BACKGROUND
Passing sutures through bony tunnels is usually performed using a blunt probe or a suture mounted on a straight needle;1 if multiple sutures are to be passed through the same canal, either technique may damage sutures already in situ, by crushing, cutting or piercing them. Apart from using specialist equipment,2 we have found no approach to overcome this problem. We describe here a simple technique, requiring no special equipment, which resolves the problem.
TECHNIQUE
A primary suture is passed through each bone canal and a loop tied in its middle (Fig. 1); the free ends may be secured with artery forceps. The sutures being used for the repair are then individually threaded through this loop and pulled through the canal using the primary suture. By the sequential use of the primary sutures in each bony canal, a single suture may be passed, in either direction, through as many bony tunnels as is required to complete the repair. Each primary suture may be used many times and to draw repair sutures in either direction. Once the repair is secure, the primary suture is removed.
Figure 1.
Diagram illustrating the suture passing technique. (i) Preparing the suture to be passed; (ii) passing the final suture through the canal.
DISCUSSION
Using this technique, the danger of crushing or cutting previously passed repair sutures is abolished, thereby preserving the strength of the repair suture. We have found this a simple technique to use, requiring no specialised equipment; it is particularly valuable in the repair of patellar tendons where multiple sutures must be woven through several bony canals.
References
- 1.Bucholz RW, Heckman JD. Rockwood and Green's Fractures in Adults. 5th edn. Philadelphia, PA: Lippincott, Williams and Wilkins; 2001. [Google Scholar]
- 2.Terry Canale S. Campbell's Operative Orthopedics. 9th edn. St Louis, MO: Mosby; 1998. [Google Scholar]