Biomechanical Characteristics of 10 Arthroscopic Knots

Purpose: To determine the optimal arthroscopic slip knot through comparison of ease of placement, loop security, knot security, and amount of suture material needed. Methods: Ten commonly used arthroscopic knots (Dines knot, Duncan loop, Field knot, Giant knot, Lieurance Modified Roeder knot, Nicky’s knot, SMC knot, Snyder knot, Tennessee slider, Weston knot) were tested. Ten knots were tied with No. 2 Ethibond (Ethicon, Somerville, NJ) for each testing mode trial. Each knot was tested with the Instron materials testing machine (Instron, Norwood, MA) for (1) forward and backward sliding characteristics; (2) loop security prior to securing with half-hitches (by assessing load); (3) resistance to sliding; (4) knot security after securing with 3 alternating half-hitches on alternating posts (by assessing ultimate load); (5) resistance to sliding; (6) distance to failure; and (7) knot weight, to evaluate for amount of suture material needed. Analysis of variance (P < .05) was used to compare different knots, and the knot with superior characteristics in most categories was selected as the best knot. Results: The Dines knot performed best, exhibiting superior biomechanical characteristics in 6 of 7 measured categories. The only category in which the Dines knot did not perform superiorly was forward sliding, indicating that the Dines knot can be rated as intermediate in ease of placement. Conclusions: Once in place, the Dines knot provides superior loop security and knot security, with use of less suture material. Clinical Significance: This study comprehensively analyzed 10 commonly used arthroscopic knots and identified the one that exhibited the best characteristics.

Key Words:  Suture—Knot security—Loop elongation