Arthroscopic Shoulder Simulation May Improve Short-Term Speed, Accuracy, and Efficiency of Surgical Movements in Orthopaedic Residents and Fellows: A Systematic Review.

Purpose: To systematically review the effectiveness and validity of orthopaedic surgery training using simulation technologies including augmented reality, virtual reality, and/or mixed reality within arthroscopic shoulder surgery.

Methods: A literature search was conducted of the EMBASE and PubMed databases from inception to January 2024 per the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Included studies described arthroscopic shoulder surgery simulation training among orthopaedic surgery trainees. Exclusion criteria included studies assessing nonarthroscopic and nonshoulder simulations, non-English-language studies, case reports, animal studies, studies with overlapping cohorts, and review articles. Simulation characteristics, performance measurements, and validity assessed were extracted. The Cochrane risk-of-bias tool and Newcastle-Ottawa Scale assessed study quality. Simulation type, validation type, and simulation outcomes were assessed.

Results: A total of 15 included articles, published from 2011 to 2021, evaluated 421 residents or fellows and 17 medical students. Virtual reality was used in 40% of studies and mixed reality in 60%. The most common outcomes assessed were time to completion (80%), visualizing and probing task performance (60%), and the Arthroscopic Surgery Skill Evaluation Tool (33.3%). Construct validity was assessed in 46.7% of studies, transfer validity in 26.7%, face validity in 20%, and content validity in 6.7%. Three studies demonstrated improved performance in those undergoing simulation training compared with nonsimulation groups. Two studies (13.3%) demonstrated improved time-to-task completion and decreased camera distance traveled when using simulation training. One study demonstrated that postgraduate year 1 and postgraduate year 5 residents derived the greatest benefit from simulation training.

Conclusions: Arthroscopic shoulder simulation training may benefit the surgical skills of orthopaedic residents of all levels of experience as measured by time-to-completion, accuracy, and efficiency of surgical movements. Simulation training exhibits differences in operative time between more- and less-experienced orthopaedic surgeons and trainees. Virtual reality simulation training may result in more-efficient orthopaedic surgical techniques.

Level Of Evidence: Level III, systematic review of level I-III studies.