Knots in Orthopedic Surgery

Knots were used since the ancient medicine and are a fundamental part of orthopedic surgery. A save and secure knot contributes significantly to an optimal adaptation of soft-tissue and, despite the rapid development of surgical methods, is an essential prerequisite for secure tissue healing and thus a successful surgical result. Despite the increasing use of arthroscopic reconstructive surgical procedures and the simultaneous development of new suture materials, a secure knot is of great importance. It is all the more important to master the nomenclature and basic mechanics of sutures and open as well as arthroscopic knotting techniques in order to ensure safe tissue healing. In addition, one must be aware of the consequences of insufficiently set knot constructs for the patient, the result of the operation, increased costs for necessary revision operation(s) and the health care system. However, one has to be aware that the knot itself, irrespective of the used suture material and knot type, is the weakest link of the repair. In particular, the principles for tying a knot with high security and strength should be a basic standard for every orthopedic surgeon. In the following, the essential basics of knot mechanics, knot technology, nomenclature, and tissue behavior will be discussed.