Validation of the Anterior Cruciate Ligament (ACL) Module of the VirtaMed Virtual Reality Arthroscopy Trainer

To assess the newly developed anterior cruciate ligament (ACL) module of a VR arthroscopy trainer for content, construct and face validity.

Participants were divided into expert and novice groups based on their experience with ACL arthroscopy. Participants were given a standardized introduction, shown a video on how to use the simulator, and performed a 5-minute partial meniscectomy task, to familiarise them with the equipment. Participants then undertook an ACL reconstruction task. On completion, the simulator produced a summary of performance metrics for the following domains: Operation Time, ACL Reconstruction, Safety, Economy, Detailed Visualization and Total Score. A 7-point Likert scale questionnaire was used to assess the face and content validity of the simulator.

Twenty one participants from a hospital orthopaedic department were recruited. Five were classified as expert, 16 as novice.

An independent Mann-Whitney U test showed no significant differences between experts and novices for any of the domains. Questionnaire responses regarding hand-eye coordination, camera navigation training, diagnostic training, tunnel preparation and overall training capacity were scored as either 'good' or 'excellent' by more than 70% of the participants. All responses regarding the 'graft insertion task' scored low.

The current iteration of the VR knee ArthroS™ simulator (VirtaMed AG, Zurich, Switzerland) is promising, but requires further development of the ACL procedure, in particular the graft insertion task, before it can be considered as part of training curricula.