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Knot security: how many throws does it really take?

John E Tidwell1, Vincent L Kish, Julie B Samora

  • 1Department of Orthopaedics, West Virginia University, Morgantown, West Virginia 26506-9196, USA. jtidwell@hsc.wvu.edu

Orthopedics
|April 13, 2012
PubMed
Summary
This summary is machine-generated.

For secure square knots, at least 4 throws are recommended, with 5 providing extra security for most suture materials. FiberWire requires a minimum of 6 throws for guaranteed knot security in surgical applications.

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Area of Science:

  • Biomedical Engineering
  • Materials Science
  • Surgical Research

Background:

  • Knot security is critical in surgical procedures to prevent complications.
  • The optimal number of throws for square knots varies with suture material and size.
  • Biomechanical testing provides essential data for determining surgical knotting standards.

Purpose of the Study:

  • To determine the minimum number of square knot throws for secure surgical knots.
  • To evaluate knot security across five common suture materials and three sizes.
  • To establish evidence-based recommendations for knot tying in surgery.

Main Methods:

  • In vitro biomechanical testing of square knots under single load to failure.
  • Testing involved five suture materials (FiberWire, Monosof, Surgipro, Maxon, Polysorb) in sizes #5, #2, 0, 2-0, and 4-0.
  • Knot security was assessed by varying the number of throws (3, 4, 5, 6) and analyzing failure modes (fracture or slippage).

Main Results:

  • At least 5 throws are recommended for general knot security (95% CI 0.84-1.0), with 4 throws providing acceptable security (95% CI 0.76-0.99).
  • FiberWire consistently required 6 throws for security at both confidence interval levels.
  • Suture material and size significantly influenced the number of throws needed for secure knot formation.

Conclusions:

  • A minimum of 4 square knot throws is advisable, with 5 recommended for enhanced security in most surgical scenarios.
  • FiberWire necessitates 6 throws for reliable knot security.
  • Surgeons should consider these findings to ensure optimal knot security and patient safety, defaulting to 4-5 throws unless specific evidence suggests otherwise.