Sagittal femoral morphology is not associated with robotic planning or soft-tissue balance during robotic-assisted total knee arthroplasty: An analysis from the Brescia Knee Research Group.

Authors

Luca Andriollo, Roberta Lazzaro, Michele Alborghetti, Lorenzo Lucchetta, Donato Coppola, Daniele Grassa, Pietro Zampedri, Riccardo Bellosta, Francesco Benazzo, Rudy Sangaletti

Published in

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. Jun 29, 2026. Epub Jun 29, 2026.

Abstract

To evaluate the influence of sagittal femoral morphology on robotic planning parameters and intraoperative soft-tissue balance in robotic-assisted total knee arthroplasty (TKA). It was hypothesised that sagittal femoral morphology has limited impact on intraoperative planning and laxity.
This retrospective study analysed a prospectively maintained database of patients undergoing primary robotic-assisted TKA between January 2021 and November 2022. Preoperative radiographic parameters included mechanical hip-knee-ankle angle (mHKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and posterior tibial slope (PTS). Sagittal femoral morphology was assessed using anterior femoral offset (AFO), posterior femoral offset (PFO) and anteroposterior femoral size (AP size). Intraoperative robotic data included femoral resections, femoral flexion, rotation referenced to the posterior condylar axis (PCA) and transepicondylar axis (TEA) and medial-lateral laxity in extension and flexion. Associations between sagittal morphology, planning parameters and soft-tissue balance were analysed using linear and logistic regression models.
A total of 212 patients were included. No meaningful associations were found between sagittal femoral morphology and robotic planning parameters, including femoral flexion, distal and posterior resections or femoral rotation (coefficient of determination R²≈ 0). Similarly, sagittal morphology was not associated with medial-lateral laxity imbalance in extension or flexion, either at the initial or final assessment (all p > 0.05).
Sagittal femoral morphology does not significantly influence robotic planning or intraoperative soft-tissue balance in robotic-assisted TKA. These findings suggest that sagittal anatomy alone is not a primary determinant of surgical planning or gap behaviour, supporting the need for a comprehensive, patient-specific and multiplanar approach.
Level III.

PMID:
42371661
Bibliographic data and abstract were imported from PubMed on 29 Jun 2026.

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