Arthroscopic knot tying

Abstract

Arthroscopy has evolved from a merely diagnostic procedure to a therapeutic procedure, with most reconstructive procedures being done by arthroscopy. Suturing has been the cornerstone of all reconstructive surgeries to hold the tissues together and without excessive tension to facilitate healing and knot tying has been practiced for centuries. Arthroscopic shoulder reconstructive procedures also employ sutures and knots, and every shoulder surgeon must understand the principle and learn the technique of arthroscopic knots. Though the principles of repair are the same, arthroscopic reconstruction is different from open techniques in that suturing is much more difficult in arthroscopic procedures. The surgeon has to suture tissues at a distance, under the constraint of cannula and in a wet field. This necessitates the use of knot pusher and placement of knot with asymmetric tensioning of suture limbs. Surgeon does not have the benefit of tactile feedback as in tying open knots. Furthermore, the knot is often tightened at an acute angle to suture and not perpendicular to defect, an ideal situation described in open knotting.