Robotic-assisted arthroscopy review: submillimeter precision in early studies, adoption gated by regulatory, economic, and training barriers
Source: HSS Journal·Published: 2025
Authors: Kunze KN, Ferguson D, Pareek A, Colyvas N·DOI: 10.1177/15563316251340983
Bottom line: Unlike total joint arthroplasty and spine, arthroscopy has not yet absorbed robotics at scale. Early preclinical and cadaveric work shows promise, including submillimeter tunnel placement in ACL reconstruction. The piece is a narrative review, not a clinical trial, and adoption depends on regulation, cost, and training pathways that do not yet exist.
What the study did
Four orthopedic surgeons from Hospital for Special Surgery, the Royal London Hospital, and the University of California San Francisco authored a narrative review synthesizing the current landscape of robotic-assisted arthroscopy. The review outlines the limitations of conventional arthroscopy that robotics aims to address (confined 2D optics, constrained dexterity, one-handed camera control), surveys early robotic platforms, and examines the clinical, regulatory, and economic barriers to adoption. The piece also introduces concepts such as "digital fencing" of cartilage surfaces to prevent iatrogenic injury during robotic instrument passes.
What they found
Preclinical and cadaveric studies cited in the review describe submillimeter precision and improved anatomic accuracy in robotic assistance for anterior cruciate ligament reconstruction tunnel placement. The authors note that robotic platforms can keep the surgical view centered, manage fluid dynamics automatically, and digitally mark cartilage surfaces to avoid breaching during instrument passes. Clinical adoption was judged to remain limited and early. The review does not report pooled diagnostic or surgical outcomes, as it is a narrative rather than a systematic synthesis.
Why it matters for orthopedic practice
Arthroscopy is the next frontier in orthopedic robotics. Residents who trained on robotic TKA and spine navigation will likely encounter robotic arthroscopy during fellowship or early practice. Familiarity with the clinical rationale (depth perception, dexterity, reproducibility) and the open questions (regulatory approval pathway, cost per case, training curriculum) is useful for trainees evaluating fellowship programs or early-career practice environments that advertise the technology. For program directors, the review helps set realistic expectations about what robotic arthroscopy can and cannot yet do.
Limitations
The article is a narrative review, not a systematic review or meta-analysis, and its claims rest on the authors’ selection of literature. Most cited performance data come from preclinical or cadaveric work, not clinical trials in living patients. Sample sizes in the cited early clinical series are small, and no head-to-head comparisons against conventional arthroscopy exist at scale. Cost-effectiveness, long-term patient-reported outcomes, and failure modes of robotic arthroscopy in real-world OR conditions have not been characterized.
Kunze KN, Ferguson D, Pareek A, Colyvas N. Robotic-assisted arthroscopy promises enhanced procedural efficiency, visualization, and control but must overcome barriers to adoption. HSS J. 2025:1-6. doi:10.1177/15563316251340983
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