Knots Tied With High–Tensile Strength Tape Biomechanically Outperform Knots Tied With Round Suture

Abstract

Background: Tape-type suture material is well-accepted in arthroscopy surgery. Purpose: To compare the knot security of a high–tensile strength round suture and high–tensile strength tape with commonly used arthroscopic knots. Study Design: Controlled laboratory study. Methods: We compared the performance of No. 2 braided nonabsorbable high-strength suture with that of 1.3-mm braided nonabsorbable high-strength tape. Five commonly used arthroscopic knots were investigated: the Roeder knot; the Western knot; the Samsung Medical Center (SMC) knot; the Tennessee knot; and a static surgeon’s knot. Seven knots were tied for each combination of knots and suture types. Knots were tied on a 30-mm circumferential metal post, and the suture loops were transferred to a materials testing machine. After preloading to 5 N, all specimens were loaded to failure. The clinical failure load, defined as the maximal force to failure at 3 mm of crosshead displacement, yield load, and stiffness, were recorded. A 2-way analysis of variance was used to determine differences between the groups. Results: Both suture type and knot type significantly affected the clinical failure load, yield load, and stiffness ( P = .002). The high-strength tape resulted in a significantly greater clinical failure load than the high-strength suture in the case of the Roeder knot, Western knot, and SMC knot ( P = .027, .005, and .016, respectively). When the high-strength round suture was used, the Roeder knot, Western knot, and SMC knot resulted in significantly smaller clinical failure loads compared with the Tennessee knot ( P = .011, .003, and .035, respectively) and the static surgeon’s knot ( P < .001 for all). When the high-strength tape was used, the Roeder knot, Western knot, and SMC knot resulted in significantly smaller clinical failure loads compared with the static surgeon’s knot ( P = .001, .001, and .003, respectively). Conclusion: The results of this study indicated that arthroscopic knots tied using 1.3-mm high-strength tape biomechanically outperformed knots tied using a No. 2 high-strength suture. While the static surgeon’s knot exhibited the best biomechanical properties, the Tennessee knot resulted in generally better biomechanical properties among the arthroscopic sliding knots. Clinical Relevance: Elongation and loosening of tied knots possibly affects the clinical results of repaired constructs.

Biomechanics of surgical knot security: a systematic review

“…Eighty-three articles were found to be of potential interest. After reviewing the title and abstract, 36 articles with objective data were included in this review 4 – 39 . Six articles were excluded because of other factors such as knotless technique, heat, and instrument effect.…”

Biomechanical Comparison of 1.2-mm Suture Tape, 2.0-mm Suture Tape, and 0.5-mm Suture Using Various Arthroscopic Knot Techniques

“…With respect to loop security, arthroscopic sliding knots are considered to be better than nonsliding knots because sliding knots with an internal locking mechanism avoid significant gaps in additional locking half-hitches. 28 Regarding knot security, the initial slip knot of SMC 15 and Tennessee 11 is fastened inside the joint, which allows better sliding capability because of the lower coefficient of friction. Also, with nonsliding knots, it is often difficult to make a secure tendon approximation in arthroscopic surgery using a knot pusher.…”

“…In this study, we evaluated the loop and knot security of 2 tape-type sutures (1.2-mm and 2.0-mm braided UHMWPE sutures) and 1 cord-type suture (0.5-mm No. 2 braided UHMWPE suture) using 4 different widely used knot types: 2 sliding knots (Samsung Medical Center [SMC] 15 and Tennessee 11 ) and 2 nonsliding knots (2-throw surgeon’s 8 and 2-throw square 1 ) (Figure 1). Both threads—XbraidTT (tape-type) and Force Fiber (cord-type)—were pulled from an ICONIX anchor (Stryker).…”