Knot security in simple sliding knots and its relationship to rotator cuff repair: How secure must the knot be?

Stephen S. Burkhart, Michael A. Wirth, Matthew Simonich, Daniel Salem, Dan Lanctot, Kyriacos Athanasiou

Research output: Contribution to journalArticlepeer-review

126 Scopus citations

Abstract

We sought to determine which simple sliding knot configurations would have adequate strength for rotator cuff repair. Four knot configurations were tied with both No. 1 polydioxanone suture and No. 2 Ethibond suture (Ethicon, Somerville, NJ) using 3 different tying techniques: hand-tie, standard knot pusher, and cannulated double-diameter knot pusher. The knots were then tested to failure on a materials testing system. The weakest standard knot configuration was S =S =S =S. The other 3 knot configurations (S//S//S//S, SxSxSxS, and S//xS//xS//xS) generally failed in the 35 to 50 N range. Ultimate strength in this range can be shown to be adequate to withstand, without suture failure, a maximal contraction of a repaired rotator cuff tear within the rotator crescent, assuming certain conditions are met (suture anchors placed 1 cm apart, 2 sutures per anchor). More complex knots are not necessary for adequate knot security. However, the same configuration with only 1 suture per anchor will not be strong enough because the suture will fail under maximum physiological load. This study shows that we can predict the adequacy of a given knot configuration under maximum physiological loading conditions.

Original languageEnglish (US)
Pages (from-to)202-207
Number of pages6
JournalArthroscopy
Volume16
Issue number2
DOIs
StatePublished - Mar 2000

Keywords

  • Biomechanics
  • Knot tying
  • Rotator cuff tears
  • Shoulder arthroscopy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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