Arthroscopic sliding knot: How many additional half-hitches are really needed?

Kim, Seung‐Ho; Yoo, Jae Chul; Wang, Joon Ho; Choi, Kuiwon; Bae, Tae Soo; Lee, Changyang

doi:10.1016/j.arthro.2004.12.010

Cited by 73 publications

(78 citation statements)

References 18 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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“…It is our experience that many popular lockable sliding knots are often unable to fully flip, thus producing only partial primary locking by post-strand strangulation that could not truly prevent knot slippage. 1,2 The evolution of the described knot occurred by chance; the knot was not adapted from other lockable sliding knots as described earlier. However, the basic knot-tying process as shown in method 3 surprisingly becomes very similar to the SMC or Roeder knot, particularly the first few steps of knot tying.…”

Section: Discussionmentioning

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 second can be seen in almost every knot that required a flipping maneuver to be locked, which prevents the knot from slipping backwards, but it also enlarges the suture loop. [33][34][35]59,69 Sliding knots are advantageous because they can be slid down the post limb without allowing the loop to loosen, but have to be used carefully as the suture may slide through the tissue, causing a potential damage to the rotator cuff tendon, or may slide along the anchor, causing abrasion and weakening of the suture itself. The type of knot affects 80% of the force required for slippage, and only 20% of the force required for rupture.…”

Section: Knotmentioning

confidence: 99%

“…However, in each case, a strong and secure knot is required to provide adequate soft-tissue apposition for good healing. Modification of knot configurations, 26,[31][32][33][34][35][36][37][38][39][40][41][42][43] suture materials, 26,[44][45][46] and instrumentation 47,48 has improved knot security, decreasing the discrepancy between the arthroscopic and open approaches. 30 When tying an arthroscopic knot, there are 2 limbs of the suture called, respectively, the wrapping limb and the post limb.…”

mentioning

confidence: 99%

Arthroscopic Knots and Strength Sutures for Rotator Cuff Repair

Longo

Buchmann²,

Berton

et al. 2011

Sports Medicine and Arthroscopy Review

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Most arthroscopic rotator cuff reconstruction techniques require a method of securing the tendon to the bone to obtain a stable construct. The available options include knotless technology and suture welding, but the most common method uses suture anchors and knots. Tissue quality, surgical technique, repair material, and tension overload influence the stability of tissue repair. Arthroscopic knots are technically demanding because they are tied through cannulas with long-handled knot pushers. The strength of the repair is also influenced by the suture material used. In this study, we review the state-of-the-art of arthroscopic knots and suture materials being used for arthroscopic rotator cuff repair.

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Arthroscopic sliding knot: How many additional half-hitches are really needed?

Cited by 73 publications

References 18 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

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

Arthroscopic Knots and Strength Sutures for Rotator Cuff Repair

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