title: Locking, jamming, and ratchet mechanisms of sliding surgical knots topologically revisited.
abstract: BACKGROUND
  The geometry of lockable, ratchet, or jamming sliding surgical knots was assessed to enhance practical and topological understanding of knots among surgeons.
  
  
  METHODS
  Using a database of more than 100 surgical knots, 29 knots that reportedly feature locking, ratchet, or jamming mechanisms were topologically assessed for their ability to lock antegradely or retrogradely, to lock by assuming their flat geometry, or to jam.
  
  
  RESULTS
  Eighteen of the 29 investigated surgical knots have previously been mistakenly categorized. Topologically, the concept of a true ratchet knot is a fallacy.
  
  
  CONCLUSIONS
  Surgical knots may be consistently classified on the basis of precise and detailed definition of various anti-backsliding geometrical characteristics of knots.
authors.affiliation: Section of Surgical Oncological Disciplines, National Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. J.JorisHage@inter.nl.net
authors.forename: J Joris
authors.initials: JJ
authors.lastname: Hage
authors.forename: Lydia P E
authors.initials: LP
authors.lastname: van der Steen
mesh_terms: D004868:Equipment Failure; D006801:Humans; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects*