Vaghela Kalpesh R, Trockels Amaury, Carobene Marco
Department of Trauma and Orthopaedics, The Royal London Hospital, Percivall Pott Rotation, London, UK.
Department of Elderly Medicine, Southend University Hospital, Southend-On-Sea, UK.
J Clin Orthop Trauma. 2021 Feb 18;16:249-256. doi: 10.1016/j.jcot.2021.02.014. eCollection 2021 May.
Virtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism.
To assess the difference in face validity between two high fidelity VR simulators employing passive and active haptic feedback technology respectively.
38 participants were recruited and divided into intermediate and expert groups based on orthopaedic training grade. Each participant completed a 12-point diagnostic knee arthroscopy VR module using the active haptic Simbionix ARTHRO Mentor and passive haptic VirtaMed ArthroS simulators. Subsequently, each participant completed a validated simulator face validity questionnaire.
The ARTHRO Mentor active haptic system failed to achieve face validity with mean scores for external appearance (6.61), intra-articular appearance (4.78) and instrumentation (4.36) falling below the acceptable threshold (≥7.0). The ArthroS passive haptic simulator demonstrated satisfactory scores in all domains: external appearance (8.42), intra-articular appearance (7.65), instrumentation (7.21) and was significantly (p < 0.001) more realistic than ARTHRO Mentor for all metrics. 61% of participants gave scores ≥7.0 for questions pertaining to haptic feedback realism from intra-articular structures such as menisci and ACL/PCL for the ArthroS vs. 12% for ARTHRO Mentor. There was no difference in face-validity perception between intermediate and expert groups for either simulator (p > 0.05).
Current active haptic technology which employs motors to simulate tactile feedback fails to demonstrate sufficient face-validity or match the sophistication of passive haptic systems in high fidelity arthroscopy simulators. Textured rubber phantoms that mirror the anatomy and haptic properties of the knee joint provide a significantly more realistic training experience for both intermediate and expert arthroscopists.
虚拟现实（VR）模拟器在骨科培训和教育中发挥着越来越重要的作用。表面效度——现实被准确呈现的程度——支撑着VR模拟器作为学员学习工具的价值。尽管触觉反馈在关节镜检查中很重要，但关于触觉在VR关节镜模拟器逼真度中的作用的证据却很少。
评估分别采用被动和主动触觉反馈技术的两种高保真VR模拟器在表面效度上的差异。
招募了38名参与者，并根据骨科培训等级分为中级组和专家组。每位参与者使用主动触觉的Simbionix ARTHRO Mentor和被动触觉的VirtaMed ArthroS模拟器完成了一个12分的诊断性膝关节镜VR模块。随后，每位参与者完成了一份经过验证的模拟器表面效度问卷。
ARTHRO Mentor主动触觉系统未能达到表面效度，其外观（6.61）、关节内外观（4.78）和器械操作（4.36）的平均得分低于可接受阈值（≥7.0）。ArthroS被动触觉模拟器在所有领域都表现出令人满意的分数：外观（8.42）、关节内外观（7.65）、器械操作（7.21），并且在所有指标上都比ARTHRO Mentor更逼真（p < 0.001）。61%的参与者对ArthroS中与半月板和前交叉韧带/后交叉韧带等关节内结构的触觉反馈逼真度相关的问题给出了≥7.0的分数，而ARTHRO Mentor为12%。对于两种模拟器，中级组和专家组在表面效度感知上没有差异（p > 0.05）。
目前采用电机模拟触觉反馈的主动触觉技术在高保真关节镜模拟器中未能表现出足够的表面效度，也无法与被动触觉系统的精细度相匹配。模仿膝关节解剖结构和触觉特性的纹理橡胶模型为中级和专家级关节镜医师提供了显著更逼真的训练体验。
