{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T19:28:00Z","timestamp":1780082880021,"version":"3.54.0"},"reference-count":97,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Imaging"],"abstract":"<jats:p>Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan\u2019s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization (\u03b5&lt;2.9mm) and low angulation errors for k-wire instrumentation (\u03b5&lt;0.75\u2218) on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.<\/jats:p>","DOI":"10.3390\/jimaging8040108","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:15:35Z","timestamp":1649798135000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1240-5809","authenticated-orcid":false,"given":"Florian","family":"Kordon","sequence":"first","affiliation":[{"name":"Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany"},{"name":"Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, 91052 Erlangen, Germany"},{"name":"Advanced Therapies, Siemens Healthcare GmbH, 91031 Forchheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9550-5284","authenticated-orcid":false,"given":"Andreas","family":"Maier","sequence":"additional","affiliation":[{"name":"Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany"},{"name":"Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, 91052 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict","family":"Swartman","sequence":"additional","affiliation":[{"name":"Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Privalov","sequence":"additional","affiliation":[{"name":"Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Siad","family":"El Barbari","sequence":"additional","affiliation":[{"name":"Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7021-2370","authenticated-orcid":false,"given":"Holger","family":"Kunze","sequence":"additional","affiliation":[{"name":"Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany"},{"name":"Advanced Therapies, Siemens Healthcare GmbH, 91031 Forchheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/BTK.0b013e318184c7e4","article-title":"Reconstruction of the Medial Patellofemoral Ligament in Skeletally Immature Patients","volume":"8","author":"Hernandez","year":"2009","journal-title":"Tech. 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