Page 25 - Arthroscopic Knot Tying: An Instruction Manual

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Another modification of Tera and Aberg's original nomenclature included the symbol (#) which represent
post switching accompanied by a reversed half hitch (10 ). This symbol has not been readily adopted in
the arthroscopic literature. Instead, some authors interpret a double slash (//) to represent both post
switching and reversing the half hitch (alternating an overhand hitch with an underhand hitch or vice
versa; 8). Other authors use a double slash followed by the letter “x” (//x) to represent post switching
and reversing the half hitch (24 ) and reserve the symbol//to signify post switching without reversing the
half hitch. Thus, when reading the literature it is important to determine what the author means when
the symbol//is used.
The most secure configuration for a series of half hitches consists of at least three reversed half hitches
with alternating posts (S//xS//xS) as described by Loutzenheiser (24 ; Fig. 12 ). Half hitches without post
switching are not as strong as those tied with post switching (4 ). Knot security of half hitches increases
with each successive throw but the gain of knot security added after the third throw diminishes and is
offset by the increased volume of the knot, which might increase tissue inflammation. Sliding knots have
increased tensile strength when “locked” with three reversed half hitches on alternating posts (24 ,25 ).
In addition, locking sliding knots with three reversed half hitches on alternating posts changes the mode
of suture failure from that of knot slippage to suture rupture (8 ). Thus, sliding and locking knots should
be reinforced with three reversed half hitches on alternating posts to enhance knot security.

FIGURE 12. Three reversed half hitches on alternating posts (S//xS//xS).