Two-Handed Knot Tying Technique for Arthroscopic Surgeries

Knot tying is a widely used and essential technique in arthroscopic tissue repair and fixation. Although it shows perceived simplicity, its technical complexity exceeds that of open surgery due to the challenges of suture fixation within confined intra-articular spaces and demanding execution requirements. Current literature predominantly focuses on variations in knot configurations, yet few studies address the technical description of arthroscopic knot tying execution details-despite their status as foundational components. This article describes an arthroscopic 2-handed knot tying technique applicable not only for arthroscopic tissue repair but also for deep tissue repairs during open surgical procedures. In this knot tying process, the combination of a knot pusher with the surgeon's hand holding it allows for a shorter stroke, akin to those found in a compact engine piston stroke. Coordination of the surgeon's both hands leads to a higher efficiency and fast tying processes.