The present invention generally provides devices and methods for tensioning a length of suture. In one embodiment, a suture tensioning device is provided having a shaft and a suture grasping member. A knotting element can be removably coupled to a distal end of the shaft, and it can be adapted to receive a suture and to lock to engage the suture. The suture grasping member can be movably coupled to the shaft and configured to grasp a suture and pull it through the knotting element to allow the knotting element to lock and engage the suture.