{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:42:49Z","timestamp":1789026169229,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"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":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Soft tissue balance is essential for optimal function and satisfaction after total knee arthroplasty (TKA). However, the clinical significance of medial gap patterns across the entire range of motion (ROM) remains unclear. This study aimed to examine the association between intraoperative medial gap patterns and post\u2010operative patient\u2010reported outcome measures (PROMs) in robotic\u2010assisted cruciate\u2010retaining (CR) TKA. It was hypothesized that medial gap patterns with smaller deep\u2010flexion gaps relative to mid\u2010flexion or 90\u00b0 flexion would be associated with superior PROMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 102 patients (120 knees) who underwent primary robotic\u2010assisted CR TKA. Bone and cartilage resection thickness and simulated gaps were assessed at the planning stage, and the final component gaps were recorded at the trial stage. Medial gap patterns were classified as: 1 (constant), 2 (gradually increasing), 3 (increasing\/decreasing) and 4 (gradually decreasing). Objective outcomes were assessed using the Knee Society Score (KSS), and subjective outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Forgotten Joint Score\u201012 and the satisfaction score of the 2011 KSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten, 47, 51 and 12 knees were classified into Patterns 1\u20134, respectively. The resection gaps at flexion and the flexion\u2013extension gap difference were relatively larger in Pattern 2. Objective outcomes were comparable among patterns; however, the PROMs differed significantly. Pattern 3 demonstrated better WOMAC stiffness and KSS satisfaction scores than Patterns 1 and 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medial gap patterns in which deep\u2010flexion gaps did not exceed those at mid\u2010flexion or 90\u00b0 flexion were associated with better PROMs in robotic\u2010assisted CR TKA. These findings support the hypothesis that avoiding underestimation of native joint gaps at deep flexion is important for optimizing patient\u2010reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70214","type":"journal-article","created":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T16:52:22Z","timestamp":1765126342000},"page":"3348-3361","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Smaller medial component gaps at deep flexion are associated with better patient\u2010reported outcomes after robotic\u2010assisted cruciate\u2010retaining total knee arthroplasty using an anatomically designed implant"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-9382","authenticated-orcid":false,"given":"Yutaka","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Gifu University Graduate School of Medicine Gifu Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4737-6481","authenticated-orcid":false,"given":"Hiroyasu","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Gifu University Graduate School of Medicine Gifu Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Ota","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Gifu University Graduate School of Medicine Gifu Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaito","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of 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