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The Development of an Objective Model to Assess Arthroscopic Performance

¹ University of Connecticut Health Center, Medical Arts and Research Building, 263 Farmington Avenue, Farmington, CT 06034-4037. E-mail address for A. Mazzocca: mazzocca{at}uchc.edu

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the University of Connecticut Medical Student Summer Research Program and the Department of Orthopaedic Surgery at the University of Connecticut. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of more than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Arthrex Inc., Naples, Florida). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Two measures from the educational literature were adapted for use specifically for arthroscopy: a task-specific checklist and a global rating scale were combined to create the Basic Arthroscopic Knee Skill Scoring System. Fifty-nine residents, three sports medicine fellows, and six sports medicine fellowship-trained attending surgeons were recruited. After completing a demographic survey, including the postgraduate year and number of knee and shoulder arthroscopies performed, each subject performed a diagnostic knee arthroscopy and a partial meniscectomy on a cadaver knee while being assessed by a single evaluator using the Basic Arthroscopic Knee Skill Scoring System.

Results: There was a strong positive correlation between global rating scale scores and both the postgraduate year (r = 0.93, p < 0.01) and the ranked number of knee arthroscopies performed (r = 0.88, p < 0.01). These scores detected significant differences between postgraduate years 1 and 2, and years 4 and 5 at the p 0.01 level and between years 2 and 3 at the p 0.05 level. Task-specific checklist scores were moderately correlated with both postgraduate year (r = 0.73, p < 0.01) and ranked number of knee arthroscopies performed (r = 0.64, p < 0.01). These scores detected significant differences only between postgraduate year-1 and year-2 residents at the p 0.01 level, indicating that these skills are acquired early in training.

Conclusion: The Basic Arthroscopic Knee Skill Scoring System can capture and differentiate levels of arthroscopic skill and was validated to objectively evaluate basic arthroscopic proficiency in a bioskills laboratory. This model will allow benchmarks of surgical skill to be created for each level of residency training and individual progress to be monitored over time.

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