Objective Evidence for Optimum Knot Configuration

Abstract

If a double-hitch throw is used in the first throw, two to three further throws are recommended. The four-throw knot configurations have the best knot qualities and should generally be used.

Pedicle ligation in ovariohysterectomy: an in vitro study of ligation techniques

“…The weights were hung via pulleys over the edge of the table to tension each throw with care taken to apply load evenly to both strands. The knot was completed with two additional square throws hand‐tightened securely by the operator such that each knot consisted of a total of four throws (Lee and others ). Because the model design did not readily accommodate the construction of a slip knot, all slip knots were thrown by hand and hand‐tightened by the operator for 15 seconds, again completed with two further square throws.…”

Variability of surgical knot tying techniques: do we need to standardize?

“…Even though some papers have claimed to have found objective evidence for an optimum knot [22], the issue remains controversial and the search for the perfect knot continues [10,[23][24][25][26][27]. As the results reported in the literature are not standardized and not easily comparable [28], the technique options presented tend to confuse rather than help the surgical community [29,30].…”

Assessment of Four Tissue Models on Knot Tensile Strength

“…Studies have been performed by tying knots onto synthetic materials, including aluminum rods, metal rings, and plastic tissue models. [3][4][5] To have an accurate understanding of how knots withstand force, it is possible that a more complete in vivo environment must be maintained, including the mechanism onto which the knot is tied. Teaching simulation laboratories have used animals (chicken thighs and pig feet) as well as industry-produced human skin-like products.…”