ArticleJB & JS open access
Manual Stress and Gap Spacer Systematically Underestimate Intraoperative Joint Gaps Compared with a Tensor Device in Robotic-Assisted Total Knee Arthroplasty.
Article in JB & JS open access. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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.
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.
Who cites it
1 citing paper in PubMed.
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Robotic-assisted total knee arthroplasty (TKA) enables precise bone resection based on intraoperative ligament balance. However, commonly used methods for assessing ligament balance-manual varus/valgus stress and gap spacers-may lack accuracy, potentially affecting surgical outcomes. This study compared intraoperative joint gap measurements among 3 techniques: manual stress, gap spacers, and a novel tensor device. Methods: This prospective cohort study included 59 varus knees that underwent robotic-assisted TKA with a primary prosthesis. Intraoperative joint gaps were digitally measured in both medial and lateral compartments at full extension and 90° flexion using 3 methods: manual stress, gap spacers, and a tensor device applying 120 N force. Measurements were repeated for reliability, and statistical comparisons were made using one-way analysis of variance. Intramethod reproducibility was assessed using intraclass correlation coefficients (ICCs). Results: Joint gaps measured using gap spacers were significantly smaller than those obtained with the tensor device (p < 0.05), particularly in flexion. Manual stress yielded intermediate values. The tensor device consistently produced the largest joint gaps. ICCs were >0.8 for all methods, indicating high reproducibility, with the tensor showing the highest consistency. However, manual and spacer methods systematically underestimated joint gaps despite their reproducibility. Conclusions: Manual stress and gap spacer techniques underestimate intraoperative joint gaps, potentially leading to unintended ligament laxity in robotic-assisted TKA. The tensor device provides more accurate and reproducible gap assessment, supporting its use for improved intraoperative decision making. Level of Evidence: Level II Prospective cohort study. See Instructions for Authors for a complete description of levels of evidence.
Identifiers
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Registered trials
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.