Introduction: There is only limited literature available evaluating the preferable treatment for active mid-age or elderly patients presenting with a degenerative medial meniscus root tear (d-MMRT) with medial meniscal extrusion (MME) and early-phase radiographic osteoarthritis (OA), failing to provide solid evidence. The aim of this study was to evaluate early outcomes of medial unicompartimental arthroplasty (mUKA) in active patients presenting a d-MMRT with meniscal extrusion and mild radiographic OA of the knee. To prove this claim we hypothesized that (1) patients with a d-MMRT with initial grade 1–3 KL OA of the medial compartment of the knee present the same pre-operative symptoms as patients with an end-stage grade 4 K-L OA, and that (2) those patients with d-MMRT and low-grade OA achieve the same early clinical and functional outcomes when treated with mUKA compared to patients with end-stage medial OA. Methods: We reviewed the prospectively collected data of 185 patients undergoing robotic-assisted image-based mUKA from January 2021 to July 2022 at a single Institution. We identified two different cohorts of non-consecutive patients: a group of 24 patients undergoing mUKA surgery following d-MMRT combined with K-L grades 1–3 OA (group 1), and a group of 161 patients who underwent mUKA but presenting with an end-stage bone-on-bone K-L grade 4 OA (group 2). Preoperative and postoperative clinical assessments at one-year follow-up included the Oxford Knee Score (OKS), 5-level EQ-5D version (EQ-5D-5L score), and a standard weight-bearing X-ray protocol. The paired t-test was used to compare clinical outcomes and radiologic values of the two cohorts and in-between the two cohorts. Statistical significance was set at p < 0.05. Results: The mean follow-up for group 1 was 16.4 ± 2.5 months, and the mean age at the time of operation was 63 ± 8.6 years with a mean time from diagnosis to intervention of 53 ± 47.5 days. Preoperative impairment was greater in group 1 compared to group 2, but with no significant difference. Postoperatively, both groups showed excellent mean outcomes at 1-year follow-up, with no significant difference. The mean preoperative HKA, mPTA, and LDFA were 176.3 ± 3.1, 88.1 ± 2.3, and 86.6 ± 1.7 respectively. The mean postoperative HKA, coronal femoral component angle, and coronal tibial component angle were 179.1 ± 2.6, 87.2 ± 2.3, and 87.2 ± 3.3. No difference was found between preoperative age, BMI, between the two cohorts. Conclusions: Favorable early clinical outcomes were obtained after mUKA in active mid-age and elderly patients presenting with degenerative medial meniscus root tear and mild isolated medial OA. Patients with mild no bone-on-bone OA but with degenerative medial meniscus root tear and medial meniscal extrusion presented the same or worse pre-operative symptoms as patients with end-stage medial OA and benefit the same from mUKA.

Purpose: Robotic‐assisted technology in medial unicompartmental knee arthroplasty (mUKA) allows for customized adjustments of joint laxity through virtual preoperative component positioning before bone preparation. Nevertheless, the optimal balancing curve has yet to be delineated. This study sought to investigate if varying intraoperative knee laxity patterns had any impact on postoperative patient outcomes.Materials and Methods: A retrospective analysis was conducted on prospectively collected data from 326 fixed‐bearing RAUKA procedures performed between 2018 and 2022 with a minimum 2‐year follow‐up. Patients were categorized into three cohorts based on intraoperative joint laxity patterns (millimetres of joint gap during valgus stress) imparted at 20°, 60°, 90° and 120° of knee flexion: cohort 1 < +0.5 mm (tight); cohort 2 between 0.6 and 1.9 mm (physiologic); cohort 3 > 2 mm (loose). Wilcoxon and Kruskal–Wallis tests were conducted to assess patient‐reported outcome measure (PROM) improvements and preoperative and postoperative differences across the cohorts. A Spearman's test evaluated the correlation between knee balance at all degrees of flexion and preoperative and postoperative HKA.Results: No differences in preoperative and postoperative PROMs were identified across the cohorts (p > 0.05). All three cohorts with different joint laxity patterns showed a significant improvement in the postoperative PROMS (p < 0.05). The preoperative or postoperative limb alignment did not significantly affect clinical outcomes relative to different laxity patterns.Conclusion: No differences were found in the outcomes across different joint laxity patterns in robotic‐assisted medial UKA using fixed‐bearing mUKAs. There was no evident advantage for maintaining a closer to physiologic laxity compared to tighter or looser balancing.Level of Evidence: Level III, therapeutic study.

Objectives: Three-dimensional (3D) planning and Patient Specific Instrumentation (PSI) can help the surgeon to obtain more predictable results in Medial Opening Wedge High Tibial Osteotomy (mOW-HTO) than the conventional techniques. We compared the accuracy of the PSI and standard techniques and measured the learning curve for surgery time and number of fluoroscopic shots. Methods: We included the first 12 consecutive cases of mOW-HTO performed with 3D planning and PSI cutting guides and the first 12 non-supervised mOW-HTO performed with the standard technique. We recorded surgery time and fluoroscopic time. We calculated the variation (Δ delta) between the planned target and the postoperative result for Hip Knee Ankle Angle (HKA), mechanical medial Proximal Tibia Angle (MPTA), Joint Line Convergence Angle (JLCA) and tibial slope (TS) and compared it both groups. We also recorded the complication rate. We then calculated the learning curves for surgery time, number of fluoroscopic shots, Δ from target in both groups. CUSUM analysis charts for learning curves were applied between the two groups. Results: Mean surgical time and mean number of fluoroscopic shots were lower in PSI group (48.58±7.87 vs. 58.75±6.86 min; p=0.034 and 10.75±3.93 vs. 18.16±4.93 shots; p<0.001). The postoperative ΔHKA was 0.42±0.51° in PSI vs. 1.25±0.87° in conventional, p=0.005. ΔMPTA was 0.50±0.67° in PSI vs. 3.75±1.48° in conventional, p<0.001; ΔTS was 1.00±0.82° in PSI vs. 3.50±1.57° in conventional, p<0.001. ΔJLCA was 1.83±1.11° in PSI vs. 4±1.41° in conventional, p<0.001. The CUSUM analysis favoured PSI group regarding surgery time (p=0.034) and number of shots (p<0.001) with no learning curve effect for ΔHKA, ΔMPTA, ΔJLCA and ΔTS. Conclusions: PSI cutting guides and 3D planning for HTO are effective in reducing the learning curves for operation time and number of fluoroscopic shots. Accuracy of the procedure has been elevated since the first cases.

Purpose: The aim of this systematic review was to evaluate the outcomes and complications associated with technology‐assisted revision total knee arthroplasty (revTKA).Methods: A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non‐randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random‐effects meta‐analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the I² statistic.Results: Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology‐assisted revTKA showed fewer outliers in hip–knee–ankle angle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6% [95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15–24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology‐assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.Conclusion: Technology‐assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.Level of Evidence: Level IV.

Purpose: Cryotherapy modulates synovial fluid composition by reducing inflammatory mediators and altering metabolite concentrations, resulting in both anti‐inflammatory and anti‐oxidative effects. The aim was to investigate whether preoperative cryocompression would (1) maintain deep tissue hypothermia during the surgical procedure, (2) attenuate inflammatory response and tissue damage and (3) improve post‐operative outcomes. Methods: The study enroled patients undergoing total knee arthroplasty (TKA) surgery who were randomly assigned to either the control group ( n = 50) receiving post‐operative cryocompression therapy, or the intervention group ( n = 50) receiving both preoperative and post‐operative cryocompression. Exclusion criteria: coagulation/psychiatric disorders. Inclusion criteria: monolateral primary Kellgren–Lawrence Grade IV knee osteoarthritis. Multiple outcomes, including patient‐reported outcomes (PROs), discharge milestones, cutaneous/osseous temperature and inflammatory biomarkers, were assessed. The primary end point was the difference in inflammatory markers across cohorts, while secondary end points included differences in pain, patient‐reported outcome measures (PROMs) and range of motion (ROM). Chi‐square test was used for categorical variables and the Mann–Whitney U ‐test for continuous variables. The minimally clinically important difference was calculated using the 0.5 SD approach. Linear mixed‐effects models analyzed the differences in inflammatory markers between the cohorts over time. The alpha value was set at 0.05. Results: Differences between the contralateral and the operated knee skin temperatures ( Z = −4.5, p < 0.001), as well as between the contralateral knee skin temperature and the operated knee bone temperature ( Z = −4.9, p < 0.001) were found. (2) Erythrocyte sedimentation rate was lower in the intervention group on post‐operative Days 1 and 2 compared to the control group. Fibrinogen had a greater increase from preoperative to post‐operative in the control group ( U = 746.5, p = 0.018). (3) Higher ROM ( p = 0.001) and shorter time to reach the rehabilitation milestones to discharge ( p = 0.007) were found in the intervention group. Conclusions: Preoperative cryocompression therapy before TKA might reduce early post‐operative inflammation, accelerate rehabilitation milestones, and improve early ROM. Levels of Evidence: Level IV.

Purpose: Medial unicompartmental knee arthroplasty (mUKA) may offer significant advantages for octogenarian patients due to its reduced surgical burden. The purpose of this study was to analyze the clinical and radiological outcomes, including complications and implant survivorship, in octogenarians following robotic‐assisted mUKA compared to patients aged ≤60 years. Methods: We conducted a retrospective analysis of prospectively collected data on robotic‐assisted mUKA performed between 2018 and 2022, with a minimum follow‐up of 24 months. Inclusion criteria were patients aged ≥80 years and patients aged ≤60 years. Participants without consent were excluded. A total of 203 patients were included in the final analysis. Propensity score matching was performed to balance the two cohorts (Young: ≤60 years; Octogenarians: ≥80 years) based on body mass index (BMI), Oxford Knee Score (OKS) and Knee Society Score (KSS). The Mann–Whitney U test was used to compare continuous variables both preoperatively and postoperatively, as well as clinical improvements across cohorts. The Wilcoxon Signed‐Rank Test and the minimally clinically important difference (MCID) were used to evaluate postoperative clinical outcome improvements within each cohort. The Chi‐Square test was used to compare survival and complication rates between groups. Results: No differences were found between groups in any clinical or radiographic parameters, either preoperatively or postoperatively. Both groups showed comparable and clinically meaningful improvements in KSS and OKS scores. In the octogenarian group, there were two cases of intracortical lateral tibial fractures managed conservatively. One case of subpopliteal deep vein thrombosis (DVT) occurred in the younger cohort. No differences in implant survival were observed between the groups. Conclusion: Advanced age alone should not preclude octogenarian patients from undergoing robotic‐assisted mUKA, as they can achieve meaningful functional improvements comparable to those of younger patients. Level of Evidence: Level III.