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The Kinematics and Kinetics of Slipknots for Arthroscopic Bankart Repair^*

Peter J. Hughes, FRCS, Richard P. Hagan, MSc, Anthony C. Fisher, PhD^,, E. Martin Holt, FRCS(Ed) and Simon P. Frostick, MA, DM, FRCS

Department of Musculoskeletal Science, Royal Liverpool University Hospital, Liverpool, United Kingdom
Department of Clinical Engineering, Royal Liverpool University Hospital, Liverpool, United Kingdom

Address correspondence and reprint requests to A. C. Fisher, PhD, Department of Clinical Engineering, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom

An apparatus has been developed to enable the in vitro measurement of the kinematics and kinetics of a slipknot, both while the knot is being tightened and with the knot in place and the tension removed. During tightening, the apparatus provides a linearly increasing resistance, which may be considered analogous to the resistance experienced when the labrum is drawn toward and apposed to the edge of the glenoid cavity during a Bankart repair. The tension to close the knot is measured with a tensiometer, in tandem with the closure of the capsule model onto the bone anchor, which is measured with a datalogger. The tightening tension was limited to 25 N and intraoperator and interoperator comparisons were made for four knots tied by six participants. Failure of a knot was taken to be reverse slippage of 2 mm. A second criterion of ease of slide was used to assess each knot. We found wide interoperator variability with regard to slipknot tying. A methodology for quality control of slipknot tying is presented.