Biomechanical evaluation of the Nice knot

Abstract

Background:The Nice knot is a bulky double-stranded knot. Biomechanical data supporting its use as well as the number of half hitches required to ensure knot security is lacking.Materials and Methods:Nice knots with, one, two, or three half-hitches were compared with the surgeon's and Tennessee slider knots with three half hitches. Each knot was tied 10 times around a fixed diameter using four different sutures: FiberWire (Arthrex, Naples, FL), Ultrabraid (Smith and Nephew, Andover, MA), Hi-Fi (ConMed Linvatec, Largo, FL) and Force Fiber (Teleflex Medical OEM, Gurnee, IL). Cyclic testing was performed for 10 min between 10N and 45N, resulting in approximately 1000 cycles. Displacement from an initial 10N load was recorded. Knots surviving cyclic testing were subjected to a load to failure test at a rate of 60 mm/min. Load at clinical failure: 3 mm slippage or opening of the suture loop was recorded. Bulk, mode of ultimate failure, opening of the loop past clinical failure, was also recorded.Results:During cyclic testing, the Nice knots with one or more half-hitches performed the best, slipping significantly less than the surgeon's and Tennessee Slider (P < 0.002). After one half-hitch, the addition of half-hitches did not significantly improve Nice knot performance during cyclic testing (P > 0.06). The addition of half-hitches improved the strength of the Nice knot during the force to failure test, however after two half-hitches, increase of strength was not significant (P = 0.59). While FiberWire was the most bulky of the sutures tested, it also performed the best, slipping the least.Conclusion:The Nice knot, especially using FiberWire, is biomechanically superior to the surgeon's and Tennessee slider knots. Two half hitches are recommended to ensure adequate knot security.

Initial Biomechanical Properties of Transtibial Meniscal Root Repair are Improved By Using a Knotless Anchor as a Post-Insertion Tensioning Device

“…Another work compared an in-situ suture anchor repair and a transtibial technique with sutures tied over a titanium plate in a porcine model 10 In the transtibial pullout repair, the mean permanent displacement registered after 1000 cycles of a [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] N load was 2.2 mm with the transtibial technique. Again, notorious methodological dissimilarities difficult contrast of the result with our study.…”

“…A recent work monitored the meniscus-suture interface and found no macroscopic damage at the meniscus-suture boundary up to a load close to ultimate failure 13 . This implies that sources other than suture cutout should contribute to generating permanent displacements, such as knot squeezing or slipping, since a certain degree of knot slippage under load has been reported 14,15 . In transtibial repair techniques, sutures are frequently fixed by tying them over a cortical button or a post at the distal end of the bone tunnel exit.…”

Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

“…The biomechanical [ 21 ] comparison showed that high-performance sutures provided an alternative to steel wire for cerclage fixation, which had certain clinical application value. A recent biomechanical study [ 5 ] demonstrated that the Nice knot, especially using fiber wire, was biomechanically superior to the surgeon’s and Tennessee slider knots. P Collin [ 4 ] et al made a mechanical analysis of Nice knot, which provided an option for sliding and locking knots, which reduced the risk of elongation during dynamic stress.…”

Biomechanical Investigation of Different Tying Forces on Knot Security

“…Prolene 4-0 (Ethicon, US), a single stranded synthetic nonabsorbable polypropylene monofilament suture was used to stitch the skin. The surgeon's knot was chosen as the knot technique of choice in our study because it is a simple and commonly adopted knot technique that has been shown to be superior to square and sliding knots in terms of knot security [4,[14][15][16]. For each specimen, a surgeon's knot with 3 throws (2-1-1) was made.…”