Arthroscopic Simulation-Based Training of Orthopaedic Surgery Residents: Past, Present, and Future.

Simulation-based training is required by many medical specialties. Barriers, however, have prevented widespread implementation of simulators for arthroscopic training. The advantages of arthroscopic simulator-based training of residents include decreased errors, decreased cost of training, and improved patient care.

Live Observational Objective Assessment of Operative Performance in a Cadaveric Model is Equivalent to Delayed Video-Based Assessment.

Purpose: The purpose of our study was to compare real-time, live observational scoring with delayed retrospective video review of operative performance and to determine whether the evaluation method affected the attainment of proficiency benchmarks.

Methods: Sixteen arthroscopy/sports medicine fellows and 2 senior residents completed training to perform arthroscopic Bankart repairs (ABRs) and arthroscopic rotator cuff repairs (ARCRs) using a proficiency-based progression curriculum. Each final operative performance for 15 randomly selected ABRs and 13 ARCRs performed on cadavers were scored live (observation during the operative performance) and on delayed video review (6-8 weeks) by 1 of 15 trained raters using validated metric-based (step and error) assessment tools.

A Proficiency-Based Progression Simulation Training Curriculum to Acquire the Skills Needed in Performing Arthroscopic Bankart and Rotator Cuff Repairs-Implementation and Impact.

Purpose: To investigate the impact of a proficiency-based progression (PBP) curriculum employed to teach trainees in the skills needed to demonstrate proficiency for an arthroscopic Bankart repair (ABR) and an arthroscopic rotator cuff repair (ARCR) by objectively comparing pre- and immediate postcourse performances.

Methods: In a prospective study, 16 arthroscopy/sports medicine fellows and 2 senior residents (complete group: N = 18) were randomly assigned to perform a precourse cadaveric ABR (Bankart subgroup: N = 6), ARCR (cuff subgroup: N = 6), or basic skills on a shoulder simulator (N = 6). After completing a PBP training curriculum, all 18 registrants performed both an ABR and ARCR scored in real time by trained raters using previously validated metrics.

Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study.

Background: Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears.

Methods: We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study.

Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique.

Purpose: The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears.

Methods: Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3.

Arthroscopic Rotator Cuff Repair Metrics: Establishing Face, Content, and Construct Validity in a Cadaveric Model.

Purpose: To create and determine face validity and content validity of arthroscopic rotator cuff repair (ARCR) performance metrics, to confirm construct validity of the metrics coupled with a cadaveric shoulder, and to establish a performance benchmark for the procedure on a cadaveric shoulder.

Methods: Five experienced arthroscopic shoulder surgeons created step, error, and sentinel error metrics for an ARCR. Fourteen shoulder arthroscopy faculty members from the Arthroscopy Association of North America formed the modified Delphi panel to assess face and content validity.

Editorial Commentary: Harnessing Surgical Simulation-Saddle up for a Long and Rigorous Ride!

Arthroscopic simulation tools will assist in the training of skills that are transferrable to the operating room. Success in that endeavor requires the following: relevant outcome metrics rather than surrogate measures of performance, evaluation tools that enable scoring of step and error metrics rather than global rating scales, construct validation of simulators and metrics based on actual performance, development of simulators that not only assess performance but also train additional skills and provide feedback, and a focus first on effective training as opposed to high-fidelity realism.

Surgical Management of Proximal Long Head Biceps Tendon Disorders.

Disorders of the long head of the biceps tendon can make a significant contribution to shoulder pain and dysfunction. Historically, open biceps tenotomy or a proximal tenodesis of the tendon through a deltopectoral approach was used to manage biceps tendonitis and instability. Recent developments have added additional options.

Inter-rater Reliability for Metrics Scored in a Binary Fashion-Performance Assessment for an Arthroscopic Bankart Repair.

Purpose: To determine the inter-rater reliability (IRR) of a procedure-specific checklist scored in a binary fashion for the evaluation of surgical skill and whether it meets a minimum level of agreement (≥0.8 between 2 raters) required for high-stakes assessment.

Methods: In a prospective randomized and blinded fashion, and after detailed assessment training, 10 Arthroscopy Association of North America Master/Associate Master faculty arthroscopic surgeons (in 5 pairs) with an average of 21 years of surgical experience assessed the video-recorded 3-anchor arthroscopic Bankart repair performance of 44 postgraduate year 4 or 5 residents from 21 Accreditation Council for Graduate Medical Education orthopaedic residency training programs from across the United States.

Editorial Commentary: Healthy Skepticism: An Invaluable Trait.

Using a switching stick from the posterior portal is a frequently employed method of identifying the location for the subscapularis split for a shoulder arthroscopic Latarjet. However, in a recent cadaveric study, in none of the 20 specimens studied did this technique result in the split being placed in the preferred position-the junction of the superior two-thirds and the inferior one-third of the subscapularis. As a result, if the position of the coracoid graft is too superior, the anteroinferior extension of the glenoid arc and the vector of the conjoined sling may be suboptimal and fail to restrain humeral head translation.

Editorial Commentary: "A Brush Too Broad" (Validation, Global Rating Scales, and the Like…What Do They Really Mean?).

Surgical simulation will play an increasingly important role in helping to train surgical skills. Tools of varying fidelity including benchtop models and virtual reality computer-generated simulations will be needed to most effectively train for accomplishing specific tasks and techniques. We must search for and identify how best to employ simulation to enable the trainee to master the requisite skills.

Editorial Commentary: A Task May Be Done Quickly, but Not Necessarily Well.

The value of video gaming in relation to endoscopic surgical skills is explored in this article. Subjects who had more experience and performed better on 3-dimensional games also performed better on an arthroscopic simulator during tasks requiring manipulation of tools. Although the correlation is established, no data are presented to support causation.

A Proficiency-Based Progression Training Curriculum Coupled With a Model Simulator Results in the Acquisition of a Superior Arthroscopic Bankart Skill Set.

Purpose: To determine the effectiveness of proficiency-based progression (PBP) training using simulation both compared with the same training without proficiency requirements and compared with a traditional resident course for learning to perform an arthroscopic Bankart repair (ABR).

Methods: In a prospective, randomized, blinded study, 44 postgraduate year 4 or 5 orthopaedic residents from 21 Accreditation Council for Graduate Medical Education-approved US orthopaedic residency programs were randomly assigned to 1 of 3 skills training protocols for learning to perform an ABR: group A, traditional (routine Arthroscopy Association of North America Resident Course) (control, n = 14); group B, simulator (modified curriculum adding a shoulder model simulator) (n = 14); or group C, PBP (PBP plus the simulator) (n = 16). At the completion of training, all subjects performed a 3 suture anchor ABR on a cadaveric shoulder, which was videotaped and scored in blinded fashion with the use of previously validated metrics.

Objective Assessment of Knot-Tying Proficiency With the Fundamentals of Arthroscopic Surgery Training Program Workstation and Knot Tester.

Purpose: To assess a new method for biomechanical assessment of arthroscopic knots and to establish proficiency benchmarks using the Fundamentals of Arthroscopic Surgery Training (FAST) Program workstation and knot tester.

Methods: The first study group included 20 faculty at an Arthroscopy Association of North America resident arthroscopy course (19.9 ± 8.

Metric Development for an Arthroscopic Bankart Procedure: Assessment of Face and Content Validity.

Purpose: To establish the metrics (operational definitions) necessary to characterize a reference arthroscopic Bankart procedure, and to seek consensus from experienced shoulder arthroscopists on the appropriateness of the steps, as well as errors identified.

Methods: Three experienced arthroscopic shoulder surgeons and an experimental psychologist (comprising the Metrics Group) deconstructed an arthroscopic Bankart procedure. Fourteen full-length videos were analyzed to identify the essential steps and potential errors.

The Bankart Performance Metrics Combined With a Cadaveric Shoulder Create a Precise and Accurate Assessment Tool for Measuring Surgeon Skill.

Purpose: To determine if previously validated performance metrics for an arthroscopic Bankart repair (ABR) coupled with a cadaveric shoulder are a valid assessment tool with the ability to discriminate between the performances of experienced and novice surgeons and to establish a proficiency benchmark for an ABR using a cadaveric shoulder.

Methods: Ten master/associate master faculty from an Arthroscopy Association of North America Resident Course (experienced group) were compared with 12 postgraduate year 4 and postgraduate year 5 orthopaedic residents (novice group). Each group was instructed to perform a diagnostic arthroscopy and a 3 suture anchor Bankart repair on a cadaveric shoulder.

The Bankart Performance Metrics Combined With a Shoulder Model Simulator Create a Precise and Accurate Training Tool for Measuring Surgeon Skill.

Purpose: To determine if a dry shoulder model simulator coupled with previously validated performance metrics for an arthroscopic Bankart repair (ABR) would be a valid tool with the ability to discriminate between the performance of experienced and novice surgeons, and to establish a proficiency benchmark for an ABR using a model simulator.

Methods: We compared an experienced group of arthroscopic shoulder surgeons (Arthroscopy Association of North America faculty) (n = 12) with a novice group (n = 7) (postgraduate year 4 or 5 orthopaedic residents). All surgeons were instructed to perform a diagnostic arthroscopy and a 3 suture anchor Bankart repair on a dry shoulder model.

A comparison of electrocochleography and high-pass noise masking of auditory brainstem response for diagnosis of Ménière's disease.

Objective: To study differences between electrocochleography (ECochG) and cochlear hydrops analysis masking procedure (CHAMP) in diagnosis of Ménière's disease.

Design: Retrospective case review from a tertiary referral center.

Study Sample: Thirty patients suspected to have Ménière's disease were assessed by ECochG and CHAMP tests.