Musculoskeletal Care

Automated gait analysis requires accurate classification and interpretable outputs. We propose an integrated framework for classifying healthy gait and multiple musculoskeletal impairment groups using bilateral ground reaction force (GRF) and center-of-pressure (COP) signals. The signals were normalized over the stance phase and standardized using training-set statistics. The model achieved a validation accuracy of 99.00% and a test accuracy of 90.07% under a session-level split. Class-specific $\epsilon$-LRP identified positive and negative contributions across both sides, multiple signal components, and different stance phases. Separately, the processed GRF signals and model predictions were synchronized within a Blender-based 3D visualization, enabling sample-level inspection of gait trials and classification results. The proposed framework integrates classification, explainability, and 3D visualization to improve model transparency. The source code is available in the following repository: https://github.com/nyoico/grf-gait-3d-visualization.git

Muscle-driven locomotion provides a physically grounded approach to generating realistic human movement. However, achieving both physiological plausibility and adaptability to changes in musculoskeletal capacity and external disturbances remains a fundamental challenge. To address this limitation, we propose a Reflex-Informed Neuromuscular Reinforcement Learning framework for muscle-driven locomotion. Within this framework, a fixed phase-dependent reflex controller serves as the underlying neuromuscular control mechanism, while the reinforcement learning policy produces four biomechanically meaningful residual parameters to modulate key reflex gains and thresholds associated with hip swing, knee support, and ankle propulsion according to the current state. Experimental results demonstrate that the proposed framework generates physiologically plausible locomotion with improved kinematic accuracy and dynamic consistency, as well as better bilateral symmetry and stride-to-stride consistency under nominal walking conditions. The learned policy remains robust under muscle weakness and external perturbations without retraining.

Trochlear dysplasia (TD) is an abnormality of the femoral trochlea associated with anterior knee pain and patellar instability. The sulcus angle (SA) is used to assess trochlear morphology, but it is typically measured on a single axial MR slice with no clear guidance on which to select, making it sensitive to slice selection and landmark placement. We propose an automatic framework for continuous SA profiling from super-resolved MR volumes. Clinically acquired axial, coronal, and sagittal MR scans are combined using implicit neural representations to reconstruct a high-resolution volume. SA measurements are computed across the trochlear region using two landmark detection U-Net models. The approach was evaluated on the public fastMRI dataset and a small in-house cohort of patients with TD. Compared with conventional manual single-slice SA measurements, the proposed automated method yielded a mean absolute error of 11.6$^\circ$ while providing continuous characterization of trochlear morphology. Population-level analysis demonstrated distinct mean SA profiles between the public cohort and the in-house TD cohort, highlighting the potential of profile-based assessment to characterize TD. By reducing reliance on a single manually selected axial slice, the proposed framework extends conventional SA assessment to a continuous profile-based description of trochlear morphology without additional imaging, while remaining conceptually linked to current clinical assessment. Further validation is required. The code is available: https://github.com/wehrlimi/SA_Profile.

Three-dimensional femoral reconstruction from radiographs supports surgical planning, implant sizing, and post-operative follow-up, but remains ill-posed as X-ray projections discard depth information. Existing methods often incorporate a 3D statistical shape model (SSM) as a shape prior to guide reconstructions toward anatomically plausible shapes, relying on iterative 3D-to-2D projection matching. Yet, these approaches are computationally expensive and constrain their SSM to a single dimensionality, leaving the statistical relationship between 2D observations and 3D geometry largely unexploited and unexplored. We instead propose a joint 2D-3D SSM that explicitly captures the co-variation between 2D and 3D segmentations in a shared latent space. During training, 2D and 3D segmentations are registered to a common 3D template and its corresponding 2D projections, and the resulting stationary velocity fields are jointly decomposed using principal component analysis (PCA). This joint modeling allows the 2D-to-3D mapping to be learned directly from data rather than computing correspondences at inference time. For unseen subjects, the 3D shape is recovered directly by lifting the 2D latent coordinates to the 3D PCA subspace, thereby eliminating the need for iterative 3D-to-2D projection. Experiments on NMDID demonstrate that the proposed joint 2D-3D SSM outperforms a widely-used 3D-only SSM baseline while achieving inference approximately 4 times faster, at under 3 seconds per subject. The code is available at: https://github.com/florence-dellaniello-picard/joint2d3d-ssm.

Computed tomography (CT) remains the reference for 3D osseous morphometry in femoroacetabular impingement (FAI) but requires ionizing radiation and manual measurement. Zero echo time (ZTE) MRI visualizes cortical bone and yields FAI angles that agree with CT, but automated angle extraction remains limited. We developed and validated automated FAI angle computation from ZTE MRI and assessed agreement with expert manual measurements in a cross-sectional study (level of evidence, 3). Pelvic ZTE MRI was acquired in 73 participants (mean age 36.8 +/- 18.5 years; 51 women, 22 men), yielding 135 hips. nnU-Net was trained on 100 manually curated hips to segment the femur, pelvis, and three osseous landmarks. Custom geometric algorithms computed alpha, femoral neck-shaft, Tonnis, coronal and sagittal center-edge, and acetabular version angles from inferred segmentations. Measurements on 35 test hips were compared with the mean of two radiologists' manual measures using intraclass correlation (ICC) and Bland-Altman analysis. Dice exceeded 0.96 for bone and ranged from 0.65 to 0.83 for landmarks. Median landmark error was 0.38 mm (femoral head), 0.82 mm (lateral acetabulum), and <2.5 mm (medial acetabulum, greater trochanter). Interrater ICC was excellent for acetabular version, coronal center-edge, and Tonnis (>=0.82) but poor for alpha and femoral neck-shaft. Model versus rater-mean agreement was excellent for acetabular version, coronal center-edge, and Tonnis (0.92-0.96), good for mid-acetabular sagittal center-edge (0.74), and fair for alpha (0.45) and femoral neck-shaft (0.55). Model Bland-Altman limits of agreement were narrower than interrater limits for most angles. Fully automated morphometric assessment from ZTE MRI is feasible and performs comparably to expert readers for most coverage and version angles.

Recovering the 6-DoF pose of the knee bones from a plain radiograph, given the patient's segmented pre-operative CT, turns a routine low-dose image into a quantitative measurement of joint geometry, without the added dose of a repeat CT or a fixed biplanar rig. Classic solutions align a rendered bone silhouette to image edges; recent alternatives refine pose by backpropagating an image-similarity loss through a differentiable X-ray renderer. Both operate one patient at a time and are fragile under a single view. Silhouettes are depth-ambiguous, and differentiable-rendering refinement has a narrow capture range at substantial per-iteration cost. We instead learn an amortized, subject-agnostic dense 2D-3D correspondence, supervised solely by projection geometry. One shared-weight model per bone, trained across 758 patients, registers patients unseen during training. The pose then follows in closed form from a global, initialization-free, render-free PnP+RANSAC solve. Because X-ray formation is transmissive, our correspondence target is transmission-aware rather than tied to a single surface. Though trained only to register, the representation is anatomically semantic: a simple classifier reads a landmark's anatomical region from its embedding across held-out patients, and the same features separate the knee's bones into a 2D-3D-consistent identity learned without any bone label. On a large single-institution cohort the model generalizes well to held-out patients.

Musculoskeletal diseases are among the leading causes of disability worldwide and create the greatest global need for rehabilitation. Because recovery, remodelling and degeneration often unfold over months to years, musculoskeletal care requires longitudinal management that repeatedly integrates evolving patient evidence, external medical knowledge and stage-specific functional goals. In routine practice, this evidence is fragmented across visits, departments and hospital systems, limiting individualized, evidence-based care. Here we report OrthoPilot, a clinical artificial intelligence system powered by a large language model that integrates hospital data streams with authoritative external knowledge for continuous musculoskeletal management. OrthoPilot autonomously retrieves real-time imaging, laboratory, pathology and order data and converts evolving patient states into evidence-based decisions from admission diagnosis to rehabilitation planning. We established a specialist-validated benchmark from real-world electronic health records spanning 1,000 disease codes. In a reader study across the complete care pathway, OrthoPilot was compared with 81 orthopaedic physicians and surpassed experts with 25 years of experience in diagnostic reasoning, clinical decision-making and management planning. It also outperformed all evaluated intelligent systems across 60 external clinical centres. In a prospective study of 1,870 complex cases, OrthoPilot increased full-chain management success by 10.6%. During an 8-month randomised deployment involving 8,240 inpatients, it increased cumulative cases per bed by 9.7% and improved patient-reported access to health information. These results move clinical AI from predicting isolated events toward executing longitudinal management across complete musculoskeletal care pathways.

Hand spasticity and resulting pain affect 12 million people worldwide, including stroke survivors, arthritis patients, and those with other muscle and nerve deficiencies. Soft robotic exogloves are being introduced to help patients enhance mobility or manage pain; however, there are no current solutions that address both pain and mobility. We present preliminary development of a soft robotic exoglove that both aids in mobility and administers massage-like compression to relax spastic muscles. The glove consists of soft pneumatic actuators that are personalized to an individual's hand topology and kinematics, allowing for optimal conformability and targeted mobility. Novel soft actuators were designed, analyzed, fabricated, assembled into an exoglove, and experimentally tested. Actuators were 3D modeled and analyzed with finite element modeling under pressures of 100 and 200 kPa. Geometries were optimized to minimize stress before fabrication and testing. A dorsal finger actuator was successfully customized to a participant's hand topology, providing full conformal contact and maximal force distribution. A ventral finger actuator was successfully fabricated that can be drastically compressed in size to fit into the tight space of a hyperflexed spastic finger. A palmar actuator was successfully printed with stereolithography, showing potential for 3D-printed soft actuators with more complex geometries. The glove was assembled and successfully worn by a pilot user to validate initial findings in comfort and effectiveness.

Radiographic assessment of lower-limb alignment (LLA) is important for predicting joint health and surgical outcomes in total knee arthroplasty. Traditional measurement methods are manual and time-consuming, while recent machine learning approaches typically rely on locating a fixed set of anatomical landmarks. This dependence limits flexibility and may require re-annotation when clinical definitions change. To address this, we propose an automated workflow using Implicit Neural Shape Functions (INSF). Rather than relying on explicit landmark coordinates, we encode the anatomy into a compact latent space and regress clinical alignment measurements directly from these latent codes. This architecture allows for rapid extendability to new tasks without altering the backbone representation. We trained our method on an internal dataset of 566 knee radiographs, each annotated with the outline of the femur and tibia. We evaluated it on both an internal test dataset of 50 patients and a separate external set of 402 preoperative cases from the MRKR dataset. Manual clinical measurements are available for these data, and the MRKR measurements will be made publicly accessible. Performance was comparable to state-of-the-art landmark-based methods and manual agreement, while offering a flexible shape representation that can be extended to additional measurement tasks.

The handling and assembly of instruments during surgery imposes high cognitive demands on scrub nurses, particularly when instruments are unfamiliar. We present a supporting guidance system for surgical instrumentation that combines multi-camera 6D pose estimation with augmented reality in-situ visualization on a head-mounted display without the requirement for additional markers. Pose estimation and consecutive camera calibration are achieved through known objects. The 6D pose estimation network is trained purely on synthetic data, aiming for better generalizability and real-world applicability. The AR guidance displays tooltip localization cues and step-wise assembly animations. Via gaze-based selection and a foot pedal, users can switch between assembly steps in intraoperative use. In a technical evaluation, our approach outperforms state-of-art 6D pose estimation. A user study with 29 scrub nurses was conducted in a surgical simulation of knee arthroplasty, comparing the system against a paper manual. AR guidance significantly reduced the perceived workload compared. Objectively, AR guidance reduced task completion time by 21.3% (4.76 minutes). Specifically, scrub nurses less experienced with the instrument set benefited when using the system. Error frequencies were comparable between conditions. Qualitative feedback highlighted improved process clarity, reduced information overload, and perceived independence. To summarize, our marker-free multi-camera AR guidance approach for surgical instruments can, subjectively and objectively, improve intraoperative instrumentation performance, particularly for untrained scrub nurses.

Accurate execution of preoperative plans in corrective femoral osteotomies remains challenging. Current techniques are limited by variable accuracy, invasiveness, and radiation exposure, with free-hand methods and patient-specific instrumentation (PSI) often requiring >30 and >6 fluoroscopic images, respectively. We present an integrated, electromagnetic tracking (EMT)-based navigation system for femoral osteotomies that minimizes dissection and intraoperative fluoroscopy. The system couples CT-based preoperative planning with one-time intraoperative C-arm calibration and accurate X-ray-to-CT registration from two fluoroscopic images acquired at initialization. This enables real-time, fluoroscopy-free EMT navigation of the saw blade and bone fragments relative to the preoperative plan, and is compatible with uniplanar and biplanar osteotomies. In a feasibility study using 18 synthetic femora, EMT guidance significantly outperformed free-hand execution in total angular error ($(3.05 \pm 0.75)^\circ$ vs.\ $(6.32 \pm 2.36)^\circ$, $p=0.031$), assuming the same minimal surgical exposure for both. No EMT-guided trials exceeded the >5° clinical threshold, whereas free-hand produced 4 outliers of 6 trials. The system achieved statistical equivalence ($\pm 2^\circ$, $\pm 2,\text{mm}$) to PSI for total angular ($p \le 0.02$) and total translational ($p=0.048$) errors, with no significant differences in user questionnaire scores. By transferring preoperative plans using only two fluoroscopic images while matching PSI accuracy without additional surgical exposure, the proposed system motivates subsequent cadaveric and clinical validation.

In computer- and robot-assisted orthopedic surgery (CAOS), patient-specific surgical plans derived from preoperative imaging define target locations and implant trajectories. During surgery, these plans must be accurately transferred, relying on precise cross-registration between preoperative and intraoperative data. However, substantial modality heterogeneity across imaging modalities makes this registration challenging and error-prone. Robust, automatic, and modality-agnostic bone surface registration is therefore clinically important. We propose NeuralBoneReg, a self-supervised, surface-based framework that registers bone surfaces using 3D point clouds as a modality-agnostic representation. NeuralBoneReg includes two modules: an implicit neural unsigned distance field (UDF) that learns the preoperative bone model, and an MLP-based registration module that performs global initialization and local refinement by generating transformation hypotheses to align the intraoperative point cloud with the neural UDF. Unlike SOTA supervised methods, NeuralBoneReg operates in a self-supervised manner, without requiring inter-subject training data. We evaluated NeuralBoneReg against baseline methods on two publicly available multi-modal datasets: a CT-ultrasound dataset of the fibula and tibia (UltraBones100k) and a CT-RGB-D dataset of spinal vertebrae (SpineDepth). The evaluation also includes a newly introduced CT-ultrasound dataset of cadaveric subjects containing femur and pelvis (UltraBones-Hip), which will be made publicly available. NeuralBoneReg matches or surpasses existing methods across all datasets, achieving mean RRE/RTE of 1.83°/2.02 mm on UltraBones100k, 1.90°/1.56 mm on UltraBones-Hip, and 3.78°/2.80 mm on SpineDepth. These results demonstrate strong generalizability across anatomies and modalities, providing robust and accurate cross-modal alignment for CAOS.

Automated evaluation of movement quality can enhance physiotherapeutic treatment and sports training by providing objective, real-time feedback. However, deep learning models that assess movements captured by inertial measurement units (IMUs) are often limited by data scarcity, class imbalance, and label ambiguity. We present a data augmentation method that generates IMU data using musculoskeletal simulations integrated with systematic modifications of movement trajectories. The approach enforces anatomically plausible kinematic constraints and enables automatic labeling by combining inverse kinematic parameters with a knowledge-based evaluation strategy. Across four datasets of varying complexity, augmented variants closely resemble real-world data and contribute to gains in classification accuracy, generalization to unseen subjects, and patient-specific fine-tuning from few examples. The magnitude of these gains varies with dataset properties, in particular class balance and label ambiguity. These findings indicate that musculoskeletal simulation-based augmentation can address common challenges faced by deep learning applications in physiotherapeutic exercise evaluation.