Mechanical testing of different knot types using high-performance suture material.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Materials Science

Background:

• Knot security is crucial for successful surgical outcomes in arthroscopic procedures.
• Evaluating the mechanical properties of different arthroscopic knot types is essential for optimizing surgical techniques.

Purpose of the Study:

• To evaluate loop security, knot security, cyclic loading resistance, and load-to-failure rate of three arthroscopic knot types.
• To establish a novel experimental setup for testing knot configurations.
• To assess the failure modes of different knot types under cyclic loading.

Main Methods:

• Utilized nonabsorbable braided polyethylene sutures (USP size No. 2) for testing.
• Compared Dines, SMC, and surgeon's knots, tied both openly and arthroscopically.
• Employed a material testing machine with a new setup to eliminate friction during testing, analyzing a total of 216 knots.

Main Results:

• All openly tied knots and ten arthroscopically tied knots resisted 1,000 cycles of loading.
• Openly tied knots exhibited significantly higher tensile strength than arthroscopically tied knots.
• The Dines knot showed the highest loop and knot security at 3 mm elongation, with knot slippage being the primary failure mechanism.

Conclusions:

• The novel experimental setup validates the loop security of arthroscopic knots.
• Clinical application using a knot pusher is vital for achieving security comparable to open techniques.
• The Dines knot offers the highest reliability and is recommended for clinical use to ensure secure tissue healing during rehabilitation.