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Hilgersom NFJ, Horeman-Franse T, Bleys RLAW, Eygendaal D, van den Bekerom MPJ, Tuijthof GJM. Force measurement metrics for simulated elbow arthroscopy training. J Exp Orthop 2018; 5:45. [PMID: 30315425 PMCID: PMC6185876 DOI: 10.1186/s40634-018-0157-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/20/2018] [Indexed: 01/15/2023] Open
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.
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Affiliation(s)
- Nick F J Hilgersom
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Tim Horeman-Franse
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, the Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, the Netherlands.,Zuyd University of Applied Science, Nieuw Eyckholt 300, 6419 DJ, Heerlen, the Netherlands
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Obdeijn MC, Horeman T, de Boer LL, van Baalen SJ, Liverneaux P, Tuijthof GJM. Navigation forces during wrist arthroscopy: assessment of expert levels. Knee Surg Sports Traumatol Arthrosc 2016; 24:3684-3692. [PMID: 25448136 DOI: 10.1007/s00167-014-3450-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To facilitate effective and efficient training in skills laboratory, objective metrics can be used. Forces exerted on the tissues can be a measure of safe tissue manipulation. To provide feedback during training, expert threshold levels need to be determined. The purpose of this study was to define the magnitude and the direction of navigation forces used during arthroscopic inspection of the wrist. METHODS We developed a set-up to mount a cadaver wrist to a 3D force platform that allowed measurement of the forces exerted on the wrist. Six experts in wrist arthroscopy performed two tasks: (1) Introduction of the camera and visualization of the hook. (2) Navigation through the wrist with visualization of five anatomic structures. The magnitude (Fabs) and direction of force were recorded, with the direction defined as α being the angle in the vertical plane and β being the angle in the horizontal plane. The 10th-90th percentile of the data were used to set threshold levels for training. RESULTS The results show distinct force patterns for each of the anatomic landmarks. Median Fabs of the navigation task is 3.8 N (1.8-7.3), α is 3.60 (-54-44) and β is 260 (0-72). CONCLUSION Unique expert data on navigation forces during wrist arthroscopy were determined. The defined maximum allowable navigation force of 7.3 N (90th percentile) can be used in providing feedback on performance during skills training. The clinical value is that this study contributes to objective assessment of skills levels.
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Affiliation(s)
- Miryam C Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Lisanne L de Boer
- Department of Technical Medicine, MIRA Institute for Biomedical Technology and Technical Medicine Enschede, University of Twente, Enschede, Netherlands
| | - Sophie J van Baalen
- Department of Technical Medicine, MIRA Institute for Biomedical Technology and Technical Medicine Enschede, University of Twente, Enschede, Netherlands
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, Illkirch, France
| | - Gabrielle J M Tuijthof
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands.,Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Horeman T, Tuijthof GJM, Wulms PB, Kerkhoffs GMMJ, Gerards RM, Karahan M. A Force Measurement System for Training of Arthroscopic Tissue Manipulation Skills on Cadaveric Specimen. J Med Device 2016. [DOI: 10.1115/1.4034145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To improve arthroscopic skills, the preferred means of training is cadaveric tissue, because this gives the most realistic scenario. A drawback of cadaveric training is that objective performance tracking and accompanied feedback cannot be provided due to the absence of a suitable system. The main criteria were that the system should be compatible with any cadaveric joint, be used with any type of instrument, easy to set up, and measure two critical parameters that reflect the task efficiency (task time) and safety (forces due to instrument–tissue interaction). This resulted in the development of a force measurement system which consists of a custom-made universal vice, a custom-designed six degree-of-freedom (DOF) force measurement table (FMT) coupled to a computer equipped with customized software to record the time and forces in all directions. The FMT was calibrated and able to measure forces in the range of 0–750 N, with an accuracy of 0.1 N. During two cadaveric training courses, measurements were performed with the FMT. It was observed that the acquired force data could discriminate between novices and experts or reflect a certain phase of a navigation task performed in a cadaveric cow and human knee. A distinct phase highlighted from the force measurements is the insufficient joint stressing of novices during navigation. This results in too small a joint space for inspection and forces the novices to readjust the stressing. As forces cannot be seen, the FMT can contribute to more efficient training by providing explicit cues on the exerted loads during training. This enables a more precise supervision of the trainees.
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Affiliation(s)
- T. Horeman
- Department of Biomechanical Engineeering, Delft University of Technology, Delft 2628 CD, The Netherlands
- Academic Medical Centre, Amsterdam 2628 CD, The Netherlands
| | - G. J. M. Tuijthof
- Department of Biomechanical Engineeering, Delft University of Technology, Delft 2628 CD, The Netherlands
- Academic Medical Centre, Amsterdam 2628 CD, The Netherlands
| | - P. B. Wulms
- Department of Biomechanical Engineeering, Delft University of Technology, Delft 2628 CD, The Netherlands
| | | | - R. M. Gerards
- Academic Medical Centre, Amsterdam 1105 AZ, The Netherlands
| | - M. Karahan
- School of Medicine, Acibadem University, Ataşehir, İstanbul 34758, Turkey
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