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First study on the new ArthroS™ simulator for arthroscopy

January 04, 2013

Evaluation of a Novel Virtual Reality Simulator for Knee Arthroscopy

Fucentese SF a, Rahm S a, Spillmann J b , Harders M b, Koch PP a

a Balgrist University Zurich, Switzerland
b ETH Zurich, Switzerland 

Abstract presented at the AGA conference in Zurich, Switzerland, September 19, 2012

Background: Simulator training in orthopaedics is still in its infancy. The aim of this study is to determine face and construct validity of a new virtual reality simulator (VirtaMed ArthroS™) for diagnostic and therapeutic knee arthroscopy by analysis of simulator metrics of participants with varying arthroscopy experience.

Methods: Participants (n=64) of an arthroscopy course (Arthroscopy Course Arosa 2012) were grouped into novices (N=33, <20 knee arthroscopies (KA) performed), intermediates (N=19, 21-99 KA) and experts (N=12, >100 KA). All participants completed a standardized introduction to the simulator followed by two exercises (diagnostic knee arthroscopy with removal of foreign bodies, and partial lateral meniscectomy). Construct validity was tested by comparing various simulator metrics between novices and experts. In order to establish face validity, all participants filled out a questionnaire with 14 items concerning different aspects of simulator realism, 7 items concerning training capacity and 8 different statements.

Results: In the foreign body removal exercise, experts were significantly faster (6min14s vs 8min25s, p=0.002), took less time for the diagnostic part (2 min 31s vs 3 min 32s, p=0.006), and had a shorter camera path length (177 vs 245 cm, p=0.003). Differences in grasper distance and number of bodies removed did not reach significance. In the meniscectomy exercise, experts were again faster (2 min 21s vs 3 min 47s, p<0.001), and had both, shorter camera distance (24cm vs 48 cm, p=0.002) and punch distance (53 cm vs 69 cm, p=0.024). In the questionnaire, overall realism was rated a mean value of 5.5 (mean value of items ranging from 3.9 for tactile sensation to 5.9 scope realism) on a 7-point Likert scale. Global training capacity was rated a mean value of 5.9 (mean value of items ranging from 5.5 for therapeutic to 6.3 for hand-eye coordination). Participants considered the simulator as useful for procedural training of diagnostic and therapeutic arthroscopy and that the simulator training should be recommended for any orthopaedic resident.

Conclusion: The VirtaMed ArthroS™-simulator is a realistic and useful training method and able to differentiate between different levels of arthroscopic experience. Virtual reality simulation could offer a significant contribution to the training of knee arthroscopy skills but further improvement of the simulator especially in the field of therapeutic arthroscopy is desirable.


The ArthroS ™ is currently being presented at IMSH conference in Orlando, Florida, USA and at the Arab Health conference in Dubai, UAE. Please feel free to stop by our booth and try it out yourself!