Can Virtual Reality Simulation Trainers Provide Transferable Skills in Knee Arthroscopy?

Virtual reality (VR) simulation is emerging as a high-fidelity training tool for knee arthroscopy, providing a risk-free learning environment. This study systematically evaluates current evidence on the effectiveness of VR simulation training in providing transferable skills for knee arthroscopy and the effects on operative time, complication rates and clinical outcomes. A systematic review of nine databases identified studies published until September 2024 using search terms "knee arthroscopy" and "simulation" or "simulator." Key outcomes included time to task completion, operative time, Arthroscopic Surgical Skill Evaluation Tool (ASSET) scores, path length and validity measures. Previous reviews were assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool. Risk of bias was evaluated with ROB-2 and ROBINS-I tools. A random-effects meta-analysis was performed to account for study heterogeneity. Nine studies (seven randomised controlled trials (RCTs) and two observational studies) involving 327 participants across eight countries were included. Seven studies confirmed skill transfer to cadaveric models; only one showed intraoperative (in vivo) transfer. Compared with controls, the VR-trained participants showed significant improvement in time to completion (mean difference (MD): -87.58 seconds; p=0.010; 95% confidence interval (CI): -153.88 to -21.28 seconds). No difference was seen compared to other methods of simulation training in time (MD: 2.97 seconds; p=0.90; 95% CI: -44.35 to 50.29) and ASSET scores (MD: 0.76; p=0.42; 95% CI: -1.09 to 2.61). Across the seven RCTs, the VR-trained groups showed shorter procedure times, improved movement economy and higher global scores compared with the non-VR-trained groups. VR simulation is a potentially effective tool for knee arthroscopic training, providing a safe learning environment, but there remains scope to improve and validate its effectiveness in vivo. While evidence supports skill transfer to simulated cadaveric and simulated environments, further research is needed to validate in vivo transfer, assess clinical impact and evaluate cost-effectiveness and scalability for widespread curriculum integration.