Tendon Suture Anchors
The suture anchor is another method of attaching tendon to bone. Using a small drill, two anchors are inserted into the thickest portion of the bone. One end of the suture is attached to the two suture anchors. The suture anchors serve to anchor the suture to the bone. The other end of the suture is again attached to the end of the tendon. The tendon is drawn up against the bone without the need to drill a hole or pass suture through to the other side of the bone.
This method is useful when suture cannot be passed through to the far side of the bone or when such a “pass through” would cause damage on the far side. Suture anchors are also easier to use during laparoscopic surgery (surgery using small holes, long instruments, and a camera). Anchor design has evolved from screws and barbs to soft anchors composed of only suture material.
Tendon repair is generally performed in one of two ways: the ends of a tendon are reattached together, or the end of a tendon is attached to bone. Modern tendon repair surgery was first described in the early 20th century with the advent of “locking” sutures to re-connect tendon ends. Multiple different suture configurations and materials have since been used. Methods of attaching tendon to bone were described in the mid-20th century.
When a tendon is attached to bone, one end of the suture is attached to the end of the tendon. A hole is drilled through the bone and the other end of the suture is brought through the bone to come out on the other side. The suture is then anchored down on the other side of the bone, and the tendon ends up drawn up against the bone. Other methods used screws, washers, or staples to attach tendon to bone.
These methods required a large area of bone as an insertion site and involved significant patient discomfort. Another method of attaching tendon to bone was developed in the mid 1980’s. It involved placing an “anchor” within the bone that would be used to attach suture, and with it a tendon, to the bone.
The body moves through the coordinated action of bones, tendons, and muscles. Muscles are connected to bones by tendons, and muscles transmit force through tendons to pull bones. Tendons can be injured from instantaneous overload, chronic overuse, forced stretch or a combination of mechanisms. Tendons can also be cut, or lacerated, by sharp objects, bites or trauma.
Tendon injury can often be evident on examination, as the patient will not be able to perform the action of that muscle and tendon. Tendon repair is usually performed soon after an injury, but the timing may be affected by type of injury, surrounding injuries, and amount of contamination in the injured area.
The Juggerknot soft anchor system, developed in 2009, consists of a thicker polyester sleeve attached to a braided suture with suture needles. A small drill is used to prepare several holes to place the anchor. The Juggerknot inserter advances the soft, thickened sleeve anchor into the drilled hole. The sutures are removed from the inserter, at which point the soft anchor is firmly locked in the hole. The suture and needles are used to suture the tendon end to the bony anchor.
The Juggerknot soft anchor system is available in various sizes and can be used for tendon repairs on the shoulder, elbow, wrist, hand, hip, knee, foot and ankle. The Juggerknot suture anchor has the benefit of a smaller hole and less removed bone without sacrificing strength of attachment. They also do not require any knots for attachment to the anchor, thus eliminating a common point of failure.