Probing forces of menisci: what levels are safe for arthroscopic surgery
Identifieur interne : 003645 ( Main/Merge ); précédent : 003644; suivant : 003646Probing forces of menisci: what levels are safe for arthroscopic surgery
Auteurs : Gabriëlle J. M. Tuijthof [Pays-Bas] ; Tim Horeman [Pays-Bas] ; Matthias U. Schafroth [Pays-Bas] ; Leendert Blankevoort [Pays-Bas] ; Gino M. M. J. Kerkhoffs [Pays-Bas]Source :
- Knee Surgery, Sports Traumatology, Arthroscopy [ 0942-2056 ] ; 2010.
Abstract
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).
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 (
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 (
The results indicate the necessity of using a safety level for tissue manipulation when training arthroscopy and a value for is magnitude.
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DOI: 10.1007/s00167-010-1251-9
PubMed: 20814661
PubMed Central: 3023859
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Tuijthof</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam</wicri:regionArea><wicri:noRegion>1105 AZ Amsterdam</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Delft University of Technology, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Horeman, Tim" sort="Horeman, Tim" uniqKey="Horeman T" first="Tim" last="Horeman">Tim Horeman</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Delft University of Technology, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Schafroth, Matthias U" sort="Schafroth, Matthias U" uniqKey="Schafroth M" first="Matthias U." last="Schafroth">Matthias U. 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M." last="Tuijthof">Gabriëlle J. M. Tuijthof</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam</wicri:regionArea><wicri:noRegion>1105 AZ Amsterdam</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Delft University of Technology, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Horeman, Tim" sort="Horeman, Tim" uniqKey="Horeman T" first="Tim" last="Horeman">Tim Horeman</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Delft University of Technology, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Schafroth, Matthias U" sort="Schafroth, Matthias U" uniqKey="Schafroth M" first="Matthias U." last="Schafroth">Matthias U. Schafroth</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam</wicri:regionArea><wicri:noRegion>1105 AZ Amsterdam</wicri:noRegion></affiliation></author><author><name sortKey="Blankevoort, Leendert" sort="Blankevoort, Leendert" uniqKey="Blankevoort L" first="Leendert" last="Blankevoort">Leendert Blankevoort</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam</wicri:regionArea><wicri:noRegion>1105 AZ Amsterdam</wicri:noRegion></affiliation></author><author><name sortKey="Kerkhoffs, Gino M M J" sort="Kerkhoffs, Gino M M J" uniqKey="Kerkhoffs G" first="Gino M. M. J." last="Kerkhoffs">Gino M. M. J. Kerkhoffs</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam</wicri:regionArea><wicri:noRegion>1105 AZ Amsterdam</wicri:noRegion></affiliation></author></analytic><series><title level="j">Knee Surgery, Sports Traumatology, Arthroscopy</title><idno type="ISSN">0942-2056</idno><idno type="eISSN">1433-7347</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>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).</p></sec><sec><title>Method</title><p>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 (<italic>P</italic> < 0.05). AMPFs were compared to the TMPF (estimated to be 8.5 N).</p></sec><sec><title>Results</title><p>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 (<italic>P</italic> < 0.05). The AMPFs are in the same order of magnitude as the TMPF.</p></sec><sec><title>Conclusion</title><p>The results indicate the necessity of using a safety level for tissue manipulation when training arthroscopy and a value for is magnitude.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bayona, S" uniqKey="Bayona S">S Bayona</name></author><author><name sortKey="Fernandez Arroyo, Jm" uniqKey="Fernandez Arroyo J">JM Fernandez-Arroyo</name></author><author><name sortKey="Martin, I" uniqKey="Martin I">I Martin</name></author><author><name sortKey="Bayona, P" uniqKey="Bayona P">P Bayona</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buchner, M" uniqKey="Buchner M">M Buchner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chami, G" uniqKey="Chami G">G Chami</name></author><author><name sortKey="Ward, J" uniqKey="Ward J">J Ward</name></author><author><name 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