Significance of the internal locking mechanism for loop security enhancement in the arthroscopic knot

Purpose: Secure tissue fixation of an arthroscopic knot depends on the security of the initial loop and additional locking half-hitches. The purpose of this report is to evaluate the loop and knot security relative to the internal locking mechanism of arthroscopic slip knot. Type of Study: This is an experimental study designed for knot and loop security on a material testing system, The measurements were carried out in a blinded fashion in which the tester was not aware of the type of knot being tested. Methods: Five configurations of arthroscopic knots (overhand throw, Duncan loop, Revo knot, Tennessee slider, and SMC knot) were created around a 5-mm diameter metal bar using a No. 2 braided suture. For each knot configuration, 10 knots were tested for displacement at cyclic loading, load to clinical failure (3-mm displacement), ultimate failure load, and mode of failure on the servo-hydraulic material testing system (NITS 858 MiniBionix test system; NITS, Minneapolis, MN). A 1 -way analysis of variance was used to determine the statistical difference in displacement at cyclic loading, load to clinical failure, and ultimate failure load between each knot configuration. Results: In the cyclic loading test, the average displacement of all knots was clinically insignificant, with the average being less than 0.24 mm. The overhand throw had the worst characteristic in the load to failure test. The other 4 knots had an optimal load to failure. The SMC knot, which has an internal locking mechanism, had good loop and knot security in the load to clinical failure and ultimate failure load (P < .05). The SMC and the Revo knots failed by knot breakage (material failure) whereas the other knots failed by knot slippage (loop failure). Conclusions: The internal locking mechanism flips the post strand to convert the loop strand into a new post strand while rerouting the original post strand around a new post. An arthroscopic knot with an internal locking mechanism can enhance loop security.