Kinematical alignment better restores native patellar tracking pattern than mechanical alignment

Abstract Purpose The purpose of this study was to assess whether kinematic alignment (KA) outperforms mechanical alignment (MA) in restoring patellar tracking to native patterns by using a clustering algorithm. Methods Twenty cadavers (40 knees) were evaluated. For each cadaver, one knee was randomly assigned to KA and the other to MA. KA total knee arthroplasty (TKA) procedures were performed using a caliper‐verified technique, while MA TKA procedures utilized a measured resection technique. Subsequently, all specimens were mounted on a customized knee‐testing system, and patellar tracking was measured using a motion analysis system. All patellar tracking data were clustered using the density‐based spatial clustering of applications with noise algorithm. Differences in patellar tracking patterns and the restoration of native patellar tracking were compared between the two alignment strategies. Results Patellar tracking patterns following KA were considerably different from MA. Pre‐ and post‐TKA patellar tracking patterns following MA were grouped into separate clusters, whereas a substantial proportion of patellar tracking patterns following KA were grouped into the pre‐TKA dominant cluster. Compared to MA, a greater proportion of patellar tracking patterns following KA showed similar patterns to native knees ( p < 0.05) and more patellar tracking patterns following KA paired with preoperative patterns ( p < 0.01). Conclusion KA restored native patellar tracking patterns more closely compared to MA. Level of Evidence Level I, therapeutic study.