Advertisement

Literature Review of Arthroscopic Knots

  • Maristella F. Saccomanno
  • Giuseppe MilanoEmail author
Chapter
First Online:

Abstract

Knot tying is a basic surgical skill. As the indications for arthroscopy have expanded, attention has turned to how arthroscopic surgery compares with open surgery, so the ability to tie secure knots arthroscopically is essential for surgeons who wish to achieve results comparable with open repairs. Though the principles of open and arthroscopic repair are the same, arthroscopic knots are more difficult than hand-tied ones. Despite the large number of knot options and suture types, most of the time the choice of the knots is not based on scientific evidence but on empirical data and surgeon’s preference. The present chapter reviewed different arthroscopic knots and their biomechanical properties.

This is a preview of subscription content, log in to check access.

References

  1. 1.
    Loutzenheiser TD, Harryman DT, Yung SW, et al. Optimizing arthroscopic knots. Arthroscopy. 1995;11:199–206.CrossRefPubMedGoogle Scholar
  2. 2.
    Nottage WM, Lieurance RK. Arthroscopic knot typing techniques. Arthroscopy. 1999;15:515–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Longo UG, Buchmann S, Berton A, et al. Arthroscopic knots and strength sutures for rotator cuff repair. Sports Med Arthrosc. 2011;19:251–65.  https://doi.org/10.1097/JSA.0b013e3182199373.CrossRefPubMedGoogle Scholar
  4. 4.
    Baums MH, Sachs C, Kostuj T, et al. Mechanical testing of different knot types using high-performance suture material. Knee Surg Sports Traumatol Arthrosc. 2013.  https://doi.org/10.1007/s00167-013-2711-9.
  5. 5.
    Elkousy H, Hammerman SM, Edwards TB, et al. The arthroscopic square knot: a biomechanical comparison with open and arthroscopic knots. Arthroscopy. 2006;22:736–41.  https://doi.org/10.1016/j.arthro.2006.04.075.CrossRefPubMedGoogle Scholar
  6. 6.
    Lo IKY, Burkhart SS, Chan KC, Athanasiou K. Arthroscopic knots: determining the optimal balance of loop security and knot security. Arthroscopy. 2004;20:489–502.  https://doi.org/10.1016/j.arthro.2004.03.005.CrossRefPubMedGoogle Scholar
  7. 7.
    Lieurance RK, Pflaster DS, Abbott D, Nottage WM. Failure characteristics of various arthroscopically tied knots. Clin Orthop Relat Res. 2003;408:311–8.CrossRefGoogle Scholar
  8. 8.
    Burkhart SS, Wirth MA, Simonick M, et al. Loop security as a determinant of tissue fixation security. Arthroscopy. 1998;14:773–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Burkhart SS, Wirth MA, Simonich M, et al. Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? Arthroscopy. 2000;16:202–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Abbi G, Espinoza L, Odell T, et al. Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy. 2006;22:38–43.  https://doi.org/10.1016/j.arthro.2005.10.010.CrossRefPubMedGoogle Scholar
  11. 11.
    Kuptniratsaikul S, Weerawit P, Kongrukgreatiyos K, Promsang T. Biomechanical comparison of four sliding knots and three high-strength sutures: loop security is much different between each combination. J Orthop Res. 2016;34:1804–7.  https://doi.org/10.1002/jor.23187.CrossRefPubMedGoogle Scholar
  12. 12.
    Miller T, Feinblatt J, Craw J, et al. Evaluation of high-strength orthopedic sutures: a head-to-head comparison. Orthopedics. 2010;33:674.  https://doi.org/10.3928/01477447-20100722-08.PubMedGoogle Scholar
  13. 13.
    Baumgarten KM, Wright RW. Ease of tying arthroscopic knots. J Shoulder Elb Surg. 2007;16:438–42.  https://doi.org/10.1016/j.jse.2006.10.013.CrossRefGoogle Scholar
  14. 14.
    Kim S-H, Yoo JC, Wang JH, et al. Arthroscopic sliding knot: how many additional half-hitches are really needed? Arthroscopy. 2005;21:405–11.  https://doi.org/10.1016/j.arthro.2004.12.010.CrossRefPubMedGoogle Scholar
  15. 15.
    Jo CH, Lee J-H, Kang S-B, et al. Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches. Knee Surg Sports Traumatol Arthrosc. 2008;16:787–93.  https://doi.org/10.1007/s00167-008-0497-y.CrossRefPubMedGoogle Scholar
  16. 16.
    Savage AJ, Spruiell MD, Schwertz JM, et al. The effect of sliding knots on the suture-tendon interface strength: a biomechanical analysis comparing sliding and static arthroscopic knots. Am J Sports Med. 2013;41:296–301.  https://doi.org/10.1177/0363546512472168.CrossRefPubMedGoogle Scholar
  17. 17.
    Wolf EM, Wilk R, Richmond JC. Arthroscopic Bankart repair using suture anchors. Oper Tech Orthop. 1991;1:184–91.CrossRefGoogle Scholar
  18. 18.
    Elkousy HA, Sekiya JK, Stabile KJ, McMahon PJ. A biomechanical comparison of arthroscopic sliding and sliding-locking knots. Arthroscopy. 2005;21:204–10.  https://doi.org/10.1016/j.arthro.2004.09.024.CrossRefPubMedGoogle Scholar
  19. 19.
    Weston PV. A new clinch knot. Obstet Gynecol. 1991;78:144–7.PubMedGoogle Scholar
  20. 20.
    Hughes PJ, Hagan RP, Fisher AC, et al. The kinematics and kinetics of slipknots for arthroscopic Bankart repair. Am J Sports Med. 2001;29:738–45.CrossRefPubMedGoogle Scholar
  21. 21.
    De Beer JF, van Rooyen K, Boezaart AP. Nicky’s knot—a new slip knot for arthroscopic surgery. Arthroscopy. 1998;14:109–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Kim SH, Ha KI. The SMC knot—a new slip knot with locking mechanism. Arthroscopy. 2000;16:563–5.  https://doi.org/10.1053/jars.2000.4821.CrossRefPubMedGoogle Scholar
  23. 23.
    Snyder SJ. Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture shuttle relays, and no. 2 nonabsorbable mattress sutures. Orthop Clin North Am. 1997;28:267–75.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim S-H, Yoo JC. Arthroscopic knot tying. Tech Shoulder Elb Surg. 2003;4:35–43.CrossRefGoogle Scholar
  25. 25.
    Fleega BA, Sokkar SH. The giant knot: a new one-way self-locking secured arthroscopic slip knot. Arthroscopy. 1999;15:451–2.CrossRefPubMedGoogle Scholar
  26. 26.
    Kim SH, Ha KI, Kim SH, Kim JS. Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot. Arthroscopy. 2001;17:850–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Snyder SJ. Technical manual for the Revo screw and knot. Largo: Linvatec Corp; 1994.Google Scholar
  28. 28.
    Loutzenheiser TD, Harryman DT, Ziegler DW, Yung SW. Optimizing arthroscopic knots using braided or monofilament suture. Arthroscopy. 1998;14:57–65.CrossRefPubMedGoogle Scholar
  29. 29.
    Hassinger SM, Wongworawat MD, Hechanova JW. Biomechanical characteristics of 10 arthroscopic knots. Arthroscopy. 2006;22:827–32.  https://doi.org/10.1016/j.arthro.2006.04.094.CrossRefPubMedGoogle Scholar
  30. 30.
    Dahl KA, Patton DJ, Dai Q, Wongworawat MD. Biomechanical characteristics of 9 arthroscopic knots. Arthroscopy. 2010;26:813–8.  https://doi.org/10.1016/j.arthro.2009.10.011.CrossRefPubMedGoogle Scholar
  31. 31.
    Baumgarten KM, Brodt MD, Silva MJ, Wright RW. An in vitro analysis of the mechanical properties of 16 arthroscopic knots. Knee Surg Sports Traumatol Arthrosc. 2008;16:957–66.  https://doi.org/10.1007/s00167-008-0595-x.CrossRefPubMedGoogle Scholar
  32. 32.
    Field MH, Edwards TB, Savoie FH. Technical note: a “new” arthroscopic sliding knot. Orthop Clin North Am. 2001;32:525–6, x.CrossRefPubMedGoogle Scholar
  33. 33.
    Mishra DK, Cannon WD, Lucas DJ, Belzer JP. Elongation of arthroscopically tied knots. Am J Sports Med. 1997;25:113–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee TQ, Matsuura PA, Fogolin RP, et al. Arthroscopic suture tying: a comparison of knot types and suture materials. Arthroscopy. 2001;17:348–52.CrossRefPubMedGoogle Scholar
  35. 35.
    Rolla PR, Surace MF. The double-twist knot: a new arthroscopic sliding knot. Arthroscopy. 2002;18:815–20.CrossRefPubMedGoogle Scholar
  36. 36.
    Karahan M, Akgun U, Espregueira-Mendes J. The Pretzel knot: a new simple locking slip-knot. Knee Surg Sports Traumatol Arthrosc. 2010;18:412–4.  https://doi.org/10.1007/s00167-009-0984-9.CrossRefPubMedGoogle Scholar
  37. 37.
    Karahan M, Akgun U, Turkoglu A, et al. Pretzel knot compared with standard suture knots. Knee Surg Sports Traumatol Arthrosc. 2012;20:2302–6.  https://doi.org/10.1007/s00167-011-1788-2.CrossRefPubMedGoogle Scholar
  38. 38.
    Kim SH, Glaser D, Doan J, et al. Loop securities of arthroscopic sliding-knot techniques when the suture loop is not evenly tensioned. Arthroscopy. 2013;29:1380–6.  https://doi.org/10.1016/j.arthro.2013.05.013.CrossRefPubMedGoogle Scholar
  39. 39.
    Clark RR, Dierckman B, Sampatacos N, et al. Biomechanical performance of traditional arthroscopic knots versus slippage-proof knots. Arthroscopy. 2013;29:1175–81.  https://doi.org/10.1016/j.arthro.2013.04.012.CrossRefPubMedGoogle Scholar
  40. 40.
    Shah MR, Strauss EJ, Kaplan K, et al. Initial loop and knot security of arthroscopic knots using high-strength sutures. Arthroscopy. 2007;23:884–8.  https://doi.org/10.1016/j.arthro.2007.02.007.CrossRefPubMedGoogle Scholar
  41. 41.
    Burkhart SS, Lo IKY, Brady PC. Burkhart’s View of the Shoulder: A Cowboy’s Guide to Advanced Shoulder Arthroscopy. Philadelphia: Lippincott, Williams & Wilkins, 2006.Google Scholar
  42. 42.
    Hammerman SM, Elkousy H, Edwards TB, et al. The arthroscopic square knot: fiction or fact? Am J Orthop (Belle Mead NJ). 2009;38:14–6.Google Scholar
  43. 43.
    Chan KC, Burkhart SS, Thiagarajan P, Goh JC. Optimization of stacked half-hitch knots for arthroscopic surgery. Arthroscopy. 2001;17:752–9.  https://doi.org/10.1053/jars.2001.25329.CrossRefPubMedGoogle Scholar
  44. 44.
    Riboh JC, Heckman DS, Glisson RR, Moorman CT. Shortcuts in arthroscopic knot tying: do they affect knot and loop security? Am J Sports Med. 2012;40:1572–7.  https://doi.org/10.1177/0363546512446676.CrossRefPubMedGoogle Scholar
  45. 45.
    Hanypsiak BT, DeLong JM, Simmons L, et al. Knot strength varies widely among expert Arthroscopists. Am J Sports Med. 2014;42:1978–84.  https://doi.org/10.1177/0363546514535554.CrossRefPubMedGoogle Scholar
  46. 46.
    Baumgarten KM, Wright RW. Incorporating evidence-based medicine in arthroscopic knot preferences: a survey of american orthopaedic society for sports medicine members. Am J Orthop (Belle Mead NJ). 2010;39:577–81.Google Scholar
  47. 47.
    Chokshi BV, Ishak C, Iesaka K, et al. The modified racking hitch(MRH) knot: a new sliding knot for arthroscopic surgery. Bull NYU Hosp Jt Dis. 2007;65:306–7.PubMedGoogle Scholar
  48. 48.
    Conca M, Taschieri S, Del Fabbro M, Conca R. Inverse knot: a personal sliding knot for arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc. 2007;15:620–3.  https://doi.org/10.1007/s00167-006-0125-7.CrossRefPubMedGoogle Scholar
  49. 49.
    Mochizuki Y, Hachisuka H, Natsu K, et al. The HU knot: a new sliding knot for arthroscopic surgery. Arthroscopy. 2005;21:1014.  https://doi.org/10.1016/j.arthro.2005.04.095.CrossRefPubMedGoogle Scholar
  50. 50.
    Yiannakopoulos CK, Hiotis I, Antonogiannakis E. The triad knot: a new sliding self-locking knot. Arthroscopy. 2005;21:899.  https://doi.org/10.1016/j.arthro.2005.04.100.PubMedGoogle Scholar
  51. 51.
    Kuptniratsaikul S, Promsang T, Kongrukgreatiyos K. The chula knot: a new sliding locking knot with a special property. Arthrosc Tech. 2014;3:e465–7.  https://doi.org/10.1016/j.eats.2014.05.007.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsCatholic University, Service of Shoulder Surgery, “A. Gemelli” University HospitalRomeItaly

Personalised recommendations

Cite chapter

Buy options