Page 31 - Arthroscopic Knot Tying: An Instruction Manual

P.24
Non-Sliding Knots

Square Knot (Fig. 16)

FIGURE 16. A-F. Square knot.

Since the square knot (27 ) is difficult to tie arthroscopically, very few arthroscopic surgeons use this knot.
If tension is not applied symmetrically, the square knot will convert into two nonidentical half hitches
that are biomechanically unfavorable. Thus, if the surgeon chooses to use this knot it is necessary to
ensure that symmetric tension is maintained on both limbs while tying the square knot arthroscopically.

 Throw an overhand loop around the post (Fig. 16A ).
 Place the knot pusher on the loop strand and pull the knot down in place. Past-point the knot
pusher on the loop strand so the post and limb are parallel to each other and pull symmetric
tension on both the loop and post strands (Fig. 16B ).
 Inspect the knot to confirm it is not a half hitch.
 Throw an underhand loop around the post limb (Fig. 16C ).
 Advance the knot down with the knot pusher on the loop limb until the hitch is gently seated
against the first hitch (Fig. 16D ).
 Place the knot pusher on the post strand and past-point the knot pusher on the post strand so the
post limb is parallel to the loop limb. When the limbs are parallel, apply symmetric tension to each
limb (Fig. 16E ).
 Inspect the knot to ensure that it did not convert into non-identical half hitches (Fig. 16F ).
 Repeat steps A to G to increase the knot-holding capacity of the square knot.