All Monofilament Knots Assume Sliding Conformation In Vivo

Abstract

BACKGROUND: Surgeons are not always cognizant of the knots they tie. It has been thought that suture material does not determine what types of knots are tied. DESIGN: Experienced surgeons were asked to tie square monofilament knots that were salvaged and microscopically evaluated. RESULTS: Tightly cinched monofilament knots assume sliding conformation in vivo regardless of configuration, instrumentation, suture polymer, or surgeon. CONCLUSIONS: When monofilament suture is securely cinched in vivo, kinetic energy forces even a flat throw into sliding conformation. A well-crafted, intentionally sliding square knot appears compacter than any other monofilament knot.