The "Make and Use" All-Suture Suture Anchor in an Open Hip Abductor Repair

All-suture anchors have gained widespread adoption in the past decade because of their small diameter profile, which permits smaller drill holes, preservation of bone stock, and the ability to place multiple fixation points. Despite these advantages, commercially available all-suture anchors may be cost-prohibitive in certain health care environments. The make-and-use (MAU) all-suture anchor technique is presented as a low-cost alternative.

This technique is particularly suited for soft-tissue repair in resource-limited health care systems or settings with limited implant availability. Contraindications include short diaphyseal canals, where a bottoming-out effect may compromise fixation, and endoscopic/arthroscopic implantation, as direct visualization is recommended to ensure adequate anchor deployment and purchase.

Two high-tensile strength, nonabsorbable sutures are secured using sequential half-hitch knots to create a compact "suture ball" construct. When inserted into a prepared intramedullary bone socket, the construct expands and functions analogously to commercially available all-suture anchors by generating cortical engagement and interference fixation. In this video, the anchor is utilized to achieve double-row fixation of the gluteal tendons to their native footprint on the greater trochanter during an open repair.

All-suture anchors have demonstrated comparable or superior biomechanical properties relative to other anchor designs, while their low-profile configuration may better preserve bone stock. The MAU anchor allows the fabrication of an all-suture anchor using readily available high-tensile-strength suture material and a low-cost nonabsorbable suture (eg, Ethibond). This construct can be produced at a fraction of the cost of commercially available all-suture anchors. In this technical demonstration, the anchor provided stable fixation during open gluteal tendon repair.

The MAU all-suture anchor is a low-cost alternative for soft-tissue fixation, particularly in economically/resource-constrained environments or when standard implants are unavailable. While indications mirror those of commercially available all-suture anchors, potential limitations include increased operative time and technical demand associated with appropriate construct sizing and deployment. Further biomechanical evaluation and long-term clinical outcomes are warranted to determine the durability and reproducibility of this technique.

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