Graft fixation using a screw or plug against suture or tissue

Abstract

A method for securing soft tissue to bone with excellent pull-out strength which does not require the surgeon to tie suture knots to secure the tissue to the bone. A blind hole or socket is created in the bone at the location the graft is to be secured. Preferably, suture is then passed through the graft at desired points. A cannulated driver is pre-loaded with a cannulated plug or screw slidably disposed onto the distal portion of the driver. In a preferred embodiment, a separate piece of suture is passed through the cannula of the driver with a loop end of that suture exposed at the distal end of the driver. The ends of the suture attached to the graft are fed through the suture loop at the end of the driver. Alternatively, the graft itself may be fed through the suture loop, in which case it is not necessary to attach suture through the graft. In another embodiment, the suture loop exposed at the distal end of the cannula of the driver may be omitted, and the sutures attached to the graft may then be fed through the driver cannula from the distal end to position the graft relative to the driver. The driver is inserted into the hole with the screw or plug just outside the hole. Tension is then placed on the suture. Once adequate tension is achieved on the suture, the driver is pressed into the hole, which engages the first thread or bump of the screw or plug on the bone. The screw or plug is then fully advanced into the hole using the driver. When the screw or plug is fully inserted, the suture loop is freed and the driver is removed. The loose ends of the sutures protruding from the anchor site can be cleaned up by clipping them short.