Wide Variability of Pediatric Knee Arthroscopy Case Volume in Orthopaedic Surgery Residency

The purpose of this study was to evaluate orthopaedic surgery resident case volume and variability for adult and pediatric knee arthroscopy from 2016 to 2020.

The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopaedic surgery residents were analyzed. The average number of total (adult and pediatric), adult, and pediatric knee arthroscopy cases were compared from 2016 to 2020. The 10th and 90th percentiles of case volumes for adult and pediatric knee arthroscopy procedures were compared from 2016 to 2020 to determine caseload variability.

There was an 18% increase in pediatric knee arthroscopy cases between 2016 and 2020 (average: 13.9 ± 10 to 16.4 ± 13; P < .005), a 5.4% decrease in adult knee arthroscopy cases (100 ± 45 to 94.6 ± 47; P < .027), and a 2.6% decrease in total knee arthroscopy (113.9 ± 47 to 111 ± 51; P = .264) cases. There was an 11-fold difference in the number of pediatric knee arthroscopy cases performed between the 10th and 90th percentile of residents in 2020 (3 vs 33 cases, respectively), a 3.28-fold difference for adult knee arthroscopy (47 vs 154, respectively), and a 2.98-fold difference for total knee arthroscopy (59 vs 176, respectively).

Pediatric knee arthroscopy comprises a small yet growing percentage of total knee arthroscopy case volume of graduating orthopaedic surgery residents. However, wide variability in resident exposure is present and likely masked by the abundance of adult cases performed each year.

The findings presented in this study may assist in optimizing arthroscopy resident education. Existing ACL reconstruction and knee arthroscopy case minimum requirements could be updated to include a set number of pediatric cases. These changes might help reduce case volume variability and discrepancies in resident education.