title: Objective Assessment of Knot-Tying Proficiency With the Fundamentals of Arthroscopic Surgery Training Program Workstation and Knot Tester.
abstract: OBJECTIVE
  To assess a new method for biomechanical assessment of arthroscopic knots and to establish proficiency benchmarks using the Fundamentals of Arthroscopic Surgery Training (FAST) Program workstation and knot tester.
  
  
  METHODS
  The first study group included 20 faculty at an Arthroscopy Association of North America resident arthroscopy course (19.9 ± 8.25 years in practice). The second group comprised 30 experienced surgeons attending an Arthroscopy Association of North America fall course (17.1 ± 19.3 years in practice). The training group included 44 postgraduate year 4 or 5 orthopaedic residents in a randomized, prospective study of proficiency-based training, with 3 subgroups: group A, standard training (n = 14); group B, workstation practice (n = 14); and group C, proficiency-based progression using the knot tester (n = 16). Each subject tied 5 arthroscopic knots backed up by 3 reversed hitches on alternating posts. Knots were tied under video control around a metal mandrel through a cannula within an opaque dome (FAST workstation). Each suture loop was stressed statically at 15 lb for 15 seconds. A calibrated sizer measured loop expansion. Knot failure was defined as 3 mm of loop expansion or greater.
  
  
  RESULTS
  In the faculty group, 24% of knots "failed" under load. Performance was inconsistent: 12 faculty had all knots pass, whereas 2 had all knots fail. In the second group of practicing surgeons, 21% of the knots failed under load. Overall, 56 of 250 knots (22%) tied by experienced surgeons failed. For the postgraduate year 4 or 5 residents, the aggregate knot failure rate was 26% for the 220 knots tied. Group C residents had an 11% knot failure rate (half the overall faculty rate, P = .013).
  
  
  CONCLUSIONS
  The FAST workstation and knot tester offer a simple and reproducible educational approach for enhancement of arthroscopic knot-tying skills. Our data suggest that there is significant room for improvement in the quality and consistency of these important arthroscopic skills, even for experienced arthroscopic surgeons.
  
  
  METHODS
  Level II, prospective comparative study.
authors: University of California, Los Angeles, California, U.S.A.. Electronic address: robertpedowitz@gmail.com.
authors: Robert A
authors: RA
authors: Pedowitz
authors: University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
authors: Gregg T
authors: GT
authors: Nicandri
authors: Evergreen Orthopaedic Clinic, Seattle, Washington, U.S.A.
authors: Richard L
authors: RL
authors: Angelo
authors: The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
authors: Richard K N
authors: RK
authors: Ryu
authors: University College Cork, Cork, Ireland.
authors: Anthony G
authors: AG
authors: Gallagher
mesh_terms: D001182:Arthroscopy / Q000193:education* / Q000379:methods; D019985:Benchmarking; D001696:Biomechanical Phenomena; D005180:Faculty, Medical / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D009656:North America; D009985:Orthopedics / Q000592:standards*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013536:Suture Techniques; D013537:Sutures