Skip to main content
Log in

A new simulator model for knee arthroscopy procedures

Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthroscopy is currently the “gold standard” for various surgeries performed on the knee joint. Therefore, surgeons wishing to operate in this professional field should be able to perform this technique. Arthroscopic training, an experimental laboratory, is important for the surgeons’ training, enabling them to increase their skills with the specific instruments and to become familiar with the operating techniques. The aim of this study was to present a new surgical simulator for training in arthroscopic procedures of the knee.

Methods

The Kneetrainer 1 is a simulator consisting of a type of thermo-retractile, thermo-sensitive synthetic rubber that has texture, colour, consistency, and mechanical resistance that mimic many human tissues. Nine simulators were used, operated by seventeen expert Brazilian surgeons in knee surgery. The surgeons performed arthroscopy, meniscectomy, and reconstruction of the anterior cruciate ligament (ACL), responded to an electronic questionnaire with several variables, and gave an overall score on the ability of the device to perform realistic simulation for the above procedures.

Results

The ability to perform the procedures of meniscectomy and ACL reconstruction was considered adequate by 82 and 100 % of the specialists, respectively. The overall scores for the ability to perform realistic simulation for the procedures meniscectomy and reconstruction of the anterior cruciate ligament by arthroscopy were 64.7 and 82.4 %, respectively. The simulator was therefore considered suitable for practical application with novice surgeons.

Conclusion

The Kneetrainer 1 simulator was assessed as an effective tool for recreating accurate arthroscopic knee procedures. In addition, the simulator may be effective as a means of honing the skills of novice surgeons. Future investigations should be performed to validate the reliability of the simulator.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Abbreviations

ACL:

Anterior cruciate ligament

References

  1. Alvand A, Auplish S, Gill H, Rees J (2011) Innate arthroscopic skills in medical students and variation in learning curves. J Bone J Surg Am 93(19):e115

    Google Scholar 

  2. Berman JR, Ben-Artzi A, Fisher MC, Bass AR, Pillinger MH (2012) A comparison of arthrocentesis teaching tools: cadavers, synthetic joint models, and the relative utility of different educational modalities in improving trainees’ comfort with procedures. J Clin Rheumatol 18(4):175–179

    Article  PubMed  Google Scholar 

  3. Bohm PE, Arnold PM (2015) Simulation and resident education in spinal neurosurgery. Surg Neurol Int 6:33

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cannon WD, Garrett WE Jr, Hunter RE, Sweeney HJ, Eckhoff DG, Nicandri GT, Hutchinson MR, Johnson DD, Bisson LJ, Bedi A, Hill JA, Koh JL, Reinig KD (2014) Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator: a randomized blinded study. J Bone Joint Surg Am 96(21):1798–1806

    Article  PubMed  Google Scholar 

  5. Cannon WD, Nicandri GT, Reinig K, Mevis H, Wittstein J (2014) Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator. J Bone Joint Surg Am 96(7):e57

    Article  PubMed  Google Scholar 

  6. Coelho G, Kondageski C, Vaz-Guimarães Filho F, Ramina R, Hunhevicz SC, Daga F (2011) Frameless image guided neuroendoscopy. Minim Invasive Neurosurg 54:115–118

    Article  CAS  PubMed  Google Scholar 

  7. Downing SM (2003) Validity: on meaningful interpretation of assessment data. Med Educ 37:830–837

    Article  PubMed  Google Scholar 

  8. Dutta S, Krummel TM (2006) Simulation: a new frontier in surgical education. Adv Surg 40:249–263

    Article  PubMed  Google Scholar 

  9. Heitmiller RF, Gupta VK, You CJ (2008) Apprenticeships: preserving the commitment in surgical education. J Surg Educ 65:259–262

    Article  PubMed  Google Scholar 

  10. Hernandez AJ, Rezende MU (1996) Importance of training in knee arthroscopy. Acta Ortop Bras 4(1):1–4

    Google Scholar 

  11. Kavic MS (2006) Simulators: a new use for an old paradigm. JSLS 10:281–283

    PubMed  PubMed Central  Google Scholar 

  12. Lüring C, Tingart M, Beckmann J, Grifka J, Bäthis H (2010) Surgical training in orthopaedic and trauma departments in Germany. Z Orthop Unf 148(4):466–470

    Article  Google Scholar 

  13. Moody L, Waterworth A (2004) A flexible virtual reality tutorial for the training and assessment of arthroscopic skills. Stud Health Technol Inform 98:244–246

    PubMed  Google Scholar 

  14. Stunt JJ, Kerkhoffs GM, Horeman T, van Dijk CN, Tuijthof GJ (2014) Validation of the PASSPORT V2 training environment for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3213-0

    Google Scholar 

  15. Stunt JJ, Kerkhoffs GM, van Dijk CN, Tuijthof GJ (2014) Validation of the ArthroS virtual reality simulator for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3101-7

    Google Scholar 

  16. Tay C, Khajuria A, Gupte C (2014) Simulation training: a systematic review of simulation in arthroscopy and proposal of a new competency-based training framework. Int J Surg 12(6):626–633

    Article  PubMed  Google Scholar 

  17. Thomas WEG (2008) The making of a surgeon. Surgery 26:400–402

    Google Scholar 

  18. Vavken P, Fleming BC, Mastrangelo AN, Machan JT, Murray MM (2012) Biomechanical outcomes after bioenhanced anterior cruciate ligament repair and anterior cruciate ligament reconstruction are equal in a porcine model. Arthroscopy 28(5):672–680

    Article  PubMed  PubMed Central  Google Scholar 

  19. Waikakul S, Chumtup W, Chotivichit A, Vanadurongwan B, Assawamongkolgui A, Rojanawanich V (2003) A knee model for arthrocentesis simulation. J Med Assoc Thail 86:282–287

    Google Scholar 

  20. Wong IH, Denkers M, Urquhart N, Farrokhyar F (2013) Construct validity testing of the Arthroscopic Knot Trainer (ArK). Knee Surg Sports Traumatol Arthrosc 23(3):906–911

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge the Scientific Innovation and Education Development Institute (SIEDI) for support of this study.

Author contributions

L.R.P. contributed to conception and design, acquisition of data, statistical analysis and interpretation of data, drafting of the manuscript, critical revision for important intellectual content, final approval of the manuscript to be published, and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. W.M.A.J. contributed to conception and design, acquisition of data, statistical analysis and interpretation of data, drafting of the manuscript, critical revision for important intellectual content, final approval of the manuscript to be published, and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. G.C. contributed to conception and design, acquisition of data, statistical analysis and interpretation of data, drafting of the manuscript, critical revision for important intellectual content, final approval of the manuscript to be published, and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. M.L. contributed to conception and design, acquisition of data, statistical analysis and interpretation of data, drafting of the manuscript, critical revision for important intellectual content, final approval of the manuscript to be published, and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luciano Rodrigo Peres.

Ethics declarations

Conflict of interest

There are no conflicts of interest involved.

Appendix

Appendix

Questionnaire

Simulator “Kneetrainer 1”

  1. A.

    Tactile identification of the bone structures and soft tissues

    • Consistency*

    • Resistance**

    • Size (Adequate/Inadequate)

    • Form (Adequate/Inadequate)

  2. B.

    Arthroscopic identification of structures and soft tissues

    • Consistency*

    • Resistance**

    • Size (Adequate/Inadequate)

    • Form (Adequate/Inadequate)

  3. C.

    Meniscectomy

    • Identification and characterization of the injury

    • Consistency*

    • Resistance**

    • General procedure (Adequate/Inadequate)

  4. D.

    ACL reconstruction

    • Consistency*

    • Resistance**

    • Screw interference (Adequate/Inadequate)

    • General procedure (Adequate/Inadequate)

  5. E.

    Final questions

    • Do you know other realistic simulator with the same surgical options? (Yes or No)

    • Do you think the proper use of “Kneetrainer 1” is capable of generating skills and/or modify the attitudes of surgeons in training? (Yes or No)

    • On a scale of 1 to 5, how would you rate the “Kneetrainer 1” as a surgical simulator realistic?

*Points:

  1. 1.

    Softened compared to normal tissue

  2. 2.

    Hardened compared to normal tissue

  3. 3.

    Amended compared to normal tissue but without prejudice to the simulation

  4. 4.

    Similar to normal tissues: without undergoing structural modifications

**Points:

  1. 1.

    Absence resistance when compared to normal tissue

  2. 2.

    Increased resistance when compared to normal tissue

  3. 3.

    Resistance reduction when compared to normal tissue

  4. 4.

    Resistance change compared to normal tissue but without prejudice to the surgical simulation

  5. 5.

    Similar to normal tissues: without undergoing structural modifications

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peres, L.R., Junior, W.M.A., Coelho, G. et al. A new simulator model for knee arthroscopy procedures. Knee Surg Sports Traumatol Arthrosc 25, 3076–3083 (2017). https://doi.org/10.1007/s00167-016-4099-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4099-9

Keywords

Navigation