Abstract
Introduction
This study aims to compare the biomechanical properties and ease of learning and tying of our novel knot (UM Knot) with other commonly used arthroscopic sliding knots.
Materials and methods
The Duncan, HU, SMC, Pretzel, Nicky’s and square knots were selected for comparisons with UM knot. All knots were prepared with size 2 HiFi® suture by a single experienced surgeon and tested with cyclic loading and load to failure tests. The ease of learning was assessed objectively by recording the time to learn the first correct knot and the total number of knots completed in 5 min by surgeons and trainees.
Results
The UM knot average failure load is significantly superior to the HU knot (p < 0.05) and comparable to Duncan, SMC, Pretzel and Nicky’s knots. According to the ease of learning assessment, UM, Duncan, SMC, Pretzel and Nicky’s knots took statistically less time to learn than the HU knot. Although not significant, the failure count due to slippage is fewer in UM knot compared with other knots.
Conclusions
This study showed that UM knot is among the easiest knot to learn and tie, along with Duncan, SMC, Pretzel and Nicky’s knots. Their biomechanical properties are comparable and their loads to failure were superior to the HU knot.
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References
Lee, T. Q., Matsuura, P. A., Fogolin, R. P., Lin, A. C., Kim, D., & McMahon, P. J. (2001). Arthroscopic suture tying: a comparison of knot types and suture materials. Arthroscopy,17, 348–352.
Rolla, P. R., & Surace, M. F. (2002). The double-twist knot: a new arthroscopic sliding knot. Arthroscopy,18, 815–820.
Burkhart, S. S., Wirth, M. A., Simonick, M., Salem, D., Lanctot, D., & Athanasiou, K. (1998). Loop security as a determinant of tissue fixation security. Arthroscopy,14, 773–776.
Loutzenheiser, T. D., Harryman, D. T., Yung, S. W., France, M. P., & Sidles, J. A. (1995). Optimizing arthroscopic knots. Arthroscopy,11, 199–206.
Elkousy, H. A., Hammerman, S. M., Edwards, T. B., Warnock, K. M., O’Connore, D. P., Ambrose, C., et al. (2006). The arthroscopic square knot: a biomechanical comparison with open and arthroscopic knots. Arthroscopy,22, 736–741.
Elkousy, H. A., Sekiya, J. K., Stabile, K. J., & McMahon, P. J. (2005). A biomechanical comparison of arthroscopic sliding and sliding-locking knots. Arthroscopy,21, 204–210.
Karahan, M., Akgun, U., Turkoglu, A., Nuran, R., Ates, F., & Yücesoy, C. (2012). Pretzel knot compared with standard suture knots. Knee Surgery, Sports Traumatology, Arthroscopy,20, 2302–2306.
Kim, S. H., Ha, K. I., Kim, S. H., & Kim, J. S. (2001). Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot. Arthroscopy,17, 850–855.
Lieurance, R. K., Pflaster, D. S., Abbott, D., & Nottage, W. M. (2003). Failure characteristics of various arthroscopically tied knots. Clinical Orthopaedics and Related Research,408, 311–318.
Mishra, D. K., Cannon, W. D., Jr., Lucas, D. J., & Belzer, J. P. (1997). Elongation of arthroscopically tied knots. American Journal of Sports Medicine,25, 113–117.
Baumgarten, K. M., & Wright, R. W. (2010). Incorporating evidence-based medicine in arthroscopic knot preferences: a survey of American Orthopaedic Society for Sports Medicine members. American Journal of Orthopedics,39, 577–581.
Mochizuki, Y., Hachisuka, H., Natsu, K., Kashiwagi, K., Yasunaga, Y., & Ochi, M. (2005). The HU knot: a new sliding knot for arthroscopic surgery. Arthroscopy,21, 1014-e1.
Kim, S. H., & Ha, K. I. (2000). The SMC knot—a new slip knot with locking mechanism. Arthroscopy,16, 563–565.
Karahan, M., Akgun, U., & Espregueira-Mendes, J. (2010). The Pretzel knot: a new simple locking slip-knot. Knee Surgery, Sports Traumatology, Arthroscopy,18, 412–414.
De Beer, J. F., van Rooyen, K., & Boezaart, A. P. (1998). Nicky’s knot—a new slip knot for arthroscopic surgery. Arthroscopy,14, 109–110.
Mahar, A. T., Moezzi, D. M., Serra-Hsu, F., & Pedowitz, R. A. (2006). Comparison and performance characteristics of three different knots when tied with two suture materials used for shoulder arthroscopy. Arthroscopy,22, 610–614.
Abbi, G., Espinoza, L., Odell, T., Mahar, A., & Pedowitz, R. (2006). Evaluation of five knots and two suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy,22, 38–43.
Field, M. H., Edwards, T. B., & Savoie, F. H., III. (2001). A ‘new’ arthroscopic sliding knot. Orthopedic Clinics of North America,32, 525–526.
Fleega, B. A., & Sokkar, S. H. (1999). The giant knot: a new one-way self-locking secured arthroscopic slip knot. Arthroscopy,15, 451–452.
Pallia, C. S. (2003). The PC knot: a secure and satisfying arthroscopic slip knot. Arthroscopy,19, 558–560.
Barber, F. A., Herbert, M. A., & Beavis, R. C. (2009). Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy,25, 192–199.
Gunderson, P. E. (1987). The half-hitch knot: a rational alternative to the square knot. American Journal of Surgery,154, 538–540.
Herrmann, J. B. (1971). Tensile strength and knot security of surgical suture materials. American Journal of Surgery,37, 209–217.
Burkhart, S. S., Wirth, M. A., Simonick, M., Salem, D., Lanctot, D., & Athanasiou, K. (2000). Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? Arthroscopy,16, 202–207.
Baumgarten, K. M., & Wright, R. W. (2007). Ease of tying arthroscopic knots. Journal of Shoulder and Elbow Surgery,16, 438–442.
Acknowledgements
We would like to thank the laboratory technician from biomechanics laboratory, Department of Orthopaedics, Faculty of Medicine, University of Malaya for their contribution to the success of this research. We would also like to thank Mr. Saravana Ramalingam for the statistical analysis support.
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Concepts: SHT, WMN, MZMA, MRMA. Design: SHT, WMN, MZMA, MRMA. Literature search: SHT, WMN, MRAR, MZMA, MRMA. Experimental studies: SHT, WMN. Data acquisition: SHT, WMN. Data analysis: SHT, WMN, MRAR. Statistical analysis: SHT, MRAR. Manuscript preparation: SHT, WMN, MRAR. Manuscript editing: SHT, MRAR. Manuscript review: SHT, WMN, MRAR, MZMA, MRMA.
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Teo, S.H., Ng, W.M., Abd Rahim, M.R. et al. A Biomechanical and Ease of Learning Comparison Study of Arthroscopic Sliding Knots. JOIO 54, 168–173 (2020). https://doi.org/10.1007/s43465-019-00024-2
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DOI: https://doi.org/10.1007/s43465-019-00024-2