A new ultrasound system lets clinicians track bones moving in 3D without radiation or expensive MRI scans. The problem is that doctors currently have poor tools to see how joints like the kneecap actually move during activity. Up to one-in-five people have kneecap joint problems from faulty biomechanics, yet treatment often fails because clinicians cannot measure what is happening inside the joint. Existing options—4D-CT, live X-rays, or cine-MRI—are costly, expose patients to radiation, or restrict movement. Skin markers cannot track the kneecap because it moves independently under the skin. If validated, CAT&MAUS would give orthopaedic surgeons a cheap, portable way to diagnose joint problems accurately. The system attaches tracking hardware to a standard NHS ultrasound machine, letting clinicians see the position and orientation of bones in real time during movement. The researchers will test it on 50 patients against bi-plane X-rays, then develop full 3D visualisation tools. Beyond kneecap problems, the same approach could work for hips, shoulders, feet, ankles, and the spine—potentially transforming how common joint conditions are diagnosed and treated across the NHS.
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AIMS: Refine and validate a hardware/software system (CAT&MAUS) capable of augmenting the NHS s ultrasound equipment with the ability to accurately measure and visualise three-dimensional movements of bones and joints such as the knee. BACKGROUND: Currently in orthopaedics, patient assessment and treatment decision-making is impaired by very limited availability of 3D imaging for bone and joint movements. Where technologies are available, they either require exposure to radiation (4D-CT or live x-rays) or advanced MRI (cine-MRI). These scans are costly, there is little space for movement, and the results are difficult to interpret. Clinical gait analysis is useful but rarely available, costly, and more mobile bones or joints cannot be tracked using markers placed on the skin. The patellofemoral joint is one such joint. This is the joint between the kneecap (patella) and the groove at the end of the thigh bone (femur). Up to one-in-five people have patellofemoral joint problems (pain or instability) caused by unfavourable biomechanics. This places a heavy burden on their quality of life, on the health service, and on society. Unfortunately, the prognosis from treatment is often poor, and this is driven in part by the limitations of current technology. CAT&MAUS combines conventional medical ultrasound with attached probe-tracking hardware and software to visualise the position and orientation of bony anatomy in 3D-space. It overcomes the described limitations of current technology and the patellofemoral joint is an ideal model for initial clinical validation and translation. CAT&MAUS has the ability, however, to overcome similar limitations for conditions affecting not only the knee joint but almost all other bones and joints, including the hip, shoulder, foot, ankle, and spine. METHODS: WP1: A stakeholder working group will be recruited to produce training and user-guides, a system specification, and actively support all development stages. WP2: A health economic, regulatory, and commercialisation workstream will run throughout the project. WP3: The CAT&MAUS system will be optimised and streamlined for integration with one of the most commonly used ultrasound machines (manufactured by GE). The existing functionality and portability of the machine will be unaffected. The precision of the integrated system will be tested with phantoms to optimise performance. WP4: The modified system will be taken to Cardiff s bi-plane x-ray biomechanics laboratory to validate CAT&MAUS s static and dynamic accuracy in a 50-patient cohort. WP5: Methods for full 3D-visualisation of the relative motion of the patella and femur during movement will be developed to include universal data export. PPI: The perspective of people living with these knee problems shaped the proposed design, conduct, and reporting of this project. Our patient involvement group will directly engage with the stakeholder working group and steering committee. This activity will ensure CAT&MAUS is suitable and accessible for all patients, and of maximal help to specialist and non-specialist health professionals. IMPACT & DISSEMINATION: CAT&MAUS has the potential to transform orthopaedic care for patellofemoral and many other joint problems. We will engage stakeholders throughout the project and aim to rapidly advance access to this technology alongside wide dissemination of the benefits.
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