Why 6 Fingers Are Better Than 5! The Versatility and Utility of the Sixth Finger Knot Pusher in Arthroscopic Shoulder Surgery

Arthroscopic knot tying in shoulder surgery offers the surgeon versatility and security when performing certain procedures. While knotless techniques have become popular, the young surgeon should develop and maintain their knot-tying skills. The surgeon's knot has been shown to offer the best loop and knot security on testing. The sixth finger knot pusher is a double-lumen knot pusher that permits tying the arthroscopic surgeon's knot, while offering a number of advantages over a traditional knot pusher. Its utility in shoulder surgery, as well as its advantages and disadvantages, are discussed in this Technical Note.