ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Patellofemoral alignment safe zones in robotic-assisted total knee arthroplasty do not affect outcomes but do influence patellar resurfacing rates.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Functional alignment in robotic total knee arthroplasty provides favourable outcomes and minimal early revisions: A systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Pooled it
- Surgical approach and insert constraint are associated with small differences in patellar tilt after robotic-assisted total knee arthroplasty: A retrospective comparative radiographic study.Journal of experimental orthopaedics · 2026Article
- Magnitude of intraoperative femoral rotational adjustment from the initial plan is associated with slower early recovery after robotic-assisted functional-alignment TKA.Journal of robotic surgery · 2026Article
- Functional alignment: Defined personalized alignment strategy with promising outcomes and room for improvement.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- The three-pillar concept for functional knee positioning in robotic total knee arthroplasty.Journal of experimental orthopaedics · 2026Review
- Robot-assisted total knee arthroplasty is associated with reduced early anterior knee pain compared with conventional techniques : A propensity score-matched study.Orthopadie (Heidelberg, Germany) · 2026Article
- Retropatellar resurfacing in primary total knee arthroplasty does not improve clinical outcomes but increases revision rates.Archives of orthopaedic and trauma surgery · 2026Observational
- Article
- Patellofemoral alignment safe zones in robotic-assisted total knee arthroplasty do not affect outcomes but do influence patellar resurfacing rates.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
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7 authors.
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Abstract
purposeAnterior compartment management remains a challenging aspect of total knee arthroplasty (TKA), particularly in personalised alignment strategies. This study aimed to assess whether restoring patellofemoral alignment parameters within predefined safe zones-specifically patellar tilt (PTi), patellar translation (PTr) and patellar offset (PO)-is associated with improved clinical outcomes following robotic-assisted TKA (rTKA).
methodsThis retrospective study included 283 patients who underwent primary rTKA between March 2021 and January 2023 using functional alignment (FA) or functional knee positioning (FKP) principles. All surgeries were performed using a CT-based robotic system (Mako, Stryker). Patients were stratified into groups based on radiographic values of PTi, PTr and ΔPO, using thresholds derived from prior robotic studies to define safe zones. Clinical outcomes at a mean follow-up of 2.8 ± 0.8 years included Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS).
resultsThere were no statistically significant differences in final KSS, FJS-12 or AKPS between groups within or outside the safe zones for PTi, PTr or ΔPO. However, patients with PTi < 0°, ΔPO > 0 mm (overstuffing) or PTr within ±2 mm showed significantly higher rates of patellar resurfacing (p < 0.001). No group demonstrated superior clinical outcomes across the three parameters studied.
conclusionRestoring patellofemoral alignment parameters within predefined safe zones was not associated with improved short-term clinical outcomes in rTKA. Robotic-assisted FA provides accurate restoration of the anterior compartment, reducing reliance on patellar resurfacing in eligible patients. Our data suggest that target biomechanical parameters can potentially be achieved without resurfacing in cases where it is not indicated. Our hypothesis that patients within the proposed safe zones would demonstrate improved clinical outcomes was not supported by the current results. Further prospective studies are needed to determine whether femoral safe zones can predict long-term benefit. LEVEL OF EVIDENCE: Level II.
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