Low-Cost, Low-Fidelity, Self-Made Arthroscopic Surgical Simulators: A Systematic Review

Purpose: To systematically review the literature regarding low-cost, low-fidelity, self-made arthroscopic surgical simulators and provide an overview of their use in the teaching of arthroscopic surgical skills. Methods: Systematic review of the literature following PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. Results: A total of 10 studies met inclusion criteria. All studies utilized low-cost, low-fidelity, self-made arthroscopic simulators of varying designs. Five studies (50%) utilized low-cost, self-made arthroscopic cameras and three (30%) utilized commercial surgical arthroscopic cameras. One study (10%) demonstrated face validity, five (50%) demonstrated construct validity, and three (30%) demonstrated transfer validity. The assessed arthroscopic tasks varied, but generally consisted of a combination of triangulation, object grasping, and tissue manipulation. Seven (70%) studies evaluated total simulator construction costs, with six (60%) studies achieving total construction costs of < $80 US Dollars. Conclusions: A growing body of literature supports the use of low-cost, low-fidelity, self-made arthroscopic surgical simulators. The cost-effectiveness and practicality of these simulators remains a major benefit to their overall utility when compared to their commercially available and high-fidelity counterparts. Furthermore, studies utilizing low-fidelity arthroscopic simulators are beginning to place a large importance on the achievement of face, construct, and transfer validity. Evidence suggests that the true utility of low-cost, low-fidelity arthroscopic surgical simulators stem not from their ability to replicate operating room conditions, but rather from their ability to provide practical training in basic and essential arthroscopic skills that will then be further refined through possible additional simulation and future surgical training.