UNDERSTANDING SURGICAL KNOT SECURITY - A PROPOSAL TO STANDARDIZE THE LITERATURE

BACKGROUND: There is very little published data concerning the knot ha ndling properties of suture materials. The few studies that are availa ble on this subject contain discrepancies in nomenclature, testing met hods, and in the type of data reported. To date, there has been no eff ort to present what is currently known concerning knot security in a u nified format. STUDY DESIGN: A review of the literature was conducted to determine what is currently known concerning surgical knots, the ef ficiency of these knots, testing techniques, and nomenclature. The str uctures of common surgical knots were analyzed and their relationships determined. The results of the various studies were analyzed and a su mmary of existing data was prepared. RESULTS: Based on current literat ure and a thorough analysis of surgical knots, a standard method for t esting knot efficiency and a standard nomenclature were proposed. Sutu re security has been shown to be strongly influenced by the type of kn ot used. Knots in which the second throw contains two turns are most e fficient. CONCLUSIONS: Existing studies have demonstrated a strong var iation in the efficiency of different surgical knots. Standards for te sting and nomenclature have been presented, Effort now needs to be dir ected in three areas: simulating in vivo conditions, testing knots und er these conditions, and determining the factors that make some suture materials more efficient in knot holding than others.