Comparative strength of ligature points achieved by various surgical knot-tying techniques: an observational study using Maxon™ monofilament sutures

Surgical knot-tying requires careful selection of the appropriate technique for optimal outcomes; however, evidence is lacking about the common ligation techniques combining square and slip knots (combination knots). This study investigates the strength of a combination knot, compared with other techniques. In this observational cohort study, we assessed the strengths of square, slip-granny, slip-reef, and combination knots using absorbable monofilament sutures, and compared them using ANOVA and a multilevel linear regression analysis. We also assessed the correlation between the number of throws and knot strength using Spearman's correlation analysis. Among 80 ligatures, ANOVA indicated significant differences in knot strength among the techniques (p