The strength of surgical knots involves a critical interplay between friction and elastoplasticity

Paul Johanns; Changyeob Baek; Paul Grandgeorge; Samia Guerid; Shawn A. Chester; Pedro M. Reis

doi:10.1126/sciadv.adg8861

The strength of surgical knots involves a critical interplay between friction and elastoplasticity

Paul Johanns, Changyeob Baek, Paul Grandgeorge, Samia Guerid, Shawn A. Chester, Pedro M. Reis

Mechanical and Industrial Engr

New Jersey Institute of Technology

Research output: Contribution to journal › Article › peer-review

Abstract

Knots are the weakest link in surgical sutures, serving as mechanical ligatures between filaments. Exceeding their safe operational limits can cause fatal complications. The empirical nature of present guidelines calls for a predictive understanding of the mechanisms underlying knot strength. We identify the primary ingredients dictating the mechanics of surgical sliding knots, highlighting the previously overlooked but critical effect of plasticity and its interplay with friction. The characterization of surgeon-tied knots reveals the relevant ranges of tightness and geometric features. Using model experiments coupled with finite element simulations, we uncover a robust master curve for the target knot strength versus the tying pre-tension, number of throws, and frictional properties. These findings could find applications in the training of surgeons and robotic-assisted surgical devices.

Original language	English (US)
Article number	eadg8861
Journal	Science advances
Volume	9
Issue number	23
DOIs	https://doi.org/10.1126/sciadv.adg8861
State	Published - Jun 2023

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title = "The strength of surgical knots involves a critical interplay between friction and elastoplasticity",

abstract = "Knots are the weakest link in surgical sutures, serving as mechanical ligatures between filaments. Exceeding their safe operational limits can cause fatal complications. The empirical nature of present guidelines calls for a predictive understanding of the mechanisms underlying knot strength. We identify the primary ingredients dictating the mechanics of surgical sliding knots, highlighting the previously overlooked but critical effect of plasticity and its interplay with friction. The characterization of surgeon-tied knots reveals the relevant ranges of tightness and geometric features. Using model experiments coupled with finite element simulations, we uncover a robust master curve for the target knot strength versus the tying pre-tension, number of throws, and frictional properties. These findings could find applications in the training of surgeons and robotic-assisted surgical devices.",

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T1 - The strength of surgical knots involves a critical interplay between friction and elastoplasticity

AU - Johanns, Paul

AU - Baek, Changyeob

AU - Grandgeorge, Paul

AU - Guerid, Samia

AU - Chester, Shawn A.

AU - Reis, Pedro M.

PY - 2023/6

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N2 - Knots are the weakest link in surgical sutures, serving as mechanical ligatures between filaments. Exceeding their safe operational limits can cause fatal complications. The empirical nature of present guidelines calls for a predictive understanding of the mechanisms underlying knot strength. We identify the primary ingredients dictating the mechanics of surgical sliding knots, highlighting the previously overlooked but critical effect of plasticity and its interplay with friction. The characterization of surgeon-tied knots reveals the relevant ranges of tightness and geometric features. Using model experiments coupled with finite element simulations, we uncover a robust master curve for the target knot strength versus the tying pre-tension, number of throws, and frictional properties. These findings could find applications in the training of surgeons and robotic-assisted surgical devices.

AB - Knots are the weakest link in surgical sutures, serving as mechanical ligatures between filaments. Exceeding their safe operational limits can cause fatal complications. The empirical nature of present guidelines calls for a predictive understanding of the mechanisms underlying knot strength. We identify the primary ingredients dictating the mechanics of surgical sliding knots, highlighting the previously overlooked but critical effect of plasticity and its interplay with friction. The characterization of surgeon-tied knots reveals the relevant ranges of tightness and geometric features. Using model experiments coupled with finite element simulations, we uncover a robust master curve for the target knot strength versus the tying pre-tension, number of throws, and frictional properties. These findings could find applications in the training of surgeons and robotic-assisted surgical devices.

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The strength of surgical knots involves a critical interplay between friction and elastoplasticity

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