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A biomechanical comparison of arthroscopic sliding and sliding-locking knots

Abstract
Purpose: To evaluate biomechanical characteristics of 3 arthroscopic sliding and sliding-locking knots and the square knot, the gold standard used in open surgery. Type of study: Biomechanical investigation. Methods: Four different knot types (Weston, square, Duncan loop, and Nicky’s) were tested in 5 configurations in a closed-loop system on a materials testing device. Three of the 5 knots were backed up with 3 reverse half-hitches and alternating posts and all sliding and sliding-locking knots were tied using an arthroscopic technique. Twelve knots of each configuration were tested for loop security with a 7-N preload, and for knot security with load to failure at a strain rate of 1.25 mm/second and cyclic loading of a 30-N force for 50 cycles. Results: No knots subjected to the 7-N preload failed or slipped and all had similar elongation (0.1 ± 0.1 mm) except Nicky’s knot (0.3 ± 0.2 mm). There was no significant difference in load at failure for the square knot (178 ± 14 N), the Weston knot backed with 3 half-hitches (168 ± 14 N), the Duncan loop (160 ± 20 N), or Nicky’s knot (148 ± 13 N). Most knots with 3 half-hitches failed with rupture at the knot. Under cyclic loading, no knots failed and none elongated greater than an average of 0.3 mm. Conclusions: All knot configurations maintained high loop security. All sliding and sliding-locking knots backed with 3 half-hitches had load at failure comparable to the square knot. With cyclic load testing, all knots tested elongated minimally. Additionally, this study confirms that all knots, even the sliding-locking Weston knot, are best backed up with 3 half-hitches alternating posts and directions of the throws. Clincial relevance: Sliding and sliding-locking knots are becoming increasingly popular among arthroscopic shoulder surgeons. This study provides a biomechanical basis for the clinical use of these arthroscopic knots and compares them with the gold standard, the open square knot.

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