Fingertip Forces and Thenar Pressure During Instrument Use in Simulated Meniscectomy: A Comparative Study of Rongeur...

Hand-intensive surgical tasks expose the thumb and surrounding musculature to repetitive mechanical loading. Instrument design may influence the distribution of forces across the hand, yet quantitative data characterizing these loads during routine orthopedic procedures remain limited. This study quantified fingertip forces and thenar pressure during simulated meniscectomy using a pituitary rongeur and Ferris-Smith forceps.

Orthopedic residents performed simulated meniscectomy on a porcine knee model while wearing TekScan pressure sensors. Each participant used both a pituitary rongeur and Ferris-Smith forceps. The rongeur employs a pistol-grip mechanism producing thenar loading, whereas the forceps use a pincer-style grip emphasizing distal thumb-index finger motion. The TekScan Grip System quantified force distribution across the fingers, thumb tip, and thenar region.

Thirteen residents completed 4 meniscectomies each. The use of the pituitary rongeur resulted in significantly higher mean forces in the fingers (50.10 ± 6.22 N vs 30.62 ± 5.69 N) and thenar region (40.69 ± 11.99 N vs 3.34 ± 1.39 N) compared with forceps. Thumb-tip forces were similar between instruments (7.66 ± 3.85 N for rongeur vs 10.59 ± 3.15 N for forceps). Linear regression revealed no significant associations between demographic variables and force measurements, except for thumb-tip force during forceps use.

Instrument design significantly affects hand force distribution during meniscectomy. The rongeur imposes substantially greater mechanical demands on the fingers and thenar region, whereas forceps rely primarily on distal thumb-index finger motion. Repetitive rongeur use may contribute to cumulative hand and thumb carpometacarpal strain in surgeons.