What is the basic surgical knot?

• A. Granny knot
• B. Surgeon's knot
• C. Slip knot
• D. Square (reef) knot

Answer: (D)

In knot tying for surgery, the basic requirement is a knot that is secure, even under pull, and lies flat to hold tissue without bulk. The square knot, also known as the reef knot, fits this role because it is formed by two throws in opposite directions, producing a symmetrical, flat knot that distributes tension evenly along the suture. When the ends are of similar thickness and tightened smoothly, it resists slipping and stays secure, which is why it is taught as the foundational knot in many training programs.

The other knots don’t fit as the basic option for this reason: the granny knot results from tying in the same direction twice, which makes the knot prone to loosening or capsizing under load. The slip knot is designed to loosen with tension release and isn’t reliable for tissue approximation. The surgeon’s knot is a reinforced version with a double throw to prevent slipping when starting with slippery or thick sutures, but it’s a variation used in tougher situations rather than the standard starting knot.