TY - JOUR
T1 - Reverse Flipping Technique
T2 - An Alternate Approach to Tie Reversing Half-Hitches on Alternating Posts
AU - Chong, Alexander C.M.
AU - Prohaska, Daniel J.
AU - Pate, Ryan C.
N1 - Publisher Copyright:
© 2016 Arthroscopy Association of North America.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Arthroscopic knot tying requires practice and attention to detail, especially tying the 3 reversing half-hitches on alternating posts (RHAPs) in a knot. Mistakes can occur that result in an unintentional tension (>10 N) applied to the wrapping suture limb, and by placing tension in the wrong limb, the previously "flipped" half-hitch is converted from a series of RHAPs into a series of identical half-hitches on the same post, thereby producing insecure knots or suture loops. This was hypothesized to be a source of knot failure by knot slippage. This error can be avoided by using a technique we describe as "reverse flipping," which purposely "flips" the half-hitch down at the main knot while tying the 3 RHAPs in a knot, and then the half-hitch is retightened using either a past-pointing or over-pointing technique. This way the surgeon can be absolutely sure that the half-hitch is tightened in the direction that it was intended to be placed, and can also prevent the unintentional tension applied to the wrapping suture limb that causes the half-hitch to "flip." However, caution should be used when tensioning the half-hitches; overtensioning (>40 N) during past-pointing or over-pointing could also potentially "flip" the previous half-hitch that has already been tightened and cause potential knot failure.
AB - Arthroscopic knot tying requires practice and attention to detail, especially tying the 3 reversing half-hitches on alternating posts (RHAPs) in a knot. Mistakes can occur that result in an unintentional tension (>10 N) applied to the wrapping suture limb, and by placing tension in the wrong limb, the previously "flipped" half-hitch is converted from a series of RHAPs into a series of identical half-hitches on the same post, thereby producing insecure knots or suture loops. This was hypothesized to be a source of knot failure by knot slippage. This error can be avoided by using a technique we describe as "reverse flipping," which purposely "flips" the half-hitch down at the main knot while tying the 3 RHAPs in a knot, and then the half-hitch is retightened using either a past-pointing or over-pointing technique. This way the surgeon can be absolutely sure that the half-hitch is tightened in the direction that it was intended to be placed, and can also prevent the unintentional tension applied to the wrapping suture limb that causes the half-hitch to "flip." However, caution should be used when tensioning the half-hitches; overtensioning (>40 N) during past-pointing or over-pointing could also potentially "flip" the previous half-hitch that has already been tightened and cause potential knot failure.
UR - http://www.scopus.com/inward/record.url?scp=84964211430&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84964211430&partnerID=8YFLogxK
U2 - 10.1016/j.eats.2016.01.012
DO - 10.1016/j.eats.2016.01.012
M3 - Article
C2 - 27462541
AN - SCOPUS:84964211430
VL - 5
SP - e403-e405
JO - Arthroscopy Techniques
JF - Arthroscopy Techniques
SN - 2212-6287
IS - 2
ER -