Arthroscopy: The Journal of Arthroscopic & Related Surgery
Arthroscopic knots: Determining the optimal balance of loop security and knot security
Section snippets
Knot configurations and suture types
Six commonly used complex sliding arthroscopic knots were used in this study: the Duncan loop,12 Nicky’s knot,8 Tennessee slider,9 Roeder knot,3 SMC knot,5 and Weston knot4 (Fig 1A-F). A second set of knots was tied with the same 6 sliding knots as base knots secured by a series of 3 reversing half-hitches on alternating posts (RHAPs). Reversing the half-hitches and alternating the posts was performed by alternately tensioning the wrapping limbs with consecutive throws as previously described.
General results
Summaries of the force to failure of each of the sliding knots and the sliding knots secured with a series of RHAPs are shown in FIGURE 5, FIGURE 6, respectively. The surgeon’s knot is included in each figure as a reference. In all cases, no knots failed by suture breakage, suggesting that all knots failed by a combination of knot slippage and suture elongation.
Summaries of the loop circumference of each of the sliding knots and the sliding knots secured with a series of RHAPs are summarized
Discussion
Optimization of both knot security15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 and loop security2, 19 for any given knot is critical, and recommendations regarding a specific knot should not be made without taking both characteristics under consideration. In this study, the loop security of almost all sliding knots tied without RHAPs (except the Duncan loop tied with No. 2 Fiberwire) was poor. Indeed, at a preload of only 5 N, many of the loop circumferences tied with No. 2 Ethibond were
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