Motion Analysis: A Validated Method for Showing Skill Levels in Arthroscopy Nick R. Howells, B.Sc., M.R.C.S., Mark D. Brinsden, F.R.C.S.(Tr&Orth), Richie S. Gill, D.Phil., Andrew J. Carr, Ch.M., F.R.C.S., and Jonathan L. Rees, M.D., F.R.C.S.(Tr&Orth) Purpose: The purpose of this study was to show the validity of a motion analysis system in its ability to differentiate between surgeons and non-surgeons when performing simple arthroscopic tasks. Methods: We divided 35 subjects into a surgeons group (n = 20) and a non-surgeons group (n = 15). The surgeons group was further subdivided based on the amount of previous arthroscopic experience. Each participant performed 2 separate simulated arthroscopic tasks while being assessed with motion analysis equipment. The time taken, total path length, and number of movements were recorded. Results: A significant difference in performance was identified between surgeons and non-surgeons (P  .0001) and between senior and junior surgeons (P  .05). We identified trends toward decreased time taken and improved economy of movement with increasing arthroscopic experience. Conclusions: This study shows the validity of a motion analysis system as a means of objective assessment of arthroscopic skills in orthopaedics. The system has been shown to differ- entiate between non-surgeons, junior surgeons, and senior surgeons in performing simple arthro- scopic tasks. Clinical Relevance: In the context of concerns regarding reductions in training time, this study validates the use of a simple, affordable, and reliable means of objective assessment of arthroscopic skills and training in such skills. The motion analysis system could subsequently be used as an adjunct to more traditional methods of assessment when planning strategies to teach, learn, and practice arthroscopic skills in the future. Key Words: Arthroscopy—Motion analysis—Simulation— Surgical education—Objective assessment. T he need for a means of objective evaluation of surgical performance in modern surgical practice has been previously identified. 1 In the light of in- creased peer and public scrutiny, the demand for per- fection in surgical outcomes is ever greater and sur- geons are under increased pressure to show their competence. 2 In many countries this, in combination with reductions in training time and the implementa- tion of restrictions on working hours, has led to well- established concerns regarding training. The result has been the development of more structured training schemes across all surgical specialties with a greater emphasis on specific skills acquisition rather than a generic apprenticeship. 3,4 Arthroscopy has become an irreplaceable diagnostic and interventional tool in orthopaedics, and its breadth of use is continuing to increase. The need for specific arthroscopic training for orthopaedic trainees has been identified for some time. 5 Complications during ar- throscopy are more common for junior trainees at the early part of their learning curve, often because of problems with adequate joint visualization and trian- gulation. 6 Minimal-access surgical procedures in gen- eral have been shown to require a different skill set than that developed during open surgery and hence require specific training. 7 Furthermore, traditional in- From the Nuffield Department of Orthopaedic Surgery, Univer- sity of Oxford, Oxford, England. The authors report no conflict of interest. Address correspondence and reprints requests to Nick R. How- ells, B.Sc., M.R.C.S., Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, England. E-mail: nickrhowells@yahoo.co.uk © 2008 by the Arthroscopy Association of North America 0749-8063/08/2403-7344$34.00/0 doi:10.1016/j.arthro.2007.08.033 335 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 3 (March), 2008: pp 335-342