Fig. 35. A slip knot, or slide knot, may be used to secure tissue that is under moderate tension. The first two loops are tied loosely, and the tissues are drawn together into the correct position by applying traction to the sutures. Once the tissues are apposed correctly, the direction of traction may be reversed such that the slip knot will convert into a more stable square knot. A third securing loop forms a square knot. This technique results in a smaller knot that is easier to bury in tissue. Use of a simple square knot is difficult because the first throw will not appose the tissue adequately and the second throw, which forms the square knot, will irreversibly tighten the knot, resulting in tissue that may not be apposed adequately.