Incorporating Evidence-Based Medicine in Arthroscopic Knot Preferences: A Survey of American Orthopaedic Society for Sports Medicine Members

An Internet-based survey was used to determine arthroscopic knot preferences. Inclusion criteria included American Orthopaedic Society for Sports Medicine (AOSSM) membership, and exclusion criteria included physician members without an e-mail address and nonphysician members.

Our hypotheses were that the majority of arthroscopic knots used in clinical practice by AOSSM members are described in the orthopedic literature and have undergone biomechanical analysis, that the majority of members reinforced sliding arthroscopic knots with 3 reversed half-hitches on alternating posts (RHAPs), and that the majority of members used a half-hitch configuration that incorporates at least 3 reversed half-hitches and 3 alternating posts.

Of the 1844 members contacted, 937 (50.8%) agreed to participate in the survey. The most common arthroscopic sliding knot used was the Duncan loop. Only 48.1% of respondents used 3 reversed half-hitches and at least 3 alternating posts when using nonsliding knots. Only 31% of respondents used 3 RHAPs to reinforce arthroscopic sliding knots.

Only a minority of respondents used the optimal configuration determined in vitro for sliding knot reinforcement and when using a nonsliding half-hitch knot configuration. An evidence-based approach is recommended for determining arthroscopic knot preference for clinical use.