In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large-gauge suture

Abstract

<p><strong>Objective</strong> To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots.</p> <p><strong>Study design</strong> In vitro mechanical study.</p> <p><strong>Study population</strong> Knotted suture.</p> <p><strong>Methods</strong> Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P < .05 considered significant.</p> <p><strong>Results</strong> In all suture types and number of throws, FE knot KHC/RKS was 28% to 66.99% (1.2‐1.6 fold) stronger compared with SQ/SU knots (P < .001). For 2 USP polydioxanone, FE knots had 10% (1.1 fold) higher KHC/RKS compared with AB knots (P < .042). However, in 2 and 3 USP polyglactin 910, FE knot KHC/RKS values were not different from those of AB knots (P > .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2‐1.4 fold) smaller compared with SQ/SU knots (P < .028). Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4‐2.0 fold) larger compared with AB knots (P < .001).</p> <p><strong>Conclusion</strong> Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots.</p> <p><strong>Clinical relevance</strong> Forwarder end knots should be considered for closures when suture is placed under tension.</p>