title: Dynamic loading of surgical knots.
abstract: Lately, many suture materials have been introduced. Their physical characteristics in combination with knots are not well known. In this study, seven knots (square--1=1, 2=1, 2=1-S and 1=1=1--and sliding--SxSxS, S=S parallel S and 1-S parallel S parallel S) made in seven suture materials (plain catgut, Dexon [polyglycolic acid)] Maxon [polyglyconate], PDS [polydiaxone], Vicryl [polyglactine 910], Mersilene [polyester fiber], Prolene [polypropylene] were tested dynamically to ascertain tensile strength. The knots were classified as "predominantly breaking" (PB) and "predominantly slipping" (PS). A new method for statistical analysis, the Kaplan-Meier survival estimate, was introduced. Square knots provided good mechanical results but did not prevent slippage completely. Most sliding knots were weak. The 1=1=1 knot was superior. PS knots (1=1, 2=1, SxSxS and S=S parallel S) were unsuitable for surgical practice in monofilament or coated multifilament suture materials. The classification PB and PS knots gave an easy impression of the knot holding capacities. Application of the Kaplan-Meier estimate resulted in a more realistic analysis than classical methods.
authors.affiliation: Department of Surgical Research, Academic Hospital, University of Amsterdam, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Brouwers
authors.forename: H
authors.initials: H
authors.lastname: Oosting
authors.forename: D
authors.initials: D
authors.lastname: de Haas
authors.forename: P J
authors.initials: PJ
authors.lastname: Klopper
mesh_terms: D008422:Materials Testing; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength