ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Joint gap produced by manual stress is dependent on the surgeon's experience and is smaller in flexion in robotic-assisted total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 15 citations in OpenAlex.
- Standardized Intraoperative Robotic Laxity Assessment in TKA Leads to No Clinically Important Improvements at 2 Years Postoperatively: A Randomized Controlled Trial.Clinical orthopaedics and related research · 2025Trial
- Smaller medial component gaps at deep flexion are associated with better patient-reported outcomes after robotic-assisted cruciate-retaining total knee arthroplasty using an anatomically designed implant.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Predictive pre-resection robotic ligament balancing in total knee arthroplasty is accurate across surgeons and patient factors.Journal of robotic surgery · 2026Article
- Is it time for a systematic and objective assessment of knee laxity? The impact of objective knee laxity after TKA on patient-reported outcomes: a comprehensive review.Archives of orthopaedic and trauma surgery · 2026Review
- Inter- and Intra-Rater Reliability of Pre-Resection Ligament Tension Assessment Using a Digital Tensioner in Imageless Robotic-Assisted Total Knee Replacement.Orthopaedic surgery · 2026Article
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- How reliable are surgeons at assessing soft-tissue laxities in robotic arm-assisted total knee arthroplasty? : a prospective, multicentre surgeon-blinded study.Bone & joint open · 2025Article
- Discrepancy between predicted and actual soft tissue balance in robot-assisted total knee arthroplasty.Journal of orthopaedics · 2025Article
- Robotic evaluation of articular laxity (REAL) classification: a new intraoperative knee soft-tissue laxity classification using ROSA robotic software.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Functional preoperative assessment of coronal knee laxity better predicts postoperative patient outcomes than intraoperative surgeon-defined laxity in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Current developments in robotic assistance technology for total knee arthroplasty: a comprehensive overview.Journal of orthopaedic surgery and research · 2025Review
- Reliability of pre-resection ligament tension assessment in imageless robotic assisted total knee replacement.Arthroplasty (London, England) · 2024Article
- Large angular correction of arithmetic coronal alignment is associated with residual lateral laxity after total knee arthroplasty in varus knees for Japanese patients.Journal of experimental orthopaedics · 2024Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThis study aimed to retrospectively investigate (1) the reproducibility of gap measurements by manual stress using the Z-shaped retractor depending on the surgeon's experience with this maneuver and (2) the consistency of the gap distraction force produced by manual stress throughout the range of motion (ROM) in the robotic-assisted total knee arthroplasty (TKA). It was hypothesized that the joint gap produced by manual stress is not reproducible depending on the surgeon's experience, and the distraction force applied by manual stress throughout the ROM is not constant.
methodsMedial and lateral joint gaps were obtained throughout the ROM by manual stress or a tensioner by two surgeons with different levels of experience in robotic-assisted TKA. The association between the differences in gap measurement by the two surgeons and the preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle and absolute and relative varus/valgus laxities were analyzed.
resultsThe experienced surgeon produced significantly greater gaps than the inexperienced surgeon from 0° to 100° flexion, with a mean difference of 0.35 ± 0.12 mm in the medial gap (p < 0.0001), and from 10° to 120° flexion with a mean difference of 0.57 ± 0.13 mm in the lateral gap (p < 0.0001). The tensioner produced a significantly greater medial gap from 70° to 110° flexion with a mean difference of 0.32 ± 0.01 mm in the medial gap (p < 0.0001) and from 0° to 110° flexion with a mean difference of 1.12 ± 0.26 mm in the lateral gap (p < 0.0001). The differences in gap distance by manual stress between experienced and inexperienced surgeons were moderately correlated with the HKA angle in the lateral gap (r = 0.40, p = 0.01). The gap differences due to manual stress and a tensioner showed moderate negative correlation with the HKA angle in the medial gap (r = - 0.50, p = 0.001) and weak negative correlation with the absolute valgus laxity in the lateral gap (r = - 0.35, p = 0.03).
conclusionsThe joint distraction force by manual stress may differ depending on the surgeon's experience and tended to be smaller in deep flexion; therefore, the flexion gap may be underestimated. Surgeons should determine implant positioning considering gap balance by manual stress, taking into account these characteristics of the manual stress maneuver. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.