Learning and optimizing arthroscopic knot-tying by surgery residents using procedural simulation.

Area of Science:

• Orthopedic Surgery
• Surgical Skills Training
• Arthroscopy

Background:

• Arthroscopic knot-tying is a fundamental skill for orthopedic surgery residents.
• Current training lacks standardized procedural guides for acquiring arthroscopic knot-tying proficiency.
• Limited research exists on resident learning curves for specific arthroscopic knots.

Purpose of the Study:

• To identify the arthroscopic knot easiest for orthopedic surgery residents to learn.
• To determine which arthroscopic knot yields the highest success rate in performance.
• To provide data for improving arthroscopic knot-tying training protocols.

Main Methods:

• Ten orthopedic surgery residents learned five distinct arthroscopic knots (Tennessee slider, Duncan loop, Revo knot, Nicky knot, SMC knot).
• Participants ranked knot learning ease and perceived reliability using a visual scale (0-10).
• An independent rater assessed knot success based on biomechanical testing (stretch < 3mm under 60N load).

Main Results:

• The Surgeon's knot (Revo knot) was ranked as the easiest to learn (p<0.0001).
• The Nicky knot achieved the highest success rate at 88%.
• Overall knot success rate was 80% across all tested knots.

Conclusions:

• The Surgeon's knot (Revo knot) is recommended as the most accessible knot for initial resident training.
• The Nicky knot's high success rate suggests its potential utility in procedures requiring robust knot security.
• Findings can inform curriculum development for more effective arthroscopic knot-tying education.