Abstract: A suture construct apparatus, including a self-cinching suture member having a first strand, a second strand, a sleeve defined on the second strand, and a self-cinching suture member fixed loop with a sheath positioned on the self-cinching suture member. The suture construct apparatus may further include an anchor disposed on the self-cinching suture member, a self-cinching suture member shuttling suture disposed on the self-cinching suture member fixed loop, and a sheath removably disposed around at least a portion of the self-cinching suture member. The first strand may pass through the sleeve and form a self-cinching suture member free end. The first strand may also be axially moveable through the sleeve.

Abstract: Surgical constructs and methods of use for a one-way adjustable fixation loop are formed by tying two knots in a surgical filament, each knot defining an individual adjustable loop and the individual adjustable loops being interconnected to form the one-way adjustable fixation loop. The knots enable a non-spliceable suture to be used in the creation of the one-way adjustable fixable loop. Embodiments can include a fixation device, such as a cortical button or plate for use in a bone tunnel, and enable the knots to work independent of and suspended below the fixation device. Embodiments can increase the compatibility of the adjustable fixation loop with existing fixation devices and can isolate and protect the knots from damage during use and after implantation.

Abstract: A method for impacting a suture anchor into bone comprises providing an implantable suture anchor and providing an impactor device for impacting the suture anchor into the bone. The suture anchor is coupled to a distal portion of the impactor device. Positioning the suture anchor engages the anchor with the bone at an implantation site, and powering the impactor device impacts the suture anchor thereby implanting the suture anchor into the bone. The frequency of impaction is less than 20 KHz. The impactor device is then decoupled from the suture anchor, and the impactor device may be removed from the implantation site.

Abstract: An apparatus for sealing a puncture through a vessel wall including a positioning assembly, a sheath releasably engaged with the positioning assembly, and a support member axially advanceable through the sheath. The positioning assembly includes a positioning element positioned at a distal portion of the positioning assembly and a sealant disposed at a distal portion of the positioning assembly. The sheath guides the sealant and positioning assembly to the puncture in the vessel wall.

Abstract: Systems, devices, and methods are provided for securing soft tissue to bone. One exemplary embodiment of a surgical soft tissue repair device includes a snare assembly coupled to a soft anchor in which the soft anchor has a first, unstressed configuration that can be used to insert the anchor into bone and a second, anchoring configuration that can be used to fixate the anchor in the bone. The snare assembly can be configured to actuate the anchor from the first configuration to the second configuration, and it can also be used to engage and approximate tissue by drawing the tissue closer to the anchor fixated in the bone. The snare assembly can be used in conjunction with a number of different anchor configurations, and other exemplary systems, devices, and methods for use with soft tissue repair are also provided.

Abstract: A suture anchor assembly includes an eyelet of a pound-in tip formed through both of a distal portion and a proximal portion of the tip. An anchor body of the assembly is configured to be inserted over the proximal portion of the tip such that it partially occludes the tip eyelet, allowing for a shorter overall total length of the anchor assembly.

Abstract: A cup plug insertion tool comprises a cylindrical base and a cylindrical collet extending from the base and including at least two longitudinal slots that divide the collet into at least two flexible segments adapted to flex radially inward under force, an annular groove formed adjacent the base, the annular groove adapted to allow the flexible segments to flex radially inward, further wherein, the force necessary to flex the flexible segments radially inward is tunable based on a width and depth of the annular groove, a first section defining a circumferential outer diameter and a circumferential inner diameter, a second section defining a circumferential outer diameter that is larger than the circumferential outer diameter of the first section, a tip positioned at the distal end of the collet, and a chamfer formed between the outer diameter of the first section and the tip.

Abstract: A method for syndesmosis fixation including at least one suture anchor configured to be implanted into bone and at least one suture assembly configured to extend from the suture anchor and about at least a portion of a fibula when the suture anchor is implanted in a tibia on either side of a fibular notch of the tibia. The suture assembly is selectively adjustable from a non-tensioned condition to a tensioned condition to stabilize and reduce the fibula relative to the tibia.

Abstract: A surgical fastener is provided for various surgical fastening applications, including attaching an implantable prosthesis, such as a soft tissue repair fabric, to tissue and/or muscle. The surgical fastener may include a coil body and a head attached to the coil body. The head may include at least one external thread adapted to engage with a corresponding internal thread of a delivery device. The head may include a through hole adapted to receive a rod therethrough for guiding and/or driving the surgical fastener from the delivery device. The through hole may have a non-circular configuration that complements at least a portion of the shape of a non-circular rod. The coil body may also define a channel with a non-circular configuration. The non-circular through hole and/or channel may be engaged and rotated by the non-circular rod to rotate the surgical fastener for delivery and insertion of the fastener into the prosthesis and/or tissue.

Abstract: The disclosure provides devices and methods of use pertaining to extra joint stabilization. Embodiments include a number of suture returning and locking anchors that feature both a suture return element and a suture locking feature that employs an interference fit between a flexible synthetic strand, a receiver of the anchor, and a set screw, where the receiver and the set screw each have a number of gradual, opposing tapers to facilitate gradual proximal-to-distal gripping and releasing of the flexible strand to achieve an optimal locking force while preventing severing of the flexible strand. Embodiments also include a counter-torque anchor driver configured to resist torsional forces generated during and translated to the anchor during set-screw insertion. Further embodiments include extra joint reinforcement, stabilization, and attachment constructs formed using the disclosed devices. Other embodiments are disclosed.

Abstract: Self-retaining suture systems including a suture thread bearing a plurality of laser-cut retainers are disclosed. A laser system allows the creation of retainers and self-retaining suture systems in configurations which are difficult and/or impossible to achieve using mechanical cutting technology.

Abstract: A simple, threaded suture anchor is pre-loaded with suture in a configuration that allows a surgeon to compress tissue against the bone without tying a knot. The knot-tying step is replaced by a simple suture looping step which requires less time and is not prone to errors in knot tying technique. The suture anchor is a screw-in style anchor body. The suture is loaded into the anchor in a configuration that allows it to create a loop on top of the tissue after it has been passed through the tissue from bottom to top. The suture limbs are then loaded into a knotless anchor which is implanted off the lateral edge of the tissue. Tensioning of the suture limbs in the knotless anchor tightens the loop on top of the tissue, providing a fulcrum point of fixation over the pre-loaded suture anchor without the otherwise need for requisite knot tying.

Abstract: An incontinence treatment device has first and second anchor assemblies. At least one of the first anchor assembly and the second anchor assembly is adjustable along the device and has a collar disposed over a body with a strand coupled to the device and located between the body and the collar.

Abstract: A suture anchoring system having an implant body that defines a bore space extending longitudinally about a central axis from a proximal end to a distal end of the implant body. A tapering interference portion is provided on an interior surface of the implant body and extends into the bore space, the taper being toward the central axis of the implant body bore space from the proximal end to the distal end of the implant body. An anchor has a threaded anchor portion extending therefrom and defines a threaded bore, where the extended threaded anchor portion configured to be received in the bore space of the implant body. A slot is defined in the threaded anchor portion, the slot configured to receive the interference portion of the implant body; and a threaded plug is configured to be received in the threaded bore of the anchor.

Abstract: Provided are tissue repair and sealing devices, and methods for the use of tissue repair and sealing devices, for use in both minimally invasive surgical (MIS) procedures and open, non-MIS procedures to rapidly repair tissue fenestrations and create a pressure-resistant, watertight seal in a tissue barrier. Tissue repair and sealing devices disclosed herein comprise an integrated graft and deployable clasp assembly and an applicator assembly having a clasp retain and release member that is slidably connected to a folded, deployable clasp. The applicator assembly places a graft on a tissue inner surface and a deployable clasp on a tissue outer surface to secure the graft to the tissue inner surface to, thereby, repair a tissue fenestration and create a watertight barrier.

Abstract: A surgical device includes a first fastener having a planar profile, a second fastener having a concave surface, and a suture that can be manipulated to change a distance between the first and second fasteners. The second fastener has a curvature that substantially matches the curvature of a top surface of a clavicle bone in a direction perpendicular to a long axis of the clavicle bone. A method of treating an acromioclavicular joint injury includes forming axially aligned passages through a patient's clavicle and coracoid process, passing a fastener having a concave surface through the passages, positioning the concave surface of the fastener against a top surface of the patient's clavicle with a long axis of the fastener extending perpendicular to a long axis of the clavicle, positioning a fastener having a planar profile below the patient's coracoid process, and adjusting a suture that couples the fasteners.

Abstract: Devices and methods for bone fixation including a bone fixation system including a bone plate or intervertebral spacer including a plurality of apertures dimensioned to receive bone fasteners and at least one polymeric element capable of transitioning from a solid state to a flowable state. The polymeric element transitions to a flowable state as a result of exposure to ultrasonic vibration. The polymeric element is placed on the bone plate or intervertebral spacer adjacent a fastener in an aperture and acts to prevent rotational and/or translational movement of the fastener relative to the bone plate or intervertebral spacer.

Abstract: A bone implant and in particular a dental implant having an apical end configured to facilitate placement and stabilization within an implantation site, wherein the distal end of said apical end has a contoured surface, and the apical surface of said apical end has at least one apical surface recess extending toward the coronal part of the implant.

Abstract: A tenodesis anchor having an anchor member coupled to at least one fiber loop. The anchor member is inserted into a bone and the loop closed about a tendon to be anchored to the bone. Closing the loops additionally deforms the anchor member so that it remains within the bone, thereby securing the tendon trapped in the loop to the bone without the use of a staple.

Abstract: A method for the treatment of plantar plate injury including insertion of at least one suture anchor into a bone opening and anchoring the at least one suture anchor and thereafter threading two ends of a suture of at least one anchored suture anchor through the plantar plate and pulling the plantar plate to the bone with the opening and fix the soft tissue to that bone by tying a knot in the suture.

Abstract: A device for closure of an atrial septal defect (ASD) by deploying a pericardial patch includes a head including a distal jaw and a proximal jaw, and a distal disc attached to the distal jaw and a proximal disc attached to the proximal jaw. Each of the distal jaw and the proximal jaw includes at least one arm which closes when the distal disc moves forward and the proximal disc moves backward. Based on an engagement status of a distal engagement portion located on the at least one arm of the distal jaw with a proximal engagement portion located on the at least one arm of the proximal jaw, the pericardial patch deploys to close the ASD.

Abstract: Methods and devices are provided for anchoring suture to bone. In one exemplary embodiment, a suture anchor is provided that includes one or more bone-engaging surfaces features and an external sidewall. The external sidewall can allow a suture coupled to the suture anchor and located between the anchor and bone to be movable relative to the suture anchor, even when the suture anchor is partially or fully disposed within a bone hole. Suture threaders and suture anchor drivers are also provided that can be used with the various methods and devices disclosed herein, or with other methods and devices known in the art.

Abstract: A bone anchor includes a shank having a free end, a longitudinal axis, a channel extending axially through the shank to the free end, the channel having a first width, and at least one opening extending through a wall of the shank, and a narrowing member including an elastically deformable portion configured to extend into the channel at or near the free end. The narrowing member is adjustable from a first configuration where the deformable portion defines an opening with a width smaller than the first width to restrict a substance from exiting through the free end, to a second configuration where the deformable portion is deformed radially outwardly to define an opening with a width that is at least the first width, while at least a portion of the shank positioned at a same axial height as the deformable portion maintains a constant outer width.

Abstract: The invention provides devices, systems and methods for tissue approximation and repair at treatment sites. The devices, systems and methods of the invention will find use in a variety of therapeutic procedures, including endovascular, minimally-invasive, and open surgical procedures, and can be used in various anatomical regions, including the abdomen, thorax, cardiovascular system, heart, intestinal tract, stomach, urinary tract, bladder, lung, and other organs, vessels, and tissues. The invention is particularly useful in those procedures requiring minimally-invasive or endovascular access to remote tissue locations, where the instruments utilized must negotiate long, narrow, and tortuous pathways to the treatment site. In addition, many of the devices and systems of the invention are adapted to be reversible and removable from the patient at any point without interference with or trauma to internal tissues.

Abstract: Methods and devices are provided for anchoring suture to tissue, incorporating anchoring devices constructed substantially from suture. The anchoring devices are constructed as longitudinally extended, preformed knot configurations that upon deployment are reconfigured to form anchoring knots having an increased cross-section relative to the preformed knot configuration, for secure lodging in tissue. The anchoring devices are suitable for single and multi-anchor surgical procedures in soft tissue or bone, and multiple anchors can be delivered using a single delivery device.

Abstract: A device that allows for the predictable/guided anatomic drilling of claviclular tunnels for graft, suture, or combined graft/suture reconstruction of the AC joint is provided. The device simultaneously allows for larger clavicle tunnels which permit graft passage while providing protection, via stress shielding, of the bone between and adjacent to the bone tunnels. In this way, the surgeon is able to utilize anatomically placed clavicular tunnels large enough for graft passage (which reduces the mechanical failure rate of the reconstruction and most closely replicates normal anatomy) while reducing the risk of clavicle fracture, which has plagued other “anatomic reconstruction” techniques.

Abstract: Various self-cinching suture anchors, self-cinching suture anchor systems, and methods of use are provided. In one exemplary embodiment, a suture anchor is provided that includes an outer member and an inner member configured to be received within the outer member. The inner and outer members can define a gap that allows a suture to be movably disposed within the outer member, e.g., within the gap, when the inner member is disposed within the outer member. The inner member can be configured to be secured within the outer member by a knot of the suture having a diameter greater than a width of the gap so as to fix the inner member within the outer member, while still allowing uni-directional tensioning of the suture.

Abstract: An anchoring system includes an anchor including an anchor body and a distal member located at a distal end of the anchor body, the distal member having a suture receiving aperture; and an implant delivery device, comprising: a cannulated outer shaft, the cannulated outer shaft configured to engage a proximal end of the anchor body for driving the anchor into a bore; and an inner shaft slidably received in the cannulated outer shaft, wherein a distal end of the inner shaft is extendable distally beyond a distal end section of the cannulated outer shaft such that, when the cannulated outer shaft is engaging the proximal end of the anchor body, the distal end of the inner shaft is extendable through the anchor body to a distance beyond the distal end of the anchor body to engage a suture located within the suture receiving aperture, wherein the anchoring system is configured such that the suture can be tensioned at a location within the bore distal from the anchor body before the anchor body is implanted within

Abstract: Button-suture assemblies which employ a knotted locking mechanism do not maintain tension when securing bone and tissue fragments. A knotless method and device for maintaining tension and providing precise placement of a button-suture assembly during stabilization procedures comprising a locking pin, which mates with a button creating pinch points with increased surface area through which suture can pass from a baseplate through two dedicated openings in the button, one for the first end of the suture and one for the second end of the suture while preventing tension loss during the locking step and therefore allowing for precise placement of the button-suture assembly.

Abstract: This anchor (1) includes two parts (2, 3) that are to be assemble: an outer part (2), forming at least a first jamming surface (16a) for jamming the suture thread (100); and an inner part (3), intended to be inserted and retained in the outer part (2), which forms a transverse conduit (21) and at least a second jamming surface (25) for jamming the suture thread (100).

Abstract: A suture anchor may include an anchor body having an exterior surface, a proximal end, a distal end, a longitudinal axis extending between the proximal and distal end, an interior longitudinal passageway extending at least partway from the proximal end toward the distal end, a proximal opening communicating with the longitudinal passageway nearer the proximal end, and a plurality of distal openings communicating with the longitudinal passageway nearer the distal end. The suture anchor may also include a suture routed through the plurality of distal openings, with a first portion extending within the longitudinal passageway between the proximal opening and the distal opening, a second portion, contiguous to the first portion, extending out of the anchor body, a third portion, contiguous to the second portion, extending within the longitudinal passageway proximally to distally, and a fourth portion, contiguous to the third portion, extending along the exterior surface distally to proximally.

Abstract: A TPLO plate configured to accommodate flexible strands (flexible loops) attached to tissue to be attached to bone. The TPLO plate has one or more suture eyelets, to allow the user (surgeon) to pass a flexible strand through the eyelets and attach/reattach the tissue to the plate at the anatomical location, and to improve the rotational stability of the joint or bone. The eyelets may have various shapes, forms and configurations and may be provided on or within a surface of the TPLO bone plate in any number, depending on the characteristics of the fractured bone or bone segments, or of the plate design. The eyelets preferably receive one or more flexible strands.

Abstract: Tissue fasteners carried on a tissue piercing deployment wire fasten tissue layers of a mammalian body together. The fasteners include a first member, a second member, and a connecting member extending between the first and second members. The first and second members are substantially parallel to each other. The fasteners may be deployed in limited spaces and in various applications including the restoration of a gastroesophageal flap valve.

Abstract: Improved suture anchors are disclosed for anchoring one or more sutures attached to soft tissue to a bone. The suture anchor has an anchor body that extends between a distal and a proximal end. A bore is formed axially in the anchor body and opens at the proximal end. A rigid member is fixed within the bore of the anchor body and limits proximal movement of a suture loop positioned within the bore of the bone anchor. One or more sutures with free ends extending from the suture anchor are used for attachment of soft tissue. The anchor body has a socket within the bore for receiving a driver tool. The distal end of the anchor body may including a non-threaded extension. The anchor body can be threaded to a periphery of a proximal face at the proximal end to engage hard bone tissue.

Abstract: Described herein is a suture for connecting a human or animal tissue comprising a suture strand, wherein at least two protrusions are provided on the suture strand, the protrusions are provided spaced apart from each other along the suture strand. Also described herein is a soft anchor, the soft anchor having a proximal end and a distal end in an insertion direction. At the proximal end and the distal end the soft anchor includes respectively at least one opening for a suture. The proximal end and the distal end of the soft anchor are connected with at least one, in particular two, connecting portions. The soft anchor has a first state, in which it is adapted to be inserted into a bore in the insertion direction, and a second state, in which it is locked in a bore. In the first state, the distal end and the proximal end defines the extension of the soft anchor in insertion direction.

Abstract: A button inserter apparatus for the insertion of a surgical button includes an inserter handle and an elongated inserter shaft connected at one end to the inserter handle. An inserter head is connected to the inserter shaft at an end opposite to the inserter handle. The inserter head includes opposing engagement projections for engaging and retaining a surgical button there between. One of the engagement projections is longitudinally movable relative to the other of the engagement projections. A button engage and release assembly extends from the inserter handle to the inserter head, and selectively prevents relative longitudinal movement between the engagement projections, and selectively permits relative movement of the engagement projections and thereby release of the surgical button. The engage and release assembly is operable from the inserter handle to cause relative longitudinal movement of the engagement projections and release of the surgical button.

Abstract: An insertion tool for deploying a flip anchor cable, including: a mechanism having a safety button and a slider, wherein the mechanism is configured to apply a clamping force on a portion of the flip anchor cable when the mechanism is in a first position; an inner tube having a proximal end connected to the mechanism configured to house a second portion of the flip anchor cable; a handle including a safety button opening and a slider opening, wherein the handle is configured to enclose a portion of the mechanism; and an outer tube having a proximal end connected to the handle configured to receive the inner tube; wherein the mechanism is configured to decrease the clamping force on the flip anchor cable when the mechanism is in a second position and to deploy a flip anchor of the flip anchor cable in the second position.

Abstract: An anchoring system for securing tissue to bone includes an implant having a body through which a suture eyelet extends transversely, a suture recess extending along a portion of a length of the body, having a predetermined depth below an outer surface of the body, and a suture pinch ramp disposed at a proximal end of the suture recess. The suture pinch ramp has a depth approximately equal to the predetermined depth at a distal end thereof and sloping outwardly in a proximal direction so that a depth of a proximal end of the suture pinch ramp approaches zero. An insertion member includes an insertion tube and a handle which is engageable with the anchor body to deploy the anchor in a selected bone site.

Abstract: Suture/needle constructs are disclosed in which either a first round or flat section of suture can be crimped on a needle. If the first section is round, then a transition to flat second section is formed by a braiding machine. After a short space of flat, the braiding machine weaves a bifurcation into the second section, forming third and fourth suture sections. The third and fourth suture sections transition back together again into a woven fifth section at a distance from the needle, which forms a suture loop. This looped section of the suture can then be used for whipstitching a tendon or a ligament graft.

Abstract: A tissue anchor, tissue anchor assembly, and tissue anchor system is disclosed.

Abstract: A surgical drill bit and corresponding systems and methods of use are disclosed. The surgical drill bit being adapted and configured for cutting first and second, collinear holes within first and second portions of a patient's bone. In one embodiment, the drill bit includes a smaller diameter distal cutting portion, a larger diameter proximal cutting portion, and a shoulder positioned between the smaller diameter distal cutting portion and the larger diameter proximal cutting portion. In use, the smaller diameter distal cutting portion is adapted and configured to cut when rotated in a first direction, the larger diameter proximal cutting portion is adapted and configured to cut when rotated in a second, opposite direction. In this manner, over-drilling of the patient's bone is thereby prevented.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose on a first portion of at least a first limb and has a second portion connected to the filament engagement feature of the anchor. Preferably, at least one free filament limb, which in some embodiments is a length of the first filament and in other embodiments is a second filament, is capable of being passed through tissue to be repaired and has at least one end passable through the noose to enable incremental tensioning of the tissue after the anchor is fixated in bone. The noose strangulates the free filament limb when tension is applied to at least one of the free filament limb and the noose.

Abstract: A suture connection system and method includes a suture connector having a body configured to be inserted into a hole in a bone plate, the body being threaded to secure the suture connector in to the bone plate. At least one recess extends inwardly from a sidewall of the suture connector to define a proximal engagement portion and a through hole configured to receive a suture extends through the proximal engagement portion and is open to the recess. A driver includes an elongate rod and an engagement element coupled to the distal end of the rod, the engagement element having at least one prong configured to engage the proximal engagement portion to insert the suture connector into the bone plate hole.

Abstract: A suture anchor method including a suture anchor and a suture anchor drive. The suture anchor is positionable on a rod of the suture anchor drive. The rod defines an awl for forming a hole in a bone. The suture anchor drive further has an impactor for moving the suture anchor along the rod between a retracted position and an advanced position so as to implant the suture anchor in the bone with the awl positioned in the bone.

Abstract: A device to close the left atrial appendage of a patient including a hollow shell having opposed male and female ratchet latches with the shell moveable into the left atrial appendage orifice to close the orifice by interconnecting the latches to expand the shell in conformance with the profile of the orifice.

Abstract: An anchor includes (a) an anchor head; and (b) a tissue-engaging member extending distally away from the anchor head until a distal tip of the tissue-engaging member, and configured to anchor the anchor to tissue. An anchor driver can include (a) a longitudinal shaft, having a flexible distal portion and a distal end; (b) a deployment element at the distal end of the shaft, reversibly lockable to the anchor head, and reversibly movable between (i) a locked state that retains locking between the deployment element and the anchor head, and (ii) an unlocked state that unlocks the deployment element from the anchor head; and (c) a tissue-piercing lance, reversibly movable between (i) an extended state in which the lance extends distally from the shaft past the distal tip of the anchor, and retains the deployment element in the locked state, and (ii) a retracted state in which the deployment element automatically moves into the unlocked state.

Abstract: A medical device for wound closure, e.g., repairing perforations and tissue wall defects. The medical device has a barbed elongate body and an outer member. The medical device may further include a foam structure. The medical device may also include an inner member which may be a tissue scaffold. A method for closing tissue is also disclosed.

Abstract: An anchor system for securing suture tissue to bone. The system includes an anchor and an inserter. The anchor is printed from a polymer by selective laser sintering in accordance with a CAD file having a geometric description of the anchor. A socket at the proximal region of the anchor has cross-section that has a width in a first dimension D1. The system includes an inserter having a protrusion being configured to matingly engage with the socket. The protrusion defines a cross-section that decreases progressively in width in the dimension D1 along the protrusion length distally from the base of the protrusion toward the distal tip of the protrusion.

Abstract: Various devices, systems and methods for knotless suturing of tissue are disclosed. These devices allow sutures to be anchored to bone, and more specifically provide a suture anchor which eliminates the need for knotting the suture. Thus, damaged tissue may be re-attached to a substrate tissue. The anchors have a minimum of moving parts may be suited to being a single molded polymer construction. The anchors will find particular utility in hip and shoulder arthroscopy, e.g. labral re-attachment and similar procedures.

Abstract: A knotless button includes a body defining a proximal portion and a distal portion. The body further defines an internal cavity and a first loop opening extending from the internal cavity to an outer surface of the body. A locking insert is slideably positioned within the internal cavity. The locking insert defines a second loop opening extending from a first side of the locking insert to a second side of the locking insert. The locking insert is slideably moveable from a first position to a second position within the internal cavity. A flexible strand defines a first adjustable loop extending through the first loop opening and the second loop opening. The locking insert is slideably moveable from a first position configured to allow adjustment of the first adjustable loop to a second position configured to lock the first adjustable loop.