Reimagining Knee Surgery: The Promises and Pitfalls of Augmented and Virtual Reality in Orthopedic Training and Preoperative Planning

Kyriakos Bekas; Alexandros Stamatopoulos; Ioannis Fotios Kechagias; Konstantinos Vamvakeros; Ioannis Bampis; Achilleas Boutsiadis

Abstract

Background: The integration of immersive technologies such as augmented reality (AR) and virtual reality (VR) is rapidly transforming orthopedic surgical practice, particularly in knee surgery. These technologies offer enhanced visualization, simulation-based education, and precise preoperative planning.Purpose: To explore the current applications of AR and VR in knee surgery, with a focus on their role in surgical training and preoperative planning, while identifying associated limitations and future directions.Methods: A narrative review was conducted of peer-reviewed literature published between 2014 and 2025 using databases including PubMed, Scopus, and Web of Science. The search focused on studies evaluating the clinical and educational use of AR and VR in knee surgery, with emphasis on simulation training, preoperative visualization, and intraoperative applications.Results: VR-based simulation platforms have demonstrated efficacy in enhancing psychomotor skills and procedural confidence among orthopedic trainees. AR has shown promise in improving anatomical orientation and precision during preoperative planning, especially in ligament reconstruction and alignment-based procedures. However, both modalities face limitations such as high costs, technical integration challenges, limited haptic feedback, and varying user adaptability. While initial results suggest improved accuracy and learning outcomes, robust clinical trials linking these tools to long-term surgical outcomes remain limited.Conclusion: AR and VR are emerging as powerful adjuncts in knee surgery education and planning. Despite promising early evidence, wider adoption is tempered by technical and financial barriers. Future research should focus on standardizing outcome measures and integrating AR/VR tools into validated surgical curricula.What this study adds: This review synthesizes recent evidence on AR and VR in knee surgery and highlights their utility and constraints in training and preoperative workflows.How this study might affect research, practice or policy: By synthesizing evidence spanning a full decade (2014–2025), this review offers a longitudinal perspective on the evolution of immersive technologies in knee surgery. The findings may aid curriculum designers, clinical educators, and surgical innovators in making evidence-informed decisions about the integration of AR and VR into orthopedic training and preoperative planning. This historical breadth provides valuable insight into emerging trends, persistent challenges, and the trajectory of future implementation across surgical education and practice.Study Design: Narrative literature reviewLevel of evidence: Level VKeywords: Augmented reality; virtual reality, knee surgery; surgical simulation; preoperative planning; orthopedic traininghttps://doi.org/10.70885/hmsj.2025.08.003

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