title: Can a Novel, Low-Cost Simulation Model be Used to Teach Anterior Cruciate Ligament Graft Preparation?
abstract: BACKGROUND
  This study evaluated an anterior cruciate ligament (ACL) graft preparation simulation learning model for use by orthopaedic surgery trainees.
  
  
  METHODS
  A simulation model for ACL graft preparation was constructed using shoelace as graft material and a wooden graft preparation board that matched the dimensions of existing products. A 12-minute instructional video targeted at novice learners was created to accompany the simulation model. A prospective randomized controlled trial was conducted on orthopaedic surgery residents divided into 2 groups with equal distributions of postgraduate year (PGY) status. The intervention group learned ACL graft preparation via the Shoelace ACL Simulation Guide, whereas a control group viewed a standard instructional video. All participants then prepared an 8-strand ACL graft using allograft materials and were evaluated via a checklist of critical steps and a global assessment rating as provided by an expert blinded to group allocation. Participants' preintervention and postintervention self-assessment scores were also collected.
  
  
  RESULTS
  Ten orthopaedic surgery residents from a single institution participated in the study, with even distributions across study groups of PGY-1, PGY-3, and PGY-4 residents. Preintervention self-assessments of knowledge and technical ability were similar between participant groups. The mean overall performance score was significantly greater in the shoelace simulation intervention group (22.6±1.5) than in the instructional video only control group (16.0±5.1) (P=0.043). Participants in the intervention group showed greater improvement in self-confidence in their technical ability than those in the control group (P=0.012). Groups demonstrated similar postintervention improvements in self-reported knowledge of ACL graft preparation (P=0.128). All participants who learned via the Shoelace ACL Simulation Guide strongly agreed that they would use the learning tool to prepare for ACL reconstruction surgery.
  
  
  CONCLUSIONS
  A self-directed low-cost simulation model for soft tissue ACL graft preparation utilizing shoelaces resulted in improved performance metrics compared with standard video instruction. The teaching model may be incorporated easily and inexpensively into simulation curricula at other training programs.
  
  
  METHODS
  Level II-therapeutic study.
authors.affiliation: *Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia †Division of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA ‡Department of Orthopaedic Surgery, Mount Sinai School of Medicine, New York, NY.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Brusalis
authors.forename: John Todd R
authors.initials: JTR
authors.lastname: Lawrence
authors.forename: Sheena C
authors.initials: SC
authors.lastname: Ranade
authors.forename: Joy C
authors.initials: JC
authors.lastname: Kerr
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pulos
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wells
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Ganley
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000193:education* / Q000379:methods; D001296:Audiovisual Aids; D057189:Checklist; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*