National Trends in Wrist Arthroscopy Training Exposure among Orthopedic Surgery Residents: A 5-year National ACGME Case Log Study

Abstract Arthroscopy is a growing field within hand surgery with advancing technology and expanding indications. The purpose of this study is to evaluate the most recent trends of wrist arthroscopy among graduating orthopedic residents from 2021 to 2025. This was a retrospective review of aggregate national data from the Accreditation Council for Graduate Medical Education (ACGME) case log data for graduating orthopedic surgery residents from 2021 to 2025. Trends in case volume were analyzed using weighted linear regression models, proportional exposure relative to total wrist and forearm cases was assessed using binomial logistic regression, and inter-resident variability was assessed using Levene's test of homogeneity. Statistical significance was set at p < 0.05. Over the 5-year study period, 4,344 graduating orthopedic surgery residents were included. The mean number of wrist arthroscopy cases remained low at approximately three cases per resident (p = 0.440), despite an overall increasing volume of wrist and forearm cases (p = 0.010). There was a small but significant downward trend in the proportion of total wrist and forearm cases represented by arthroscopy from 1.78% in 2021 to 1.64% in 2025 (OR = 0.981, CI 0.969–0.993, p = 0.002). Inter-resident variability was significant and most pronounced in 2025, with the 10th percentile remaining at 0 across all study years and the 2025 cohort demonstrating a range of 0 to 37 wrist arthroscopy cases. Wrist arthroscopy exposure remains low and highly variable among graduating orthopedic residents. This study newly identifies a proportional decline in wrist arthroscopy case exposure, highlighting a mismatch between expanding clinical indications and resident procedural exposure, with potential implications for surgical preparedness. These findings are particularly relevant as the ACGME is transitioned to the Knowledge, Skills, and Behavior (KSB) model, which creates a timely opportunity to better define and address gaps in procedural exposure.