Page 59 - Arthroscopic Knot Tying: An Instruction Manual

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Lafosse Knot (Fig. 30)

FIGURE 30. A-J. Lafosse knot.

FIGURE 30. (Continued)

The Lafosse knot is similar in structure to the Easy knot but incorporates the post switching technique. In
addition, it is locked with two identical half hitches on the alternated post rather than one (16 ,21 ,41 ).

 The post limb should be approximately half the length of the loop limb.
 Throw an overhand half hitch around the post while maintaining tension on the post strand (Fig.
30A ).
 Throw four identical overhand half hitches. Each half hitch should be thrown distal (farther from
the joint and arthroscopic cannula) than the previous throw. Ensure to maintain tension on the
post strand (Fig. 30B ).
 Push the knot into the joint with the knot pusher on the post strand and while simultaneously
pulling on the post (Fig. 30C ).
 Cross the knot pusher over the loop strand at the level of the knot, pull tension on the loop strand,
and past-point. This causes the post to switch and the last hitch reverses to lock the sliding knot
(Fig. 30D ).
 At this point, if the knot is not tight enough, pull on the initial post and the half hitch reverses
thereby unlocking the knot. The knot can be further tightened by pulling on the post and pushing
the knot down with the pusher. The knot can be relocked in the manner described in step E.
 Throw an overhand half hitch around the same post (Fig. 30E ).
 With the knot pusher on the post strand, advance the locking half hitch by pushing the hitch into
the joint with the knot pusher (Fig. 30F ).
 Cross the knot pusher over the loop strand at the level of the knot, pull tension on the loop strand,
and past-point. This causes the post to switch and the hitch to reverse directions (Fig. 30G ).
 Throw a second overhand half hitch around the same post (Fig. 30H ).
 With the knot pusher on the post strand, advance the locking half hitch by pushing the hitch into
the joint with the knot pusher (Fig. 30I ).
 Cross the knot pusher over the loop strand at the level of the knot, pull tension on the loop strand,
and past-point. This causes the post to switch and the hitch to reverse directions to further
reinforce the knot (Fig. 30J ).