Validation of Different Combination of Three Reversing Half-Hitches Alternating Posts (RHAPs) Effects on Arthroscopic Knot Integrity

Abstract

Introduction. With arthroscopic techniques being used, the importance
of knot tying has been examined. Previous literature
has examined the use of reversing half-hitches on alternating
posts (RHAPs) on knot security. Separately, there has been research
regarding different suture materials commonly used in
the operating room. The specific aim of this study was to validate
the effect of different stacked half-hitch configuration and
different braided suture materials on arthroscopic knot integrity.

Methods. Three different suture materials tied with
five different RHAPs in arthroscopic knots were compared.
A single load-to-failure test was performed and
the mean ultimate clinical failure load was obtained.

Results. Significant knot holding strength improvement was
found when one half-hitch was reversed as compared to baseline
knot. When two of the half-hitches were reversed, there
was a greater improvement with all knots having a mean ultimate
clinical failure load greater than 150 newtons (N). Comparison
of the suture materials demonstrated a higher mean
ultimate clinical failure load when Force Fiber® was used and
at least one half-hitch was reversed. Knots tied with either
Force Fiber® or Orthocord® showed 0% chance of knot slippage
while knots tied with FiberWire® or braided fishing line
had about 10 and 30% knot slippage chances, respectively.

Conclusion. A significant effect was observed in regards to both
stacked half-hitch configuration and suture materials used on
knot loop and knot security. Caution should be used with tying
three RHAPs in arthroscopic surgery, particularly with
a standard knot pusher and arthroscopic cannulas. The findings
of this study indicated the importance of three RHAPs
in performing arthroscopic knot tying and provided evidence
regarding discrepancies of maximum clinical failure loads observed
between orthopaedic surgeons, thereby leading to better
surgical outcomes in the future. KS J Med 2017;10(2):35-39.