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Updated: Jul 17, 2026

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Arthrosopic knot pushers. Does one size fit all?

C Kerin¹, N Patel, R S Bale

¹Oswestry Rotational, Baschurch, Shropshire, UK. cronankerin@doctors.org.uk

International Journal of Clinical Practice

|February 1, 2007

Summary

Knot-pusher size significantly impacts arthroscopic knot tying efficiency. A single knot-pusher size is not optimal for all suture materials, suggesting the need for varied knot-pusher designs to prevent knot snagging and loosening.

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Area of Science:

Surgical Technology
Biomaterials Science
Orthopedic Surgery

Background:

Arthroscopic knot tying is a critical surgical skill.
Knot-pusher design can influence knot security and surgical outcomes.
Observed issues include knot-pusher overriding and snagging during tightening.

Purpose of the Study:

To determine the optimal knot-pusher size for efficient arthroscopic knot tying.
To investigate the relationship between suture material and knot dimensions.
To assess the compatibility of current knot-pushers with various suture types.

Main Methods:

Modeled arthroscopic knot tying using a custom apparatus.
Tied Duncan loops with polydioxanone (PDS), Ethibond, Fibrewire, and Panacryl sutures.

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Last Updated: Jul 17, 2026

A Novel Arthroscopic Medial Knot-Tying Suture-Bridge Repair with Rip-Stop Technique for Rotator Cuff Tears

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Measured knot and suture diameters under controlled tension (50 N) and analyzed knot-pusher internal diameter.

Main Results:

Significant differences in mean knot diameters were observed across suture materials (PDS, Panacryl, Ethibond, Fibrewire).
The Mitek knot-pusher (1.95 mm internal diameter) was well-suited for PDS and Panacryl sutures.
The Mitek knot-pusher was less ideal for Ethibond and Fibrewire sutures, which produced smaller knots.

Conclusions:

Knot-pusher size optimization is crucial for preventing knot overriding and snagging.
A 'one-size-fits-all' knot-pusher is insufficient for diverse suture materials.
Recommendations include utilizing different knot-pushers tailored to specific suture materials for improved arthroscopic knot tying.