Aim of Study To assess the efficacy of commonly used sutures materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

Methods The investigation was carried out in three phases. Initially the ultimate strength of the suture material was tested. Materials compared were 1PDS, 2 Ethibond, 1 Panacryl The suture was then tested to failure by two surgeons comparing five different knotting techniques. Knots tested were Tennessee slider, Duncan loop, SMC, Tautline hitch, and Surgeons knot. Finally the test was repeated after soaking the suture with normal saline.

Results As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in > 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

Conclusions Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength.

Introduction The aim of this study was to assess the efficacy of current arthroscopic knotting techniques with commonly used suture materials.

Methods A Hounsfield tensiometer with a 1000N load cell, strain rate of 25 mm/min, bar separation of 7.5 mm was used under standard temperature and pressure. Suture materials were those in common use; 2 Ethibond, 1 PDS and 1 Panacryl. The knotting techniques compared were the Tennessee slider, Tautline hitch, Duncan Loop, SMC knot and the Surgeon’s knot. Two surgeons tied each knot 10 times using a suture passer and standardised knot technique. Each knot was tested to failure on 10 sequential experiments. Suture material strength was tested alone, tested to failure using the different knots and after suture immersion in normal saline. The ultimate strength of the suture material and of the various knotting techniques were assessed. The mode of failure, slip or suture material fractured was also investigated.

Results The 2 Ethibond had superior strength compared to 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slip rate, with superior internal security than the other knotting techniques (p < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in more than 50% of experiments. No difference was observed after soaking in normal saline. The number of additional half hitches required for maximum knot holding was consistently three, confirming previous findings.

Conclusions The Tautline hitch is recommended with its superior internal security, tying characteristics and overall knot strength. Whichever arthroscopic knot is selected, the addition of three alternating half hitches for consistent security and reliability is strongly supported.

The study assesses the efficacy of commonly used suture materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

The investigation was carried out in three phases. Initially the suture material strength was tested. The suture was then tested to failure using the different knotting techniques. Finally the test was repeated after soaking the suture with normal saline.

A Hounsfield tensometer was utilised with a load cell of 1000N, strain rate of 25mm/min, bar separation of 7.5mm and standard temperature and pressure. Suture material tested was 2 ethibond, 1 PDS and 1 Panacryl. Knotting techniques compared were the Tennessee slider, Tautline hitch, Duncan Loop, SMC knot and Surgeon’s knot. Two surgeons tied each knot 10 times after first becoming practiced with each technique. Each knot was tested to failure on 10 sequential experiments.

Ultimate strength of the suture material and of the knotting techniques was assessed. In addition the mode of failure, whether the knot slipped or suture material fractured was investigated.

As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in more than 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

The Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength