Abstract:

The attachment of soft tissue to bone is a problem in orthopedic surgery. Over the last one hundred years several methods have been used. The earliest method involved drilling a hole in the bone, pulling the tendon through the hole and sewing the tendon onto itself. While this worked on tendon transfers, it did not work particularly well around the knee, shoulder and the ankle where there are large areas of cancellous bone and the tissue to be reattached is ligamentous and is less well-defined than a tendon. The second method was to split the periosteum, prepare a trough in the bone, and sew the tendon or the soft tissue directly into the periosteum. This method requires long immobilization of the joint, and while it does work, the immobilization often leads to arthrofibrosis. Staples, nails, tacks, and other devices have been used to attach soft tissue with various degrees of success.

Authors:

Willliam S. Ogden, M.D., Duke University Medical Center, Durnham, NC

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