Page 79 - Arthroscopic Knot Tying: An Instruction Manual

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Laparoscopic Knots

Sliding knots are not unique to arthroscopic surgery. There are a number of sliding knots that have been
used in laparoscopy. Many of these knots have not been described in the arthroscopic literature. However,
it is conceivable that one or more of these knots could be effective in arthroscopic surgery. Although
these laparoscopic knots have been studied biomechanically, they have not been tested when using
arthroscopic techniques. Thus, one should use caution if a laparoscopic knot is chosen to approximate
tissue in arthroscopic surgery. The purpose of including several arthroscopic knots in this manual is to
expose the arthroscopic surgeon to the slipknots being used in other areas of surgery (33 ).

Blood Slipknot (Fig. 41)

FIGURE 41. A-G. Blood slipknot.

The blood knot is a popular fishing knot that has been adapted to be used in laparoscopic surgery.

 The post limb should be one half the length of the loop limb.
 Cross the loop over the post strand (Fig. 41A ).
 Wrap the loop behind and around the parallel post and loop strands proximal (closer to the joint)
to the initial intersection of post and loop strands (Fig. 41B ).
 Again wrap the tail of the loop strand around the parallel post and loop strands distal (further from
the joint) to the preceding throw for a total of five turns. After the fifth turn, the tail of the loop
strand should pass through the large initial loop created in step 2 (Figs. 41C-E ).
 Tension the knot by gently pulling on both the loop and the post strands simultaneously (Fig. 41F ).
 Advance the knot by pulling on the post limb while pushing the knot with the knot pusher on the
post strand (Fig. 41G ).

In one biomechanical study, the blood knot was determined to be an unreliable knot with all ligatures
tested (33 ).