Page 16 - Arthroscopic Knot Tying: An Instruction Manual

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With locking and sliding knots, it is important that the loop limb is at least twice as long as the post limb.
If it is not, when pulling the post limb to advance the knot through the cannula and into the joint, the
shortened loop limb may be pulled into the cannula making it impossible to secure the knot.
When using a sliding or locking knot configuration, it is important to ensure that the suture slides easily
through the tissue being opposed. If the suture does not slide easily, the surgeon should consider using a
nonsliding knot.

Knot Pushing and Pulling

Knot configurations can be either pushed or pulled into the joint. Sliding and locking knots are pushed
into the joint whereas half hitches are normally pulled into the joint. To perform the knot-pulling
technique, the arthroscopic knot-tying device is positioned on the loop limb and is advanced past the half
hitch thus pulling the loop over the post limb into the joint (Fig. 7A ). To perform the knot-pushing
technique, the arthroscopic knot-tying device is positioned on the post limb behind the knot thus pushing
the loop over the post limb into the joint (Fig. 7B ).

FIGURE 7. A. Knot pulling, B. Knot pushing.