Accuracy and Repeatability of a Pressure Measurement System in the Patellofemoral Joint

The objective of this study was to assess how accurately and repeatably the Iscan system measures force and pressure in the natural patellofemoral joint. These measurements must be made to test widely held assumptions about the relationships between mechanics, pain and cartilage degeneration. We assessed the system's accuracy by using test rigs in a materials testing machine to apply known forces and force distributions across the sensor. The root mean squared error in measuring resultant force (for five trials at each of seven load levels) was 6.5 +/- 4.4% (mean +/- standard deviation over all trials at all load levels), while the absolute error was -5.5 +/- 5.6%. For force distribution, the root mean squared error (for five trials at each of five force distributions) was 0.86 +/- 0.58%, while the absolute error was -0.22 +/- 1.03%. We assessed the repeatability of the system's measurements of patellofemoral contact force, pressure and force distribution in four cadaver specimens loaded in continuous and static flexion. Variability in measurement (standard deviation expressed as a percentage of the mean) was 9.1% for resultant force measurements and 3.0% for force distribution measurements for static loads, and 7.3% for resultant force and 2.2% for force distribution measurements for continuous flexion. Cementing the sensor to the cartilage lowered readings of resultant force by 31 +/- 32% (mean +/- standard deviation), area by 24 +/- 13% and mean pressure by 9 +/- 34% (relative to the uncemented sensor). Maximum pressure measurement, however, was 24 +/- 43% higher in the cemented sensor than in the uncemented sensor. The results suggest that the sensor measures force distribution more accurately and repeatably than absolute force. A limitation of our work, however, is that the sensor must be cemented to the patellar articular surface to make the force distribution measurements, and our results suggest that this process reduces the accuracy of force, pressure and area measurements. Our results suggest that the Iscan system's pressure measurement accuracy and repeatability are comparable to that of Fuji Prescale film, but its advantages are that it is thinner than most Fuji Prescale film, it measures contact area more accurately and that it makes continuous measurements of force, pressure and area.