Skip to main content
SpringerLink
Log in

Literature Review of Arthroscopic Knots

  • Chapter
  • First Online:
Knots in Orthopedic Surgery

Abstract

Knot tying is a basic surgical skill. As the indications for arthroscopy have expanded, attention has turned to how arthroscopic surgery compares with open surgery, so the ability to tie secure knots arthroscopically is essential for surgeons who wish to achieve results comparable with open repairs. Though the principles of open and arthroscopic repair are the same, arthroscopic knots are more difficult than hand-tied ones. Despite the large number of knot options and suture types, most of the time the choice of the knots is not based on scientific evidence but on empirical data and surgeon’s preference. The present chapter reviewed different arthroscopic knots and their biomechanical properties.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Loutzenheiser TD, Harryman DT, Yung SW, et al. Optimizing arthroscopic knots. Arthroscopy. 1995;11:199–206.

    Article  CAS  PubMed  Google Scholar 

  2. Nottage WM, Lieurance RK. Arthroscopic knot typing techniques. Arthroscopy. 1999;15:515–21.

    Article  CAS  PubMed  Google Scholar 

  3. Longo UG, Buchmann S, Berton A, et al. Arthroscopic knots and strength sutures for rotator cuff repair. Sports Med Arthrosc. 2011;19:251–65. https://doi.org/10.1097/JSA.0b013e3182199373.

    Article  PubMed  Google Scholar 

  4. Baums MH, Sachs C, Kostuj T, et al. Mechanical testing of different knot types using high-performance suture material. Knee Surg Sports Traumatol Arthrosc. 2013. https://doi.org/10.1007/s00167-013-2711-9.

  5. Elkousy H, Hammerman SM, Edwards TB, et al. The arthroscopic square knot: a biomechanical comparison with open and arthroscopic knots. Arthroscopy. 2006;22:736–41. https://doi.org/10.1016/j.arthro.2006.04.075.

    Article  PubMed  Google Scholar 

  6. Lo IKY, Burkhart SS, Chan KC, Athanasiou K. Arthroscopic knots: determining the optimal balance of loop security and knot security. Arthroscopy. 2004;20:489–502. https://doi.org/10.1016/j.arthro.2004.03.005.

    Article  PubMed  Google Scholar 

  7. Lieurance RK, Pflaster DS, Abbott D, Nottage WM. Failure characteristics of various arthroscopically tied knots. Clin Orthop Relat Res. 2003;408:311–8.

    Article  Google Scholar 

  8. Burkhart SS, Wirth MA, Simonick M, et al. Loop security as a determinant of tissue fixation security. Arthroscopy. 1998;14:773–6.

    Article  CAS  PubMed  Google Scholar 

  9. Burkhart SS, Wirth MA, Simonich M, et al. Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? Arthroscopy. 2000;16:202–7.

    Article  CAS  PubMed  Google Scholar 

  10. Abbi G, Espinoza L, Odell T, et al. Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy. 2006;22:38–43. https://doi.org/10.1016/j.arthro.2005.10.010.

    Article  PubMed  Google Scholar 

  11. Kuptniratsaikul S, Weerawit P, Kongrukgreatiyos K, Promsang T. Biomechanical comparison of four sliding knots and three high-strength sutures: loop security is much different between each combination. J Orthop Res. 2016;34:1804–7. https://doi.org/10.1002/jor.23187.

    Article  PubMed  Google Scholar 

  12. Miller T, Feinblatt J, Craw J, et al. Evaluation of high-strength orthopedic sutures: a head-to-head comparison. Orthopedics. 2010;33:674. https://doi.org/10.3928/01477447-20100722-08.

    PubMed  Google Scholar 

  13. Baumgarten KM, Wright RW. Ease of tying arthroscopic knots. J Shoulder Elb Surg. 2007;16:438–42. https://doi.org/10.1016/j.jse.2006.10.013.

    Article  Google Scholar 

  14. Kim S-H, Yoo JC, Wang JH, et al. Arthroscopic sliding knot: how many additional half-hitches are really needed? Arthroscopy. 2005;21:405–11. https://doi.org/10.1016/j.arthro.2004.12.010.

    Article  PubMed  Google Scholar 

  15. Jo CH, Lee J-H, Kang S-B, et al. Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches. Knee Surg Sports Traumatol Arthrosc. 2008;16:787–93. https://doi.org/10.1007/s00167-008-0497-y.

    Article  PubMed  Google Scholar 

  16. Savage AJ, Spruiell MD, Schwertz JM, et al. The effect of sliding knots on the suture-tendon interface strength: a biomechanical analysis comparing sliding and static arthroscopic knots. Am J Sports Med. 2013;41:296–301. https://doi.org/10.1177/0363546512472168.

    Article  PubMed  Google Scholar 

  17. Wolf EM, Wilk R, Richmond JC. Arthroscopic Bankart repair using suture anchors. Oper Tech Orthop. 1991;1:184–91.

    Article  Google Scholar 

  18. Elkousy HA, Sekiya JK, Stabile KJ, McMahon PJ. A biomechanical comparison of arthroscopic sliding and sliding-locking knots. Arthroscopy. 2005;21:204–10. https://doi.org/10.1016/j.arthro.2004.09.024.

    Article  PubMed  Google Scholar 

  19. Weston PV. A new clinch knot. Obstet Gynecol. 1991;78:144–7.

    CAS  PubMed  Google Scholar 

  20. Hughes PJ, Hagan RP, Fisher AC, et al. The kinematics and kinetics of slipknots for arthroscopic Bankart repair. Am J Sports Med. 2001;29:738–45.

    Article  CAS  PubMed  Google Scholar 

  21. De Beer JF, van Rooyen K, Boezaart AP. Nicky’s knot—a new slip knot for arthroscopic surgery. Arthroscopy. 1998;14:109–10.

    Article  PubMed  Google Scholar 

  22. Kim SH, Ha KI. The SMC knot—a new slip knot with locking mechanism. Arthroscopy. 2000;16:563–5. https://doi.org/10.1053/jars.2000.4821.

    Article  CAS  PubMed  Google Scholar 

  23. Snyder SJ. Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture shuttle relays, and no. 2 nonabsorbable mattress sutures. Orthop Clin North Am. 1997;28:267–75.

    Article  CAS  PubMed  Google Scholar 

  24. Kim S-H, Yoo JC. Arthroscopic knot tying. Tech Shoulder Elb Surg. 2003;4:35–43.

    Article  Google Scholar 

  25. Fleega BA, Sokkar SH. The giant knot: a new one-way self-locking secured arthroscopic slip knot. Arthroscopy. 1999;15:451–2.

    Article  CAS  PubMed  Google Scholar 

  26. Kim SH, Ha KI, Kim SH, Kim JS. Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot. Arthroscopy. 2001;17:850–5.

    Article  CAS  PubMed  Google Scholar 

  27. Snyder SJ. Technical manual for the Revo screw and knot. Largo: Linvatec Corp; 1994.

    Google Scholar 

  28. Loutzenheiser TD, Harryman DT, Ziegler DW, Yung SW. Optimizing arthroscopic knots using braided or monofilament suture. Arthroscopy. 1998;14:57–65.

    Article  CAS  PubMed  Google Scholar 

  29. Hassinger SM, Wongworawat MD, Hechanova JW. Biomechanical characteristics of 10 arthroscopic knots. Arthroscopy. 2006;22:827–32. https://doi.org/10.1016/j.arthro.2006.04.094.

    Article  PubMed  Google Scholar 

  30. Dahl KA, Patton DJ, Dai Q, Wongworawat MD. Biomechanical characteristics of 9 arthroscopic knots. Arthroscopy. 2010;26:813–8. https://doi.org/10.1016/j.arthro.2009.10.011.

    Article  PubMed  Google Scholar 

  31. Baumgarten KM, Brodt MD, Silva MJ, Wright RW. An in vitro analysis of the mechanical properties of 16 arthroscopic knots. Knee Surg Sports Traumatol Arthrosc. 2008;16:957–66. https://doi.org/10.1007/s00167-008-0595-x.

    Article  PubMed  Google Scholar 

  32. Field MH, Edwards TB, Savoie FH. Technical note: a “new” arthroscopic sliding knot. Orthop Clin North Am. 2001;32:525–6, x.

    Article  CAS  PubMed  Google Scholar 

  33. Mishra DK, Cannon WD, Lucas DJ, Belzer JP. Elongation of arthroscopically tied knots. Am J Sports Med. 1997;25:113–7.

    Article  CAS  PubMed  Google Scholar 

  34. Lee TQ, Matsuura PA, Fogolin RP, et al. Arthroscopic suture tying: a comparison of knot types and suture materials. Arthroscopy. 2001;17:348–52.

    Article  CAS  PubMed  Google Scholar 

  35. Rolla PR, Surace MF. The double-twist knot: a new arthroscopic sliding knot. Arthroscopy. 2002;18:815–20.

    Article  PubMed  Google Scholar 

  36. Karahan M, Akgun U, Espregueira-Mendes J. The Pretzel knot: a new simple locking slip-knot. Knee Surg Sports Traumatol Arthrosc. 2010;18:412–4. https://doi.org/10.1007/s00167-009-0984-9.

    Article  PubMed  Google Scholar 

  37. Karahan M, Akgun U, Turkoglu A, et al. Pretzel knot compared with standard suture knots. Knee Surg Sports Traumatol Arthrosc. 2012;20:2302–6. https://doi.org/10.1007/s00167-011-1788-2.

    Article  PubMed  Google Scholar 

  38. Kim SH, Glaser D, Doan J, et al. Loop securities of arthroscopic sliding-knot techniques when the suture loop is not evenly tensioned. Arthroscopy. 2013;29:1380–6. https://doi.org/10.1016/j.arthro.2013.05.013.

    Article  PubMed  Google Scholar 

  39. Clark RR, Dierckman B, Sampatacos N, et al. Biomechanical performance of traditional arthroscopic knots versus slippage-proof knots. Arthroscopy. 2013;29:1175–81. https://doi.org/10.1016/j.arthro.2013.04.012.

    Article  PubMed  Google Scholar 

  40. Shah MR, Strauss EJ, Kaplan K, et al. Initial loop and knot security of arthroscopic knots using high-strength sutures. Arthroscopy. 2007;23:884–8. https://doi.org/10.1016/j.arthro.2007.02.007.

    Article  PubMed  Google Scholar 

  41. Burkhart SS, Lo IKY, Brady PC. Burkhart’s View of the Shoulder: A Cowboy’s Guide to Advanced Shoulder Arthroscopy. Philadelphia: Lippincott, Williams & Wilkins, 2006.

    Google Scholar 

  42. Hammerman SM, Elkousy H, Edwards TB, et al. The arthroscopic square knot: fiction or fact? Am J Orthop (Belle Mead NJ). 2009;38:14–6.

    Google Scholar 

  43. Chan KC, Burkhart SS, Thiagarajan P, Goh JC. Optimization of stacked half-hitch knots for arthroscopic surgery. Arthroscopy. 2001;17:752–9. https://doi.org/10.1053/jars.2001.25329.

    Article  CAS  PubMed  Google Scholar 

  44. Riboh JC, Heckman DS, Glisson RR, Moorman CT. Shortcuts in arthroscopic knot tying: do they affect knot and loop security? Am J Sports Med. 2012;40:1572–7. https://doi.org/10.1177/0363546512446676.

    Article  PubMed  Google Scholar 

  45. Hanypsiak BT, DeLong JM, Simmons L, et al. Knot strength varies widely among expert Arthroscopists. Am J Sports Med. 2014;42:1978–84. https://doi.org/10.1177/0363546514535554.

    Article  PubMed  Google Scholar 

  46. Baumgarten KM, Wright RW. Incorporating evidence-based medicine in arthroscopic knot preferences: a survey of american orthopaedic society for sports medicine members. Am J Orthop (Belle Mead NJ). 2010;39:577–81.

    Google Scholar 

  47. Chokshi BV, Ishak C, Iesaka K, et al. The modified racking hitch(MRH) knot: a new sliding knot for arthroscopic surgery. Bull NYU Hosp Jt Dis. 2007;65:306–7.

    PubMed  Google Scholar 

  48. Conca M, Taschieri S, Del Fabbro M, Conca R. Inverse knot: a personal sliding knot for arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc. 2007;15:620–3. https://doi.org/10.1007/s00167-006-0125-7.

    Article  PubMed  Google Scholar 

  49. Mochizuki Y, Hachisuka H, Natsu K, et al. The HU knot: a new sliding knot for arthroscopic surgery. Arthroscopy. 2005;21:1014. https://doi.org/10.1016/j.arthro.2005.04.095.

    Article  PubMed  Google Scholar 

  50. Yiannakopoulos CK, Hiotis I, Antonogiannakis E. The triad knot: a new sliding self-locking knot. Arthroscopy. 2005;21:899. https://doi.org/10.1016/j.arthro.2005.04.100.

    PubMed  Google Scholar 

  51. Kuptniratsaikul S, Promsang T, Kongrukgreatiyos K. The chula knot: a new sliding locking knot with a special property. Arthrosc Tech. 2014;3:e465–7. https://doi.org/10.1016/j.eats.2014.05.007.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Catholic University, Service of Shoulder Surgery, “A. Gemelli” University Hospital, Rome, Italy

    Maristella F. Saccomanno & Giuseppe Milano

Authors
  1. Maristella F. Saccomanno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Milano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Milano .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, Ataşehir, Istanbul, Turkey

    Umut Akgun

  2. Dept. of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, Ataşehir, Istanbul, Turkey

    Mustafa Karahan

  3. Istituto Ortopedico Gaetano Pini, University of Milan, Milan, Italy

    Pietro S. Randelli

  4. Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal

    João Espregueira-Mendes

Rights and permissions

Reprints and permissions

Copyright information

© 2018 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Saccomanno, M.F., Milano, G. (2018). Literature Review of Arthroscopic Knots. In: Akgun, U., Karahan, M., Randelli, P., Espregueira-Mendes, J. (eds) Knots in Orthopedic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-56108-9_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-56108-9_18

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-56107-2

  • Online ISBN: 978-3-662-56108-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation