Authors: Paul Y. Lee^1,2 — ¹ MSK Doctors, UK · ² United Lincolnshire Hospitals NHS Trust, UK

Abstract

As robotic technology transforms orthopaedic precision, the surgeon's role evolves into that of a \"human algorithm\" — blending data, motion analysis, and biologic science. This lecture explores how MRI biomarkers, MAI Motion, and regenerative design principles combine with robotics to create intelligent, patient-centred knee surgery for the future.

Why it matters

Robotics can deliver millimetre accuracy, but precision alone does not guarantee a better knee. The next era of knee surgery is about decision engineering: selecting the right intervention, for the right patient, at the right time based on how they move, what their MRI is really showing, and how their tissue biology can be protected or regenerated.

Robotic systems achieve consistency and precision, but the intelligence of surgery still depends on how information is interpreted and applied by the surgeon. Motion is presented as a functional biomarker, with MAI Motion enabling the quantification of real-world knee behaviour beyond static imaging. By analysing movement patterns, compensations, and asymmetries, clinicians can identify drivers of symptoms and dysfunction that conventional scans may fail to reveal.

The role of MRI biomarkers is explored in depth, moving beyond descriptive reporting towards tissue-level signals that genuinely inform surgical choice and prognosis. This includes understanding what imaging can reliably predict — and where it may mislead without functional or biological context.

Regenerative design principles are introduced as a core component of modern knee surgery. Rather than focusing solely on mechanical correction, surgical strategies are discussed in terms of how they preserve joint biology, minimise inflammatory burden, and protect long-term cartilage health.

Finally, the lecture outlines a future-ready clinical pathway, integrating prehabilitation, data-driven intra-operative planning, and biologically informed post-operative recovery into a single connected system — designed around the patient rather than the procedure.