Purpose
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.
Level of Evidence
Level II, prospective comparative study.
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Article info
Publication history
Published online: August 19, 2015
Accepted:
June 17,
2015
Received:
December 2,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: R.A.P. receives support from Virtamed. R.L.A. receives support from DePuy Mitek. R.K.N.R. receives support from MedBridge, Mitek, and Rotation Medical.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
