SPUR 2021: Quantitative Modeling to Evaluate Ankle Osteoarthritis Morphology


Clinical evaluation of end-stage ankle osteoarthritis (OA) is primarily derived from 2D conventional x-rays. To improve on current medical imaging and interpretation new emerging weightbearing CT technology, a computational study is proposed to characterize ankle joint complex disease by quantifying 3D anatomical variation through statistical shape modeling of patients with ankle OA. The proposed research is relevant to public health because patients with end-stage ankle osteoarthritis are in general 10 to 15 years younger than patients suffering of knee or hip OA, making the likelihood of patients outliving current surgical treatment options a challenging clinical problem. Our lab's contribution here is expected to be a 3D computational study to characterize ankle joint complex osteoarthritis by quantifying anatomical shape variation through Statistical Shape Modeling of the tibiotalar and subtalar joints. This new and substantially different approach to computationally evaluate ankle morphometrics is expected to allow us to overcome the current limitations of clinical radiographic evaluation of ankle joint complex osteoarthritis, thereby opening new horizons for more quantifiable methods to aid in treatment planning for patients with end-stage ankle OA.

Student Role

Dr. Lenz is a Research Instructor in the Department of Orthopaedics. She is an expert in foot and ankle medical imaging and computational modeling. The undergraduate student on this project will be mentored directly by Dr. Lenz and work closely with the members of the Orthopaedic Research Laboratory Lenz Research Group. The undergraduate will be part of each portion of this study, from collection of weightbearing CTs with patients in our University Orthopaedic Center, to learning methods in image processing, to working with Dr. Lenz's graduate student to develop and interpret statistical shape models of the arthritic ankle joint. The student will be responsible for segmenting all weight-bearing CT images to create 3D reconstructions for input to statistical shape modeling. The student will be encouraged to perform a literature review at the beginning of the summer to understand the scope, relevance and clinical motivation for the research to be completed. In Dr. Lenz's lab, undergraduate students have an excellent history of earning co-authorship on published manuscripts. Therefore, discussions and expectations for consideration as a co-author will be clearly outlined at the beginning of the summer semester. COVID permitting, students in Dr. Lenz's lab are also typically given the opportunity to shadow surgeons in the OR, clinic and participate in research meetings with the foot and ankle surgeon collaborators. Overall, it is Dr. Lenz's goal to provide a comprehensive research experience by providing many learning opportunities while setting tangible goals to complete the proposed research.

Student Learning Outcomes & Benefits

At the completion of the SPUR program, the student will have a comprehensive experience of conducting foot and ankle orthopaedic biomechanics research with a focus on morphology of patients with ankle OA. Students seeking a future career as an engineering graduate student (biomedical or mechanical) or professional clinical degree (MD, DO, PA, or PT) will gain valuable experiences to prepare them for the next step in their professional and academic careers. As previously mentioned, co-authorship on the project will be considered and clear expectations will be outlined. Furthermore, students wishing to pursue any of the above mentioned post-undergraduate career options will have resources and colleagues in the department to discuss options and seek additional mentorship from outside of the immediate Lenz Research Group.

Remote Contingency Plan

I am currently well set up to continue with the proposed research, regardless of whether students are allowed to travel to campus to conduct research. All students in my lab are currently working remotely and have been since March 2020. To enable the success and productivity of all of my students, I provide a lab desktop computer with all the needed software programs and computing power to conduct meaningful research remotely. For example, this past May a student from outside of the University of Utah system started working with me remotely. I shipped a desktop and monitor to her in order to ensure she was well set up to conduct the outlined research we discussed. She has been incredibly productive and we just submitted a manuscript this month on her research started in May. While her research internship was initially intended to end at the completion of summer semester, she has chosen to continue working with me because of her excitement for the research and successful experience with working remotely. The only exception of the complete research experience was that I personally conducted the medical imaging at the university and then sent the de-identified files to her to complete all the next steps in the research project. All of my students meet with me regularly over Zoom and additionally meet with my surgeon collaborators to continue with ongoing research in a meaningful manner. We aim to remain productive and connected despite the challenging times and unprecedented work environment.

Amy Lenz
Research instructor,
OUR certified mentor

School of Medicine

My goals as a research faculty are to: 1) create insightful curiosity for orthopaedic biomechanics research through my style of mentorship, 2) help students develop their own way to arrive at successful research accomplishments, 3) inspire students to push through the difficult frustrations of research and continue to ask manageable research questions. I am a nurturing mentor that does not want to micromanage but let creative exploration of research occur while providing clear expectations. As a mentor, I strive to pick up on the soft signs and body language when students are lost. I always encourage students to feel comfortable asking questions and highlight that all questions are excellent. I have a "Lenz Lab" slack account in which I encourage frequent networking within our research group (aka asking other students in the lab questions, as well as reaching out directly to me). We have weekly lab meetings, so that all students are aware of what other students are working on. This promotes collaborative work, sharing of knowledge and helpful troubleshooting.