{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:12:59Z","timestamp":1792789979024,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The metaverse and extended reality (XR), which includes augmented reality (AR), virtual reality (VR) and mixed reality (MR), are transforming orthopaedic surgery by enhancing training, procedural accuracy and rehabilitation. However, a literature review of these new virtual tools is lacking. The purpose of this narrative review is to summarise available evidence about the metaverse and discuss current and future clinical applications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A narrative review of the current literature was performed for studies evaluating XR tools and their respective clinical and educational utility. Studies from all orthopaedic subspecialties were eligible for inclusion. The XR tools evaluated in each study were categorised according to the reality spectrum and future research or clinical applications were discussed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>XR is a technological spectrum that includes AR, VR and MR to create immersive and interactive surgical training environments. VR\u2010based simulators may improve surgical education by allowing trainees to refine their skills in a risk\u2010free setting. AR may enhance intraoperative guidance and has been studied within orthopaedics to improve implant positioning accuracy and reduce complications in procedures including arthroscopy and total joint arthroplasty. In rehabilitation, AR and VR have been implemented to facilitate patient engagement and adherence, promoting functional recovery through gamified therapy and remote telerehabilitation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There has been a paradigm shift in orthopaedic care in which digital tools are integrated with patient care to optimise patient outcomes. However, challenges to the widespread implementation of promising XR technology include high costs, steep learning curves and limited clinical validation. Ethical concerns, including data security and patient privacy, further complicate its use in clinical settings. Future research must focus on cost\u2010effectiveness, standardisation and improving accessibility to ensure seamless integration into clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level V.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12723","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:16:43Z","timestamp":1751876203000},"page":"3039-3050","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The metaverse in orthopaedics: Virtual, augmented and mixed reality for advancing surgical training, arthroscopy, arthroplasty and rehabilitation"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9545-7454","authenticated-orcid":false,"given":"Mahmut Enes","family":"Kayaalp","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology Istanbul Fatih Sultan Mehmet Training and Research Hospital University of Health Sciences Istanbul T\u00fcrkiye"},{"name":"Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-8593","authenticated-orcid":false,"given":"Efstathios","family":"Konstantinou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma University Hospital of Larisa, School of Health Sciences University of Thessaly Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedri","family":"Karaismailoglu","sequence":"additional","affiliation":[{"name":"CAST (Cerrahpasa Research, Simulation and Design Laboratory) Istanbul University\u2010Cerrahpasa Istanbul T\u00fcrkiye"},{"name":"Department of Orthopaedics and Traumatology Cerrahpasa Faculty of Medicine Istanbul University\u2010Cerrahpasa Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Andrea","family":"Lucidi","sequence":"additional","affiliation":[{"name":"II Clinica, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3548-5672","authenticated-orcid":false,"given":"Mehmet","family":"Kaymakoglu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology Faculty of Medicine Izmir University of Economics Izmir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romed","family":"Vieider","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"},{"name":"Department of Sports Orthopaedics Technical University of Munich Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D.","family":"Giusto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jumpei","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Nagoya Tokushukai General Hospital Kasugai Aichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Hirschmann","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland Bruderholz Switzerland"},{"name":"Department of Clinical Research Research Group Michael T. 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