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World Journal of Surgery

Published in:

01-04-2009

Locking, Jamming, and Ratchet Mechanisms of Sliding Surgical Knots Topologically Revisited

Authors: J. Joris Hage, Lydia P. E. van der Steen

Published in: World Journal of Surgery | Issue 4/2009

Abstract

Background

The geometry of lockable, ratchet, or jamming sliding surgical knots was assessed to enhance practical and topological understanding of knots among surgeons.

Methods

Using a database of more than 100 surgical knots, 29 knots that reportedly feature locking, ratchet, or jamming mechanisms were topologically assessed for their ability to lock antegradely or retrogradely, to lock by assuming their flat geometry, or to jam.

Results

Eighteen of the 29 investigated surgical knots have previously been mistakenly categorized. Topologically, the concept of a true ratchet knot is a fallacy.

Conclusions

Surgical knots may be consistently classified on the basis of precise and detailed definition of various anti-backsliding geometrical characteristics of knots.

Categorization of knots

Sliding knot:

allows both forward and backward sliding, even after tightening the knot.

Ratchet knot:

allows only forward sliding toward the suture loop after tightening the working end.

Jamming knot:

prevents both forward and backward sliding, as a result of anything less than a bight in the standing part that was caused by traction on the working end.

Locking knot:

prevents both forward and backward sliding by change to a flat knot or by distortion of the straight standing part into a bight upon traction on the working end.

Retrograde locking knot:

locked by distortion upon traction on the loop part of the working end.

Antegrade locking knot:

locked by distortion upon traction on the tag end of the working end.

Proximal antegrade locking knot:

locked by a bight that is formed in the standing part by the most proximal turn of the working end, nearest to the knot-tier.

Middle antegrade locking knot:

locked by a bight that is formed in the standing part by an intermediate turn of the working end.

Distal antegrade locking knot:

locked by a bight being formed in the standing part by the most distal turn of the working, nearest to the suture loop.

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Title: Locking, Jamming, and Ratchet Mechanisms of Sliding Surgical Knots Topologically Revisited
Authors: J. Joris Hage
Lydia P. E. van der Steen
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 4/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-008-9904-2

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Springer Medicine

Locking, Jamming, and Ratchet Mechanisms of Sliding Surgical Knots Topologically Revisited

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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