# US 10,864,028 B2 · Adjustable suture-button construct for ankle syndesmosis repair > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,864,028 B2 - Document ID: US10864028B2 - Status: Granted - Kind: B2 - Application number: 16/794,542 - Filed: 2020-02-19 - Published: 2020-06-11 - Granted: 2020-12-15 - Earliest claimed: 2010-11-17 - Assignees: Arthrex, Inc. - Applicants: Arthrex, Inc. - Inventors: Eric S. Zajac; Ricardo Albertorio; Brandon L. Roller - Web page: https://patentgrep.com/patent/US10864028B2 ## CPC - A61B 17/0401: {Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811)} - A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery} - A61B 17/80: Cortical plates {, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates} - A61B 17/8061: {specially adapted for particular bones (A61B17/70 and A61B17/74 take precedence)} - A61B 17/809: {with bone-penetrating elements, e.g. blades or prongs (bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233)} - A61B 17/842: {Flexible wires, bands or straps (A61B17/72, A61B17/82, A61B17/86 take precedence)} - A61B 17/86: Pins or screws {or threaded wires; nuts therefor (A61B17/72 take precedence)} - A61B 2017/0404: {Buttons} - A61B 2017/0477: {with pre-tied sutures} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract An adjustable, knotless button/loop construct for fixation of ankle syndesmosis tibio-fibular diastasis and an associated method of ankle repair using the same. The knotless construct comprises a pair of buttons attached to a flexible, continuous, self-cinching, adjustable loop integrated with two splices that are interconnected. The knotless construct is passed through fibular and tibia tunnels and the buttons are secured on the cortical surfaces of tibia and fibula. One of the buttons (for example, an oblong button) is secured on the medial side of the tibia by passing the button and the flexible, adjustable loop though the fibular and tibia tunnels and then flipping and seating the button outside the tibia. The length of the flexible adjustable loop is adjusted so that the second button (for example, a round button) is appropriately secured on the lateral fibula. ## Claims ### Claim 1 A method of ankle syndesmosis repair, comprising: preparing a hole through a fibula and a tibia with a drill bit; passing a first fixation device through the hole until the first fixation device exits at a medial side of the tibia; flipping the first fixation device to an engagement position relative to the tibia; and positioning a second fixation device at a lateral side of the fibula, wherein the first fixation device and the second fixation device are knotles sly secured relative to the tibia and the fibula, wherein a flexible suture construct is connected to the first fixation device and the second fixation device, and wherein the flexible suture construct includes at least one spliced section formed by splicing a strand of the flexible suture construct through itself. ### Claim 2 (depends on 1) The method as recited in claim 1, comprising reducing a fracture of the fibula prior to preparing the hole through the fibula and the tibia. ### Claim 3 (depends on 2) The method as recited in claim 2, wherein reducing the fracture includes: mounting a bone plate to the fibula. ### Claim 4 (depends on 3) The method as recited in claim 3, wherein passing the first fixation device includes: pulling the first fixation device through an opening of the bone plate before entering the hole of the fibula. ### Claim 5 (depends on 3) The method as recited in claim 3, wherein mounting the bone plate includes: inserting a screw through an opening of the bone plate and then into the fibula. ### Claim 6 (depends on 1) The method as recited in claim 1, wherein passing the first fixation device includes: connecting the first fixation device to a suture passing instrument with a pull-through suture; and inserting the suture passing instrument through the hole to advance the first fixation device horizontally through the hole. ### Claim 7 (depends on 6) The method as recited in claim 6, wherein flipping the first fixation device includes: applying traction to the pull-through suture while applying counter-traction to the flexible suture construct until the first fixation device pivots from a position generally parallel to the hole to the engagement position, wherein, in the engagement position, the first fixation device is generally transverse to the hole. ### Claim 8 (depends on 1) The method as recited in claim 1, wherein positioning the second fixation device includes: applying traction to a free strand of the strand of the flexible suture construct, wherein applying the traction tightens the second fixation device down at the lateral side of the fibula. ### Claim 9 (depends on 8) The method as recited in claim 8, wherein applying the traction reduces a length of the flexible suture construct to move the first fixation device and the second fixation device closer together. ### Claim 10 (depends on 1) The method as recited in claim 1, wherein the first fixation device includes a first configuration and the second fixation device includes a second configuration that is shaped different from the first configuration. ### Claim 11 (depends on 10) The method as recited in claim 10, wherein the first configuration of the first fixation device is an elongated configuration. ### Claim 12 (depends on 1) The method as recited in claim 1, wherein a free end of the strand of the flexible suture construct is received through a round aperture formed through a round portion of the second fixation device. ### Claim 13 (depends on 1) The method as recited in claim 1, wherein the flexible suture construct includes a loop portion. ### Claim 14 (depends on 13) The method as recited in claim 13, wherein the loop portion interlinks with a second loop portion at a location between the first fixation device and the second fixation device. ### Claim 15 (depends on 14) The method as recited in claim 14, wherein the location is spaced apart from both the first fixation device and the second fixation device. ### Claim 16 A method of ankle syndesmosis repair, comprising: attaching a bone plate to a fibula, wherein attaching the bone plate includes positioning a first bone screw within a first opening of the bone plate; preparing a hole through the fibula and a tibia with a drill bit; passing a first fixation device through the bone plate and then through the hole until the first fixation device exits at a medial side of the tibia; flipping the first fixation device to an engagement position relative to the tibia; and positioning a second fixation device within a second opening of the bone plate, wherein positioning the second fixation device includes applying traction to a free end of a strand of a flexible suture construct that is connected to the first fixation device and the second fixation device, wherein the first fixation device and the second fixation device are secured relative to the tibia and the fibula, respectively, without tying knots, wherein the flexible suture construct includes at least one spliced section formed by splicing the strand of the flexible suture construct through itself, wherein the free end of the strand extends from the at least one spliced section and is received through an aperture formed in a round portion of the second fixation device. ### Claim 17 (depends on 16) The method as recited in claim 16, wherein the second fixation device is shaped differently from the first fixation device. ### Claim 18 (depends on 16) The method as recited in claim 16, wherein the flexible suture construct includes a first loop that interlinks with a second loop at a location between the first fixation device and the second fixation device. ### Claim 19 (depends on 16) The method as recited in claim 16, wherein a length of the at least one spliced section extends a distance of at least 17 mm. ### Claim 20 (depends on 16) The method as recited in claim 16, wherein the free end of the strand extends at least 15 inches outwardly from the aperture of the second fixation device.