Cyclic testing of arthroscopic knot security

Ilahi, Omer A.; Younas, Shiraz; Alexander, Jerry W.; Noble, Philip C.

doi:10.1016/j.arthro.2003.11.002

Cited by 54 publications

(91 citation statements)

References 9 publications

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“…Since Loutzenheiser et al [12] reported that they used the same post for the first half-hitch to support initial slip knots, as was recommended by Trimbos et al [22,23], all subsequent studies have followed this principle, and somewhat surprisingly, no objective study has been conducted to verify this rationale [13][14][15][16][17][18][19][20][21]24,25]. Moreover, the original studies conducted by Trimbos et al dealt with optimal configurations of stacked half-hitches, rather than those of modern sliding knots with back-up half-hitches.…”

Section: Discussionmentioning

confidence: 99%

“…It has been routine practice in orthopedic surgery to add three reverse half-hitches on alternating posts (RHAPs) to support sliding knots, since the merits of this were reported by Loutzenheiser et al [12,17], and somewhat surprisingly, whereas numerous studies have been conducted on the mechanical characteristics of sliding knots with or without three RHAPs [12][13][14][15][16][17][18][19][20], few studies have been performed to verify optimal number of additional half-hitches [14,21].…”

Section: Introductionmentioning

confidence: 99%

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Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches

Lee

Kang

et al. 2008

Knee Surg Sports Traumatol Arthr

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The purpose of this biomechanical study was to determine optimized configuration of additional half-hitches placed after various arthroscopic sliding knots. Four commonly used arthroscopic sliding knots, namely, the Duncan loop, the SMC, Weston, and SP knot, were included in this study. All knots were tied with a single-hole knot pusher using a knot-tying simulator. After tying a sliding knot, it was backed up with zero to four additional reverse half-hitches on alternating posts (RHAPs). The first half-hitch was either placed on the same post (conventional RHAP; c-RHAP) or on the loop limb of the sliding knot (switched RHAP; s-RHAP). Ten knots were tied in each configuration using No. 2 Ethibond or No. 1 PDSII sutures. Loop security (loop circumference at 5 N) and knot security (highest load to failure at a cross-head displacement of 3 mm) were measured. Knot configurations, number of RHAPs, or mode of placement of the first half-hitch did not make clinically significant effects on loop security for either suture type. Using No. 2 Ethibond sutures, SMC, SP, and Weston knots required at least three additional half-hitches before knot security plateaued. However, when the first half-hitch was switched to the loop limb of the sliding knot, only two additional half-hitches (2 s-RHAPs) were required to reach maximum knot security. Using No. 1 PDSII sutures, SMC knots needed one additional half-hitch to reach maximum knot security, whereas SP and Weston knots required two half-hitches. However, SMC, SP and Weston knots with switched first half-hitch only required one additional half-hitch (1 s-RHAP) to achieve maximum knot security. This study demonstrated that switching the post just after the sliding knot could save one half-hitch without compromising knot security. That means that sliding knots with 2 s-RHAPs for No. 2 Ethibond and 1 s-RHAPs for No. 1 PDSII achieved knot security comparable to that of sliding knots with 3 c-RHAPs and with 2 c-RHAPs, respectively. The results suggested that the optimized configuration for arthroscopic sliding knots required a secure sliding knot, such as, the SMC, SP, or Weston knots and 2 s-RHAPs when No. 2 Ethibond or No. 1 PDSII suture materials were used considering the unraveling tendency of No. 1 PDSII. Results of the current study may be helpful for establishing arthroscopic sliding knot-tying routines for best results in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches

Lee

Kang

et al. 2008

Knee Surg Sports Traumatol Arthr

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“…The Weston and square knots also were backed up with three half hitches. They were selected because they have been used by other authors in biomechanical testing and are example of a common sliding knots and a common static knot [1,3,8].…”

Section: Methodsmentioning

confidence: 99%

Optimization of the Racking Hitch Knot: How Many Half Hitches and Which Suture Material Provide the Greatest Security?

Kelly¹,

Vaishnav

Saunders³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…2 fi berwire, the addition of three RHAPs decreased the loop circumference of the Nicky's knot, the Mishra knot and the Roeder knot. No signifi cant Reversed half-hitches 7,8,12 Practical knot (simple version) [11][12][13] Practical knot (advanced version) [11][12][13] Nicky's knot or taut-line hitch [7][8][9][10][11][12][13][14] Giant knot 15 Modifi ed taut line hitch 15,16 Tennessee slider 13 Clinch knot 14 Roeder's knot 7,[16][17][18] Secure knot 17 Meltzer's knot 7,8,15,16 Mishra's knot 7,8,16 Duncan loop, blood slipknot, Hangman's knot, easy loop 17,18 Weston knot 18,19 SMC knot 15 Tayside knot 19 Hangman's knot 18,[20][21][22] Hangman's tie [20][21][22] …”

Section: Resultsmentioning

confidence: 99%

“…11 It is believed that this increased knot security occurs because the wrapping limbs tighten (removal of slack) around the post until the internal interference and friction are high enough to resist the applied load. [20][21][22] Also, locking the knot by tensioning the wrapping limb and 'fl ipping' the knot also provided another potential mechanism of enlargement of the suture loop. 12 Although this locking mechanism is particularly useful in preventing the knot from sliding back, locking the knot also causes expansion of the suture loop.…”

Section: Discussionmentioning

confidence: 99%

Comparing Extracorporeal Knots in Laparoscopy using Knot and Loop Securities

Akindele¹,

Fasanu²,

Mondal³

et al. 2014

WJOLS

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Background: Laparoscopic knot tying is a basic surgical skill that has been practiced for centuries having their roots in fi shing and sailing. [1][2][3][4] The advent of endoscopic surgery placed more challenges on the surgeons and this ever growing skills need to be acquired. Since endoscopic and arthroscopic knots must be delivered over a distance to a tissue with minimal access maintaining tension is more important than the knot confi guration chosen. 5,6 The aim of this article review is to determine which hand tied knot confi guration and possibly, suture size, and suture type that would be safe in laparoscopic surgery.

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Cyclic testing of arthroscopic knot security

Cited by 54 publications

References 9 publications

Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches

Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches

Optimization of the Racking Hitch Knot: How Many Half Hitches and Which Suture Material Provide the Greatest Security?

Comparing Extracorporeal Knots in Laparoscopy using Knot and Loop Securities

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