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Biomechanical evaluation of the Nice knot
Shannon W Hill1, Christopher R Chapman2, Samer Adeeb3
1Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada.
International Journal of Shoulder Surgery
|March 17, 2016
Summary
The Nice knot, particularly with FiberWire suture, demonstrates superior biomechanical performance compared to surgeon's and Tennessee slider knots. Two half hitches are recommended for optimal knot security in surgical applications.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Surgical Knot Tying
Background:
- The Nice knot is a bulky double-stranded surgical knot.
- Limited biomechanical data exists regarding its security and optimal configuration.
Purpose of the Study:
- To compare the biomechanical performance of the Nice knot with varying half-hitches against established surgical knots.
- To determine the optimal number of half-hitches for Nice knot security.
Main Methods:
- Nice knots (1-3 half-hitches) were tested against surgeon's and Tennessee slider knots (3 half-hitches).
- Four suture types (FiberWire, Ultrabraid, Hi-Fi, Force Fiber) were used, with 10 knots each.
- Cyclic testing (10N-45N, ~1000 cycles) and load-to-failure tests were conducted.
Main Results:
- Nice knots with one or more half-hitches showed significantly less slippage during cyclic testing (P < 0.002).
- Additional half-hitches beyond one did not significantly improve cyclic performance.
- Nice knot strength increased with half-hitches, with no significant gain after two (P = 0.59).
- FiberWire suture, despite its bulk, exhibited the least slippage.
Conclusions:
- The Nice knot, especially with FiberWire, is biomechanically superior to surgeon's and Tennessee slider knots.
- Two half hitches are recommended for secure and effective use of the Nice knot.
