ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Unworn cartilage in total knee arthroplasty strongly deviates from 2 mm: MRI, robotic-assisted and ruler assessment.
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 5 papers.
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Who cites it
5 citing papers in PubMed.
- Removing cartilage in the "unworn" side increases the accuracy in restoring the distal joint line in kinematic alignment total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
- Influence of Cartilage on Femoral Component Rotation in Robotic-Assisted Total Knee Arthroplasty: A Model-Based Quantitative Analysis and Clinical Data Evaluation.Orthopaedic surgery · 2025Article
- Posterior condylar cartilage thickness determines accuracy of femoral component rotation during total knee arthroplasty in valgus knees: Comparison with varus knees.Journal of experimental orthopaedics · 2025Article
- Inverse Kinematic Alignment in Robot-Assisted Total Knee Arthroplasty: A Simplified Surgical Technique.Arthroplasty today · 2025Article
- Unworn cartilage in total knee arthroplasty strongly deviates from 2 mm: MRI, robotic-assisted and ruler assessment.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
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Abstract
backgroundKinematic alignment (KA) in total knee arthroplasty (TKA) aims to resurface the articular surface of the pre-arthritic knee. One cornerstone of KA TKA and the basis for conventional instrumentation (CI) is a 2 mm cartilage thickness of the healthy distal femur. This study of image-based (CT) robotic-assisted surgery (RAS) TKA determined (1) the difference in measuring cartilage thickness using preoperative MRI, the RAS registration probe and MRI and (2) the percentage of knees with a <1.5 or >2.5 mm thickness of the unworn cartilage.
methodsForty-two patients undergoing a TKA using an image-based RAS were included. Preoperative long-leg radiographs provided the limb phenotype. The two zones of interest for cartilage thickness were the distal unworn (DU) and posterior unworn (PU) condyle. The preoperative MRI provided cartilage thickness values for both zones. Intraoperatively, the surgeon identified the zones without cartilage wear (healthy cartilage) and measured the distance between the cartilage and bone with the RAS registration probe. After resecting the condyles, a ruler was provided to measure the cartilage thickness reference.
resultsMean patient age was 68.2 ± 4.1 years, and gender was evenly distributed. According to the phenotype classification, there were 8 NEU
conclusionThere is a significant variation of unworn cartilage thickness from the assumed 2 mm, with a significant proportion (up to 67.7%) having >2.5 or <1.5 mm. If KA is applied, additional preoperative or intraoperative measurements might provide valuable information to avoid the risk of femoral component malposition. LEVEL OF EVIDENCE: Level II, diagnostic study.
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