Abstract

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 (Fabs) 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 Fabs 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 Fabs) 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.

Details

Title
Force measurement metrics for simulated elbow arthroscopy training
Author
Hilgersom, Nick F J 1   VIAFID ORCID Logo  ; Horeman-Franse, Tim 2 ; Ronald L A W Bleys 3 ; Eygendaal, Denise 4 ; Michel P J van den Bekerom 5 ; Gabriëlle J M Tuijthof 6 ; Bertram The; Carina LE Gerritsma; Boerboom, Lex; Roeling, Tom; van der Pluijm, Marco; Michel PJ van den Bekerom

 Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands 
 Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands 
 Department of Anatomy, University Medical Centre Utrecht, Utrecht, the Netherlands 
 Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands 
 Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands 
 Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Zuyd University of Applied Science, Heerlen, the Netherlands 
Pages
1-9
Publication year
2018
Publication date
Oct 2018
Publisher
Springer Nature B.V.
e-ISSN
21971153
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2118720206
Copyright
Journal of Experimental Orthopaedics is a copyright of Springer, (2018). All Rights Reserved., © 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.