Abstract
BackgroundThe aim of this study is to evaluate which of three arthroscopic knots are most reliably taught to and executed by residents at varying levels of training.MethodsThree arthroscopic knots, the Samsung Medical Center (SMC), the Weston, and the surgeon’s knot, were taught to 16 orthopaedic surgery residents. Each knot was tied in triplicate at two sessions 1 week apart. The knots were then biomechanically tested for strength. Corresponding knots tied by a sports medicine fellow served as the respective controls.ResultsComparing all knots regardless of year of training, the SMC knot failed at significantly higher loads (237.2 ± 66.6 N) than the surgeon’s knot (203.7 ± 45.3 N, p = 0.049) and the Weston knot (193.5 ± 56.1 N, p = 0.013). No significant differences in knot strength were found when comparing knots tied by residents at different levels of training and when comparing residents to the sports medicine fellow. There was no difference in conditioning elongation between surgeon’s (p = 0.343), Weston (p = 0.486), or SMC knots (p = 0.200) tied by post-graduate year one and five residents.ConclusionsWe report the first study that evaluates the loop strength of an arthroscopically tied knot performed by orthopaedic surgery residents in various levels of training. In our cohort, the SMC knot required a higher load to failure, when compared to the Surgeon’s and Weston knot, after a simple arthroscopic knot tying curriculum. Based on these findings, he SMC knot should be considered as a part of future orthopaedic surgery resident arthroscopic training programs.
Highlights
The aim of this study is to evaluate which of three arthroscopic knots are most reliably taught to and executed by residents at varying levels of training
Knot security is defined as the ability of a knot to resist slippage with the application of a load, whereas loop security refers to the strength of a first knot after it is locked without three reversing half-hitch throws (Kim et al 2013; Lo et al 2010)
The cohort consisted of four PGY1, three PGY2, four PGY3, one PGY4, and four PGY5 orthopaedic surgery residents
Summary
The aim of this study is to evaluate which of three arthroscopic knots are most reliably taught to and executed by residents at varying levels of training. With the rise in popularity of these procedures, residency programs are incorporating arthroscopic knot training into their curricula (Baumgarten and Wright 2007; Fischer et al 2010; Lo et al 2010; Loutzenheiser et al 1998; Milia et al 2005). 2004; Lo et al 2010; Loutzenheiser et al 1998; Milia et al 2005) This creates confusion for orthopaedic surgery residents as well as those attempting to develop arthroscopic knot tying curriculums (Fischer et al 2010; Gilmer et al 2015). We hypothesize that there would be no difference in biomechanical testing between different arthroscopic knots tied by orthopaedic surgery residents
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