The combination of three-dimensional (3-D) models with dual fluoroscopy is increasingly popular for evaluating joint function in vivo. Applying these modalities to study knee motion with high accuracy requires reliable anatomical coordinate systems (ACSs) for the femur and tibia. Therefore, a robust method for creating ACSs from 3-D models of the femur and tibia is required. We present and evaluate an automated method for constructing ACSs for the distal femur and proximal tibia based solely on 3-D bone models. The algorithm requires no observer interactions and uses model cross-sectional area, center of mass, principal axes of inertia, and cylindrical surface fitting to construct the ACSs. The algorithm was applied to the femur and tibia of 10 (unpaired) human cadaveric knees. Due to the automated nature of the algorithm, the within specimen variability is zero for a given bone model. The algorithm's repeatability was evaluated by calculating variability in ACS location and orientation across specimens. Differences in ACS location and orientation between specimens were low (<1.5mm and <2.5 degrees). Variability arose primarily from natural anatomical and morphological differences between specimens. The presented algorithm provides an alternative method for automatically determining subject-specific ACSs from the distal femur and proximal tibia.
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