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Shannon W Hill1, Christopher R Chapman2, Samer Adeeb3, Kajsa Duke1, Lauren Beaupre2, Martin J Bouliane2
1 Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
3 Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada
Correspondence Address:
Samer Adeeb
Department of Civil and Environmental Engineering, University of Alberta, 3-025 NREF, Edmonton, Alberta T6G 2W2
Canada
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0973-6042.174513
Background: The Nice knot is a bulky double-stranded knot. Biomechanical data supporting its use as well as the number of half hitches required to ensure knot security is lacking.
Materials and Methods: Nice knots with, one, two, or three half-hitches were compared with the surgeon's and Tennessee slider knots with three half hitches. Each knot was tied 10 times around a fixed diameter using four different sutures: FiberWire (Arthrex, Naples, FL), Ultrabraid (Smith and Nephew, Andover, MA), Hi-Fi (ConMed Linvatec, Largo, FL) and Force Fiber (Teleflex Medical OEM, Gurnee, IL). Cyclic testing was performed for 10 min between 10N and 45N, resulting in approximately 1000 cycles. Displacement from an initial 10N load was recorded. Knots surviving cyclic testing were subjected to a load to failure test at a rate of 60 mm/min. Load at clinical failure: 3 mm slippage or opening of the suture loop was recorded. Bulk, mode of ultimate failure, opening of the loop past clinical failure, was also recorded.
Results: During cyclic testing, the Nice knots with one or more half-hitches performed the best, slipping significantly less than the surgeon's and Tennessee Slider (P < 0.002). After one half-hitch, the addition of half-hitches did not significantly improve Nice knot performance during cyclic testing (P > 0.06). The addition of half-hitches improved the strength of the Nice knot during the force to failure test, however after two half-hitches, increase of strength was not significant (P = 0.59). While FiberWire was the most bulky of the sutures tested, it also performed the best, slipping the least.
Conclusion: The Nice knot, especially using FiberWire, is biomechanically superior to the surgeon's and Tennessee slider knots. Two half hitches are recommended to ensure adequate knot security.
The level of Evidence: 2, prospective comparative study.
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