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Pretzel knot compared with standard suture knots

Knee Surgery, Sports Traumatology, Arthroscopy volume 20, pages 2302–2306 (2012)Cite this article

Abstract

Purpose

Aim of this paper is to compare the biomechanical properties of the Pretzel knot with the selected arthroscopic knots and to test the mechanical safety of this knot. The hypothesis was that the Pretzel knot may have equal or better mechanical properties than the arthroscopic knots tested in this study.

Methods

SMC, Giant, Dines, Nicky’s, Tennessee Slider knots were chosen for comparison. Original and backed configuration of knots were prepared with no. 2 braided polyester sutures. Cyclic loading and load to failure tests were performed. Parameters tested were loop security, maximum elongation and load at failure. Number of steps needed for preparation of each knot was also recorded. One-way ANOVA for repeated measures was performed for all knots.

Results

Steps needed for preparation were 2 for Pretzel and Tennessee Slider, 3 for Nicky’s, SMC and Dines and 4 for Giant. The Pretzel knot in original configuration had significantly better loop security compared to SMC, Dines, Nicky’s and Tennessee knots (P = 0.01). Loads at failure were not significantly different between knots in their original configurations. Giant and Dines knots showed better maximum elongations in cyclic loading (P = 0.0059) and load to failure tests (P = 0.0001). Backing up the knots with 3-RHAPs eliminated most of these significant differences.

Conclusions

Clinically, simplicity and safety are two important components in arthroscopic knot tying. Despite its simple configuration, Pretzel knot has some similar and increased mechanical properties compared to the tested knots that are widely used.

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Acknowledgment

Authors thank Michele Haus Karahan for her contribution in this paper.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Marmara University School of Medicine, Istanbul, Turkey

    Mustafa Karahan

  2. Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey

    Umut Akgun

  3. Institute of Biomechanical Engineering, Bogazici University, Istanbul, Turkey

    Ahu Turkoglu, Filiz Ates & Can A. Yücesoy

  4. Department of Orthopedics and Traumatology, Acibadem Health Group, Kozyatagi Hospital, Istanbul, Turkey

    Rustu Nuran

  5. Orthopedics and Traumatology Clinic, Acibadem Kozyatagi Hospital, Inonu Cad. Okur Sok. No: 20, 34742, Kozyatagi, Istanbul, Turkey

    Umut Akgun

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  1. Mustafa Karahan
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  2. Umut Akgun
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  3. Ahu Turkoglu
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  4. Rustu Nuran
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  5. Filiz Ates
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  6. Can A. Yücesoy
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Correspondence to Umut Akgun.

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Karahan, M., Akgun, U., Turkoglu, A. et al. Pretzel knot compared with standard suture knots. Knee Surg Sports Traumatol Arthrosc 20, 2302–2306 (2012). https://doi.org/10.1007/s00167-011-1788-2

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  • DOI: https://doi.org/10.1007/s00167-011-1788-2

Keywords

  • Pretzel knot
  • Locking sliding knot
  • Loop security
  • Arthroscopic knots