The use of virtual reality to assess the bony landmarks at the knee joint - The role of imaging modality and the assessor's experience.

Background: At present, extended reality technologies such as virtual reality (VR) have gained popularity in orthopedic surgery. The first aim of this study was to assess the precision of VR and other imaging modalities - computed tomography (CT), magnetic resonance imaging (MRI) - to localize bony landmarks near the knee joint. Secondly, the impact of the educational level of the assessor - medical master students, orthopedic residents, and orthopedic surgeons - on the precision with which landmarks near the knee joint could be localized was analyzed.

A robotic-assisted simulation of kinematic alignment in TKA leads to excessive valgus and internal rotation in valgus knees.

Purpose: Strategies to further improve patient satisfaction after total knee arthroplasty include the introduction of new alignment philosophies and more precise instruments such as navigation and robotics. The aim of this study was to investigate the effect of a combination of image-based robotic assistance and the use of modern alignment strategies on the resulting joint line obliquity as well as femoral component rotation and to compare this between varus, neutral and valgus knees.

Methods: This retrospective study included 200 patients who received a robotic-assisted total knee arthroplasty (MAKO, Stryker) using functional alignment between 2018 and 2020.

Knee kinematics during staircase descent.

The goal was to evaluate tibiofemoral knee joint kinematics during stair descent, by simulating the full stair descent motion in vitro. The knee joint kinematics were evaluated for two types of knee implants: bi-cruciate retaining and bi-cruciate stabilized. It was hypothesized that the bi-cruciate retaining implant better approximates native kinematics.

The Definition of the Tibial Sagittal Plane and the Paradox of Imageless Navigation and Robotics: A Cadaveric Study.

Background: The accuracy, precision, and repeatability by which the tibial sagittal plane can be found with imageless technology is currently unknown. The purpose of this study was to identify any differences between imageless and image-based technology to define the sagittal plane of the tibia.

Methods: A computed tomography (CT) was obtained of 18 cadavers with the knee fully extended.

Effect of iliotibial band and gastrocnemius activation on knee kinematics.

Background: This paper aimed to evaluate the effects of iliotibial band (ITB) activation and gastrocnemius activation on knee kinematics and stability. A quantitative analysis needs to determine the effect of ITB and gastrocnemius activation in each of the six degrees of freedom of the knee joint.

Methods: Four cadaveric knee specimens were tested during squat motions with physiological loads.

Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy.

Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate.

The learning curve of imageless robot-assisted total knee arthroplasty with standardised laxity testing requires the completion of nine cases, but does not reach time neutrality compared to conventional surgery.

Purpose: The assistance of robot technology is introduced into the operating theatre to improve the precision of a total knee arthroplasty. However, as with all new technology, new technology requires a learning curve to reach adequate proficiency. The primary aim of this study was to identify the learning curve of an imageless robotic system with standardised laxity testing.

Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients.

Introduction: Robotically assisted surgery was introduced in total knee arthroplasty (TKA) to increase the precision of implant positioning and optimize clinical outcomes. However, the target implant position or alignment is debated. The aim of this study was twofold: to compare clinical outcomes of conventional TKA vs.

The evolution of robotic systems for total knee arthroplasty, each system must be assessed for its own value: a systematic review of clinical evidence and meta-analysis.

Introduction: Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated.

Accuracy of intraoperative bone registration and stereotactic boundary reconstruction during total knee arthroplasty surgery.

Background: The intraoperative registration of the bones play a crucial role in image-based computer-assisted knee arthroplasty to achieve accurate implant placement and to create reliable stereotactic bone boundaries for robot-assisted surgical systems.

Method: This study assessed the intraoperative registration accuracy on six intact fresh frozen cadavers.

Results: Rotational errors around the mechanical axis were the largest, with a standard deviation of 1.

Which Fracture Types Are Associated with Widening of the Scapholunate Distance? A CT-Scan Study of Acute Intraarticular Distal Radius Fractures.

Scapholunate injuries in distal radius fractures may frequently be overlooked. The aims of this study were to measure the scapholunate distance in intraarticular distal radius fractures and to find out which fracture types were associated with an increased scapholunate width. Measurements of the scapholunate distance were performed on computed tomography scans of 143 intraarticular distal radius fractures in 140 patients.

Equal bony resection of distal and posterior femur will lead to flexion/extension gap inequality in robot-assisted cruciate-retaining TKA.

Purpose: Joint imbalance has become one of the main reasons for early revision after total knee arthroplasty (TKA) and it is directly related to the surgical technique. Therefore, a better understanding of how much bone has to be removed to obtain a balanced flexion/extension gap could improve current practice. The primary objective of this study was to analyse the amount of bone that needed to be removed from the distal and posterior femoral joint surfaces to obtain an equal flexion/extension gap in robot-assisted TKA.

Custom TKA: what to expect and where do we stand today?

Introduction: The concept of custom total knee arthroplasty (TKA) is explored with specific attention to current limitations. Arguments in favor of custom TKA are the anatomic and functional variability we encounter in our patients. The biggest conceptual challenge is to marry the need for correction of deformity with the ambition to stay as close as possible to original anatomy.

Biceps Femoris Compensates for Semitendinosus After Anterior Cruciate Ligament Reconstruction With a Hamstring Autograft: A Muscle Functional Magnetic Resonance Imaging Study in Male Soccer Players.

Background: Rates of reinjury, return to play (RTP) at the preinjury level, and hamstring strain injuries in male soccer players after anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, due to multifactorial causes. Recent insights on intramuscular hamstring coordination revealed the semitendinosus (ST) to be of crucial importance for hamstring functioning, especially during heavy eccentric hamstring loading. Scientific evidence on the consequences of ST tendon harvest for ACLR is scarce and inconsistent.

Can robot-assisted total knee arthroplasty be a cost-effective procedure? A Markov decision analysis.

Background: Total knee arthroplasty (TKA) is a frequently and increasingly performed surgery in the treatment of disabling knee osteoarthritis. The rising number of procedures and related revisions pose an increasing economic burden on health care systems. In an attempt to lower the revision rate due to component malalignment and soft tissue imbalance in TKA, robotic assistance (RA) has been introduced in the operating theatre.

Three-dimensional correction of fibular hemimelia using a computer-assisted planning : technical report and literature review.

The purpose of this survey in Belgium and the Netherlands was to assess treatment variation in glenohumeral osteoarthritis between experienced and less experienced orthopedic surgeons, and to investigate perioperative treatment after shoulder arthroplasty in a large group of orthopedic surgeons. Orthopedic surgeons specialized in shoulder surgery were invited to complete a survey between November 2013 and February 2015. Seventy-one percent of the approached surgeons com-pleted the survey.

Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing.

Purpose: The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA.

Positioning of longest axis of the radial head in neutral forearm rotation.

Introduction: The radial head has an ellipsoid shape so that a longest and a shortest axis can be defined. The aim of this study is to evaluate the position of the longest axis of the radial head (LARH) in relation to proximal radioulnar joint (PRUJ) and to the forearm in neutral position using 3D computed tomography (CT).

Materials And Methods: 3D CT reconstructions of the distal humerus, the radius and the ulna of 27 healthy volunteers (average age 27.

Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty.

Aims: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level.

How should we evaluate robotics in the operating theatre?

The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking.

Knee joint laxity is restored in a bi-cruciate retaining TKA-design.

Purpose: The goal is to evaluate the passive stability of a bicruciate retaining, cruciate retaining and bicruciate substituting TKA design in relation to the native knee stability in terms of the laxity envelope. A bicruciate retaining knee prosthesis was hypothesized to offer a closer to normal knee stability in vitro.

Methods: Fourteen cadaveric knee specimens have been tested under passive conditions with and without external loads, involving a varus/valgus and an external/internal rotational torque, distraction/compression force and an anteroposterior shear force.

Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT.

Background:: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques.

Methods:: Eighteen patients with a unilateral syndesmotic lesion were included.

Effect of three consecutive meals on the physicochemical properties of HDL and LDL in individuals with the metabolic syndrome and patients with type 2 diabetes.

Background/objectives: Postprandial hyperlipidemia, which is exaggerated and prolonged in insulin-resistant individuals, has been associated with cardiovascular disease. The objective of this study was to investigate whether and how the composition, size and function of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles are affected in the postprandial state among males with the metabolic syndrome (MetS) or type 2 diabetes (T2DM), compared with controls.

Subjects/methods: A total of 14 males with T2DM, 14 with the MetS and 14 age-matched controls were given three standardized high-fat mixed meals (900 kcal; 50-g fat, 75-g carbohydrate and 35-g protein) as breakfast, lunch and dinner.

Myeloperoxidase concentrations in EDTA-plasma of healthy subjects are discordant with concentrations in heparin-plasma and serum.

Objectives: To examine the effect of blood anticoagulation type on the myeloperoxidase (MPO) concentration.

Design And Methods: MPO was measured in EDTA-plasma and matched heparin-plasma and serum samples collected from healthy volunteers.

Results: MPO concentrations in heparin-plasma and serum were higher than in EDTA-plasma (both P<0.