{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:35:26Z","timestamp":1769528126707,"version":"3.49.0"},"reference-count":29,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["CO-2019-12370947"],"award-info":[{"award-number":["CO-2019-12370947"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Abnormalities in patellar tracking, often overlooked in surgical planning, have been identified as a contributing factor to total knee arthroplasty (TKA) complications, including anterior knee pain, patellar subluxation, and dislocation. This study aims to evaluate the repeatability of a novel intraoperative setup for assessing patellofemoral kinematics and its interaction with prosthesis design and positioning during surgery. This setup may support personalized alignment techniques in TKA, potentially improving surgical outcomes. Methods: Kinematic data were collected under both native and post-TKA conditions, and the Repeatability Coefficient (RC), Intraclass Correlation Coefficient (ICC), and Limits of Agreement of the Mean were calculated to assess measurement reliability. Results: RC values indicated high repeatability, with patellar flexion averaging an RC of 1\u00b0. Rotation and tilt demonstrated an RC below 1\u00b0 post-mid-flexion, while patellar shift maintained an RC of approximately 1.6 mm. ICC and the extended Bland and Altman analysis showed an excellent agreement (ICC &gt; 0.9) and an expected mean difference of zero for all the measured parameters. Measurements were consistent across both flexion and extension, and between native and post-TKA conditions. Conclusions: The proposed setup for intraoperative patellofemoral kinematic assessment demonstrated high repeatability and practical utility. The approach was found to be non-intrusive to patellar motion tracking and can be robustly integrated into the intraoperative workflow. This method provides a reliable approach for real-time patellar tracking, which may contribute to more personalized and precise TKA procedures, potentially reducing post-surgical dissatisfaction and complications.<\/jats:p>","DOI":"10.3390\/jcm13247784","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T07:42:18Z","timestamp":1734680538000},"page":"7784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Patellofemoral Kinematic Acquisition: The Design, Testing, and Validation of a Setup for Clinical Studies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9143-0393","authenticated-orcid":false,"given":"Alberto","family":"Favaro","sequence":"first","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Bonanzinga","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Avallone","sequence":"additional","affiliation":[{"name":"Orthokey Italia S.r.l., Piazza Giacomo Puccini, 26, 50144 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5998-9453","authenticated-orcid":false,"given":"Simone","family":"Bignozzi","sequence":"additional","affiliation":[{"name":"Orthokey Italia S.r.l., Piazza Giacomo Puccini, 26, 50144 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Costantini","sequence":"additional","affiliation":[{"name":"Orthokey Italia S.r.l., Piazza Giacomo Puccini, 26, 50144 Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Iacono","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","article-title":"Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature","volume":"38","author":"DeFrance","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_2","first-page":"44","article-title":"Kinematic Alignment in Total Knee Arthroplasty Definition, History, Principle, Surgical Technique, and Results of an Alignment Option for TKA","volume":"1","author":"Howell","year":"2014","journal-title":"Arthropaedia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1007\/s00167-020-06165-4","article-title":"Higher Satisfaction after Total Knee Arthroplasty Using Restricted Inverse Kinematic Alignment Compared to Adjusted Mechanical Alignment","volume":"30","author":"Luyckx","year":"2022","journal-title":"Knee Surg. Sport. Traumatol. Arthrosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.otsr.2017.10.009","article-title":"Differences in Trochlear Parameters between Native and Prosthetic Kinematically or Mechanically Aligned Knees","volume":"104","author":"Iranpour","year":"2018","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.otsr.2018.05.010","article-title":"Kinematic Alignment of Current TKA Implants Does Not Restore the Native Trochlear Anatomy","volume":"104","author":"Dhaif","year":"2018","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1016\/j.otsr.2018.04.028","article-title":"Patellar Complications after Total Knee Arthroplasty","volume":"105","author":"Putman","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1007\/s11999-009-1156-4","article-title":"The Geometry of the Trochlear Groove","volume":"468","author":"Iranpour","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1007\/s00167-020-06224-w","article-title":"The Sagittal Geometry of the Trochlear Groove Could Be Described as a Circle: An Intraoperative Assessment with Navigation","volume":"29","author":"Grassi","year":"2021","journal-title":"Knee Surg. Sport. Traumatol. Arthrosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1136\/jisakos-2018-000220","article-title":"Patellar Instability Can Be Classified into Four Types Based on Patellar Movement with Knee Flexion: A Three-Dimensional Computer Model Analysis","volume":"3","author":"Yamada","year":"2018","journal-title":"J. ISAKOS"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.jbiomech.2003.09.034","article-title":"A New in Vivo Technique for Determination of 3D Kinematics and Contact Areas of the Patello-Femoral and Tibio-Femoral Joint","volume":"37","author":"Siebert","year":"2004","journal-title":"J. Biomech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.jbiomech.2004.07.021","article-title":"Magnetic Resonance Imaging for in Vivo Assessment of Three-Dimensional Patellar Tracking","volume":"38","author":"Fellows","year":"2005","journal-title":"J. Biomech."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.blo.0000072905.36018.30","article-title":"In Vivo Three-Dimensional Patellar Tracking on the Femur","volume":"413","author":"Asano","year":"2003","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1749-799X-3-38","article-title":"Accuracy of Biplane X-Ray Imaging Combined with Model-Based Tracking for Measuring in-Vivo Patellofemoral Joint Motion","volume":"3","author":"Bey","year":"2008","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Rath, B., Asseln, M., Betsch, M., Prescher, A., Tingart, M., and Eschweiler, J. (2018). Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/7189714"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1002\/jor.20919","article-title":"Three-dimensional Patellar Motion at the Natural Knee during Passive Flexion\/Extension. An in Vitro Study","volume":"27","author":"Belvedere","year":"2009","journal-title":"J. Orthop. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"444","DOI":"10.3109\/17453674.2015.1005907","article-title":"The Influence of Component Alignment on Patellar Kinematics in Total Knee Arthroplasty","volume":"86","author":"Keshmiri","year":"2015","journal-title":"Acta Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"377","DOI":"10.3109\/10929080802594563","article-title":"In Vivo Patellar Kinematics during Total Knee Arthroplasty","volume":"13","author":"Anglin","year":"2008","journal-title":"Comput. Aided Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.knee.2019.09.007","article-title":"Development and Validation of a Robust Patellar Reference Coordinate System for Biomechanical and Clinical Studies","volume":"27","author":"Innocenti","year":"2020","journal-title":"Knee"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/s00167-001-0276-5","article-title":"Standardisation of the Description of Patellofemoral Motion and Comparison between Different Techniques","volume":"10","author":"Bull","year":"2002","journal-title":"Knee Surg. Sport. Traumatol. Arthrosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s00167-007-0320-1","article-title":"Patellar Tracking during Total Knee Arthroplasty: An in Vitro Feasibility Study","volume":"15","author":"Belvedere","year":"2007","journal-title":"Knee Surg. Sport. Traumatol. Arthrosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/01.blo.0000068767.86536.9a","article-title":"Measurement of Patellar Tracking: Assessment and Analysis of the Literature","volume":"412","author":"Katchburian","year":"2003","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1053\/j.oto.2008.11.001","article-title":"Accuracy, Reliability, and Repeatability of Navigation Systems in Clinical Practice","volume":"18","author":"Bignozzi","year":"2008","journal-title":"Oper. Tech. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00167-008-0699-3","article-title":"Intraoperative Evaluation of Total Knee Replacement: Kinematic Assessment with a Navigation System","volume":"17","author":"Casino","year":"2009","journal-title":"Knee Surg. Sport. Traumatol. Arthrosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1115\/1.3138397","article-title":"A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee","volume":"105","author":"Grood","year":"1983","journal-title":"J. Biomech. Eng."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"9159267","DOI":"10.1155\/2019\/9159267","article-title":"Research Methods and Progress of Patellofemoral Joint Kinematics: A Review","volume":"2019","author":"Yu","year":"2019","journal-title":"J. Healthc. Eng."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"M\u00f6ller, S., Debrabant, B., Halekoh, U., Petersen, A.K., and Gerke, O. (2021). An Extension of the Bland\u2013Altman Plot for Analyzing the Agreement of More than Two Raters. Diagnostics, 11.","DOI":"10.3390\/diagnostics11010054"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Vaz, S., Falkmer, T., Passmore, A.E., Parsons, R., and Andreou, P. (2013). The Case for Using the Repeatability Coefficient When Calculating Test\u2013Retest Reliability. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073990"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100287","DOI":"10.1016\/j.jisako.2024.06.006","article-title":"Robotic Assessment of Patella Tracking in Total Knee Arthroplasty","volume":"9","author":"Shatrov","year":"2024","journal-title":"J. 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