Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing. Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions. Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback. Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

A Radiolucent Electromagnetic Tracking System for Use with Intraoperative X-ray Imaging

In recent times, the use of electromagnetic tracking for navigation in surgery has quickly become a vital tool in minimally invasive surgery. In many procedures, electromagnetic tracking is used in tandem with X-ray technology to track a variety of tools and instruments. Most commercially available EM tracking systems can cause X-ray artifacts and attenuation due to their construction and the metals that form them. In this work, we provide a novel solution to this problem by creating a new radiolucent electromagnetic navigation system that has minimal impact on -ray imaging systems. This is a continuation of our previous work where we showed the development of the Anser open-source electromagnetic tracking system. Typical electromagnetic tracking systems operate by generating low frequency magnetic fields from coils that are located near the patient. These coils are typically made from copper, steel, and other dense radiopaque materials. In this work, we explore the use of low density aluminum to create these coils and we demonstrate that the effect on X-ray images is significantly reduced as a result of these novel changes in the materials used. The resulting field generator is shown to give at least a 60% reduction in the X-ray attenuation in comparison to our earlier designs. We verify that the system accuracy of approximately 1.5 mm RMS error is maintained with this change in design.

Titanium-Alloy Anchoring System as a Suitable Method of Extracapsular Repair

Objective: To characterize the effect of a titanium-alloy anchoring system (TAS) on the motion of the cranial cruciate ligament (CrCL) deficient stifle. To compare the motion with the TAS to that of the CrCL-intact and CrCL-deficient stifle.Study Design: Each canine pelvic limb was mounted in a loading jig under 30% body weight. Motion data was collected using an electromagnetic tracking system at stifle angles of 125°, 135°, and 145° with the CrCL-intact, CrCL-deficient and the TAS applied.Results: Total translation of the CrCL-deficient stifle following the TAS was reduced, but remained greater than the CrCL-intact stifle at angles of 125°, 135°, and 145°. Internal rotation of the TAS groups was greater than the CrCL-intact group at 145°, but not 125° and 135°. Varus motion of the TAS group was decreased compared to the CrCL-deficient group, but increased compared to the CrCL-intact group at angles of 125°, 135°, and 145°.Conclusion: Total translation and internal rotation of the CrCL-deficient stifle following the TAS differed from that of the CrCL-intact stifle. However, the TAS reduced total translation and internal rotation of the tibia relative to the femur in the CrCL-deficient stifle to levels that may yield clinically acceptable results.

Lower Extremity Pain and Pitching Kinematics and Kinetics in Collegiate Softball Pitchers

The primary aims of the study were (1) to examine kinematics and kinetics of those pitching with and without lower extremity pain in collegiate softball pitchers, and (2) to determine if there was an association between the lower extremity pain and lower extremity kinematics, trunk kinematics, and shoulder kinetics in collegiate softball pitchers. Thirty-seven NCAA Division I female collegiate softball pitchers (19.8±1.3 yrs,173.7±7.7 cm, 79.0±12.4 kg) participated. Participants were divided into two groups, those who were currently experiencing lower extremity pain and those who were not. Participants threw three rise ball pitches. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. Mann-Whitney U tests revealed no significant kinematic or kinetic differences between pitchers with and without lower extremity pain. Additionally, there were no significant correlations between pain and recorded kinematic and kinetic variables. Considering there were no biomechanical differences observed between pitchers, coaches and athletic trainers should take caution with athlete assessment since athletes may not display altered biomechanics. Further examination into the duration and degree of pain is needed in an attempt to fully understand the implication of pain and pitching mechanics.

Knee Kinetics in Baseball Hitting and Return to Play After ACL Reconstruction

The purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.

Assessment of Position Repeatability Error in an Electromagnetic Tracking System for Surgical Navigation

In this paper we present a study of the repeatability of an innovative electromagnetic tracking system (EMTS) for surgical navigation, developed to overcome the state of the art of current commercial systems, allowing for the placement of the magnetic field generator far from the operating table. Previous studies led to the development of a preliminary EMTS prototype. Several hardware improvements are described, which result in noise reduction in both signal generation and the measurement process, as shown by experimental tests. The analysis of experimental results has highlighted the presence of drift in voltage components, whose effect has been quantified and related to the variation of the sensor position. Repeatability in the sensor position measurement is evaluated by means of the propagation of the voltage repeatability error, and the results are compared with the performance of the Aurora system (which represents the state of the art for EMTS for surgical navigation), showing a repeatability error about ten times lower. Finally, the proposed improvements aim to overcome the limited operating distance between the field generator and electromagnetic (EM) sensors provided by commercial EM tracking systems for surgical applications and seem to provide a not negligible technological advantage.

Accuracy and repeatability of wrist joint angles in boxing using an electromagnetic tracking system

The hand-wrist region is reported as the most common injury site in boxing. Boxers are at risk due to the amount of wrist motions when impacting training equipment or their opponents, yet we know relatively little about these motions. This paper describes a new method for quantifying wrist motion in boxing using an electromagnetic tracking system. Surrogate testing procedure utilising a polyamide hand and forearm shape, and in vivo testing procedure utilising 29 elite boxers, were used to assess the accuracy and repeatability of the system. 2D kinematic analysis was used to calculate wrist angles using photogrammetry, whilst the data from the electromagnetic tracking system was processed with visual 3D software. The electromagnetic tracking system agreed with the video-based system (paired t tests) in both the surrogate (< 0.2°) and quasi-static testing (< 6°). Both systems showed a good intraclass coefficient of reliability (ICCs > 0.9). In the punch testing, for both repeated jab and hook shots, the electromagnetic tracking system showed good reliability (ICCs > 0.8) and substantial reliability (ICCs > 0.6) for flexion–extension and radial-ulnar deviation angles, respectively. The results indicate that wrist kinematics during punching activities can be measured using an electromagnetic tracking system.