← Articles

Barnes et al: Evaluation of the in vitro performance of the double forwarder knot, compared to square and surgeon's knots using large gauge suture
Veterinary Surgery 2, 2024

🔍 Key Findings

  • Double forwarder (DF) knots had significantly higher knot holding capacity (KHC) than square (SQ) and surgeon’s (SU) knots when tied with <6 throws.
  • In 3 USP polyglactin 910, DF knots with 4–5 throws were not significantly stronger than SU knots with 6–8 throws (p > .43).
  • DF knots never unraveled, while SQ and SU knots with 4–5 throws showed substantial unraveling.
  • KHC did not increase in DF knots when throws increased from 3 to 5.
  • Knot volume and weight were significantly higher in DF knots than SQ/SU knots at the same throw count (p < .003).
  • DF knots allow sliding placement, potentially useful in minimally invasive or deep cavity procedures.

Simini Surgery Review Podcast

How critical is this paper for crushing the Boards?

🚨 Must-know. I’d bet on seeing this.

📚 Useful background, not must-know.

💤 Skip it. Doubt it’ll ever show up.

Thanks for the feedback!
‍We'll keep fine-tuning the articles vault.
Oops — didn’t go through.
‍Mind trying that again?
← Articles

Barnes et al: Evaluation of the in vitro performance of the double forwarder knot, compared to square and surgeon's knots using large gauge suture
Veterinary Surgery 2, 2024

🔍 Key Findings

  • Double forwarder (DF) knots had significantly higher knot holding capacity (KHC) than square (SQ) and surgeon’s (SU) knots when tied with <6 throws.
  • In 3 USP polyglactin 910, DF knots with 4–5 throws were not significantly stronger than SU knots with 6–8 throws (p > .43).
  • DF knots never unraveled, while SQ and SU knots with 4–5 throws showed substantial unraveling.
  • KHC did not increase in DF knots when throws increased from 3 to 5.
  • Knot volume and weight were significantly higher in DF knots than SQ/SU knots at the same throw count (p < .003).
  • DF knots allow sliding placement, potentially useful in minimally invasive or deep cavity procedures.

Simini Surgery Review Podcast

Know What Matters in the Literature - and Why

We distill peer-reviewed surgical studies into clinically relevant summaries and
exam-style questions, so you can make informed decisions with confidence.

Free Access. No Spam. Just Smarter Surgical Learning

Multiple Choice Questions on this study

In Barnes 2024 et al., on knot strength testing, how did increasing the number of throws affect DF knot strength?

A. Significantly increased KHC in all cases
B. KHC decreased with more throws
C. No significant change in KHC
D. KHC dropped after 4 throws
E. Inconsistent effects by suture type

Answer: No significant change in KHC

Explanation: Increasing throws from 3 to 5 in DF knots did not significantly increase KHC.
In Barnes 2024 et al., on knot performance, what advantage does the DF knot provide in confined surgical spaces?

A. It can be pre-tied and slid into place
B. It unravels less under pressure
C. It has the smallest knot volume
D. It resists cyclic tension better
E. It performs better in adipose tissue

Answer: It can be pre-tied and slid into place

Explanation: The DF knot allows sliding placement like the forwarder knot, aiding use in deep/limited access fields.
In Barnes 2024 et al., on knot strength testing, which knot type had the highest overall knot holding capacity (KHC)?

A. Square knot with 7 throws
B. Surgeon's knot with 8 throws
C. Double forwarder knot with 4 throws
D. Surgeon's knot with 4 throws
E. Double forwarder knot with 5 throws

Answer: Double forwarder knot with 4 throws

Explanation: The DF knot with 4 throws in 3 USP suture had the highest KHC of 208.21 N.
In Barnes 2024 et al., on knot strength testing, which of the following statements is true about unraveling?

A. DF knots unraveled in 10% of tests
B. SU knots with 6+ throws showed unraveling
C. SQ knots with 4 throws showed unraveling
D. All knots with 5+ throws unraveled
E. DF knots unraveled more than SU knots

Answer: SQ knots with 4 throws showed unraveling

Explanation: Unraveling occurred in SQ knots with 4 throws; DF knots did not unravel in any test.
In Barnes 2024 et al., on knot performance, which was a notable disadvantage of the double forwarder knot?

A. Increased risk of unraveling
B. Lower strength than SU knot with 8 throws
C. Technically difficult to tie
D. Higher knot volume and weight
E. Prone to cyclic loading failure

Answer: Higher knot volume and weight

Explanation: The DF knot had significantly greater volume and weight compared to SQ/SU knots at the same throw count.

Access the full library of surgical summaries and exam-style questions.

Get Instant Access

Educational content developed independently and supported by Simini.

The maker of Simini Protect Lavage.

Review More Key Summaries from this Veterinary Surgery Journal Issue

Korchek

 et al: 

Association of fracture gap with implant failure in radius and ulna fractures in toy breed dogs—A multicenter retrospective cohort study

Low

 et al: 

The association between gonadectomy and timing of gonadectomy, and the risk of canine cranial cruciate ligament disease: A systematic review and meta-analysis

Smith

 et al: 

Variables associated with the prevalence of self-reported work-related musculoskeletal disorders in veterinary laparoscopic surgeons

Carwardine

 et al: 

Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial

Sherman

 et al: 

Linear external skeletal fixation applied in minimally invasive fashion for stabilization of nonarticular tibial fractures in dogs and cats