{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:39:05Z","timestamp":1791934745208,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T00:00:00Z","timestamp":1742601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The impact of posterior tibial slope (PTS) on clinical outcomes after robot\u2010assisted total knee arthroplasty (RTKA) with functional alignment (FA) remains unclear. This study aimed to evaluate the effect of PTS on clinical outcomes following RTKA with FA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospectively collected database was retrospectively reviewed for patients who underwent primary cruciate\u2010retaining RTKA (CR\u2010RTKA) with FA using the MAKO robotic system, with a minimum 1\u2010year follow\u2010up. Knees were categorized into two groups: the small change (SC) group (<jats:italic>n<\/jats:italic>\u2009=\u200947) with a small PTS change (&lt;4\u00b0) and the large change (LC) group (<jats:italic>n<\/jats:italic>\u2009=\u200953) with a large PTS change (\u22654\u00b0). PTS change was defined as differences between pre\u2010 and post\u2010operative PTS values. At the 1\u2010year follow\u2010up, clinical outcomes including Knee Society Score (KSS), Western Ontario and McMaster University Index (WOMAC), Forgotten Joint Score\u201012 (FJS\u201012) and post\u2010operative complications were compared between groups. A multiple linear regression analysis was conducted to identify independent factors influencing post\u2010operative WOMAC scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The SC group demonstrated significantly better post\u2010operative clinical outcomes than the LC group (KSS\u2010functional score: 85.63\u2009\u00b1\u200913.00 vs. 77.08\u2009\u00b1\u200918.39, <jats:italic>p<\/jats:italic>\u2009=\u20090.026; WOMAC: 10.46\u2009\u00b1\u20095.36 vs. 16.98\u2009\u00b1\u200910.69, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; FJS\u201012: 75.94\u2009\u00b1\u200921.96 vs. 61.37\u2009\u00b1\u200926.61, <jats:italic>p<\/jats:italic>\u2009=\u20090.019). In multivariate regression analysis, PTS change was identified as an independent factor correlated with the post\u2010operative WOMAC score (<jats:italic>\u03b2<\/jats:italic>: 0.842, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). No post\u2010operative complications were observed in either group during the follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Restoring the native PTS within 4\u00b0 leads to better clinical outcomes following CR\u2010RTKA with FA without post\u2010operative complications for up to 1 year. Therefore, efforts to restore the native PTS are critical for achieving optimal short\u2010term clinical outcomes after CR\u2010RTKA with FA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12649","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T12:34:05Z","timestamp":1742733245000},"page":"2592-2604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Restoring native posterior tibial slope within 4\u00b0 leads to better clinical outcomes after cruciate\u2010retaining robot\u2010assisted total knee arthroplasty with functional alignment"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5317-9628","authenticated-orcid":false,"given":"Young Tak","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Kangnam Sacred Heart 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