Knotless syndesmosis system

A system comprising:

• a plate comprising a body having a bone contact surface and an opposing outer surface, wherein the body defines at least one capsule hole extending from the outer surface to the bone contact surface;
• and
• an anchor construct comprising:
• a flexible strand defining a first adjustable loop;
• a friction knot coupled to a proximal end of the first adjustable loop, wherein the friction knot is configured to allow adjustment of the first adjustable loop in a first configuration and is configured to prevent adjustment of the first adjustable loop in a second configuration, and wherein configuring the friction knot in the first configuration or the second configuration is independent of adjustment of the first adjustable loop;
• and
• a knot capsule having a body extending from a proximal end to a distal end and defining an internal knot cavity, wherein the friction knot and a portion of the first adjustable loop are positioned within the internal knot cavity, wherein the internal knot cavity defines one or more impingement surfaces configured to maintain the friction knot in a fixed position within the internal knot cavity when the friction knot is in the second configuration, and wherein a portion of the knot capsule is sized and configured to be inserted through the at least one capsule hole.

A surgical method, comprising:

• forming a bone tunnel through a first bone and a second bone;
• inserting a portion of a bone anchor through the bone tunnel, wherein the bone anchor comprises a flexible strand defining a first adjustable loop, a friction knot coupled to a proximal end of the first adjustable loop, and a knot capsule having a body extending from a proximal end to a distal end and defining an internal knot cavity, wherein the friction knot and a portion of the first adjustable loop are positioned within the internal knot cavity;
• coupling a distal portion of the first adjustable loop to a lateral surface of the second bone;
• reducing the length of the first adjustable loop to reduce a distance between the first bone and the second bone;
• and
• tightening the friction knot to lock the first adjustable loop at a selected length, wherein the internal knot cavity defines one or more impingement surfaces configured to maintain the friction knot in a fixed position within the internal knot cavity when the friction knot is in the second configuration, and wherein tightening the friction knot is independent of reducing the length of the first adjustable loop.