRefPubMedGoogle Scholar
  31. 31.
    Mabrey JD, Reinig KD, Cannon WD (2010) Virtual reality in orthopaedics: is it a reality? Clin Orthop Relat Res 468(10):2586–2591CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Maeyama A, Hoshino Y, Debandi A, Kato Y, Saeki K, Asai S, Goto B, Smolinski P, Fu FH (2011) Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer: a biomechanical model in porcine knees. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19(8):1233–1238CrossRefGoogle Scholar
  33. 33.
    Martin KD, Cameron K, Belmont PJ, Schoenfeld A, Owens BD (2012) Shoulder arthroscopy simulator performance correlates with resident and shoulder arthroscopy experience. J Bone Joint Surg Am 94(21):e160CrossRefPubMedGoogle Scholar
  34. 34.
    Mauer UM, Kunz U (2010) Management of neurotrauma by surgeons and orthopedists in a military operational setting. Neurosurg Focus 28(5):E10CrossRefPubMedGoogle Scholar
  35. 35.
    McCarthy AD, Moody L, Waterworth AR, Bickerstaff DR (2006) Passive haptics in a knee arthroscopy simulator: is it valid for core skills training? Clin Orthop Relat Res 442:13–20CrossRefPubMedGoogle Scholar
  36. 36.
    Moffet H, Tousignant M, Nadeau S, Merette C, Boissy P, Corriveau H, Marquis F, Cabana F, Ranger P, Belzile EL, Dimentberg R (2015) In-home telerehabilitation compared with face-to-face rehabilitation after total knee arthroplasty: a noninferiority randomized controlled trial. J Bone Joint Surg Am 97(14):1129–1141CrossRefPubMedGoogle Scholar
  37. 37.
    Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V (2016) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Engin 19:217–228CrossRefPubMedGoogle Scholar
  38. 38.
    Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang JJ, Zaffagnini S, Karlsson J, Fu FH (2012) The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 20(4):724–731CrossRefGoogle Scholar
  39. 39.
    Pollard TC, Khan T, Price AJ, Gill HS, Glyn-Jones S, Rees JL (2012) Simulated hip arthroscopy skills: learning curves with the lateral and supine patient positions: a randomized trial. J Bone Joint Surg Am 94(10):e68CrossRefPubMedGoogle Scholar
  40. 40.
    Srivastava S, Youngblood PL, Rawn C, Hariri S, Heinrichs WL, Ladd AL (2004) Initial evaluation of a shoulder arthroscopy simulator: establishing construct validity. J Shoulder Elbow Surg Am Shoulder Elbow Surg [et al]) 13(2):196–205CrossRefGoogle Scholar
  41. 41.
    Tay C, Khajuria A, Gupte C (2014) Simulation training: a systematic review of simulation in arthroscopy and proposal of a new competency-based training framework. Int J Surg 12(6):626–633CrossRefPubMedGoogle Scholar
  42. 42.
    Thomas GW, Johns BD, Marsh JL, Anderson DD (2014) A review of the role of simulation in developing and assessing orthopaedic surgical skills. Iowa Orthop J 34:181–189PubMedPubMedCentralGoogle Scholar
  43. 43.
    Toomey RJ, Ryan JT, McEntee MF, Evanoff MG, Chakraborty DP, McNulty JP, Manning DJ, Thomas EM, Brennan PC (2010) Diagnostic efficacy of handheld devices for emergency radiologic consultation. AJR Am J Roentgenol 194(2):469–474CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Top ortho apps. Accessed 29 July 2015
  45. 45.
    Wang JH, Kim JG, Ahn JH, Lim HC, Hoshino Y, Fu FH (2012) Is femoral tunnel length correlated with the intercondylar notch and femoral condyle geometry after double-bundle anterior cruciate ligament reconstruction using the transportal technique? An in vivo computed tomography analysis. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 28(8):1094–1103CrossRefGoogle Scholar
  46. 46.
    Wellmon RH, Gulick DT, Paterson ML, Gulick CN (2015) VValidity and Reliability of Two Goniometric Mobile Apps: Device, Application and Examiner Factors. J Sport Rehabil. [Epub ahead of print] PubMed PMID: 25945601Google Scholar
  47. 47.
    Yang JH, Chang M, Kwak DS, Wang JH (2014) Volume and contact surface area analysis of bony tunnels in single and double bundle anterior cruciate ligament reconstruction using autograft tendons: in vivo three-dimensional imaging analysis. Clin Orthop Surg 6(3):290–297CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Zaffagnini S, Lopomo N, Signorelli C, Marcheggiani Muccioli GM, Bonanzinga T, Grassi A, Raggi F, Visani A, Marcacci M (2014) Inertial sensors to quantify the pivot shift test in the treatment of anterior cruciate ligament injury. Joints 2(3):124–129PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Amir Ata Rahnemai-Azar
    • 1
  • Justin W. Arner
    • 1
  • Jan-Hendrik Naendrup
    • 1
  • Volker Musahl
    • 2
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Department of Orthopaedic SurgeryUPMC Center for Sports MedicinePittsburghUSA

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