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Contribution à la modélisation du genou arthrosique. Application à l’étude d’une orthèse de décharge

Abstract : The context is the knee osteoarthritis and its treatment via an unloading brace. As the evaluated brace has specific kinematics, a dedicated protocol was set up using clinical routine tools (EOS® and Vicon®). Sixteen symptomatic subjects participated to this study. The main objective was to validate and to use personalization methods of the biomechanical models to improve the accuracy kinematics and kinetics parameter computation in this specific context. Indeed, the state of the art highlights that the dynamic indicator, currently used in knee osteoarthritis studies, the external adduction joint moment is controversial. The secondary objectives were both the characterization of the pathology using indicators obtained on the acquired data and the in-depth study of the mechanical action of the unloading brace evaluated in this study. Thus, two main methods were investigated. The first one is the sequential analysis of the knee kinematics using EOS® system. This analysis required a registration step of a 3D object on 2D biplanar views. The manual registration reliability was quantified by evaluating both the method accuracy with in-vitro data and the method repeatability thanks to the participation of 3 operators and 6 asymptomatic subjects allowing the acquisition of knee images in several positions (extension and 20°, 40°, and 90° flexion). The second method consists in the fusion of data obtained in the two acquisitions environments (EOS® and Vicon®), to obtain the external knee joint moment in order to define the point where the moment is computed from the femur 3D model. This model is registered in the Vicon® environment through external markers visible in both the EOS® and Vicon® acquisitions. The main results relate to: 1/the reliability of the registration of the bone 3D model on 2D views estimated at about 0,3° and 1,6 mm in the sagittal plane and about 2,1° and 1,8 mm in the transverse plane ; 2/ the quantification of the angular relative position of the shank and tibia of the symptomatic lower limbs, showing the tibial plateau horizontality opposed to the femur emphasized inclination ; 3/ external joint moment variation according to the computation method (with or without internal model included) ; 4/ brace and knee sequential kinematic quantification. As the reliability of the methods developed in this study was estimated, further developments and clinical applications and development could now be explored using these methods.Keywords : knee osteoarthritis; brace, sequential analysis; registration.
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Karine Langlois. Contribution à la modélisation du genou arthrosique. Application à l’étude d’une orthèse de décharge. Biomécanique [physics.med-ph]. Ecole nationale supérieure d'arts et métiers - ENSAM, 2016. Français. ⟨NNT : 2016ENAM0074⟩. ⟨tel-01564463⟩

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