Page 39 - Arthroscopic Knot Tying: An Instruction Manual

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Sliding Knots

Overhand Throw (Fig. 20)

FIGURE 20. A-E. Overhand throw.

The Overhand Throw is a sliding knot that is also known as the Overhand knot and the Overhand loop. It is
different from an overhand half hitch. It is included in this manual for historical purposes only because
multiple biomechanical studies have shown it to have poor tensile strength, and it is inferior to all the
knots with which it has been compared (20 ,26 ). The authors of this manual do not recommend use of
this knot.

 Make the post limb half as long as the loop limb.
 Throw the loop strand over and around both the post and the loop limbs (Fig. 20A ).
 Pass the tail of the loop limb through the “hole” made by the initial throw between the parallel
loop and post strands (Fig. 20B ).
 Pull on the loop limb and post limb simultaneously to tighten the knot (Fig. 20C ).
 Advance the knot by pulling on the post limb and simultaneously pushing the knot with the knot
pusher on the post limb (Fig. 20D ).
 Lock the knot with a series of three alternating half hitches with post switching (Fig. 20E ).
o Throw an underhand loop on the original post. Tension with the knot pusher.
o Switch posts.
o Throw an overhand loop over the new post. Tension with the knot pusher.
o Switch posts.
o Throw an underhand loop on the original post again. Tension with the knot pusher.

Duncan Loop

The Duncan loop (27 ) was originally described in the fishing literature (Uni-Knot; 36 ) and has been
modified for use in arthroscopic surgery. The arthroscopic Duncan loop is also known as the Fisherman's
knot (2 ) or the Hangman's knot (28 ). The difference between the fishing knot and the arthroscopic knot
is the direction the loop strand travels around the post. When tying the fishing Duncan loop, one wraps
the loop limb around the post in a direction away from the joint. To tie the modified Duncan loop or
Hangman's knot, the surgeon sequentially wraps the loop limb around the post in a direction toward the
joint.