{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:09Z","timestamp":1789844529639,"version":"4.0.1"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":76,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Kinematic alignment (KA) total knee arthroplasty (TKA) aims to restore native knee kinematics by aligning prosthetic components with each patient's constitutional anatomy. While femoral resurfacing is well established, tibial resection in KA\u2010TKA remains largely subjective, particularly in cases with advanced deformity or bone loss. This study introduces a novel augmented reality (AR)\u2013based technique for tibial resection that utilises real\u2010time ligament elongation patterns to support personalised alignment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>More than 200 consecutive KA\u2010TKA procedures were performed using an AR navigation system (NextAR, Medacta) with medial\u2010stabilised implants (GMK Sphere). After femoral resurfacing and osteophyte removal, trial femoral components were inserted to restore functional intraoperative reference configuration, thereby defining a \u2018zero\u2010position\u2019 baseline. Real\u2010time elongation data of the medial and lateral collateral ligaments were visualised throughout the full range of motion via AR smart glasses. Tibial resection parameters\u2014including varus\/valgus angle and posterior slope\u2014were quantitatively adjusted according to elongation patterns to replicate physiological soft\u2010tissue tension. Spacer blocks were used intraoperatively to verify bone\u2010gap balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Intraoperative tibial adjustments guided by ligament elongation patterns enabled patient\u2010specific resection strategies without reliance on ambiguous osseous landmarks or purely subjective gap assessments. This approach facilitated consistent intraoperative evaluation of medial and lateral soft\u2010tissue behaviour in both extension and flexion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This AR\u2010based KA\u2010TKA technique enables individualised tibial resection guided by real\u2010time ligament behaviour. It provides a reproducible and objective framework to support soft\u2010tissue\u2010informed intraoperative decision\u2010making, particularly in patients with complex deformities. This approach may complement existing KA principles and serve as a foundation for future outcome\u2010based investigations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>NA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70773","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:58:08Z","timestamp":1781603888000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical technique for augmented reality\u2010guided tibial resection in kinematic alignment total knee arthroplasty: Real\u2010time ligament elongation enables personalised soft tissue balance"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2197-9003","authenticated-orcid":false,"given":"Atsushi","family":"Sato","sequence":"first","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Ota","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiharu","family":"Miyazawa","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misako","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reo","family":"Nagasaka","sequence":"additional","affiliation":[{"name":"Showa Medical University Koto Toyosu Hospital, Orthopaedic Surgery  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Mukunoki","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Izukashi","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Oike","sequence":"additional","affiliation":[{"name":"Showa Medical University Koto Toyosu Hospital, Orthopaedic Surgery  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Okumo","sequence":"additional","affiliation":[{"name":"Showa Medical University School of Medicine, Physiology  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Yagura","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Koya","sequence":"additional","affiliation":[{"name":"Showa Medical University Koto Toyosu Hospital, Orthopaedic Surgery  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Kanzaki","sequence":"additional","affiliation":[{"name":"Showa Medical University Fujigaoka Hospital, Orthopaedic Surgery  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-04204-4"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(97)00043-0"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1302\/2633-1462.35.BJO-2022-0021.R2"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-020-02459-3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2621-x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.07.020"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2024.12.010"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200709000-00016"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.09.039"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-025-05984-9"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.07.010"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2026.102024"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-025-06033-1"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1742645"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.697020"}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70773","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jeo2.70773","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70773","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:15:01Z","timestamp":1789841701000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/jeo2.70773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/jeo2.70773"],"URL":"https:\/\/doi.org\/10.1002\/jeo2.70773","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-11-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70773"}}