ABSTRACT
Surgical knot tying has been a basic surgical skill for centuries. Over 1400 different knots have been described, most of which have their roots in fishing and sailing. Orthopedic knot tying used to be less of a technical difficulty then in other general surgery subspecialties; however, with the advent of minimally invasive techniques, arthroscopic surgery of the shoulder in particular, the need for simple but effective knot tying in tight spaces has become a crucial issue for the success of the surgical procedure. Particularly in the shoulder, the difficulty arises from the need to deliver an effective knot through soft tissue tunnels or cannulas over a distance. The knot cannot be tied until delivered through the soft tissues and has to be tied effectively with the use of finger extenders.
