Alexander Cm Chong1,2, Pie Pichetsurnthorn3, Daniel J Prohaska2,4. 1. Department of Graduate Medical Education - Orthopaedics Surgery, Via Christi Health, 929 N. Saint Francis, Wichita, KS 67214. 2. Department of Orthopaedics Surgery, The University of Kansas School of Medicine-Wichita, 929 N. Saint Francis, Wichita, KS 67214. 3. KU School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214. 4. Advanced Orthopaedics Associates, 2778 N. Webb Road, Wichita, KS 67226.
Abstract
PURPOSE: The purpose of this study was to biomechanically determine the minimum strength required to "flip" a seated and tightened half-hitch in a knot of different braided polyblend sutures. METHODS: ForceFiber, FiberWire, Orthocord, and Ultrabraid were evaluated. All knot tying processes began by advancing an initial base knot down to a standardized rod. All half-hitches were tied using a single-hole knot pusher in a dry environment, and were tightened with 45N by using past-pointing maneuver. A tension was then deliberately applied to the wrapping suture limb until a "flip" occurred, and the amount of tension was measured by the load cell. Three trials for each half-hitch and 3 half-hitches for each arthroscopic knot with 12 knots of each material were tied. All respective tension loads were collected through the digital video recordings (knot closeup view and load cell reading). RESULTS: Orthocord was the easiest to "flip" a seated and tightened half-hitch (average: 10±3N), whereas Ultrabraid was hardest to "flip" (average: 23±7N). ForceFiber and FiberWire were about 49% and 15% more resistance to "flip" when compared to Orthocord. After each trial of flipping the half-hitch back and re-tightened, there was a significant reduction in strength required to "flip" the tightened half-hitch. CONCLUSION: 1) The unintentional minimum tensile strength greater than 10N applied to the wrapping suture limb on the seated and tightened half-hitch could potentially "flip" the half-hitch in a knot during arthroscopic procedures, and 2) different braided suture material has an affect on the tensile strength to "flip" a seated and tightened half-hitch in an arthroscopic knot. CLINICAL RELEVANCE: The findings of this study indicated that even a seated and tightened half-hitch in an arthroscopic knot could easily be "flipped" if an unintentional tension was applied to the wrapping suture limb, and thereby reduced the knot security strength. In addition different suture materials could have an effect on the strength needed to "flip" the tightened half-hitch.
PURPOSE: The purpose of this study was to biomechanically determine the minimum strength required to "flip" a seated and tightened half-hitch in a knot of different braided polyblend sutures. METHODS: ForceFiber, FiberWire, Orthocord, and Ultrabraid were evaluated. All knot tying processes began by advancing an initial base knot down to a standardized rod. All half-hitches were tied using a single-hole knot pusher in a dry environment, and were tightened with 45N by using past-pointing maneuver. A tension was then deliberately applied to the wrapping suture limb until a "flip" occurred, and the amount of tension was measured by the load cell. Three trials for each half-hitch and 3 half-hitches for each arthroscopic knot with 12 knots of each material were tied. All respective tension loads were collected through the digital video recordings (knot closeup view and load cell reading). RESULTS: Orthocord was the easiest to "flip" a seated and tightened half-hitch (average: 10±3N), whereas Ultrabraid was hardest to "flip" (average: 23±7N). ForceFiber and FiberWire were about 49% and 15% more resistance to "flip" when compared to Orthocord. After each trial of flipping the half-hitch back and re-tightened, there was a significant reduction in strength required to "flip" the tightened half-hitch. CONCLUSION: 1) The unintentional minimum tensile strength greater than 10N applied to the wrapping suture limb on the seated and tightened half-hitch could potentially "flip" the half-hitch in a knot during arthroscopic procedures, and 2) different braided suture material has an affect on the tensile strength to "flip" a seated and tightened half-hitch in an arthroscopic knot. CLINICAL RELEVANCE: The findings of this study indicated that even a seated and tightened half-hitch in an arthroscopic knot could easily be "flipped" if an unintentional tension was applied to the wrapping suture limb, and thereby reduced the knot security strength. In addition different suture materials could have an effect on the strength needed to "flip" the tightened half-hitch.