Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?

Abstract

Arthroscopy is a technically demanding procedure with a prolonged learning curve. The purpose of this study is to determine if current arthroscopic case volume over the course of an orthopaedic surgery residency is sufficient to meet the number of cases required to achieve competence and/or mastery in complex arthroscopic tasks as well as hip arthroscopy. Publicly available Accreditation Council for Graduate Medical Education case log data for arthroscopic procedures from accredited orthopaedic residencies were reviewed from 2007 to 2017. Linear and segmental regression analyses were used to identify temporal trends, with significance set to p < 0.05. From 2007 to 2013, there was a significant increase in the median number of shoulder and knee arthroscopy case logs (p < 0.001). A sharp decline in the median number of shoulder and knee arthroscopy case logs was seen in 2013 to 2014 (p < 0.001), and the number remained low from 2014 to 2017 (p = 0.02, p = 0.03). The median number of hip arthroscopy procedures logged increased significantly from zero cases in 2012 (range: 0–48 cases) to five cases in 2017 (range: 0–76 cases) (p = 0.02). Over the study period, the median number of total arthroscopic procedures decreased from 301 to 186 (p = 0.01). In the United States, the majority of orthopaedic surgery residents graduate with case log numbers that meet theoretical minimum requirements for competence in basic diagnostic arthroscopy of the shoulder, hip, and knee. Resident experience with hip arthroscopy has increased; however, the majority of residents are graduating with little to no hip arthroscopy experience. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex hip or shoulder arthroscopy tasks based on previously published data. These findings support the need for further investigation into the best methods for training residents interested in performing arthroscopy as part of their careers. This was a level of evidence III, retrospective cohort study.