Compression and tension instruments and methods of use to reinforce ligaments

A tension instrument for tensioning and knotlessly locking a flexible strand having first and second opposing flexible strand ends, the first flexible strand end fixed adjacent to a first member and the second flexible strand end free proximal to the first member and adjacent to a second member, the tension instrument comprising:

• a member engagement feature configured to engage with the second member through which the second flexible strand end passes;
• and
• an adjustment mechanism operably coupled to a proximal end of the member engagement feature, the adjustment mechanism including:
• a selectively adjustable flexible strand clamp configured to capture the second flexible strand end and translate the second flexible strand end proximally relative to the member engagement feature to place a tensile force on the flexible strand between the first and the second members;
• a force gauge operably coupled with the selectively adjustable flexible strand clamp, the force gauge including force indicia to provide an indication of the tensile force placed on the flexible strand;
• and
• a pathway extending through the adjustment mechanism from a proximal end to a distal end adjacent the member engagement feature to provide clearance for fixation hardware that knotlessly locks the second flexible strand end relative to the second member to maintain the tensile force between the first and the second flexible strand ends.

A method of reinforcing a syndesmosis joint of a patient using:

• a clamp having first and second opposing jaws that define a longitudinal clamp axis, and an adjustment mechanism configured to apply a measurable compression force along a directional force vector between the first and the second clamp jaws that is parallel with the longitudinal clamp axis;
• and
• a tension instrument having an anchor engagement feature coupled with an adjustment mechanism configured place a measurable tensile force on a flexible strand extending between a first anchor in a first bone portion and a second anchor in a second bone portion, the method comprising:
• actuating the adjustment mechanism of the clamp to translate the second jaw of the clamp distally to achieve a desired compression force between the first and the second bone portions along the directional force vector;
• noting the desired compression force reflected upon a force gauge of the adjustment mechanism of the clamp;
• inserting a guide along the longitudinal clamp axis through the first jaw and into the first and the second bone portions to form a bone tunnel extending between the first and the second bone portions;
• and
• removing the clamp, leaving the guide in position.