The Role of Anxiety in Simulation-Based Dexterity and Overall Performance: Does It Really Matter?

BACKGROUND: Essential Skills in the Management of Surgical Cases (ESMSC) is an international undergraduate surgical masterclass which combines ex vivo, dry lab and high fidelity in vivo simulation-based learning (SBL). It consists of 32 stations of skills-based learning, including open reduction internal fixation (ORIF) of fractures. Current literature suggests early involvement in skills-based learning at the undergraduate level is vital. AIMS: To compare students' dexterity and skills-based performance with demographic and educational background parameters. METHODS: 112 medical students from European Union countries including the United Kingdom, Germany, Greece, Cyprus, Germany, and Bulgaria were selected from a competitive pool of candidates to attend the course. Students undertook ORIF in an ex vivo swine model, and in a simulated fracture on a bamboo rod. Skills-based performance was assessed by two consultant surgeons with validated direct observation of procedural skills (DOPS) forms. Anxiety was self-assessed using the Westside Anxiety Scale prior to the ORIF stations. Dexterity was measured with the O'Connor tweezer dexterity test. RESULTS: Female students had significantly higher dexterity scores (median difference 7, p =.003). Right-handed students achieved higher dexterity than left-handed students (median difference 7, p =.043). There was no difference in students' performance across different medical schools, and across year groups (p <.05 for any correlation). Self-reported anxiety was not correlated with high fidelity skills-based performance (r = 0.032, p =.74). CONCLUSION: Anxiety does not seem to play a significant role in Simulation Skills-Based learning. Undergraduate surgical curricula should incorporate SBL-based modules to enhance practical skills learning and motivate future orthopedic surgeons.

Anterior Cruciate Ligament Remnant-Preserving Reconstruction Using a "Lasso-Loop" Knot Configuration.

Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant-sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device.