A Nomenclature for Surgical Knots and the Principles of Knot Security

A rise in knot-related complications in the 1970s due to the growing number of synthetic sutures available to surgeons led to the experimental study of the security of tied surgical knots. Great progress in the understanding of the effect of knot configuration on knot security has been made since that time, but the findings have had uneven penetration both among and within the various surgical specialties. The emergence of multiple different knot-tying lexicons as well as inconsistencies between the verbal descriptions and illustrations of some of these lexicons presents a challenge to surgeons interested in learning about the subject. This has contributed to the lack of dissemination of knowledge on sliding knots, which in turn almost certainly contributes to the many complications reported in the literature related to knot slippage that can be as devastating as patient mortality. Disentangling the divergent nomenclatures and understanding the reasons for their emergence allow for the critical appraisal of the existing landscape of knot-tying literature.