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

Kuptniratsaikul, Somsak; Weerawit, Pawin; Kongrukgreatiyos, Kitiphong; Promsang, Trai

doi:10.1002/jor.23187

Cited by 16 publications

(20 citation statements)

References 18 publications

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“…The literature has shown variation in knot strength to be a multifactorial phenomenon that is affected by both biomechanical factors such as suture material and knot configuration, as well as intrinsic variations in surgeon performance. Kuptniratsaikul et al 24 compared the loop security of the Weston, Chula, SMC, and Tennessee sliding knots using MagnumWire, Hi-Fi, and FiberWire sutures and found considerable variation in loop security across different knot-suture combinations. Similarly, Hassinger et al 25 found significant differences in loop security and knot security across 10 commonly used arthroscopic knots tied using the same suture material, suggesting that biomechanical factors such as knot type and suture material contribute to variation in knot strength.…”

Section: Discussionmentioning

confidence: 99%

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Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies

Xin

Sheth

Abouali

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To provide a comprehensive review of the current clinical and biomechanical evidence for the use of knotless suture anchors during arthroscopic Bankart repair. Methods: A comprehensive search of 5 electronic databases from inception to July 2020 was performed for clinical and biomechanical studies in English evaluating outcomes following arthroscopic Bankart repair using knotless suture anchors. Two independent reviewers assessed articles for inclusion. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORs) criteria. Clinical outcomes of interest and key findings from biomechanical studies were summarized. Results: Ten clinical studies (430 knotless repairs), including 4 cohort studies directly comparing knotless (N ¼ 117) to knot-tying repairs (N ¼ 192), were deemed eligible. Four biomechanical studies were also identified. Heterogeneity and the lack of randomized studies precluded data pooling and quantitative meta-analysis. Rates of redislocation ranged from 2.2% to 14.7% and 1.5% to 23.8% for knottying and knotless repair, respectively. Both knot-tying and knotless repair demonstrated excellent postoperative functional outcome, as assessed by visual analog scale, Constant-Murley, Rowe, and QuickDASH scores, with 80% to 94% of patients returning to sports participation. Biomechanical studies showed similar stiffness and load to failure between knottying and knotless repairs, with the most common mode of failure being retear at the sutureesoft tissue interface. Conclusions: Current level II to IV clinical and biomechanical evidence supports knotless arthroscopic Bankart repair as an effective procedure with excellent functional outcomes and low rates of complication and reoperation. Level of Evidence: Level IV, systematic review of level II to IV studies.A rthroscopic Bankart repair using suture anchors is a widely accepted method of restoring labral anatomy, with results similar to that of open stabilization. 1,2 The benefits of arthroscopic surgery include faster return to activity, smaller surgical scars, improved range of motion, and shorter hospital stay. 3

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Section: Discussionmentioning

confidence: 99%

“…Kuptniratsaikul et al. 24 compared the loop security of the Weston, Chula, SMC, and Tennessee sliding knots using MagnumWire, Hi-Fi, and FiberWire sutures and found considerable variation in loop security across different knot-suture combinations. Similarly, Hassinger et al.…”

Section: Discussionmentioning

confidence: 99%

Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies

Xin

Sheth

Abouali

2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…This study included surgical interventions for the treatment of shoulder instability and rotator cuff tears, but techniques and indications for these surgical procedures also vary and are not directly comparable across studies. It should be noted, however, that there are studies 27,30 that suggest that as long as 3 reversing half-hitch knots are tied, the strength of the SK is dependent on the half-hitch throws and independent of SK configuration. Additionally, the suture material and number of reversing half-hitches on alternating posts locking the knot in position affect the amount of friction holding the knot in position and, therefore, the integrity of the knot itself.…”

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

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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.

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“…The number of labral penetrations with the BirdBeak suture passer must be no more than 1 or 2; otherwise, large labral defect will be created. Knot tying is done using a Chula Knot, 22 followed by 3 reversing half-hitches through the posterior portal. Excess suture limbs are cut arthroscopically.…”

Section: Surgical Techniquementioning

confidence: 99%

Arthroscopic Decompression of Spinoglenoid Notch Cyst and SLAP Repair Through a Single Working Portal

Promsang¹,

Kongrukgreatiyos

Kuptniratsaikul

2018

Arthroscopy Techniques

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A SLAP lesion can be found with a concomitant spinoglenoid notch cyst. The cyst can cause suprascapular nerve compression, resulting in shoulder pain and weakness of external rotation. Their management varies from conservative treatment to operative treatment. Cyst decompression through the labral tear is our preferred treatment. Previous studies demonstrated a good result after arthroscopic decompression of the cyst through the labral tear combined with SLAP repair. Many surgeons usually use 3 portals to perform this procedure. However, we prefer to use only 2 portals, 1 anterior viewing portal and 1 posterior working portal. This strategy is more time and cost efficient. The patient is positioned in lateral decubitus. The SLAP lesion is demonstrated by using a probe. Tissue elevator is inserted into the labral lesion to penetrate into the cyst wall. A soft anchor is placed. A birdbeak suture passer penetrates the posterior labrum. Then knot tying is done. The advantages of this single working portal technique are short operative time, a decreased risk of iatrogenic rotator cuff injury from accessory anterolateral portal or posterior labral injury from posterolateral portal, and avoiding unnecessary superior capsule incision for cyst exposure.

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

Cited by 16 publications

References 18 publications

Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies

Excellent Functional Outcomes and Low Complication Rates Following Knotless Arthroscopic Bankart Repair: A Systematic Review of Clinical and Biomechanical Studies

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

Arthroscopic Decompression of Spinoglenoid Notch Cyst and SLAP Repair Through a Single Working Portal

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