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Initial Loop and Knot Security of Arthroscopic Knots Using High-Strength Sutures

      Purpose: There are many options for arthroscopic knots including the type of knot and suture material used. The current investigation evaluated knot properties using 3 high-strength suture materials tied in 5 common arthroscopic knot configurations. Methods: Four arthroscopic sliding knots including the Roeder, Weston, SMC, and Tennessee Slider and an arthroscopic nonsliding Surgeon’s knot were evaluated. Each knot was tied with each of 3 No. 2 polyblended suture types (Fiberwire [Arthrex, Naples, FL], Ultrabraid [Smith & Nephew, Andover, MA], and Orthocord [Mitek, Raynham, MA]). Each configuration was tied 8 times, for a total of 120 samples. Loop security and knot security were then evaluated by using a previously described protocol comparing the different knot types and suture material. Results: With respect to loop security, Orthocord performed better than the other tested suture materials, producing on average smaller knot loops. For the nonsliding Surgeon’s knot, there was no difference in loop security observed between suture types. For the Roeder knot, Fiberwire had superior knot security compared with Ultrabraid and Orthocord (P < .001). For the Weston knot, Ultrabraid showed superior knot security compared with Orthocord (P < .02). Knot security for the Tenessee slider knot was better for both Fiberwire and Ultrabraid compared with Orthocord (P < .001, respectively). Similar results were seen with the SMC knot, with Fiberwire and Ultrabraid outperforming Orthocord (P < .001, respectively). The nonsliding Surgeon’s knot had significantly lower mean loads to failure compared with arthroscopic sliding knots for each tested suture material (P < .02 for all comparisons). Conclusions: Loop security and knot security varied depending on the type of knot tied and suture material used. Arthroscopic sliding knots performed better than the nonsliding Surgeon’s knot. Clinical Relevance: Surgeons should try to use sliding knots instead of Surgeon’s knots when using polyblend suture material. Differences between the brands in this suture category will change the characteristics of the knots thrown and may ultimately affect tissue fixation.

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      Linked Article

      • Roeder Knot or Not: A Frayed Knot!
        ArthroscopyVol. 23Issue 11
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          Shah et al.1 recently reported on their assessment of knot properties using 3 high-strength suture materials tied in 5 common arthroscopic configurations. One of the knots included in their assessment is referred to as the Roeder knot (Fig 1, middle). We are afraid theirs is not a Roeder knot but a knot incorrectly called that for the first time in Arthroscopy by Nottage and Lieurance2 and, subsequently, in other publications by Willems3,4 and Fischer.5 The incorrectness lies in the lack of a half-hitch that is made with the working end of the suture around its standing part as the first throw of a true Roeder knot and before the working end is turned around both these strands of the suture loop (Fig 1, left).
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