Loop Securities of Arthroscopic Sliding-Knot Techniques When the Suture Loop Is Not Evenly Tensioned

Kim, Sae Hoon; Glaser, Diana; Doan, Josh; Chung, Seok Won; Choi, Hye Yeon; Oh, Joo Han; Hargens, Alan R.

doi:10.1016/j.arthro.2013.05.013

Cited by 12 publications

(13 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This added complication makes these knots more challenging to master but critical for situations when the suture cannot slide freely. 47 Biomechanical studies [1][2][3]20,22,23,44 have demonstrated that different types of SKs and NSKs have different ultimate loads to failure, 1,2 resistance to sliding, 20,23 ease of knot tying, 3 elongation and knot migration, 24,25,44 and distance to failure. 22 Therefore, even if 2 studies use SKs, they may produce inconsistent results because of differences between the knot types.…”

Section: Discussionmentioning

confidence: 99%

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Morrissey

Houck

Jang

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes. Purpose: To assess the clinical outcomes of arthroscopic sliding knot (SK)– versus nonsliding knot (NSK)–tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score. Results: Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology. Conclusion: The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Morrissey

Houck

Jang

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…A definition of loop security is that of “the ability to resist backsliding when tension is released on the post strand after locking is confirmed by pulling the non‐post limb.” The loop security is more important than knot security since knot security essentially resulted from the half‐hitch throw that was added after initial sliding knot. 1 Previous studies demonstrated that most of sliding knots with additional half‐hitched throws had optimal knot security .…”

Section: Discussionmentioning

confidence: 99%

“…Loop security of a sliding knot originates from its ability to resist backsliding when tension is released on the post strand after locking is confirmed by pulling the non—post limb. Knot security refers to the strength of the completed knot after it is locked with successive three reversing half‐hitch throws …”

mentioning

confidence: 99%

“…Most of them are not significantly different in load to failure and clinical use . However, loop security of initial sliding locking knot without RHAPs is different significantly between each knot types . Success of a sliding locking knot depends on the initial sliding knot that can inherently maintain under tension without slack until it is seated by subsequent locking half‐hitches .…”

mentioning

confidence: 99%

See 1 more Smart Citation

Biomechanical comparison of four sliding knots and three high‐strength sutures: Loop security is much different between each combination

Kuptniratsaikul

Weerawit²,

Kongrukgreatiyos

et al. 2016

Journal Orthopaedic Research

View full text Add to dashboard Cite

There are many types of sliding knots and suture materials used in arthroscopic surgery. The purposes of this study are (i) to evaluate the loop security of standard sliding knots when using different types of high-strength suture materials and (ii) to compare the loop security of a new sliding knot (Chula knot) to other standard sliding knots. Four configurations of sliding locking knots (Weston, SMC, Tennessee and Chula knots) were tied using three commonly used suture materials: MagnumWire, Hi-Fi, and FiberWire. The suture loops were mounted on two metallic hooks of the universal testing machine. Then, the suture loop was pulled apart until failure. The Weston knot demonstrated the greatest load to failure in all suture materials. By using MagnumWire, the load to failure was as follow: Weston 53.2 N, Chula 48.8 N, SMC 39.2 N, and Tennessee 29.3 N. By using Hi-Fi, the load to failure was as follow: Weston 58.8 N, Chula 51.5 N, SMC 38.1 N, and Tennessee 28.7 N. By using FiberWire, the load to failure was as follow: Weston 38.8 N, Chula 29.7 N, SMC 23.2 N, and Tennessee 21.9 N. Weston knot has the highest loop security in all suture materials. Weston-HiFi combination demonstrate the strongest loop security. Conversely, the weakest combination is Tennessee-FiberWire. Chula knot has similar properties to other commonly used arthroscopic sliding knots. Our findings indicate that surgeons should be careful in selecting proper knot-suture combinations. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1804-1807, 2016.

show abstract

“…The concepts of loop security and knot security are fundamental when evaluating the effectiveness of these arthroscopic knots. Knot security is defined as the ability of a knot to resist slippage with the application of a load, whereas loop security refers to the strength of a first knot after it is locked without three reversing half-hitch throws (Kim et al 2013 ; Lo et al 2010 ). The purpose of our study was to evaluate the loop strength of the three described knots tied by residents in various levels of training and to identify which knot performs best at various levels of training in regards to loop and knot security.…”

Section: Introductionmentioning

confidence: 99%

The effect of residency training on arthroscopic knot tying and knot stability: which knot is best tied by Orthopaedic surgery residents?

et al. 2018

View full text Add to dashboard Cite

BackgroundThe aim of this study is to evaluate which of three arthroscopic knots are most reliably taught to and executed by residents at varying levels of training.MethodsThree arthroscopic knots, the Samsung Medical Center (SMC), the Weston, and the surgeon’s knot, were taught to 16 orthopaedic surgery residents. Each knot was tied in triplicate at two sessions 1 week apart. The knots were then biomechanically tested for strength. Corresponding knots tied by a sports medicine fellow served as the respective controls.ResultsComparing all knots regardless of year of training, the SMC knot failed at significantly higher loads (237.2 ± 66.6 N) than the surgeon’s knot (203.7 ± 45.3 N, p = 0.049) and the Weston knot (193.5 ± 56.1 N, p = 0.013). No significant differences in knot strength were found when comparing knots tied by residents at different levels of training and when comparing residents to the sports medicine fellow. There was no difference in conditioning elongation between surgeon’s (p = 0.343), Weston (p = 0.486), or SMC knots (p = 0.200) tied by post-graduate year one and five residents.ConclusionsWe report the first study that evaluates the loop strength of an arthroscopically tied knot performed by orthopaedic surgery residents in various levels of training. In our cohort, the SMC knot required a higher load to failure, when compared to the Surgeon’s and Weston knot, after a simple arthroscopic knot tying curriculum. Based on these findings, he SMC knot should be considered as a part of future orthopaedic surgery resident arthroscopic training programs.

show abstract

Loop Securities of Arthroscopic Sliding-Knot Techniques When the Suture Loop Is Not Evenly Tensioned

Cited by 12 publications

References 16 publications

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Biomechanical comparison of four sliding knots and three high‐strength sutures: Loop security is much different between each combination

The effect of residency training on arthroscopic knot tying and knot stability: which knot is best tied by Orthopaedic surgery residents?

Contact Info

Product

Resources

About