Search

Background: Virtual-reality and cadaveric simulations are expensive and not readily accessible. Innovative and accessible training adjuncts are required to help to meet training needs. Cognitive task analysis has been used extensively to train pilots and in other surgical specialties. However, the use of cognitive task analyses within orthopaedics is in its infancy. The purpose of this study was to evaluate the effectiveness of a novel cognitive task analysis tool to train novice surgeons in diagnostic knee arthroscopy in high-fidelity, phantom-limb simulation., Methods: Three expert knee surgeons were interviewed independently to generate a list of technical steps, decision points, and errors for diagnostic knee arthroscopy. A modified Delphi technique was used to generate the final cognitive task analysis. A video and a voiceover were recorded for each phase of this procedure. These were combined to produce the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool that utilizes written and audiovisual stimuli to describe each phase of a diagnostic knee arthroscopy. In this double-blinded, randomized controlled trial, a power calculation was performed prior to recruitment. Sixteen novice orthopaedic trainees who performed ≤10 diagnostic knee arthroscopies were randomized into 2 equal groups. The intervention group (IKACTA group) was given the IKACTA tool and the control group had no additional learning material. They were assessed objectively (validated Arthroscopic Surgical Skill Evaluation Tool [ASSET] global rating scale) on a high-fidelity, phantom-knee simulator. All participants, using the Likert rating scale, subjectively rated the tool., Results: The mean ASSET score (and standard deviation) was 19.5 ± 3.7 points in the IKACTA group and 10.6 ± 2.3 points in the control group, resulting in an improvement of 8.9 points (95% confidence interval, 7.6 to 10.1 points; p = 0.002); the score was determined as 51.3% (19.5 of 38) for the IKACTA group, 27.9% (10.6 of 38) for the control group, and 23.4% (8.9 of 38) for the improvement. All participants agreed that the cognitive task analysis learning tool was a useful training adjunct to learning in the operating room., Conclusions: To our knowledge, this is the first cognitive task analysis in diagnostic knee arthroscopy that is user-friendly and inexpensive and has demonstrated significant benefits in training., Clinical Relevance: The IKACTA will provide trainees with a demonstrably strong foundation in diagnostic knee arthroscopy that will flatten learning curves in both technical skills and decision-making.

To evaluate the feasibility of identifying the anterior and posterior meniscofemoral ligaments (aMFL and pMFL, respectively) at arthroscopy, both visually and using the "meniscal tug test", which exploits the anatomical attachments of the posterior cruciate ligament (PCL) and MFLs. This is an observational type of study. Arthroscopy using anteromedial and anterolateral portals was performed in 68 knees in 68 patients (36 right, 32 left). The MFLs were identified using several anatomical cues, including their femoral and meniscal attachments, their obliquity relative to the PCL, and the meniscal tug test. Identification was classed as easy or hard by the operating surgeon. From 68 knees, the aMFL was seen and confirmed to be an MFL using the tug test in 60 (88%). Identification of the aMFL was classed as easy in 64 (94%), whilst the pMFL was easy to identify in only 6 (9%) of knees, of which 3 had a ruptured PCL. Thus, with the exception of PCL-deficient knees, it was felt that the meniscal "tug test" as applied in this study was not suitable for the pMFL. The study shows that identification of the aMFL is possible in most knees at arthroscopy, using the "tug test" and other anatomical cues. However, identification of the pMFL may require a posterior portal. A subgroup of PCL injuries in which the MFLs were intact was also observed. The "meniscal tug test" can be used in arthroscopic examinations of the PCL to distinguish between fibres of the true PCL from the MFLs, thus avoiding the misdiagnosis of partial versus complete PCL rupture. This will also aid studies examining the role of the MFLs in stabilising the PCL-deficient knee.

Overview: Introduction: The Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool utilizes simultaneous written and audiovisual stimuli to teach each phase of a diagnostic knee arthroscopy procedure, which has demonstrated significant benefits in training this procedure to novices. Indications & Contraindications: Phase 1: Operating Room and Patient Setup (Video 1) Phase 2: Preparation and Draping of the Patient (Video 2) Phase 3: Placement of Anterolateral Portal (Video 3) Phase 4: Diagnostic Arthroscopy of the Patellofemoral Joint (PFJ) and Lateral Gutter (Video 4) Phase 5: Diagnostic Arthroscopy of the Medial Compartment and Anteromedial Portal Placement (Video 5) Phase 6: Diagnostic Arthroscopy of the Intercondylar Notch and Lateral Compartment (Video 6) Phase 7: Postoperative Care and Rehabilitation Results: We undertook a randomized double-blinded controlled trial to evaluate the effectiveness of the IKACTA tool to train novice residents in diagnostic knee arthroscopy9. Pitfalls & Challenges: Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation. For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applicable. Rationale: This learning tool allows a trainee to learn each technical step, the cognitive decision-making underpinning each step, and potential errors and solutions relevant to each phase of the procedure. Furthermore, the learner can use written and audiovisual modalities simultaneously to learn this technique by reading the written component of the tool first and then watching the relevant video clips with the audio recordings for each phase of the procedure. Alternative training techniques currently include the traditional apprenticeship model, which is becoming increasingly insufficient in the current environment of reduced training hours7,8. Adjuncts to this model are essential to help meet training needs. The IKACTA tool has demonstrated significant objective benefits for novice trainees to learn diagnostic knee arthroscopy9. The idea behind this learning tool is for the trainee surgeon to use this tool independent of the trainer, prior to attending the operating room. The tool provides trainees with knowledge and cognitive understanding of the procedural steps before they perform this procedure on patients. They are aware of potential errors and methods to avoid or overcome these errors. We believe that this tool will reduce the initial difficult phase of the learning curve for junior residents and, therefore, will improve training efficiency in the operating room. [ABSTRACT FROM AUTHOR]

Background: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. Findings: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. Conclusions: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance. [ABSTRACT FROM AUTHOR]

Knee arthroscopy has proved to be a useful tool in the diagnosis of common knee intra-articular pathologies and has become a mainstay of treatment for meniscal, cruciate and chondral disorders of the knee. The aim of this article is to give a brief history of arthroscopic surgery, explain the safe positioning of the patient on the operating table and how to navigate the knee with an arthroscope, and cover the potential complications. [ABSTRACT FROM AUTHOR]

Abstract: There are various surgical approaches to the knee joint and its surrounding structures, and such approaches are generally designed to allow the best access to an area of pathology whilst safeguarding important surrounding structures. In this article we provide a concise account of the commonly used approaches to the knee joint. Many knee procedures nowadays are routinely performed via arthroscopic or arthroscopic assisted methods. However, knowledge of open surgical access to the knee remains vital for knee arthroplasty surgery and cases where arthroscopy is not possible or practical. [Copyright &y& Elsevier]