ArticleJournal of experimental orthopaedics2026
Flexion-dependent differences in tibial rotation measured by navigation and robotic systems during bicruciate-stabilised total knee arthroplasty.
Article in Journal of experimental orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Purpose: This study compared the intraoperative tibial rotational kinematics between navigation-assisted and robotic-assisted bicruciate-stabilised total knee arthroplasty (BCS-TKA). Although both systems can evaluate knee motion intraoperatively, it is unclear whether they provide comparable rotational measurements. We hypothesised that these systems would show different tibial rotation profiles, particularly in deep knee flexion. Methods: This retrospective cohort study included 238 knees that underwent BCS-TKA using an image-free navigation system (Precision N) or an image-free handheld robotic-assisted system (NAVIO or CORI). Tibial rotation relative to the femur was measured intraoperatively through 0° to 120° of knee flexion. Patient-reported outcomes were assessed using the 2011 Knee Society Score (KSS). Discrepancies in rotational display between the systems were evaluated by a preliminary bench test using a synthetic bone model. Groups were compared using the Kruskal-Wallis test followed by Dunn's post hoc test with Bonferroni correction. Results: Across all groups, BCS-TKA demonstrated a characteristic pattern of internal rotation in early flexion, slight external rotation in mid-flexion and progressive internal rotation towards deep flexion. At 120° of flexion, tibial internal rotation differed significantly among the three groups ( Conclusions: The robotic platform consistently indicated a more externally rotated tibial position compared to the navigation system, suggesting that the two systems apply different reference orientations for tibial rotation in deep knee flexion during BCS-TKA. Therefore, caution is warranted when comparing intraoperative kinematic data across measurement platforms. Level of Evidence: Level III, retrospective cohort study.
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