A Force Measurement System for Training of Arthroscopic Tissue Manipulation Skills on Cadaveric Specimen

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