Arthroscopic Shoulder Simulation Studies Reveal Improvements in Performance Metrics Without Proven Transferability to the Operating Room: A Systematic Review

Madeleine Grace DeClercq; Mitchell T Pfennig; James Gannon; Olamide Oshikoya; Bradley Perry; Kevin F Dunne; J Michael Wiater

doi:10.1016/j.arthro.2024.08.020

Arthroscopic Shoulder Simulation Studies Reveal Improvements in Performance Metrics Without Proven Transferability to the Operating Room: A Systematic Review

Arthroscopy. 2024 Sep 2:S0749-8063(24)00618-2. doi: 10.1016/j.arthro.2024.08.020. Online ahead of print.

Authors

Madeleine Grace DeClercq¹, Mitchell T Pfennig¹, James Gannon¹, Olamide Oshikoya², Bradley Perry³, Kevin F Dunne², J Michael Wiater⁴

Affiliations

¹ Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, U.S.A.; Departments of Orthopedic Surgery, Corewell Health William Beaumont University, Royal Oak, Michigan, U.S.A.
² Departments of Orthopedic Surgery, Corewell Health William Beaumont University, Royal Oak, Michigan, U.S.A.
³ General Surgery, Corewell Health William Beaumont University, Royal Oak, Michigan, U.S.A.
⁴ Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan, U.S.A.; Departments of Orthopedic Surgery, Corewell Health William Beaumont University, Royal Oak, Michigan, U.S.A.. Electronic address: j.michael.wiater@corewellhealth.org.

PMID: 39233191
DOI: 10.1016/j.arthro.2024.08.020

Abstract

Purpose: To evaluate the use of shoulder arthroscopic simulation in orthopaedic surgery trainees.

Methods: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed, and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I².

Results: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n = 9 [60%]), arthroscopic Bankart repairs (n = 3 [20%]), and rotator cuff repairs (n = 2 [13%]). Simulations primarily used virtual reality (60%) and benchtop models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool scores. Time to task completion improved significantly with training (range 13-439 seconds pretest to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I² = 87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pretest to 17.9-28.5 post-test), with low heterogeneity (I² = 20%). In addition, both camera and probe distances decreased after simulation use, whereas the 14-point anatomic checklist showed no pre- to post-test differences.

Conclusions: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated.

Level of evidence: Level IV, systematic review of Level I-IV studies.

Publication types

Review