Knotless Fixation Is Stronger and Less Variable Than Knotted Constructs in Securing a Suture Loop

Orthopaedic Journal of Sports Medicine
Patrick J DenardCoen A Wijdicks

Abstract

Historically, tendon-to-bone fixation has relied on knot tying. However, considerable variability exists in knot-tying strength among surgeons. The purpose of this study was to compare the biomechanical properties of knotted and knotless fixation and to evaluate variability among surgeons. The hypothesis was that knotless constructs would be stronger and have less variability as compared with knotted constructs. Controlled laboratory study. A total of 34 orthopaedic surgeons participated in a laboratory study to compare knotted and knotless constructs, where 104 knotted constructs were performed with No. 2 suture, 21 knotless constructs with No. 2 suture (K2 group), and 79 knotless constructs with suture tape (KT group). Mechanical testing was performed to compare load at 3 mm of displacement, load to failure, and stiffness of each construct. The mean load at 3 mm of displacement was greatest in the KT group, with significant differences among all 3 groups (P < .001). Load to failure was significantly greater in the KT group as compared with the K2 group and the knotted group (P < .001), but there was no difference between the K2 and knotted groups (P ≥ .999). Stiffness and displacement were also greatest in the KT group. Based...Continue Reading

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Citations

Apr 24, 2020·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Hong LiShiyi Chen
Dec 12, 2020·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Bogdan A MatacheKirk A Campbell
Jul 13, 2021·Orthopaedic Journal of Sports Medicine·Aravind AthivirahamCoen A Wijdicks
Aug 7, 2021·Arthroscopy Techniques·Jim C Hsu, James C Linhoff
Feb 1, 2022·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Xiaosong ZhiShijun Wei

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