Application of virtual reality in simulated training for arthroscopic surgeries: A systematic literature review


  • Juan Molleda-Antonio Universidad Tecnológica del Perú
  • Erick Vargas-Montes Universidad Tecnológica del Perú
  • Brian Meneses-Claudio Universidad Tecnológica del Perú
  • Monica Auccacusi-Kañahuire Universidad Tecnológica del Perú



virtual reality, arthroscopic surgeries, systematic literature review


INTRODUCTION: In recent years, technology has provided significant contributions to the health area with innovative projects such as artificial intelligence, virtual reality, augmented reality, etc.

OBJECTIVE: This review aims to review studies that propose solutions with virtual reality (VR) technologies for the training of surgeons in the arthroscopic surgery procedure.

Method: We identified 352 articles from the Scopus database, from 2017 to the present, of which 31 studies were retrieved by a screening procedure based on the principles of the PRISMA declaration for the study of this systematic literature review (RSL).

Results: The implementation of virtual reality in surgical simulations has significantly reduced the percentage of risk in the execution of arthroscopic surgeries.

Conclusions: The virtual reality implemented in the simulations of arthroscopic surgeries stands out and represents a promising tool that will allow improvements with respect to the formation of skills and the anticipation of possible events. However, it is necessary to address certain limitations, such as the accuracy and realism of simulations, as well as the implementation of haptic or perceptual systems to improve tactile or visual feedback during simulation.


Download data is not yet available.


Vaughan N, Dubey VN, Wainwright TW, Middleton RG. A review of virtual reality based training simulators for orthopaedic surgery. Medical Engineering & Physics 2016;38:59-71.

Campos Sánchez CM, Guillén León LA, Acosta Yanes RC, Gil Oloriz MA. Metaverso: el futuro de la medicina en un mundo virtual. Metaverse Bas App Res 2022;1:4.

Gonzales Tito YM, Quintanilla López LN, Pérez Gamboa AJ. Metaverse and education: a complex space for the next educational revolution. Metaverse Basic and Applied Research 2023;2:56.

Polce EM, Kunze KN, Williams BT, Krivicich LM, Maheshwer B, Beletsky A, et al. Efficacy and Validity of Orthopaedic Simulators in Surgical Training: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Acad Orthop Surg 2020;28:1027-40.

Prakash A, Haque A, Islam F, Sonal D. Exploring the Potential of Metaverse for Higher Education: Opportunities, Challenges, and Implications. Metaverse Bas App Res 2023:40.

De Luca G, Choudhury N, Pagiatakis C, Laroche D. A Multi-procedural Virtual Reality Simulator for Orthopaedic Training. En: Chen JYC, Fragomeni G, editores. Virtual, Augmented and Mixed Reality. Applications and Case Studies, vol. 11575, Cham: Springer International Publishing; 2019, p. 256-71.

Tumiri S, Duran L, Lin J, Ríos NB, Mosca A, Gómez T. Image in nursing and simulation. Metaverse Bas App Res 2023:36.

Lepez CO. Metaverso y educación: una revisión panorámica. Metaverse Bas App Res 2022;1:2.

Kumar D, Haque A, Mishra K, Islam F, Kumar Mishra B, Ahmad S. Exploring the Transformative Role of Artificial Intelligence and Metaverse in Education: A Comprehensive Review. Metaverse Basic and Applied Research 2023;2:55.

Figueroa Pelaez IF. Patient Identification in the Prevention of Errors and Adverse Events: A Systematic Review. Data & Metadata 2022:11.

Ledesma F, Malave González BE. Patterns of scientific communication on E-commerce: a bibliometric study in the Scopus database. Reg Cient 2022:202214.

Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. International Journal of Surgery 2022;101:106616.

Ribau AI, Collins JE, Chen AF, Sousa RJ. Is Preoperative Staphylococcus aureus Screening and Decolonization Effective at Reducing Surgical Site Infection in Patients Undergoing Orthopedic Surgery? A Systematic Review and Meta-Analysis With a Special Focus on Elective Total Joint Arthroplasty. The Journal of Arthroplasty 2021;36:752-766.e6.

Mendoza Rivas L, Martínez Cruz L. Revisión de ensayos clínicos sobre la eficacia de la rehabilitación cognitiva en pacientes con lesión cerebral traumática. Interdisciplinary Rehabilitation / Rehabilitacion Interdisciplinaria 2022;2:25.

Dayal D, Gupta BM, Bansal J, Singh Y. COVID-19 associated mucormycosis: A bibliometric analysis of Indian research based on Scopus. Iberoamerican Journal of Science Measurement and Communication 2023;3.

Gupta BM, Kappi M, Walke R, Bansal M. Covid-19 research in Bangladesh: A scientometric analysis during 2020-23. Iberoamerican Journal of Science Measurement and Communication 2023;3.

Fillingham YA, Hannon CP, Kopp SL, Sershon RA, Stronach BM, Meneghini RM, et al. The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty: Systematic Review and Direct Meta-Analysis. The Journal of Arthroplasty 2022;37:1922-1927.e2.

Fabre Morales EJ, Guzmán Canaba CA, Llerena Chicaiza LB, Pino Vaca DP, Muñoz Villacres LS, Romero Córdova CA, et al. El arte y la ciencia de la cirugía de reconstrucción tumoral pediátrica: una revisión exhaustiva. Salud, Ciencia y Tecnología 2023;3:467.

Robaina Castillo JI. Identifying promising research areas in health using bibliometric analysis. Data & Metadata 2022:10.

Macea-Anaya M, Baena-Navarro R, Carriazo-Regino Y, Alvarez-Castillo J, Contreras-Florez J. Designing a Framework for the Appropriation of Information Technologies in University Teachers: A Four-Phase Approach. Data Metadata 2023;2:53.

Hannon CP, Fillingham YA, Gililland JM, Sporer SM, Casambre FD, Verity TJ, et al. A Systematic Review of the Efficacy and Safety of Ketamine in Total Joint Arthroplasty. The Journal of Arthroplasty 2023;38:763-768.e2.

Fillingham YA, Hannon CP, Roberts KC, Mullen K, Casambre F, Riley C, et al. The Efficacy and Safety of Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis. The Journal of Arthroplasty 2020;35:2739-58.

Pérez Gamboa AJ, Gómez Cano CA, Sánchez Castillo V. Decision making in university contexts based on knowledge management systems. Data and Metadata 2023;1:92.

Ismail Adakawa M. Relevance of Akerloff’s theory of information asymmetry for the prevention and control of zoonotic infectious diseases in Sub-Saharan Africa: Perspective of Library and Information Services Provision. En: Huisa Veria E, editor. Advanced Notes in Information Science, vol. 1, ColNes Publishing; 2022.

Silva Júnior EMD, Dutra ML. A roadmap toward the automatic composition of systematic literature reviews. Iberoamerican Journal of Science Measurement and Communication 2021;1:1-22.

Golahmadi AK, Khan DZ, Mylonas GP, Marcus HJ. Tool-tissue forces in surgery: A systematic review. Annals of Medicine & Surgery 2021;65.

Petrona Aguirre JI, Marsollier R, Vecino J. Teaching Burnout: a conceptual cartographic review. AWARI 2020;1:e021.

Demirel D, Yu A, Cooper‐Baer S, Dendukuri A, Halic T, Kockara S, et al. A hierarchical task analysis of shoulder arthroscopy for a virtual arthroscopic tear diagnosis and evaluation platform (VATDEP). Robotics Computer Surgery 2017;13:e1799.

McCracken LC, Trejos AL, LeBel M, Poursartip B, Escoto A, Patel RV, et al. Development of a physical shoulder simulator for the training of basic arthroscopic skills. Robotics Computer Surgery 2018;14:e1868.

Bartlett JD, Lawrence JE, Khanduja V. Virtual reality hip arthroscopy simulator demonstrates sufficient face validity. Knee Surg Sports Traumatol Arthrosc 2019;27:3162-7.

Putzer D, Dammerer D, Baldauf M, Lenze F, Liebensteiner MC, Nogler M. A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents—Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves. Surg Innov 2022;29:398-405.

Honda H, Kobayashi N, Kamono E, Yukizawa Y, Higashihira S, Takagawa S, et al. Effect of 3-Dimensional Versus Single-Plane Changes in Pelvic Dynamics on Range of Motion in Hips With Femoroacetabular Impingement: A Computer Simulation Analysis. Orthopaedic Journal of Sports Medicine 2022;10:232596712211236.

Kobayashi N, Higashihira S, Kitayama H, Kamono E, Yukizawa Y, Oishi T, et al. Effect of Decreasing the Anterior Pelvic Tilt on Range of Motion in Femoroacetabular Impingement: A Computer-Simulation Study. Orthopaedic Journal of Sports Medicine 2021;9:232596712199946.

Jacobsen ME, Gustafsson A, Jørgensen PG, Park YS, Konge L. Practicing Procedural Skills Is More Effective Than Basic Psychomotor Training in Knee Arthroscopy: A Randomized Study. Orthopaedic Journal of Sports Medicine 2021;9:232596712098512.

Higashihira S, Kobayashi N, Choe H, Sumi K, Inaba Y. Use of a 3D Virtually Reconstructed Patient-Specific Model to Examine the Effect of Acetabular Labral Interference on Hip Range of Motion. Orthopaedic Journal of Sports Medicine 2020;8:232596712096446.

Cai B, Duan S, Yi J, Bay BH, Huang J, Huang W, et al. A three-dimensional (3D) printed simulator as a feasible assessment tool for evaluating hip arthroscopy skills. Knee Surg Sports Traumatol Arthrosc 2023;31:2030-7.

Huri̇ G, Gülşen MR, Karmiş EB, Karagüven D. Cadaver versus simulator based arthroscopic training in shoulder surgery. Turk J Med Sci 2021;51:1179-90.

Hauschild J, Rivera JC, Johnson AE, Burns TC, Roach CJ. Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study. Orthopaedic Journal of Sports Medicine 2021;9:232596712110038.

Feeley AA, Gibbons JP, Feeley IH, Fitzgerald E, Merghani K, Sheehan E. Hand dominance and experience improve bimanual performance on arthroscopic simulator task. Knee Surg Sports Traumatol Arthrosc 2022;30:3328-33.

Choi CH, Kim S-J, Chun Y-M, Kim S-H, Lee S-K, Eom N-K, et al. Influence of knee flexion angle and transverse drill angle on creation of femoral tunnels in double-bundle anterior cruciate ligament reconstruction using the transportal technique: Three-dimensional computed tomography simulation analysis. The Knee 2018;25:99-108.

Dinc F, Oumimoun K, Kwabla W, Kockara S, Halic T, Arikatla S, et al. Towards Real-time Bone Drilling Simulation for Anchor Placement in VR Based Arthroscopic Rotator Cuff Surgery Simulation. AMIA Jt Summits Transl Sci Proc 2022;2022:178-85.

Foo QC, Hariri F, Abdul Rahman ZA. Fabrication of a three-dimensional temporomandibular joint model for arthrocentesis and arthroscopy simulation. International Journal of Oral and Maxillofacial Surgery 2021;50:1095-9.

Peserico-DalFarra P, Gagliardi-Lugo AF. Training simulation for oral and maxillofacial surgeons based on the techniques of arthroscopy in the temporomandibular joint. British Journal of Oral and Maxillofacial Surgery 2019;57:929-31.

Kwak J-M, Kholinne E, Gandhi M, Adikrishna A, Hong H, Sun Y, et al. Improvement of arthroscopic surgical performance using a new wide-angle arthroscope in the surgical training. PLoS ONE 2019;14:e0203578.

Chae S, Jung S-W, Park H-S. In vivo biomechanical measurement and haptic simulation of portal placement procedure in shoulder arthroscopic surgery. PLoS ONE 2018;13:e0193736.

Bhattacharyya R, Davidson DJ, Sugand K, Bartlett MJ, Bhattacharya R, Gupte CM. Knee Arthroscopy Simulation: A Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool. The Journal of Bone and Joint Surgery 2017;99:e103.

Bhattacharyya R, Davidson DJ, Sugand K, Akhbari P, Bartlett MJ, Bhattacharya R, et al. Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool. JBJS Essential Surgical Techniques 2018;8:e32.

Banaszek D, You D, Chang J, Pickell M, Hesse D, Hopman WM, et al. Virtual Reality Compared with Bench-Top Simulation in the Acquisition of Arthroscopic Skill: A Randomized Controlled Trial. The Journal of Bone and Joint Surgery 2017;99:e34.

Bishop ME, Ode GE, Hurwit DJ, Zmugg S, Rauck RC, Nguyen JT, et al. The Arthroscopic Surgery Skill Evaluation Tool Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2021;37:1856-66.

Bauer DE, Wieser K, Aichmair A, Zingg PO, Dora C, Rahm S. Validation of a Virtual Reality–Based Hip Arthroscopy Simulator. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2019;35:789-95.

Shigi A, Oka K, Tanaka H, Abe S, Miyamura S, Takao M, et al. Validation of the registration accuracy of navigation-assisted arthroscopic débridement for elbow osteoarthritis. Journal of Shoulder and Elbow Surgery 2019;28:2400-8.

Bartlett JD, Lawrence JE, Yan M, Guevel B, Stewart ME, Audenaert E, et al. The learning curves of a validated virtual reality hip arthroscopy simulator. Arch Orthop Trauma Surg 2020;140:761-7.

LeBel M-E, Haverstock J, Cristancho S, Van Eimeren L, Buckingham G. Observational Learning During Simulation-Based Training in Arthroscopy: Is It Useful to Novices? Journal of Surgical Education 2018;75:222-30.

Tronchot A, Berthelemy J, Thomazeau H, Huaulmé A, Walbron P, Sirveaux F, et al. Validation of virtual reality arthroscopy simulator relevance in characterising experienced surgeons. Orthopaedics & Traumatology: Surgery & Research 2021;107:103079.

Al-Hiyari N, Jusoh S. The Current Trends of Virtual Reality Applications in Medical Education. 2020 12th International Conference on Electronics, Computers and Artificial Intelligence (ECAI), Bucharest, Romania: IEEE; 2020, p. 1-6.

Gerez R. Implementation of protocol to reduce surgical site infections in arthroplasty with hip prosthesis. Salud, Ciencia y Tecnología 2023;3:550.

Vásquez Mendoza MM, Santillán Lima JC, Delgado Quezada SV, Morales Morales BM, Robayo Herrera RS, Ortega Larrea DE, et al. Precision in restoration: new frontiers in surgical techniques for complex tissue reconstruction. Salud, Ciencia y Tecnología 2023;3:551.

Veloz Montano MDLN, Keeling Álvarez M. The educational and pedagogical intervention in scientific research. Community and Interculturality in Dialogue 2023;3:70.

Guiroy A, Gagliardi M, Cabrera JP, Coombes N, Arruda A, Taboada N, et al. Access to Technology and Education for the Development of Minimally Invasive Spine Surgery Techniques in Latin America. World Neurosurgery 2020;142:e203-9.

Talaat W, Hamdoon Z, Ghoneim M. Minimally invasive surgeries for the treatment of temporomandibular disorders: Prognostic indicators and persistence of treatment outcomes over a 5-year follow-up. Adv Biomed Health Sci 2022;1:34.

Espín López VI, Quenorán Almeida VS, Manzano Quisimalin DE, López Pérez GP, Jiménez Peralta AL, Rivera Aguilar TE. Manejo de neonatos con Colangiopatía Obstructiva Crónica Neonatal. Cirugía de Kasai. Salud Cienc Tecnol 2022;2:246.

Díaz-Chieng LY, Auza-Santiváñez JC, Robaina Castillo JI. El futuro de la salud en el metaverso. Metaverse Bas App Res 2022;1:1.

Gómez Cano CA, Sánchez Castillo V, Clavijo Gallego TA. Unveiling the Thematic Landscape of Generative Pre-trained Transformer (GPT) Through Bibliometric Analysis. Metaverse Bas App Res 2023:33.

Mallqui Cáceres YM. Management of pain reduction in mechanically ventilated care subjects. Interdisciplinary Rehabilitation / Rehabilitacion Interdisciplinaria 2023;3:59.

Catrambone R, Ledwith A. Enfoque interdisciplinario en el acompañamiento de las trayectorias académicas: formación docente y psicopedagógica en acción. Interdisciplinary Rehabilitation / Rehabilitacion Interdisciplinaria 2023;3:50.

Gonzalez-Argote J. Uso de la realidad virtual en la rehabilitación. Interdisciplinary Rehabilitation / Rehabilitacion Interdisciplinaria 2022;2:24.

Gómez Cano CA, Sánchez Castillo V. Estructura del conocimiento en rehabilitación dentro y fuera del área de la Medicina: Perspectivas Bibliométricas de las categorías «Physical Therapy, Sports Therapy and Rehabilitation» y «Rehabilitation». Interdisciplinary Rehabilitation / Rehabilitacion Interdisciplinaria 2022;2:22.

Pérez Egües MA, Torres Zerquera LDC, Hernández Delgado M. Evaluation of the conditions of the Psychopedagogical Office of the Universidad de Cienfuegos in the management of virtual guidance services. Reg Cient 2023:202384.

Thompson JW, Thompson EL, Sanghrajka AP. The future of orthopaedic surgical education: Where do we go now? The Surgeon 2022;20:e86-94.

Stambough JB, Curtin BM, Gililland JM, Guild GN, Kain MS, Karas V, et al. The Past, Present, and Future of Orthopedic Education: Lessons Learned From the COVID-19 Pandemic. The Journal of Arthroplasty 2020;35:S60-4.

Álvarez Campos H. Pedagogical strategies based on inverted classroom - Integration of ICT in naval technologies at the Escuela Naval de Suboficiales A.R.C. Barranquilla. Reg Cient 2023:202397.

Pérez Gamboa AJ, García Acevedo Y, García Batán J, Raga Aguilar LM. La configuración de proyectos de vida desarrolladores: Un programa para su atención psicopedagógica. Act Inv en Educ 2022;23:1-35.

Cirulli A, Godoy A. Inclusive Recruitment: Exploring Theories, Legal Aspects, and Trans Talent in the Corporate World. Community and Interculturality in Dialogue 2022;2:27.

Ripoll Rivaldo M. University social entrepreneurship as a development strategy for people, communities and territories. Reg Cient 2023:202379.

Veloz Montano MDLN, González Martínez MDLC, Pérez Lemus L. Rehabilitation of occupational stress from the perspective of Health Education. Community and Interculturality in Dialogue 2023;3:71.

Lepez CO, Simeoni IA. Pedagogical experience with Public Health campaigns from the design of socio-educational projects with insertion in the local territory. Community and Interculturality in Dialogue 2023;3:74.

Cardeño Portela N, Cardeño Portela EJ, Bonilla Blanchar E. ICT and academic transformation in universities. Reg Cient 2023:202370.

Álvarez Loyola C. The NOOCs as a training strategy for teachers in the use of technological tools in primary education. Reg Cient 2023:202362.

Wu Y-M, Xiong Y-L, Liu W-J, Tang H, Xiao Y-F, Gao S-G. Computer-Assisted and Hip Arthroscopy for Avascular Necrosis of the Femoral Head With Femoroacetabular Impingement. Arthroscopy Techniques 2023;12:e557-62.

Gontijo MCA, Hamanaka RY, De Araujo RF. Research data management: a bibliometric and altmetric study based on Dimensions. Iberoamerican Journal of Science Measurement and Communication 2021;1:1-19.

Benito PV. Contemporary art and networks: Analysis of the Venus Project using the UCINET software. AWARI 2022;3.

Gutiérrez EM, Larrosa JMC. Popularity in Facebook Pages: What role network structural variables play? AWARI 2020;1:e005.

Mae Samuel A, Garcia-Constantino M. User-centred prototype to support wellbeing and isolation of software developers using smartwatches. En: Huisa Veria E, editor. Advanced Notes in Information Science, vol. 1, ColNes Publishing; 2022.

Picalho AC, Bisset Álvarez E, Fadel LM. Virtual reality and augmented reality in tourism: Indicative of use by government agencies in Brazilian states. En: Huisa Veria E, editor. Advanced Notes in Information Science, vol. 1, ColNes Publishing; 2022.




How to Cite

Molleda-Antonio J, Vargas-Montes E, Meneses-Claudio B, Auccacusi-Kañahuire M. Application of virtual reality in simulated training for arthroscopic surgeries: A systematic literature review. EAI Endorsed Trans Perv Health Tech [Internet]. 2023 Oct. 26 [cited 2023 Dec. 10];9. Available from: