Flexible Anchors for Tissue Fixation

Abstract

An anchor for securing tissue to bone can include a flexible first tubular member, a flexible second tubular member, and a first suture member. The first tubular member can include a first wall defining a first passage between first and second ends. The second tubular member can include a second wall defining a second passage between first and second ends. The first suture member can couple the first tubular member and the second tubular member. The first suture member can pass through the first wall and the first passage and the second wall and the second passage. The first tubular member and the second tubular member can engage each other and deform to form an anchoring mass upon tensioning the first suture member. A method of preparing an anchor for securing tissue to bone and a method of securing a tissue to a bone are also provided.

Description

FIELD

The present disclosure relates to surgical methods and apparatuses, and generally for attaching tissue to bone.

BACKGROUND

This section provides background information related to the present disclosure which is not necessarily prior art.

Tears caused by trauma or disease in soft tissue, such as cartilage, ligament, or muscle, can be repaired by suturing. Various repair techniques and devices have been developed for facilitating suturing that include the use of rigid, non-flexible anchors and that are effective for their intended purposes. Nevertheless, there is still a need in the relevant art for tissue repair techniques and associated devices for facilitating suturing without requiring the use of rigid anchors.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

In one form, the present disclosure provides an anchor for securing tissue to bone that can include a flexible first tubular member, a flexible second tubular member, and a first suture member. The first tubular member can include a first wall defining a first passage between first and second ends. The second tubular member can include a second wall defining a second passage between first and second ends. The first suture member can couple the first tubular member and the second tubular member. The first suture member can pass through the first wall and the first passage and the second wall and the second passage. The first tubular member and the second tubular member can engage each other and deform to form an anchoring mass upon tensioning the first suture member.

In various aspects, the present disclosure also provides an anchor for securing tissue to bone that can include a flexible first tubular member and a first suture member. The first tubular member can include a wall defining a passage extending along an axis between first and second ends. The first suture member can pass through the wall and the passage a plurality of times to create a plurality of intersecting sections and at least one loop section coupling the plurality of intersecting sections. The intersecting sections can extend between a first aperture in the wall through which the first suture member enters the passage and a second aperture in the wall through which the first suture member exits the passage. At least two of the plurality of intersecting sections can move towards each other and deform a section extending between them upon tensioning the first suture member.

In other aspects, the present disclosure also provides an anchor for securing tissue to bone that can include a flexible first elongate member having first and second ends, a flexible second elongate member having first and second ends, and a suture member. The suture member can couple the first elongate member and the second elongate member. The suture member can pass through both the first elongate member and the second elongate member a plurality of times. The first elongate member and the second elongate member can engage each other and can deform to form an anchoring mass upon tensioning the suture member.

In another form, the present disclosure provides a method of preparing an anchor for securing soft tissue to bone. The method can include: (i) providing a flexible first tubular member including a first wall defining a first passage between first and second ends, (ii) providing a flexible second tubular member including a second wall defining a second passage between first and second ends, and (iii) passing a suture member through the first wall and the first passage and the second wall and the second passage to couple the first tubular member and the second tubular member.

In various aspects, the present disclosure also provides a method of securing a tissue to a bone that can include determining an area of the bone to couple an anchor. The anchor can include: (i) a flexible first tubular member including a first wall defining a first passage between first and second ends, (ii) a flexible second tubular member including a second wall defining a second passage between first and second ends, and (iii) a first suture member passing through the first wall and the first passage and the second wall and the second passage. The method can further include positioning the anchor at a position relative to the area, and tensioning the first suture member until the first tubular member engages the second tubular member, and the first flexible tubular member and the second tubular member deform to form an anchoring mass.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

FIG. 1 is a perspective view illustrating an exemplary anchor for securing tissue to bone according to the present disclosure;

FIG. 2A is a fragmentary cross-sectional view illustrating an exemplary method of positioning an anchor within a bone according to the present disclosure;

FIG. 2B is a fragmentary side elevation view illustrating an exemplary insertion instrument according to the present disclosure;

FIG. 3 is a fragmentary cross-sectional view illustrating an exemplary method of engaging an anchor with a cancellous bone tissue according to the present disclosure;

FIG. 4 is a perspective view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 5 is a perspective view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 6 is a perspective view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 7 is a side elevation view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 8 is a perspective view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 9 is a fragmentary cross-sectional view illustrating an exemplary method of engaging the anchor shown in FIG. 8 with a tissue according to the present disclosure;

FIG. 10 is a fragmentary cross-sectional view illustrating an exemplary method of engaging the anchor shown in FIG. 8 with a cortical bone tissue according to the present disclosure;

FIG. 11 is a side elevation view illustrating another anchor for securing tissue to bone according to the present disclosure;

FIG. 12 is a perspective view illustrating another anchor for securing tissue to bone according to the present disclosure; and

FIG. 13 is a fragmentary side elevation view illustrating an exemplary method of engaging the anchor of FIG. 12 with a cancellous bone tissue according to the present disclosure.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, its application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

The present disclosure provides various anchors for securing a tissue to a bone, as well as methods of assembling the anchors, and methods of securing a tissue to a bone using the anchors. It will be appreciated that the anchors and methods can be used for various therapeutic purposes including, but not limited to, suturing repairs of tears caused by trauma or disease in soft tissue, such as cartilage, ligament, or muscle. For example, the anchors and methods can be used to attach soft tissue to bone. It will be further appreciated that the anchors and methods are not limited to attaching soft tissue to bone and can also be used to attach bone to bone. Moreover, while the anchors are illustrated as being positioned within a bone in various examples, the anchors can be embedded within or engage an outer surface of the bone or an adjoining tissue as illustrated in other examples.

With particular reference to FIG. 1, a perspective view illustrates an exemplary anchor 10 that can be used for securing a tissue to a bone according to the present disclosure. In various aspects, the tissue can be a soft tissue or bone. The anchor 10 can be made from various resorbable and non-resorbable bio-compatible materials including, but not limited to, polymeric materials such as polyester, polyethylene, and polypropylene, and natural materials such as cotton and silk. In various aspects, one or more components of the anchor 10 can include biological or biocompatible coatings, and also can be soaked in platelets and other biologics.

The anchor 10 can include flexible tubular members 12, 14 and a flexible suture member 16. The tubular members 12, 14 can have properties that allow the tubular members 12, 14 to change shape. For example, the tubular members 12, 14 can have properties that make them flexible, foldable, compressible, stretchable, elastic, deformable, flaccid, limp, soft, spongy or otherwise capable of changing shape. The tubular members 12, 14 can be hollow elongated structures having a sleeve or tubular configuration. In alternate constructions, the anchor 10 can include substantially solid flexible elongate members in place of the tubular members 12, 14. In various aspects, the elongate members can have a substantially flat, planar, or ribbon-like shape formed, for example, from a flat sponge-like material or a piece of woven fabric which can be pierced to allow the suture member 16 to pass through. In various other aspects, the elongate members can also have various cross-sectional shapes. For example, the shapes can be circular, polygonal, square, rectangular, etc.

The tubular member 12 can include a wall 20 defining an elongated passage 22 extending along an axis 24 between ends 26, 28. The passage 22 can have a diameter or size configured to allow the suture member 16 to pass through the tubular member 12 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 16 when the suture member 16 is tensioned. The tubular member 12 can further include one or more apertures disposed between the ends 26, 28 for passing the suture member 16 through the wall 20. For example, the tubular member 12 can have six apertures 30, 32, 34, 36, 38, 40 as illustrated by the present example. The apertures 30, 32, 34, 36, 38, 40 can be spaced apart in a line as shown, and in various aspects, circumferentially spaced apart.

The tubular member 14 can include a wall 50 defining a passage 52 extending along an axis 54 between ends 56, 58. The passage 52 can have a diameter or size configured to allow the suture member 16 to pass through the tubular member 14 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 16 when the suture member 16 is tensioned. The tubular member 14 can further include one or more apertures disposed between the ends 56, 58 for passing the suture member 16 through the wall 50. For example, the tubular member 14 can have four apertures 60, 62, 64, 66.

The suture member 16 can be a suture thread of a suitable length between ends 70, 72 for coupling the tubular members 12, 14 in a desired manner and for coupling the anchor 10 to the tissue by, for example, a suture stitch or other suitable coupling member.

With continued reference to FIG. 1, an exemplary method of assembling or forming the anchor 10 will now be described. The method includes coupling the tubular member 12 and the tubular member 14 using the suture member 16. The anchor 10 can be assembled or formed and the tubular members 12, 14 coupled by passing the suture member 16 through the walls 20, 50 and the passages 22, 52 in a predetermined manner. According to the present example, the suture member 16 can be passed through the walls 20, 50 to create two compression loops 74, 76 that couple the tubular members 12, 14 in a substantially parallel arrangement. The loop 74 can couple the tubular members 12, 14 near the ends 26, 56 and the loop 76 can couple the tubular members 12, 14 near the ends 28, 58.

To create the loops 74, 76, the end 70 of the suture member 16 can be passed through the aperture 30, guided through the passage 22, and passed out through the aperture 32. Next, the end 70 can be passed through the aperture 62, guided through the passage 52, and passed through the aperture 60. Next, the end 70 can be passed through the aperture 34, guided through the passage 22, and passed through the aperture 36, creating the loop 74. Next, the suture member 16 can be passed through the aperture 66, guided through the passage 52, and passed through the aperture 64. Next, the suture member 16 can be passed through the aperture 38, guided through the passage 22, and passed through the aperture 40, creating the loop 76.

Once the loops 74, 76 are created, the ends 70, 72 can be pulled to adjust a diameter or size of the loops 74, 76 and thereby bring the tubular members 12, 14 into a desired relationship in an untensioned state suitable for positioning the anchor 10 relative to the bone. In various aspects, the ends 70, 72 can be pulled such that a predetermined spacing 78 between the tubular members 12, 14 is achieved and the tubular members 12, 14 extend generally parallel to each other. In various aspects, the spacing 78 and an angle between the tubular members 12, 14 can vary so that a predetermined relationship is achieved and the anchor 10 has a desired first shape in an untensioned state when initially positioned relative to the bone. For example, the spacing 78 can be such that one or both of the tubular members 12, 14 can be deformed or folded in half without engaging each other in the untensioned state. In this way, a width of the anchor 10 in an untensioned state and a corresponding hole size can be minimized. The spacing 78 can be minimized to minimize insertion depth.

The suture member 16 can be passed through the walls 20, 50 and the passages 22, 52 in the foregoing manner to create a series of intersecting sections 80, 82, 84 and sections 86, 88 in the tubular member 12 and the tubular member 14, respectively. The intersecting sections 80, 82, 84 are sections where the suture member 16 intersects the tubular member 12, and the intersecting sections 86, 88 are sections where the suture member 16 intersects the tubular member 14. The intersecting sections 80, 82, 84, 86, 88 can be defined between the respective apertures 30, 32, 34, 36, 38, 60, 62, 64, 66. As one example, the intersecting section 80 can be defined between the aperture 30 where the suture member 16 enters the passage 22 through the wall 20 and the aperture 32 where the suture member 16 exits the passage 22 through the wall 20.

The intersecting sections 80, 82, 84, 86, 88 can be drawn towards each other and into engagement by pulling on the ends 70, 72 of the suture member 16 to create tension within the suture member 16. Tension in the suture member 16 can compress and/or deform the intersecting sections 80, 82, 84, 86, 88 individually, and together. Tension in the suture member 16 can further compress and/or deform sections of the tubular members 12, 14 extending between the intersecting sections 80, 82, 84 and sections between the intersecting sections 86, 88. In various aspects, a number and location of the intersecting sections 80, 82, 84, 86, 88 can vary and the intersecting sections 80, 82, 84, 86, 88 can have a predetermined relationship so the anchor 10 deforms between the first shape and a second shape when positioned relative to the bone and tensioned. The sections extending between the intersecting sections 80, 82, 84 and the sections extending between the intersecting sections 86, 88 can define portions of the anchoring mass that provide additional frictional and/or mechanical resistance for securing the anchor 10 relative to the bone.

In an exemplary construction, the tubular members 12, 14 can be made from a No. 5 size braided suture and the suture member 16 can be made from a No. 1 size suture. It will be appreciated that the present disclosure is not limited to such a construction, and that constructions made from other suture sizes are contemplated. The apertures 30, 32, 34, 36, 38, 40 and the apertures 60, 62, 64, 66 can be defined by voids between two or more fibers of the woven fabric of the braided suture forming the tubular members 12, 14. In this way, the apertures 30, 32, 34, 36, 38, 40, 60, 62, 64, 66 can be present without breaking the weave. When coupled by the suture member 16 in an untensioned state, the spacing 78 between the tubular members 12, 14 can be around 0.4 inches. According to the foregoing construction, the anchor 10 can provide pull out forces of between around twenty-five pounds (25 lbs) and thirty-one pounds (31 lbs) and, more particularly, around twenty-eight pounds (28 lbs). Thus, it will be appreciated that the anchor 10 according to the present disclosure can provide pull out forces that are greater than other conventional flexible anchors.

An overall length of the tubular member 12 can be around 0.74 inches. The apertures 30, 32, 34, 36, 38, 40 are disposed along the length of the tubular member 12 in a symmetrical arrangement about a line of symmetry located midway along the length located at around 0.37 inches from the ends 26, 28. Centers of the apertures 30, 32, 34 are spaced apart from the end 26 by around 0.06 inches, 0.21 inches, and 0.31 inches, respectively. Centers of the apertures 36, 38, 40 are spaced apart from the end 28 by around 0.31 inches, 0.21 inches, and 0.06 inches, respectively. According to the foregoing spacing, the intersecting sections 80, 82, 84 have lengths of around 0.15 inches, 0.12 inches, and 0.15 inches, respectively.

An overall length of the tubular member 14 can be around 1.10 inches. The apertures 60, 62, 64, 66 are disposed along the length of the tubular member 14 in a symmetrical arrangement about a line of symmetry located midway along the length located at around 0.55 inches from the ends 56, 58. Centers of the apertures 60, 62 are spaced apart from the end 56 by around 0.06 inches and 0.25 inches, respectively. Centers of the apertures 64, 66 are spaced apart from the end 58 by around 0.25 inches and 0.06 inches, respectively. Accordingly, the intersecting sections 86, 88 each have a length of around 0.19 inches. It will be appreciated that the present disclosure is not limited to the foregoing dimensions, and that other dimensional features and relationships are contemplated.

With additional reference to FIGS. 1-3, an exemplary method of securing the anchor 10 with a bone 100 according to the present disclosure will now be described. The method can include securing the anchor 10 within a region of cancellous bone tissue 102 adjacent a region of cortical bone tissue 104. The method can be used during a surgical procedure for coupling adjoining anatomy such as a soft tissue 106 to the bone 100, or other bone. For example, the method can be used during a surgical procedure for repairing a tear in the soft tissue 106 to be attached to the bone 100. More specifically, the method can be used in labral repairs, rotator cuff repairs, and anterior cruciate ligament (ACL) reconstructions.

First, an area 110 of the bone 100 for securing the anchor 10 is selected and an aperture 112 is formed in the area 110. The aperture 112 can be formed by boring into the bone 100 through the cortical bone tissue 104 into the cancellous bone tissue 102. Next, the anchor 10 can be loaded onto an insertion instrument 114 configured to insert and position the anchor 10 at a predetermined position relative to the aperture 112. As best seen in FIG. 2B, an exemplary insertion instrument 114 can include a fork 116 configured to pass between the tubular members 12, 14 and engage the tubular member 14. The anchor 10 can be loaded onto the insertion instrument 114 by coupling the tubular member 14 to the fork 116. The insertion instrument 114 can optionally include a fork 117 as shown that is configured to engage the tubular member 12 and to hold the tubular members 12, 14 in a desired relationship when positioned within the aperture 112.

With the anchor 10 loaded on to the insertion instrument 114, the loaded insertion instrument 114 can be coupled to a guide (not shown) and advanced within the aperture 112. For example, the insertion instrument 114 carrying the anchor 10 can be inserted into a cannulated guide typically used for arthroscopic surgery. The insertion instrument 114 can be advanced until the anchor 10 is positioned in a region of the cancellous bone tissue 102 a predetermined distance below the cortical bone tissue 104 as shown in FIG. 2A. With the anchor 10 thus positioned, the insertion instrument 114, and more particularly the fork 116, can be uncoupled from the anchor 10 by moving and/or withdrawing the insertion instrument 114 in an axial direction relative to the aperture 112. In an untensioned state, the anchor 10 can have a first configuration 120 or shape as shown in FIG. 2A and can frictionally and/or mechanically engage the cancellous bone tissue 102.

With the insertion instrument 114 uncoupled, the tubular members 12, 14 can be drawn into engagement to create an anchoring mass 122 that can secure the anchor 10 relative to the bone 100 substantially at the predetermined position as shown in FIG. 3. The anchoring mass 122 can have a second configuration 124 or shape that is different than the first configuration 120. The tubular members 12, 14 can be drawn towards each other and into engagement by pulling on the ends 70, 72 of the suture member 16 in a direction that is generally coaxial with and away from the aperture 112. In various aspects, the ends 56, 58 of the tubular member 14 can frictionally and/or mechanically engage a wall of the aperture 112. The engagement of the ends 56, 58 can retain the tubular member 14 in place relative to the aperture 112 as the tubular member 12 is drawn towards the tubular member 14 and into engagement. In this way, the tubular member 14 can retain the anchor 10 substantially at the same predetermined position as the anchor 10 is initially positioned as the suture member 16 is tensioned. In various aspects, the ends 26, 28 of the tubular member 12 do not catch on the wall of the aperture 112 as the tubular member 12 is drawn towards the tubular member 14 deeper in the aperture 112. In other aspects, as the tubular members 12, 14 are drawn into engagement with one another, the intersecting sections 80, 82, 84 of the tubular member 12 can be drawn towards and into engagement with the intersecting sections 86, 88. In still other aspects, the suture member 16 is passed through the tubular members 12, 14 so that sections of the tubular members 12, 14, including one or more of the intersecting sections 80, 82, 84, 86, 88 are forced in a direction of the wall of the aperture 112.

During the engagement, sections of the tubular members 12, 14 can compress, collapse, buckle, fold, bunch, expand, or otherwise deform to form the anchoring mass 122. In various aspects, the second configuration 124 can include an overall width that is greater than that of the first configuration 120 and a diameter or width of the aperture 112. By having a greater width, the second configuration 124 can expand into the cancellous bone tissue 102, beyond the width of the aperture 112. In this way, the second configuration 124 can provide a mechanical locking feature that secures the anchor 10 relative to the cancellous bone tissue 102. In various other aspects, the anchoring mass 122 can engage and lock against a ledge 126 defined by the cortical bone tissue.

With the anchor 10 thus set, remaining portions of the suture member 16 can be coupled to the soft tissue 106 and/or other surrounding anatomy. The suture member 16 can be coupled to the soft tissue 106 using a desired suturing technique for performing the repair. The suturing technique can include attaching the suture member 16 to another anchor and engaging the anchor with the soft tissue 106. The suturing technique can include knotting, and other suture coupling techniques. In various aspects, the suture member 16 can form various parts of a self-locking, adjustable loop construction such as those described in commonly assigned U.S. Pat. Nos. 7,658,751 and 7,601,165, the entire disclosures of which are incorporated by reference herein. For example, one or both the ends 70, 72 of the suture member 16 can form one or more loops of the construct. Alternately or additionally, one or both the ends 70, 72 can provide a tubular construct through which one or more loops of another suture pass.

With particular reference to FIG. 4 a perspective view illustrates another anchor 200 for securing soft tissue to bone according to the present disclosure. The anchor 200 can include flexible tubular members 212, 214 and suture members 216, 218. The anchor 200 illustrates an alternate configuration according to the present disclosure. The anchor 200 is similar to the anchor 10, except that the two suture members are used to couple and deform two soft anchoring members.

The tubular member 212 can include a wall 220 defining a passage 222 extending along an axis 224 between ends 226, 228. The passage 222 can have a diameter or size configured to allow the suture members 216, 218 to pass through the tubular member 212 and to provide a locking feature through frictional and/or mechanical engagement with the suture members 216, 218 when one or both of the suture members 216, 218 are tensioned. The tubular member 212 can have eight apertures 230, 232, 234, 236, 238, 240, 242, 244. The apertures 230, 234, 240, 244 can be spaced apart along a first line as shown, and the apertures 232, 236, 238, 242 can be spaced apart along a second line circumferentially spaced apart from the first line.

The tubular member 214 can include a wall 250 defining a passage 252 extending along an axis 254 between ends 256, 258. The passage 252 can have a diameter or size configured to allow the suture members 216, 218 to pass through the tubular member 214 and to provide a locking feature through frictional and/or mechanical engagement with the suture members 216, 218 when one or both of the suture members 216, 218 are tensioned. The tubular member 214 can further include four apertures 260, 262, 264, 266.

The suture members 216, 218 can be suture threads of suitable lengths between ends 270, 272 and ends 274, 276 for coupling the tubular members 212, 214 in a desired manner and for coupling the anchor 200 to the soft tissue by, for example, a suture stitch or other suitable coupling member.

The suture member 216 can be passed through the walls 220, 250 and the passages 222, 252 to create a first loop 280 coupling the ends 226, 256 of the tubular members 212, 214, respectively. The suture member 216 can further create a series of intersecting sections 282, 284 and an intersecting section 286 in the tubular member 212 and the tubular member 214, respectively. The suture member 218 can be passed through the walls 220, 250 and the passages 222, 252 to create a second loop 290 coupling the ends 228, 258 of the tubular members 212, 214, respectively. The suture member 216 can further create a series of intersecting sections 292, 294 and an intersecting section 296 in the tubular member 212 and the tubular member 214, respectively.

With particular reference to FIG. 5, a perspective view illustrates another anchor 300 for securing soft tissue to bone according to the present disclosure. The anchor 300 can include flexible tubular members 312, 314 and suture members 316, 318. The anchor 300 illustrates an alternate configuration according to the present disclosure. The anchor 300 is similar to the anchor 200, except that only one of the two suture members is used to couple and deform two soft anchoring members, while the second suture member is used to deform one of the two soft anchoring members. Additionally, the two suture members overlap in at least one intersecting section. The anchor 300 can provide an additional feature that multiple suture members can be separately employed to couple the two soft anchoring members and to individually deform the two soft anchoring members.

The tubular member 312 can include a wall 320 defining a passage 322 extending along an axis 324 between ends 326, 328. The passage 322 can have a diameter or size configured to allow the suture members 316, 318 to pass together through a section of the tubular member 312 and to provide a locking feature through frictional and/or mechanical engagement with the suture members 316, 318 when one or both of the suture members 316, 318 are tensioned. The tubular member 312 can have eight apertures 330, 332, 334, 336, 338, 340, 342, 344. The apertures 330, 334, 340, 344 can be spaced apart along a first line as shown, and the apertures 332, 336, 338, 342 can be spaced apart along a second line circumferentially spaced apart from the first line.

The tubular member 314 can include a wall 350 defining a passage 352 extending along an axis 354 between ends 356, 358. The passage 352 can have a diameter or size configured to allow the suture member 316 alone to pass through the tubular member 314 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 316 when the suture member 316 is tensioned. The tubular member 314 can further include four apertures 360, 362, 364, 366.

The suture members 316, 318 can be suture threads of suitable lengths between ends 370, 372 and ends 374, 376 for coupling the tubular members 312, 314 in a desired manner and for coupling the anchor 300 to the soft tissue by, for example, a suture stitch or other suitable coupling member.

The suture member 316 can be passed through the walls 320, 350 and the passages 322, 352 to create two loops 380, 382 that can couple the ends 326, 356 and the ends 328, 358 of the tubular members 312, 314, respectively. The suture member 316 can be passed through the walls 320, 350 and the passages 322, 352 to create a series of intersecting sections 384, 386, 388 and sections 390, 392 in the tubular member 312 and the tubular member 314, respectively. The suture member 318 can be passed through the wall 320 and the passage 222 to create an intersecting section 394 that overlaps with the intersecting section 386. In various aspects, the suture 318 can provide a second strand of suture to secure the anchor 300 to soft tissue. The anchor 300 can be implanted or secured within a bone in a manner similar to that of the anchor 10.

With particular reference to FIG. 6, a perspective view illustrates another anchor 400 for securing soft tissue to bone according to the present disclosure. The anchor 400 is an example of a flexible anchor configuration for creating an anchoring mass that can be constructed by coupling a single flexible tubular member and a single suture. The anchor 400 can have a configuration similar to the configuration 124 of the second anchoring mass 122 created by the anchor 10. It will be appreciated that the anchor 400 can be coupled with a second flexible tubular member incorporating features of, for example, the anchor 10, the anchor 200, and the anchor 300. The anchor 400 can include a flexible tubular member 402 and a suture member 404.

The tubular member 402 can include a wall 410 defining a passage 412 extending along an axis 414 between ends 416, 418. The passage 412 can have a diameter or size configured to allow the suture member 404 to pass through the tubular member 402 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 404 when the suture member 404 is tensioned. The tubular member 402 can further include one or more apertures disposed between the ends 416, 418 for passing the suture member 404 through the wall 410. For example, the tubular member 402 can have twelve apertures 420, 422, 424, 426, 428, 430, 432, 434, 436, 438, 440, 442 as illustrated by the present example.

The apertures 420, 422, 424, 426, 428, 430, 432, 434, 436, 438, 440, 442 can be spaced apart in a line as shown, and in various aspects, circumferentially spaced apart. The apertures 420, 422, 424, 426, 428, 430, 432, 434, 436, 438, 440, 442 can have a symmetrical spacing about a line of symmetry 450, which can be located at around a midpoint between the ends 416, 418 as shown. Accordingly, the apertures 420, 422, 424, 426, 428, 430 can have a spacing relative to the line of symmetry 450 that is the same as that of the apertures 442, 440, 438, 436, 434, 432, respectively.

The suture member 404 can be a suture thread of a suitable length between ends 452, 454 for passing through the tubular member 402 in a desired manner and for coupling the anchor 400 to the soft tissue by, for example, a suture stitch or other suitable coupling member. The suture member 404 can be passed through the wall 410 and the passage 412 to create a series of nested loop sections 460, 462, nested loop sections 464, 466, a loop section 468, and intersecting sections 470, 472, 474, 476, 478, 480. For example, the end 452 of the suture member 404 can be passed through the apertures 420, 422, 430, 428, 424, 426, 436, 438, 434, 432, 440, 442 in that order. When passed in the foregoing order, the suture member 404 passes through the passage 412 between the apertures 420, 422, the apertures 424, 426, the apertures 436, 438, and the apertures 440, 442 in a first direction relative to the axis 414 indicated by arrows pointing to the right in FIG. 6. The suture member 404 passes through the passage 412 between the apertures 430, 428 and the apertures 434, 432 in a second direction relative to the axis 414 opposite the first direction indicated by the arrows pointing to the left in FIG. 6.

In an untensioned state, the anchor 400 can have a first shape as shown generally in FIG. 6. While still in the untensioned state, the anchor 400 can be deformed or folded about the line of symmetry 450 into an intermediate V-shape. The anchor 400 can be inserted within an aperture of a bone while in the intermediate V-shape. The anchor 400 can deform from the intermediate V-shape (or the first shape) to a second shape forming an anchoring mass by tensioning the suture member 404. Tension in the suture member 404 can be created by pulling on the ends 416, 418. Tension in the suture member 404 draws various intersecting sections towards each other and other intersecting sections away from each other, which deforms the tubular member 402. In various aspects, the anchoring mass can be secured within an aperture of a bone in a manner similar to that illustrated by the anchor 10 in FIG. 3, or engage a surface of a soft tissue or bone in a similar manner to that illustrated by another exemplary anchor in FIG. 9. The anchor 400 can be secured using an insertion instrument similar to the insertion instrument 114 and having a single fork (e.g., fork 116). The insertion instrument can be coupled to the anchor 400 at a location where the anchor 400 is folded.

With particular reference to FIG. 7, a side elevation view illustrates another anchor 500 for securing soft tissue to bone according to the present disclosure. The anchor 500 is another example of a flexible anchor configuration for creating an anchoring mass that can be constructed by coupling a single flexible tubular member and a single suture. The anchor 500 illustrates a feature in which the suture can deform the tubular member by twisting sections along a longitudinal axis. The anchor 500 can include a flexible tubular member 502 and a suture member 504.

The tubular member 502 can include a wall 510 defining a passage 512 extending along an axis 514 between ends 516, 518. The passage 512 can have a diameter or size configured to allow the suture member 504 to pass through the tubular member 502 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 504 when the suture member 504 is tensioned. The tubular member 502 can further include two or more apertures disposed on opposite sides between the ends 516, 518 for passing the suture member 504 through the wall 510. For example, the tubular member 502 can have four apertures 520, 522, 524, 526 as illustrated by the present example.

The apertures 520, 524 can be disposed on a first side of the tubular member 502, for example, a near side in FIG. 7. The apertures 522, 526 can be disposed on a second side of the tubular member 502 opposite the first side, for example, a far side in FIG. 7. In various aspects, the apertures 520, 524 and the apertures 522, 526 can be diametrically opposed (i.e., disposed at 180 degrees relative to each other) when viewed along the axis 514.

In an untensioned state, the anchor 500 can have an accordion first shape as shown generally in FIG. 7. While still in the untensioned state, the anchor 500 can be deformed or folded into an intermediate V-shape. The intermediate V-shape can have a height in a first direction indicated by arrow 530 that is proportional to the length of the tubular member 502. The intermediate V-shape can have a width in a second direction transverse to the first direction indicated by arrow 532 that is proportional to the diameter of the diameter of the tubular member 502. The anchor 500 can be inserted within an aperture of a bone while in the intermediate V-shape. The anchor 500 can deform from the intermediate V-shape (or the first shape) to an accordion second shape forming an anchoring mass by tensioning the suture member 504. The second shape can be wider than the intermediate V-shape in the first direction indicated by arrow 532, and can be narrower than the intermediate V-shape in the second direction indicated by arrow 530. Tension in the suture member 504 can be created by pulling on the ends 516, 518. Tension in the suture member 504 can draw the aperture 522 towards the aperture 524 and twist and ball up a section of the tubular member 502 between them.

In various aspects, the anchoring mass can be secured within an aperture of a bone in a manner similar to that illustrated by the anchor 10 in FIG. 3. For example, the anchor 500 can be positioned within a preformed bore so that the suture member 504 extends generally parallel to an axis of the bore and the tubular member 502 expands in a direction transverse to the axis when the suture member 504 is tensioned. Alternately, the anchoring mass can engage a surface of a soft tissue or a bone in a similar manner to that illustrated by the exemplary anchor shown in FIG. 9.

With particular reference to FIG. 8, a perspective view illustrates another anchor 600 for securing soft tissue to bone according to the present disclosure. The anchor 600 is another example of a flexible anchor configuration for creating an anchoring mass that can be constructed by coupling a single flexible tubular member and a single suture. The anchor 600 illustrates a feature in which the suture can deform the tubular member by bending or folding sections in an alternate manner.

The anchor 600 can include a flexible tubular member 602 and a suture member 604. The tubular member 602 can include a wall 610 defining a passage 612 extending along an axis 614 between ends 616, 618. The passage 612 can have a diameter or size configured to allow the suture member 604 to pass through the tubular member 602 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 604 when the suture member 604 is tensioned. The tubular member 602 can further include, for example, six or more apertures disposed on opposite sides between the ends 616, 618 for passing the suture member 604 through the wall 610. For example, the tubular member 602 can have twelve apertures 620, 622, 624, 626, 628, 630, 632, 634, 636, 638, 640, 642 as illustrated by the present example.

The apertures 620, 622, 624, 626, 628, 630 can be disposed in a first line on a first side of the tubular member 602, for example, a top side in FIG. 8. The apertures 632, 634, 636, 638, 640, 642 can be disposed in a second line on a second side of the tubular member 602 opposite the first side, for example, a bottom side in FIG. 8. In various aspects, the apertures 620, 622, 624, 626, 628, 630 and the apertures 632, 634, 636, 638, 640, 642 can be diametrically opposed. A longitudinal spacing of the apertures 620, 622, 624, 626, 628, 630 can be equal to that of the apertures 632, 634, 636, 638, 640, 642. As one example, the aperture 620 and the aperture 632 can be equally spaced from the first end 616 as shown.

The suture member 604 can be a suture thread of a suitable length between ends 644, 646 for passing through the tubular member 602 in a desired manner and for coupling the anchor 600 to the soft tissue by, for example, a suture stitch or other suitable coupling member. In an untensioned state, the anchor 600 can have a first shape as shown generally in FIG. 8. The anchor 600 can deform from the first shape to an accordion second shape as shown in FIGS. 9-10 forming an anchoring mass 648 by tensioning the suture member 604. Tension in the suture member 604 can be created by pulling on the ends 644, 646. Tension in the suture member 604 can draw the apertures 620, 622, the apertures 634, 636, the apertures 624, 626, 638, 640, and the apertures 628, 630 towards each other in an alternating fashion and create a series of folded sections 650, 652, 654, 656, 658 as shown in FIGS. 9-10.

With additional reference to FIGS. 8-9, an exemplary method of securing the anchor 600 with a bone 660 according to the present disclosure will now be described. The method can include securing the anchor 600 within a region of cancellous bone tissue 662 adjacent a region of cortical bone tissue 664. The method can be used during a surgical procedure for coupling adjoining anatomy such as a soft tissue 668 to the bone 660.

The method can include positioning the anchor 600 in a bore 670 prepared in a selected area of the bone 660 and tensioning the suture member 602 to set the anchoring mass 648 within the cancellous bone tissue 662 as shown in FIG. 9. With the anchoring mass 648 set, the ends 644, 646 can be passed through the soft tissue 668 and can be coupled to the soft tissue 668 by, for example, a suturing technique. When coupled, tension in the suture member 602 can compress the soft tissue 668 against the bone 660.

With additional reference to FIGS. 8 and 10, an exemplary method of engaging the anchor 600 with a bone 682 will now be described. It will be appreciated that the following method is not limited to the anchor 600, and can be used with other anchors according to the present disclosure. Generally, the method includes coupling the anchor 600 with a bone engaging surface 686. The method can include tensioning the suture member 602 to create the anchoring mass 648 and passing the ends 644, 646 through an aperture 688 formed in the bone 682 and coupling the ends 644, 646 to an anchor (not shown) positioned within the aperture 688. When coupled, tension in the suture member 602 can compress the anchor 600 against the bone engaging surface 686 of the bone 682. The anchoring mass 648 resists pull through. The foregoing method of coupling the anchor 600 to the bone 682 can be used, for example, during an ACL reconstruction surgery.

With particular reference to FIG. 11, a side elevation view illustrates another anchor 700 for securing soft tissue to bone according to the present disclosure. The anchor 700 is another example of a flexible anchor configuration for creating an anchoring mass that can be constructed by coupling a single flexible tubular member and a single suture member. The anchor 700 illustrates a feature in which the suture member can be wrapped around the flexible tubular member and can deform the tubular member by twisting sections of the tubular member about its longitudinal axis.

The anchor 700 can include a flexible tubular member 702 and a suture member 704. The tubular member 702 can include a wall 710 defining a passage 712 extending along an axis 714 between ends 716, 718. The passage 712 can have a diameter or size configured to allow the suture member 704 to pass through the tubular member 702 and to provide a locking feature through frictional and/or mechanical engagement with the suture member 704 when the suture member 704 is tensioned. The tubular member 702 can further include, for example, two or more apertures disposed on opposite sides between the ends 716, 718 for passing the suture member 704 through the wall 710. For example, the tubular member 702 can have four apertures 720, 722, 724, 726 as illustrated by the present example.

The apertures 720, 722 can be disposed in a first line on a first side of the tubular member 702, for example, a bottom side in FIG. 11. The apertures 724, 726 can be disposed in a second line on a second side of the tubular member 702 opposite the first side, for example, a top side in FIG. 11. In various aspects, the apertures 720, 722 and the apertures 724, 726 can be diametrically opposed when viewed along the axis 714. A longitudinal spacing of the apertures 720, 722 can be different than that of the apertures 724, 726. As one example, the apertures 724, 726 can be spaced further from the first end 716 than the apertures 720, 722, respectively, as shown.

The suture member 704 can be a suture thread of a suitable length between ends 730, 732 for passing through the tubular member 702 in a desired manner and for coupling the anchor 700 to the soft tissue. The anchor 700 can be assembled or formed by passing the suture member 704 through the wall 710 and the passage 712 in the following manner. The end 730 can be passed in the first side through the aperture 720, guided through the passage 712, and out the second side through the aperture 724. Next, the end 730 can be wrapped around the circumference of the tubular member 702 to the first side. The end 730 can then passed in the first side again through the aperture 722, guided through the passage 712, and out the second side again through the aperture 726.

In an untensioned state, the anchor 700 can have a first shape as shown generally in FIG. 11. The anchor 700 can deform from the first shape to second shape forming an anchoring mass by tensioning the suture member 704. Tension in the suture member 704 can be created by pulling on the ends 730, 732. Tension in the suture member 704 can draw the aperture 722 towards the aperture 724 and twist a section of the tubular member 702 between them.

With particular reference to FIG. 12, a perspective view illustrates another anchor 800 for securing soft tissue to bone according to the present disclosure. The anchor 800 can include a flexible tubular member 802 and a suture member 804. The tubular member 802 can include a wall 810 defining a passage 812 extending along an axis 814 between ends 816, 818. The passage 812 can have a diameter or size configured to allow the suture member 804 to pass through the tubular member 802 when doubled up and to provide a locking feature through frictional and/or mechanical engagement with the suture member 804 when the suture member 804 is tensioned. The tubular member 802 can further include three or more apertures disposed between the ends 816, 818 for passing the suture member 804 through the wall 810. For example, the tubular member 802 can have five apertures 820, 822, 824, 826, 828 as illustrated by the present example.

The apertures 820, 822, 824, 826, 828 can extend transverse to the axis 814 through the wall 810 from a first side, for example, a side facing to the left in FIG. 12, through to a second side opposite the first side, for example, a side facing to the right in FIG. 12. The apertures 820, 822, 824 have a size configured to allow the suture member 804 to pass through the wall 810 when doubled up as shown. The apertures 826, 828 can be smaller than the apertures 820, 822, 824 and can have a size configured to allow the suture member 804 to pass through the wall 810.

The suture member 804 can be a suture thread of a suitable length between ends 830, 832 for passing through the tubular member 802 in a desired manner and for coupling the anchor 800 to the soft tissue by, for example, a suture stitch or other suitable coupling member.

The anchor 800 can be assembled or formed by passing the suture member 804 through the wall 810 and the passage 812 in the following manner. The ends 830, 832 can be individually passed in the second side through the apertures 826, 828, respectively, guided through the passage 812, and passed out the first side through the apertures 826, 828, respectively. Passing the ends 830, 832 in the foregoing manner can create a loop section 840 that can engage an outer surface 842 of the wall 810. In various aspects, the loop section 840 can provide a stop that fixes a section of the tubular member 802 at the end 816 relative to the loop section 840. Next, the ends 830, 832 can be passed together in the second side through aperture 824, guided through the passage 812, and passed out the first side together through the aperture 824. The ends 830, 832 can be passed together through the apertures 822, and 820, in that order, in a similar manner as just described relative to the aperture 824.

In an untensioned state, the anchor 800 can have an accordion first shape as shown generally in FIG. 12. The anchor 800 can deform from the first shape to an accordion second shape as shown in FIG. 13 forming an anchoring mass 850 by tensioning the suture member 804. Tension in the suture member 804 can be created by pulling on the ends 830, 832. Tension in the suture member 804 can draw the apertures 820, 822, 824 towards the apertures 826, 828, and can compress the tubular member 802 to create a series of folded sections 860, 862, 864 as shown in FIG. 13.

With additional reference to FIG. 13, an exemplary method of securing the anchor 800 with a bone 870 according to the present disclosure will now be described. The method can include securing the anchor 800 within a region of cancellous bone tissue 872 adjacent a region of cortical bone tissue 874. The method can be used during a surgical procedure for coupling adjoining anatomy such as a soft tissue 875 to the bone 870.

The method can include positioning the anchor 800 in a bore 876 prepared in a selected area of the bone 870 and tensioning the suture member 802 to set the anchoring mass 850 within the cancellous bone tissue 872 as shown in FIG. 13. During setting, the folded sections 860, 862, 864 and sections at the ends 816, 818 can frictionally engage and/or expand beyond the bore 876 and can become embedded in the cancellous bone tissue 872. With the anchoring mass 850 set, the ends 830, 832 can be passed through the soft tissue 875 and can be coupled to the soft tissue 875 by, for example, a suturing technique. When coupled, tension in the suture member 802 can compress the soft tissue 875 against the bone 870.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.

Claims

1. An anchor for securing tissue to bone, comprising: a flexible first tubular member including a first wall defining a first passage between first and second ends;a flexible second tubular member including a second wall defining a second passage between first and second ends; anda first suture member coupling the first tubular member and the second tubular member, the first suture member passing through the first wall and the first passage and the second wall and the second passage,wherein the first tubular member and the second tubular member engage each other and deform to form an anchoring mass upon tensioning the first suture member.

2. The anchor according to claim 1, wherein: the first suture member passes through the first wall and first passage and the second wall and the second passage a plurality of times to form a first loop and a second loop,the first loop couples the first end of the first tubular member and the first end of the second tubular member, andthe second loop couples the second end of the first tubular member and the second end of the second tubular member.

3. The anchor according to claim 2, further comprising a second suture member passing through the first wall and the first passage, and overlapping the first suture member within the first passage.

4. The anchor according to claim 1, wherein the first tubular member and the second tubular member have a braided construction.

5. The anchor according to claim 1, wherein the anchoring mass has a locking configuration.

6. The anchor according to claim 1, further comprising a second suture member coupling the first tubular member and the second tubular member, wherein: the first suture member passes through the first wall and first passage and the second wall and the second passage to form a first loop coupling the first end of the first tubular member and the first end of the second tubular member, andthe second suture member passes through the first wall and first passage and the second wall and the second passage to form a second loop coupling the second end of the first tubular member and the second end of the second tubular member.

7. The anchor according to claim 1, wherein the first tubular member and the second tubular member each deform from a first shape to a second shape upon tensioning the first suture member.

8. The anchor according to claim 1, wherein: the first suture member intersects first sections of the first tubular member and second sections of the second tubular member, andthe first sections engage the second sections upon tensioning the first suture member.

9. The anchor according to claim 1, wherein the first tubular member extends substantially parallel to the second tubular member.

10. An anchor for securing tissue to bone, comprising: a flexible first tubular member including a wall defining a passage extending along an axis between first and second ends; anda first suture member passing through the wall and the passage a plurality of times to create a plurality of intersecting sections and at least one loop section coupling the plurality of intersecting sections,wherein each of the intersecting sections extends between a first aperture in the wall through which the first suture member enters the passage and a second aperture in the wall through which the first suture member exits the passage, and wherein at least two of the plurality of intersecting sections move towards each other and deform a section extending between them upon tensioning the first suture member.

11. The anchor according to claim 10, wherein: the first suture member passes through the wall a plurality of times to create a first pair of nested loop sections, a second pair of nested loop sections disposed adjacent the first pair of nested loop sections, and a third loop section coupling the first pair of nested loop sections and the second pair of nested loop sections, andthe first pair of nested loop sections, the second pair of nested loop sections, and the third loop section move the at least two of the intersecting sections towards each other.

12. The anchor according to claim 10, wherein the first suture member passes through the wall between a first side and a second side a plurality of times.

13. The anchor according to claim 10, wherein: the first suture member couples the first tubular member and a flexible second tubular member, andthe first tubular member and the second tubular member engage each other and deform to form an anchoring mass upon tensioning the first suture member.

14. The anchor according to claim 10, wherein the first suture member: exits a first aperture formed in the wall at a first rotational position and a first longitudinal position with respect to the axis,wraps at least partially around a circumference of the first tubular member, andenters a second aperture formed in the wall at a second rotational position and a second longitudinal position with respect to the axis, wherein the second rotational position is different than the first rotational position and the second longitudinal position is different than the first longitudinal position.

15. The anchor according to claim 10, wherein: ends of the first suture member separately extend through a pair of apertures in the wall to form a loop section that engages an outer surface of the first tubular member, andthe ends extend together from the loop section through a single aperture in the wall.

16. An anchor for securing tissue to bone, comprising: a flexible first elongate member having a first end and a second end;a flexible second elongate member having a first end and a second end; anda suture member coupling the first elongate member and the second elongate member, the suture member passing through both the first elongate member and the second elongate member a plurality of times,wherein the first elongate member and the second elongate member engage each other and deform to form an anchoring mass upon tensioning the suture member.

17. The anchor according to claim 16, wherein: at least one of the first elongate member and the second elongate member includes a tubular construction having a wall defining a passage between the first and second ends, andthe suture member passes through the wall at a plurality of different locations and extends through a length of the passage.

18. The anchor according to claim 16, wherein at least one of the first elongate member and the second elongate member has a braided construction.

19. The anchor according to claim 16, wherein at least one of the first elongate member and the second elongate member has a substantially solid construction.

20. The anchor according to claim 16, wherein: the suture member passes through the first elongate member and the second elongate member to form a first loop and a second loop,the first loop couples the first end of the first elongate member and the first end of the second elongate member, andthe second loop couples the second end of the first elongate member and the second end of the second elongate member.

21. The anchor according to claim 16, wherein the first elongate member extends substantially parallel to the second elongate member.

22. A method of preparing an anchor for securing tissue to bone, comprising: providing a flexible first tubular member including a first wall defining a first passage between first and second ends;providing a flexible second tubular member including a second wall defining a second passage between first and second ends; andpassing a suture member through the first wall and the first passage and the second wall and the second passage to couple the first tubular member and the second tubular member.

23. The method according to claim 22, wherein passing the suture member includes passing the suture member through the first tubular member and the second tubular member a plurality of times to form a first loop and a second loop, and wherein the first loop couples the first ends of the first tubular member and the second tubular member, and the second loop couples the second ends of the first tubular member and the second tubular member.

24. The method according to claim 22, wherein passing a suture member includes: passing a first suture member through the first tubular member and the second tubular member to form a first loop that couples the first ends of the first tubular member and the second tubular member, andpassing a second suture member through the first tubular member and the second tubular member to form a second loop that couples the second ends of the first tubular member and the second tubular member.

25. The method according to claim 22, wherein passing the suture member includes: passing a first suture member through the first tubular member and the second tubular member a plurality of times to form a first loop and a second loop, the first loop coupling the first ends of the first tubular member and the second tubular member, and the second loop coupling the second ends of the first tubular member and the second tubular member, andpassing a second suture member through the first wall and the first passage in a section of the first tubular member where the first suture member passes through the first passage.

26. A method of securing a tissue to a bone, comprising: determining an area of the bone to couple an anchor, wherein the anchor includes: (i) a flexible first tubular member including a first wall defining a first passage between first and second ends, (ii) a flexible second tubular member including a second wall defining a second passage between first and second ends, and (iii) a first suture member passing through the first wall and the first passage and the second wall and the second passage;positioning the anchor at a position relative to the area; andtensioning the first suture member until the first tubular member engages the second tubular member, and the first flexible tubular member and the second tubular member deform to form an anchoring mass.

27. The method according to claim 26, wherein positioning the anchor relative to the area includes positioning the anchor in an aperture formed in the bone.

28. The method according to claim 27, wherein positioning the anchor in the aperture includes coupling an insertion instrument to at least one of the first tubular member or the second tubular member.

29. The method according to claim 27, further comprising: passing the first suture member through the tissue; andcoupling the first suture member to the tissue.

30. The method according to claim 26, wherein positioning the anchor relative to the area includes positioning the anchor relative to a major surface of the tissue.

31. The method according to claim 30, further comprising: engaging the anchoring mass with the major surface;passing the first suture member through the tissue; andcoupling the first suture member to the bone.

32. The method according to claim 26, wherein tensioning the first suture member includes pulling on the first suture member adjacent ends of the first suture member.

33. The method according to claim 26, wherein the anchor remains substantially at the position while tensioning the first suture member.