BACKGROUND: Although virtual reality (VR) simulators have demonstrated their efficiency for basic technical skill training of healthcare professionals, validation for more complex and sequential procedures, especially in arthroscopic surgery, is still warranted. We hypothesized that the VR-based training simulation improves arthroscopic cuff repair skills when transferred to realistic visual and haptic conditions. HYPOTHESIS: VR-based training simulation improves arthroscopic cuff repair skills when transferred to realistic visual and haptic conditions. STUDY DESIGN: This study is prospective, multicentric and randomized. METHODS: Thirty orthopedic surgery residents were enrolled in the study and randomized in two groups: VR training (VR+) and no VR training (VR-). Only the VR+ group underwent a monthly VR-based training program for rotator cuff repair. The 1-h VR training sessions were standardized and supervised by the same instructor. After six months, all participants performed a double-row arthroscopic rotator cuff repair procedure on a benchtop shoulder model providing realistic visual and haptic conditions with implants. Two independent surgeons with expertise in shoulder repair and blinded to the randomization rated the participants' performance using the Arthroscopic Surgical Skill Evaluation Tool (ASSET). RESULTS: Demographic characteristics and surgical experience were comparable between the two groups. The ASSET global rating score was higher in the VR+ group than in the VR- group (34.4 ± 3.1 and 30.5 ± 5.7, respectively
p = 0.046) and the VR+ group performed the procedure faster than the VR- group (27.3 ± 3.6 vs. 31.7 ± 0.4 min, respectively
p = 0.003). DISCUSSION: This study demonstrated that a monthly VR-based program for 6 months was better than standard peer training alone for mastering a complex and sequential rotator cuff repair when using the validated ASSET Score. Overall, nonspecific arthroscopic skills were also higher in the VR+ group. LEVEL OF EVIDENCE: II, therapeutic study.