Evolution of Technology

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.

Evolution of Procedure

Tendon Repair

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.

Evolution of Diagnosis

Tendon Injury

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.