Probing forces of menisci: what levels are safe for arthroscopic surgery.
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.
Tuijthof
Gabriëlle J M
GJ
Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. g.j.tuijthof@amc.uva.nl
Horeman
Tim
T
Schafroth
Matthias U
MU
Blankevoort
Leendert
L
Kerkhoffs
Gino M M J
GM
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*
Clin Orthop Relat Res. 2009 Feb;467(2):546-52
18791774
J Bone Joint Surg Br. 2008 Apr;90(4):494-9
18378926
Surg Endosc. 2010 Dec;24(12):3102-8
20464416
Ir J Med Sci. 2008 Sep;177(3):253-6
18584274
J Robot Surg. 2008 Sep;2(3):151-8
27628252
Am J Sports Med. 2008 Jun;36(6):1139-42
18326032
Knee Surg Sports Traumatol Arthrosc. 2010 Feb;18(2):218-24
19629441
Surg Endosc. 2008 Jul;22(7):1614-9
17973165
Arthroscopy. 2002 Jul-Aug;18(6):E29
12098111
Stud Health Technol Inform. 2006;119:85-9
16404020
Clin Orthop Relat Res. 2008 Apr;466(4):963-8
18213507
Arthroscopy. 2002 Sep;18(7):795-800
12209439
Clin Orthop Relat Res. 1990 Mar;(252):19-31
2406069
J Appl Biomater Biomech. 2009 May-Aug;7(2):97-103
20799169
Stud Health Technol Inform. 2003;94:413-8
15455938