Design Features and Clinical Considerations of Orthopedic Knee Rehabilitation Exoskeletons: A Systematic Literature Review and Analysis

Sammanfattning

As rehabilitation robotics expands from neurorehabilitation to orthopedics, thebiomechanical suitability of existing devices remains unclear. This paper systematicallyreviews 57 wearable knee exoskeletons (2015–2025) to evaluate their clinicalcompatibility. It highlights the critical design divergence between the “repurposingstrategy” of neuro-derived systems and the “specialized design philosophy” oforthopedic-specific solutions.Using a novel five-dimensional evaluation framework, this study reveals a significantdesign "mismatch." While systems relying on a generalist, neuro-adapted approachoffer advanced control, their architectures often lack the kinematic compatibilityand structural support required for vulnerable orthopedic joints. In contrast, "specialized"designs have seen explosive growth, prioritizing unilateral modularity andanatomical protection. However, a "valley of death" persists in translational research:over 60% of orthopedic-specific devices remain at Technology ReadinessLevel (TRL) 4, failing to reach clinical patient trials.The study concluded that most current cases of transplanting neurological rehabilitationequipment for orthopedic use cannot address the specific needs and limitationsof orthopedics. Future development should adopt an "orthopedic-first" philosophy—prioritizing multi-DOF stability, modular adaptability, and pain-aware control.These shifts are imperative to reduce adverse events and optimize treatmentoutcomes in orthopedic rehabilitation.In addition, another systematic review should be conducted on mature and cuttingedgeneurosurgical exoskeletons that do not claim to include orthopedic rehabilitationfunctions to analyze their potential to meet orthopedic rehabilitation needs.