15th International Conference on Bioinformatics &
Bioengineering (BIBE)
Nov-02-04, 2015, Belgrade, Serbia
A TWO-LEVEL COMPETITIVE FUZZY
COGNITIVE MAP FOR MODELLING
SOFT
TISSUE KNEE INJURIES
PhD Candidate Antigoni P. Anninou
Laboratory for Automation and Robotics
Department of Electrical and Computer Engineering
University of Patras
Authors
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Anninou P. Antigoni, Ph.D Candidate, Laboratory of Automation
and Robotics, Department of Electrical and Computer
Engineering, University of Patras
Groumpos P. Peter, Professor, Laboratory of Automation and
Robotics, Department of Electrical and Computer Engineering,
University of Patras
Gkliatis Ioannis, Assistant Professor, Orthopaedic Clinic,
Department of Medicine, University of Patras, Greece
Poulios Panagiotis, Orthopaedic Clinic, Department of
Medicine, University of Patras,Greece
Layout
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Aim
Soft Tissue Knee Injuries
Fuzzy Cognitive Maps
Competitive Fuzzy Cognitive Maps
Modelling Knee Injuries
Case Studies
Conclusions
Future Research
3
Aim

Propose a novel approach of modelling soft tissue
knee injuries using a two-level Competitive Fuzzy
Cognitive Map
Soft Tissue Knee Injury
Most
common
and
clinically
challenging
musculoskeletal disorder met in the emergency
department

Problem:
 Many
and complex parameters
 Impossible an accurate diagnosis
Solution


A modeling tool that can handle all these challenges
and at the same time be able to infer a decision
A special type of Fuzzy Cognitive Maps has been
introduced for Medical Diagnosis systems, with
advanced capabilities, the Competitive Fuzzy
Cognitive Map (CFCM)
6
Fuzzy Cognitive Maps (FCM)
Modeling method for describing
particular domains
 Fyzzy-graph
structures
for
representing causal reasoning

Fuzzy Cognitive Maps

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Nodes: Represent the
concepts or variables
system’s
Arrows: Interconnection between
nodes. Show the cause-effect
relationship between them.
W: Weight between two nodes:

W>0 positive causality

W<0 negative causality

W=0 no relationship
8
Fuzzy Cognitive Maps

The value of each concept at every simulation step is
calculated, computing the influence of the
interconnected concepts to the specific concept, by
applying the following calculation rule:
Fuzzy Cognitive Maps

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Ai(k+1) : the value of the concept Ci at the iteration step k+1
Ai(k): the value of the concept Cj at the iteration step k
Wij : the weight of interconnection from concept Ci to concept Cj
k1: the influence of the interconnected concepts in the
configuration of the new value of the concept Ai
k2: the proportion of the contribution of the previous value of
the concept in the computation of the new value
f : the sigmoid function
Competitive Fuzzy Cognitive Maps
(CFCM)
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The output nodes of a FCM used in decisionmaking, in many cases, must "compete" against
each other in order for only one of them to
dominate and be considered the correct decision
In order to achieve this "competition", the
interaction of each of these nodes with the others
should have a very high negative weight. This
implies that the higher the value of a given node,
the lower the value of competing nodes
11
Modelling Knee Injuries Using CFCM
Two-Level CFCM
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Mechanisms of injury:
The manner in which a
physical injury
occurred
Clinical Tests: Clinical
examination results –
Confirm a diagnosis
Possible Mechanisms of Injury
Possible Symptoms
All Possible Diagnoses
CFCM Model of Mechanisms of Injury
and Diagnoses
CFCM Model of Symptoms and
Diagnoses
1st Case

A 22 year old male, victim of traffic road accident with
motorcycle, recalls landing on his right leg with the knee
flexed, in valgus moment, unable to ambulate after injury with
sense of instability
Mechanism of injury: M7
(Flexion, valgus and external
rotation)
Symptoms: C1 (acute effusion), C4 (effusion
generalized), C5 (extension lag), C6 (flexion
contracture), C7 (knee joint unstable in
extension), C8 (knee joint unstable in
flexion), C12 (tenderness), C13 (unable to
bear weight joint), C14 (sense of instability).
1st Case-1st Level
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D1 (Meniscus Injury):
0.38
D2 (ACL Injury): 0.44
D3 (PCL Injury): 0.15
D4 (MCL/PMCC Injury) :
0.44
D5 (LCL): 0.15
D6 (PLCC Injury): 0.21
D7 (Patella
Dislocation/Extensor
Apparatus Injury): 0.15
1st Case-2nd Level
Diagnoses:
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ACL injury (D2)  0.9
Medial Collateral
Ligament(D4)  0.95
Lateral Collateral Ligament
(D5)  0.95
Posterior Lateral Complex
(D6)  0.83
Patella Dislocation (D7) 
0.95
Clinical Tests - Diagnoses
1st Case – Final Diagnoses
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Positive Clinical Tests: T5, T13, T14, T15, T17, T18
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Possible Diagnoses based on tests: D2, D3, D5, D6
Diagnoses from CFCM
Model: D2, D4, D5,
D6, D7
Final Diagnoses:
• ACL injury D2,
• Lateral Collateral
Ligament D5,
• Posterior Lateral
Complex D6
2nd Case
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A 34 year old man, during a martial art session, heard a
”pop” and he had a pivoting moment with foot planted on
mat, he was unable to ambulate after injury and had a sense
of instability
Mechanism of injury: M7
(Flexion, valgus and external
rotation)
Symptoms: C1 (acute effusion), C4 (effusion
generalized), C5 (extension lag), C6 (flexion
contracture), C7 (knee joint unstable in
extension), C13 (unable to bear weight
joint), C14 (sense of instability), C15
(”Poping” Sound during Injury)
2nd Case-2nd Level
Diagnoses:
 Meniscus Injury (D1) 
0.85
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ACL injury (D2)  0.97
Patella Dislocation (D7)
 0.96
2nd Case – Final Diagnoses
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Positive Clinical Tests: T5, T7, T11
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Possible Diagnoses based on tests: D2, D3, D4, D6
Diagnoses from CFCM
Model: D1, D2, D7
Final Diagnoses:
• ACL injury D2
3rd Case
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A 20 year old woman suffered forced valgus injury of knee
during a tackling maneuver in Mixed Martial Arts (MMA)
match. She couldn’t bear weight, heard a ”pop”, with acute
effusion of the knee joint, and had a sense of instability
Mechanism of injury: M5
(Flexion, valgus and external
rotation)
Symptoms: C1 (acute effusion), C4 (effusion
generalized), C5 (extension lag), C13
(unable to bear weight joint), C14 (sense of
instability), C15 (”Poping” Sound during
Injury)
3rd Case – 1st Level
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D1 (Meniscus Injury): 0.39
D2 (ACL Injury): 0.34
D3 (PCL Injury): 0.29
D4 (MCL/PMCC Injury) :
0.41
D5 (LCL): 0.16
D6 (PLCC Injury): 0.18
D7 (Patella
Dislocation/Extensor
Apparatus Injury): 0.16
3rd Case – 2nd Level
Diagnoses:
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Meniscus Injury (D1)  0.86
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ACL injury (D2)  0.81
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Medial Collateral
Ligament(D4)  0.84
Patella Dislocation (D7) 
0.91
3st Case – Final Diagnoses
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Positive Clinical Tests: T2, T5, T6, T7, T11
Possible Diagnoses based on tests: D1, D2, D3, D4,
D6
Diagnoses from CFCM
Model: D1, D2, D4, D7
Final Diagnoses:
• Meniscus Injury D1
• ACL injury D2,
• MCL/PMCC Injury
D4
Conclusions

A new CFCM model for knee injuries
 Simple
 Real-time
 Fast
 Reliable

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Satisfactory results for three real cases
Helps physicians for a first and accurate diagnosis
without having to use modern imaging techniques
(MRI) in every single patient
Future Research

A more comprehensive CFCM model for knee
injuries

Clinical use in real-time medical diagnosis
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New simulations with more clinical data
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Use the CFCM model in other medical problems
Thank you for your attention
Antigoni P. Anninou
Email: [email protected]
Peter P. Groumpos
Email: [email protected]
Ioannis Gkliatis
Email: [email protected]
Panagiotis Poulios
Email: [email protected]