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2025 ; 6
(9
): 1044-1052
Nephropedia Template TP
gab.com Text
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English Wikipedia
How reliable are surgeons at assessing soft-tissue laxities in robotic
arm-assisted total knee arthroplasty? : a prospective, multicentre
surgeon-blinded study
#MMPMID40907974
Corbett JA
; Chen DB
; Gallie P
; Leong A
; Mulford JS
; Penn D
; Wood JA
; MacDessi SJ
Bone Jt Open
2025[Sep]; 6
(9
): 1044-1052
PMID40907974
show ga
AIMS: Regardless of one's alignment philosophy and belief in ligament releases,
the precise estimation of soft-tissue laxities is crucial in total knee
arthroplasty (TKA). This study prospectively assessed the reliability of
surgeons' and assistants' measurements of ligament tension during robotic
arm-assisted TKA. METHODS: A prospective, surgeon-blinded study was performed in
123 patients undergoing TKA by six surgeon/assistant pairs. Ligament tensions
were captured using manual stress and instrumented distraction techniques for
four gaps: medial extension, lateral extension, medial flexion, and lateral
flexion. Assessors were blinded during gap measurements. The primary outcome was
intrarater and inter-rater reliability using intraclass correlation coefficients
(ICCs). Secondary outcomes were the reliability of manual compared with
instrumented distraction measures and comparison of planned pre-resection virtual
gaps against actual post-implantation laxities. RESULTS: The intrarater mean ICC
for surgeons' measurements of gap laxities was 0.95 (0.90 to 0.97) and 0.94 (0.91
to 0.96) for assistants' measurements. These results indicate excellent
reliability for all four gaps for both surgeons and assistants. For inter-rater
reliability, both extension gaps returned an ICC > 0.90, indicating excellent
reliability between surgeons and assistants. Lateral flexion ICC was 0.75 and
medial flexion 0.86, indicating good reliability. Comparing manual with
instrumented distraction techniques, the mean ICC was 0.72, indicating moderate
reliability (0.55 to 0.88). The mean difference between planned and final gap
measures was 0.5 mm (-1.5 to 3.0, SD 0.71). CONCLUSION: Surgeons' ability to
assess knee laxities using manual stressing during robotic arm-assisted TKA has
excellent intrarater and good-to-excellent inter-rater reliability. Distraction
values for the medial side were more reliable than the lateral side, where
constitutional laxity and the technical challenge of assessment may increase
variability. High reliability of manual stressed gap assessment in robotic
arm-assisted TKA should give surgeons confidence in using this information for
measuring and achieving soft-tissue balance.