The SMC knot—a new slip knot with locking mechanism

doi:10.1053/jars.2000.4821

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 16, Issue 5, July–August 2000, Pages 563-565

https://doi.org/10.1053/jars.2000.4821 Get rights and content

Abstract

Summary: A new slip knot for arthroscopic surgery, the SMC knot, is described. By pulling the post strand, a self-locking loop is created. By tensioning the loop strand, the self-locking loop creates a snug knot without sliding backward. The SMC knot is simple and has a low profile. With a nonabsorbable suture, it provides great knot security.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 5 (July), 2000: pp 563–565

Section snippets

Technique

After passing the tissue with a nonabsorbable suture, a short post strand and a longer loop strand are separated. While grasping the post strand, make an underhand throw with the loop strand under both the loop and the post strands (Fig 1).

. Make an underhand throw with the loop strand under both the loop and the post strands.

Make a second underhand throw with the loop strand under the post strand (Fig 2).

. Make a second underhand throw with the loop strand under the post strand.

Bring the loop

Discussion

Many techniques for tying arthroscopic knots have been described.2, 3, 5, 6 Some have good knot strength while others have less optimal strength with selected suture materials. To reduce the possibility of a failed repair by loss of suture fixation, a strong initial knot security is recommended.1, 4, 7, 8

The SMC knot provides good initial knot security through the locking mechanism of the self-locking loop. After locking the post by pulling the loop strand, the knot does not slide backward. We

References (8)

NJ Soper et al.
Suturing and knot tying in laparoscopy
Surg Clin North Am
(1992)
TD Loutzenheiser et al.
Optimizing arthroscopic knots
Arthroscopy
(1995)
JF De Beer et al.
Nicky's knot—A new slip knot for arthroscopic surgery
Arthroscopy
(1998)
D. Delimar
A secure arthroscopic knot
Arthroscopy
(1996)

There are more references available in the full text version of this article.

Cited by (108)

Comparison of two arthroscopic repair techniques for small-medium supraspinatus tendon tear: 1 triple-loaded vs 2 double-loaded metallic sutures anchors
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Surgical repair of the rotator cuff is based on the use of anchors whose ideal numbers and configurations continue to be controversial. We compared the clinical-functional results arising from the arthroscopic repair of shoulders, with small-medium lesions of the supraspinatus tendon, among patients using one anchor with three sutures, or two anchors with two sutures.
In this retrospective study patient were resolved into 2 groups. Clinical and functional results were assessed based on Constant Score and instrumental isometric examination.
Patients in Group 1 experienced shoulder repair using a single anchor with three sutures (n = 21, mean age = 56 years, range = 51–65). In Group 2, patients received two anchors with two sutures each (n = 24, mean age = 59 years, range = 24–75). The mean follow-up time was 15 months. The mean values of the operated shoulders’ Constant Score were 88.05 and 88.25 respectively. Examination of isometric test results in operated shoulders, healthy shoulders and the two different rotator cuff repair techniques did not reveal any statistically significant differences.
In the arthroscopic repair of small-medium supraspinatus tendon tears, the short to mid-term clinical and functional outcomes arising from use of 1 triple-loaded or 2 double-loaded metallic sutures anchors are comparable.
Use of a Dry Surgical Simulator Improves Orthopaedic Residents’ Competency and Technical Skills for Arthroscopic Rotator Cuff Repair
2022, Arthroscopy, Sports Medicine, and Rehabilitation
To evaluate whether an anatomic dry shoulder Dexter training model surgical simulator would be effective in augmenting orthopaedic residents’ skills for arthroscopic rotator cuff repair.
Nine residents, enrolled for this prospective study, watched a video presentation about transosseus equivalent (TOE) double-row, rotator cuff repair technique, repeating the aforementioned technique twice on the simulator. The time to complete all steps to final repair, as well as the quality of the final repair, were measured.
The data for repair completion time showed a statistically significant difference in the total duration time of performing the procedure, when comparing the timing in tests 1 and 2, demonstrating a reduced operative time. The qualitative data collected show an increase in the final score in 100% (9 out of 9) of the participants between the first and second tests, with an improvement in the average score of 16.4% (3.22 points with a standard deviation of 2.64). Hence, there is a statistically significant difference (P = .006) between the total scores obtained by the participants at the end of tests 1 and 2, presenting an improvement of the quality score, shifting from the first (average score 19.7) to the second (average score 22.9) test. Conclusion: The dry simulator may be a valuable device to improve arthroscopic technical skills. This improvement was observed both in the resulting reduced operative time required to carry out the surgical procedure and the increased quality score (established to evaluate the quality of the required tasks).
In order to provide as many training opportunities as possible, an arthroscopy simulator could be used to supplement clinical arthroscopy skills training for orthopaedic residents.
Learning and optimizing arthroscopic knot-tying by surgery residents using procedural simulation
2021, Orthopaedics and Traumatology: Surgery and Research
Procedural training of orthopedic surgery residents includes learning arthroscopic knot-tying. The models used comprise arthroscopy training modules of increasing complexity, although there is no procedural training guide for the acquisition of arthroscopic knot-tying skills. Few studies have focused on how residents learn arthroscopic knot-tying. The aim of our study was to determine the type of arthroscopic knot that is the easiest to perform and learn and that can be done the most successfully by orthopedic surgery residents.
Each participant had to learn five knots in a random order: Tennessee slider, Duncan loop, Revo knot (Surgeon's knot), Nicky knot, and the SMC (Samsung Medical Center) knot. The FAST Arthroscopy Workstation™ (Sawbones, Vashon Island, WA) was used for this study. Each participant could use a FAST Knot Tester™ (Sawbones®, Vashon Island, WA) to evaluate by themselves the biomechanical properties of the knots to optimize learning. Each participant had to rank how easy it was to learn this knot on a visual scale from 0 to 10. They also had to rank the reliability of the knots done on a visual scale from 0 to 10. Then, an independent rater assessed whether the knots were completed successfully; a knot was considered successful if it stretched by less than 3 mm when 60 N of load was applied.
Ten participants were included in the study; 250 knots were done and evaluated. When ranked from simplest to most complicated, the easiest knot to learn was the Surgeon's knot, followed by the Duncan loop, Tennessee slider, Nicky knot and SMC knot (p < 0.0001). The overall success rate for the knots was 80%. There was a statistical trend for the Nicky being done better than the other arthroscopic knots (88% success rate).
For orthopedics surgery residents, the surgeon's knot (Revo knot) was the easiest to learn, while the Nicky knot had the highest success rate.
II; prospective, randomized study with low power.
Learning and optimizing arthroscopic knot-tying by surgery residents using procedural simulation
2021, Revue de Chirurgie Orthopedique et Traumatologique
La formation procédurale de l’interne comprend l’apprentissage des nœuds arthroscopiques. Les maquettes comprennent des modules de formation en arthroscopie de complexité croissante, mais il n’existe pas de guide de formation procédurale pour l’acquisition des compétences en nœuds arthroscopiques. Peu d’études s’intéressent à l’apprentissage des nœuds arthroscopiques chez des internes en formation. L’objectif de l’étude était de déterminer le type de nœud arthroscopique qui associe la plus grande facilité et fiabilité d’apprentissage et la meilleure réussite de réalisation chez des internes en formation.
Chaque participant devait exécuter 5 nœuds avec un ordre d’apprentissage tiré au sort : nœuds de Tennesse, de Duncan, de chirurgien (RevoKnot), de Nicky et le SMC (Samsung Medical Center). Le support de travail mis à disposition était la FAST Workstation (Sawbones, Vashon Island, WA). Chaque participant avait à sa disposition un testeur de nœuds (Sawbones®, FAST Knot Tester™, Vashon Island, WA) permettant une auto-évaluation de la qualité biomécanique des nœuds afin d’optimiser l’apprentissage. Chaque participant devait noter la facilité d’apprentissage de ce nœud sur une échelle visuelle allant de 0 à 10. Il devait également noter la fiabilité des nœuds réalisés sur une échelle visuelle allant de 0 à 10. Un évaluateur indépendant évaluait la réussite des nœuds réalisés ; un nœud était considéré comme réussi si après application d’une charge de 60N il présentait un glissement inférieur à 3 mm.
Dix participants ont été inclus dans cette étude. 250 nœuds ont été réalisés et évalués. La facilité d’apprentissage basé sur l’échelle visuelle était du plus simple au plus compliqué le nœud de chirurgien, de Pêcheur, de Tennesse, de Nicky et le nœud SMC (p < 0,0001). Le pourcentage global de réussite des nœuds était au total de 80 %. Le nœud de Nicky présente une tendance statistique à être mieux exécuté que les autres nœuds arthroscopiques (88 % de réussite).
Le nœud de chirurgien présente la plus grande facilité d’apprentissage. Le nœud de Nicky présente le meilleur de taux de réussite chez des internes en formation.
II, prospectif randomisé de faible puissance.
Mechanical Comparison of High-Strength Tape Suture Versus High-Strength Round Suture
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To compare knot and loop characteristics of commonly used high-strength tapes and high-strength round sutures.
Twenty tied 30-mm loops were prepared for using suture-knot combinations of 4 common arthroscopic knots or a hand-tied surgeon’s knot and 7 sutures. Two tapes (BroadBand, SutureTape) and three no. 2 sutures (MaxBraid, FiberWire, DynaCord) were compared. Two additional larger tape sutures (FiberTape, PermaTape) not commonly tied arthroscopically were included in the hand-tied group. Each suture-knot combination was evaluated for loop integrity (single load to a specified elongation), knot security (plastic loop deformation with cyclic testing), loop security, and knot volume. Data were compared using analysis of variance followed by Tukey-Kramer post hoc tests.
BroadBand and SutureTape demonstrated superior loop integrity compared to most no. 2 suture-knot combinations. FiberTape (430.48 ± 89.00 N) and PermaTape (545.16 ± 95.09 N) required significantly greater force to undergo 3 mm of displacement than all other hand-tied sutures (P < .001). All suture-knot configurations demonstrated significant plastic deformation (cyclic elongation) over 1000 cycles (P < 0.001). DynaCord displayed the best loop security except when paired with the Duncan loop. Overall, BroadBand and SutureTape had lower knot volumes compared to all other sutures.
This study exhibits the ability of narrow tape sutures to provide reliable tissue apposition and fixation in multiple suture-knot configurations, while decreasing the potential adverse effects accompanying knot prominence. Generally, BroadBand and SutureTape demonstrated an ideal balance of mechanical characteristics to achieve the optimal suture-knot construct among those tested. Dynacord displayed superior loop security and performed best among round sutures. PermaTape and FiberTape showed greater loop integrity, albeit to the detriment of loop security and knot volume.
When securing a rotator cuff repair construct with a knot, one should have a basic understanding of the mechanical properties of the suture and knot being used to provide the best possible repair. This study will provide information about the mechanical characteristics of commonly used high-strength tape suture knots and loops to help determine what knot type may provide the best overall construct.
Arthroscopic Bankart Repair With Inferior to Superior Capsular Shift in Lateral Decubitus Position
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Citation Excerpt :
Using the curvature of the suture passer to estimate where to grab (Fig 6), the 6-o'clock labrum and capsular tissue (inferior to the anchor) are secured while the tissue is under upward tension from the original traction suture (Fig 7). This labrum and capsular tissue are then secured to the 5-o'clock position on the glenoid using knot pusher and a Seoul Medical Center knot,17 followed by alternating half hitches. A second suture anchor is then secured at the 3-o'clock position on the glenoid.
Traditional Bankart repairs for anterior labral tears of the shoulder use suture anchors to repair the anterior shoulder labrum and capsule to the glenoid. The technique described here involves releasing the anterior capsule of the glenoid and shifting it superiorly along with the labrum before anchoring. The intention of this extra step is to replicate the open technique, where the entire capsule is shifted superiorly on the glenoid.

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^*: Address correspondence and reprint requests to Seung-Ho Kim, M.D., Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. E-mail: [email protected]

^**: 0749-8063/00/1605-2308$3.00/0

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Technical NotesThe SMC knot—a new slip knot with locking mechanism*,**

Abstract

Section snippets

Technique

Discussion

Surg Clin North Am

Arthroscopy

Arthroscopy

Arthroscopy

Technical Notes
The SMC knot—a new slip knot with locking mechanism*,**