Wrist arthroscopy is taking up an important place in hand surgery. The purpose of this study was to build a wrist arthroscopy simulator to train the key navigation and probing skills required for a diagnostic wrist arthroscopy.

Our starting point was to keep the simulated environment as close as possible to the real-life situation by using normal equipment and replacing the joint by a physical anatomical model that can be mounted on a force platform to track performance. The specific requirements for the simulator were determined by questioning a panel of experts. These were translated into technical demands regarding the intra-articular structures and the skin. Especially the skin substitute was tested to provide the same elastic and resistance properties as human skin. A prototype was built and tested for face validity by asking the opinion of 14 experts.

All 14 participants found the simulator a good tool to teach wrist arthroscopy. The aspects that were paid most attention to in the design demonstrated face validity - realism of the lubricated top layer (mean 7.7 SD 1.6), realistic size of the joint structures (mean 7.7 SD 1.6) and realistic arthroscopic image (mean 7.9 SD 1.2). The flexibility of the prototype (mean 6.0 SD 2.3) and the color of the structures (mean 5.4 SD 1.9) were rated lower. The structures that the experts missed most were the TFCC and the volar ligaments.

Training of skills is a prerequisite for good clinical care and should start outside the operating room for patient safety reasons. By introducing a validated wrist arthroscopy simulator, we have added a necessary and relevant training tool.

The concept to use a physical model for wrist arthroscopy training is well perceived, and indicates the potential for continued development.