Skip to main content
SpringerLink
Log in

Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Simulator arthroscopy training has gained popularity in recent years. However, it remains unclear what level of competency surgeons may achieve in what time frame using virtual training. It was hypothesized that 10 h of training would be sufficient to reach the target level defined by experts based on the Diagnostic Arthroscopic Skill Score (DASS).

Methods

The training concept was developed by ten instructors affiliated with the German-speaking Society of Arthroscopy and Joint Surgery (AGA). The programme teaches the basics of performing arthroscopy; the main focus is on learning and practicing manual skills using a simulator. The training was based on a structured programme of exercises designed to help users reach defined learning goals. Initially, camera posture, horizon adjustment and control of the direction of view were taught in a virtual room. Based on these skills, further training was performed with a knee model. The learning progress was assessed by quantifying the exercise time, camera path length and instrument path length for selected tasks. At the end of the course, the learners’ performance in diagnostic arthroscopy was evaluated using DASS. Participants were classified as novice or competent based on the number of arthroscopies performed prior to the assessment.

Results

Except for one surgeon, 131 orthopaedic residents and surgeons (29 women, 102 men) who participated in the seven courses agreed to anonymous data analysis. Fifty-eight of them were competents with more than ten independently performed arthroscopies, and 73 were novices, with fewer than ten independently performed arthroscopies. There were significant reductions in exercise time, camera path length and instrument path length for all participants after the training, indicating a rapid increase in performance. No difference in camera handling between the dominant and non-dominant sides was found in either group. The competents performed better than the novices in various tasks and achieved significantly better DASS values on the final performance test.

Conclusions

Our data have demonstrated that arthroscopic skills can be taught effectively on a simulator, but a 10-h course is not sufficient to reach the target level set by experienced arthroscopists. However, learning progress can be monitored more objectively during simulator training than in the operating room, and simulation may partially replace the current practice of arthroscopic training.

Level of evidence

III.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Aïm F, Lonjon G, Hannouche D, Nizard R (2016) Effectiveness of virtual reality training in orthopaedic surgery. Arthroscopy 32:224–232

    Article  PubMed  Google Scholar 

  2. Akhtar K, Sugand K, Wijendra A, Standfield NJ, Cobb JP, Gupte CM (2015) Training safer surgeons: How do patients view the role of simulation in orthopaedic training? Patient Saf Surg 9:11. https://doi.org/10.1186/s13037-015-0058-5

    Article  PubMed  PubMed Central  Google Scholar 

  3. Anetzberger H, Becker R, Eickhoff H, Seibert FJ, Döring B, Haasters F, Mohr M, Reppenhagen S (2021) The Diagnostic Arthroscopy Skill Score (DASS) – a reliable and suitable assessment tool for arthroscopic skill training. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06554-3

    Article  PubMed  Google Scholar 

  4. Anetzberger H, Mohr M, Eickhoff HJ, Seibert FJ, Döring B, Reppenhagen S (2021) Drei Jahre AGA Simulator Training Arthroskopie. Ein Erfahrungsbericht. Arthroskopie. https://doi.org/10.1007/s00142-020-00428-5

    Article  Google Scholar 

  5. Bartlett JD, Lawrence JE, Stewart ME, Nakano N, Khanduja V (2018) Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? Bone Jt J 100-B:559–565

    Article  CAS  Google Scholar 

  6. Baumann Q, Hardy A, Courage O, Lacombes P, Accadbled F (2019) Lessons taught by a knee arthroscopy simulator about participants in a European arthroscopy training programme. Orthop Traumatol Surg Res 105:287–291

    Article  Google Scholar 

  7. Bouaicha S, Epprecht S, Jentzsch T, Ernstbrunner L, El Nashar R, Rahm S (2020) Three days of training with a low-fidelity arthroscopy triangulation simulator box improves task performance in a virtual reality high-fidelity virtual knee arthroscopy simulator. Knee Surg Sports Traumatol Arthrosc 28:862–868

    Article  PubMed  Google Scholar 

  8. Boutefnouchet T, Laios T (2016) Transfer of arthroscopic skills from computer simulation training to the operating theatre: a review of evidence from two randomised controlled studies. SICOT J 2:4. https://doi.org/10.1051/sicotj/2015039

    Article  PubMed  PubMed Central  Google Scholar 

  9. Camp CL (2018) Editorial Commentary: “Virtual Reality” simulation in orthopaedic surgery: realistically helpful, or virtually useless? Arthroscopy 34:1678–1679

    Article  PubMed  Google Scholar 

  10. Camp CL, Krych AJ, Stuart MJ, Regnier TD, Mills KM, Turner NS (2016) Improving resident performance in knee arthroscopy: a prospective value assessment of simulators and cadaveric skills laboratories. J Bone Jt Surg Am 98:220–225

    Article  Google Scholar 

  11. 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 Jt Surg Am 96:1798–1806

    Article  Google Scholar 

  12. Cychosz CC, Tofte JN, Johnson A, Gao Y, Phisitkul P (2018) Fundamentals of arthroscopic surgery training program improves knee arthroscopy simulator performance in arthroscopic trainees. Arthroscopy 34:1543–1549

    Article  PubMed  Google Scholar 

  13. Fitts PM, Posner MI (1967) Human performance. Brooks/Cole Pub. Co, Belmont

    Google Scholar 

  14. Garfjeld Roberts P, Guyver P, Baldwin M, Akhtar K, Alvand A, Price AJ, Rees JL (2017) Validation of the updated ArthroS simulator: face and construct validity of a passive haptic virtual reality simulator with novel performance metrics. Knee Surg Sports Traumatol Arthrosc 25:616–625

    Article  PubMed  Google Scholar 

  15. Jung K, Kang DJ, Kekatpure AL, Adikrishna A, Hong J, Jeon IH (2016) A new wide-angle arthroscopic system: a comparative study with a conventional 30° arthroscopic system. Knee Surg Sports Traumatol Arthrosc 24:1722–1729

    Article  PubMed  Google Scholar 

  16. Kagerer FA, Contreras-Vidal IL, Stelmach GE (1997) Adaptation to gradual as compared with sudden visuo-motor distortions. Exp Brain Res 115:537–561

    Article  Google Scholar 

  17. Magill RA, Hall KG (1990) A review of the contextual interference effect in motor skill acquisition. Hum Mov Sci 9:241–289

    Article  Google Scholar 

  18. Pedowitz RA (2017) Virtual reality surgical simulation for arthroscopy training. J Med Educ Train 1:008

    Google Scholar 

  19. Rahm S, Wieser K, Bauer DE, Waibel FW, Meyer DC, Gerber C, Fucentese SF (2018) Efficacy of standardized training on a virtual reality simulator to advance knee and shoulder arthroscopic motor skills. BMC Musculoskelet Disord 16(19):150. https://doi.org/10.1186/s12891-018-2072-0

    Article  Google Scholar 

  20. Rashed S, Ahrens PM, Maruthainar N, Garlick N, Saeed MZ (2018) The role of arthroscopic simulation in teaching surgical skills: a systematic review of the literature. JBJS Rev 6:e8. https://doi.org/10.2106/JBJS.RVW.17.00201

    Article  PubMed  Google Scholar 

  21. Shea JB, Morgan RL (1979) Contextual interference effects on the acquisition, retention, and transfer of a motor skill. J Exp Psychol Learn Mem Cogn 5:179–187

    Article  Google Scholar 

  22. St. Pierre P (2018) Editorial Commentary: proficiency-based training: are we ready for a new way to train and test orthopaedic surgeons? Arthroscopy 34:2199–2200

    Article  PubMed  Google Scholar 

  23. Stunt JJ, Kerkhoffs GM, van Dijk CN, Tuijthof GJM (2015) Validation of the ArthroS virtual reality simulator for arthroscopic skills. Knee Surg Sports Traumatol Arthrosc 23:3436–3442

    Article  CAS  PubMed  Google Scholar 

  24. Thut G, Cook ND, Regard M, Leenders KL, Halsband U, Landis T (1996) Intermanual transfer of proximal and distal motor engrams in humans. Exp Brain Res 108:321–327

    Article  CAS  PubMed  Google Scholar 

  25. Tofte JN, Westerlind BO, Martin KD, Guetschow BL, Uribe-Echevarria B, Rungprai C, Phisitkul P (2017) Knee, shoulder, and fundamentals of arthroscopic surgery training: validation of a virtual arthroscopy Simulator. Arthroscopy 33:641–646

    Article  PubMed  Google Scholar 

  26. Walbron P, Common H, Thomazeau H, Hosseini K, Peduzzi L, Bulaid Y, Sirveaux F (2020) Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res 106:717–724

    Article  PubMed  Google Scholar 

  27. Wang KC, Bernardoni ED, Cotter EJ, Cole BJ, Verma NN, Romeo AA, Bush-Joseph CA, Bach BR, Frank RM (2019) Impact of simulation training on diagnostic arthroscopy performance: a randomized controlled trial. Arthrosc Sports Med Rehabil 1:e47–e57. https://doi.org/10.1016/j.asmr.2019.07.002

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wittmann M, Kagerer F, Poeppel E (1999) Wie, wann und was können wir lernen? Zeitlichen und räumliche Merkmale sensomotorischer Koordination. Zentralbl Chir 124:876–883

    CAS  PubMed  Google Scholar 

  29. Yari SS, Jandhyala CK, Sharareh B, Athiviraham A, Shybut TB (2018) Efficacy of a virtual arthroscopic simulator for orthopaedic surgery residents by year in training. Orthop J Sports Med. https://doi.org/10.1177/2325967118810176

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Author notes

  1. Hermann Anetzberger and Stephan Reppenhagen have contributed equally to this work.

Authors and Affiliations

  1. Orthopädische Gemeinschaftspraxis am OEZ, Hanauer Str. 65, 80993, Munich, Germany

    Hermann Anetzberger

  2. Orthopädische Klinik König-Ludwig-Haus, Brettreichstraße 11, 97074, Wurzburg, Germany

    Stephan Reppenhagen

  3. Orthopädie u. Unfallchirurgie, Abteilung Arthroskopie u. Schulterchirurgie, GFO-Kliniken Troisdorf, Hospitalstr. 45, 53840, Troisdorf, Germany

    Hansjörg Eickhoff

  4. Medizinische Universität Graz, Universitätsklinik für Orthopädie und Traumatologie LKH-Uniklinikum, Auenbruggerplatz 7a, 8010, Graz, Austria

    Franz Josef Seibert

  5. Zentrum für Orthopädie und Unfallchirurgie, Medizinische Hochschule Theodor Fontane, 14770, Brandenburg, Germany

    Bernd Döring & Roland Becker

  6. Schönklinik München Harlaching, Harlachinger Straße 51, 81547, Munich, Germany

    Florian Haasters

  7. Orthopädisches Zentrum Bad Säckingen, Rudolf-Eberle-Platz 3, 79713, Bad Sackingen, Germany

    Michael Mohr

Authors
  1. Hermann Anetzberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephan Reppenhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hansjörg Eickhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franz Josef Seibert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Döring
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Florian Haasters
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roland Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hermann Anetzberger.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethical committee of the Bavarian State Chamber of Physicians (BLÄK) (approval number: 2021-1033).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anetzberger, H., Reppenhagen, S., Eickhoff, H. et al. Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score. Knee Surg Sports Traumatol Arthrosc 30, 1471–1479 (2022). https://doi.org/10.1007/s00167-021-06648-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06648-y

Keywords

Search

Navigation