The behaviour of knots and sutures during the first 12 hours following a Bankart repair (original) (raw)
Related papers
Initial Loop and Knot Security of Arthroscopic Knots Using High-Strength Sutures
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
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 Ͻ .001). For the Weston knot, Ultrabraid showed superior knot security compared with Orthocord (P Ͻ .02). Knot security for the Tenessee slider knot was better for both Fiberwire and Ultrabraid compared with Orthocord (P Ͻ .001, respectively). Similar results were seen with the SMC knot, with Fiberwire and Ultrabraid outperforming Orthocord (P Ͻ .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 Ͻ .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.
Cyclic testing of arthroscopic knot security
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Purpose: Arthroscopic soft tissue repairs undergo many cycles of tensioning and relaxation before significant tissue healing occurs, and knot security under cyclic loads is essential for good results after these repairs. The current study was designed to assess the security of arthroscopic knots under stepwise cyclic loading. Type of Study: In vitro materials testing. Methods: Three types of arthroscopic knotssliding knots with loop reversal but without post switching (SϭSϫSϫSϫS), modified Revo knots with loop reversal and post switching twice (SϭS//ϫSϫS//ϫS), and the SMC knot backed by 2 throws with loop reversal and post switching (S//ϫS//ϫS)-were compared with five-throw square knots tied with an open technique. All knots were tied with No. 2 braided nonabsorbable suture around 2 aluminum rods. They were pretensioned to 10 N, and initial displacement was recorded. The knots were then cycled at 1 Hz for 9 different load levels, with 250 cycles at each level, followed by a 30-second rest period to allow recording of permanent laxity of the suture loop. The first step of cyclic loading was from 10 to 40 N, and the upper limit was increased by 10 N for each successive load level. Any knot surviving cyclical loading was pulled to failure. Results: Ten knots of each configuration were tested. All 3 arthroscopic slip knots showed significantly less initial displacement compared with the square knots (0.26 mm compared with 0.45 mm, respectively, P Ͻ .005). All square and modified Revo knots reached the ninth (120 N) loading level, whereas only 6 of the SMC knots and 3 of the arthroscopic knots without post switching reached the ninth loading level. Furthermore, all square and modified Revo knots failed by suture breakage at the knot, whereas 8 arthroscopic knots without post switching and 5 SMC knots failed by slipping. In fact, 3 of the arthroscopic knots without post switching and 1 of the SMC knots failed during the initial cyclic loading from 10 to 40 N. The modified Revo knots reached 3 mm of permanent laxity at significantly higher load levels than the square knots tied with an open technique (96 N v 78 N, P Ͻ .005). The SMC knots reached 3 mm of permanent laxity at statistically similar load levels compared with the square knots, but showed considerably more variability. None of the arthroscopic knots without post switching survived the entire cyclic-loading protocol. Four square, 5 modified Revo, and 5 SMC knots that survived cyclic loading reached ultimate failure at statistically similar load levels (157, 156, and 152 N, respectively). Conclusions: Post switching and loop reversal are key to arthroscopic knot security. Arthroscopic slip knots may be tighter at the time of knot construction than openly hand-tied square knots. The modified Revo knots appear to be as durable as openly hand-tied square knots regarding resistance to loosening under cyclic loading conditions. Security of arthroscopic knots without post switching is quite variable, making these knots less reliable. The SMC knot also proved not to be as reliable as the square and modified Revo knots when cyclically tested.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2001
The purpose of this study was to determine the structural properties of 3 arthroscopically tied knots using 2 different suture materials: the French knot, the Duncan loop knot, and the original Revo knot. Type of Study: Cohort analytic study. Methods: The sutures used were No. 1 PDS II, an absorbent monofilament, and No. 1 Ethibond (Ethicon, Somerville, NJ), a braided nonabsorbent material. The resulting 6 suture-knot combinations were individually tested to failure in both openand closed-loop configurations. Results: The French knot showed the greatest strength compared with the Duncan loop and the Revo knot with both No. 1 Ethibond and No. 1 PDS II sutures (P Ͻ .05). The No. 1 Ethibond exhibited higher initial stiffness than the No. 1 PDS II for all 3 knot types (P Ͻ .05). Results were similar for both open and closed-loop configurations. Also, the French knot failed predominantly by suture breakage instead of knot slippage for both suture materials. Conclusions: The results of this study suggest that, among the suture and knot combinations investigated in this study, the arthroscopic repair of musculoskeletal injuries should be performed using the French knot and No. 1 Ethibond suture.
2021
In this study, the objective was to compare the knot integrity and efficiency between the two most commonly utilized surgical knots – the two double throws (2DT) and three single throws (3ST) knots via experimental testing and computational modelling. A single suture material Polyglactin 910 (Vicryl; Ethicon, Inc) was selected for this study and all sutures were of a 4-0-gauge size. 12 knotted suture samples (n=12) were prepared for each of the two surgical knot configurations. A tensile testing machine a load cell of 100N was utilized. The knots were loaded via a crosshead movement rate of 1mm/s throughout the test until knot failure, either by suture rupture at the knot or knot slippage. To test knot strength, assuming slippage does not occur, 3D scaled computational models of the 2DT and 3ST knots were created in SOLIDWORKS, and exported to a finite element analysis (FEA) software ABAQUS. The sutures were subjected to increasing static forces until the yield stress within the sut...
Mechanical testing of different knot types using high-performance suture material
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose This laboratory study aimed to evaluate the loop security, knot security, cyclic loading resistance and loadto-failure rate of three different knot types with establishing a new experimental setup. Additionally, the mode of failure of each knot was evaluated. Methods With the use of nonabsorbable, braided polyethylene sutures, USP size No. 2 [Hi-Fi Ò ; ConMed Linvatec], the arthroscopic knot types Dines, SMC as well as the surgeon's knot were tested using a material testing machine. The knots were tied openly as well as arthroscopically. The setup enables testing of knot configurations while eliminating friction between knot loop and its suspension points. Including all test procedures, a total of 216 knots were tested. Results All openly tied knot types and ten of each type of arthroscopically tied knots resisted against cyclic loading of 1,000 cycles. With subsequent load-to-failure testing, openly tied knot types achieved significantly higher values of tensile strength than arthroscopically tied knots. Regarding clinical failure, defined as an elongation of 3 mm, Dines knot reached highest loop as well as knot security. Knot slippage was the most common failure mechanism at an elongation of 3 mm, whereas suture breakage was evaluated most at an elongation of 6 mm. Conclusions The new experimental setup confirms the loop security of arthroscopic knot types. Using a knot pusher clinically is a key factor to attain this as compared to openly hand-tied techniques. The Dines knot presented the highest reliability. It may provide a secure tissue healing during rehabilitation and consequently can be recommended for clinical application.
Clinical Results of Arthroscopic Bankart Repair With Knot-Tying and Knotless Suture Anchors
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
To compare the results of arthroscopic Bankart repair completed with knot-tying with results of the procedure performed with knotless suture anchors. Methods: We evaluated 82 patients who underwent arthroscopic Bankart repair. A total of 61 patients were treated with knot-tying suture anchors, and 21 patients were treated with knotless suture anchors during the same period. In all, 75 male and 7 female patients were studied. Mean patient age at the time of operation was 24 years (range, 16 to 42 years), and the mean follow-up period had a duration of 29 months (range, 24 to 41 months' duration). Results: Shoulder scores improved in both groups (P Ͻ .05). Postoperative pain, patient satisfaction score, and redislocation rate were significantly different between the 2 groups, with the knot-tying suture anchor group showing better results (P ϭ .007, P ϭ .007, and P ϭ .012, respectively). In the knot-tying suture anchor group, 4.9% (3 patients) experienced redislocation and 1 patient underwent revision surgery. The redislocation rate in the knotless suture anchor group was 23.8% (5 patients), and 4 patients underwent revision surgery. Conclusions: The knot-tying and knotless suture anchor groups showed improvement in postoperative shoulder scores after arthroscopic Bankart repair. However, results after the knotless technique was performed were unsatisfactory when compared with results in the standard suture anchor group, particularly in terms of redislocation rate. Level of Evidence: Level III, retrospective comparative therapeutic study.
Knee Surgery, Sports Traumatology, Arthroscopy, 2004
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A Biomechanical and Ease of Learning Comparison Study of Arthroscopic Sliding Knots
Indian Journal of Orthopaedics, 2020
Introduction This study aims to compare the biomechanical properties and ease of learning and tying of our novel knot (UM Knot) with other commonly used arthroscopic sliding knots. Materials and methods The Duncan, HU, SMC, Pretzel, Nicky's and square knots were selected for comparisons with UM knot. All knots were prepared with size 2 HiFi ® suture by a single experienced surgeon and tested with cyclic loading and load to failure tests. The ease of learning was assessed objectively by recording the time to learn the first correct knot and the total number of knots completed in 5 min by surgeons and trainees. Results The UM knot average failure load is significantly superior to the HU knot (p < 0.05) and comparable to Duncan, SMC, Pretzel and Nicky's knots. According to the ease of learning assessment, UM, Duncan, SMC, Pretzel and Nicky's knots took statistically less time to learn than the HU knot. Although not significant, the failure count due to slippage is fewer in UM knot compared with other knots. Conclusions This study showed that UM knot is among the easiest knot to learn and tie, along with Duncan, SMC, Pretzel and Nicky's knots. Their biomechanical properties are comparable and their loads to failure were superior to the HU knot.
Knots Tied With High–Tensile Strength Tape Biomechanically Outperform Knots Tied With Round Suture
Orthopaedic Journal of Sports Medicine, 2021
Background: Tape-type suture material is well-accepted in arthroscopy surgery. Purpose: To compare the knot security of a high–tensile strength round suture and high–tensile strength tape with commonly used arthroscopic knots. Study Design: Controlled laboratory study. Methods: We compared the performance of No. 2 braided nonabsorbable high-strength suture with that of 1.3-mm braided nonabsorbable high-strength tape. Five commonly used arthroscopic knots were investigated: the Roeder knot; the Western knot; the Samsung Medical Center (SMC) knot; the Tennessee knot; and a static surgeon’s knot. Seven knots were tied for each combination of knots and suture types. Knots were tied on a 30-mm circumferential metal post, and the suture loops were transferred to a materials testing machine. After preloading to 5 N, all specimens were loaded to failure. The clinical failure load, defined as the maximal force to failure at 3 mm of crosshead displacement, yield load, and stiffness, were reco...