Clinical Orthopaedics and Related Research®

, Volume 469, Issue 5, pp 1512–1516 | Cite as

Emerging Ideas: Soft Tissue Applications of Radiostereometric Analysis

Emerging Ideas



Currently, the movement that occurs at the site of soft tissue repair cannot be measured accurately in vivo. Radiostereometric analysis (RSA) is the gold standard for measuring movement between two skeletal segments in vivo but its application to studying soft tissue migration has been limited by the unknown stability of tantalum beads in tendons and ligaments and their ability to define rigid bodies in these structures.


RSA can be used to accurately measure movement between two tendon segments or between a bony and a tendon segment in vivo.

Methods of Study

The stability of tantalum beads and the ability to use such beads to define rigid bodies in some soft tissues will be investigated in animal models of tendon repair. Several tantalum bead insertion techniques will be tested using in vivo RSA measurements of bead movement followed by morphologic studies of the repaired tendon and soft tissue reaction to the tantalum beads.


RSA performed on tantalum beads encapsulated in muscles and tendons could be a powerful new tool to study the in vivo motion at the site of soft tissue repairs, for instance, the tendon gap formation. If RSA could be used to evaluate the efficiency of different tendon repair techniques in vivo, enhanced rehabilitation protocols could be developed and complications associated with prolonged protection or failure of repair could be reduced.


  1. 1.
    Adam F, Pape D, Schiel K, Steimer O, Kohn D, Rupp S. Biomechanical properties of patellar and hamstring graft tibial fixation techniques in anterior cruciate ligament reconstruction: experimental study with roentgen stereometric analysis. Am J Sports Med. 2004;32:71–78.PubMedCrossRefGoogle Scholar
  2. 2.
    Alberius P. Bone reactions to tantalum markers: a scanning electron microscopic study. Acta Anat. 1983;115:310–318.PubMedCrossRefGoogle Scholar
  3. 3.
    Arai Y, Hara K, Takahashi T, Urade H, Minami G, Takamiya H, Kubo T. Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Knee Surg Sports Traumatol Arthrosc. 2008;16:342–347.PubMedCrossRefGoogle Scholar
  4. 4.
    Aronson AS, Jonsson N, Alberius P. Tantalum markers in radiography: an assessment of tissue reactions. Skeletal Radiol. 1985;14:207–211.PubMedCrossRefGoogle Scholar
  5. 5.
    Bragdon CR, Malchau H, Yuan X, Perinchief R, Karrholm J, Borlin N, Estok DM, Harris WH. Experimental assessment of precision and accuracy of radiostereometric analysis for the determination of polyethylene wear in a total hip replacement model. J Orthop Res. 2002;20:688–695.PubMedCrossRefGoogle Scholar
  6. 6.
    Cashman PM, Baring T, Reilly P, Emery RJ, Amis AA. Measurement of migration of soft tissue by modified Roentgen stereophotogrammetric analysis (RSA): validation of a new technique to monitor rotator cuff tears. J Med Eng Technol. 2010;34:159–165.PubMedCrossRefGoogle Scholar
  7. 7.
    Chehade MJ, Solomon LB, Callary SA, Benveniste SH, Pohl AP, Howie DW. Differentially loaded radiostereometric analysis to monitor fracture stiffness: a feasibility study. Clin Orthop Relat Res. 2009;467:1839–1847.PubMedCrossRefGoogle Scholar
  8. 8.
    Downing MR, Ashcroft PB, Johnstone AJ, Bach O, Mackenzie S, Ashcroft GP. Assessment of inducible fracture micromotion in distal radial fractures using radiostereometry. J Orthop Trauma. 2008;22(suppl):S96–S105.PubMedCrossRefGoogle Scholar
  9. 9.
    Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg Am. 2010;35:77–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Friden T, Ryd L, Lindstrand A. Laxity and graft fixation after reconstruction of the anterior cruciate ligament: a roentgen stereophotogrammetric analysis of 11 patients. Acta Orthop Scand. 1992;63:80–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Haut Donahue TL, Howell SM, Hull ML, Gregersen C. A biomechanical evaluation of anterior and posterior tibialis tendons as suitable single-loop anterior cruciate ligament grafts. Arthroscopy. 2002;18:589–597.PubMedCrossRefGoogle Scholar
  12. 12.
    Jorn LP, Friden T, Ryd L, Lindstrand A. Simultaneous measurements of sagittal knee laxity with an external device and radiostereometric analysis. J Bone Joint Surg Br. 1998;80:169–172.PubMedCrossRefGoogle Scholar
  13. 13.
    Karrholm J. Roentgen stereophotogrammetry. Review of orthopedic applications. Acta Orthop Scand. 1989;60:491–503.CrossRefGoogle Scholar
  14. 14.
    Karrholm J, Gill RH, Valstar ER. The history and future of radiostereometric analysis. Clin Orthop Relat Res. 2006;448:10–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Karrholm J, Selvik G, Elmqvist LG, Hansson LI. Active knee motion after cruciate ligament rupture: stereoradiography. Acta Orthop Scand. 1988;59:158–164.PubMedGoogle Scholar
  16. 16.
    Karrholm J, Selvik G, Elmqvist LG, Hansson LI, Jonsson H. Three-dimensional instability of the anterior cruciate deficient knee. J Bone Joint Surg Br. 1988;70:777–783.PubMedGoogle Scholar
  17. 17.
    Khan R, Konyves A, Rama KR, Thomas R, Amis AA. RSA can measure ACL graft stretching and migration: development of a new method. Clin Orthop Relat Res. 2006;448:139–145.PubMedCrossRefGoogle Scholar
  18. 18.
    Khan RJ, Yao F, Li M, Nivbrant B, Wood D. Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J Arthroplasty. 2007;22:840–843.PubMedCrossRefGoogle Scholar
  19. 19.
    Madanat R, Moritz N, Larsson S, Aro HT. RSA applications in monitoring of fracture healing in clinical trials. Scand J Surg. 2006;95:119–127.PubMedGoogle Scholar
  20. 20.
    O’Driscoll SW, Goncalves LB, Dietz P. The hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35:1865–1869.PubMedCrossRefGoogle Scholar
  21. 21.
    Roos PJ, Hull ML, Howell SM. How cyclic loading affects the migration of radio-opaque markers attached to tendon grafts using a new method: a study using roentgen stereophotogrammetric analysis (RSA). J Biomech Eng. 2004;126:62–69.PubMedCrossRefGoogle Scholar
  22. 22.
    Sckell A, Leunig M, Fraitzl CR, Ganz R, Ballmer FT. The connective-tissue envelope in revascularisation of patellar tendon grafts. J Bone Joint Surg Br. 1999;81:915–920.PubMedCrossRefGoogle Scholar
  23. 23.
    Selvik G. Roentgen stereophotogrammetry: a method for the study of the kinematics of the skeletal system. Acta Orthop Scand Suppl. 1989;232:1–51.PubMedGoogle Scholar
  24. 24.
    Smith CK, Hull ML, Howell SM. Migration of radio-opaque markers injected into tendon grafts: a study using roentgen stereophotogrammetric analysis (RSA). J Biomech Eng. 2005;127:887–890.PubMedCrossRefGoogle Scholar
  25. 25.
    Solomon LB, Lee YC, Callary SA, Beck M, Howie DW. Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. J Bone Joint Surg Br. 2010;92:1317–1324.PubMedCrossRefGoogle Scholar
  26. 26.
    Stähelin T, Drittenbass L, Hersche O, Miehlke W, Munzinger U. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res. 2004;420:199–204.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumaUniversity of Adelaide and Royal Adelaide HospitalAdelaideAustralia

Personalised recommendations