• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.127-130
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• 2005

We describe a secure and easy-to-tie knot with a lag bight, the SP knot. An optimal sliding knot is required to be a low-profile, easy to throw, slide well, and provide a good initial security. The SP knot easily slides and sets while avoiding premature locking during sliding. While maintaining tension on the post limb with a knot pusher, pulling the loop limb makes it to flip and distort post limb, resulting in creation of a snug knot on the exact location with desired tension. The SP knot has one knot configuration before pulling the loop limb, but it converts to two knots after pulling the loop limb, one half-hitch and one 'clove hitch', which could provide enough loop security before any additional half-hitches. The configuration of the completed SP knot is formed lying along the loop of the knot, rather than stacking up, which enables a very low profile. The SP knot has various characteristics of the optimal arthroscopic slip knot and may be a useful tool for successful arthroscopic surgery.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.117-121
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• 2005

A secure slip knot is very important in the arthroscopic surgery of the shoulder joint. The new 'Hallym Slider', developed by the first author(KCN), has the properties of being a simple sliding and one-way locking knot. This technique can be performed alone without an assistant and has no accidental premature locking during the knot tying. The initial slip knot determines the adequacy of tissue approximation and consequent healing. The 'Hallym Slider' has excellent initial holding capacity, maintaining tension on soft tissue while additional half-hitches are being tied. It locks readily, it takes less time to tie than numerous square knots, and it is not as bulky as other knots. Therefore, we introduce this new sliding and one-way locking knot during the arthroscpic surgery of shoulder.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.2
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• pp.70-75
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• 2013

We experienced three cases with chronic shoulder pain due to a knot impingement after arthroscopic rotator cuff tear repair and treated with arthroscopic revision surgery. Ultrasonography is commonly used for an imaging scan and an useful diagnostic tool to follow up after rotator cuff repair recently. We also could diagnose three cases with the knot impingement using ultrasonography obviously. And we report these cases with a review of current literature.

• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.68-76
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• 2017

Background: In general, the outcomes of arthroscopic repair for superior labrum anterior to posterior lesions (SLAP) are favorable, however, persistent pain and limitation of motion are not rare complications. One of the possible cause is a "knot-ache". This study evaluated the results of reoperation of symptomatic recurrent SLAP lesions and asked whether the knot is associated with postoperative complications. Methods: Between 2005 and 2015, a total of 11 patients who had undergone arthroscopic SLAP repair were reoperated for recurrent symptomatic SLAP lesion. By retrospective chart review, operative findings, the visual analogue scale for pain (pVAS), the range of motion (ROM), and functional scores were analyzed. Results: The mean age of the study participants was 38.3 years, and the mean follow-up period was 42.5 months. In the primary operation, there were nine cases of repairs with conventional knot-tying anchors and three cases with knotless anchors. Impingement of the knots during abduction and external rotation of the shoulder was observed in the all cases with knot-tying anchors. The mean pVAS, ROM, and functional scores significantly improved with reoperation. At the final follow-up, the mean satisfaction VAS was 8.3. Conclusions: The knots of suture anchor maybe a possible etiology of the pain, which we termed a "knot-ache". Considering that reoperation is performed due to pain after primary repair, the use of knotless suture anchor may have benefits of eliminating one of possible cause, "knot-ache". Therefore, authors suggest the use of knotless anchors during reoperation for recurrent or recalcitrant pain after primary SLAP repair.

• Journal of Biomedical Engineering Research
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• v.41 no.4
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• pp.154-164
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• 2020

Various simulator systems for surgery training have been developed and recently become more widely utilized with technology advancement and change in medical education adopting actively simulation-based training. The authors have developed tissue-instrument interaction modeling and graphical simulation algorithms for an arthroscopic surgery training simulator system. In this paper, we propose algorithms for basic surgical techniques, such as cutting, shaving, drilling, grasping, suturing and knot tying for rotator cuff surgery. The proposed method constructs a virtual 3-dimensional model from actual patient data and implements a real-time deformation of the surgical object model through interaction between ten types of arthroscopic surgical tools and a surgical object model. The implementation is based on the Simulation Open Framework Architecture (SOFA, Inria Foundation, France) and custom algorithms were implemented as pulg-in codes. Qualitative review of the developed results by physicians showed both feasibility and limitations of the system for actual use in surgery training.

• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.280-284
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• 2009

Purpose: The authors introduce a new technique of arthroscopic reduction of subluxed medial meniscus using suture anchor for the restoration of hoop stress. Operative Technique: Anterolateral, anteromedial, and medial midpatellar arthroscopic portal are used. Arthroscope was inserted through anterolateral portal. Through the scope, we confirmed subluxation of medial meniscus. Transection of menisci including radial and root tear were excluded. We released the anterior horn of medial meniscus through anteromedial and burred the future insertion site of suture anchor. After inserting suture anchor through medial midpatellar portal, we used 90 degree suture hook and no.2 Nylon to retrieve the suture of inserted anchor. We tied the suture by sliding knot-tying method. Weight bearing was limited for 6 weeks postoperatively. Conclusion: Arthroscopic retightening of medial meniscus is less invasive, conserving and progressed method for subluxed meniscus.

• Journal of the Korean Arthroscopy Society
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• v.8 no.1
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• pp.37-44
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• 2004

Purpose: To evaluate the optimal number of additional half hitches for achieving an optimal knot-holding capacity (KHC) of Lockable sliding knots. Methods: Four configurations of arthroscopic knots (Duncan loop, Field knot, Giant knot, and SMC knot) were tested for their knot-holding capacity. For each knot configuration, 6 sequential knots were made including the initial sliding knot and additional 5 knots by incrementing one half hitches at a time. Each added half-hitch were in reversing half-hitches with alternate posts (RHAPs) fashion. For each sequential knot configuration, 12 knots were made by No. 2 braided sutures. On the servo-hydraulic material testing system (Instron 8511, MTS, Minneapolis, MN), cyclic loading, load to clinical failure (3-mm displacement), load to ultimate failure, and mode of failure were measured. Results: Most of the initial loop without additional half-hitch showed dynamic failure with cyclic loading. The mean displacement after the end of cyclic loading decreased with each additional half-hitches. SMC and Giant knot reached plateau to 0.1 mm or less displacement after one additional half-hitch, shereas Field and Duncan loop needed 3 additional half-hitches. The SMC and Duncan knots needed 1 additional half-hitch to reach greater than 80N at clinical failure, whefeas the other 2 knots needed2 additional half-hitches. For the load exceeding 100N for clinical failure, the SMC knot required 3 additional half-hitches and the other three knots needed 4 additional half-hitches. As the number of additional half-hitches incremented, the mode of failure switched from pure loop failure (slippage) to material failure (breakage). Duncan loop showed poor loop security in that even with 5 additional half-hitches, some failed by slippage (17%). On the other hand, after 3 additional half-hitches, the 3 other knots showed greater than 75% of failure by material breakage mode (SMC and Field 92%, Giant 75%). Conclusion: Even with its own locking mechanism, lockable sliding knot alone does not withstand the initial dynamic cyclic load. For all tested variables, SMC knot requires a minimum of 2 additional half-hitches. Duncan knot may need more than 3 additional half-hitches for optimal security. All knots showed a mear plateau in knot security with 3 or more additional half-hitches.

• Journal of the Korean Arthroscopy Society
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• v.17 no.1
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• pp.50-55
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• 2013

Purpose: The purpose of this study was to compare the clinical results of absorbable knot-tying and absorbable knotless suture anchors in arthroscopic Bankart repair. Materials and Methods: This study compared the patients who underwent arthroscopic Bankart repairs using absorbable knottying suture anchors (59 patients: KT Group), and absorbable knotless suture anchors (52 patients: KL Group). Preoperative and postoperative evaluations were performed by Rowe scores, patient satisfaction score, visual analogue scale (VAS), American shoulder and elbow surgeons (ASES) score, range of motion (ROM), and re-dislocation rate. Results: Postoperative VAS, Rowe scores, ASES score were significantly not different between the 2 groups (VAS: p=0.250, Rowe score: p=0.412, ASES: p=0.052). Mean postoperative VAS was 0.5 in KT Group and 0.8 in KL Group (p=0.250), and limited ROM was noted only in one patient in KL Group. Mean Rowe score was 94.3 in KT Group and 96.3 in KL Group (p=0.412), and mean ASES score was 97.3 in KT Group and 94.0 in KL Group (p=0.052). Re-dislocation rate were no different between the 2 groups. Conclusion: There were no differences in clinical outcomes and re-dislocation rate between Knot-Tying and Knotless repairs.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.172-179
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• 2008

Purpose: To evaluate the functional and structural results of arthroscopic double-row repair using combined knot-tying and knotless suture anchors in rotator cuff tears. Materials and Methods: From March 2006 to June 2007, twenty-one patients (15 males, 6 females; mean age 55.6 years; range 48 to 67) were included who underwent arthroscopic double-row repair for full-thickness tears of the rotator cuff following conservative treatment for a mean of 6.5 months (range 3 to 11). The tear size was carefully inspected arthroscopically and we found 2 small, 13 medium and 6 large-sized rotator cuff tears, with a mean tear size of 2.5cm(range 1.8 to 3.2). The repair constructs were consisted of horizontal mattress sutures using conventional knot-tying suture anchors medially and simple suture at the same level of medial row stitch with Bioknotless RC anchors (DePuy Mitek, Norwood, MA) as lateral row. Clinical and functional evaluations were made according to the range of motion, the ASES, UCLA scale and the isokinetic strength testing. Postoperative cuff integrity was determined through magnetic resonance imaging. The mean follow-up was 15 months (range 13 to 24). Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up (p < 0.01). Nineteen patients (90%) were satisfied with the result of the treatment. In 17 of 21 patients (81%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 7 months postoperatively. There were no significant functional differences according to the preoperative tear size (p<0.01), but large-sized tear shows less favorable structural results in 3 out of 6 cases(50%). Conclusion: Our results document the usefulness and variability of arthroscopic double-row rotator cuff repairs comparable to the results of the other types of double-row repairs.

• Clinics in Shoulder and Elbow
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• v.22 no.3
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• pp.146-148
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• 2019

We report a simple technique for repairing capsular tear, using only a hook-like, cannulated instrument and braided sutures without relaying steps. A No. 2 braided suture is passed through the lumen of the instrument. Under direct arthroscopic view, the tip of the instrument is passed through the side of the capsule that has previously been separated with the probe. One end of the suture is retrieved with a grasper through a separate portal. The tip is moved back without withdrawing through the skin, and reinserted into the other side of the capsule. Holding the end retrieved earlier, the other end of the suture is retrieved with a suture retriever. After complete removal of the instrument, the suture is tied through a cannula using the standard knot tying techniques. The same procedures are repeated for other required knots.