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Arthroscopic sliding knot: how many additional half-hitches are really needed?
Seung-Ho Kim1, Jae Chul Yoo, Joon Ho Wang
1Departments of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Summary
Lockable sliding knots need at least two additional half-hitches for optimal knot-holding capacity. Increasing half-hitches improves security, switching failure from slippage to material breakage.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Surgical Techniques
Background:
- Lockable sliding knots are crucial in arthroscopic surgery.
- Their knot-holding capacity (KHC) is vital for surgical success.
- The optimal number of additional half-hitches for secure knot tying is not well-established.
Purpose of the Study:
- To determine the optimal number of additional half-hitches required for maximum knot-holding capacity (KHC) in various lockable sliding arthroscopic knots.
- To compare the KHC of four different arthroscopic knot configurations.
Main Methods:
- A mechanical testing study was conducted on four arthroscopic knot types: Duncan loop, Field knot, Giant knot, and SMC knot.
- Knots were constructed with a sequential increase of up to five additional half-hitches.
- Knot-holding capacity was assessed using cyclic loading, load to clinical failure (3-mm displacement), load to ultimate failure, and mode of failure on a servo-hydraulic testing system.
Main Results:
- Initial knots without additional half-hitches often failed under cyclic loading.
- One additional half-hitch secured SMC, Field, and Giant knots against dynamic cyclic load; the Duncan loop required two.
- Three additional half-hitches generally resulted in a plateau of knot security, with failure modes shifting from slippage to material breakage for most knots.
Conclusions:
- Lockable sliding knots require additional half-hitches to withstand initial dynamic loads.
- The SMC knot consistently required a minimum of two additional half-hitches for optimal security.
- Three or more additional half-hitches provided near-plateau knot security for most configurations, though the Duncan loop may necessitate more for optimal performance.