Using a Markerless Motion Capture System to Identify Preinjury Differences in Functional Assessments

Abstract

Functional assessments identify biomechanical issues which may indicate risk for injury and can be used to monitor functional recovery after an injury or surgery. Although the gold standard to assess functional movements is marker-based motion capture systems, these are cost prohibitive and have high participant burden. As such, this study was conducted to determine if a markerless motion capture system could detect preinjury differences in functional movements between those who did and did not experience a noncontact lower extremity injury (NCLEI). A three-dimensional markerless motion capture system comprised an area of 3 m × 5 m × 2.75 m was used. Participants were Division I collegiate athletes wearing plain black long-sleeve shirts, pants, and running shoes of their choice. Functional assessments were the bilateral squat, right and left squat, double leg drop vertical jump, static vertical jump, right and left vertical jump, and right and left 5 hop. Measures were recorded once and the first NCLEI was recorded during the first year after measurement. Two-factor analysis of variance models were used for each measure with factors sex and injury status. Preinjury functional measures averaged 8.4 ± 3.4 minutes capture time. Out of the 333 participants recruited, 209 were male and 124 were female. Of those, 127 males (61%) and 92 females (74%) experienced later NCLEI. The most common initial NCLEI was nonanterior cruciate ligament knee injury in 38 females (41.3%) and 80 males (62.0%). Females had decreased flexion and lower valgus/varus displacement during the bilateral squat (p < 0.006). In addition, knee loading flexion for those who were not injured were more than that seen in the injured group, and was more pronounced for injured females (p < 0.03). The markerless motion capture system can efficiently provide data that can identify preinjury functional differences for lower extremity noncontact injuries. This method holds promise for effectively screening patients or other populations at risk of injury, as well as for monitoring pre-/postsurgery function, without the large costs or participant burden.

Keywords

noncontact lower extremity injury - markerless motion capture system - body biomechanics - functional outcome

• References

• 1 Sheu Y, Chen LH, Hedegaard H. Sports- and recreation-related injury episodes in the United States, 2011-2014. Natl Health Stat Rep 2016; (99) 1-12
• 2 Alonso JM, Junge A, Renström P, Engebretsen L, Mountjoy M, Dvorak J. Sports injuries surveillance during the 2007 IAAF World Athletics Championships. Clin J Sport Med 2009; 19 (01) 26-32
• 3 Kennedy M, Dunne C, Mulcahy B, Molloy M. The sports' clinic: a one year review of new referrals. Ir Med J 1993; 86 (01) 29-30
• 4 Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 2014; 44 (01) 123-140
• 5 Cavazos GJ, Lawrence BH. The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes. J Sports Med Ther 2021; 6 (02) 8-17
• 6 Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med 2017; 45 (01) 201-209
• 7 Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med 2007; 17 (03) 215-219
• 8 Renstrom P, Ljungqvist A, Arendt E. et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008; 42 (06) 394-412
• 9 Hewett TE, Ford KR, Hoogenboom BJ, Myer GD. Understanding and preventing ACL injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther 2010; 5 (04) 234-251
• 10 Krosshaug T, Andersen TE, Olsen OEO, Myklebust G, Bahr R. Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities. Br J Sports Med 2005; 39 (06) 330-339
• 11 Mandelbaum BR, Silvers HJ, Watanabe DS. et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 2005; 33 (07) 1003-1010
• 12 Hewett TE, Myer GD, Ford KR. et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33 (04) 492-501
• 13 Bell KM, Onyeukwu C, Smith CN. et al. A portable system for remote rehabilitation following a total knee replacement: a pilot randomized controlled clinical study. Sensors (Basel) 2020; 20 (21) 6118
• 14 Halvorson RT, Castillo FT, Ahamed F. et al. Point-of-care motion capture and biomechanical assessment improve clinical utility of dynamic balance testing for lower extremity osteoarthritis. PLOS Digit Health 2022; 1 (07) e0000068
• 15 Singh JA, Dowsey M, Choong PF. Patient Endorsement of the Outcome Measures in Rheumatology (OMERACT) Total Joint Replacement (TJR) clinical trial draft core domain set. BMC Musculoskelet Disord 2017; 18 (01) 111
• 16 Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020-2040 using the National Inpatient Sample. J Rheumatol 2019; 46 (09) 1134-1140
• 17 Gupta AS, Pierpoint LA, Comstock RD, Saper MG. Sex-based differences in anterior cruciate ligament injuries among United States high school soccer players: an epidemiological study. Orthop J Sports Med 2020; 8 (05) 2325967120919178
• 18 Barber-Westin SD, Noyes FR, Smith ST, Campbell TM. Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete. Phys Sportsmed 2009; 37 (03) 49-61
• 19 Brant JA, Johnson B, Brou L, Comstock RD, Vu T. Rates and patterns of lower extremity sports injuries in all gender-comparable US high school sports. Orthop J Sports Med 2019; 7 (10) 2325967119873059
• 20 Ingram JG, Fields SK, Yard EE, Comstock RD. Epidemiology of knee injuries among boys and girls in US high school athletics. Am J Sports Med 2008; 36 (06) 1116-1122
• 21 Rechel JA, Collins CL, Comstock RD. Epidemiology of injuries requiring surgery among high school athletes in the United States, 2005 to 2010. J Trauma 2011; 71 (04) 982-989
• 22 Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 2007; 35 (10) 1756-1769
• 23 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325.e6
• 24 Mendiguchia J, Ford KR, Quatman CE, Alentorn-Geli E, Hewett TE. Sex differences in proximal control of the knee joint. Sports Med 2011; 41 (07) 541-557
• 25 Ford KR, Myer GD, Hewett TE. Valgus knee motion during landing in high school female and male basketball players. Med Sci Sports Exerc 2003; 35 (10) 1745-1750
• 26 Bird MB, Mi Q, Koltun KJ. et al. Unsupervised clustering techniques identify movement strategies in the countermovement jump associated with musculoskeletal injury risk during US Marine Corps Officer Candidates School. Front Physiol 2022; 13: 868002
• 27 Bodendorfer BM, Arnold NR, Shu HT. et al. Do neoprene sleeves and prophylactic knee braces affect neuromuscular control and cutting agility?. Phys Ther Sport 2019; 39: 23-31
• 28 Colyer SL, Evans M, Cosker DP, Salo AIT. A review of the evolution of vision-based motion analysis and the integration of advanced computer vision methods towards developing a markerless system. Sports Med Open 2018; 4 (01) 24
• 29 Richard J. The measurement of human motion: a comparison of commercially available systems. Hum Mov Sci 1999; 5: 589-602
• 30 Smith J, Laskowski ER. The preparticipation physical examination: Mayo Clinic experience with 2,739 examinations. Mayo Clin Proc 1998; 73 (05) 419-429
• 31 DARI Motion = Motion Health. Dari. Accessed September 22, 2021, at: https://www.darimotion.com
• 32 Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum 2005; 52 (09) 2835-2844
• 33 Cabarkapa D, Cabarkapa DV, Philipp NM, Downey GG, Fry AC. Repeatability of motion health screening scores acquired from a three-dimensional markerless motion. Capture System J Funct Morphol Kinesiol 2022; 7: 65
• 34 Perrott MA, Pizzari T, Cook J, McClelland JA. Comparison of lower limb and trunk kinematics between markerless and marker-based motion capture systems. Gait Posture 2017; 52: 57-61
• 35 Nüesch C, Ismailidis P, Koch D. et al. Assessing site specificity of osteoarthritic gait kinematics with wearable sensors and their association with patient reported outcome measures (PROMs): knee versus hip osteoarthritis. Sensors (Basel) 2021; 21 (16) 5363
• 36 Outerleys JB, Dunbar MJ, Richardson G, Hubley-Kozey CL, Astephen Wilson JL. Quantifying achievable levels of improvement in knee joint biomechanics during gait after total knee arthroplasty relative to osteoarthritis severity. J Appl Biomech 2021; 37 (02) 130-138
• 37 DARI Motion. Collection Expert Manual version 1.0. Published online 2012
• 38 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc 1995; 1 (57) 289-300
• 39 Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 2007; 42 (02) 311-319
• 40 Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle injuries among United States high school sports athletes, 2005-2006. J Athl Train 2007; 42 (03) 381-387
• 41 Armitano-Lago C, Willoughby D, Kiefer AW. A SWOT analysis of portable and low-cost markerless motion capture systems to assess lower-limb musculoskeletal kinematics in sport. Front Sports Act Living 2022; 3: 809898
• 42 Klöpfer-Krämer I, Brand A, Wackerle H, Müßig J, Kröger I, Augat P. Gait analysis - available platforms for outcome assessment. Injury 2020; 51 (Suppl. 02) S90-S96
• 43 Lam WWT, Tang YM, Fong KNK. A systematic review of the applications of markerless motion capture (MMC) technology for clinical measurement in rehabilitation. J Neuroeng Rehabil 2023; 20 (01) 57
• 44 Yeadon MR, Pain MTG. Fifty years of performance-related sports biomechanics research. J Biomech 2023; 155: 111666
• 45 Knippenberg E, Verbrugghe J, Lamers I, Palmaers S, Timmermans A, Spooren A. Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy. J Neuroeng Rehabil 2017; 14 (01) 61