Jo Chris H, Lee Ji-Ho, Kang Seung-Baik, Lee Jae Hyup, Han Hyuk Soo, Bae Tae Soo, Choi Kuiwon, Lee Changyang, Lee Myung Chul, Yoon Kang-Sup
Department of Orthopedic Surgery, Seoul National University Boramae Hospital, Dongjak-gu, Seoul, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2008 Aug;16(8):787-93. doi: 10.1007/s00167-008-0497-y. Epub 2008 Mar 5.
The purpose of this biomechanical study was to determine optimized configuration of additional half-hitches placed after various arthroscopic sliding knots. Four commonly used arthroscopic sliding knots, namely, the Duncan loop, the SMC, Weston, and SP knot, were included in this study. All knots were tied with a single-hole knot pusher using a knot-tying simulator. After tying a sliding knot, it was backed up with zero to four additional reverse half-hitches on alternating posts (RHAPs). The first half-hitch was either placed on the same post (conventional RHAP; c-RHAP) or on the loop limb of the sliding knot (switched RHAP; s-RHAP). Ten knots were tied in each configuration using No. 2 Ethibond or No. 1 PDSII sutures. Loop security (loop circumference at 5 N) and knot security (highest load to failure at a cross-head displacement of 3 mm) were measured. Knot configurations, number of RHAPs, or mode of placement of the first half-hitch did not make clinically significant effects on loop security for either suture type. Using No. 2 Ethibond sutures, SMC, SP, and Weston knots required at least three additional half-hitches before knot security plateaued. However, when the first half-hitch was switched to the loop limb of the sliding knot, only two additional half-hitches (2 s-RHAPs) were required to reach maximum knot security. Using No. 1 PDSII sutures, SMC knots needed one additional half-hitch to reach maximum knot security, whereas SP and Weston knots required two half-hitches. However, SMC, SP and Weston knots with switched first half-hitch only required one additional half-hitch (1 s-RHAP) to achieve maximum knot security. This study demonstrated that switching the post just after the sliding knot could save one half-hitch without compromising knot security. That means that sliding knots with 2 s-RHAPs for No. 2 Ethibond and 1 s-RHAPs for No. 1 PDSII achieved knot security comparable to that of sliding knots with 3 c-RHAPs and with 2 c-RHAPs, respectively. The results suggested that the optimized configuration for arthroscopic sliding knots required a secure sliding knot, such as, the SMC, SP, or Weston knots and 2 s-RHAPs when No. 2 Ethibond or No. 1 PDSII suture materials were used considering the unraveling tendency of No. 1 PDSII. Results of the current study may be helpful for establishing arthroscopic sliding knot-tying routines for best results in clinical practice.
本生物力学研究的目的是确定在各种关节镜下滑动结之后放置额外半结的优化配置。本研究纳入了四种常用的关节镜下滑动结，即邓肯环、SMC、韦斯顿和SP结。所有结均使用单孔结推器通过打结模拟器进行打结。在打好一个滑动结后，在交替的柱上（RHAP）用零至四个额外的反向半结进行加固。第一个半结要么放在同一柱上（传统RHAP；c-RHAP），要么放在滑动结的环肢上（转换RHAP；s-RHAP）。每种配置使用2号Ethibond或1号PDSII缝线各打10个结。测量环的安全性（5 N时的环周长）和结的安全性（在十字头位移3 mm时的最大破坏载荷）。结的配置、RHAP的数量或第一个半结的放置方式对两种缝线类型的环安全性均无临床显著影响。使用2号Ethibond缝线时，SMC、SP和韦斯顿结在结安全性达到稳定之前至少需要三个额外的半结。然而，当第一个半结转换到滑动结的环肢上时，仅需要两个额外的半结（2个s-RHAP）就能达到最大结安全性。使用1号PDSII缝线时，SMC结需要一个额外的半结来达到最大结安全性，而SP和韦斯顿结需要两个半结。然而，第一个半结转换后的SMC、SP和韦斯顿结仅需要一个额外的半结（1个s-RHAP）就能实现最大结安全性。本研究表明，在滑动结之后转换柱可以节省一个半结，而不影响结的安全性。这意味着，对于2号Ethibond缝线，带有2个s-RHAP的滑动结和对于1号PDSII缝线，带有1个s-RHAP的滑动结分别实现了与带有3个c-RHAP和2个c-RHAP的滑动结相当的结安全性。结果表明，考虑到1号PDSII的解缠趋势，当使用2号Ethibond或1号PDSII缝线材料时，关节镜下滑动结的优化配置需要一个牢固的滑动结，如SMC、SP或韦斯顿结以及2个s-RHAP。本研究结果可能有助于建立关节镜下滑动打结程序，以在临床实践中获得最佳效果。
