How to Tie a Surgeon’s Knot [With Video Instructions]

Learning a surgeon’s knot is useful in many situations, from medicine to fishing to everyday tasks. It stands out because it holds securely even when other knots tend to slip.

As you continue through this guide, the step-by-step instructions will walk you through the process so you can tie the knot with confidence.

What is a Surgeon’s Knot & Why Use It

A surgeon’s knot is a secure variation of the reef knot that includes an extra wrap on the first throw. This added twist increases friction between the two ends, which prevents the knot from slipping while you finish tying it.

Because it stays in place under tension, the surgeon’s knot is preferred for situations where materials are slippery, hard to control, or require a strong, reliable hold.

Benefits of the Surgeon’s Knot

The extra friction created by the double wrap provides several advantages:

• Better tension retention, helping the knot stay secure while you work
• Safer, more stable closure when used for suturing
• Strong, reliable hold on slippery or constantly stressed materials such as wet meat, fishing line, or synthetic cords

Typical Use Cases of the Surgeon’s Knot

You’ll find the surgeon’s knot in many fields because it performs well when reliability matters:

• Surgical sutures and ligatures
• Fly fishing and joining lines of different diameters
• Crafts involving smooth ribbons or cords
• Binding roasts or preparing cuts of meat
• General-purpose tying when you need a knot that won’t slip

See the Surgeon's Knot in Action

Understanding how to tie a surgeon's knot becomes much clearer when you can watch the process unfold. The basic surgeon's knot works beautifully for hand-tying applications whether you're working with fishing line, craft materials, or general cordage.

Basic Surgeon’s Knot

Video by Johnson & Johnson MedTech | Surgery, “How to Tie a Surgeon's Knot”, YouTube. 

Tying a surgeon’s knot is easiest when you focus on control and even tension. The goal is to add extra friction on the first throw so the knot holds steady while you finish tying it.

Keeping both lines taut and paying attention to your wrapping direction will prevent the knot from slipping or turning into a granny knot, which is weaker.

To tie a surgeon’s knot, follow these steps:

• Overlap the two ends you want to join, leaving about six inches of working length on each side.
• Make the first throw as you would for an overhand knot, but pass the ends through the loop twice instead of once.
• Pull this double-wrapped throw snug, but not fully tight, so the lines stay in place.
• Make the second throw with a single wrap in the opposite direction of the first throw.
• Tighten the knot by pulling all four strands evenly so it lies flat without twisting.

One-Handed Surgical Knot

Video by Johnson & Johnson MedTech | Surgery, “Suture Basics: How to Tie a One-Handed Surgical Knot”, YouTube. 

For medical use, surgeons tie a surgeon’s knot using either one-handed or two-handed techniques. The one-handed method is useful in tight spaces or when tension must be maintained with the other hand.

Right-handed surgeons use their right hand to handle the suture while the left maintains tension. The key is looping the suture properly and tightening evenly to secure tissue.

Steps for a one-handed surgeon’s knot:

• Hold the long end of the suture with the needle holder or fingers.
• Loop the suture twice around the instrument or fingers.
• Pass the needle end through both loops.
• Pull the ends apart evenly to tighten while keeping them parallel.
• Make a second throw in the opposite direction with a single wrap to complete the knot.

Two-Handed Surgical Knot

Video by Johnson & Johnson MedTech | Surgery, “How to Tie a Two-Handed Surgical Knot for Wound Closures”, YouTube. 

The two-handed method, also called the instrument-tie technique, is ideal for deeper cavities or situations needing extra control.

Using a needle holder in each hand, you create the first throw with two wraps and then pass the free end through both loops.

This method takes coordination but provides superior precision in tight or limited-visibility surgical areas.

Steps for a two-handed surgeon’s knot:

• Hold a needle holder in each hand.
• Wrap the suture twice around the first needle holder for the first throw.
• Grasp the free end of the suture with the second needle holder.
• Pull the free end through both loops to tighten the first throw.
• Complete the knot with a second throw using a single wrap in the opposite direction.

Common Mistakes When Performing the Surgeon's Knot  & How to Avoid Them

Even experienced practitioners occasionally make errors when learning how to tie a surgeon's knot properly. Understanding these common pitfalls helps you avoid them from the start.

Surgeon’s Knot vs. Other Common Knots

How does the surgeon's knot compare to alternatives? A standard reef knot is faster to tie but slips more easily under tension or with slippery materials.

The surgical loop offers advantages when you need to adjust tension after tying, but it's more complex and takes longer to master.

The constrictor knot offers exceptional holding power. It is essentially permanent and hard to untie. This makes it best for situations where suture removal is not needed.

The table below summarizes when each knot works best:

How to Get Good at Tying a Surgeon's Knot

Building confidence with the surgeon's knot requires deliberate, focused practice under progressively challenging conditions. Here’s how to develop skill, consistency, and precision with each step

Start with Simple Materials

Start learning the surgeon's knot with easy materials like twine, thick thread, or yarn. Thicker materials let you see each step clearly and correct mistakes quickly.

Using a knot-tying practice board, such as the one from Artagia Med, helps even more. It keeps the materials under steady tension and mimics the resistance and spacing you’ll face in real situations, making it easier to build muscle memory.

Practice Both Hand and Instrument Techniques

Once comfortable with basic materials, practice both hand-tying and instrument-tying methods. Different scenarios may require one technique over the other, especially in surgical or precision tasks.

Practicing both approaches improves versatility and reinforces the fundamental mechanics of the knot.

Simulate Real-World Conditions

Next, introduce conditions that mirror actual use. Practice with wet or slippery materials for fishing or synthetic cord, and work in confined spaces for surgical applications.

These challenges teach you to maintain control and tension in situations where the knot must hold securely.

Use Feedback and Good Lighting

Start with bright lighting to clearly see your hands and the knot. Then, record yourself and compare the footage to reference videos. This makes it easier to catch subtle mistakes in tension or hand placement that might otherwise go unnoticed.

Build Confidence with Consistent Practice

The surgeon's knot is a versatile skill with applications across many fields. Regular, structured practice helps you tie knots confidently, accurately, and reliably in any situation.

Practice Your Surgeon’s Knot with Artagia Med’s Training Kits

Artagia Med’s knot tying practice kits provide a dedicated platform to build muscle memory and develop consistent, reliable skills.

The Basic Surgical Knot Tying Practice Board Kit includes a sturdy board, premium rope that mimics suture material, and a tie-fast tool to guide hand positioning and instrument handling.

For those ready to take their skills to the next level, the Advanced Surgical Knot Tying Board Kit  offers adjustable tension, anatomical markers, and specialized instruments.

These features simulate real surgical conditions and help you master both one-handed and two-handed techniques.

Order your practice board kit today and start mastering the surgeon’s knot!