Dataset Information

Beyond the square knot: a novel knotting technique for surgical use.

ABSTRACT:

Background

Knot holding strength is essential to maintain wound closure and ensure tissue contact for healing. Knot unraveling can lead to severe complications, especially for high-tension closures such as tendon repairs, which have recently been reported to have knot unraveling rates as high as 86%. In the current study, a novel surgical knot, the two-strand-overhand locking (TSOL) knot, was designed and mechanically evaluated with use of different suture materials and knot configurations and in actual tendon repairs.

Methods

The knot holding strength of the TSOL knot was compared with that of a 4-throw square knot with use of three different suture materials that are in common clinical use. With use of braided polyblend suture, the TSOL knot was also compared with five other surgical knot configurations. Finally, the strength of tendon repairs performed with use of the TSOL knot and a 4-throw square knot was studied.

Results

Compared with the 4-throw square knot, the holding strength of the TSOL knot was 143% greater for braided polyblend, 216% greater for polydioxanone, and 118% greater for polyester suture, with a significantly lower knot unraveling rate compared with that of the 4-throw square knot regardless of suture material. The TSOL knot holding strength was also greater than that of the other surgical knot configurations. The strength and stiffness of tendon repairs with a TSOL knot were significantly increased over those of repairs with a 4-throw square knot.

Conclusions

The TSOL knot provided superior knot holding strength compared with some commonly used surgical knots.

Clinical relevance

The TSOL knot has potential clinical applications, especially when knot security is important and high loads are expected, as in tendon or ligament repairs.

SUBMITTER: Zhao C

PROVIDER: S-EPMC3748986 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Publications

Beyond the square knot: a novel knotting technique for surgical use.

Zhao Chunfeng C Hsu Chung-Chen CC Moriya Tamami T Thoreson Andrew R AR Cha Steven S SS Moran Steven L SL An Kai-Nan KN Amadio Peter C PC

The Journal of bone and joint surgery. American volume 20130601 11

<h4>Background</h4>Knot holding strength is essential to maintain wound closure and ensure tissue contact for healing. Knot unraveling can lead to severe complications, especially for high-tension closures such as tendon repairs, which have recently been reported to have knot unraveling rates as high as 86%. In the current study, a novel surgical knot, the two-strand-overhand locking (TSOL) knot, was designed and mechanically evaluated with use of different suture materials and knot configuratio ...[more]

PMID: 23780540

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Project description:Revision patella tendon repairs are technically challenging, and to this point there is no gold standard with regard to treatment. Understanding how the surgeon previously repaired the tendon can be of use in the revision case. This includes a repair using anchor fixation in tunnels from the primary procedure, allograft augmentation under the retinacular layer, and application of a bioinductive implant. Technique Video Video 1 (0-0:05): Title. Video 2. (0:06-0:07): Disclosures. Video 3. (0:08-0:30): Intraoperative setup that includes both legs prepped in. Ensure the operative extremity is on a bone foam, has a tourniquet on, and x-ray machine is in the room. Video 4. (0:31-0:49): It’s critical to evaluate the primary repair. Sutures from the primary repair are seen extending from the inferior pole of the patella into the proximal portion of the tendon. Video 5. (0:50-1:10): This is a critical step in the procedure. Evaluates the patella bone tunnels from the primary repair. This needs to be thoroughly evaluated to determine if they can be used for anchor placement in the revision setting. Video 6. (1:11-1:24): Running locking sutures are placed within in the proximal aspect of the tendon. This suture will be anchored into the inferior pole of the patella using the old bone tunnels. Video 7. (2:12-2:37): Anchors are placed into the inferior pole of the patella using the old bone tunnels. The anchors are loaded using suture that was placed in the tendon. The allograft augmentation path in the retinacular layer is also viewed and showed being tied at the superior pole of the patella. Video 8. (2:38-2:52): Anchors placed within the inferior pole of the patella and the augment path under the retinacular layer. The yellow dotted layer is the path of the augment. Video 9. (1:25-1:40): A guide pin in the tibial tubercle in preparation for the allograft augmentation. This guide pin will be over-reamed. Video 10. (1:41-1:56): The allograft augment is placed through the tunnel and slide proximally. Video 11. (1:57-2:11): The graft is then placed under the retinacular layer. This is passed to the superior pole of the patella. Video 12. (2:53-3:10): Placement of the bioinductive implant over the portion of the tear.

Dataset Information

Beyond the square knot: a novel knotting technique for surgical use.

Background

Methods

Results

Conclusions

Clinical relevance

Publications

Beyond the square knot: a novel knotting technique for surgical use.

Similar Datasets

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