Diquattro Emanuele, Andriollo Luca, Koutserimpas Christos, Baltzer Jean, Servien Elvire, Batailler Cécile, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, Lyon, France.
SC Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 18. doi: 10.1002/ksa.12786.
Anterior 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).
This 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).
There 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.
Restoring 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 II.
前侧间室的处理仍然是全膝关节置换术（TKA）中具有挑战性的一个方面，尤其是在个性化对线策略中。本研究旨在评估在预定义的安全区内恢复髌股对线参数——特别是髌骨倾斜度（PTi）、髌骨平移（PTr）和髌骨偏移（PO）——是否与机器人辅助TKA（rTKA）后改善的临床结果相关。
这项回顾性研究纳入了283例在2021年3月至2023年1月期间采用功能对线（FA）或功能膝关节定位（FKP）原则接受初次rTKA的患者。所有手术均使用基于CT的机器人系统（Mako，史赛克）进行。根据PTi、PTr和ΔPO的影像学值将患者分层，使用先前机器人研究得出的阈值来定义安全区。平均随访2.8±0.8年时的临床结果包括膝关节协会评分（KSS）、遗忘关节评分 - 12（FJS - 12）和库贾拉前膝痛量表（AKPS）。
对于PTi、PTr或ΔPO，安全区内或安全区外的组在最终KSS、FJS - 12或AKPS方面没有统计学上的显著差异。然而，PTi < 0°、ΔPO > 0 mm（填充过多）或PTr在±2 mm范围内的患者髌骨表面置换率显著更高（p < 0.001）。在所研究的三个参数中，没有一组表现出更优的临床结果。
在预定义的安全区内恢复髌股对线参数与rTKA的短期临床结果改善无关。机器人辅助FA可准确恢复前侧间室，减少了对符合条件患者进行髌骨表面置换的依赖。我们的数据表明，在未表明需要进行表面置换的情况下，有可能在不进行表面置换的情况下实现目标生物力学参数。我们关于处于提议安全区内的患者将表现出改善的临床结果的假设未得到当前结果的支持。需要进一步的前瞻性研究来确定股骨安全区是否能预测长期益处。
二级。
