Wrist and elbow arthroscopy case volume is low and declining in orthopedic residency and fellowship training.

PURPOSE: Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that graduating orthopedic surgery residents and fellows receive.

METHODS

Accreditation Council for Graduate Medical Education (ACGME) case log data from 2014 to 2024 was reviewed for graduating orthopedic residents, hand surgery fellows, and orthopedic sports medicine fellows in the United States. Mean and median numbers of wrist and elbow arthroscopy cases logged per resident or fellow were compared to assess procedure volume. The 10th and 90th percentiles of case volumes were analyzed to assess variability. Trends were evaluated over time to determine changes in case exposure.

RESULTS

Wrist arthroscopy volume reported by orthopedic residents decreased from 4.6 ± 5 (median 3, range 0-46) to 3.0 ± 3 (1, 0-23) cases per resident (p < 0.001). Elbow arthroscopy volume decreased from 2.1 ± 2 (2, 0-18) to 1.8 ± 3 (1, 0-38) cases per resident (p < 0.001). Among hand surgery fellows, wrist arthroscopy volume decreased from 18.5 ± 13 (15, 3-102) to 14.4 ± 8 (13, 5-65) cases per fellow (p < 0.001), and elbow arthroscopy volume from 5.2 ± 7 (4, 0-35) to 2.6 ± 3 (1, 0-20) cases per fellow (p < 0.001). Sports medicine fellow elbow arthroscopy volume decreased from 6.6 ± 8 (4, 0-48) to 3.1 ± 4 (2, 0-23) cases per fellow (p < 0.001). Wrist arthroscopy volume was not reported for sports medicine fellows.

CONCLUSIONS

Despite the established role of wrist arthroscopy in upper extremity orthopedic surgery, resident exposure is limited and has declined over recent years. Fellowship training has not offset this decline, with wrist and elbow arthroscopy volume decreasing significantly in hand and sports medicine fellowships. These trends raise concerns over preparedness to safely and independently perform these technically demanding procedures in practice after training.

LEVEL OF EVIDENCE: IV.