When sutures are to be tied the ends of the suture are called “limbs”.
The “limb” of the suture that the knot will be tied around is called the “post”. This is typically the limb which is away from the bone and through the soft tissue or the limb on which you want to slide the knot down to re-approximate the tissues.
The other strand is called the “loop”, and is the limb which is tied into a knot around the post strand or looped around the post strand.
The knots are created and pushed down the “post” by the knot pusher which advances the knot, or alternatively, the knot “pusher” is placed on the loop strand ahead of the knot and the knot is “pulled” down the cannula into the joint.
Ten tips for Arthroscopic knot tying:
- Only one pair of sutures at a time should be in a portal at one time. 'Park' other sutures out seperate portals.
- Use a cannula to avoid "catching" tissue in the knot.
- Only if the suture slides freely, through the anchor eyelet, in both directions can a sliding knot be tied.
- The "post" should be the suture limb on the capsular side of the joint for a labral repair and on the cuff side for a rotator cuff repair.
- A haemostat should be clipped onto the end of the post limb to identify it as the “post” and provide a grip.
- The suture should be checked to make sure there are no twists of the suture limbs within the cannula, and that there is no soft tissue entangled around the sutures.
- Use at least 3 additional half-hitches after the sliding knot
- Change both the post and the knot direction with each knot.
- "Past-point" - i.e. push the suture passer past the knot to ensure a tight knot.
- After the knot is tied, it should be cut approximately 3mm from the knot. Use a freehand suture scissors, rather than a sliding scissor.