The effect of residency training on arthroscopic knot tying and knot stability: which knot is best tied by Orthopaedic surgery residents?

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.

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

“…18 However, in practice, the arthroscopic knot utilized is often determined by surgeon preference, training, and experience. 7,11,14 In a study by Baumgarten and Wright, 4 an internet-based survey was used to determine arthroscopic knot preferences of American Orthopaedic Society for Sports Medicine members. Interestingly, the survey 4 demonstrated that most surgeons rely on experience and preference of a knot type over biomechanical evidence, with only 17.4% of respondents basing their knot tying on a literature review and the majority using the same knot configuration for all arthroscopic procedures.…”