Evidence map›Paper›PMID 40053918›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025

Image-based robotic total knee arthroplasty preserves the knee joint line level even in advanced fixed flexion deformities when combined with functional alignment principles: A retrospective comparative cohort study.

Giacomo Pacchiarotti, Alessandro Todesca, George Mihai Avram, Giovanni Longo, Domenico Paolicelli, Stefano Gumina

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
  5. Review
  6. Reduced spinopelvic mobility does not correlate with knee flexion deformity in patients undergoing total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026
    Article
  7. Review
  8. Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025
    Observational
  9. Article
  10. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Giacomo PacchiarottiDepartment of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy.ORCID https://orcid.org/0000-0001-9718-8027
Alessandro TodescaIstituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy.
George Mihai AvramDepartment of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland.
Giovanni LongoDepartment of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy.
Domenico PaolicelliDepartment of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy.
Stefano GuminaDepartment of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeFixed flexion deformity (FFD) is traditionally addressed in total knee arthroplasty (TKA) with extensive soft tissue release and distal femoral recut, which increases bone stock consumption and raises the knee joint line (JL). This study aimed to evaluate differences in the anatomical restoration of the JL and bone stock preservation between FFD knees and a control group during robotic-assisted (RA) TKA combined with functional alignment (FA).

methodsA retrospective comparative cohort study examined 120 knees undergoing RA TKA. The knees were categorised into two groups: the study group, with FFD > 5°, and the control group, without FFD. Further analysis stratified the study group based on the severity of the deformity: mild (5-9°), intermediate (10-14°) and advanced (>15°). The Mann-Whitney U test was utilised to investigate the differences between the control and study groups.

resultsThe study group comprised 64 knees, presenting an average flexion contracture and range of motion (ROM) of 11.3 ± 4.7° and 112.7 ± 11.6°, respectively. The control group comprised 56 knees, with an extension deficit and ROM of 1.6 ± 2.1° and 123.5 ± 8.3°, respectively. The JL was proximally displaced on average by 0.1 ± 1.2 mm in the study group and lowered by 0.7 ± 0.9 mm in the control group. Analysis of JL in the subgroups showed a lowering of 0.3 ± 1.2 mm in the mild deformity subgroup and a rise of 0.08 ± 1.3 mm and 0.8 ± 0.8 mm in the intermediate and advanced FFD subgroups, respectively, showing no statistical significance. The combined thickness of tibial proximal and femoral distal bone cuts measured 12.3 ± 1.6 mm in the study group and 11.4 ± 1.4 mm in the control group.

conclusionsFA in RA-assisted TKA can correct FFD, minimising bone cuts while preserving anatomical JL level. LEVEL OF EVIDENCE: Level III.

Indexed as

Arthroplasty, Replacement, KneeKnee JointOsteoarthritis, KneeRobotic Surgical ProceduresAgedAged, 80 and overFemaleHumansMaleMiddle AgedRange of Motion, ArticularRetrospective Studiesfixed flexiondeformityfunctional alignmentimage‐basedknee joint linerobotic‐assisted surgerytotal knee arthroplasty

Identifiers

PMID40053918
PMCPMC12205415

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Registered trials

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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.