Biomechanical Performance of Traditional Arthroscopic Knots Versus Slippage-Proof Knots

Clark, Randy; Dierckman, Brian D.; Sampaticos, Nels; Snyder, Stephen J.

doi:10.1016/j.arthro.2013.04.012

Cited by 15 publications

(21 citation statements)

References 12 publications

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“…Many widely cited articles arbitrarily define a cutoff of 3 mm of elongation to represent clinical failure. 6,9,10,13,14,16,18,19,21,22,[24][25][26][27][28]33,35,36 To remain consistent with other studies and because the tolerance for loss of tissue apposition with respect to healing is unclear, 3 mm of suture loop elongation, or suture breakage, defined clinical failure in this study. Given the possibility that healing potential requires less than 3 mm of gap formation, results were collected for failure defined at 2 mm of displacement.…”

Section: Discussionmentioning

confidence: 85%

“…6,16,17 Knot security has been defined as the knot's ability to resist slippage (or breakage) and is dependent on factors including friction, internal interference, and amount of slack between throws. 11,16,19,21,22,24,25 Single-load strength testing is a commonly used method to quantify knot security. 13,16,18,19,21,22,24,26,27 However, this fails to account for the material properties of the suture, which will elongate based on its innate elasticity.…”

mentioning

confidence: 99%

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Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

Ensminger

McIff

Vopat

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare knot and loop characteristics of commonly used high-strength tapes and high-strength round sutures. Methods: Twenty tied 30-mm loops were prepared for using suture-knot combinations of 4 common arthroscopic knots or a hand-tied surgeon's knot and 7 sutures. Two tapes (BroadBand, SutureTape) and three no. 2 sutures (MaxBraid, FiberWire, DynaCord) were compared. Two additional larger tape sutures (FiberTape, PermaTape) not commonly tied arthroscopically were included in the hand-tied group. Each suture-knot combination was evaluated for loop integrity (single load to a specified elongation), knot security (plastic loop deformation with cyclic testing), loop security, and knot volume. Data were compared using analysis of variance followed by Tukey-Kramer post hoc tests.Results: BroadBand and SutureTape demonstrated superior loop integrity compared to most no. 2 suture-knot combinations. FiberTape (430.48 AE 89.00 N) and PermaTape (545.16 AE 95.09 N) required significantly greater force to undergo 3 mm of displacement than all other hand-tied sutures (P < .001). All suture-knot configurations demonstrated significant plastic deformation (cyclic elongation) over 1000 cycles (P < 0.001). DynaCord displayed the best loop security except when paired with the Duncan loop. Overall, BroadBand and SutureTape had lower knot volumes compared to all other sutures. Conclusion: This study exhibits the ability of narrow tape sutures to provide reliable tissue apposition and fixation in multiple suture-knot configurations, while decreasing the potential adverse effects accompanying knot prominence. Generally, BroadBand and SutureTape demonstrated an ideal balance of mechanical characteristics to achieve the optimal suture-knot construct among those tested. Dynacord displayed superior loop security and performed best among round sutures. PermaTape and FiberTape showed greater loop integrity, albeit to the detriment of loop security and knot volume. Clinical Relevance: When securing a rotator cuff repair construct with a knot, one should have a basic understanding of the mechanical properties of the suture and knot being used to provide the best possible repair. This study will provide information about the mechanical characteristics of commonly used high-strength tape suture knots and loops to help determine what knot type may provide the best overall construct.

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Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

Ensminger

McIff

Vopat

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Degrees of initial loop security relate to the tightness of loop constriction or post-strand strangulation 5 and, ultimately, suture flipping to create primary knot security. A complex knot provides good initial loop tightness but is usually difficult to flip and interlock.…”

Section: Discussionmentioning

confidence: 99%

“…Additional reversed half-hitches on alternating posts, though recommended for secondary knot security, are not obligatory. This is helpful in reducing surgical time, especially when tying a large number of knots is required, 5 although further research is essential to reach scientific conclusions. …”

Section: Knot Completionmentioning

confidence: 99%

The Sliding, Interlocking “8-2-Alpha Knot” for Arthroscopic Surgery

Laupattarakasem

2016

Arthroscopy Techniques

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We describe a sliding knot that is ideally lockable by transforming the original simple figure-of-8 configuration into a true interlocking, low-profile knot with an a-a configuration that creates strong primary knot security when tying is finished. Reversed half-hitches on alternating posts for secondary knot security can be added, but to save surgical time, these are not obligatory. Three simple knot-tying methods are presented; the choice of which to use is based on the surgeon's preference. Pulling the loop limb simultaneously on both sides of the knot could trigger premature knot flipping. Therefore, the loop limb should not be over-tensioned while sliding down the knot; the knot should always be "pulled" down, rather than "pushed" down, onto the target tissues. Because all loops would be disassembled after the post limb is removed from the knot, a salvage procedure is proposed to save the suture from unintentional premature locking.

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“…The weakest link of this repair is the tendon-suture interface. 1,2 Causes of repair failure include the lack of consistent tendon approximation to bone from knot rupture, knot slippage 3,4 and suture loosening, 5 which can be magnified by patient noncompliance during the healing period. The viscoelastic property creep affects suture material, and suture loosening can be observed shortly after a repair construct has been completed.…”

mentioning

confidence: 99%

Suture-Based Debris Behavior in the Draining Lymph Nodes of a Porcine Knee: A Study of Silicone, Polyethylene and Carbon

Barber

Spenciner

Zani

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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To determine whether debris from a silicone core suture has an observable intra-articular or extra-articular impact or can be shown to migrate into the lymphatic system. Methods: Using a porcine stifle joint model, 2 study groups were created: 1 group used silicone-suture particles created by rupturing hand-tied knots of a nonabsorbable suture with an outer sheath of ultrahigh molecular-weight polyethylene, an inner polyester sheath and a medical-grade silicone/sodium chloride-filled core. The second group used a mixture of 3 vitreous carbon particles sizes. Twelve Yorkshire pigs were randomly assigned to each group. Only 1 type of study particle was used in a single animal to avoid crosscontamination. Half of the study materials were placed by arthrotomy into the joint and, after capsular closure, the remaining half were placed on the joint capsule before skin closure. Six weeks postimplantation, the stifle joints and regional lymph nodes were examined macroscopically and microscopically. The extracapsular and intra-articular tissue and the lymph nodes were examined. Results: Macroscopically, none of the 12 silicone-suture particle group limbs had abnormal macroscopic observations. Of the 12 limbs in the carbon particle group, 8 demonstrated discoloration in the extracapsular, intra-articular and lymph node tissues; 6 limbs demonstrated joint discoloration (extracapsular and intraarticular). The silicone-suture particle group showed lymph node inflammation in 25% of the iliac lymph nodes and 42% of the inguinal lymph nodes but none in the popliteal lymph nodes. In the carbon particle group, 100% of the iliac lymph nodes, 75% of the inguinal lymph nodes and 8% of the popliteal nodes showed inflammation. No silicone-suture debris migration was observed microscopically. Visible carbon particle migration was present in 100% of the iliac lymph nodes and in 50% of the inguinal lymph nodes but in none (0) of the popliteal lymph nodes. The carbon particle group also showed inflammation in these areas. Conclusions: Carbon particles in the porcine knee migrated into the lymph nodes (iliac 100%; inguinal 50%, popliteal 0); gross discoloration was observed in 8 of 12 specimens. Silicone-suture particles could not be found in the lymph nodes, and no macroscopic joint damage was observed. Clinical Relevance: The clinical use of a suture containing a silicone/salt central core is common, and the porcine lymphatic model suggests that this type of suture material does not result in clinically significant silicone particulates.

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Biomechanical Performance of Traditional Arthroscopic Knots Versus Slippage-Proof Knots

Cited by 15 publications

References 12 publications

Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture

The Sliding, Interlocking “8-2-Alpha Knot” for Arthroscopic Surgery

Suture-Based Debris Behavior in the Draining Lymph Nodes of a Porcine Knee: A Study of Silicone, Polyethylene and Carbon

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