AANA Middle East Arthroscopy Master Course (International)-Optimizing Knot Security

Optimizing Knot Security

Pdf Summary

This presentation by Dr. Mark R. Hutchinson, Professor of Orthopaedics at the University of Illinois, focuses on optimizing the security of arthroscopic surgical knots. Key factors influencing knot security include the friction and strength of the suture material—braided sutures offer better friction compared to monofilament—as well as the knot’s internal mechanics, the tightness without slack in each loop or throw, and the quality of tissue and anchor edges involved.<br /><br />A unique knot structure plays a role, but importantly, the knot must be backed up with alternating half-hitches (a technique emphasized by Doug Harryman) to ensure stability. The presentation introduces the specific language of arthroscopic knots such as the post limb, loop limb, primary knot, sliding versus non-sliding knots, half-hitches, pass-pointing, over/under throws, flipping knots, and identifies common knot types like Revo, Duncan loop, and SMC sliding locking knot.<br /><br />Dr. Hutchinson explains that slip and locking mechanisms depend on proper technique, including deliberate identification of the post limb, consistent passing sequences (e.g., over/under patterns), and secure pass-pointing for each loop to create mechanical security without relying solely on friction.<br /><br />To develop proficiency and reliability in tying secure knots, surgeons must practice intentionally and validate their technique beyond patient outcomes. Research by Pedowitz et al. suggests a FAST knot tester is a useful objective tool for assessing skill. For example, the AANA Fundamentals in Arthroscopy Course requires trainees to successfully tie three consecutive sliding knots and three consecutive non-sliding knots as a measure of competence.<br /><br />In summary, knot security is multifactorial, relying on suture choice, meticulous technique, knot configuration, and reinforcement with alternating half-hitches, with systematic practice and mechanical testing vital to prevent surgical failure.

Keywords

arthroscopic surgical knots

knot security

suture material friction

braided sutures

alternating half-hitches

knot mechanics

sliding vs non-sliding knots

knot tying technique

FAST knot tester

AANA Fundamentals in Arthroscopy