Page 69 - Arthroscopic Knot Tying: An Instruction Manual

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SMC Knot (Fig. 36)

FIGURE 36. A-G. SMC knot.

The SMC knot (19 ) is a sliding knot with a locking mechanism. This knot was designed to slide easily then
lock once in place. The developers of this knot reported that the locking mechanism of this knot obviates
the need for multiple half hitches to further secure the knot, thus maintaining a low profile.

 The post limb should be one half the length of the loop limb.
 Hold both the loop limb and the post limb between the thumb and the index finger.
 Pass the loop strand over the post limb and behind both the loop and post limbs (Fig. 36A ).

 Pass the loop strand over both limbs but around only the post limb (Figs. 36B, C )
 Pass the tail of the loop under the post limb and in between the post limb and the loop limb in
between the first and second loops (Fig. 36D ).
 Tension the knot by gently pulling on both the loop and the post strands simultaneously. Do not
pull too hard on the loop strand or the knot will lock prematurely (Fig. 36E ).
 Pull the post strand to advance the knot while pushing the knot down with the knot pusher on the
post limb (Fig. 36F ).
 While maintaining the tension of the post strand and the knot pusher, pull the loop strand to lock
the knot in place (Fig. 36G ).

Although, the original description of this knot reported that locking half hitches were unnecessary, our
experience indicates that the knot would be able to sustain higher loads with locking half hitches
(unpublished data). In addition, when the authors who initially described the knot tested the
biomechanical properties of the knot, they chose to reinforce the knot with three reversed half hitches on
alternating posts (20 ). They showed that the SMC knot had a greater load to clinical failure than the
Overhand knot, a similar load to clinical failure than the Duncan loop and the Tennessee Slider, and a
lower load to clinical failure than the Revo knot. Other descriptions of the SMC knot also recommend
augmenting the knot with locking half hitches to increase knot security (15 ).