Force measurement metrics for simulated elbow arthroscopy training

Force measurement metrics for simulated elbow arthroscopy training

Hilgersom, Nick F.J. (Universiteit van Amsterdam)
Horeman, T. (TU Delft Medical Instruments & Bio-Inspired Technology; Vrije Universiteit Amsterdam)
Bleys, Ronald L.A.W. (University Medical Center Utrecht)
Eygendaal, Denise (Universiteit van Amsterdam; Amphia Hospital)
van den Bekerom, Michel P.J. (Onze Lieve Vrouwe Gasthuis)
Tuijthof, G.J.M. (TU Delft Medical Instruments & Bio-Inspired Technology; Universiteit van Amsterdam; Zuyd University of Applied Science)

2018

Background: Elbow arthroscopy is a difficult surgical technique. Objective metrics can be used to improve safe and effective training in elbow arthroscopy. Force exerted on the elbow tissue during arthroscopy can be a measure of safe tissue manipulation. The purpose of this study was to determine the force magnitude and force direction used by experts during arthroscopic elbow navigation in cadaveric specimens and assess their applicability in elbow arthroscopy training. Methods: Two cadaveric elbows were mounted on a Force Measurement Table (FMT) that allowed 3-dimensional measurements (x-, y-, and z-plane) of the forces exerted on the elbow. Five experts in elbow arthroscopy performed arthroscopic navigation once in each of two cadaveric elbows, navigating through the posterior, posterolateral and anterior compartment in a standardized fashion with visualization of three to four anatomic landmarks per compartment. The total absolute force (F_abs) and force direction exerted (α and β) on the elbow during arthroscopy were recorded. α being the angle in the horizontal plane and β being the angle in the vertical plane. The 10th–90th percentiles of the data were used to set threshold levels for training. Results: The median F_abs was 24 N (19 N – 30 N), 27 N (20 N – 33 N) and 29 N (23 N – 32 N) for the posterior, posterolateral and anterior compartment, respectively. The median α was - 29° (- 55° – 5°), - 23° (- 56° – -1°) and 4° (- 22° – -18°) for the posterior, posterolateral and anterior compartment, respectively. The median β was - 71° (- 80° – -65°), - 76° (- 86° – -69°) and - 75° (- 81° – -71°) for the posterior, posterolateral and anterior compartment, respectively. Conclusion: Expert data on force magnitude and force direction exerted on the elbow during arthroscopic navigation in cadaveric specimens were collected. The proposed maximum allowable force of 30 N (smallest 90th percentile of F_abs) exerted on the elbow tissue, and the 10th–90th percentile range of the force directions (α and β) for each compartment may be used to provide objective feedback during arthroscopic skills training.

Arthroscopy
Cadaver
Education
Elbow
Experts
Navigational forces
Skills assessment

http://resolver.tudelft.nl/uuid:e2247d38-786a-4d56-a86f-20126a79394b

https://doi.org/10.1186/s40634-018-0157-1

2197-1153

Journal of Experimental Orthopaedics, 5 (1)

Institutional Repository

journal article

© 2018 Nick F.J. Hilgersom, T. Horeman, Ronald L.A.W. Bleys, Denise Eygendaal, Michel P.J. van den Bekerom, G.J.M. Tuijthof