{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:18:23Z","timestamp":1778631503880,"version":"3.51.4"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Knot tying technique is an extremely important basic skill for all surgeons. Clinically, knot slippage or suture breakage will lead to wound complications. Although some previous studies described the knot-tying technique of medical students or trainees, little information had been reported on the knot-tying technique of instructors. The objective of the preset study was to assess surgeons\u2019 manual knot tying techniques and to investigate the differences of tensile strength in knot tying technique between surgical instructors and trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 48 orthopaedic surgeons (postgraduate year: PGY 2\u201318) participated. Surgeons were requested to tie surgical knots manually using same suture material. They were divided into two groups based on each career; instructors and trainees. Although four open conventional knots with four throws were chosen and done with self-selected methods, knot tying practice to have the appropriate square knots was done as education only for trainees before the actual trial. The knots were placed over a 30\u00a0cm long custom made smooth polished surface with two cylindrical rods. All knots were tested for tensile strength using a tensiometer. The surgical loops were loaded until the knot slipped or the suture broke. The tensile strength of each individual knot was defined as the force (N) required to result in knot failure. Simultaneously, knot failure was evaluated based on knot slippage or suture rupture. In terms of tensile strength or knot failure, statistical comparison was performed between groups using two-tailed Mann\u2013Whitney U test or Fisher exact probability test, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four instructors (PGY6\u2013PGY18) and 24 trainees (PGY2\u2013PGY5) were enrolled. Tensile strength was significantly greater in trainees (83.0\u2009\u00b1\u200927.7\u00a0N) than in instructors (49.9\u2009\u00b1\u200934.4\u00a0N, P\u2009=\u20090.0246). The ratio of slippage was significantly larger in instructors than in trainees (P\u2009&lt;\u20090.001). Knot slippage (31.8\u2009\u00b1\u200917.7\u00a0N) was significantly worse than suture rupture (89.9\u2009\u00b1\u200922.2\u00a0N, P\u2009&lt;\u20090.001) in tensile strength.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mean tensile strength of knots done by trainees after practice was judged to be greater than that done by instructors in the present study. Clinically, knot slippage can lead to wound dehiscence, compared to suture rupture.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-021-01079-5","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T13:52:44Z","timestamp":1612792364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Differences of tensile strength in knot tying technique between orthopaedic surgical instructors and trainees"],"prefix":"10.1186","volume":"21","author":[{"given":"Kengo","family":"Harato","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Yagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Kaneda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Iwama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihiko","family":"Masuda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Kaneko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihito","family":"Oya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noboru","family":"Matsumura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,6]]},"reference":[{"key":"1079_CR1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.3928\/0147-7447-19950601-08","volume":"18","author":"DA Franz","year":"1995","unstructured":"Franz DA, Batra EK, Morgan RF, Edlich RF. A portable tensiometer for assessing knot-tying technique. Orthopedics. 1995;18:555\u20138.","journal-title":"Orthopedics"},{"key":"1079_CR2","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1177\/0363546514535554","volume":"42","author":"BT Hanypsiak","year":"2014","unstructured":"Hanypsiak BT, DeLong JM, Simmons L, Lowe W, Burkhart S. Knot strength varies widely among expert arthroscopists. Am J Sports Med. 2014;42:1978\u201384.","journal-title":"Am J Sports Med"},{"key":"1079_CR3","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1016\/j.arthro.2015.02.008","volume":"31","author":"BB Gilmer","year":"2015","unstructured":"Gilmer BB, Guerrero DM, Coleman NW, Chamberlain AM, Warme WJ. Orthopaedic residents improve confidence and knot-tying speed with a skills course. Arthroscopy. 2015;31:1343-8.e2.","journal-title":"Arthroscopy"},{"key":"1079_CR4","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1177\/0954411913518317","volume":"228","author":"Y Kiriyama","year":"2014","unstructured":"Kiriyama Y, Matsumoto H, Toyama Y, Nagura T. A miniature tension sensor to measure surgical suture tension of deformable musculoskeletal tissues during joint motion. Proc Inst Mech Eng H. 2014;228:140\u20138.","journal-title":"Proc Inst Mech Eng H"},{"key":"1079_CR5","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1111\/j.1471-0528.2001.00251.x","volume":"108","author":"TE Ind","year":"2001","unstructured":"Ind TE, Shelton JC, Shepherd JH. Influence of training on reliability of surgical knots. BJOG Int J Obstet Gynaecol. 2001;108:1013\u20136.","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"1079_CR6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.jsurg.2012.07.002","volume":"70","author":"SS Ching","year":"2013","unstructured":"Ching SS, Mok CW, Koh YX, Tan SM, Tan YK. Assessment of surgical trainees\u2019 quality of knot-tying. J Surg Educ. 2013;70:48\u201354.","journal-title":"J Surg Educ"},{"key":"1079_CR7","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1006\/gyno.1993.1018","volume":"48","author":"EK Batra","year":"1993","unstructured":"Batra EK, Taylor PT, Franz DA, Towler MA, Edlich RF. A portable tensiometer for assessing surgeon\u2019s knot tying technique. Gynecol Oncol. 1993;48:114\u20138.","journal-title":"Gynecol Oncol"},{"key":"1079_CR8","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jsurg.2019.07.022","volume":"77","author":"R Willis","year":"2020","unstructured":"Willis R, Erwin D, Adelaja F. Struggling prior to a teaching event results in superior short-term skills acquisition in novice learners. J Surg Educ. 2020;77:34\u20139.","journal-title":"J Surg Educ"},{"key":"1079_CR9","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/j.jsurg.2015.01.002","volume":"72","author":"E Huang","year":"2015","unstructured":"Huang E, Vaughn CJ, Chern H, O\u2019Sullivan P, Kim E. An objective assessment tool for basic surgical knot-tying skills. J Surg Educ. 2015;72:572\u20136.","journal-title":"J Surg Educ"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01079-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12893-021-01079-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01079-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T08:27:43Z","timestamp":1619252863000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01079-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,6]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1079"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01079-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-44407\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-44407\/v3","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-44407\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-44407\/v4","asserted-by":"object"}]},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,6]]},"assertion":[{"value":"4 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This educational study was done using a verbal consent, which was approved by the Ethics Committee and Institutional Review Board of Keio University Hospital (IRB No. 20190174). In our hospital, a written consent was not applicable regarding the educational study as any patients were not involved.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}