Is the Nice Knot Comparable to the Modified Prusik Knot for Soft Tissue Fixation in ACL Reconstruction?

Description

In this presentation, Shahbaz Malik discusses the comparative effectiveness of two knot techniques used in anterior cruciate ligament (ACL) reconstruction: the Nice knot and the modified Prusik knot. Shahbaz begins by introducing the topic from Perth, Australia, confirming no conflicts of interest. He highlights the advantages of needleless techniques over traditional needle techniques, citing faster performance and reduced injury risk. Subsequently, he dives into a biomechanical study that compares the elongation and load to failure of these techniques, noting that the Nice knot shows significantly less elongation after testing, suggesting that it offers a reliable alternative method for graft fixation. He describes the experimental setup using quadriceps tendon grafts and details the testing parameters, including tensile loading protocols. The findings reveal that while the Nice knot has less elongation, the Prusik knot demonstrates slightly higher peak load but is affected by outlier data. Shahbaz concludes that the Nice knot could be advantageous in surgical applications, though notes limitations inherent in in-vitro studies. The discussion later includes questions about physiological ramifications of the study findings and practical differences between the knot techniques, emphasizing how needleless knots can be prepared quicker, which can enhance surgical efficiency. The session wraps up with reassurances about the practicality and reliability of both knot methods in clinical contexts.

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