Half hitch knot surgery. A square knot is satisfactory, but because of its configuration it is difficult to tie, and in actual practice it is seldom used. Subsequent sections give precise instructions on the tying techniques for the various open and arthroscopic knots, including the square knot, the surgeon’s knot, half hitches, and sliding and non-sliding knots. A half-hitch is formed when the suture material is looped and one end is completely twisted around the other end. The purple working strand is initially held in the right hand. Jun 15, 2025 路 The half hitch is the simplest kind of hitch. Constructing a durable arthroscopic knot is critical for secure tissue fixation. Suture material was braided polyblend non-bioresorbable polyester. Most surgeons tie half-hitch knots, of which some configurations are prone to slippage. This review focuses on articles that have quantitated through laboratory experimentation the ability of knots to remain secure under tensional load. Knot security of half-knot and half-hitch sequences also varies with rotation [4, 8, 9, 10]. How to tie a half hitch knot instructions, step by step procedure, picture, diagram, definition, guide, steps. It is easier to untie. They do not risk destabilisation, and loop security improves approximation of tissues under traction, permitting tight knots. Basic Knots The knots demonstrated on the following pages are those most frequently used, and are applicable to all types of operative procedures. However, it too must be tied in proper configuration to The forces that caused knot combinations to open before breaking of the suture were used to calculate the risk of opening with low forces. Techniques: There are many variations of the Surgical Slip Tie Knot. Whippings, seizings, and lashings serve a similar One-pass friction knots are the surgeon’s knot (not recommended for ligation) and the double reverse half hitch knot. Uses: The Surgical Slip Tie Knot provides a method of pushing half hitches down into a wound. The forces needed to transform an H3 into an S3 are higher than those for an H2 (p <. The left Half-hitch sequences are clinically superior to half-knot sequences. Double reverse half hitch (DRHH) Miller’s knot Strangle knot: A new (to the surgery realm), highly effective, and easy-to-tie binding knot. Worse, common techniques may create an unreliable stack of Half Hitches instead of the intended Square (Reef) knot. This permits the recommendation to use preferentially H3H2 knots or 5 half hitches (SSSbSbSb). Round turn and two half hitches – The double half hitch is a part of this simple knot. How To Tie Two-Half Hitches Follow these steps to tie two half hitches: Step 1: Wrap the rope’s working end around support, like a pole or a post. 001). To assess the clinical outcomes of arthroscopic sliding knot (SK)– Constructing a durable arthroscopic knot is critical for secure tissue fixation. These knot characteristics allow the surgeon to stepwise improve their reduction before committing and locking a construct, preventing hanging knots or under-tensioned repairs. Adding a second asymmetric blocking half-hitch (Sab) increases security further to 105+3 N. A common pitfall in arthroscopic knot tying occurs after the sliding knot (knot A) has been placed and secured by past pointing, 2 when the surgeon is placing the alternating half-hitch knot (knot B, knot C, knot D, and so on). The effect of various arthroscopic base knot configurations paired with various overhand/underhand stacking combinations of three reversing half-hitches on alternating How to Tie a Double Half Hitch - Veterinary Suture Skills Obi Veterinary Education 2. This is not entirely trustworthy; it is too easy Feb 1, 2025 路 Insecure surgical knots can cause surgical complications ranging from wound dehiscence to massive exsanguination and death. Separately, there has been research regarding The rolling hitch (repeating half-hitches, aka clove hitch plus additional half-hitches) is a burly fucking knot if you do it right. . We aim to characterize the securities of different half-hitch knot configurations. The loop and knot security of symmetrical and asymmetrical sliding and blocking Apr 30, 2025 路 Background: Most surgeons tie half-hitch knots, but many are unfamiliar with the principles underlying their security leading to insecure knots. Special thank you to Armando Romeo 馃檹 and his amazing colleagues with their JMIG article publication “What is the Best Surgeons’s Knot? Evaluation of the Sec - references: - Over-pointing technique: an approach to past-pointing arthroscopic knots on alternating suture posts without alternating the knot pusher. Typical sliding knots consist of a series of half-hitches around a nearly straight filament segment under tension. 1, 3, 4 Reinforcing the knot with added reverse half-hitches with alternating posts (RHAPs) showed optimal Feb 27, 2023 路 In this chapter, the topology of recently used knots is described regarding conventional and laparoscopic surgery. Half-hitches are made by pulling one end of the suture, called the passive end. Blog entryThere are a variety of knots that can be used to tie off the end of a string. The surgical literature was reviewed for studies comparing the securities of single strand to single strand half-hitch knots of different configurations. Dec 1, 2021 路 The strength and integrity of complex surgical knots are variable between surgeons. , 2016). The Half Hitch is one of 23 essential rope knots included on the waterproof Pro-Knot Outdoor Knot Cards - click to see. In most cases, 3 to 4 snug additional square throws will secure the ligature knot. Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same Three trials for each half-hitch and 3 half-hitches for each arthroscopic knot with 12 knots of each material were tied. A sequence of an H2 or a 3-throw half knot (H3) followed by a H2, either symmetric or The half-hitch is the first basic throw of the surgeon in creating a square, hybrid or granny knot. Half-knots (H) require that both ends are pulled Stacked half-hitch knots locked with 3 RHAPs are unlikely to fail by slippage. We aimed to compare medical students’ knot-tying proficiency, knot-tying self-confidence and final knot characteristics for RHAP and square knots in a simulated deep body cavity Arthroscopy Techniques, 2016 We describe a sliding knot that is ideally lockable by transforming the original simple figure-of-8 configuration into a true interlocking, low-profile knot with an a-a configuration that creates strong primary knot security when tying is finished. Square knots are the gold standard in hand-tie wound closure, but are difficult to reproduce in deep cavities, inadvertently resulting in slipknots. Jan 6, 2014 路 The racking hitch knot in contrast to half hitches allows sequential tightening, even under tension, with minimal risk of knot slippage or premature locking. Special care must be taken to ensure that Dec 1, 2018 路 Background: Proficiency-based knot-tying curricula have been developed for square knots for medical students, but, to our knowledge, no such curriculum exists for the reverse half hitch alternating-post (RHAP) knot. Half-hitch sequences with opposite rotation remain in one plane, with both ends on one side squeezing the passive end symmetrically and firmly. If he or she is not careful, unnecessary tension on the post limb will easily result in loosening of the primary sliding knot (knot A). When presented with evidence regarding tying technique and knot security, we note a proclivity among surgeons Abstract Background Proficiency-based knot-tying curricula have been developed for square knots for medical students, but, to our knowledge, no such curriculum exists for the reverse half hitch alternating-post (RHAP) knot. During surgery, once the fi rst friction knot/throw is applied and tightened fi rmly, it should be considered only temporarily stable; additional square throws are applied on top of it to make it permanently secure. Here, a bight of the rope is passed through the second half hitch instead of the free end. A secure arthroscopic knot requires placing a series of reversed half-hitches on alternating posts and has traditionally involved alternating the knot-passing device between suture limbs to “past-point Sep 24, 2023 路 Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). To investigate the rotation of half-hitch (S) sequences on knot security. Of course when it's parachute cord and you're teaching, the knots are perfectly square, beautiful and unyielding but the minute the gloves are on and it's monofilament them shits are 100% pure unadulterated half-hitches. Feb 11, 2014 路 The racking hitch knot in contrast to half hitches allows sequential tightening, even under tension, with minimal risk of knot slippage or premature locking. Apr 1, 2016 路 During arthroscopic surgery, the surgeon is commonly required to tie an arthroscopic knot that needs to slide through the arthroscopic cannula using a knot pusher, followed by a series of half-hitches on alternating posts to yield a secure knot capable of secure tissue fixation. 91K subscribers Subscribed Jun 7, 2023 路 Surgeons tie sliding knots daily, consciously, or unwittingly (12); all intended flat knots tied in monofilaments capsize into a sliding conformation (13). According to the Ashley Book of Knots, the two-half-hitch knot was invented in 1794 by a man named Steel. Biomechanical data supporting its use as well as the number of half hitches required to ensure knot security is lacking. Since the knot pusher must be removed to allow passing of further locking hitches, during this stage the slipknot or hitch tend to loosen slightly before final locking. While the proposed Modified Nice Knot has a theoretical advantage because the half hitches reinforce the primary knot, in load to failure testing both the Modified Nice Knot and the Nice Knot failed where the suture passed through the loop in the primary knot. It has been shown that at least 3 reversing half-hitches on alternating posts (RHAPs), after the placement of most Nov 27, 2017 路 The half hitch knot is one of the easiest and most versatile knots out there. Two ends of the line being knotted together. The highly dependable 2-pass friction knots commonly chosen in practice include the traditional miller’s knot and the newly introduced strangle knot. This partly explains the custom of adding multiple extra Half Knots. Reversed half-hitches on alternating posts for secondary knot security can be added, but to save surgical time, these To reduce the risk of accidentally transforming a first H into an S knot, it is recommended to start with an H3, tie with force, avoid short sutures, and use bimanual suturing. Most slip knots can slide forward or backward. 02) and half hitches (p <. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes. Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches Philippe R. Surgeons tying single-post half-hitch knots, regardless of whether they use square or granny half-hitches, should consider transitioning to alternating-post half-hitch knots, as these are significantly more secure. Apart from the above, the vertical, horizontal, diagonal Knot tying is a crucial component of successful arthroscopic shoulder surgery. When in doubt, half knot com … Arthroscopically tied stacked half-hitch knots and sliding knots are best locked with half-hitches on alternating posts. 1. Scroll to see Animated Half Hitch Knot below the illustration and tying instructions. The Nice knot is a bulky double-stranded knot. However, RHAPs construction involves looping the suture in either an “overhand” Half Hitch Knot. Am a former commercial fisherman and, as such, have used a great many of knots of the years. The first step in tying an arthro-scopic knot usually involves an initial slip knot, followed by a series of half hitches to lock the knot. However, it too must be tied in proper configuration to What Is A Half-hitch Knot In Surgery? In this informative video, we will break down the half-hitch knot and its significance in the field of surgery. Most surgeons tie half-hitch knots, but many are unfamiliar with the principles underlying their security leading to insecure knots. It can be used either in open interventions as well as arthroscopic procedures of the knee and shoulder joint. Half Hitch Knot Tying Instructions Pass the end of a rope around the object and tie an overhand knot. It is better for securing things to boats and posts having small diameters. 76K subscribers Subscribed Feb 1, 2025 路 Insecure surgical knots can cause surgical complications ranging from wound dehiscence to massive exsanguination and death. Knots are introduced and made by hand and by instruments, while further demonstrating laparoscopic and microsurgical knotting techniques. Sep 1, 2001 路 The half-hitch knot is the simplest of all the sliding knots. Constrictor: First Use in Surgery and Research A completed surgical knot is sometimes out of sight. What is known and what is new? • The relative securities of half-hitch knot configurations have been studied, but the relationship between knot The basics of knot biomechanics are explained, highlighting the risk of failure of knots and sutures if their capacities are exceeded. Key Words: Knot tying—Half hitch— Arthroscopy—Knot holding capacity. By the way, the learning curve is a long process that requires effort and practice. Used to tie rope around an object and back to itself. Nov 1, 1987 路 The half-hitch knot, an alternative to the square knot for tying a suture, has been presented. Even if you perform the correct hand movements but apply uneven tension, an insecure knot will be created. Jan 9, 2024 路 A two-half hitch knot capsizes into a granny knot, one of the most insecure knots you can use. Koninckx 1,2,3,4,* , Anastasia Ussia 5, Arnaud Wattiez 4,6, William Kondo 7 and Armando Romeo 8 Dec 1, 2018 路 Methods This in vitro biomechanical study repeatedly tested 12 different knots with a static distraction material testing machine with a constant tensile speed. In practice the knot is often pushed down using a finger. Aug 20, 2015 路 During arthroscopic surgery, the surgeon is commonly required to tie an arthroscopic knot that needs to slide through the arthroscopic cannula using a knot pusher, followed by a series of half-hitches on alternating posts to yield a secure knot capable of secure tissue fixation. The half-hitch knot is longer and more slender than the square knot, but the length of suture incor- porated in knots of both types with the same num- ber of throws is the same. Conclusions: Stacked half-hitch knots locked with 3 RHAPs are unlikely to fail by slippage. Apr 1, 2005 路 How many additional half-hitch knots are really needed to sufficiently secure arthroscopic sliding knots? Whether they are lockable or nonlockable knots such as the SMC knot 1 or Duncan loop, 2 it is routine procedure to secure the original sliding knot with 3 alternating half-hitches. It is a knot whose working end wraps around an object and back under its standing part. Reply reply More repliesMore Arthroscopic repair procedures rely on secure knot tying techniques. Opposite rotation results in (more secure) symmetric (s) knots, … Jun 15, 2025 路 In this illustrated guide, we show you how to tie a Surgeon's Knot. It is possible to switch posts without rethreading the suture through the knot tier by flipping the half-hitch. With arthroscopic techniques being used, the importance of knot tying has been examined. These knot characteristics allow the Insecure surgical knots can cause surgical complications ranging from wound dehiscence to massive exsanguination and death. Whichever knot is used, it must secure the tension without Double reverse half hitch (DRHH) Miller’s knot Strangle knot: A new (to the surgery realm), highly effective, and easy-to-tie binding knot. In the case where suture does not slide through the tissue and the suture anchor, it is still possible to Highlight box Key findings • The security of a knot tied exclusively with single post half-hitch throws is coupled with the tautness of its associated loop, but the use of alternating half-hitch throws confers security independent of loop tautness. The double half hitch knot is perhaps the most common and is the simplest knot to learn. For clarity, one-half of the strand is purple and the other white. The animation shows two alternating half hitches being slid down one at a time and then inverted to tie a Square (Reef) Knot. The effect of various arthroscopic base knot configurations paired with various overhand/underhand stacking combinations of three reversing half-hitches on alternating posts The racking hitch knot in contrast to half hitches allows sequential tightening, even under tension, with minimal risk of knot slippage or premature locking. Instead, a series of half hitches is tied. Half-knots are easily converted into half-hitches and vice-versa. Nice knots with, one, two, or three half-hitches were compared with the surgeon's and Variations Slipped double half hitch – Easier to untie. Applications: Ideal for most suturing scenarios where standard tension is required. Previous literature has examined the use of reversing half-hitches on alternating posts (RHAPs) on knot security. It has been shown that at least 3 reversing half-hitches on alternating posts (RHAPs), after the placement of most Nov 26, 2024 路 We aim to characterize the securities of different half-hitch knot con gurations. Feb 18, 2025 路 The Slippery Half Hitch Knot (ABoK #394) is a slipped variation of the classic Half Hitch Knot that can be untied by just pulling the withdraw loop. All respective tension loads were collected through the digital video recordings (knot closeup view and load cell reading). The cow hitch, its altered version, and conventional half hitches were also tested on bovine tendon. 46K subscribers 19 Jul 28, 2020 路 Reverse Flipping Technique - Method for Locking Surgical Knots - Arthroscopic Knot Tying UKyOrtho 6. This occasional opening at low forces persisted after 1 or 2 additional H1s knots. A variety of ingenious knots have been described using these techniques, and the specific knot configuration is generally locked in place by a series of half hitches. Knots p Dec 13, 2023 路 Knot security of half-knot (H) sequences varies with rotation, but half-knots risk destabilisation. 001), and the risk increases when the surgeon is inexperienced (p This is a slip knot or half-hitch, and should be avoided as it is not secure. Morphological and technical similarities and differences of the most common knots are discussed, while also considering their transformability. The half-hitch knot, an alternative to the square knot for tying a suture, has been presented. It has been shown that at least 3 reversing half-hitches on alternating posts (RHAPs), after the placement of most uring repair of proximal humeral fractures often rely on alternating half hitches or surgeon's knots regardless of the suture configuration used passing through the tissue (eg, Mason-Allen, Krackow). Oct 14, 2012 路 Ok, I am exposing my utter lack of knowledge in surgery…but here it goes: First, my understanding of these knots is: · Square-knot: Alternating throws laid flat · Slip-knot: Two consecutive throws slipped down, followed by a third opposite direction throw laid flat My questions: In Apr 25, 2016 路 During arthroscopic surgery, the surgeon is commonly required to tie an arthroscopic knot that needs to slide through the arthroscopic cannula using a knot pusher, followed by a series of half-hitches on alternating posts to yield a secure knot capable of secure tissue fixation. The half-hitch is the first basic throw of the surgeon in creating a square, hybrid or granny knot. The racking hitch knot in contrast to half hitches allows sequential tightening, even under tension, with minimal risk of knot slippage or premature locking. In surgery, knot security varies with the type of suture and the knot characteristics but not with suture size (Silver et al. A half-hitch knot is as secure a … A half-hitch knot can be the result of uneven tension applied to the two suture ends while tightening the knot (either granny or square), when the suture is pulled upward while tightening (a frequent mistake) or when the second simple throw is placed in the same direction as the first (without crossing over to create a square knot). This will then lead to failure Sep 5, 2022 路 Surgical knot - squares knot, half hitch, granny knot Jae-Hoon Lee 75 subscribers Subscribed Purpose Evidence is lacking on the effect of different combinations of three stacked half-hitches and suture materials on the loop/ knot security of an arthroscopic knot under cyclic loading conditions. A save and secure knot contributes significantly to an optimal adaptation of soft-tissue and, despite the rapid development of surgical methods, is an essential prerequisite Description: A basic and commonly used knot in surgery, consisting of two opposite half-knots. (A) Changing the overhand knot (top) into a half-hitch (bottom) by putting tension on one end is the simplest example of capsizing a knot. The specific aim of this study was to identify variables, such as stacked half-hitch configurations, suture materials, and testing environments, that affect knot strength and loop security Rotation is alternate when the rotation of the same active end is the opposite compared to the previous one. Nov 25, 2019 路 Previous literature demonstrated the importance of stacking at least three reversing half-hitches on alternating posts (RHAPs) following arthroscopic knot placement. The reversing half-hitch alternating post (RHAP) knot has been suggested as an alternative owing to With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In surgery, most knots (for an overview (Chisnall, 2020)) are sequences of half-hitches (S) or half-knots (H) (Table I). The initial slip knot determines the adequacy of soft tissue approximation and consequent healing. The half-hitch is the simplest of all the sliding knots, consisting of a single turn around the post limb. This is also referred to as a simple knot. Apart from the above, the vertical, horizontal, diagonal A common pitfall in arthroscopic knot tying occurs after the sliding knot (knot A) has been placed and secured by past pointing,2when the surgeon is placing the alternating half-hitch knot (knot B, knot C, knot D, and so on). A half-hitch knot is as secure as a square knot and much easier to tie. Insecure surgical knots can cause surgical complications ranging from wound dehiscence to massive exsanguination and death. The only problem is that you can't tie a line/rope/string to itself with the rolling hitch unless all you want is a high friction slipknot. This article describes extra- and intra-articular techniques for fl … Jul 11, 2023 路 Arthroscopic knot tying is a bit harder than hand-tied ones because of tying the half hitches at a distance, in a wet field, and tightening the knot at the level of the target tissue with the help of an instrument. As arthroscopic reconstructive surgery evolves, new techniques that improve operative efficiency while maintaining proven technical principles will enhance a surgeon’s skill repertoire. Half-hitches form when uneven tension is applied to the ends of a knot. It is formed by wrapping the suture limb once around the post limb of the suture (1 turn) with the wrapping limb emerging between the post limb and the wrapping limb distal to the turn. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization. The loop of a compound sliding knot, such as the modi铿乪d Duncan loop,1is tightened by advanc- ing the knot along the post limb of the suture. Sep 24, 2023 路 Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Study with Quizlet and memorize flashcards containing terms like How many throws equal one knot?, In surgery you generally tie how many knots?, How is a knot named? and more. However, it too must be tied in proper configuration to Mar 24, 2023 路 The knots that are in everyday use in surgery are derived from traditional practice rather than experimental analysis of the physical factors that determine knot security. The Parnell knot and PC knot are also common alternatives, while some experienced stringers may even use a ‘signature’ knot of their own to mark their work. Methods: A literature search was conducted using PubMed and Embase for studies in which Mar 10, 2019 路 Suturing Tubes In Place (Half-Hitch Technique) Stepwards 5. 5% of tests and at <10 N in 5% of tests. Follow these step-by-step instructions for creating double reverse half hitch, miller’s, and strangle knots. The camera was placed behind the demonstrator so that each step of the knot is shown as seen by the operator. The knot security of 2 sliding and 1 blocking half-hitch doubles from 52+3 to 98+2 N for the worst (asymmetric sliding and symmetric blocking, SSaSsb) or best rotation sequences (SSsSab). Half-knots (H) require symmetrical pulling of both ends. The Constrictor eliminates this risk. We also compare it with other fishing knots that can be used as alternatives. Variations Slipped double half hitch – Easier to untie. We aimed to compare medical students’ knot-tying proficiency, knot-tying self-confidence and final knot characteristics for RHAP and square knots in a simulated deep body The half-hitch knot, an alternative to the square knot for tying a suture, has been presented. (B) Flipping a half-hitch from one end of the suture (top) to the other end (bottom). Two reviewers screened fi and selected articles. The loop of the knot can be tightened just as in the compound sliding knot by advancing the knot along the post limb and the slack in the loop taken up by pulling on the post limb. Primary outcome was knot security (stiffness) at clinical failure Reverse slippage (loop security) - knot loosening after placement of the slipknot or first throw half-hitch. Compare it to the square knot (at the top). Knots were used since the ancient medicine and are a fundamental part of orthopedic surgery. Think of the Half Hitch as a starter knot—it won't support a lot of strain, but it's easily tightened and loosened and forms the base for many more complicated knots. Knots Are Sequences of Half-Knots and Half-Hitches In surgery, most knots (for an overview [1]) are sequences of half-hitches (S) or half-knots (H) (Figure 1) Half-hitches result from pulling one end of the suture, called the passive end. For a knot of any kind to be performed, placement of two half-hitches is required. When presented with evidence regarding tying technique and knot security, we note a proclivity among surgeons towards resistance to change with rationalizations such as concerns regarding tissue Measurements and Main Results: Surprisingly, the combination of a 2-throw half knot (H2) and a symmetric 1-throw half knot (H1s) (a surgical flat knot) opened at <1 Newton (N) in 2. Tying more strongly increased the security of half knots (H2H1sH1s) (p <. - Optimizing arthroscopic knots using braided or monofilament suture - Optimization of stacked half-hitch knots for arthroscopic surgery - Cyclic testing of arthroscopic knot security Figure 1. fi Methods: A literature search was conducted using PubMed and Embase for studies in which comparisons of knot security were made between different half-hitch knot con gurations. Background: Insecure surgical knots can cause surgical complications ranging from wound dehiscence to massive exsanguination and death. In this animation the second Half Hitch shows how it is customarily tied - wrapping it round the standing end and tucking it under itself. osvwu vrrvou ziayg qvbjgh mpnnn udjkh xkcjxap qzqnu hsptmkk udv