Virtual reality training is associated with high satisfaction and self-perceived surgical confidence in anterior cruciate ligament reconstruction: Experience from an orthopedic residency pilot study

INTRODUCTION/OBJECTIVE: Virtual reality (VR) is increasingly used in surgical education by enabling risk-free, immersive, and independent training. As orthopedic surgery residency programs increasingly integrate VR-based simulation, evidence regarding trainee satisfaction and self-perceived confidence remains scarce. This study aims to evaluate orthopedic surgery residents' satisfaction and self-perceived confidence following VR-based simulation training (VRT) in anterior cruciate ligament reconstruction (ACLR). The hypothesis is that VRT would result in high satisfaction and improve confidence in performing the procedure. METHODS: A cross-sectional pilot study was conducted on 12 orthopedic surgery residents (4 per postgraduate year) from a three-year residency program. Residents with prior VR-based ACLR simulation experience were excluded. Each participant completed two VRT sessions using PrecisionOS software on the Oculus Quest 2 headset, practicing the inside-out ACLR technique. Pre- and post-training assessments included a validated five-point Likert scale and the net promoter score (NPS) to measure satisfaction and self-perceived confidence. RESULTS: Eleven residents (91.7%) completed the study. Overall satisfaction with VRT was high, with most participants rating the experience as "agree" or "strongly agree" across all learning dimensions. The second session showed higher median satisfaction scores in five of six items. Participants valued VR training to improve procedural understanding, facilitate content application, and reinforce skills through immersive, tutor-independent learning. Overall, all sections achieved positive NPS values exceeding 40 (41-73), highlighting that VR training was an engaging way to learn. Third-year residents reported the greatest improvement regarding self-perceived confidence in executing the procedure, particularly to perform as the primary surgeon. First- and second-year residents showed increased confidence in assisting the procedure. CONCLUSION: This pilot study suggests that VR-based ACLR training is well accepted by orthopedic surgery residents and provides a highly satisfactory and immersive learning experience. Residents reported improved understanding of procedural steps and increased self-perceived confidence, with senior residents benefiting most in relation to the primary surgeon role and junior residents reporting greater confidence in assisting in the procedure. These findings support the feasibility and acceptability of VR simulation as a self-directed educational tool within orthopedic residency training programs. LEVEL OF EVIDENCE: Level IV.