title: Probing forces of menisci: what levels are safe for arthroscopic surgery.
abstract: OBJECTIVE
  to facilitate effective learning, feedback on performance during arthroscopic training is essential. Less attention has been paid to feedback on monitoring safe handling of delicate tissues such as meniscus. The goal is to measure in vitro probing forces of menisci and compare them with a theoretical maximum probing force (TMPF).
  
  
  METHODS
  menisci samples of ten cadavers were mounted on force platforms to measure probing forces up to 20 N in three directions. Nineteen subjects participated: six novices (experience <60 arthroscopies), ten intermediates (>60 arthroscopies), and three faculty (>250 a year). All had to perform three tasks on each meniscus sample with an arthroscopic probe: push three times on the superior meniscal surface, perform one continuous run on the superior meniscal surface, and push three times on the inferior meniscal surface. The absolute maximum probing force (AMPF) was determined for each condition. A multivariable linear regression analysis was performed to assess the influence of experience on the force magnitude (P < 0.05). AMPFs were compared to the TMPF (estimated to be 8.5 N).
  
  
  RESULTS
  the AMPF of the push task was on average 2.8 N (standard deviation (SD) of 0.8 N), of the continuous run task 2.5 N (SD 0.9 N), and of the pull task 3.9 N (SD 2.0 N). Significant difference was present between experts and novices (P < 0.05). The AMPFs are in the same order of magnitude as the TMPF.
  
  
  CONCLUSIONS
  the results indicate the necessity of using a safety level for tissue manipulation when training arthroscopy and a value for is magnitude.
authors.affiliation: Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. g.j.tuijthof@amc.uva.nl
authors.forename: Gabriëlle J M
authors.initials: GJ
authors.lastname: Tuijthof
authors.forename: Tim
authors.initials: T
authors.lastname: Horeman
authors.forename: Matthias U
authors.initials: MU
authors.lastname: Schafroth
authors.forename: Leendert
authors.initials: L
authors.lastname: Blankevoort
authors.forename: Gino M M J
authors.initials: GM
authors.lastname: Kerkhoffs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000193:education; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007721:Knowledge of Results, Psychological; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*
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