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The purposes were to compare (1) ligament balancing in extension and flexion after TKA in the AFIP group, (2) TKA alignment, implant positioning and patellar tracking between AFIP and adjusted mechanical alignment (aMA) techniques, (3) clinical outcomes between both groups at 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      All robotic\u2010assisted TKA with an AFIP technique were included (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940). Exclusion criteria were genu valgum (HKA angle\u2009&gt;\u2009183\u00b0), extra\u2010articular deformity more than 10\u00b0, and patellar maltracking (high\u2010grade J\u2010sign). One control patient with a TKA implanted by an aMA technique was matched for each case, based on age, body mass index, sex, and knee alignment. Ligament balancing (medial and lateral gaps in millimeters) in full extension and at 90\u00b0 of flexion after TKA in the AFIP group was assessed with the robotic system. TKA alignment (HKA angle), implants positioning (femoral and tibial coronal axis, tibial slope, joint\u2010line orientation), patellar tracking (patellar tilt and translation) and the Knee Society Score (KSS) at 6 and 12\u00a0months were compared between both groups. The ligament balancing was compared using a\n                      <jats:italic>t<\/jats:italic>\n                      test for paired samples in the AFIP group. The radiographic measurements and KSS scores were compared between groups using a\n                      <jats:italic>t<\/jats:italic>\n                      test for independent samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the AFIP group, there was no significant difference between the medial and lateral gap laxity in extension (NS). A significant opening of the lateral gap was observed in flexion compared to extension (mean:\u2009+\u20092.9\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). The mean postoperative HKA angle was comparable between both groups (177.3\u00b0\u2009\u00b1\u20092.1\u00a0in the AFIP group vs 176.8\u00b0\u2009\u00b1\u20093.2; NS). In the AFIP group, the femoral anatomy was restored (90.9\u00b0\u2009\u00b1\u20091.6) and the tibial varus was partially corrected (87.4\u00b0\u2009\u00b1\u20091.8). The improvement of Knee and Function KSS at 6\u00a0months was better in the AFIP group (59.3\u2009\u00b1\u200911.9 and 51.7\u2009\u00b1\u200920, respectively, versus 49.3\u2009\u00b1\u20099.7 and 20.8\u2009\u00b1\u200913;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The AFIP concept allowed the restoration of the native knee alignment and a natural functional ligament pattern. With a more physiological target for ligament balancing, the AFIP technique had equivalent clinical outcomes at 12\u00a0months compared to aMA, with a faster recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III retrospective therapeutic case control series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00167-022-06995-4","type":"journal-article","created":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T10:03:51Z","timestamp":1652436231000},"page":"1334-1346","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["An anatomo\u2010functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6\u00a0months compared to an adjusted mechanical technique"],"prefix":"10.1002","volume":"31","author":[{"given":"S\u00e9bastien","family":"Parratte","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery International Knee and Joint Centre Abu Dhabi United Arab Emirates"},{"name":"<!--<label>2<\/label>--> Institute for Locomotion Aix\u2010Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Van Overschelde","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedic Surgery AZ Maria Middelares Buitenring Sint\u2010Denijs 30 9000 Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Bandi","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Zimmer, GmbH Winterthur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak Yagmur","family":"Ozturk","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery International Knee and Joint Centre Abu Dhabi United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3990-0906","authenticated-orcid":false,"given":"C\u00e9cile","family":"Batailler","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Orthopaedic Surgery Croix\u2010Rousse Hospital, Lyon University Hospital 103 Grande rue de la Croix Rousse Lyon 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PVO: Consultant for Microport; Shareholder for MoveUP. MB: Employee from Zimmer Biomet. BYO: Consultant for Smith and Nephew. CB: Grant from SoFCOT (Soci\u00e9t\u00e9 francaise de chirurgie orthop\u00e9dique et traumatologique).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures were performed in accordance with the ethical standards of the institutional and\/or national research committee, the 1964 Helsinki declaration, and its later amendments, or comparable ethical standards. The approval from the internal review board was obtained (study ID Number: MF3867, approval date: 20th December 2020).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patient participants provided informed consent for review of their medical records.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}