scholarly journals Comparison of Short-Term Biodex Results after Anatomic ACL Reconstruction Between Three Autografts

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015 ◽  
Author(s):  
Jonathan Daniel Hughes ◽  
Jeremy M. Burnham ◽  
Angela Hirsh ◽  
Volker Musahl ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Quadriceps Strength ◽  
Primary Objective ◽  
Return To Play ◽  
Short Term ◽  
Anatomic Acl Reconstruction ◽  
Quadriceps Weakness ◽  
Significant Difference ◽  
Hamstrings Tendon

Objectives: Recent literature has suggested residual quadriceps weakness up to 12 months after anterior cruciate ligament reconstruction (ACLR), especially with quadriceps tendon autograft. These studies, though, have not directly compared different autograft options. The primary objective of this study was to compare short-term quadriceps and hamstring muscle strength between individuals undergoing primary ACLR with quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), or hamstrings tendon (HS) autograft. The secondary objective was to assess how patients performed relative to common clinical strength thresholds used for return to activity decisions. We hypothesized that QT autografts would have poorer quadriceps strength symmetry at 5-8 months as compared to HS and BPTB, but there would be no significant difference at 9-15 months among all three groups. Methods: Patients who underwent anatomic primary ACLR with autograft at one institution from 2010-2015 were retrospectively reviewed. Isometric quadriceps and hamstrings strength measurements were routinely obtained between 5-8 months and 9-15 months postoperatively in these patients. To normalize strength outcomes between participants, we created a quadriceps (QI) and hamstring (HI) strength indices by expressing the ACLR limb strength as a percentage of the uninvolved limb strength. Values less than 100% indicated a strength deficit, while values greater than 100% indicated greater strength in the ACLR limb. Patients could be cleared to run if strength symmetry exceeded 80% and cleared to play if quadriceps strength symmetry exceeded 90%. Results: A total of 73 patients were identified with 5-8 month follow up, and 52 patients with 9-15 month data (Table 1). The QT group had significantly lower QI at 5-8 months (69.5 ± 17.4) as compared to the BPTB (82.8 ± 14.6, p = 0.01) and HS (86.0 ± 18.6, p < 0.01) groups. Similarly, the HS group demonstrated a significantly lower HI at 5-8 months (79.5 ± 14.6) compared to the BPTB group (98.0 ± 17.5, p < 0.01). However, there was no significant difference when compared to the QT group (88.4 ± 17.4, p = 0.06). At 5-8 months, more patients with HS autograft met criteria to return to run and play (84% and 26%, respectively) compared to QT (26% and 13%, respectively). In the 9-15 month analysis, the HS group had a significantly lower HI (84.2 ± 23.1) compared to the QT group (99.8 ± 20.1, p = 0.03), but no difference was noted when compared to the BPTB (99.6 ± 17.6, p = 0.08) group. There was no significant difference in quadriceps strength symmetry between the QT (83.3 ± 20.7), BPTB (97.0 ± 13.8), and HS (90.0 ± 17.5) groups at 9-15 months (p = 0.13). Additionally, there was no significant difference in percent of patients that met return to play and return to run thresholds between groups at 9-15 months. Conclusion: In conclusion, patients undergoing ACLR with QT demonstrated clinically meaningful quadriceps asymmetry, and patients reconstructed with HS had significant hamstring asymmetry at 5-8 months and 9-15 months postoperatively. Additionally, significantly fewer patients in the QT group met criteria to return to play and run at 5-8 months than the BPTB and HS groups. No significant difference was found at 9-15 months in regards to QI and return to play and run criteria between all three groups. These data suggest a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary due to residual quadriceps weakness after ACLR with QT. [Table: see text]

scholarly journals Comparison of Short-term Biodex Results After Anatomic Anterior Cruciate Ligament Reconstruction Among 3 Autografts

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984763 ◽  
Author(s):  
Jonathan D. Hughes ◽  
Jeremy M. Burnham ◽  
Angela Hirsh ◽  
Volker Musahl ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Quadriceps Weakness ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background: An individualized approach to anterior cruciate ligament reconstruction (ACLR) typically includes criteria-based postoperative rehabilitation. However, recent literature has suggested residual quadriceps weakness up to 12 months after ACLR, especially with a quadriceps tendon (QT) autograft. Hypothesis: The QT would have poorer quadriceps strength symmetry at 5 to 8 months compared with the hamstring tendon (HS) and patellar tendon (BPTB), but there would be no significant difference at 9 to 15 months among all 3 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent anatomic primary ACLR with an autograft were reviewed retrospectively. Isometric quadriceps and hamstring strength measurements were obtained clinically at 5 to 8 months and 9 to 15 months postoperatively. Return-to-running and return-to-play criteria included greater than 80% and 90% quadriceps strength symmetry, respectively. Results: A total of 73 patients with 5- to 8-month follow-up were identified, and 52 patients had 9- to 15-month data. The QT group had a significantly lower quadriceps index at 5 to 8 months (69.5 ± 17.4) compared with the BPTB (82.8 ± 14.6; P = .014) and the HS (86.0 ± 18.6; P = .001) groups. More patients with an BPTB autograft met criteria for return to running and return to play (60% and 47%, respectively) compared with the QT group (26% and 13%, respectively) at 5 to 8 months. Given the sample sizes available, we observed no significant difference in the quadriceps index and return-to-play and return-to-running criteria at 9 to 15 months among those undergoing ACLR with a QT, BPTB, or HS graft. Conclusion: Patients undergoing ACLR with a QT graft demonstrated clinically meaningful quadriceps asymmetry at 5 to 8 months and 9 to 15 months postoperatively. Additionally, fewer patients in the QT group met criteria for return to play and running at 5 to 8 months than the BPTB and HS groups. These data suggest that a longer time to return to play and specific rehabilitation protocols that emphasize quadriceps strengthening may be necessary because of residual quadriceps weakness after ACLR with a QT graft.

Confidence to Return to Play After ACL Reconstruction: An Evaluation of Quadriceps Strength Symmetry and Injury Mechanism in Male Athletes

2021 ◽  
pp. 194173812110438
Author(s):  
Rachel K. Straub ◽  
Francesco Della Villa ◽  
Bert Mandelbaum ◽  
Christopher M. Powers
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Return To Sport ◽  
Quadriceps Strength ◽  
Injury Mechanism ◽  
Return To Play ◽  
Negative Consequences ◽  
Male Athletes ◽  
The Relationship

Background: After anterior cruciate ligament reconstruction (ACLR), diminished quadriceps strength symmetry and reduced psychological readiness to return to play (RTP) increase the risk for subsequent injury. Although the relationship between quadriceps strength symmetry and psychological readiness to RTP has been reported to be influenced by injury mechanism in female athletes, it is unclear whether such a relationship exists in male athletes. Hypothesis: Quadriceps strength symmetry would be positively associated with greater psychological readiness to RTP after ACLR, regardless of injury mechanism. Study Design: Retrospective cohort. Level of Evidence: Level 3 (cohort study). Methods: Sixty male patients completed strength testing and the Injury-Psychological Readiness to Return to Sport Scale (I-PRRS) at an outpatient clinical facility as part of return to sport testing after ACLR. Linear regression analysis was used to assess the relationship between the I-PRRS and the independent variables of interest (quadriceps strength symmetry and injury mechanism). Results: For all patients combined, no symmetry × mechanism interaction was found ( P = 0.11). A significant positive relationship was found between quadriceps strength symmetry and the I-PRRS score ( P < 0.001, R2 = 0.31), after adjusting for time post-ACLR and injury mechanism. Conclusion: Greater quadriceps strength symmetry was associated with greater psychological readiness to RTP after ACLR in male athletes. In contrast to what has been reported in female athletes, this relationship was independent of injury mechanism. Clinical Relevance: Given the potential negative consequences of quadriceps strength deficits on one’s confidence to RTP, the need to restore quadriceps symmetry during the postoperative period is readily apparent. Low confidence or low psychological readiness to RTP may be indicative of quadriceps strength asymmetry or poor physical function in general.

scholarly journals Effects of Short-Term Core Stability Training on Dynamic Balance and Trunk Muscle Endurance in Novice Olympic Weightlifters

2020 ◽  
Vol 74 (1) ◽  
pp. 43-50
Author(s):  
Rafał Szafraniec ◽  
Janusz Bartkowski ◽  
Adam Kawczyński
Keyword(s):  
Training Program ◽  
Dynamic Balance ◽  
Exercise Program ◽  
Primary Objective ◽  
Trunk Muscle ◽  
Core Stability ◽  
Muscle Endurance ◽  
Short Term ◽  
Significant Difference ◽  
Stability Training

Abstract Our primary objective was to investigate the effects of short-term core stability training on dynamic balance and trunk muscle endurance in novice weightlifters learning the technique of the Olympic lifts. Our secondary objective was to compare dynamic balance and trunk muscle endurance between novice and experienced weightlifters. Thirty novice (NOV) and five experienced (EXP) weightlifters participated in the study. Mediolateral (ML) and anteroposterior (AP) dynamic balance and trunk muscle endurance testing were performed a week before (Pre) and after (Post) a 4-week core stability training program. In the NOV group, there was an improvement of both dynamic balance (ML and AP, p = 0.0002) and trunk muscle endurance (p = 0.0002). In the EXP group, there was no significant difference between Pre and Post testing conditions, except an increase in muscle endurance in the right-side plank (p = 0.0486). Analysis of the results showed that experienced lifters were characterized by more effective dynamic balance and greater core muscle endurance than their novice peers, not only before the training program but after its completion as well. In conclusion, the applied short-term core stability training improved dynamic balance and trunk muscle endurance in novice weightlifters learning the Olympic lifts. Such an exercise program can be incorporated into a training regime of novice weightlifters to prepare them for technically difficult tasks of the Olympic snatch and clean and jerk.

scholarly journals RECOVERY FOLLOWING ACL RECONSTRUCTION IN MALE VS. FEMALE ADOLESCENTS: A MATCHED, SEX-BASED COHORT ANALYSIS OF 543 PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Kathleen Maguire ◽  
Dai Sugimoto ◽  
Lyle J. Micheli ◽  
Mininder S. Kocher ◽  
Benton E. Heyworth
Keyword(s):  
Dynamic Balance ◽  
Cohort Analysis ◽  
Quadriceps Strength ◽  
Analysis Of Covariance ◽  
Return To Play ◽  
Meniscus Tear ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Males And Females ◽  
Time Point

Background: The subject of sex-based differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between males and females has been incompletely investigated, with no published comparative analyses specifically in adolescent sub-populations, which represent those most affected by ACL injury. Purpose/Hypothesis: To compare the 6-month postoperative functional recovery following ACLR between adolescent males and females. We hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes. Methods: All adolescent athletes with closed or closing growth plates who underwent ACLR at a single institution between May 2014 and May 2018 and who underwent functional return-to-sport (RTS) testing between 5-8 months post-operatively were considered for inclusion in this IRB-approved study. To control for potential graft-based rehabilitation differences or donor site morbidity as confounders, only primary ACLRs performed with hamstring autograft were included. Exclusions were previous knee surgery (contralateral or ipsilateral knee), concomitant injury other than meniscus tear, allograft supplementation, and incomplete medical records. Limb Symmetry Indexes (LSI) for strength (quadriceps, hamstrings, hip abductors, hip extensors), dynamic Y-balance (anterior, posterolateral and posteromedial distance), and functional hopping (single hop, triple hop, and cross-over hop for distance, and 6-meter timed hop) were compared between groups. To account for differences in physical characteristics between the sexes, one-way between group multivariate analysis of covariance (MANCOVA) was used, with p = 0.05. Results: Amongst 543 subjects (211 male, 332 female), there was no significant difference in age, BMI, incidence of concomitant meniscal pathology, use of regional anesthesia blocks, or time to functional testing between cohorts. However, height and weight differences were incorporated in the MANCOVA model. Females demonstrated a statistically significant greater deficit in quadriceps strength LSI compared to males (Table 1). Both males and females demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing, though single leg hop deficits were less severe in males, which trended towards significance (-4% vs. -8%, p=0.062). Conclusion: Females demonstrated greater quadriceps strength deficits than males at 6 months post-ACLR with hamstring autograft, which may translate into greater functional hop testing deficits. Severe hamstring strength deficits persist in both males and females at this time point, underscoring the potential importance of mitigating risk of ACL re-tear by delaying return to play until a later time point with more normalized, symmetric, performance-based metrics. [Table: see text]

scholarly journals 6- VS 9-MONTH RETURN TO SPORT TESTING RESULTS AFTER ACL RECONSTRUCTION WITH QUADRICEPS AUTOGRAFT IN ADOLESCENT PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Michael Saper
Keyword(s):  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Knee Extension ◽  
Quadriceps Strength ◽  
Balance Test ◽  
Isokinetic Testing ◽  
Adolescent Patients ◽  
Isokinetic Strength Testing ◽  
Tendon Autograft

Background: Recently, anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft has gained in popularity, particularly in adolescent patients. Studies are lacking that evaluate return to sport (RTS) testing after ACLR with quadriceps tendon autograft (QT). Hypothesis/Purpose: To investigate differences between the 6-month and 9-month RTS assessment in adolescent patients undergoing ACLR with QT. Methods: A retrospective review of adolescent patients who underwent primary ACLR with all soft-tissue QT identified 18 patients with formal RTS testing data at 6 and 9 months. Surgeries were performed between June 2017 and October 2018 by single surgeon using an all-inside technique. Concomitant meniscus repairs were performed in 38.9% of patients. All patients followed the same standardized rehabilitation protocol and completed a structured RTS test 6 and 9 months after surgery. The RTS test consisted of isometric and isokinetic strength testing, the Lower Quarter Y-Balance Test (YBT-LQ), and single-legged hop testing. The recovery of muscle strength, assessed via isometric/isokinetic and hop testing, was defined by a limb symmetry index (LSI) ≥ 90%. Differences were compared between the two RTS time points. Results: The mean age at the time of surgery was 15.2 years (range, 13-17 years). There were statistically significant improvements in the Pedi-IKDC (92.1 ± 8.4 vs. 82.9 ± 8.7; P = 0.001) and Tegner activity scale (7.1 ± 2 vs. 5.1 ± 2; P = 0.001). There were statistically significant improvements in isometric quadriceps strength (LSI, 82.6 ± 16.8 vs. 93.1 ± 11; P = 0.03) and hamstring strength (LSI, 86.4 ± 11.3 vs. 98.2 ± 9.6; P = 0.001). There were improvements in isokinetic knee extension at both 60 deg/sec (LSI, 75 ± 16.9 vs. 82.8 ± 13.9) and 180 deg/sec (LSI, 79.1 ± 14.8 vs. 84.6 ± 10.9), but the differences were not statistically significant ( P = 0.08 and P = 0.11, respectively). There were no significant differences in isokinetic testing of knee flexion at either 60 deg/sec or 180 deg/sec. There were no statistically significant differences in the anterior reach component of the YBT-LQ at 6 and 9 months. Patients demonstrated statistically significant improvements on single-legged hop testing with mean LSIs > 95% for each of the four tests at 9 months postop. Conclusion: Adolescent patients undergoing ACLR with QT demonstrated significant improvements in subjective function and quadriceps strength between 6 and 9 months postop. This data supports delaying RTS beyond 9 months in this at-risk population. [Table: see text]

scholarly journals Recovery Following ACL Reconstruction in Male vs. Female Adolescents: A Matched, Sex-Based Cohort Analysis of 543 Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Dai Sugimoto ◽  
Lyle Micheli ◽  
Mininder Kocher ◽  
Benton Heyworth ◽  
Kathleen Maguire
Keyword(s):  
Test Performance ◽  
Dynamic Balance ◽  
Quadriceps Strength ◽  
Return To Play ◽  
Meniscus Tear ◽  
Hamstring Autograft ◽  
Significant Difference ◽  
Hop Test ◽  
Males And Females ◽  
Time Point

Objectives: The subject of sex-based differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between males and females has been incompletely investigated, with no published comparative analyses specifically in adolescents, which represents the sub-population most affected by ACL injury. The purpose of this study was to compare the 6-month postoperative functional recovery following ACLR between adolescent males and females. We hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes. Methods: All adolescent athletes with closed or closing growth plates who underwent ACLR at a single institution between May 2014 and May 2018 and who underwent functional return-to-sport (RTS) testing between 5-8 months post-operatively were considered for inclusion in this IRB-approved study. To control for potential graft-based rehabilitation differences or donor site morbidity as confounders, only primary ACLRs performed with hamstring autograft were included. Exclusion criteria were previous knee surgery (contralateral or ipsilateral knee), concomitant injury/surgery other than meniscus tear/repair, allograft supplementation, and incomplete medical records. Limb Symmetry Indexes (LSI) for strength (quadriceps, hamstrings, hip abductors, hip extensors), dynamic Y-balance (anterior, posterolateral and posteromedial distance), and functional hop test performance (single hop, triple hop, cross-over hop for distance, and 6-meter timed hop) were compared between groups. To account for differences in physical characteristics between the sexes, one-way between group multivariate analysis of covariance (MANCOVA) was used, with p = 0.05. Results: Amongst 543 subjects (211 male, 332 female), there was no significant difference in age, BMI, incidence of concomitant meniscal pathology, use of regional anesthesia blocks, or time to functional testing between cohorts. However, the height and weight differences, which were expected, were incorporated in the MANCOVA model. Females demonstrated a statistically significantly greater deficit in quadriceps strength LSI compared to males (Table 1). Both males and females demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing, though single leg hop deficits were less severe in males, which trended towards significance (-4% vs. -8%, p=0.062). Conclusion: Females demonstrated greater quadriceps strength deficits than males at 6 months post-ACLR with hamstring autograft, which may translate into greater functional hop testing deficits. Severe hamstring strength deficits persist in both males and females at this time point, underscoring the potential importance of mitigating risk of ACL re-tear by delaying return to play until a later time point with more normalized, symmetric, performance-based metrics.

scholarly journals Evaluation of Quadriceps Strength Post-medial Patellofemoral Ligament Reconstruction Using Quadriceps Tendon Autografts

2020 ◽  
Vol 8 (A) ◽  
pp. 943-946
Author(s):  
Sholahuddin Rhatomy ◽  
Roy Lisang ◽  
Noha Roshadiansyah Soekarno ◽  
Bambang Kisworo
Keyword(s):  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Quadriceps Tendon ◽  
Quadriceps Strength ◽  
Mpfl Reconstruction ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Thigh Circumference ◽  
Significant Difference ◽  
Epiphyseal Plates

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon (QT) grafts provides favorable results with minimal complications and can be performed in patients with open epiphyseal plates. Following MPFL reconstruction using QT grafts, the outcomes have been evaluated, but the residual quadriceps strength (QS) has never been evaluated. AIM: We analyzed the knee’s range of motion (ROM), thigh circumference (TC), and QS at donor leg sites compared with those at contralateral healthy sites after MPFL reconstruction. The hypothesis was that there is no morbidity at donor sites. MATERIALS AND METHODS: Patients who underwent MPFL reconstruction using QT autografts between January and December 2017 were recruited. The ROM, TC, and QS were measured 6 months postoperatively. RESULTS: Twenty-one patients (8 men, 14 women; mean age, 28.40 ± 10.78 years [range, 16–45]) were included in the study. The TCs at the donor and contralateral sites (medians: 37 and 37.5 cm, respectively) showed no significant difference (p = 0.64). QS measurements showed means of 182 ± 4.6 N and 190 ± 4.7 N at the donor and contralateral sites, respectively (p = 0.376). There were no ROM deficits. CONCLUSIONS: The ROM, TC, and QS at donor sites were similar to those at contralateral sites. The QT is a suitable graft for MPFL reconstruction.

scholarly journals Poredjenje klinickih rezultata rekonstrukcije prednjeg ukrstenog ligamenta koriscenjem dvaju razlicitih postupaka

2005 ◽  
Vol 52 (2) ◽  
pp. 89-94
Author(s):  
S. Ninkovic ◽  
D. Savic ◽  
M. Stankovic ◽  
S. Radic ◽  
A. Milicic ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Patella Tendon ◽  
Significant Difference ◽  
Golden Standard ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B ◽  
Hamstrings Tendon

During the last two decades the "golden standard" in reconstruction of anterior cruciate ligament knee was the middle third of patellar tendon, but now are more used hamstrings tendon autograft. The aim of this work was to compare our results of the artroscopic reconstruction ACL ( anterior cruciate ligament) of the knee using two different techniques. We were controling 60 patients within the period of two years after operation. Group A was composed of 39 patients which had reconstructed ACL done with bone-patella tendon-bone autografts, in the group B were 21 patients and at them as autographts have been used hamstring tendon. Difference between health and the ill knee by the Lachman?s test after operation, in the group A was 2,4mm , but in the group B was 2,2mm (p> 0,05 ). Postoperative middle value of the Lysholm and Gillquist score in the group A was 97,74, in the group B it was 96,67 (p>0,05). IKDC score results are following: Group A- mark A 32 patients (84,6%); mark B 5 (12,8%); mark C 1 (2,6%) and in the group B: mark A 17 patients (81%); mark B 3 (14,28%): mark C 1 (4,72%) (p> 0,05). Postoperative value for the Tegner and Lyscholm score activity in the A group was 8,23, in B group it was 8,81. The reconstruction of ACL with bone-patella tendon-bone grafts gave better results then the reconstruction with the hamstring tendon only according to Tegner score values. In other parameters between those two groups there was no statistically significant difference.

Comparison of Iatrogenic Soft Tissue Trauma in Robotic-Assisted versus Manual Partial Knee Arthroplasty

2021 ◽  
Vol 39 ◽  
Author(s):  
Emily Hampp ◽  
◽  
Laura Scholl ◽  
Ahmad Faizan ◽  
Nipun Sodhi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Statistical Tests ◽  
Cruciate Ligament ◽  
Soft Tissue Injuries ◽  
Quadriceps Tendon ◽  
Soft Tissue Trauma ◽  
Partial Knee Arthroplasty ◽  
Significant Difference ◽  
Tissue Trauma

Partial knee arthroplasty (PKA) is performed to treat end-stage osteoarthritis in a single compartment. There are minimal data characterizing soft-tissue injuries for PKA with robotic and manual techniques. This cadaver study compared the extent of soft-tissue trauma sustained through robotic-arm assisted PKA (RPKA) and manual PKA (MPKA). Five surgeons prepared 24 cadaveric knees for medial PKA, including six MPKA controls and 18 RPKA assigned into three different workflows: RPKA-LB (six knees) – RPKA with legacy burr; RPKA-NB (six knees) – RPKA with new burr design; and RPKA-NBS (six knees) – RPKA with new burr design and oscillating saw. Two surgeons estimated trauma to the patellar tendon, quadriceps tendon, anterior cruciate ligament (ACL), medial collateral ligament (MCL), medial capsule, posterior capsule, and posterior cruciate ligament (PCLs) using a five-grade system: Grade 1 – complete soft tissue preservation; Grade 2 – ≤25%; Grade 3 – 26 to 50%; Grade 4 – 51 to 75%; and Grade 5 – ≥76% trauma. A total trauma grade was assigned by summing the grades. Kruskal-Wallis statistical tests were used to assess outcomes. When compared to the MPKA group, all RPKA subgroups had lower total trauma grading (p<0.01), lower posterior capsular damage (p<0.01), and less severe ACL damage (p<0.01). The analysis demonstrated no significant difference between the three RPKA workflows. As this study was performed using cadaveric specimens, additional investigations are necessary to determine associations between robotic or manual-assisted technique, observed soft tissue damage, and postoperative clinical outcomes following PKA.

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