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Nutr Clin Pract. Dasani B, Sahdev P. Knotting of a nasogastric tube: a case report. Am J Emerg Med. Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx. South Med J. Santhanam V, Margarson M. Removal of self-knotted nasogastric tube: technical note. Int J Oral Maxillofac Surg. A unique complication of primary tracheoesophageal puncture: knotting of the nasogastric tube. Otolaryngol Head Neck Surg.

Ozer S, Benumof JL. Oro- and nasogastric tube passage in intubated patients: fiberoptic description of where they go at the laryngeal level and how to make them enter the esophagus. Forward displacement of the larynx for nasogastric tube insertion in intubated patients. Crit Care Med. Submucosal passage of a nasogastric tube complicating attempted intubation during anesthesia. Present perfect I. Present perfect continuous I. Past perfect I. Past perfect continuous I. Future I. Future continuous I. Future perfect I. Future perfect continuous I. Conditional present I.

Conditional present progressive I. Conditional perfect I. For the knotted constructs, each surgeon was asked to tie his or her preferred knot to simulate a typical knot seen in clinical practice. For the knotted technique, a 5. A mm steel tube was then placed directly over the anchor, and the surgeon tied his or her preferred arthroscopic knot Figure 1.

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To mimic the real world, neither the type of knot nor the usage of a suture pusher was controlled. A total of knotted constructs were performed: 32 surgeons performed 3 knots; 1 surgeon, 6 knots; and 1 surgeon, 2 knots. Examples of a knotless suture tape construct left and knotted suture construct right performed in a foam block. In the knotless technique, either No. Then the suture was threaded through the eyelet of a 5.


The surgeon was instructed to remove slack in the construct prior to placement of the anchor Figure 1. Each surgeon used the same suture for 3 attempts eg, if No.

The knotless constructs were divided into 2 groups based on the suture material. Group K2 consisted of 21 cases based on No. Group KT consisted of 79 attempts with suture tape; 25 surgeons performed 3 attempts each, and 2 surgeons performed 2 attempts each. Following fixation, the steel tube was removed, and the constructs were subjected to mechanical testing.

Data were collected at Hz. Maximum load F max was defined as the ultimate failure load at which the suture or anchor failed. The mechanism of failure was noted. Load over displacement was recorded for each specimen and was used to calculate load at 3 mm termed clinical failure 4 , maximum load, and stiffness. Statistical analysis was performed with Sigma Plot Statistics for Windows v The 3 groups were compared with a Kruskal-Wallis test to analyze differences in load at 3 mm, maximum load, stiffness, and displacement.

Differences in maximum load within each group were also compared among attempts 1, 2, and 3 for each construct.

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An F test was performed to compare SDs to determine variance in load to failure among the groups. Table 1 summarizes the results for load to 3 mm of displacement, load to failure, displacement, and stiffness. The mean load to 3 mm of displacement was highest in the KT group, with significant differences among all 3 groups Figure 3. Stiffness was highest in the KT group, and there were significant differences among all 3 groups. K2, knotless No. Load at 3 mm of displacement among constructs: knotted vs knotless No.

There were significant differences among all 3 groups.

Supplementary files

Maximum load to failure among constructs: knotted vs knotless No. There were significant differences among all groups. Based on the F test, the variance in load to failure was significantly different between the knotted and knotless constructs. The findings of this study support our hypothesis. Knotless fixation with suture tape showed higher loads to failure than a knotted or knotless No. Constructs with No. Additionally, the knotless constructs demonstrated less variability among surgeons. These findings may have important implications for maximizing fixation and reducing variability of suture constructs in rotator cuff repair.

In a bovine study, De Carli et al 6 reported that knotless fixation with tape had a significantly higher load to failure than knotted fixation with No. Likewise, in the current study, load to 3 mm of displacement and maximum load to failure were higher in the knotless constructs as compared with the knotted constructs. It was also interesting that the mode of failure was different among the constructs.

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The knotted constructs most commonly failed by knot slippage, whereas the knotless constructs failed by suture slippage in the K2 constructs and anchor slippage in the KT constructs. The latter likely reflects the greater thickness of the tape relative to the No. While this was an idealized environment that does not reflect tissue quality, the weak link in the knotless construct with tape was effectively anchor fixation.

Several studies have examined the biomechanical performance of knotless versus knotted suture bridge double-row rotator cuff repairs, and many have concluded that knots lead to greater strength.

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In other words, the knotted constructs had additional points of fixation as compared with the knotless constructs. But when evaluation is isolated to fixation of the loop itself, as in the current study, a knotless method appears to exceed the strength of a knotted method.

In addition to increased strength knot security , a knotless construct may have improved loop security. As compared with the knotted group, the KT group had lower displacement, indicating that the KT constructs have a greater ability to maintain tissue contact, which has important implications for rotator cuff healing. In addition to biomechanical strength, knotless constructs may be more reproducible. Some studies have compared different types of arthroscopic knots, 1 , 10 , 13 but few have evaluated the variance among surgeons in the ability to execute knots.

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Hanypsiak et al 9 evaluated the strength and consistency of knots tied by 73 expert arthroscopists and noted considerable variability of knots tied by an individual surgeon and among surgeons. Interestingly, among the surgeons in the study, volume of cases performed was not a factor.

Mean load to failure was N but ranged from 29 N to N. In contrast to Hanypsiak et al, 9 we found no statistically significant differences between attempts for any of the constructs within our study, which might be due to the decreased number of attempts per surgeon 3 vs 5. However, the mean load to failure also varied widely in the knotted group mean, N; range, N , indicating high variability among surgeons.

Among knotless constructs, not only was load to failure higher, but the variability among surgeons was also significantly reduced according to the F test analysis of SD.

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