Partially assembled knotless suture construct

A syndesmotic anchoring system comprising:

• a bone plate defining at least one construct hole sized to receive a flexible strand, the bone plate configured to couple to a first bone;
• the flexible strand extending through the construct hole and defining a first strand passage and a second strand passage spaced apart from the first strand passage, each of the first strand passage and the second strand passage sized to receive a portion of the flexible strand, and including a channel defined within the flexible strand and sized to slidably receive a free end of the flexible strand therethrough;
• a first adjustable loop defined by a first free end of the flexible strand extending through the first strand passage;
• a second adjustable loop defined by a second free end of the flexible strand extending through the second strand passage, the first adjustable loop and the second adjustable loop being interlocked with one another;
• a first anchor coupled to the flexible strand, received within the construct hole, and positioned between the first strand passage and the second strand passage, the first anchor sized to prevent the first strand passage and the second strand passage from passing therethrough;
• a second anchor coupled to the first adjustable loop and the second adjustable loop;
• and
• a pull-through strand coupled to the first adjustable loop and the second adjustable loop and configured to draw the flexible strand through a bone tunnel extending between the first bone and a second bone.

A syndesmotic anchoring system comprising:

• a bone plate having an upper surface, a lower surface opposite the upper surface, and at least one construct hole extending between the upper surface and the lower surface, the bone plate configured to be positioned against a first bone with the lower surface facing the first bone;
• a flexible strand extending through the construct hole, the flexible strand defining a first strand passage and a second strand passage, each strand passage sized to slidably receive a portion of the flexible strand and;
• a first anchor coupled to the flexible strand, configured to abut the upper surface of the bone plate when the syndesmotic anchoring system is deployed, and sized to prevent passage of the first strand passage and the second strand passage therethrough, the first anchor positioned between the first strand passage and the second strand passage;
• a first free end of the flexible strand extending through the first strand passage to define a first adjustable loop;
• a second free end of the flexible strand extending through the second strand passage to define a second adjustable loop interlocked with the first adjustable loop;
• a second anchor, configured to abut the second bone while coupled to the first adjustable loop and the second adjustable loop at an end opposite the first anchor;
• a pull-through strand releasably coupled to the first adjustable loop and the second adjustable loop;
• and
• a guide element coupled to the pull-through strand, the guide element configured to pass through a bone tunnel extending between the first bone and a second bone to draw the flexible strand, the first anchor, the second anchor, the first adjustable loop, and the second adjustable loop through the bone tunnel.