Background: Objective assessment of technical skill in orthopaedic surgery remains elusive. The general surgeons have validated a motion analysis model as a measurement of surgical ability for laparoscopic procedures. The aim of this study was to validate the motion analysis model in the context of simulated shoulder arthroscopy and use it to assess technical ability in a mixed population.

Methods: 35 volunteer subjects were recruited from the Oxford University Medical School and the Nuffield Orthopaedic Centre and stratified into groups according to their professional background. There were seven groups: consultant arthroscopic orthopaedic surgeons; senior orthopaedic SpRs (year 5/6); junior orthopaedic SpRs (year 1/2); basic surgical trainees; musculoskeletal physicians; graduate medical students; and hospital managers. Each subject completed a questionnaire to record previous arthroscopic experience and underwent psychometric testing. After receiving standardised instructions, each subject performed one diagnostic and one therapeutic procedure using the Alex Shoulder Professor (Sawbones Europe AB, Malmo, Sweden) model. The Patriot (Polhemus, Colchester, USA) electromagnetic tracking system was used to track hand movements during each procedure.

Results: We present the results of psychometric testing and motion analysis (time, distance and number of hand movements) data in subjects with a variety of experience of arthroscopic surgical techniques. We have demonstrated differences between the groups.

Conclusions: Objective assessment of arthroscopic surgical skills using motion analysis is valuable in identifying differing surgical abilities. We believe that this may help with the career development of trainees and in the development of specific teaching programmes for arthroscopic surgery.

We present a single-surgeon series of surgical release of post-traumatic flexion contracture of the elbow performed via a limited lateral approach.

We undertook a retrospective review of patients having surgery for established post-traumatic flexion deformity of the elbow. All patients underwent anterior capsulectomy via a limited lateral approach. Patients with an intrinsic contracture also had the intra-articular lesion addressed at the time of surgery. Short-term follow-up was available from clinical review until discharge. Medium-to-long term follow-up was conducted by telephone interview supplemented by clinical review in selected cases.

Between 1998 and 2004, 23 patients were treated surgically for established flexion contracture of the elbow. There were 15 males and 8 females with a median age of 35 yrs (range 16–52 yrs). In sixteen patients the contracture was not associated with damage to the joint surface (extrinsic) and in seven it was (intrinsic). The mean pre-operative deformity was 55 degrees (95%CI 49 – 61) which was corrected at the time of surgery to 18 degrees (95%CI 12 – 23). The mean residual deformity was 25 degrees (95%CI 20 – 31). The difference between the pre-operative and discharge deformities was significant (Wilcoxson test p< 0.001). In the extrinsic group the mean deformity at discharge was 21 degrees (95%CI 17 – 25) compared to 34 degrees (95%CI 19 – 49) in the intrinsic group – this difference was significant (Mann-Whitney U test p< 0.01). In those patients with an extrinsic contracture all elbows had a return of functional extension. One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve which resolved after six weeks.

Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe, reliable technique with the best results achieved in patients with an isolated extrinsic contracture.