A comparison of knot security and loop security in arthroscopic knots tied with newer high-strength suture materials.

PURPOSE: The purpose of this study was to compare the knot security and loop security of 2 sliding and 1 static arthroscopic knot tied with different types of suture material. METHODS: We evaluated 3 commonly used arthroscopic knots (surgeon's knot, Roeder knot, and Weston knot) tied with 6 different braided No. 2 sutures (FiberWire [Arthrex, Naples, FL]; Ethibond [Ethicon, Somerville, NJ]; Orthocord [DePuy Mitek, Raynham, MA]; Herculine [now called HiFi; ConMed Linvatec, Largo, FL]; MaxBraid [Arthrotek, Warsaw, IN]; and UltraBraid [Smith & Nephew, Andover, MA]). Each suture loop was then mounted on a materials testing system, and its circumference was measured at a 5-N preload to assess each knot's ability to maintain a tight suture loop without slippage (loop security). Knot security was measured as the maximum force to failure at 3 mm of crosshead displacement or suture breakage during single-pull load testing. RESULTS: We found that tying knots with different types of suture material can affect both the knot security and loop security of various types of arthroscopic knots. When a Roeder knot or surgeon's knot was tied, No. 2 FiberWire had the highest force to failure when compared with similar knots tied with other suture material (P < .001). The loop security for many of the knot and suture configurations was not significantly different. However, No. 2 FiberWire consistently showed the smallest loop circumference when compared with other suture materials. CONCLUSIONS: Arthroscopic knots tied with No. 2 FiberWire provide superior knot security and similar loop security compared with other commonly used high-strength polyethylene suture materials. CLINICAL RELEVANCE: High-strength sutures exhibit unique mechanical characteristics that may vary significantly between suture types. In addition, knot configuration plays an important role in altering these characteristics as they relate to knot security.

Arthroscopic double-pulley remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs.

We present a modified arthroscopic technique used to treat anterior shoulder instability associated with mild glenoid bone loss and a large Hill-Sachs lesion. The procedure aims to convert a bony intra-articular defect into an extra-articular defect by insetting the infraspinatus into the Hill-Sachs lesion. The arthroscopic procedure is performed with the patient in the lateral decubitus position, and the same portals used for anterior instability repair are used for this technique. The sequence of steps involves placing and passing the glenoid anchors and sutures and then waiting to tie the anterior sutures until after the humeral suture anchors have been placed. The subacromial bursa is cleared; then 2 transtendon suture anchors are placed in the Hill-Sachs lesion. Next, the previously placed Bankart repair sutures are tied, and finally, the remplissage sutures are tied in the subacromial space over the infraspinatus by use of the transtendon double-pulley technique. This technique uses the eyelets of the 2 suture anchors as pulleys and creates a double-mattress suture.

Glenohumeral bone defects in the treatment of anterior shoulder instability.

There is a well-recognized association between osseous defects of the glenoid or humerus and shoulder dislocation, which often leads to recurrent instability. A variety of strategies have been used to treat bone loss, and procedures have become more refined as the goals of surgery have evolved. Achieving optimal motion and function and minimizing the risk of osteoarthritis have become almost as important as stabilizing the joint.