EP4213721A1 - Method and device for detecting and therapeutically monitoring knee ligament injuries - Google Patents

Method and device for detecting and therapeutically monitoring knee ligament injuries

Info

Publication number
EP4213721A1
EP4213721A1 EP21785961.0A EP21785961A EP4213721A1 EP 4213721 A1 EP4213721 A1 EP 4213721A1 EP 21785961 A EP21785961 A EP 21785961A EP 4213721 A1 EP4213721 A1 EP 4213721A1
Authority
EP
European Patent Office
Prior art keywords
patient
sensor
knee
tibia
motor
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
EP21785961.0A
Other languages
German (de)
French (fr)
Inventor
Stéphane NOUVEAU
Henri Robert
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Genourob
Original Assignee
Genourob
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Genourob filed Critical Genourob
Publication of EP4213721A1 publication Critical patent/EP4213721A1/en
Pending legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/45For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4528Joints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/103Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1071Measuring physical dimensions, e.g. size of the entire body or parts thereof measuring angles, e.g. using goniometers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/103Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
    • A61B5/1121Determining geometric values, e.g. centre of rotation or angular range of movement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/45For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4533Ligaments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/68Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6801Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
    • A61B5/6813Specially adapted to be attached to a specific body part
    • A61B5/6828Leg
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/70Means for positioning the patient in relation to the detecting, measuring or recording means
    • A61B5/702Posture restraints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/70Means for positioning the patient in relation to the detecting, measuring or recording means
    • A61B5/704Tables

Definitions

  • TITLE Method and apparatus for the detection and therapeutic monitoring of knee ligament injuries.
  • the invention relates to the field of measuring methods and apparatus intended for the detection, characterization and monitoring of injuries to the ligaments of a patient's knee. More specifically, the invention relates to a method and an apparatus for its implementation, making it possible to measure rotational instability of the knee in combination with a measurement of a translational movement of the tibia relative to the femur of a patient, at different degrees of knee flexion.
  • the anterior cruciate ligament is made up of numerous collagen fibers that can be separated into two bundles according to their insertion on the tibia and the femur, including an anteromedial bundle and a posterolateral bundle.
  • an ACL tear can be total or partial.
  • ACL lesion It is essential to be able to quickly detect and establish an accurate diagnosis of an ACL lesion, especially in the event of a partial lesion which is difficult to detect when the patient is hot after physical exertion.
  • Such early diagnosis is particularly crucial for athletes whose knee strength conditions their performance.
  • a start of ACL tear diagnosed as soon as possible allows the patient time to heal, avoiding the risk of permanent ACL tearing, and setting up suitable rehabilitation to protect the ligament during its healing.
  • the device comprises a seat for installing the patient, comprising a support plate for the patient's leg which is pivotally mounted on the seat.
  • the patient's knee is immobilized on the plate and the patient's foot is immobilized on a foot support rotatably mounted on the plate.
  • the plate is equipped with a member for pushing the patient's calf, which is mounted so as to be able to move in translation on the plate.
  • a first sensor measures a displacement in translation of the antero-superior face of the patient's tibia as a result of the thrust exerted on the calf by said thrust member.
  • the foot support is equipped with a second sensor arranged as an inclinometer, to identify an angle of rotation of the tibia following a rotation of the foot support.
  • a logic analysis system identifies a possible partial lesion of the anteromedial ligament and/or of the posterolateral ligament. To do this, the measurement is then established from a comparison between measurements carried out successively on the one hand for the leg potentially affected by an ACL lesion, and on the other hand for the healthy leg of the patient.
  • a measurement of the internal and/or external rotation of the foot of a tested leg makes it possible to detect any rotational instability of the knee during a translational movement of the tibia relative to the femur caused via the thrust member, and this at different degrees of knee flexion. This allows to highlight a partial lesion of one of the two bundles of the ACL of the knee and rotational instability of the knee.
  • Such a technique is therefore advantageous in that it makes it possible to detect with precision a lesion of the anteromedial bundle and/or a lesion of the posterolateral bundle which take into account the rotational instability of the knee.
  • JPH09276252A proposing a knee support and an ankle support, and a seat with a backrest mounted on the upper end of the base. It includes a forward pulling mechanism, a backward pressing mechanism and a measuring means are arranged on the knee support base. A subject's calf is pushed forward to impart forward pulling force to the knee joint ligament, and the upper surface of the patella placed on the hamstring support is pressed by the pressure imparting mechanism backwards to impart a rearward pressure force to the patella.
  • the forward movement of the vertically displaced tibia is measured as a function of the displacement of the upper surface of the patella by the measuring means.
  • Patent WO2008/040790 is also known, describing a device for detecting and monitoring a lesion (rupture or tear) of the ACL by anterior translation of the tibia relative to the femur comprising a lower limb support characterized in that it comprises a pushing means for the postero-upper face of the calf and a tibia displacement sensor positioned on the antero-upper face of the tibia, on the ATT (Anterior Tibia Tuberosity).
  • Patent EP2839775 proposes a device for determining a relative position of a femur with respect to a tibia comprising at least:
  • a first measuring member intended to be positioned against the tibia and comprising means for generating a signal representative of a position of the measuring member
  • a second and a third measurement member intended to be positioned relative to the femur, each encircling the thigh associated with the femur at different heights, the second and the third measuring device each comprising means for generating a signal representative of a position of the associated measuring device;
  • a calculating unit comprising communication means for receiving at least the signals generated by the first, second and third measuring units, comparison means which compare the signals from the second and third units to deduce therefrom an absolute position of the femur and processing means which analyze the signal from the first measurement member and the absolute position of the femur to deduce therefrom a relative position of the femur with respect to the tibia.
  • Patent EP3178381 relates to an evaluation device, for evaluating morphological parameters of a lower limb of a patient, in particular during a preoperative or postoperative consultation, the evaluation device being characterized in that it comprises at less :
  • a femoral set of inertial sensors comprising three femoral gyrometers and three femoral accelerometers, the femoral gyrometers being configured to respectively generate signals representative of their respective angular velocities around the three dimensions of a Galilean frame of reference, the femoral accelerometers being configured to generate signals representative of their respective linear accelerations according to the three dimensions of the Galilean frame of reference,
  • a tibial set of inertial sensors comprising three tibial gyrometers and three tibial accelerometers, the tibial gyrometers being configured to respectively generate signals representative of their respective angular velocities around the three dimensions of a Galilean frame of reference, the tibial accelerometers being configured to generate signals representative of their respective linear accelerations according to the three dimensions of the Galilean frame of reference, - a femoral support configured to hold the femoral inertial sensor assembly on the patient's thigh, the femoral support having: i) a proximal femoral attachment portion configured to secure the femoral support on a proximal portion of the thigh, and ii) a distal femoral fixation portion configured to fix the femoral support to a distal portion of the thigh,
  • tibial bracket configured to hold the tibial inertial sensor assembly to the patient's leg
  • the tibial bracket having: i) a proximal tibial attachment portion configured to secure the tibial bracket to a proximal portion of the leg and ii) a distal tibial fixation portion configured to fix the tibial support to a distal portion of the leg,
  • the malleolar feeler fixed to the tibial support
  • the malleolar feeler comprising a medial branch and a lateral branch which are articulated to the tibial support so as to be movable between: oi) a contact configuration, in which a contact zone of the medial branch and a side branch contact zone are brought into contact with the medial malleolus and the lateral malleolus, respectively, and o ii) a distant configuration, in which the medial branch and the lateral branch are distant from the medial malleolus and the lateral malleolus, and o a calculation unit configured to receive the signals generated by the femoral gyrometers, by the femoral accelerometers, by the tibial gyrometers and by the tibial accelerometers, the calculation unit being further configured for:
  • receiving said signals generated when the tibial assembly of inertial sensors follows a first circular movement induced when the lower limb in extension or in hyperextension rotates around the femoral head of the patient, ⁇ calculate, from the signals received, the position of the center of the femoral head,
  • receiving said signals generated when the femoral set of inertial sensors is stationary, the patient's thigh being stationary and in extension or hyperextension, and when the tibial set of inertial sensors follows a second circular movement induced by at least one flexion of the upper leg at 60 degrees, for example higher than 90 degrees,
  • calculate, from the signals received, the position of the center of the knee
  • the subject of the invention is a method for evaluating a cruciate ligament lesion of the knee of a patient, by implementing an apparatus of the aforementioned type according to which measurements are carried out to identify a possible rotational instability of the knee in combination with a translational movement of the tibia relative to the femur, at different degrees of knee flexion.
  • the apparatus is of the aforementioned type comprising a seat placed on a base (6) comprising an extended seat with a backrest that can be tilted with respect to the seat, and an installation plate for the leg of a patient which is movably mounted in tilting relative to the seat.
  • a thrust member for the patient's calf is mounted to move in translation on the plate and a first sensor is assigned to the measurement of a displacement in translation of the patient's tibia as a result of the thrust exerted against the calf.
  • a foot support is rotatably mounted at the end of the plate, to cause rotation of the tibia and a second sensor is assigned to the measurement of an angle of rotation of the tibia.
  • a logic system for analyzing the measurements taken by the first sensor and by the second sensor makes it possible to diagnose and/or monitor the evolution of a possible partial lesion of the ACL of the knee.
  • the object of the invention is in particular to propose such improvements to apparatuses belonging to the prior art.
  • a related objective is to allow demonstration of a lesion of the lateral capsulo-ligamentary structures at the level of the knee joint - such as in particular the antero-lateral ligament or other lateral capsulo-ligamentary structures - which have a strong influence on the rotational instability of the knee, making it very difficult to assess it objectively.
  • Another related objective is to make it possible to rapidly detect a lesion of the ACL of a patient's knee, by being able, if possible - in particular during therapeutic follow-up - to abstain, without prejudice to the relevance of the diagnosis obtained, from then comparing measurements carried out respectively for the leg affected by a lesion of the ACL of the knee and for the healthy leg of the patient.
  • Another related objective is to find ways to measure rotational instability of the knee in combination with translational and rotational movement of the tibia relative to the femur, making it possible to increase the relevance of the diagnosis which is deduced therefrom and/or to avoid a loss of reliability of the measurements carried out in the event of translation or tibial rotation tests alone.
  • Another related objective of the invention is to improve the ergonomics of the device, by allowing the practitioner to perform reliably and quickly various measurements in translation and rotation of the tibia during therapeutic follow-up of the patient, at from which he can establish a precise diagnosis of the evolution of the lesion of the ACL of the patient's knee by easily adapting his examination methods.
  • Another related objective is to obtain reliable and precise measurements favoring the relevance of their comparison with similar measurements subsequently carried out within the framework of a therapeutic follow-up, in particular in the postoperative phase of the patient. More precisely, the goal is to take into consideration an evaluation of the evolution of the resistance of a transplant during repeated tests throughout the rehabilitation and the resumption of a pivotal sport of the patient, to detect a potential relaxation of the transplant.
  • the aim is to make it possible to evaluate an apparent distension of the transplant from the measurements taken via the device during the first months, to correct exercises performed by the patient in the postoperative phase in order to make them less restrictive. It is thus finally sought to allow the transplant to tighten thanks to the process of reconstruction of the graft of the transplant, which is not an ordinary healing, by promoting early and progressive post-operative care of the patient.
  • the invention proposes via a control device to enslave in correlation motorized rotation of the patient's foot and motorized translational displacement of the tibia relative to the femur at different degrees of knee flexion caused by the thrust member.
  • the rotation of the foot support controlled by the control member in correlation with the thrust exerted against the patient's calf, at different degrees of knee flexion, has the advantage of causing an equivalent to jump tests which is problem to be carried out manually by a practitioner in an awake subject. This also makes it possible to objectify the examination carried out of the patient under conditions of optimum reproducibility during the therapeutic follow-up of the patient.
  • such servo-control makes it possible to easily carry out such jump tests at different stressing thresholds of the tibia, according to various predefined examination methods and/or adaptable by the practitioner according to the evolution of the ACL lesion during therapeutic follow-up of the patient.
  • the practitioner is also allowed to adapt the correlated servoing of the rotational and translational movements imparted to the tibia, by being able to modify the stressing efforts of the tibia according to the evolution of the healing of the ACL lesion and/or based on the practitioner's search for an identification of a specific ligament injury in the patient's knee.
  • the rotation of the foot support by the control member is preferably carried out at constant speed, according to a torque supplied by the foot rotation drive motor which is selected from force laws listed in a range of several torques to be applied between 3 N/m and 8 N/m (N/m: Newton per meter of lever arm), depending on the rotation amplitude of the foot and/or motorized translational movement of the tibia via the thrust member.
  • a torque supplied by the foot rotation drive motor which is selected from force laws listed in a range of several torques to be applied between 3 N/m and 8 N/m (N/m: Newton per meter of lever arm), depending on the rotation amplitude of the foot and/or motorized translational movement of the tibia via the thrust member.
  • the rotation of the foot support can be carried out according to an internal angle then according to an external angle of values varying for example over a range of angles which can extend up to 45 degrees on either side of a position neutral of the foot in position at the zenith of the anterior tibial tuberosity, depending on the torque applied.
  • the motorized displacement in translation of the tibia is achieved by applying - according to an amplitude of displacement of the thrust member - of a force which can for example reach 134 N (N: Newton) - or according to the international reference 30 lbs (lbs: pounds) -, in accordance with listed effort laws.
  • Such a servo-control makes it possible to measure either simultaneously or consecutively on the one hand an angle of rotation of the tibia and on the other hand a displacement in translation of the tibia, while allowing a logical correlation by an analysis system of the measurements respectively obtained .
  • the practitioner has the possibility of carrying out diversified measurements at different degrees of given flexion of the knee, according to various selected conditions of rotation of the tibia combined with its displacement in translation, and this simultaneously and/or consecutively.
  • the diversification of the measurements obtained allows the practitioner to compare the results of the logical analysis obtained to increase the relevance of his diagnosis.
  • TTA anterior tibial tuberosity
  • An assistance device is preferably used to guide the practitioner in positioning the first sensor and/or the second sensor on the patient.
  • a signal transmitter such as sound and/or visual signals, can be used for this purpose based on a prior calibration of the sensors in a reference position.
  • Such a calibration is also advantageously used for the construction models of efforts exploited by the control unit to reproduce and/or adapt - during the therapeutic follow-up of the patient - the methods of putting the tibia under stress and consequently the measurements previously carried out and stored for a specific patient.
  • the second sensor can be placed on the leg segment as close as possible to the antero-superior part of the tibia, preferably on the tibial edge (close to the ATT).
  • the second sensor is potentially placed as a temporary replacement for the first sensor preferably placed in the active position against the ATT. This is particularly useful for best placing the second sensor in application close to the ATT without excluding a measurement previously or subsequently carried out by the first sensor then placed on the ATT, in the case of respective measurements of the rotation of the tibia and its displacement in translation which are carried out alternately under the control of the control member.
  • Account is therefore taken of the potential presence of the first sensor for measuring the displacement in translation of the tibia, which is preferably placed in application against the ATT.
  • the second sensor is then placed as close as possible to the ATT in the immediate vicinity of the first sensor following the extension of the patient's leg, in being for example mounted on a legging at least partially enclosing the patient's calf.
  • the second sensor can then be placed on the ATT as a temporary replacement for the first sensor which are then advantageously jointly mounted independently movable on an articulated bracket.
  • the seat is furthermore equipped with various motor members via which the patient is installed on the seat in the examination position.
  • Such motor organs are assigned at least to the relative positioning of the components of the seat, in particular to the positioning in relative inclination between and the seat and the backrest, at the positioning in relative inclination between the plate and the seat, and alternatively to the positioning in elevation of the seat.
  • a method relating to the invention is a method for evaluating a lesion of the ACL of the knee of a patient, at least by measuring rotational instability of the knee in combination with a measurement of a translational displacement movement of the tibia relative to the patient's femur at different degrees of knee flexion.
  • the method implements an apparatus at least comprising a seat for installing the patient comprising an extended seat with a reclining backrest relative to the seat, and comprising a support plate for a patient's leg which is mounted tilting in position on the seat.
  • the plate is equipped with a first member for immobilizing the patient's knee on the plate, with a foot support which is provided with a second member for immobilizing the patient's foot and which is rotatably mounted on the plate, and a thrust member for the patient's knee mounted movable in translation on the plate, the device being equipped with a first sensor for measuring a translational displacement of the tibia relative to the femur placed on the ATT, and a second sensor for measuring an angle of rotation of said tibia close to the ATT.
  • said evaluation of an ACL lesion is diagnosed from a collection and a logical processing by a measurement analysis system at least comprising a first measurement provided by the first sensor and a second measurement provided by the second sensor for each of said different degrees of knee flexion.
  • a method in accordance with the invention has the following characteristics:
  • the measurement of the displacement in translation of the tibia is carried out by the first measurement sensor from a translation of the thrust member on the plate which is operated by a first motor,
  • the measurement of the angle of rotation of the tibia is carried out by the second sensor placed closest to the ATT of the patient's knee, from a rotation of the foot support which is operated by a second motor,
  • first control module that includes a control device
  • the respective activation methods of the first motor and of the second motor are regulated dependent on each other, in particular with regard to their kinematics, their dynamics and their simultaneous and/or consecutive implementations, according to at least one model of efforts listed for stressing the tibia of a specific patient which is pre-established and reproducible and/or adaptable according to the evolution of the lesion of the ACL of the patient's knee, in particular within the framework of a therapeutic follow-up of the patient for which said at least one effort model is listed,
  • said at least one force model combines, for each of the degrees of flexion of the patient's knee, on the one hand a first force law relating to the translational displacement of the tibia, via the displaced thrust member in translation on the plate by the first motor, and on the other hand a second force law relating to the rotation of the patient's foot, via the foot support, by the second motor for rotating the foot support .
  • the second sensor is placed close to the thrust member following the extension of the leg, the first sensor being placed on the ATT and the second sensor being placed adjacent to the first sensor.
  • the second sensor is for example mounted on a leg piece installed at least partially around the patient's calf.
  • the second sensor and the first sensor are mounted on an articulated bracket which is fixed to the plate, on which bracket the second sensor and the first sensor are installed selectively in isolation and/or jointly individually mobile on the bracket.
  • first sensor can be installed on the stem and the second sensor can be placed adjacent to the first sensor, for example being mounted on said leg piece.
  • first sensor and the second sensor can be jointly installed on the same said bracket, or be installed on said respective brackets.
  • bracket or brackets are equipped with respective members for mounting the first sensor and the second sensor on the bracket or brackets, in respective adjustable positions.
  • the second sensor can be placed on the ATT as a temporary replacement for the first sensor.
  • the first sensor is for example mounted in isolation on the stem and the second sensor is mounted on the leg guard, and/or the first sensor and the second sensor are jointly mounted on a stem or are mounted on respective stems, being selectively applied in alternation against the TTA.
  • the measurement of the translational displacement of the tibia by the first sensor and the measurement of the angle of rotation of the tibia by the second sensor are carried out simultaneously under control of the control member in accordance with the says at least one effort model.
  • the measurement of the translational displacement of the tibia by the first sensor and the measurement of the angle of rotation of the tibia by the second sensor are carried out consecutively under control of the control member in accordance at least said effort model.
  • the first sensor and the second sensor are calibrated in respective reference positions, by examination of a healthy leg of the patient subjected to said at least one stress model.
  • the control member comprises a second servo control module correlated with at least a third motor for positioning in relative inclination between the seat and the backrest, a fourth motor for positioning in relative inclination between the plate and the seat, and a fifth positioning motor in elevation of the seat.
  • the respective strokes of the third motor, of the fourth motor and of the fifth motor are in particular regulated dependent on one another according to at least one pre-established and reproducible seat configuration model for a specific patient.
  • Said seat configuration model is constructed in particular during an initial examination of the patient to detect a possible lesion of the ACL.
  • the invention also relates to an apparatus configured for the implementation of a method in accordance with the invention.
  • the device of the invention is of the type of device comprising said seat comprising an extended seat with a backrest that can be tilted relative to the seat, and comprising a support plate for the patient's leg which is mounted tilting in position on the seat and which is equipped with a first member for immobilizing the patient's knee on the plate, such as for example arranged as a knee tightening strap on a knee support base.
  • the plate is also equipped with a knee thrust member mounted movable in translation on the plate and with a foot support which is provided with a second member for immobilizing the patient's foot on the foot support, such as for example arranged as a strap for tightening the foot and the base of the leg on the foot support.
  • the foot support is rotatably mounted on the plate.
  • the apparatus also comprises a member for positioning the first sensor on the ATT and a second member for positioning the second sensor relative to the foot support.
  • the apparatus also comprises a system for analyzing the measurements respectively supplied by the first sensor and by the second sensor and relating to their travels following a setting in motion of the tibia respectively in translation and in rotation, and an interface for display of data provided by the analysis system from which a diagnosis of at least partial lesion of the ACL of the knee is deduced by a practitioner.
  • the apparatus comprises said first motor assigned to a translational setting of the thrust member and said second motor assigned to a rotational setting of the foot support.
  • the apparatus also comprises said first control module which comprises said control member for correlated implementations of the first motor and of the second motor, in accordance with the application of said at least one pre-established force model and stored in a first directory via a first memory equipping said first control module.
  • Said at least one effort model is assigned to a specific patient and/or is selected by the practitioner, via for example a menu with selective choices, according to the examination to be performed from among a plurality of standard effort models previously established and listed in the first memory.
  • the first repertoire of effort models can be upgraded during the therapeutic follow-up of the patient, by being adapted and/or supplemented by the practitioner with one or more new effort models specific to the patient.
  • at least one said second member for positioning the second sensor is configured to be placed on the patient in an area of one of the patient's legs located closest to the ATT of the patient's knee.
  • a said second member for positioning a said second sensor is for example arranged in a said leg piece for at least partially enclosing the patient's calf placed close to the thrust member, and/or is part of a said gallows articulated which is fixed to the plate and which is moreover potentially carrying the first sensor.
  • the first member for positioning the first sensor and a said second member for positioning a said second sensor are mounted on at least one articulated bracket which is fixed to the plate.
  • the potentially alternate or joint uses of a second sensor mounted on the leg piece and/or of a second sensor mounted on the stem allows the practitioner to perform diversified measurements of the rotation of the tibia.
  • the practitioner can selectively use, in isolation or in combination, a second sensor mounted on the leg piece by being placed close to the ATT and/or a second sensor mounted on the stem and applied against the ATT as a temporary replacement for the first sensor.
  • Such a combination of use of several second sensors makes it possible to refine the detection of rotational instability of the knee.
  • the apparatus is provided with at least one assistance device comprising a signal transmitter capable of indicating to a practitioner correct positioning of the first sensor and/or of the second sensor on a specific patient, with regard to reference positions respectively of the first sensor and/or of the second sensor on the patient which are previously defined and stored in a second directory of positions of the individualized sensors for various patients via a second memory of the assistance device.
  • a signal transmitter capable of indicating to a practitioner correct positioning of the first sensor and/or of the second sensor on a specific patient, with regard to reference positions respectively of the first sensor and/or of the second sensor on the patient which are previously defined and stored in a second directory of positions of the individualized sensors for various patients via a second memory of the assistance device.
  • a calibration of the sensors is performed at reference positions of the sensors which are then stored in the second directory.
  • the practitioner can reproduce the positioning of the first sensor and/or of the second sensor on the same patient in accordance with their respective previously stored reference positions, by being guided by an audible signal and/or by a light signal emitted by the assistance device.
  • a reliable reproducibility of the initial examination is obtained, which reinforces the relevance of the diagnoses then made during the therapeutic follow-up of the patient.
  • the control member comprises a second control module for at least one configuration of the seat for a specific patient, the second control module being a servo module correlated with at least a third motor for positioning in relative inclination between the seat and the backrest, a fourth motor for positioning in relative inclination between the plate and the seat, and preferably a fifth motor for positioning in elevation of the seat.
  • the second control module comprises a third memory for storing a third directory of individualized seat configuration models for various patients which are previously established and which are reproducible by the control unit.
  • Figure (1) is a schematic presentation of the profile of a patient installed on a seat that includes a device according to an embodiment of the invention.
  • an apparatus is organized to assess a possible injury to the ACL of a patient's knee.
  • the apparatus comprises a seat (1) for installing the patient for his examination by a practitioner.
  • the seat (1) comprises a seat (18) and a backrest (19) which can be tilted relative to each other, the position of the seat (18) being adjustable in height.
  • a plate (17a) for supporting the patient's leg is mounted on a support (17b) which is pivotally articulated with respect to the seat (18)).
  • the seat (1) can thus be placed in various specific configurations for installing the patient on the device, by adjusting the relative positions between the seat (18), the backrest (19) and the plate (17a). During an examination of the patient, the practitioner can thus modify the configuration of the seat (1) according to specific methods of implementation of the device in order to establish an evaluation at various degrees of flexion of the patient's knee.
  • the plate (17a) is equipped with a base (11a) for supporting the patient's knee.
  • the tray (17a) is also equipped with a foot support (11b) receiving the patient's foot and with a thrust member (9a) comprising a shell (9c) on which the patient's calf rests, close to his knee.
  • the patient's knee is firmly held on the base (11a) via a first immobilization member (16) arranged in a strap for enclosing the knee on the base (11a).
  • the patient's foot is firmly held on the foot support (11 b) via a second immobilization member (13) arranged in a strap gripping at least the foot and the base of the patient's leg on the support foot (11b).
  • the thrust member (9a) is mounted to move in translation on the plate (17a), to exert a thrust force against the patient's calf at a desired force threshold.
  • the foot support (11b) is rotatably mounted on the plate (17a), to cause rotation of the tibia at a desired force threshold.
  • the apparatus is equipped with different motors (4, 5, 7) to adjust the configuration of the seat (1) at various patient examination stations.
  • the motor (4) adjusts the inclination between the seat (18) and the backrest (19).
  • the motor (7) makes it possible to adjust the inclination between the seat (18) and the plate (17a) via the support 10 carrying the plate (17a).
  • the motor (5) makes it possible to adjust the elevation position of the seat (18).
  • the apparatus is also equipped with various motors (9b, 12) to place the patient's tibia under stress in translation and/or in rotation.
  • a first motor (9b) such as in particular an electric actuator, is assigned to the translation maneuver of the thrust member (9a), in order to cause a translational movement of the tibia relative to the femur.
  • a second motor (12) such as in particular an electric rotary motor, is assigned to the rotational maneuver of the foot support (11b), in order to cause rotation of the patient's tibia.
  • the device is also equipped with a first sensor (15a) for measuring the translational displacement of the tibia following the activation of the first motor (9b) causing the translational displacement of the thrust member (9a).
  • the first sensor (15a) such as a proximity sensor with potential difference
  • a second sensor (14b) such as a potential difference proximity sensor configured as an inclinometer and/or an accelerometer, is mounted according to the example illustrated on a leg piece (14a) for enclosing the patient's calf by being applied against the tibia close to the first sensor (15), as close as possible to the ATT.
  • HMI Man/Machine Interface
  • a display interface of the logical processing of the measurements carried out by the analysis system provides a display of the result obtained in the form of a diagram.
  • the diagram includes two comparative curves, including a reference curve relating to an absence of ACL injury (green curve) and a curve relating to a possible ACL injury (red curve) identified by the analysis system from the treatment of measurements taken.
  • a control member that comprises the HMI comprises a second control module which regulates the implementation of the motor (4), the motor (5) and the motor (7) to place the seat (19) according to previously defined configurations at different degrees of knee flexion.
  • the configurations of the seat (19) are then applied according to configuration models of the seat (19) which are selected and/or adaptable by the practitioner, and which are classified according to a third directory previously established and stored in a third memory of the second module control.
  • the first sensor (15a) and the second sensor (14b) Prior to an examination of the patient, the first sensor (15a) and the second sensor (14b) are calibrated by being placed in reference positions (15b, 14a), respectively against the TTA for the first sensor (15a) and near of the ATT for the second sensor (14b) according to the example illustrated.
  • the HMI comprises an assistance device guiding the practitioner to reproduce the reference positions (15b), (14a) of the first sensor (15a) and of the second sensor (14b) to carry out an examination of the patient.
  • the respective reference positions (15b, 14a) of the sensors (15a, 14b) are classified according to a second directory previously established and stored in a second memory of the assistance device.
  • the positions of installation of the sensors (15b, 14a) by the practitioner are compared with their respective reference positions (15a, 14b), to define the relevance of the subsequent positioning of the sensors (15a, 14b) on the patient.
  • the practitioner is then guided via a transmitter of a signal - sound and/or light - to placing the first sensor (15a) and the second sensor (14b) on the patient in accordance with their respective reference positions (15a, 14b).
  • the control unit comprises a first control module for implementing the first motor (9b) and the second motor (12), which are regulated in correlation by the first control module.
  • the forces and/or the amplitudes of stressing the tibia in translation - via the first motor (9b) - and in rotation - via the second motor (12) are regulated according to effort models selected and/or adaptable by the practitioner, which are classified according to a first directory established beforehand and stored in a first memory.
  • Each of the force models comprises a first force law regulating the operation of the first motor (9b) and a second force law regulating the operation of the second motor (12).
  • the first motor (9b) and the second motor (12) are thus slaved in combination, by applying a force model - combining in correlation a said first law of force and a said second law of force - which is selected by the practitioner from among various effort models listed in the first memory, and this for various degrees of inflection of the knee.
  • the implementation of the first motor 9a and the second motor 12 according to a model of effort selected by the practitioner makes it possible to regulate - via the control member - the methods of placing the tibia under stress desired by the practitioner.
  • a combined servoing of the first motor (9a) and the second motor (12) by the first control module makes it possible to subject the patient's tibia to a constraint in translation and in rotation according to forces and amplitudes which are correlated, being able to be selectively applied - on requests from the practitioner - simultaneously or consecutively.
  • the various measurements of the mobility of the tibia in translation and/or in rotation are selectively carried out by the practitioner according to predefined effort models adapted to a specific patient, from which effort models the respective implementations of the first motor (9b) and the second motor (12) are correlated.
  • the effort models are pre-established on the basis of standardized effort models or on the basis of specific effort models constructed and/or potentially adapted during an initial examination of a patient, being reproducible during a therapeutic follow-up of the patient and/or adapted according to the evolution of the ACL lesion identified during the initial examination.
  • a precise and reliable diagnosis can thus be quickly established by the practitioner, taking into account a rotational instability of the tibia evaluated precisely from various measurements of a translation of the tibia and a rotation of the tibia which are correlated on both sides.
  • the reproducibility of the examination during a therapeutic follow-up is thereby made more reliable and/or can be adapted according to the evolution of the patient's ACL lesion, based on a choice by the practitioner of the effort models to be applied and /or to adapt.
  • the accuracy of the measurements performed is also enhanced by applying the first sensor (15a) and/or the second sensor (14b) against the TTA, or at least as close as possible to the TTA.
  • the analysis system can provide effective and comparative results between measurements whose measurement methods can be diversified while being easy to implement by the practitioner on the basis of pre-established and/or adapted effort models.
  • the interlocking of the constraints applied to the tibia for its displacement in translation for various configurations of the seat - under the control of the implementation of the first motor (9b) and of the second motor (12) by the control member - contribute to the quality and the precision obtained - via the analysis system - from the analysis of the measurements carried out.
  • the aforementioned apparatus is intended in particular for preoperative diagnosis.
  • a device at least comprising a seat (1) for installing the patient comprising a seat (18) extended by a backrest (19) tiltable with respect to the seat (18 ), and comprising a plate (17a) for supporting a leg of the patient which is mounted tilting in position on the seat (18), the plate (17a) being equipped with a first member (16) for immobilizing the patient's knee on the plate (17a), a foot support (11 b) which is provided with a second member (13) for immobilizing the patient's foot and which is rotatably mounted on the plate (10 ), and a thrust member (9a) for the patient's knee which is mounted to move in translation on the plate (17a), the apparatus being equipped with a first sensor (15a) for measuring a translational displacement
  • the measurement of the displacement in translation of the tibia is carried out by the first measurement sensor (15a) based on a translation of the thrust member (9a) on the plate (17a) which is operated by a first motor (9b),
  • the measurement of the angle of rotation of the tibia is carried out by the second sensor (14b) placed closest to the ATT of the patient's knee, from a rotation of the foot support (11b) which is operated by a second motor (12), and
  • the respective activation modes of the first motor (9b) and of the second motor (12) are regulated dependent on each other according to at least one model of efforts listed for stressing the tibia of a patient specific which is pre-established and reproducible and/or adaptable to the patient in question,
  • said at least one force model combines, for each of the degrees of flexion of the patient's knee, on the one hand a first force law relating to the translational displacement of the tibia, via the thrust member ( 9a) moved in translation on the plate (17a) by the first motor (9b), and on the other hand a second force law relating to the rotation of the patient's foot, via the foot support (11b) , by the second motor (12) for rotating the foot support (11 b).
  • the second sensor (14b) is placed close to the thrust member (9a) following the extension of the leg, the first sensor (15a) being placed on the TTA and the second sensor (14b) being placed adjacent to the first sensor (15a), close to the TTA.
  • the second sensor (14b) is mounted on a leg piece (14a) fitted around the patient's calf.
  • first examination methods the measurement of the translational displacement of the tibia by the first sensor (15a) and the measurement of the angle of rotation of the tibia by the second sensor (14b) are carried out simultaneously under the control of the controller in accordance with said at least one effort model.
  • second examination methods the measurement of the translational displacement of the tibia by the first sensor (15a) and the measurement of the angle of rotation of the tibia by the second sensor (14b) are carried out consecutively under the control of the controller in accordance with said at least one effort model.
  • the first sensor (15a) and the second sensor (14b) are calibrated in respective reference positions (15b, 14a) by examination of a healthy leg of the patient subjected to said at least one effort model.
  • the control member comprises a second servo control module correlated with at least a third motor (4) for positioning in relative inclination between the seat (18) and the backrest (19), a fourth motor (7) for positioning in relative inclination between the plate (17b) and the seat (18), and of a fifth motor (5) for positioning the seat (18) in elevation, the respective strokes of the third motor (4), the fourth motor (7) and the fifth motor (5) being regulated dependent on each other according to at least one configuration model of the seat (3 and 8) pre-established and reproducible for a specific patient.

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Abstract

According to the method of the invention, a translational movement of the tibia of a patient is caused by a first motor (9b) for moving a thrust member (9a) of the patient's calf, and is measured by a first sensor (15a) located on the TTA. The tibia is caused to rotate by a second motor (12) for rotating a foot support (11b) of the patient, and is measured by a second sensor (14b) located as close as possible to the TTA. The respective operations of the first motor (9b) and the second motor (12) are correlated by a control member, by being mutually controlled according to pre-set and reproducible force models.

Description

DESCRIPTION DESCRIPTION
TITRE : Méthode et appareil d’aide à la détection et au suivi thérapeutique des lésions des ligaments du genou. TITLE: Method and apparatus for the detection and therapeutic monitoring of knee ligament injuries.
Domaine technique de l'invention Technical field of the invention
L'invention relève du domaine des méthodes et appareils de mesure destiné à la détection, la caractérisation et au suivi des lésions des ligaments du genou d'un patient. Plus spécifiquement, l'invention concerne une méthode et un appareil pour sa mise en œuvre, permettant de mesurer une instabilité rotatoire du genou en combinaison avec une mesure d'un mouvement de translation du tibia par rapport au fémur d'un patient, à différents degrés de flexion du genou. The invention relates to the field of measuring methods and apparatus intended for the detection, characterization and monitoring of injuries to the ligaments of a patient's knee. More specifically, the invention relates to a method and an apparatus for its implementation, making it possible to measure rotational instability of the knee in combination with a measurement of a translational movement of the tibia relative to the femur of a patient, at different degrees of knee flexion.
Terminologie Terminology
Dans le présent brevet, les abréviations suivantes, usuelles pour l’homme du métier, seront utilisées : In this patent, the following abbreviations, usual for those skilled in the art, will be used:
• LCA pour « ligament croisé antérieur » • ACL for “anterior cruciate ligament”
• TTA pour « Tubérosité Tibiale Antérieure » • TTA for “Anterior Tibial Tuberosity”
Art antérieur Prior art
Parmi les appareils de mesure servant à établir un diagnostic, il est connu des appareils permettant de mesurer et de suivre une lésion de ligament croisé antérieur du genou d'un patient. Le ligament croisé antérieur (LCA) est composé de nombreuses fibres de collagènes que l'on peut séparer en deux faisceaux selon leur insertion sur le tibia et le fémur, dont un faisceau antéro-médial et un faisceau postéro-latéral. Selon le traumatisme subi par le patient, une rupture du LCA peut être totale ou partielle. Among the measuring devices used to establish a diagnosis, devices are known that make it possible to measure and monitor an anterior cruciate ligament lesion of a patient's knee. The anterior cruciate ligament (ACL) is made up of numerous collagen fibers that can be separated into two bundles according to their insertion on the tibia and the femur, including an anteromedial bundle and a posterolateral bundle. Depending on the trauma suffered by the patient, an ACL tear can be total or partial.
Il est essentiel de pouvoir dépister et élaborer rapidement un diagnostic précis d'une lésion du LCA, surtout en cas de lésion partielle qui est difficile à détecter à chaud après un effort physique du patient. Un tel diagnostic précoce est notamment crucial pour un sportif dont la solidité du genou conditionne ses performances. Un début de rupture du LCA diagnostiqué au plus tôt permet de laisser du temps au patient pour cicatriser en évitant un risque de rupture définitive du LCA, et de mettre en place une rééducation adaptée pour protéger le ligament pendant sa cicatrisation. It is essential to be able to quickly detect and establish an accurate diagnosis of an ACL lesion, especially in the event of a partial lesion which is difficult to detect when the patient is hot after physical exertion. Such early diagnosis is particularly crucial for athletes whose knee strength conditions their performance. A start of ACL tear diagnosed as soon as possible allows the patient time to heal, avoiding the risk of permanent ACL tearing, and setting up suitable rehabilitation to protect the ligament during its healing.
Il est important que le diagnostic établi soit le plus précis possible pour optimiser les modalités de rééducation du patient dans le cadre d'un suivi thérapeutique. L'état du patient doit être surveillé en mesurant de manière répétitive, précise et fiable révolution d'une amélioration du LCA du patient, ce qui permet notamment d'adapter au mieux son suivi thérapeutique. It is important that the established diagnosis be as precise as possible in order to optimize the patient's rehabilitation methods within the framework of a therapeutic follow-up. The patient's condition must be monitored by repetitively, accurately and reliably measuring the progress of an improvement in the patient's ACL, which in particular makes it possible to best adapt his therapeutic follow-up.
A cet effet il est connu des appareils de détection d'une lésion partielle du LCA du genou, tel que par exemple l'appareil décrit par le document EP2699160-B1 (GENOUROB). Selon ce document, l'appareil comprend un siège d'installation du patient, comportant un plateau de soutien de la jambe du patient qui est monté basculant sur l'assise. Le genou du patient est immobilisé sur le plateau et le pied du patient étant immobilisé sur un support de pied monté tournant sur le plateau. For this purpose, devices are known for detecting a partial lesion of the ACL of the knee, such as for example the device described by the document EP2699160-B1 (GENOUROB). According to this document, the device comprises a seat for installing the patient, comprising a support plate for the patient's leg which is pivotally mounted on the seat. The patient's knee is immobilized on the plate and the patient's foot is immobilized on a foot support rotatably mounted on the plate.
Le plateau est équipé d'un organe de poussée du mollet du patient, qui est monté mobile en translation sur le plateau. Un premier capteur mesure un déplacement en translation de la face antéro-supérieure du tibia du patient par suite de la poussée exercée sur le mollet par ledit organe de poussée. Le support de pied est équipé d'un deuxième capteur agencé en inclinomètre, pour identifier un angle de mise en rotation du tibia par suite d'une mise en rotation du support du pied. The plate is equipped with a member for pushing the patient's calf, which is mounted so as to be able to move in translation on the plate. A first sensor measures a displacement in translation of the antero-superior face of the patient's tibia as a result of the thrust exerted on the calf by said thrust member. The foot support is equipped with a second sensor arranged as an inclinometer, to identify an angle of rotation of the tibia following a rotation of the foot support.
A partir des mesures effectuées par le premier capteur et le deuxième capteur, un système logique d'analyse identifie une éventuelle lésion partielle du ligament antéro-médial et/ou du ligament postéro-latéral. Pour ce faire, la mesure est alors établi à partir d'une comparaison entre des mesures réalisées successivement d'une part pour la jambe potentiellement affectée d'une lésion du LCA, et d'autre part pour la jambe saine du patient. Une mesure de la rotation interne et/ou externe du pied d'une jambe testée, permet de détecter une éventuelle instabilité rotatoire du genou lors d'un mouvement de translation du tibia par rapport au fémur provoqué via l'organe de poussée, et cela à différents degrés de flexion du genou. Ceci permet de mettre en évidence une lésion partielle d'un des deux faisceaux du LCA du genou et une instabilité rotatoire du genou. Une telle technique est dès lors avantageuse en ce qu'elle permet de détecter avec précision une lésion du faisceau antéro- médial et/ou une lésion du faisceau postéro-latéral qui prennent en compte l'instabilité rotatoire du genou. From the measurements made by the first sensor and the second sensor, a logic analysis system identifies a possible partial lesion of the anteromedial ligament and/or of the posterolateral ligament. To do this, the measurement is then established from a comparison between measurements carried out successively on the one hand for the leg potentially affected by an ACL lesion, and on the other hand for the healthy leg of the patient. A measurement of the internal and/or external rotation of the foot of a tested leg makes it possible to detect any rotational instability of the knee during a translational movement of the tibia relative to the femur caused via the thrust member, and this at different degrees of knee flexion. this allows to highlight a partial lesion of one of the two bundles of the ACL of the knee and rotational instability of the knee. Such a technique is therefore advantageous in that it makes it possible to detect with precision a lesion of the anteromedial bundle and/or a lesion of the posterolateral bundle which take into account the rotational instability of the knee.
On connaît aussi la demande de brevet japonnais JPH09276252A proposant un support de genou et un support de cheville, et un siège avec un dossier montés sur l'extrémité supérieure de la base. Il comprend un mécanisme de traction vers l'avant, un mécanisme de pression vers l'arrière et un moyen de mesure sont disposés sur la base de support de genou. Le mollet d'un sujet est poussé vers l'avant pour conférer une force de traction vers l'avant au ligament articulaire du genou, et la surface supérieure de la rotule placée sur le support ischio-jambiers est pressée par le mécanisme conférant une pression vers l'arrière pour conférer une force de pression vers l'arrière à la rotule. Also known is the Japanese patent application JPH09276252A proposing a knee support and an ankle support, and a seat with a backrest mounted on the upper end of the base. It includes a forward pulling mechanism, a backward pressing mechanism and a measuring means are arranged on the knee support base. A subject's calf is pushed forward to impart forward pulling force to the knee joint ligament, and the upper surface of the patella placed on the hamstring support is pressed by the pressure imparting mechanism backwards to impart a rearward pressure force to the patella.
Le mouvement vers l'avant du tibia déplacé verticalement est mesuré en fonction du déplacement de la surface supérieure de la rotule par le moyen de mesure. The forward movement of the vertically displaced tibia is measured as a function of the displacement of the upper surface of the patella by the measuring means.
On connaît aussi le brevet W02008/040790 décrivant un dispositif de détection et de suivi d'une lésion (rupture ou déchirure) du LCA par translation antérieure du tibia par rapport au fémur comportant un support du membre inférieur caractérisé en ce qu'il comprend un moyen de poussée de la face postéro-supérieure du mollet et d'un capteur de déplacement du tibia venant se positionner sur la face antéro- supérieure du tibia, sur la TTA (Tubérosité Tibia Antérieure). Patent WO2008/040790 is also known, describing a device for detecting and monitoring a lesion (rupture or tear) of the ACL by anterior translation of the tibia relative to the femur comprising a lower limb support characterized in that it comprises a pushing means for the postero-upper face of the calf and a tibia displacement sensor positioned on the antero-upper face of the tibia, on the ATT (Anterior Tibia Tuberosity).
Le brevet EP2839775 propose un dispositif de détermination d'une position relative d'un fémur par rapport à un tibia comportant au moins : Patent EP2839775 proposes a device for determining a relative position of a femur with respect to a tibia comprising at least:
- un premier organe de mesure destiné à être positionné contre le tibia et comportant des moyens pour générer un signal représentatif d'une position de l'organe de mesure ; un deuxième et un troisième organe de mesure destinés à être positionnés relativement au fémur en encerclant chacun la cuisse associée au fémur à des hauteurs différentes, le deuxième et le troisième organe de mesure comportant chacun des moyens pour générer un signal représentatif d'une position de l'organe de mesure associé ; - a first measuring member intended to be positioned against the tibia and comprising means for generating a signal representative of a position of the measuring member; a second and a third measurement member intended to be positioned relative to the femur, each encircling the thigh associated with the femur at different heights, the second and the third measuring device each comprising means for generating a signal representative of a position of the associated measuring device;
- un organe de calcul comportant des moyens de communication pour recevoir au moins les signaux générés par le premier, deuxième et troisième organes de mesure, des moyens de comparaison qui confrontent les signaux des deuxième et troisième organes pour en déduire une position absolue du fémur et des moyens de traitement qui analysent le signal du premier organe de mesure et la position absolue du fémur pour en déduire une position relative du fémur par rapport au tibia. - a calculating unit comprising communication means for receiving at least the signals generated by the first, second and third measuring units, comparison means which compare the signals from the second and third units to deduce therefrom an absolute position of the femur and processing means which analyze the signal from the first measurement member and the absolute position of the femur to deduce therefrom a relative position of the femur with respect to the tibia.
Le brevet EP3178381 a pour objet un dispositif d'évaluation, pour évaluer des paramètres morphologiques d'un membre inférieur d'un patient, en particulier pendant une consultation préopératoire ou postopératoire, le dispositif d'évaluation étant caractérisé en ce qu'il comprend au moins : Patent EP3178381 relates to an evaluation device, for evaluating morphological parameters of a lower limb of a patient, in particular during a preoperative or postoperative consultation, the evaluation device being characterized in that it comprises at less :
- un ensemble fémoral de capteurs inertiels comprenant trois gyromètres fémoraux et trois accéléromètres fémoraux, les gyromètres fémoraux étant configurés pour générer respectivement des signaux représentatifs de leurs vitesses angulaires respectives autour des trois dimensions d'un référentiel galiléen, les accéléromètres fémoraux étant configurés pour générer des signaux représentatifs de leurs accélérations linéaires respectives selon les trois dimensions du référentiel galiléen, - a femoral set of inertial sensors comprising three femoral gyrometers and three femoral accelerometers, the femoral gyrometers being configured to respectively generate signals representative of their respective angular velocities around the three dimensions of a Galilean frame of reference, the femoral accelerometers being configured to generate signals representative of their respective linear accelerations according to the three dimensions of the Galilean frame of reference,
- un ensemble tibial de capteurs inertiels comprenant trois gyromètres tibiaux et trois accéléromètres tibiaux, les gyromètres tibiaux étant configurés pour générer respectivement des signaux représentatifs de leurs vitesses angulaires respectives autour des trois dimensions d'un référentiel galiléen, les accéléromètres tibiaux étant configurés pour générer des signaux représentatifs de leurs accélérations linéaires respectives selon les trois dimensions du référentiel galiléen, - un support fémoral configuré pour maintenir l'ensemble fémoral de capteurs inertiels sur la cuisse du patient, le support fémoral ayant : i) une portion proximale de fixation fémorale configurée pour fixer le support fémoral sur une portion proximale de la cuisse, et ii) une portion distale de fixation fémorale configurée pour fixer le support fémoral sur une portion distale de la cuisse, - a tibial set of inertial sensors comprising three tibial gyrometers and three tibial accelerometers, the tibial gyrometers being configured to respectively generate signals representative of their respective angular velocities around the three dimensions of a Galilean frame of reference, the tibial accelerometers being configured to generate signals representative of their respective linear accelerations according to the three dimensions of the Galilean frame of reference, - a femoral support configured to hold the femoral inertial sensor assembly on the patient's thigh, the femoral support having: i) a proximal femoral attachment portion configured to secure the femoral support on a proximal portion of the thigh, and ii) a distal femoral fixation portion configured to fix the femoral support to a distal portion of the thigh,
- un support tibial configuré pour maintenir l'ensemble tibial de capteurs inertiels sur la jambe du patient, le support tibial ayant : i) une portion proximale de fixation tibiale configurée pour fixer le support tibial sur une portion proximale de la jambe et ii) une portion distale de fixation tibiale configurée pour fixer le support tibial sur une portion distale de la jambe, - a tibial bracket configured to hold the tibial inertial sensor assembly to the patient's leg, the tibial bracket having: i) a proximal tibial attachment portion configured to secure the tibial bracket to a proximal portion of the leg and ii) a distal tibial fixation portion configured to fix the tibial support to a distal portion of the leg,
- un palpeur malléolaire fixé au support tibial, le palpeur malléolaire comprenant une branche médiale et une branche latérale qui sont articulées au support tibial de façon à être déplaçables entre : o i) une configuration de contact, dans laquelle une zone de contact de la branche médiale et une zone de contact de la branche latérale sont mises en contact respectivement avec la malléole médiale et avec la malléole latérale, et o ii) une configuration distante, dans laquelle la branche médiale et la branche latérale sont distantes respectivement de la malléole médiale et de la malléole latérale, et o une unité de calcul configurée pour recevoir les signaux générés par les gyromètres fémoraux, par les accéléromètres fémoraux, par les gyromètres tibiaux et par les accéléromètres tibiaux, l'unité de calcul étant en outre configurée pour : - a malleolar feeler fixed to the tibial support, the malleolar feeler comprising a medial branch and a lateral branch which are articulated to the tibial support so as to be movable between: oi) a contact configuration, in which a contact zone of the medial branch and a side branch contact zone are brought into contact with the medial malleolus and the lateral malleolus, respectively, and o ii) a distant configuration, in which the medial branch and the lateral branch are distant from the medial malleolus and the lateral malleolus, and o a calculation unit configured to receive the signals generated by the femoral gyrometers, by the femoral accelerometers, by the tibial gyrometers and by the tibial accelerometers, the calculation unit being further configured for:
■ recevoir lesdits signaux générés lorsque l'ensemble tibial de capteurs inertiels suit un premier mouvement circulaire induit lorsque le membre inférieur en extension ou en hyperextension tourne autour de la tête fémorale du patient, ■ calculer, à partir des signaux reçus, la position du centre de la tête fémorale, ■ receiving said signals generated when the tibial assembly of inertial sensors follows a first circular movement induced when the lower limb in extension or in hyperextension rotates around the femoral head of the patient, ■ calculate, from the signals received, the position of the center of the femoral head,
■ recevoir lesdits signaux générés lorsque l'ensemble fémoral de capteurs inertiels est immobile, la cuisse du patient étant en immobile et en extension ou en hyperextension, et lorsque l'ensemble tibial de capteurs inertiels suit un deuxième mouvement circulaire induit par au moins une flexion de la jambe supérieure à 60 degrés, par exemple supérieure à 90 degrés, ■ receiving said signals generated when the femoral set of inertial sensors is stationary, the patient's thigh being stationary and in extension or hyperextension, and when the tibial set of inertial sensors follows a second circular movement induced by at least one flexion of the upper leg at 60 degrees, for example higher than 90 degrees,
■ calculer, à partir des signaux reçus, la position du centre du genou, ■ calculate, from the signals received, the position of the center of the knee,
■ recevoir lesdits signaux générés lorsque la branche médiale et la branche latérale sont mises en contact respectivement avec la malléole médiale et avec la malléole latérale pendant que le pied est immobile, et calculer, à partir desdits signaux reçus, la position du centre de la cheville comme étant le milieu du segment délimité par la zone de contact de la branche médiale et la zone de contact de la branche latérale lorsque la branche médiale et la branche latérale sont en configuration de contact. ■ receiving said signals generated when the medial branch and the lateral branch are brought into contact respectively with the medial malleolus and with the lateral malleolus while the foot is immobile, and calculating, from said signals received, the position of the center of the ankle as the midpoint of the segment bounded by the medial branch contact area and the side branch contact area when the medial branch and the side branch are in contact configuration.
Présentation de l'invention Presentation of the invention
L'invention a pour objet une méthode d'évaluation d'une lésion de ligament croisé du genou d'un patient, par mise en œuvre d'un appareil du type susvisé selon lequel des mesures sont effectuées pour identifier une éventuelle instabilité rotatoire du genou en combinaison avec un mouvement de translation du tibia par rapport au fémur, à différents degrés de flexion du genou. The subject of the invention is a method for evaluating a cruciate ligament lesion of the knee of a patient, by implementing an apparatus of the aforementioned type according to which measurements are carried out to identify a possible rotational instability of the knee in combination with a translational movement of the tibia relative to the femur, at different degrees of knee flexion.
L'appareil est du type susvisé comprenant un siège placé sur une base (6) comportant une assise prolongée d'un dossier inclinable par rapport à l'assise, et un plateau d'installation de la jambe d'un patient qui est monté mobile en basculement par rapport à l'assise. Un organe de poussée du mollet du patient est monté mobile en translation sur le plateau et un premier capteur est affecté à la mesure d'un déplacement en translation du tibia du patient par suite de la poussée exercée contre le mollet. Un support de pied est monté mobile en rotation en bout du plateau, pour provoquer une mise en rotation du tibia et un deuxième capteur est affecté à la mesure d'un angle de rotation du tibia. Un système logique d'analyse des mesures effectuées par le premier capteur et par le deuxième capteur permet de diagnostiquer et/ou de suivre l'évolution d'une éventuelle lésion partielle du LCA du genou. The apparatus is of the aforementioned type comprising a seat placed on a base (6) comprising an extended seat with a backrest that can be tilted with respect to the seat, and an installation plate for the leg of a patient which is movably mounted in tilting relative to the seat. A thrust member for the patient's calf is mounted to move in translation on the plate and a first sensor is assigned to the measurement of a displacement in translation of the patient's tibia as a result of the thrust exerted against the calf. A foot support is rotatably mounted at the end of the plate, to cause rotation of the tibia and a second sensor is assigned to the measurement of an angle of rotation of the tibia. A logic system for analyzing the measurements taken by the first sensor and by the second sensor makes it possible to diagnose and/or monitor the evolution of a possible partial lesion of the ACL of the knee.
Il est apparu à l'usage qu'un tel appareil et ses modalités de mise en œuvre pouvaient être perfectionnés pour améliorer son ergonomie, la qualité du diagnostic obtenu et l'adaptation d'un suivi thérapeutique du patient, y compris le cas échéant en phase post-opératoire. It appeared in use that such a device and its methods of implementation could be improved to improve its ergonomics, the quality of the diagnosis obtained and the adaptation of a therapeutic follow-up of the patient, including if necessary in postoperative phase.
Sur la base de ce constat, le but de l'invention est notamment de proposer de tels perfectionnements aux appareils relevant de l'art antérieur. On the basis of this observation, the object of the invention is in particular to propose such improvements to apparatuses belonging to the prior art.
Un objectif connexe est de permettre une mise en évidence d'une lésion des structures capsulo-ligamentaires latérales au niveau de l’articulation du genou - tel que notamment le ligament antéro-latéral ou autres structures capsulo- ligamentaires latérales - qui présentent une forte influence sur l’instabilité rotatoire du genou rendant alors très difficile son évaluation de manière objective. A related objective is to allow demonstration of a lesion of the lateral capsulo-ligamentary structures at the level of the knee joint - such as in particular the antero-lateral ligament or other lateral capsulo-ligamentary structures - which have a strong influence on the rotational instability of the knee, making it very difficult to assess it objectively.
Un autre objectif connexe est de permettre de détecter rapidement une lésion du LCA du genou d'un patient, en pouvant si possible - notamment au cours d'un suivi thérapeutique - s'abstenir sans préjudice de la pertinence du diagnostic obtenu de comparer alors des mesures réalisées respectivement pour la jambe affectée d'une lésion du LCA du genou et pour la jambe saine du patient. Another related objective is to make it possible to rapidly detect a lesion of the ACL of a patient's knee, by being able, if possible - in particular during therapeutic follow-up - to abstain, without prejudice to the relevance of the diagnosis obtained, from then comparing measurements carried out respectively for the leg affected by a lesion of the ACL of the knee and for the healthy leg of the patient.
Un autre objectif connexe est de rechercher des modalités de mesure d'une instabilité rotatoire du genou en combinaison avec un mouvement de translation et de rotation du tibia par rapport au fémur, permettant d'accroître la pertinence du diagnostic qui en est déduit et/ou d'éviter une perte de fiabilité des mesures effectuées en cas de tests de translation ou de rotation tibiales seules. Another related objective is to find ways to measure rotational instability of the knee in combination with translational and rotational movement of the tibia relative to the femur, making it possible to increase the relevance of the diagnosis which is deduced therefrom and/or to avoid a loss of reliability of the measurements carried out in the event of translation or tibial rotation tests alone.
Un autre objectif connexe de l'invention est d'améliorer l'ergonomie de l'appareil, en permettant au praticien de réaliser de manière fiable et rapide diverses mesures en translation et en rotation du tibia lors d'un suivi thérapeutique du patient, à partir desquelles il peut établir un diagnostic précis de l'évolution de la lésion du LCA du genou du patient en adaptant aisément ses modalités d'examen. Another related objective of the invention is to improve the ergonomics of the device, by allowing the practitioner to perform reliably and quickly various measurements in translation and rotation of the tibia during therapeutic follow-up of the patient, at from which he can establish a precise diagnosis of the evolution of the lesion of the ACL of the patient's knee by easily adapting his examination methods.
Un autre objectif connexe est d'obtenir des mesures fiables et précises favorisant la pertinence de leur comparaison avec des mesures analogues ultérieurement effectuées dans le cadre d'un suivi thérapeutique, notamment en phase postopératoire du patient. Plus précisément, le but est de prendre en considération une évaluation de l’évolution de la résistance d'un transplant au court de tests répétés tout au long de la rééducation et à la reprise d'un sport de pivot du patient, pour détecter une potentielle détente du transplant. Another related objective is to obtain reliable and precise measurements favoring the relevance of their comparison with similar measurements subsequently carried out within the framework of a therapeutic follow-up, in particular in the postoperative phase of the patient. More precisely, the goal is to take into consideration an evaluation of the evolution of the resistance of a transplant during repeated tests throughout the rehabilitation and the resumption of a pivotal sport of the patient, to detect a potential relaxation of the transplant.
Plus précisément il est visé de permettre d'évaluer une distension apparente du transplant à partir des mesures effectuées via l'appareil au cours des premiers mois, pour corriger des exercices pratiqués par le patient en phase post-opératoire afin de les rendre moins contraignants. Il est ainsi finalement recherché de permettre au transplant de se retendre grâce au processus de reconstruction de la greffe du transplant, qui n’est pas une cicatrisation ordinaire, en favorisant une prise en charge post-opératoire précoce et évolutive du patient. More specifically, the aim is to make it possible to evaluate an apparent distension of the transplant from the measurements taken via the device during the first months, to correct exercises performed by the patient in the postoperative phase in order to make them less restrictive. It is thus finally sought to allow the transplant to tighten thanks to the process of reconstruction of the graft of the transplant, which is not an ordinary healing, by promoting early and progressive post-operative care of the patient.
Il est aussi plus précisément visé de fournir une analyse précise de la translation associée à la rotation interne du tibia, pour notamment parvenir à une étude objective et précise de lésions potentiellement existantes des structures capsulo- ligamentaires latérales, antéro-latérale et/ou postéro-latérale, à partir d'une analyse comparative des mesures précisément effectuées en phase post-opératoire du patient. It is also more specifically aimed at providing a precise analysis of the translation associated with the internal rotation of the tibia, in particular to achieve an objective and precise study of potentially existing lesions of the lateral, antero-lateral and/or postero-lateral capsulo-ligamentary structures. lateral, based on a comparative analysis of the measurements precisely taken in the patient's post-operative phase.
Pour ce faire et selon une approche de l'invention, tant dans sa généralité que dans ses spécificités, l'invention propose via un organe de commande d'asservir en corrélation une mise en rotation motorisée du pied du patient et un déplacement motorisé en translation du tibia par rapport au fémur à différents degrés de flexions du genou provoquées par l'organe de poussée. To do this and according to an approach of the invention, both in its generality and in its specificities, the invention proposes via a control device to enslave in correlation motorized rotation of the patient's foot and motorized translational displacement of the tibia relative to the femur at different degrees of knee flexion caused by the thrust member.
La mise en rotation du support de pied contrôlée par l'organe de commande en corrélation avec la poussée exercée contre le mollet du patient, à différents degrés de flexion du genou, présente l'avantage de provoquer un équivalent à des tests de ressaut qui est problématique à effectuer manuellement par un praticien chez un sujet éveillé. Ceci permet aussi d'objectiver l'examen effectué du patient dans des conditions de reproductibilité optimum lors du suivi thérapeutique du patient. The rotation of the foot support controlled by the control member in correlation with the thrust exerted against the patient's calf, at different degrees of knee flexion, has the advantage of causing an equivalent to jump tests which is problem to be carried out manually by a practitioner in an awake subject. This also makes it possible to objectify the examination carried out of the patient under conditions of optimum reproducibility during the therapeutic follow-up of the patient.
En outre, un tel asservissement permet de réaliser aisément de tels tests de ressaut à différents seuils de mise sous contrainte du tibia, selon diverses modalités d'examen prédéfinies et/ou adaptables par le praticien selon l'évolution de la lésion du LCA au cours d'un suivi thérapeutique du patient. In addition, such servo-control makes it possible to easily carry out such jump tests at different stressing thresholds of the tibia, according to various predefined examination methods and/or adaptable by the practitioner according to the evolution of the ACL lesion during therapeutic follow-up of the patient.
Il est ainsi non seulement possible de surmonter la difficulté pour un praticien d'effectuer le test manuellement, mais aussi d'obtenir d'une part des mesures fiables et précises et d'autre part une possibilité de reproduire à l'identique - dans le cadre d'un suivi thérapeutique - les mouvements combinés de mise en rotation du pied et de mise en translation du tibia par rapport au fémur opérés sous contrôle de l'organe de commande. It is thus not only possible to overcome the difficulty for a practitioner to carry out the test manually, but also to obtain on the one hand reliable and precise measurements and on the other hand a possibility of identical reproduction - in the framework of a therapeutic follow-up - the combined movements of rotation of the foot and translation of the tibia with respect to the femur operated under control of the control device.
Il est aussi permis au praticien d'adapter l'asservissement corrélé des mouvements en rotation et en translation imprimés au tibia, en pouvant modifier les efforts de mise sous contrainte du tibia selon l'évolution de la cicatrisation de la lésion du LCA et/ou selon la recherche par le praticien d'une identification d'une lésion ligamentaire spécifique du genou du patient. The practitioner is also allowed to adapt the correlated servoing of the rotational and translational movements imparted to the tibia, by being able to modify the stressing efforts of the tibia according to the evolution of the healing of the ACL lesion and/or based on the practitioner's search for an identification of a specific ligament injury in the patient's knee.
La mise en rotation du support de pied par l'organe de commande est de préférence effectuée à vitesse constante, selon un couple fourni par le moteur d'entraînement en rotation du pied qui est sélectionné parmi des lois d'effort répertoriées dans une plage de plusieurs couples à appliquer comprise entre 3 N/m et 8 N/m (N/m : Newton par mètre de bras de levier), en fonction d'une amplitude de mise en rotation du pied et/ou d'un déplacement motorisé en translation du tibia via l'organe de poussée. The rotation of the foot support by the control member is preferably carried out at constant speed, according to a torque supplied by the foot rotation drive motor which is selected from force laws listed in a range of several torques to be applied between 3 N/m and 8 N/m (N/m: Newton per meter of lever arm), depending on the rotation amplitude of the foot and/or motorized translational movement of the tibia via the thrust member.
La mise en rotation du support de pied peut être réalisée suivant un angle interne puis suivant un angle externe de valeurs variant par exemple sur une plage d'angle pouvant s'étendre jusqu'à 45 degrés de part et d'autre d'une position neutre du pied en position au zénith de la tubérosité tibiale antérieure, en fonction du couple appliqué. Le déplacement motorisé en translation du tibia est réalisé par application - selon une amplitude de déplacement de l'organe de poussée - d'un effort pouvant par exemple atteindre 134 N (N : Newton) - ou selon la référence internationale 30 lbs (lbs : pounds) -, conformément à des lois d'effort répertoriées. The rotation of the foot support can be carried out according to an internal angle then according to an external angle of values varying for example over a range of angles which can extend up to 45 degrees on either side of a position neutral of the foot in position at the zenith of the anterior tibial tuberosity, depending on the torque applied. The motorized displacement in translation of the tibia is achieved by applying - according to an amplitude of displacement of the thrust member - of a force which can for example reach 134 N (N: Newton) - or according to the international reference 30 lbs (lbs: pounds) -, in accordance with listed effort laws.
Un tel asservissement permet de mesurer soit simultanément soit consécutivement d'une part un angle de rotation du tibia et d'autre part un déplacement en translation du tibia, tout en permettant une mise en corrélation logique par un système d'analyse des mesures respectivement obtenues. Such a servo-control makes it possible to measure either simultaneously or consecutively on the one hand an angle of rotation of the tibia and on the other hand a displacement in translation of the tibia, while allowing a logical correlation by an analysis system of the measurements respectively obtained .
Notamment dans le cadre d'un suivi thérapeutique, il est ainsi évité une perte de fiabilité de la mise en combinaison des mesures effectuées relatives à la mise en mobilité du tibia en translation par rapport au fémur et à sa mise en rotation, par rapport à de telles mesures obtenues par des mises en mobilité du tibia non asservie et/ou obligatoirement effectuées seulement simultanément en rotation et en translation. In particular within the framework of a therapeutic follow-up, it is thus avoided a loss of reliability of the setting in combination of the measurements carried out relating to the setting in mobility of the tibia in translation compared to the femur and to its setting in rotation, compared to such measurements obtained by setting the mobility of the tibia not controlled and/or necessarily carried out only simultaneously in rotation and in translation.
En outre le praticien dispose de la possibilité d'effectuer des mesures diversifiées à différents degrés de mise en flexion donnée du genou, selon diverses conditions sélectionnâmes de mise en rotation du tibia combinée avec son déplacement en translation, et cela simultanément et/ou consécutivement. La diversification des mesures obtenues permet au praticien de comparer les résultats de l'analyse logique obtenue pour accroître la pertinence de son diagnostic. In addition, the practitioner has the possibility of carrying out diversified measurements at different degrees of given flexion of the knee, according to various selected conditions of rotation of the tibia combined with its displacement in translation, and this simultaneously and/or consecutively. The diversification of the measurements obtained allows the practitioner to compare the results of the logical analysis obtained to increase the relevance of his diagnosis.
Il en ressort que la précision, la diversité et l'adaptation paramétrables par le praticien des modalités de capture des mesures, permet d'établir rapidement et aisément un diagnostic fiable et pertinent à partir dudit asservissement corrélé des motorisations respectivement affectées à la mise en rotation du tibia et à son déplacement en translation, et cela indépendamment des mises en œuvre simultanées et/ou successives des dites motorisations. It emerges that the precision, diversity and adaptation that can be configured by the practitioner of the methods of capturing the measurements, makes it possible to quickly and easily establish a reliable and relevant diagnosis from said correlated servoing of the motorizations respectively assigned to the rotation of the tibia and to its displacement in translation, and this independently of the simultaneous and/or successive implementations of said motorizations.
Ceci est particulièrement utile dans le cadre d'une détection précoce d'une éventuelle lésion du LCA du genou. Ceci est aussi particulièrement utile dans le cadre d'un suivi thérapeutique du patient, à partir d'une modélisation des modalités de mise en mobilité du tibia via lesdites motorisations asservies en corrélation sur la base de modèles d'efforts préétablis, permettant leur reproduction ultérieure à l'identique et/ou adaptée dans le cadre du suivi thérapeutique d'un patient spécifique. This is particularly useful in the context of early detection of a possible injury to the ACL of the knee. This is also particularly useful in the context of therapeutic follow-up of the patient, from a modeling of the modalities of mobility of the tibia via said motorizations servo-controlled in correlation on the basis of pre-established effort models, allowing their subsequent reproduction. identically and/or adapted in the context of the therapeutic follow-up of a specific patient.
Il est aussi proposé de placer le deuxième capteur de mesure d'une rotation du tibia au plus proche de la tubérosité tibiale antérieure - ci-après désignée par TTA. Une telle position du deuxième capteur procure des mesures fiables et précises de l'angle de rotation du tibia au plus proche de l’articulation fémoro-tibiale, ce qui améliore la pertinence du diagnostic obtenu, notamment en raison de son éloignement du pied auquel est appliqué la mise en rotation du tibia. It is also proposed to place the second sensor for measuring a rotation of the tibia as close as possible to the anterior tibial tuberosity—hereinafter referred to as TTA. Such a position of the second sensor provides reliable and precise measurements of the angle of rotation of the tibia closest to the femoro-tibial joint, which improves the relevance of the diagnosis obtained, in particular because of its distance from the foot to which it is applied rotation of the tibia.
Ceci permet d'éviter un parasitage des mesures réalisées par le deuxième capteur et/ou d'obtenir des mesures précises de la mise en rotation effective du tibia par comparaison avec un angle donné de mise en rotation du support de pied. Il est aussi évité de potentielles interférences sur les mesures fournies par le deuxième capteur pouvant affecter leurs pertinences. De telles interférences sont susceptibles d'intervenir en cas d'une surestimation de l'amplitude de l'angle de rotation du tibia par suite des mouvements induits par les articulations du pied et de la cheville, et/ou en raison de la masse de tissus collagènes interfacée entre le pied et le genou du patient. This makes it possible to avoid interference with the measurements taken by the second sensor and/or to obtain precise measurements of the effective rotation of the tibia by comparison with a given angle of rotation of the foot support. It is also avoided potential interference on the measurements provided by the second sensor which could affect their relevance. Such interferences are likely to occur in the event of an overestimation of the amplitude of the angle of rotation of the tibia as a result of the movements induced by the joints of the foot and the ankle, and/or due to the mass of collagenous tissues interfaced between the patient's foot and knee.
Un dispositif d'assistance est de préférence utilisé pour guider le praticien dans le positionnement du premier capteur et/ou du deuxième capteur sur le patient. Un émetteur de signaux, tel que des signaux sonores et/ou visuels, peut être utilisé à cet effet à partir d'un étalonnage préalable des capteurs en une position de référence. Un tel étalonnage est aussi avantageusement utilisé pour la construction de modèles d'efforts exploités par l'organe de commande pour reproduire et/ou adapter - lors du suivi thérapeutique du patient - les modalités de mises sous contrainte du tibia et par suite les mesures précédemment effectuées et mémorisées pour un patient spécifique. An assistance device is preferably used to guide the practitioner in positioning the first sensor and/or the second sensor on the patient. A signal transmitter, such as sound and/or visual signals, can be used for this purpose based on a prior calibration of the sensors in a reference position. Such a calibration is also advantageously used for the construction models of efforts exploited by the control unit to reproduce and/or adapt - during the therapeutic follow-up of the patient - the methods of putting the tibia under stress and consequently the measurements previously carried out and stored for a specific patient.
Le deuxième capteur peut être placé sur le segment jambier au plus proche possible de la partie antéro-supérieure du tibia, de préférence sur l'arrête tibiale (proche de la TTA). Le deuxième capteur est potentiellement placé en substitution temporaire du premier capteur de préférence placé en position active contre la TTA. Ceci est notamment utile pour placer au mieux le deuxième capteur en application proche de la TTA sans exclure une mesure préalablement ou postérieurement effectuée par le premier capteur alors placé sur la TTA, dans le cas de mesures respectives de la rotation du tibia et de son déplacement en translation qui sont effectuées alternativement sous contrôle de l'organe de commande. The second sensor can be placed on the leg segment as close as possible to the antero-superior part of the tibia, preferably on the tibial edge (close to the ATT). The second sensor is potentially placed as a temporary replacement for the first sensor preferably placed in the active position against the ATT. This is particularly useful for best placing the second sensor in application close to the ATT without excluding a measurement previously or subsequently carried out by the first sensor then placed on the ATT, in the case of respective measurements of the rotation of the tibia and its displacement in translation which are carried out alternately under the control of the control member.
Il est dès lors tenu compte de la potentielle présence du premier capteur de mesure du déplacement en translation du tibia, qui est de préférence placé en application contre la TTA. Account is therefore taken of the potential presence of the first sensor for measuring the displacement in translation of the tibia, which is preferably placed in application against the ATT.
Dans le cas de mesures simultanées de l'angle de rotation du tibia et de son déplacement en translation, le deuxième capteur est alors placé au plus proche de la TTA à proximité immédiate du premier capteur suivant l'extension de la jambe du patient, en étant par exemple monté sur une jambière d'enserrement au moins partiel du mollet du patient. Dans le cas de mesures consécutives de l'angle de rotation du tibia et de son déplacement en translation, le deuxième capteur peut alors être placé sur la TTA en substitution temporaire du premier capteur qui sont alors avantageusement conjointement montés indépendamment mobile sur une potence articulée. In the case of simultaneous measurements of the angle of rotation of the tibia and its displacement in translation, the second sensor is then placed as close as possible to the ATT in the immediate vicinity of the first sensor following the extension of the patient's leg, in being for example mounted on a legging at least partially enclosing the patient's calf. In the case of consecutive measurements of the angle of rotation of the tibia and its displacement in translation, the second sensor can then be placed on the ATT as a temporary replacement for the first sensor which are then advantageously jointly mounted independently movable on an articulated bracket.
Par ailleurs, le siège est en outre équipé de divers organes moteurs via lesquels le patient est installé sur le siège en position d'examen. De tels organes moteurs sont affectés au moins au positionnement relatif des composants du siège, notamment au positionnement en inclinaison relative entre et l'assise et le dossier, au positionnement en inclinaison relative entre le plateau et l'assise, et subsidiairement au positionnement en élévation de l'assise. Moreover, the seat is furthermore equipped with various motor members via which the patient is installed on the seat in the examination position. Such motor organs are assigned at least to the relative positioning of the components of the seat, in particular to the positioning in relative inclination between and the seat and the backrest, at the positioning in relative inclination between the plate and the seat, and alternatively to the positioning in elevation of the seat.
Il est dès lors aussi proposé de modéliser pour un patient donné les conditions d'examen initial d'un patient, et donc les conditions dans lesquelles les mesures de mise en mobilité du tibia sont réalisées. Un tel modèle des conditions d'examen du patient est réalisé à partir d'une mémorisation des positions relatives entre les composants mobiles du siège, à partir de laquelle mémorisation les différents organes moteurs affectés aux composants du siège sont mis en œuvre. Ainsi, les conditions d'un examen initial à différents degrés de mise en flexion du genou du patient peuvent être reproduites avec précision lors de son suivi thérapeutique, notamment via l'organe de commande. It is therefore also proposed to model for a given patient the conditions of initial examination of a patient, and therefore the conditions under which the measures of mobility of the tibia are carried out. Such a model of the patient's examination conditions is produced from a memorization of the relative positions between the movable components of the seat, from which memorization the various motor organs assigned to the components of the seat are implemented. Thus, the conditions of an initial examination at different degrees of flexion of the patient's knee can be reproduced with precision during his therapeutic follow-up, in particular via the control member.
A la lumière de ce qui vient d'être exposé, une méthode relevant de l'invention est une méthode d'évaluation d'une lésion du LCA du genou d'un patient, au moins par mesure d'une instabilité rotatoire du genou en combinaison avec une mesure d'un mouvement de déplacement en translation du tibia par rapport au fémur du patient à différents degrés de flexion du genou. In the light of what has just been explained, a method relating to the invention is a method for evaluating a lesion of the ACL of the knee of a patient, at least by measuring rotational instability of the knee in combination with a measurement of a translational displacement movement of the tibia relative to the patient's femur at different degrees of knee flexion.
La méthode met en œuvre un appareil au moins comprenant un siège d'installation du patient comportant une assise prolongée d'un dossier inclinable par rapport à l'assise, et comportant un plateau de soutien d'une jambe du patient qui est monté basculant en position sur l'assise. Le plateau est équipé d'un premier organe d'immobilisation du genou du patient sur le plateau, d'un support de pied qui est muni d'un deuxième organe d'immobilisation du pied du patient et qui est monté mobile en rotation sur le plateau, et d'un organe de poussée du genou du patient monté mobile en translation sur le plateau, l'appareil étant équipé d'un premier capteur de mesure d'un déplacement en translation du tibia par rapport au fémur placé sur la TTA, et d'un deuxième capteur de mesure d'un angle de rotation dudit tibia proche de la TTA. The method implements an apparatus at least comprising a seat for installing the patient comprising an extended seat with a reclining backrest relative to the seat, and comprising a support plate for a patient's leg which is mounted tilting in position on the seat. The plate is equipped with a first member for immobilizing the patient's knee on the plate, with a foot support which is provided with a second member for immobilizing the patient's foot and which is rotatably mounted on the plate, and a thrust member for the patient's knee mounted movable in translation on the plate, the device being equipped with a first sensor for measuring a translational displacement of the tibia relative to the femur placed on the ATT, and a second sensor for measuring an angle of rotation of said tibia close to the ATT.
Selon une telle méthode, ladite évaluation d'une lésion du LCA est diagnostiquée à partir d'une collecte et d'un traitement logique par un système d'analyse des mesures au moins comprenant une première mesure fournie par le premier capteur et une deuxième mesure fournie par le deuxième capteur pour chacun desdits différents degrés de flexion du genou. According to such a method, said evaluation of an ACL lesion is diagnosed from a collection and a logical processing by a measurement analysis system at least comprising a first measurement provided by the first sensor and a second measurement provided by the second sensor for each of said different degrees of knee flexion.
Dans ce contexte, une méthode conforme à l'invention présente les caractéristiques suivantes : In this context, a method in accordance with the invention has the following characteristics:
-) la mesure du déplacement en translation du tibia est réalisée par le premier capteur de mesure à partir d'une translation de l'organe de poussée sur le plateau qui est opérée par un premier moteur, -) the measurement of the displacement in translation of the tibia is carried out by the first measurement sensor from a translation of the thrust member on the plate which is operated by a first motor,
-) la mesure de l'angle de rotation du tibia est effectuée par le deuxième capteur placé au plus proche de la TTA du genou du patient, à partir d'une mise en rotation du support de pied qui est opérée par un deuxième moteur, -) the measurement of the angle of rotation of the tibia is carried out by the second sensor placed closest to the ATT of the patient's knee, from a rotation of the foot support which is operated by a second motor,
-) Les mises en œuvre respectives du premier moteur et du deuxième moteur sont asservies en corrélation par un premier module de commande que comporte un organe de commande, -) The respective implementations of the first motor and the second motor are controlled in correlation by a first control module that includes a control device,
-) Les modalités d'activation respectives du premier moteur et du deuxième moteur sont régulées dépendantes l'une de l'autre, notamment au regard de leur cinématique, de leur dynamique et de leurs mises en œuvre simultanées et/ou consécutives, selon au moins un modèle d'efforts répertorié de mise sous contrainte du tibia d'un patient spécifique qui est préétabli et reproductible et/ou adaptable selon révolution de la lésion du LCA du genou du patient, notamment dans le cadre d'un suivi thérapeutique du patient pour lequel ledit au moins un modèle d'effort est répertorié, -) The respective activation methods of the first motor and of the second motor are regulated dependent on each other, in particular with regard to their kinematics, their dynamics and their simultaneous and/or consecutive implementations, according to at least one model of efforts listed for stressing the tibia of a specific patient which is pre-established and reproducible and/or adaptable according to the evolution of the lesion of the ACL of the patient's knee, in particular within the framework of a therapeutic follow-up of the patient for which said at least one effort model is listed,
-) ledit au moins un modèle d'efforts combine, pour chacun des degrés de mise en flexion du genou du patient, d'une part une première loi d'effort relative au déplacement en translation du tibia, via l'organe de poussée déplacé en translation sur le plateau par le premier moteur, et d'autre part une deuxième loi d'effort relative à la mise en rotation du pied du patient, via le support de pied, par le deuxième moteur de mise en rotation du support de pied. -) said at least one force model combines, for each of the degrees of flexion of the patient's knee, on the one hand a first force law relating to the translational displacement of the tibia, via the displaced thrust member in translation on the plate by the first motor, and on the other hand a second force law relating to the rotation of the patient's foot, via the foot support, by the second motor for rotating the foot support .
Selon une mise en œuvre de la méthode, le deuxième capteur est placé à proximité de l'organe de poussée suivant l'extension de la jambe, le premier capteur étant placé sur la TTA et le deuxième capteur étant placé adjacent au premier capteur. Selon ce cas, le deuxième capteur est par exemple monté sur une jambière installée au moins partiellement autour du mollet du patient. According to one implementation of the method, the second sensor is placed close to the thrust member following the extension of the leg, the first sensor being placed on the ATT and the second sensor being placed adjacent to the first sensor. In this case, the second sensor is for example mounted on a leg piece installed at least partially around the patient's calf.
Selon une variante, le deuxième capteur et le premier capteur sont montés sur une potence articulée qui est fixée au plateau, sur laquelle potence le deuxième capteur et le premier capteur sont installés sélectivement isolément et/ou conjointement individuellement mobiles sur la potence. According to a variant, the second sensor and the first sensor are mounted on an articulated bracket which is fixed to the plate, on which bracket the second sensor and the first sensor are installed selectively in isolation and/or jointly individually mobile on the bracket.
Autrement dit, seul le premier capteur peut être installé sur la potence et le deuxième capteur peut être placé adjacent au premier capteur, en étant par exemple monté sur ladite jambière. Selon une variante le premier capteur et le deuxième capteur peuvent être conjointement installés sur une même dite potence, ou être installés sur de dites potences respectives. Dans ce cas, la ou les potences sont équipées d'organes de montage respectifs du premier capteur et du deuxième capteur sur la ou les potences, en des positions respectives réglables. In other words, only the first sensor can be installed on the stem and the second sensor can be placed adjacent to the first sensor, for example being mounted on said leg piece. According to a variant, the first sensor and the second sensor can be jointly installed on the same said bracket, or be installed on said respective brackets. In this case, the bracket or brackets are equipped with respective members for mounting the first sensor and the second sensor on the bracket or brackets, in respective adjustable positions.
Ceci permet d'effectuer sélectivement des mesures de la mise en mobilité du tibia d'une part par applications respectives sur la TTA pour le premier capteur et à proximité de la TTA pour le deuxième capteur pour effectuer lesdites mesures simultanément, et/ou par applications individuelles en alternance du premier capteur ou du deuxième capteur contre la TTA, pour effectuer lesdites mesures consécutivement pour en améliorer au besoin leurs précisions. This makes it possible to selectively carry out measurements of the mobility of the tibia on the one hand by respective applications on the ATT for the first sensor and close to the ATT for the second sensor to carry out said measurements simultaneously, and/or by applications individual alternately of the first sensor or of the second sensor against the ATT, to carry out said measurements consecutively to improve their accuracy as needed.
Ainsi, le deuxième capteur peut être placé sur la TTA en substitution temporaire du premier capteur. Le premier capteur est par exemple monté isolément sur la potence et le deuxième capteur est monté sur la jambière, et/ou le premier capteur et le deuxième capteur sont conjointement montés sur une potence ou sont montés sur des potences respectives, en étant sélectivement appliqués en alternance contre la TTA. Thus, the second sensor can be placed on the ATT as a temporary replacement for the first sensor. The first sensor is for example mounted in isolation on the stem and the second sensor is mounted on the leg guard, and/or the first sensor and the second sensor are jointly mounted on a stem or are mounted on respective stems, being selectively applied in alternation against the TTA.
Ainsi selon des premières modalités d'examen, la mesure du déplacement en translation du tibia par le premier capteur et la mesure de l'angle de rotation du tibia par le deuxième capteur, sont effectuées simultanément sous contrôle de l'organe de commande conformément au dit au moins un modèle d'effort. Ainsi encore selon des deuxièmes modalités d'examen, la mesure du déplacement en translation du tibia par le premier capteur et la mesure de l'angle de rotation du tibia par le deuxième capteur, sont effectuées consécutivement sous contrôle de l'organe de commande conformément au dit au moins un modèle d'effort. Thus, according to first examination methods, the measurement of the translational displacement of the tibia by the first sensor and the measurement of the angle of rotation of the tibia by the second sensor, are carried out simultaneously under control of the control member in accordance with the says at least one effort model. Thus again according to second examination methods, the measurement of the translational displacement of the tibia by the first sensor and the measurement of the angle of rotation of the tibia by the second sensor, are carried out consecutively under control of the control member in accordance at least said effort model.
Selon une mise en œuvre de la méthode et préalablement à un examen d'évaluation d'une lésion du LCA du genou d'un patient spécifique, le premier capteur et le deuxième capteur sont calibrés en des positions de référence respectives, par examen d'une jambe saine du patient soumise au dit au moins un modèle d'efforts. According to an implementation of the method and prior to an evaluation examination of a lesion of the ACL of the knee of a specific patient, the first sensor and the second sensor are calibrated in respective reference positions, by examination of a healthy leg of the patient subjected to said at least one stress model.
Un tel calibrage étant effectué et compte tenu des mises en œuvre corrélées du premier moteur et du deuxième moteur selon ledit au moins un modèle d'effort préétabli, l'examen du genou du patient lors d'un suivi thérapeutique peut être directement effectué sans nouvelles mesures effectuées sur la jambe saine. Such a calibration being carried out and taking into account the correlated implementations of the first motor and of the second motor according to said at least one pre-established effort model, the examination of the patient's knee during a therapeutic follow-up can be carried out directly without new measurements taken on the healthy leg.
Selon une mise en œuvre de la méthode, l'organe de commande comporte un deuxième module de commande d'asservissement corrélé au moins d'un troisième moteur de positionnement en inclinaison relative entre l'assise et le dossier, d'un quatrième moteur de positionnement en inclinaison relative entre le plateau et l'assise, et d'un cinquième moteur de positionnement en élévation de l'assise. Les courses respectives du troisième moteur, du quatrième moteur et du cinquième moteur sont notamment régulées dépendantes l'une de l'autre selon au moins un modèle de configuration du siège préétabli et reproductible pour un patient spécifique. Ledit modèle de configuration du siège est notamment construit lors d'un examen initial du patient de détection d'une éventuelle lésion du LCA. According to one implementation of the method, the control member comprises a second servo control module correlated with at least a third motor for positioning in relative inclination between the seat and the backrest, a fourth motor for positioning in relative inclination between the plate and the seat, and a fifth positioning motor in elevation of the seat. The respective strokes of the third motor, of the fourth motor and of the fifth motor are in particular regulated dependent on one another according to at least one pre-established and reproducible seat configuration model for a specific patient. Said seat configuration model is constructed in particular during an initial examination of the patient to detect a possible lesion of the ACL.
L'invention a aussi pour objet un appareil configuré pour la mise en œuvre d'une méthode conforme à l'invention. L'appareil de l'invention relève du type d'appareil comprenant ledit siège comportant une assise prolongée d'un dossier inclinable par rapport à l'assise, et comprenant un plateau de soutien d'une jambe du patient qui est monté basculant en position sur l'assise et qui est équipé d'un premier organe d'immobilisation du genou du patient sur le plateau, tel que par exemple agencé en sangle de serrage du genou sur un socle de soutien du genou. Le plateau est aussi équipé d'un organe de poussée du genou monté mobile en translation sur le plateau et d'un support de pied qui est muni d'un deuxième organe d'immobilisation du pied du patient sur le support de pied, tel que par exemple agencé en sangle de serrage du pied et de la base de la jambe sur le support de pied. Le support de pied est monté mobile en rotation sur le plateau. The invention also relates to an apparatus configured for the implementation of a method in accordance with the invention. The device of the invention is of the type of device comprising said seat comprising an extended seat with a backrest that can be tilted relative to the seat, and comprising a support plate for the patient's leg which is mounted tilting in position on the seat and which is equipped with a first member for immobilizing the patient's knee on the plate, such as for example arranged as a knee tightening strap on a knee support base. The plate is also equipped with a knee thrust member mounted movable in translation on the plate and with a foot support which is provided with a second member for immobilizing the patient's foot on the foot support, such as for example arranged as a strap for tightening the foot and the base of the leg on the foot support. The foot support is rotatably mounted on the plate.
L'appareil comprend aussi un organe de positionnement du premier capteur sur la TTA et un deuxième organe de positionnement du deuxième capteur par rapport au support de pied. The apparatus also comprises a member for positioning the first sensor on the ATT and a second member for positioning the second sensor relative to the foot support.
L'appareil comprend encore un système d'analyse des mesures respectivement fournies par le premier capteur et par le deuxième capteur et relatives à leurs courses par suite d'une mise en mobilité du tibia respectivement en translation et en rotation, et une interface d'affichage des données fournies par le système d'analyse à partir desquelles un diagnostic d'une lésion au moins partielle du LCA du genou est déduite par un praticien. The apparatus also comprises a system for analyzing the measurements respectively supplied by the first sensor and by the second sensor and relating to their travels following a setting in motion of the tibia respectively in translation and in rotation, and an interface for display of data provided by the analysis system from which a diagnosis of at least partial lesion of the ACL of the knee is deduced by a practitioner.
Conformément à l'invention, l'appareil comprend ledit premier moteur affecté à une mise en translation de l'organe de poussée et ledit deuxième moteur affecté à une mise en rotation du support de pied. L'appareil comprend encore le dit premier module de commande que comporte ledit organe de commande de mises en œuvre corrélées du premier moteur et du deuxième moteur, conformément à l'application dudit au moins un modèle d'efforts préétabli et stocké dans un premier répertoire via une première mémoire équipant ledit premier module de commande. According to the invention, the apparatus comprises said first motor assigned to a translational setting of the thrust member and said second motor assigned to a rotational setting of the foot support. The apparatus also comprises said first control module which comprises said control member for correlated implementations of the first motor and of the second motor, in accordance with the application of said at least one pre-established force model and stored in a first directory via a first memory equipping said first control module.
Ledit au moins un modèle d'efforts est affecté à un patient spécifique et/ou est sélectionné par le praticien, via par exemple un menu à choix sélectifs, selon l'examen à effectuer parmi une pluralité de modèles d'efforts types préalablement établis et répertoriés dans la première mémoire. Le premier répertoire de modèles d'efforts peut être évolutif au cours du suivi thérapeutique du patient, en étant adapté et/ou complété par le praticien par un ou plusieurs nouveaux modèles d'efforts spécifiques au patient. Selon une forme de réalisation, au moins un dit deuxième organe de positionnement du deuxième capteur est configuré pour être placé sur le patient en une zone d'une jambe du patient située au plus proche de la TTA du genou du patient. Said at least one effort model is assigned to a specific patient and/or is selected by the practitioner, via for example a menu with selective choices, according to the examination to be performed from among a plurality of standard effort models previously established and listed in the first memory. The first repertoire of effort models can be upgraded during the therapeutic follow-up of the patient, by being adapted and/or supplemented by the practitioner with one or more new effort models specific to the patient. According to one embodiment, at least one said second member for positioning the second sensor is configured to be placed on the patient in an area of one of the patient's legs located closest to the ATT of the patient's knee.
Un dit deuxième organe de positionnement d'un dit deuxième capteur est par exemple agencé en une dite jambière d'enserrement au moins partiel du mollet du patient placée à proximité de l'organe de poussée, et/ou est participant d'une dite potence articulée qui est fixée au plateau et qui est par ailleurs potentiellement porteuse du premier capteur. A said second member for positioning a said second sensor is for example arranged in a said leg piece for at least partially enclosing the patient's calf placed close to the thrust member, and/or is part of a said gallows articulated which is fixed to the plate and which is moreover potentially carrying the first sensor.
Selon une forme avantageuse de réalisation, le premier organe de positionnement du premier capteur et un dit deuxième organe de positionnement d'un dit deuxième capteur sont montés sur au moins une potence articulée qui est fixée au plateau. According to an advantageous embodiment, the first member for positioning the first sensor and a said second member for positioning a said second sensor are mounted on at least one articulated bracket which is fixed to the plate.
Les utilisations potentiellement alternées ou conjointes d'un deuxième capteur monté sur la jambière et/ou d'un deuxième capteur monté sur la potence, permet au praticien d'effectuer des mesures diversifiées de la mise en rotation du tibia. Le praticien peut utiliser sélectivement isolément ou en combinaison un deuxième capteur monté sur la jambière en étant placé proche de la TTA et/ou un deuxième capteur monté sur la potence et appliqué contre la TTA en substitution temporaire du premier capteur. Une telle combinaison d'utilisation de plusieurs deuxièmes capteurs permet d'affiner la détection d'une instabilité rotatoire du genou. The potentially alternate or joint uses of a second sensor mounted on the leg piece and/or of a second sensor mounted on the stem, allows the practitioner to perform diversified measurements of the rotation of the tibia. The practitioner can selectively use, in isolation or in combination, a second sensor mounted on the leg piece by being placed close to the ATT and/or a second sensor mounted on the stem and applied against the ATT as a temporary replacement for the first sensor. Such a combination of use of several second sensors makes it possible to refine the detection of rotational instability of the knee.
Selon une forme de réalisation, l'appareil est pourvu d'un dispositif d'assistance au moins comprenant un émetteur de signaux propre à indiquer à un praticien un positionnement correct du premier capteur et/ou du deuxième capteur sur un patient spécifique, au regard de positions de référence respectivement du premier capteur et/ou du deuxième capteur sur le patient qui sont préalablement définies et stockées dans un deuxième répertoire de positionnements des capteurs individualisés pour divers patients via une deuxième mémoire du dispositif d'assistance. According to one embodiment, the apparatus is provided with at least one assistance device comprising a signal transmitter capable of indicating to a practitioner correct positioning of the first sensor and/or of the second sensor on a specific patient, with regard to reference positions respectively of the first sensor and/or of the second sensor on the patient which are previously defined and stored in a second directory of positions of the individualized sensors for various patients via a second memory of the assistance device.
Par suite de l'application du premier capteur et/ou du deuxième capteur sur la jambe d'un patient spécifique lors d'un examen initial, un étalonnage des capteurs est effectué en des positions de référence des capteurs qui alors stockées dans le deuxième répertoire. Following the application of the first sensor and/or the second sensor to a specific patient's leg during an initial examination, a calibration of the sensors is performed at reference positions of the sensors which are then stored in the second directory.
Lors d'un examen ultérieur, notamment dans le cadre d'un suivi thérapeutique du patient, le praticien peut reproduire le positionnement du premier capteur et/ou du deuxième capteur sur le même patient conformément à leurs positions de référence respectives préalablement stockées, en étant guidé par un signal sonore et/ou par un signal lumineux émis par le dispositif d'assistance. Une reproductibilité fiable de l'examen initial est obtenue, ce qui conforte la pertinence des diagnostics ensuite effectués lors du suivi thérapeutique du patient. During a subsequent examination, in particular in the context of therapeutic follow-up of the patient, the practitioner can reproduce the positioning of the first sensor and/or of the second sensor on the same patient in accordance with their respective previously stored reference positions, by being guided by an audible signal and/or by a light signal emitted by the assistance device. A reliable reproducibility of the initial examination is obtained, which reinforces the relevance of the diagnoses then made during the therapeutic follow-up of the patient.
Selon une forme de réalisation, l'organe de commande comporte un deuxième module de commande d'au moins une mise en configuration du siège pour un patient spécifique, le deuxième module de commande étant un module d'asservissement corrélé au moins d'un troisième moteur de positionnement en inclinaison relative entre l'assise et le dossier, d'un quatrième moteur de positionnement en inclinaison relative entre le plateau et l'assise, et de préférence d'un cinquième moteur de positionnement en élévation de l'assise. According to one embodiment, the control member comprises a second control module for at least one configuration of the seat for a specific patient, the second control module being a servo module correlated with at least a third motor for positioning in relative inclination between the seat and the backrest, a fourth motor for positioning in relative inclination between the plate and the seat, and preferably a fifth motor for positioning in elevation of the seat.
Le deuxième module de commande comprend une troisième mémoire de stockage d'un troisième répertoire de modèles de configuration du siège individualisés pour divers patients qui sont préalablement établis et qui sont reproductibles par l'organe de commande. The second control module comprises a third memory for storing a third directory of individualized seat configuration models for various patients which are previously established and which are reproducible by the control unit.
Présentation des figures Presentation of figures
L'invention sera mieux comprise à la lecture de la description détaillée qui suit d'un exemple de réalisation de la présente invention, en relation avec la figure suivante : The invention will be better understood on reading the following detailed description of an embodiment of the present invention, in relation to the following figure:
[Fig. 1] La figure (1 ) est une présentation schématique de profil d'un patient installé sur un siège que comprend un appareil selon un exemple de réalisation de l'invention. [Fig. 1] Figure (1) is a schematic presentation of the profile of a patient installed on a seat that includes a device according to an embodiment of the invention.
Description détaillée de l'invention La figure et sa description détaillée non limitative, exposent l'invention selon des modalités particulières qui ne sont pas restrictives quant à la portée de l'invention. Les figures et leurs descriptions détaillées d'un exemple de réalisation de l'invention peuvent servir à mieux la définir, si besoin en relation avec la description générale qui vient d’en être faite. Detailed description of the invention The figure and its non-limiting detailed description, expose the invention according to particular modalities which are not restrictive as to the scope of the invention. The figures and their detailed descriptions of an exemplary embodiment of the invention can be used to better define it, if necessary in relation to the general description which has just been given.
Sur la figure 1 , un appareil est organisé pour évaluer une éventuelle lésion du LCA du genou d'un patient. L'appareil comprend un siège (1 ) d'installation du patient pour son examen par un praticien. Le siège (1 ) comporte une assise (18) et un dossier (19) qui sont inclinables l'un par rapport à l'autre, la position de l'assise (18) étant réglable en hauteur. Un plateau (17a) de soutien d'une jambe du patient est monté sur un support ( 17b) qui est articulé en basculement par rapport à l'assise (18)). In FIG. 1, an apparatus is organized to assess a possible injury to the ACL of a patient's knee. The apparatus comprises a seat (1) for installing the patient for his examination by a practitioner. The seat (1) comprises a seat (18) and a backrest (19) which can be tilted relative to each other, the position of the seat (18) being adjustable in height. A plate (17a) for supporting the patient's leg is mounted on a support (17b) which is pivotally articulated with respect to the seat (18)).
Le siège (1 ) peut ainsi être placé en diverses configurations spécifiques d'installation du patient sur l'appareil, par réglage des positions relatives entre l'assise (18), le dossier (19) et le plateau (17a). Lors d'un examen du patient, le praticien peut ainsi modifier la configuration du siège (1 ) selon des modalités spécifiques de mise en œuvre de l'appareil pour établir une évaluation à divers degrés de mise en flexion du genou du patient. The seat (1) can thus be placed in various specific configurations for installing the patient on the device, by adjusting the relative positions between the seat (18), the backrest (19) and the plate (17a). During an examination of the patient, the practitioner can thus modify the configuration of the seat (1) according to specific methods of implementation of the device in order to establish an evaluation at various degrees of flexion of the patient's knee.
Le plateau (17a) est équipé d'un socle (11 a) de soutien du genou du patient. Le plateau (17a) est aussi équipé d'un support de pied (11 b) recevant le pied du patient et d'un organe de poussée (9a) comprenant une coque (9c) sur laquelle repose le mollet du patient, à proximité de son genou. The plate (17a) is equipped with a base (11a) for supporting the patient's knee. The tray (17a) is also equipped with a foot support (11b) receiving the patient's foot and with a thrust member (9a) comprising a shell (9c) on which the patient's calf rests, close to his knee.
Le genou du patient est fermement maintenu sur le socle (11 a) via un premier organe d'immobilisation (16) agencé en une sangle d'enserrement du genou sur le socle (11 a). Le pied du patient est fermement maintenu sur le support de pied (11 b) via un deuxième organe d'immobilisation (13) agencé en une sangle d'enserrement au moins du pied et de la base de la jambe du patient sur le support de pied (11 b). The patient's knee is firmly held on the base (11a) via a first immobilization member (16) arranged in a strap for enclosing the knee on the base (11a). The patient's foot is firmly held on the foot support (11 b) via a second immobilization member (13) arranged in a strap gripping at least the foot and the base of the patient's leg on the support foot (11b).
L'organe de poussée (9a) est monté mobile en translation sur le plateau (17a), pour exercer un effort de poussée contre le mollet du patient à un seuil d'effort souhaité. Le support de pied (11 b) est monté mobile en rotation sur le plateau (17a), pour provoquer une mise en rotation du tibia à un seuil d'effort souhaité. The thrust member (9a) is mounted to move in translation on the plate (17a), to exert a thrust force against the patient's calf at a desired force threshold. The foot support (11b) is rotatably mounted on the plate (17a), to cause rotation of the tibia at a desired force threshold.
L'appareil est équipé de différents moteurs (4, 5, 7) pour régler la configuration du siège (1 ) en diverses stations d'examen du patient. Le moteur (4) permet de régler l'inclinaison entre l'assise (18) et le dossier (19). Le moteur (7) permet de régler l'inclinaison entre l'assise (18) et le plateau (17a) via le support 10 porteur du plateau (17a). Le moteur (5) permet de régler la position en élévation de l'assise (18). The apparatus is equipped with different motors (4, 5, 7) to adjust the configuration of the seat (1) at various patient examination stations. The motor (4) adjusts the inclination between the seat (18) and the backrest (19). The motor (7) makes it possible to adjust the inclination between the seat (18) and the plate (17a) via the support 10 carrying the plate (17a). The motor (5) makes it possible to adjust the elevation position of the seat (18).
L'appareil est aussi équipé de différents moteurs (9b, 12) pour placer le tibia du patient sous contrainte en translation et/ou en rotation. Un premier moteur (9b), tel que notamment un vérin électrique, est affecté à la manœuvre en translation de l'organe de poussée (9a), afin de provoquer un déplacement en translation du tibia par rapport au fémur. Un deuxième moteur (12), tel que notamment un moteur rotatif électrique, est affecté à la manœuvre en rotation du support de pied (11 b), afin de provoquer une mise en rotation du tibia du patient. The apparatus is also equipped with various motors (9b, 12) to place the patient's tibia under stress in translation and/or in rotation. A first motor (9b), such as in particular an electric actuator, is assigned to the translation maneuver of the thrust member (9a), in order to cause a translational movement of the tibia relative to the femur. A second motor (12), such as in particular an electric rotary motor, is assigned to the rotational maneuver of the foot support (11b), in order to cause rotation of the patient's tibia.
L'appareil est encore équipé d'un premier capteur (15a) de mesure du déplacement en translation du tibia par suite de l'activation du premier moteur (9b) provoquant le déplacement en translation de l'organe de poussée (9a). The device is also equipped with a first sensor (15a) for measuring the translational displacement of the tibia following the activation of the first motor (9b) causing the translational displacement of the thrust member (9a).
Le premier capteur (15a), tel qu'un capteur de proximité à différence de potentiels, est monté sur une potence (15b) fixée au plateau (17a) en étant appliqué contre la TTA lors de l'examen du patient. Un deuxième capteur (14b) tel qu'un capteur de proximité à différence de potentiels configuré en inclinomètre et/ou en accéléromètre, est monté selon l'exemple illustré sur une jambière (14a) d'enserrement du mollet du patient en étant appliqué contre le tibia à proximité du premier capteur (15), au plus proche possible de la TTA. The first sensor (15a), such as a proximity sensor with potential difference, is mounted on a bracket (15b) fixed to the plate (17a) by being applied against the ATT during the examination of the patient. A second sensor (14b) such as a potential difference proximity sensor configured as an inclinometer and/or an accelerometer, is mounted according to the example illustrated on a leg piece (14a) for enclosing the patient's calf by being applied against the tibia close to the first sensor (15), as close as possible to the ATT.
Une Interface Homme/Machine ci après désigné par IHM - permet au praticien d'établir son diagnostic à partir du traitement logique par un système d'analyse des mesures fournies au moins par le premier capteur (15a) et le deuxième capteur (14b) qui sont effectuées à différents degrés de flexion du genou par inclinaison du plateau (17a) par rapport à l'assise (18) selon les configurations prédéfinies du siège (19). A Man/Machine Interface hereinafter referred to as HMI - allows the practitioner to establish his diagnosis from the logic processing by a system for analyzing the measurements provided at least by the first sensor (15a) and the second sensor (14b) which are performed at different degrees of knee flexion by tilting the plate (17a) relative to the seat (18) according to the predefined configurations of the seat (19).
A l'issue d'une séquence d'examen du patient, une interface d'affichage du traitement logique des mesures effectué par le système d'analyse, procure un affichage du résultat obtenu sous forme d'un diagramme. Le diagramme comporte deux courbes comparatives, dont une courbe de référence relative à une absence de lésion du LCA (courbe verte) et une courbe relative à une éventuelle lésion du LCA (courbe rouge) identifiée par le système d'analyse à partir du traitement des mesures effectuées. At the end of a patient examination sequence, a display interface of the logical processing of the measurements carried out by the analysis system provides a display of the result obtained in the form of a diagram. The diagram includes two comparative curves, including a reference curve relating to an absence of ACL injury (green curve) and a curve relating to a possible ACL injury (red curve) identified by the analysis system from the treatment of measurements taken.
Pour effectuer l'examen du patient, un organe de commande que comporte l'IHM comprend un deuxième module de commande qui régule la mise en œuvre du moteur (4), du moteur (5) et du moteur (7) pour placer le siège (19) selon des configurations préalablement définies à différents degrés de mise en flexion du genou. To perform the examination of the patient, a control member that comprises the HMI comprises a second control module which regulates the implementation of the motor (4), the motor (5) and the motor (7) to place the seat (19) according to previously defined configurations at different degrees of knee flexion.
Les configurations du siège (19) sont alors appliquées selon des modèles de configuration du siège (19) qui sont sélectionnâmes et/ou adaptables par le praticien, et qui sont classifiés selon un troisième répertoire préalablement établis et stockés dans une troisième mémoire du deuxième module de commande. The configurations of the seat (19) are then applied according to configuration models of the seat (19) which are selected and/or adaptable by the practitioner, and which are classified according to a third directory previously established and stored in a third memory of the second module control.
Préalablement à un examen du patient, le premier capteur (15a) et le deuxième capteur (14b) sont étalonnés en étant placés en des positions de référence (15b, 14a), respectivement contre la TTA pour le premier capteur (15a) et à proximité de la TTA pour le deuxième capteur (14b) selon l'exemple illustré. L'IHM comprend un dispositif d'assistance guidant le praticien pour reproduire les positions de référence (15b), (14a) du premier capteur (15a) et du deuxième capteur (14b) pour effectuer un examen du patient. Les positions de référence (15b, 14a) respectives des capteurs (15a, 14b) sont classifiées selon un deuxième répertoire préalablement établis et stockés dans une deuxième mémoire du dispositif d'assistance. Par la suite lors d'un suivi thérapeutique du patient, les positions d'installation des capteurs (15b, 14a) par le praticien sont comparées avec leur positions de référence (15a, 14b) respectives, pour définir la pertinence du positionnement ultérieur des capteurs (15a, 14b) sur le patient. En cas d'un décalage de position des capteurs (15a et 14b) par rapport à leurs positions de référence (15b, 14a) préalablement mémorisées, le praticien est alors guidé via un émetteur d'un signal - sonore et/ou lumineux - pour placer sur le patient le premier capteur (15a) et le deuxième capteur (14b) conformément à leurs positions de référence (15a, 14b) respectives. Prior to an examination of the patient, the first sensor (15a) and the second sensor (14b) are calibrated by being placed in reference positions (15b, 14a), respectively against the TTA for the first sensor (15a) and near of the ATT for the second sensor (14b) according to the example illustrated. The HMI comprises an assistance device guiding the practitioner to reproduce the reference positions (15b), (14a) of the first sensor (15a) and of the second sensor (14b) to carry out an examination of the patient. The respective reference positions (15b, 14a) of the sensors (15a, 14b) are classified according to a second directory previously established and stored in a second memory of the assistance device. Subsequently during a therapeutic follow-up of the patient, the positions of installation of the sensors (15b, 14a) by the practitioner are compared with their respective reference positions (15a, 14b), to define the relevance of the subsequent positioning of the sensors (15a, 14b) on the patient. In the event of a position shift of the sensors (15a and 14b) with respect to their previously stored reference positions (15b, 14a), the practitioner is then guided via a transmitter of a signal - sound and/or light - to placing the first sensor (15a) and the second sensor (14b) on the patient in accordance with their respective reference positions (15a, 14b).
Pour effectuer un examen du patient, le praticien exploite l'IHM pour provoquer le déplacement en translation de l'organe de poussée (9a) et la rotation du support de pied (11 b). A cet effet, l'organe de commande comprend un premier module de commande de mise en œuvre du premier moteur (9b) et du deuxième moteur (12), qui sont régulés en corrélation par le premier module de commande. To perform an examination of the patient, the practitioner uses the MMI to cause the translational movement of the thrust member (9a) and the rotation of the foot support (11b). To this end, the control unit comprises a first control module for implementing the first motor (9b) and the second motor (12), which are regulated in correlation by the first control module.
Plus particulièrement pour une phase d'examen du patient, les efforts et/ou les amplitudes de mise sous contrainte du tibia en translation - via le premier moteur (9b) - et en rotation - via le deuxième moteur (12) sont régulées selon des modèles d'effort sélectionnâmes et/ou adaptables par le praticien, qui sont classifiés selon un premier répertoire préalablement établis et stockés dans une première mémoire. Chacun des modèles d'effort comprend une première loi d'effort régulant la mise en œuvre du premier moteur (9b) et une deuxième loi d'effort régulant la mise en œuvre du deuxième moteur (12). More particularly for a patient examination phase, the forces and/or the amplitudes of stressing the tibia in translation - via the first motor (9b) - and in rotation - via the second motor (12) are regulated according to effort models selected and/or adaptable by the practitioner, which are classified according to a first directory established beforehand and stored in a first memory. Each of the force models comprises a first force law regulating the operation of the first motor (9b) and a second force law regulating the operation of the second motor (12).
Le premier moteur (9b) et le deuxième moteur (12) sont ainsi asservis en combinaison, par application d'un modèle d'effort - combinant en corrélation une dite première loi d'effort et une dite deuxième loi d'effort - qui est sélectionné par le praticien parmi divers modèles d'effort répertoriés dans la première mémoire, et cela pour divers degrés d'inflexion du genou. The first motor (9b) and the second motor (12) are thus slaved in combination, by applying a force model - combining in correlation a said first law of force and a said second law of force - which is selected by the practitioner from among various effort models listed in the first memory, and this for various degrees of inflection of the knee.
La mise en œuvre du premier moteur 9a et du deuxième moteur 12 selon un modèle d'effort sélectionné par le praticien permet de réguler - via l'organe de commande - des modalités de mise sous contrainte du tibia souhaitées par le praticien. A partir de l'application d'un modèle d'effort , un asservissement combiné du premier moteur (9a) et du deuxième moteur (12) par le premier module de commande permet de soumettre le tibia du patient à une contrainte en translation et en rotation selon des efforts et des amplitudes qui sont corrélés, en pouvant sélectivement être appliqués - sur requêtes du praticien - simultanément ou consécutivement. The implementation of the first motor 9a and the second motor 12 according to a model of effort selected by the practitioner makes it possible to regulate - via the control member - the methods of placing the tibia under stress desired by the practitioner. From the application of an effort model, a combined servoing of the first motor (9a) and the second motor (12) by the first control module makes it possible to subject the patient's tibia to a constraint in translation and in rotation according to forces and amplitudes which are correlated, being able to be selectively applied - on requests from the practitioner - simultaneously or consecutively.
Les diverses mesures de la mise en mobilité du tibia en translation et/ou en rotation sont sélectivement effectuées par le praticien selon des modèles d'efforts prédéfinis et adaptés à un patient spécifique, à partir desquels modèles d'efforts les mises en œuvre respectives du premier moteur (9b) et du deuxième moteur (12) sont corrélées. Les modèles d'effort sont préétablis sur la base de modèles d'effort standardisés ou sur la base de modèles d'effort spécifiques construits et/ou potentiellement adaptés lors d'un examen initial d'un patient, en étant reproductibles lors d'un suivi thérapeutique du patient et/ou adaptés selon l'évolution de la lésion du LCA identifiée lors de l'examen initial. The various measurements of the mobility of the tibia in translation and/or in rotation are selectively carried out by the practitioner according to predefined effort models adapted to a specific patient, from which effort models the respective implementations of the first motor (9b) and the second motor (12) are correlated. The effort models are pre-established on the basis of standardized effort models or on the basis of specific effort models constructed and/or potentially adapted during an initial examination of a patient, being reproducible during a therapeutic follow-up of the patient and/or adapted according to the evolution of the ACL lesion identified during the initial examination.
Un diagnostic précis et fiable peut-être ainsi rapidement établi par le praticien, en prenant en compte une instabilité rotatoire du tibia évaluée précisément à partir de diverses mesures d'une translation du tibia et d'une rotation du tibia qui sont corrélées de part l'asservissement combiné des mises en œuvre du premier moteur (9b) selon une dite première loi d'effort spécifique et du deuxième moteur (12) selon une dite deuxième loi d'effort spécifique. A precise and reliable diagnosis can thus be quickly established by the practitioner, taking into account a rotational instability of the tibia evaluated precisely from various measurements of a translation of the tibia and a rotation of the tibia which are correlated on both sides. combined enslavement of the implementations of the first motor (9b) according to a so-called first specific force law and of the second motor (12) according to a said second specific force law.
La reproductibilité de l'examen lors d'un suivi thérapeutique en est fiabilisée et/ou peut être adaptée selon l'évolution de la lésion du LCA du patient, à partir d'un choix par le praticien des modèles d'effort à appliquer et/ou à adapter. La précision des mesures effectuées est aussi renforcée par l'application du premier capteur (15a) et/ou du deuxième capteur (14b) contre la TTA, ou tout au moins au plus proche de la TTA. The reproducibility of the examination during a therapeutic follow-up is thereby made more reliable and/or can be adapted according to the evolution of the patient's ACL lesion, based on a choice by the practitioner of the effort models to be applied and /or to adapt. The accuracy of the measurements performed is also enhanced by applying the first sensor (15a) and/or the second sensor (14b) against the TTA, or at least as close as possible to the TTA.
Le système d'analyse peut procurer des résultats performants et comparatifs entre des mesures dont les modalités de mesure peuvent être diversifiées en étant aisée à mettre en œuvre par le praticien sur la base de modèles d'effort préétablis et/ou adaptées. L'asservissement entre elles des contraintes appliquées au tibia pour son déplacement en translation pour diverses configurations du siège - sous contrôle de la mise en œuvre du premier moteur (9b) et du deuxième moteur (12) par l'organe de commande - concourent à la qualité et à la précision obtenues - via le système d'analyse - de l'analyse des mesures effectuées. The analysis system can provide effective and comparative results between measurements whose measurement methods can be diversified while being easy to implement by the practitioner on the basis of pre-established and/or adapted effort models. The interlocking of the constraints applied to the tibia for its displacement in translation for various configurations of the seat - under the control of the implementation of the first motor (9b) and of the second motor (12) by the control member - contribute to the quality and the precision obtained - via the analysis system - from the analysis of the measurements carried out.
Utilisation de l’équipement breveté Use of patented equipment
L’appareil susvisé est notamment destiné au diagnostic préopératoire. The aforementioned apparatus is intended in particular for preoperative diagnosis.
Il permet de mettre en œuvre une méthode de mesure d’un mouvement de rotation d’un genou d’un patient en combinaison avec une mesure d'un mouvement de déplacement en translation du tibia associé par rapport au fémur associé du patient à différents degrés de flexion du genou, la méthode étant mise en œuvre par un appareil au moins comprenant un siège (1 ) d'installation du patient comportant une assise (18) prolongée d'un dossier (19) inclinable par rapport à l'assise (18), et comportant un plateau (17a) de soutien d'une jambe du patient qui est monté basculant en position sur l'assise (18), le plateau (17a) étant équipé d'un premier organe d'immobilisation (16) du genou du patient sur le plateau (17a), d'un support de pied (11 b) qui est muni d'un deuxième organe d'immobilisation (13) du pied du patient et qui est monté mobile en rotation sur le plateau (10), et d'un organe de poussée (9a) du genou du patient qui est monté mobile en translation sur le plateau (17a), l'appareil étant équipé d'un premier capteur (15a) de mesure d'un déplacement en translation du tibia par rapport au fémur placé sur la TTA, et d'un deuxième capteur (14b) de mesure d'un angle de rotation dudit tibia, proche de la TTA, selon laquelle méthode une collecte et un traitement logique sont réalisés par un système d'analyse des mesures au moins comprenant une première mesure fournie par le premier capteur (15a) et une deuxième mesure fournie par le deuxième capteur (14b) pour chacun desdits différents degrés de flexion du genou, caractérisée en ce que : It makes it possible to implement a method for measuring a rotational movement of a knee of a patient in combination with a measurement of a movement of displacement in translation of the associated tibia with respect to the associated femur of the patient at different degrees knee flexion, the method being implemented by a device at least comprising a seat (1) for installing the patient comprising a seat (18) extended by a backrest (19) tiltable with respect to the seat (18 ), and comprising a plate (17a) for supporting a leg of the patient which is mounted tilting in position on the seat (18), the plate (17a) being equipped with a first member (16) for immobilizing the patient's knee on the plate (17a), a foot support (11 b) which is provided with a second member (13) for immobilizing the patient's foot and which is rotatably mounted on the plate (10 ), and a thrust member (9a) for the patient's knee which is mounted to move in translation on the plate (17a), the apparatus being equipped with a first sensor (15a) for measuring a translational displacement of the tibia relative to the femur placed on the ATT, and a second sensor (14b) for measuring an angle of rotation of said tibia, close to the TTA, according to which method a collection and a logical processing are carried out by a measurement analysis system at least comprising a first measurement provided by the first sensor (15a) and a second measurement provided by the second sensor (14b) for each said different degrees of knee flexion, characterized in that:
-) la mesure du déplacement en translation du tibia est réalisée par le premier capteur (15a) de mesure à partir d'une translation de l'organe de poussée (9a) sur le plateau (17a) qui est opérée par un premier moteur (9b), -) the measurement of the displacement in translation of the tibia is carried out by the first measurement sensor (15a) based on a translation of the thrust member (9a) on the plate (17a) which is operated by a first motor (9b),
-) la mesure de l'angle de rotation du tibia est effectuée par le deuxième capteur (14b) placé au plus proche de la TTA du genou du patient, à partir d'une mise en rotation du support de pied (11 b) qui est opérée par un deuxième moteur (12), et -) the measurement of the angle of rotation of the tibia is carried out by the second sensor (14b) placed closest to the ATT of the patient's knee, from a rotation of the foot support (11b) which is operated by a second motor (12), and
-) Les mises en œuvre respectives du premier moteur (9b) et du deuxième moteur (12) sont asservies en corrélation par un premier module de commande que comporte un organe de commande, -) The respective implementations of the first motor (9b) and of the second motor (12) are controlled in correlation by a first control module that comprises a control member,
-) les modalités d'activation respectives du premier moteur (9b) et du deuxième moteur (12) sont régulées dépendantes l'une de l'autre selon au moins un modèle d'efforts répertorié de mise sous contrainte du tibia d'un patient spécifique qui est préétabli et reproductible et/ou adaptable au patient considéré, -) the respective activation modes of the first motor (9b) and of the second motor (12) are regulated dependent on each other according to at least one model of efforts listed for stressing the tibia of a patient specific which is pre-established and reproducible and/or adaptable to the patient in question,
-) ledit au moins un modèle d'efforts combine, pour chacun des degrés de mise en flexion du genou du patient, d'une part une première loi d'effort relative au déplacement en translation du tibia, via l'organe de poussée (9a) déplacé en translation sur le plateau (17a) par le premier moteur (9b), et d'autre part une deuxième loi d'effort relative à la mise en rotation du pied du patient, via le support de pied (11 b), par le deuxième moteur (12) de mise en rotation du support de pied (11 b). -) said at least one force model combines, for each of the degrees of flexion of the patient's knee, on the one hand a first force law relating to the translational displacement of the tibia, via the thrust member ( 9a) moved in translation on the plate (17a) by the first motor (9b), and on the other hand a second force law relating to the rotation of the patient's foot, via the foot support (11b) , by the second motor (12) for rotating the foot support (11 b).
De préférence, le deuxième capteur (14b) est placé à proximité de l'organe de poussée (9a) suivant l'extension de la jambe, le premier capteur (15a) étant placé sur la TTA et le deuxième capteur (14b) étant placé adjacent au premier capteur (15a), proche de la TTA. Preferably, the second sensor (14b) is placed close to the thrust member (9a) following the extension of the leg, the first sensor (15a) being placed on the TTA and the second sensor (14b) being placed adjacent to the first sensor (15a), close to the TTA.
Avantageusement, le deuxième capteur (14b) est monté sur une jambière (14a) installée autour du mollet du patient. Advantageously, the second sensor (14b) is mounted on a leg piece (14a) fitted around the patient's calf.
Selon des premières modalités d'examen, la mesure du déplacement en translation du tibia par le premier capteur (15a) et la mesure de l'angle de rotation du tibia par le deuxième capteur (14b), sont effectuées simultanément sous contrôle de l'organe de commande conformément au dit au moins un modèle d'effort. Selon des deuxièmes modalités d'examen, la mesure du déplacement en translation du tibia par le premier capteur (15a) et la mesure de l'angle de rotation du tibia par le deuxième capteur (14b), sont effectuées consécutivement sous contrôle de l'organe de commande conformément au dit au moins un modèle d'effort. According to first examination methods, the measurement of the translational displacement of the tibia by the first sensor (15a) and the measurement of the angle of rotation of the tibia by the second sensor (14b) are carried out simultaneously under the control of the controller in accordance with said at least one effort model. According to second examination methods, the measurement of the translational displacement of the tibia by the first sensor (15a) and the measurement of the angle of rotation of the tibia by the second sensor (14b) are carried out consecutively under the control of the controller in accordance with said at least one effort model.
Avantageusement, préalablement à un relevé de mesures sur le patient, le premier capteur (15a) et le deuxième capteur (14b) sont calibrés en des positions de référence (15b, 14a) respectives par examen d'une jambe saine du patient soumise au dit au moins un modèle d'efforts. Advantageously, prior to a reading of measurements on the patient, the first sensor (15a) and the second sensor (14b) are calibrated in respective reference positions (15b, 14a) by examination of a healthy leg of the patient subjected to said at least one effort model.
De préférence, l'organe de commande comporte un deuxième module de commande d'asservissement corrélé au moins d'un troisième moteur (4) de positionnement en inclinaison relative entre l'assise (18) et le dossier (19), d'un quatrième moteur (7) de positionnement en inclinaison relative entre le plateau (17b) et l'assise (18), et d'un cinquième moteur (5) de positionnement en élévation de l'assise (18), les courses respectives du troisième moteur (4), du quatrième moteur (7) et du cinquième moteur (5) étant régulées dépendantes l'une de l'autre selon au moins un modèle de configuration du siège (3 et 8) préétabli et reproductible pour un patient spécifique. Preferably, the control member comprises a second servo control module correlated with at least a third motor (4) for positioning in relative inclination between the seat (18) and the backrest (19), a fourth motor (7) for positioning in relative inclination between the plate (17b) and the seat (18), and of a fifth motor (5) for positioning the seat (18) in elevation, the respective strokes of the third motor (4), the fourth motor (7) and the fifth motor (5) being regulated dependent on each other according to at least one configuration model of the seat (3 and 8) pre-established and reproducible for a specific patient.

Claims

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Revendications Claims
1 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient, comprenant un siège (1 ) pourvu d’une assise (18) présentant un dossier (19) inclinable, un plateau (17a) de soutien de la jambe du patient, mobile en rotation par rapport à l'assise (18) et d'un organe (9a de poussée du mollet du patient (2) équipé d'un premier organe d'immobilisation (16) du genou du patient sur le plateau (17a), d'un organe de poussée (9a) du genou monté mobile en translation sur le plateau (17a) 1 - Measuring device for the characterization of a lesion of the anterior cruciate ligament of the knee (ACL) of a patient, comprising a seat (1) provided with a seat (18) having a reclining backrest (19), a (17a) for supporting the patient's leg, movable in rotation relative to the seat (18) and a member (9a for pushing the patient's calf (2) equipped with a first immobilizing member (16 ) of the patient's knee on the plate (17a), a thrust member (9a) of the knee mounted movable in translation on the plate (17a)
Caractérisé en ce que ledit appareil comporte en outre : Characterized in that said apparatus further comprises:
- un support de pied (11 b), mobile en rotation sur le plateau (17a), apte à provoquer une mise en rotation du tibia à un seuil d'effort souhaité, ledit support de pied (11 b) étant muni d'un deuxième organe d'immobilisation (13) du pied du patient un premier capteur (15a) apte à être positionné sur la TTA dudit patient ainsi qu’un deuxième capteur (14b) affecté à la mesure d'un angle de rotation du tibia et monté sur un organe de positionnement dudit deuxième capteur par rapport au support de pied (11 b) - a foot support (11 b), rotatable on the plate (17a), capable of causing rotation of the tibia at a desired force threshold, said foot support (11 b) being provided with a second member (13) for immobilizing the patient's foot a first sensor (15a) capable of being positioned on the ATT of said patient as well as a second sensor (14b) assigned to the measurement of an angle of rotation of the tibia and mounted on a member for positioning said second sensor relative to the foot support (11b)
- un système d'analyse des mesures respectivement fournies par le premier capteur (15a) et par le deuxième capteur (14b) et relatives à leurs courses par suite d'une mise en mobilité du tibia respectivement en translation et en rotation, et une interface d'affichage des données fournies par le système d'analyse. - a system for analyzing the measurements respectively supplied by the first sensor (15a) and by the second sensor (14b) and relating to their strokes following a setting in motion of the tibia respectively in translation and in rotation, and an interface display of data provided by the analysis system.
2 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient selon la revendication 1 caractérisé en ce qu’il comprend un premier moteur (9b) commandant la translation de l'organe de poussée (9a) et un deuxième moteur (12) commandant une mise en rotation du support de pied (11 b). 2 - Measuring device for the characterization of a lesion of the anterior cruciate ligament of the knee (ACL) of a patient according to claim 1 characterized in that it comprises a first motor (9b) controlling the translation of the organ of thrust (9a) and a second motor (12) controlling rotation of the foot support (11b).
3 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient selon la revendication précédente caractérisé en ce qu’il comprend une mémoire informatique pour l’enregistrement d’au moins un modèle numérique d'efforts et un calculateur contrôlant lesdits moteur (9b et 12) en appliquant des lois de commande fonctions du contenu de ladite mémoire informatique. 3 - Measuring device for the characterization of a lesion of the anterior cruciate ligament of the knee (ACL) of a patient according to the preceding claim characterized in that it comprises a computer memory for recording at least one digital model effort and a computer controlling said motor (9b and 12) by applying control laws functions of the content of said computer memory.
4 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient selon la revendication 1 caractérisé en ce que ledit deuxième organe de positionnement d'un dit deuxième capteur (14b) est agencé en une dite jambière (14a). 4 - Measuring device for the characterization of a lesion of the anterior cruciate ligament of the knee (ACL) of a patient according to claim 1 characterized in that said second member for positioning a said second sensor (14b) is arranged in a said leg piece (14a).
5 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient selon la revendication 1 caractérisé en ce que le premier organe de positionnement du premier capteur (15a) et un dit deuxième organe de positionnement d'un dit deuxième capteur (14b) sont montés sur au moins une potence (15b) articulée qui est fixée au plateau (17a). 5 - Measuring device for characterizing a lesion of the anterior cruciate ligament of the knee (ACL) of a patient according to claim 1 characterized in that the first positioning member of the first sensor (15a) and a said second member of positioning of a said second sensor (14b) are mounted on at least one articulated bracket (15b) which is fixed to the plate (17a).
6 - Appareil de mesure pour la caractérisation d'une lésion du ligament croisé antérieur du genou (LCA) d'un patient selon la revendication 1 caractérisé en ce qu’il est en outre pourvu d'un dispositif d'assistance au moins comprenant un émetteur de signaux propre à indiquer à un praticien un positionnement correct du premier capteur (15a) et/ou du deuxième capteur (14b) sur un patient spécifique, au regard de positions de référence (15b et 14a) respectivement du premier capteur (15a) et/ou du deuxième capteur (14b) sur le patient préalablement définies et stockées dans un deuxième répertoire de positionnements des capteurs individualisés pour divers patients via une deuxième mémoire du dispositif d'assistance. 6 - Measuring device for the characterization of a lesion of the anterior cruciate ligament of the knee (ACL) of a patient according to claim 1 characterized in that it is further provided with an assistance device at least comprising a signal transmitter suitable for indicating to a practitioner a correct positioning of the first sensor (15a) and/or of the second sensor (14b) on a specific patient, with regard to reference positions (15b and 14a) respectively of the first sensor (15a) and/or of the second sensor (14b) on the patient previously defined and stored in a second directory of positions of individualized sensors for various patients via a second memory of the assistance device.
7. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de commande comporte un deuxième module de commande d'au moins une mise en configuration du siège (1 ) pour un patient spécifique, le deuxième module de commande étant un module d'asservissement corrélé au moins d'un troisième moteur (4) de positionnement en inclinaison relative entre l'assise (18) et le dossier (19), d'un quatrième moteur (7) de positionnement en inclinaison relative entre le plateau (17a) et l'assise (18), le deuxième module de commande comprenant une troisième mémoire de stockage d'un troisième répertoire de modèles de configuration du siège (1 ) individualisés pour divers patients qui sont préalablement établis et qui sont reproductibles par l'organe de commande. 7. Apparatus according to any one of the preceding claims, characterized in that the control member comprises a second control module for at least one configuration of the seat (1) for a specific patient, the second control module being a servo module correlated with at least a third motor (4) for positioning in relative inclination between the seat (18) and the backrest (19), of a fourth motor (7) for positioning in relative inclination between the plate (17a) and the seat (18), the second control module comprising a third memory of storage of a third directory of seat configuration models (1) individualized for various patients which are previously established and which are reproducible by the control unit.
EP21785961.0A 2020-09-15 2021-09-15 Method and device for detecting and therapeutically monitoring knee ligament injuries Pending EP4213721A1 (en)

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FR2009339A FR3114020B1 (en) 2020-09-15 2020-09-15 Method and apparatus for the detection and therapeutic monitoring of knee ligament injuries
PCT/FR2021/051585 WO2022058686A1 (en) 2020-09-15 2021-09-15 Method and device for detecting and therapeutically monitoring knee ligament injuries

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CN117158976B (en) * 2023-11-03 2024-01-30 北京大学第三医院(北京大学第三临床医学院) Novel forward looseness measuring instrument for knee joint

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JPH09276252A (en) * 1996-04-18 1997-10-28 Mitsubishi Heavy Ind Ltd Injury degree measuring device for ligament in knee joint part
WO2008040790A1 (en) * 2006-10-05 2008-04-10 Genourob Method for detecting and monitoring injuries of the knee anterior cruciate ligament
FR2974286B1 (en) 2011-04-22 2013-05-17 Genourob APPARATUS AND METHOD FOR DETECTING PARTIAL LESION OF CROSS LIGAMENT ANTERIOR KNEE
FR3009677B1 (en) * 2013-08-19 2015-08-07 Amplitude DEVICE FOR DETERMINING A RELATIVE POSITION OF A FEMUR IN RELATION TO A TIBIA
FR3044539B1 (en) * 2015-12-08 2017-12-15 Amplitude EVALUATION DEVICE FOR EVALUATING MORPHOLOGICAL PARAMETERS OF A LOWER MEMBER

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FR3114020A1 (en) 2022-03-18

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