Over-pointing technique: an approach to past-pointing arthroscopic knots on alternating suture posts without alternating the knot pusher.

As arthroscopic reconstructive surgery evolves, new techniques that improve operative efficiency while maintaining proven technical principles will enhance a surgeon's skill repertoire. A secure arthroscopic knot requires placing a series of reversed half-hitches on alternating posts and has traditionally involved alternating the knot-passing device between suture limbs to "past-point" each half-hitch, ensuring overall knot security. To increase the speed of knot-tying, a technical variation of keeping the knot pusher on the same suture limb throughout the knot-tying process, while still alternating posts, can be used. This technique involves alternately "pushing" and "pulling" sequential half-hitches into place. It is important to note that although conventional past-pointing is performed when "pulling" a half-hitch, it cannot be performed when purely "pushing" a half-hitch. In this article we describe a novel technique of "over-pointing" to be performed when pushing half-hitches into place. This is meant to be a complement to past-pointing by use of the knot pusher to advance the half-hitch and tighten the knot by over-riding the knot, effectively providing the equivalent of past-pointing by "pulling" the knot tight. In this way, a knot can be constructed without removing the device from the initial post strand of suture, saving time while maintaining the principles of secure knot-tying.