Arthroscopic Knots and Strength Sutures for Rotator Cuff Repair

Most arthroscopic rotator cuff reconstruction techniques require a method of securing the tendon to the bone to obtain a stable construct. The available options include knotless technology and suture welding, but the most common method uses suture anchors and knots. Tissue quality, surgical technique, repair material, and tension overload influence the stability of tissue repair. Arthroscopic knots are technically demanding because they are tied through cannulas with long-handled knot pushers. The strength of the repair is also influenced by the suture material used. In this study, we review the state-of-the-art of arthroscopic knots and suture materials being used for arthroscopic rotator cuff repair.

[1]  V. Denaro,et al.  Animal Models for Translational Research on Shoulder Pathologies: From Bench to Bedside , 2011, Sports medicine and arthroscopy review.

[2]  V. Denaro,et al.  Tissue engineered biological augmentation for tendon healing: a systematic review. , 2011, British medical bulletin.

[3]  Umile Giuseppe Longo,et al.  Sport injuries: a review of outcomes. , 2011, British medical bulletin.

[4]  V. Denaro,et al.  Effect of Pulsed Electromagnetic Fields on Human Tenocyte Cultures From Supraspinatus and Quadriceps Tendons , 2011, American journal of physical medicine & rehabilitation.

[5]  B. Morrey.  Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial , 2011 .

[6]  V. Denaro,et al.  The low-profile Roman bridge technique for knotless double-row repair of the rotator cuff , 2011, Archives of Orthopaedic and Trauma Surgery.

[7]  E. Bozdag,et al.  Loop security and tensile properties of polyblend and traditional suture materials , 2011, Knee Surgery, Sports Traumatology, Arthroscopy.

[8]  Stephen S. Burkhart,et al.  A comparison of knot security and loop security in arthroscopic knots tied with newer high-strength suture materials. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[9]  R. Pedowitz,et al.  Comparison of mechanical stability in double-row rotator cuff repairs between a knotless transtendon construct versus the addition of medial knots. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[10]  Q. Dai,et al.  Biomechanical characteristics of 9 arthroscopic knots. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[11]  Umile Giuseppe Longo,et al.  Tendon augmentation grafts: a systematic review. , 2010, British medical bulletin.

[12]  G. Lippi,et al.  Genetics and sports. , 2010, British medical bulletin.

[13]  V. Denaro,et al.  Effect of dihydrotestosterone on cultured human tenocytes from intact supraspinatus tendon , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[14]  Eric C McCarty,et al.  Arthroscopic Suture Material and Knot Type , 2009, The American journal of sports medicine.

[15]  V. Denaro,et al.  Triglycerides and total serum cholesterol in rotator cuff tears: do they matter? , 2009, British Journal of Sports Medicine.

[16]  J. Schoolfield,et al.  A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[17]  F. Alan Barber,et al.  Cyclic load and failure behavior of arthroscopic knots and high strength sutures. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  Shiraz A Younas,et al.  Security of Knots Tied with Ethibond, Fiberwire, Orthocord, or Ultrabraid , 2008, The American journal of sports medicine.

[19]  V. Denaro,et al.  Higher fasting plasma glucose levels within the normoglycaemic range and rotator cuff tears , 2008, British Journal of Sports Medicine.

[20]  Keith M. Baumgarten,et al.  An in vitro analysis of the mechanical properties of 16 arthroscopic knots , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[21]  V. Denaro,et al.  Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair , 2008, BMC musculoskeletal disorders.

[22]  Umile Giuseppe Longo,et al.  Movin and Bonar Scores Assess the Same Characteristics of Tendon Histology , 2008, Clinical orthopaedics and related research.

[23]  T. Bae,et al.  Optimal configuration of arthroscopic sliding knots backed up with multiple half-hitches , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[24]  V. Denaro,et al.  Histopathology of the Supraspinatus Tendon in Rotator Cuff Tears , 2008, The American journal of sports medicine.

[25]  Umile Giuseppe Longo,et al.  No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50 , 2008, The American journal of sports medicine.

[26]  B. Morrey.  Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial , 2008 .

[27]  Ian K.Y. Lo,et al.  Arthroscopic Knot Tying , 2008 .

[28]  V. Denaro,et al.  The Roman Bridge: a "double pulley – suture bridges" technique for rotator cuff repair , 2007, BMC musculoskeletal disorders.

[29]  N Maffulli,et al.  Characteristics at haematoxylin and eosin staining of ruptures of the long head of the biceps tendon , 2007, British Journal of Sports Medicine.

[30]  R. Pedowitz,et al.  A biomechanical analysis of a novel arthroscopic suture method compared to standard suture knots and materials for rotator cuff repair. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[31]  Umile Giuseppe Longo,et al.  Light microscopic histology of supraspinatus tendon ruptures , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[32]  L. Jazrawi,et al.  Initial loop and knot security of arthroscopic knots using high-strength sutures. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[33]  V. Denaro,et al.  Arthroscopic management of calcific tendinitis of the subscapularis tendon , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[34]  J. Hage.  The Duncan loop: all knots and tangles. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[35]  V. Denaro,et al.  To detach the long head of the biceps tendon after tenodesis or not: Outcome analysis at the 4-year follow-up of two different techniques , 2007, International Orthopaedics.

[36]  M. Yeh,et al.  Strength of damaged suture: an in vitro study. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[37]  Christian Gerber,et al.  Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[38]  L. McIntyre,et al.  Comparison of suture welding and hand-tied knots in mini-open rotator cuff repair. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[39]  Montri D Wongworawat,et al.  Biomechanical characteristics of 10 arthroscopic knots. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[40]  D. Adams,et al.  Cyclic Loading of Achilles Tendon Repairs: A Comparison of Polyester and Polyblend Suture , 2006, Foot & ankle international.

[41]  D. P. O'connor,et al.  The arthroscopic square knot: a biomechanical comparison with open and arthroscopic knots. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[42]  R. Pedowitz,et al.  Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[43]  Harpreet S Gill,et al.  Suture Anchors and Tacks for Shoulder Surgery, Part 1 , 2005, The American journal of sports medicine.

[44]  A. Mahar,et al.  Increasing the insertion depth of suture anchors for rotator cuff repair does not improve biomechanical stability. , 2005, Journal of shoulder and elbow surgery.

[45]  K. Kashiwagi,et al.  The HU knot: a new sliding knot for arthroscopic surgery. , 2005, Arthroscopy: The Journal of Arthroscopy And Related.

[46]  C. Yiannakopoulos,et al.  The triad knot: a new sliding self-locking knot. , 2005, Arthroscopy: The Journal of Arthroscopy And Related.

[47]  T. Bae,et al.  Arthroscopic sliding knot: how many additional half-hitches are really needed? , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[48]  Patrick J McMahon,et al.  A biomechanical comparison of arthroscopic sliding and sliding-locking knots. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[49]  Andrew Mahar,et al.  Failure mode of suture anchors as a function of insertion depth. , 2003, The American journal of sports medicine.

[50]  R. Peindl,et al.  Arthroscopic knot tying: the role of instrumentation in achieving knot security. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[51]  Stephen S Burkhart,et al.  Arthroscopic knots: determining the optimal balance of loop security and knot security. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[52]  E. M. Wolf,et al.  Arthroscopic rotator cuff repair: 4- to 10-year results. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[53]  Philip C Noble,et al.  Cyclic testing of arthroscopic knot security. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[54]  Wesley M Nottage,et al.  Failure Characteristics of Various Arthroscopically Tied Knots , 2003, Clinical orthopaedics and related research.

[55]  M. Surace,et al.  The double-twist knot: a new arthroscopic sliding knot. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[56]  S. Frostick,et al.  The Kinematics and Kinetics of Slipknots for Arthroscopic Bankart Repair * , 2001, The American journal of sports medicine.

[57]  J. S. Kim,et al.  Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[58]  S S Burkhart,et al.  Optimization of stacked half-hitch knots for arthroscopic surgery. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[59]  P J McMahon,et al.  Arthroscopic suture tying: A comparison of knot types and suture materials. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[60]  T. B. Edwards,et al.  Technical note: a "new" arthroscopic sliding knot. , 2000, The Orthopedic clinics of North America.

[61]  K I Ha,et al.  The SMC knot--a new slip knot with locking mechanism. , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[62]  S S Burkhart,et al.  Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[63]  C. Gerber,et al.  Experimental rotator cuff repair. A preliminary study. , 1999, The Journal of bone and joint surgery. American volume.

[64]  Wesley M. Nottage,et al.  Arthroscopic Knot Tying Techniques , 1999 .

[65]  B A Fleega,et al.  The giant knot: a new one-way self-locking secured arthroscopic slip knot. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[66]  L P Carro,et al.  Totally intra-articular arthroscopic knot: push and twist technique. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[67]  W. Nottage,et al.  Arthroscopic knot typing techniques. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[68]  S S Burkhart,et al.  Loop security as a determinant of tissue fixation security. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[69]  D. T. Harryman,et al.  Optimizing arthroscopic knots using braided or monofilament suture. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[70]  J. D. de Beer,et al.  Nicky's knot--a new slip knot for arthroscopic surgery. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[71]  S. Snyder,et al.  Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture Shuttle Relays, and no. 2 nonabsorbable mattress sutures. , 1997, The Orthopedic clinics of North America.

[72]  W D Cannon,et al.  Elongation of Arthroscopically Tied Knots , 1997, The American journal of sports medicine.

[73]  D Delimar,et al.  A secure arthroscopic knot. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[74]  F. Savoie,et al.  The arthroscopic treatment of anterior and multidirectional shoulder instability. , 1996, Instructional course lectures.

[75]  J A Sidles,et al.  Optimizing arthroscopic knots. , 1995, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[76]  J A Sidles,et al.  Arthroscopic labral repair to the glenoid rim. , 1994, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[77]  P. Cawley,et al.  Suture anchor failure strength--an in vivo study. , 1993, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[78]  Wolf Em,et al.  Arthroscopic capsulolabral repair using suture anchors. , 1993 .

[79]  E. M. Wolf.  Arthroscopic capsulolabral repair using suture anchors. , 1993, The Orthopedic clinics of North America.

[80]  D. de Haas,et al.  Dynamic loading of surgical knots. , 1991, Surgery, gynecology & obstetrics.

[81]  Weston Pv.  A new clinch knot. , 1991 .

[82]  P. Weston.  A new clinch knot. , 1991, Obstetrics and Gynecology.

[83]  P. Gunderson.  The half-hitch knot: a rational alternative to the square knot. , 1987, American journal of surgery.

[84]  P. Klopper,et al.  Performance of sliding knots in monofilament and multifilament suture material , 1986, Obstetrics and gynecology.

[85]  C. Aberg,et al.  Tensile strengths of twelve types of knot employed in surgery, using different suture materials. , 1976, Acta chirurgica Scandinavica.

[86]  D. Holmlund.  Knot properties of surgical suture materials. A model study. , 1974, Acta chirurgica Scandinavica.

[87]  J. Herrmann.  Tensile strength and knot security of surgical suture materials. , 1971, The American surgeon.