Page 61 - Arthroscopic Knot Tying: An Instruction Manual

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Double-Twist Knot (Fig. 31 ,32)

FIGURE 31. A-C. Double-twist knot.

The double-twist knot (31 ) is a knot that employs a double suture stitch. It can be used with a suture
anchor or when doing a side-to-side rotator cuff repair (Fig. 31 ).

 A suture is doubled over and the limbs are passed thru the soft tissues and both the loop and two
strands are retrieved from the cannula (Figs. 32A, B ).
 Each strand is twisted clockwise around the loop twice (Fig. 32C ).
 Pull on both limbs simultaneously to advance the knot (Figs. 32D , E , F ).
 Use the knot pusher on each limb to advance the loop down while each strand is alternately pulled
(Figs. 32G , H , I )
 Lock the knot with a series of three alternating half hitches with post switching (Fig. 32J ).
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.

FIGURE 32. A-J. Double-twist knot.

FIGURE 32. (Continued)

The Double-twist knot was shown to have a significantly higher mean peak to failure compared to the
Tennessee Slider and Snyder's knot (31 ).