Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator

Purpose

To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year.

Methods

Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05.

Results

35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = −0.92, P = .004, 95% CI = −0.96, −0.84; and camera path length, r = −0.97, P = .0004, 95% CI = −0.98, −0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = −0.54, P = .002, 95% CI = −0.75, −0.22; and camera path length, r = −0.62, P = .0003, 95% CI = −0.8, −0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = −0.94, P = .001, 95% CI = −0.97, −0.89; and camera path length, r = −0.89, P = .007, 95% CI = −0.95, −0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = −0.62, P = .0002, 95% CI = −0.8, −0.33; and camera path length, r = −0.37, P = .044, 95% CI = −0.64, −0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = −0.86, P = .012, 95% CI = −0.93, −0.74; and camera path lengths, r = −0.85, P = .015, 95% CI = −0.92, −0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance.

Conclusions

We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time.

Clinical Relevance

We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents.