Abstract: Assemblies and methods suitable for knotless arthroscopic repair of tissue defects include two fixation members coupled by two limbs of suture comprising a continuous loop. A unidirectional restriction element that can be a preformed locking, sliding suture knot proximate to one of the fixation members, provides tensioning of the repair.

Abstract: A surgical stapling apparatus includes an end effector having an anvil assembly and a staple cartridge assembly, and an anvil buttress retention system releasably disposed on the anvil assembly. The anvil buttress retention system includes an anvil buttress and a retention member including an elongated body looped around at least a portion of the anvil buttress with a free end of the elongated body extendable through a looped end of the elongated body in an untightened configuration such that the anvil buttress retention system is slidable relative to the anvil assembly. The free end of the retention member is movable relative to and through the looped end to a tightened configuration to secure the anvil buttress retention system to the anvil assembly.

Abstract: Described herein are methods and apparatus for approximating targeted tissue using locking sutures. The locking sutures can be configured to receive suture ends that are interweaved through portions of the locking sutures. In a pre-deployment configuration, a locking suture can slide along suture tails and can be positioned at a target location within a target region. Once a desired position and/or tension is achieved, the locking suture can be transitioned to a post-deployment configuration where the locking suture constricts around the suture tails to inhibit relative movement between the suture tails and the locking suture.

Abstract: Systems, devices, and methods for soft tissue repair are generally provided and they generally involve the use of surgical filaments that are configured in a variety of manners to minimize and/or eliminate the tying of knots during a surgical procedure. Moreover, systems and devices described herein can provide for a reversible locking knot, which allows for additional tension to be applied to the repair if adjustments are required after the construct has been locked. The reversible locking knot can be “flipped” or actuated without requiring the knot to be untied and then retied. Further, systems and devices described herein can additionally be used to associate implantable bodies and suture constructs within a bone to secure soft tissue while not restricting the relative movements of operative sutures once the implantable body has been deployed.

Abstract: A prosthetic suturing device is disclosed. The prosthetic suturing device has a housing and a needle press slideably engaged with the housing. The prosthetic suturing device also has a plurality of needles coupled to the needle press. The prosthetic suturing device further has a prosthetic retainer. The prosthetic suturing device also has a ferrule platen having a plurality of ferrule holders, each corresponding to one of the plurality of needles. The prosthetic suturing device further has an actuator configured to move the needle press from a retracted position where needle tips of the plurality of needles are away from the ferrule platen to an engaged position where the needle tips of the plurality of needles are at least partially within the ferrule holders of the ferrule platen.

Abstract: An improved method for attaching a sheet-like implant to tissue or bone with a fastener having a first and second arm, and a bridge extending therebetween. Each of the first and second arms include a trunk portion including a longitudinally displaced first and second projections extending in opposite directions within a plane defined by the trunk portions. The method includes forming first and second pilot holes in the tissue or bone using a trocar, receiving the first and second trunk portions within their respective pilot holes, and applying a pullout force on the bridge to create an in-plane torque on each trunk such that the resistance to pullout is increased.

Abstract: The present invention relates to an apparatus (3) for use during implanting at least one medical implant (6) at an implantation site within a patient's body, wherein the apparatus (3) comprises an aligning device (9) for aligning the apparatus (3) at the implantation site, wherein the aligning device (9) is capable of being transferred from a non-aligning position into an aligning position. It further relates to a set and a method.

Abstract: A tendo calcaneus suturing instrument, comprising: a first support and a second support that are of a U-shaped structure, a distance adjustment device, a first guide sleeve, a second guide sleeve, a first positioning tube, a second positioning tube and a tendo sheath cutter. An outer arm and an inner arm of the first support, and an outer arm and an inner arm of the second support are respectively provided with a first positioning hole, a first guide hole, a second positioning hole and a second guide hole; and the first guide sleeve/the second guide sleeve is fixed by means of the first positioning hole/the second positioning hole and is matched with the first guide hole/the second guide hole. The first positioning tube/the second positioning tube provided with a through hole is arranged in the first guide sleeve/the second positioning sleeve or the tendo sheath cutter is arranged in the first guide sleeve and/or the second guide sleeve in a matching manner.

Abstract: A tissue thickness compensator may generally comprise a first layer comprising a first biocompatible material sealingly enclosed in a water impermeable material and a second layer comprising a second biocompatible material comprising at least one encapsulation, wherein the first biocompatible material expands when contacted with a fluid. The tissue thickness compensator may comprise a haemostatic agent, an anti-inflammatory agent, an antibiotic agent, anti-microbial agent, an anti-adhesion agent, an anti-coagulant agent, a medicament, and/or pharmaceutically active agent. The encapsulation may comprise a biodegradable material to degrade in vivo and/or in situ. The tissue thickness compensator may comprise a hydrogel. The reaction product may comprise a fluid-swellable composition. Articles of manufacture comprising the tissue thickness compensator and methods of making and using the tissue thickness compensator are also described.

Abstract: Intravascular devices and systems useful for blocking the opening of an aneurysm or a vessel branch are disclosed. In some aspects, the disclosure provides arrangements that align a covering material of a stent graft with an opening in the vessel wall before, during, and/or after expansion of the stent graft within the vasculature of a patient. In some instances, systems and devices include a sheath with a side aperture arranged to align a portion of the sheath and/or a portion of a stent graft contained within the sheath with the mouth of an aneurysm. Similarly, the present disclosure also provides embodiments in which the stent graft comprises an aligning member arranged to align the stent graft and/or a sheath with the mouth of an aneurysm. Other embodiments are disclosed.

Abstract: A fixing device for suturing of blood vessels is provided, which includes a connecting rod, a first clamping member, a second clamping member, a first extension tube and a second extension tube. One end of the first clamping member is disposed on the connecting rod, and the other end of the first clamping member has a first clamping head. One end of the second clamping member is disposed on the connecting rod, and the other end of the second clamping member has a second clamping head. The first extension tube is disposed on an inner side of the first clamping head. The second extension tube is disposed on an inner side of the second clamping head and opposite to the first extension tube, wherein a relative position of the first extension tube and the second extension tube is adjustable.

Abstract: A suturing device includes a needle, a suture, an elongate body, an actuator and a needle holder. The suture connects with the needle. The needle holder extends away from a distal end portion or is provided as part of the distal end portion of the elongate body. The needle holder includes a distal end section having a distal-most tip, and defines a needle passage for holding the needle and a distal opening. At least a portion of the suture extends through the distal opening when the needle is received in the needle passage and the actuator is in a first operating position. At least a portion of the suture extends along the needle passage toward the distal opening between the needle and an inner surface of the needle holder when the needle is received in the needle passage and the actuator is in the first operating position.

Abstract: A suturing system including apparatus and methods for disposing stitches in a substrate comprising a thread carrier which inserts a thread in the substrate at a first location and withdraws the thread from the substrate at a second location.

Abstract: A method and apparatus for securing a suture to bone can include grasping a first suture portion with a grasping member on a positioning tool. The first suture portion can be located into a first cannulation defined in the positioning tool. A cutting member can be advanced through a second cannulation defined on the positioning tool and out through a distal opening defined on the positioning tool. A first bone hole can be cut into the bone with the cutting member. A flexible member advancing tool can be advanced through the first cannulation. The first suture portion can be urged out of the distal opening and into the first bone hole.

Abstract: A surgical port is disclosed. The surgical port has a multi-level flange defining one or more suture channels therethrough. Adjacent levels of the multi-level flange are configured to pinch one or more sutures placed therebetween. The surgical port also has a cannular frame defining one or more cannular channels in communication with the one or more suture channels.

Abstract: A suturing device includes a curved needle, a suture, an elongate body, an actuator and a curved needle holder. The suture connects with the curved needle. The actuator is operable between a first operating position and a second operating position. The curved needle holder extends away from a distal end portion or is provided as part of the distal end portion of the elongate body. The curved needle holder includes a distal end section having a distal-most tip. The curved needle holder defines a curved needle passage and a distal opening. Movement of the actuator from the first operating position toward the second operating position moves the curved needle with respect to the curved needle holder toward a released condition. The distal end section is configured to allow the curved needle to release from the curved needle holder at a location offset from the distal-most tip.

Abstract: A suture securing assembly comprises a two-bodied anchor and an associated delivery system which enhances fixation of a micro anchor in a bone hole or tunnel, as well as improving suture lock within bone. Initially, the two bodies are separated by a length of an inner shaft of the delivery system. The proximal body is fixed on the inner shaft of the delivery system and cannot move relative to the handle until after insertion into the bone, when the delivery system is disengaged from the anchor. The distal body further includes expansion wings and/or other features for increasing suture lock within the bone hole.

Abstract: Anchor delivery systems and methods for repairing a valve inside a body, such as an atrioventricular valve, may include an anchor delivery device including a sheath for at least partially retaining an anchor in a collapsed form. The anchor delivery device may be configured to deliver the anchor to the atrioventricular valve. The anchor and an adjacent anchor may be connectable to each other in an expanded form, to link a series of anchors implanted at least partially around the atrioventricular valve. In some embodiments, the anchors may be connectable by a connecting member, such as a pledget, or a material disposable on a bulb of the anchor. In other embodiments, a bulb of the anchor and a bulb of the adjacent anchor may be configured to be directly interlocked.

Abstract: Provided is a digestive-tract treatment method including: pulling, inside a digestive tract (A), an end portion of a first wall portion (A1) positioned at a rim of a treatment target site (B), and moving the first wall portion (A1) to a position on a second wall portion (A2) on an opposite side of the treatment target site (B) from the first wall portion (A1); and joining the first wall portion (A1) and the second wall portion (A2) in a state in which the first wall portion (A1) and the second wall portion (A2) are layered.

Abstract: A surgical stapling apparatus includes a jaw assembly including an anvil assembly and a staple cartridge assembly, at least one which includes a surgical buttress retention system, and a surgical buttress releasably secured to a tissue facing surface of the anvil assembly or the staple cartridge assembly via the surgical buttress retention system. The surgical buttress retention system includes proximal guide slots defined in opposed sides of the anvil assembly or the staple cartridge assembly that have a generally U-shaped configuration that are mirror images of each other, a plug coupled to a distal portion of the anvil assembly or the staple cartridge assembly, and a retention member including a central portion extending across a proximal portion of the surgical buttress, second portions positioned within the proximal guide slots, third portions extending across a distal portion of the surgical buttress, and end portions coupled to the plug.

Abstract: Surgical constructs, assemblies and methods for tissue reinforcement with a reinforcement (reinforcing) material such as suture, tape, weave, ribbon or mesh, among many others. The reinforced construct includes a reinforced section that prevents a suture from pulling apart. The reinforced section is be a piece of material (a reinforcement or reinforcing material) such as reinforced stitched suture tape attached to a flexible strand. A needle attached to the flexible strand terminating with the reinforced section passes through a proximal end of the reinforced section to form an adjustable “starter loop.” The starter loop is slid and positioned over tissue (for example, graft, tendon, ligament, etc.) and the suture is pulled apart to tighten the loop around the tissue.

Abstract: Embodiments include a method of stapling an anatomical structure of a patient during a minimally invasive procedure, the anatomical structure having a first side and a second side, the method comprising the steps of providing an end effector, the end effector comprising a first jaw having an anvil, a second jaw having a cartridge housing a plurality of staples, providing a buttress, the buttress comprising a first buttress member and a second buttress member, attaching the first buttress member to the anvil, attaching the second buttress member to the cartridge, deploying the plurality of staples, and cutting the first buttress member and the second buttress member.

Abstract: A suturing device includes an elongate body, an actuator, a needle holder and a knot pusher. The elongate body includes a proximal end portion and a distal end portion. The actuator interacts with the elongate body and is operable between a first operating position and a second operating position. The needle holder extends away from the distal end portion or is provided as part of the distal end portion of the elongate body, and includes a distal end section having a distal-most tip. The needle holder defines a needle passage and a distal opening adjacent the distal-most tip. The knot pusher connects with and extends away from at least one of the elongate body and the needle holder.

Abstract: Knot pushers and suture cutter apparatuses to be used arthroscopically, for example, in an arthroscopic knee surgery may be operated with a single control to both lock the suture within the distal end of the apparatus and cut the suture once the knot has been pushed to the appropriate location. The apparatus may include a safety lock preventing deployment of the cutter until the safety lock (e.g., cutter release) has been released.

Abstract: A penile prosthesis implantation apparatus and related methods are described.

Abstract: A trocar assembly includes a cannula assembly, an obturator assembly, and a catch arm. The cannula assembly has a housing, a cannula, and a working channel defining a longitudinal axis from a proximal opening to a distal opening. The obturator assembly includes a proximal head, a distal tip, and a shaft extending therebetween. The catch arm is selectively moveable from a retracted position to a first and second deployed positions and is configured to releasably capture a suture thread. In the retracted position, the catch arm is positioned radially inward from the first deployed position. In the first deployed position, the catch arm is positioned radially outward from the retracted position. In addition, the catch arm is configured to be moved a predetermined distance from the first deployed position to the second deployed position and release the captured suture thread therefrom.

Abstract: Devices, systems and/or methods for repairing soft tissue, such as, a lacerated tendon. A repair device includes a frame having a tubular structure with a longitudinal length and struts at least partially defining the tubular structure. The frame includes a first portion and a second portion with an intermediate portion therebetween, each extending along the longitudinal length. The intermediate portion is configured to substantially maintain a fixed position and is configured to be positioned over first and second ends of the lacerated tendon to substantially maintain the first end abutted against the second end. The first portion and the second portion of the frame are configured to be positioned over separate portions of the tendon and configured to move and elongate along a length of the respective first portion and second portion of the frame as the portions of the tendon elongate.

Abstract: A suture apparatus having a housing, actuator and capture rod, the actuator being engaged to the capture rod to form an actuator-capture rod assembly, an elongated cannula shaft having a lumen that extends through the shaft, and capture rod retraction means, the housing including an internal region that is configured to receive and support the capture rod retraction means, actuator proximal end and actuator rod distal end therein, wherein said capture rod retraction means is in communication with said actuator. The actuator-capture rod assembly and capture rod retraction means being positioned and configured to transition from a retracted position to an extended position when an actuation force is applied to the actuator and return the retracted position by the retraction means when the actuation force is released.

Abstract: The maxillary frenum clamping tool includes two articulating members, each of the members having a clamping end and a gripping end. The clamping ends of the articulating members are curved to retract the upper lip while clamping the maxillary labial frenum and have blunt tips to minimize damage to the surrounding tissue. Immediately below the blunt tips, each member defines a jaw section having a serrated inner edge. The outer edges of the jaw sections define guide indentations for guiding a curved suture needle. The gripping end of each member defines a finger loop and part of a ratcheting lock mechanism for locking the members at set positions. During use, the clamping too may be used to clamp the maxillary frenum with the jaw portions so that the clamped tissue can be easily sutured using the guide indentations.

Abstract: An exemplary suture anchor system includes a first suture anchor having a central axis, a distal end portion, a proximal end portion, and an internal passage extending along the central axis between the distal end portion and the proximal end portion. The resilient member is at least partially external to the internal passage, and a flexible strand is connected to the resilient member. An exemplary method includes fixating a spring loaded first suture anchor in a first bone, passing a flexible strand from the spring loaded first suture anchor to a second suture anchor, and fixating the second suture anchor in a second bone.

Abstract: Devices, systems, and methods are provided for managing suture filament during a tissue repair procedure. One exemplary embodiment of an anchor insertion tool includes a handle, an elongate shaft extending distally from the handle, and a ring disposed around the elongate shaft. The ring can be configured to slide along a length of the shaft, and can be configured to engage a filament extending from an anchor removably coupled to the shaft's distal end during a suture anchor insertion procedure. In some embodiments, the ring can include one or more slots for receiving a filament and maintaining a tension applied to the filament. The ring can also include features that prevent it from rotating with respect to the shaft, such as a boss formed on a ring's central opening that engages a slot formed in the shaft. Other devices, systems, and methods for suture anchor insertion are also provided.

Abstract: A surgical suturing device having an axis extending between a proximal end and a distal end is operable to move a suture through body tissue. An actuating rod extends between the handle assembly and the shaft. A needle assembly at the distal end of the actuating rod is movable with the actuating rod between an extended state and a retracted state. Bifurcated portions of the needle assembly define a suture slot, the bifurcated portions have a proximate relationship when the needle assembly is in the retracted state and having a separated relationship when the needle assembly is in the extended state. The needle assembly is biased to the retracted state and the bifurcated portions are biased to the separated relationship. A handle assembly is configured to releasably receive the needle assembly and is operable to move the needle assembly between a free suture state and a captured suture state.

Abstract: A system and method for closing a fascial opening is disclosed. The system may include a strap that may be locked into each of a pair of anchors placed anterior to a muscle and on opposite sides of a fascial opening, one or more delivery tubes for delivering the anchors, and a needle for pulling the strap into each anchor. The method may include the steps of placing a dilating port through a skin incision, inserting an anchor through the dilating port, placing a strap into the body cavity, whereupon the strap may be pulled through the anchor. A second anchor may be placed on the contralateral side of the defect so that the strap may be pulled through the second anchor and cinched tightly closing the defect. The anchors may have a locking aperture that engages with the strap.

Abstract: This document relates to the apparatus and methods used in the minimally invasive creation of arteriovenous fistula (AVF). In particular, the invention relates to the creation of an AVF using catheters and an alignment methodology that is based upon detection of asymmetric electric fields. The invention finds particular application in vascular access (VA) in the hemodialysis (HD) population.

Abstract: An aiding and guiding instrument for surgical sutures includes a frame that can be rested on a patient proximate to a wound to be sutured and/or to flaps of body tissue and/or prosthetic tissue to be mutually fixed. The frame defines, on the other side from the area configured to be placed on the patient, a plurality of raised portions arranged in series. At least some of the raised portions are mutually spaced to define respective seats for accommodating blocks. In the gap between each block and each contiguous raised portion, it is possible to temporarily stably accommodate a portion of a suture thread. At least one portion of the frame, associated with the raised portions and seats, can be plastically deformed to maintain the shape obtained following a deformation imparted by a user, and freely select the frame shape, and of the mutual arrangement of the raised portions and blocks.

Abstract: An implant system for providing stabilized fixation of tissue includes a button having a slot, a band threaded through the slot, and a lock including a member having a slot for receiving an end of the band and a movable member for clamping the band in place. The movable member is movable between an open position and a locking position. The lock is a plug assembly which includes a flange. The slot is disposed in the flange. The movable member is a cap which is movable between clamping and non-clamping orientations relative to the flange. The plug assembly further comprises a screw for moving the cap between its clamping and non-clamping orientations relative to the flange. The flange is a portion of a plug, which plug further includes a boss extending from one side of the flange.

Abstract: Disclosed are devices and methods for delivering several sutures accurately and simultaneously around the perimeter of an annular prosthetic device (prosthetic heart valve, annuloplasty ring, etc.) to secure the prosthetic device within a native heart valve region. Devices can comprise a proximal handle portion including an actuator and a distal suturing portion including several curved and straight needles arrayed around the shaft axis. The straight needles and the curved needles are configured to simultaneously guide a plurality of sutures through the native tissue and through the annular prosthetic device. The actuator can cause the straight needles to move axially relative to the curved needles and can also cause the curved needles to rotate, such that the motions are coordinated to simultaneously place all the sutures.

Abstract: An apparatus includes an end effector including an anvil and lower jaw. The anvil is pivotable toward the lower jaw to capture tissue. The apparatus further includes a stapling and severing assembly configured to sever and staple tissue clamped between the anvil and the lower jaw. A staple cartridge is coupled with the lower jaw. The staple cartridge includes a deck facing the anvil, a plurality of staples positioned in a plurality of staple openings formed through the deck, and a cinching feature positioned on the deck. At least a portion of the cinching feature is configured to be captured by the staples as the staples are driven out of the staple openings in response to activation of the stapling and severing mechanism. The cinching feature is configured to cinch severed and stapled tissue.

Abstract: In repairing soft tissue with a bone anchoring instrument (such as reattaching a tendon of a torn rotator cuff), the bone anchoring instrument may be used to anchor the soft tissue to a region of bone. The anchors inserted into the underlying bone may have one or more lengths of suture or wire attached thereto which may be tensioned independently of one another to affix the soft tissue to the bone by having a selector mechanism selectively engage and disengage ratcheted tensioning wheels from one another. Suture loading mechanisms may be employed for passing suture lengths into and/or through the anchors prior to deployment into the bone where such mechanisms may employ suture snares which are configured to reconfigure from an expanded shape through which suture lengths may be easily passed to a low-profile shape which secures the suture lengths within the snare.

Abstract: An apparatus includes a buttress body, an adhesive material, and a containment sheet. The buttress body is sized to fit on an anvil or a staple cartridge deck of a surgical stapler. The adhesive material is disposed on the buttress body. The adhesive material is configured to flow across the buttress body in response to a temperature exceeding a melting temperature. The containment sheet is disposed on the adhesive material. The containment sheet is secured relative to the buttress body such that the containment sheet is configured to contain the adhesive material on the buttress body.

Abstract: A staple cartridge assembly for use with a surgical instrument is disclosed. The staple cartridge assembly comprises a staple cartridge and a compressible tissue thickness compensator. The staple cartridge defines a longitudinal axis. The staple cartridge comprises a cartridge body and a plurality of staples stored in the cartridge body. The compressible tissue thickness compensator comprises a deck-facing side, a tissue-facing side, a first portion, and a second portion. The second portion comprises a curved depression on the tissue-facing side of the compressible tissue thickness compensator. The curved depression partially extends through the second portion of the compressible tissue thickness compensator. The curved depression is transverse to the longitudinal axis defined by the staple cartridge.

Abstract: A surgical stapling apparatus, a surgical stapling loading unit and a staple cartridge assembly are provided including a buttress releasably disposed against a tissue contacting surface of a cartridge assembly and/or an anvil assembly, a continuous length of suture securing a respective surgical buttress against the respective the tissue contacting surface, wherein the suture extends transversely across the respective surgical buttress, and a retaining feature securing each suture to the respective cartridge assembly and anvil assembly. The retaining feature may include an adhesive adhering the suture to a surface of the cartridge assembly and/or anvil assembly. The adhesive may adheres the suture to multiple locations along the surface of the cartridge assembly and/or anvil assembly.

Abstract: Disclosed herein is a surgical instrument having a cylindrical tube affixed thereto. A guidewire can be threaded through the cylindrical tube to allow for advancement of the surgical instrument to a surgical site.

Abstract: The suture passer includes a body from which two mechanisms protrude: a hollow needle through which a suture is guided, the suture exiting at the surgical site; and a sliding hollowing tube with a distal opening, exposing a resilient member. When gripping of a suture is required, the resilient member is intentionally over-extended, causing the resilient member to bow and protrude from the distal opening. A suture is then passed into the resulting gap between the sliding hollowing tube and resilient member, the resilient member then allowed to retract back into place, thereby clamping the suture.

Abstract: The present invention discloses a suturing method and system 10 for repairing hernia. The method comprises applying multiple layers of sutures for closing a primary defect 101. The invention comprises a suturing means for strengthening the repair by securing the primary defect to non-damaged tissue 120 The method of the present invention can decrease the chances of recurring hernia.

Abstract: A buttressed anvil assembly is provided for use with a surgical stapling instrument. The buttressed anvil assembly generally includes an anvil member having a strip of buttress material attached thereto by a pair of sutures. A tensioning mechanism is provided to secure or tension the buttress material to the anvil member prior to use and allow for release of the buttress material after stapling of tissue. The tensioning mechanism includes a cinch track engageable with one of the pair of sutures.

Abstract: A suture retention device is described. The suture retention device has various uses, one being for a gastropexy. A gastropexy may use a suture to hold the stomach against the abdominal wall of a patient. According to one example, a suture retention device is described that may have a shell having a thickness and an upper surface and a lower surface spaced apart by the thickness, the shell having an outer diameter that is greater than the thickness, the shell defining an internal chamber. A spring may be mounted within the internal chamber. The shell may be movable relative to a suture that passes through the shell and engages the spring.

Abstract: In one embodiment, the present invention include a method of securing tissue using a filamentary construct, the method including the steps of passing a length of filament through or around tissue; implanting a filamentary sleeve, formed of filament, into tissue; and passing at least a portion of the length of filament at least partially through the filamentary sleeve to form a one-way cleat. The present invention also provides for various devices, systems, assemblies, kits and methods of use, assembly and manufacture thereof.

Abstract: Devices and methods for inserting an implant into skin or other tissue of a patient can include an insertion device having moveable portions that can retain, move, or otherwise control engagement and injection of a hyaluronic thread. The device can include a tubular member and a handle. The handle can include two or more components that each include apertures through which a needle can be placed. The handle can be manipulated to align or offset the apertures with respect to each other to modify a clearance through the apertures and selectively engage or disengage the needle or thread.

Abstract: A surgical instrument comprising a loading unit and an end effector is disclosed. The end effector comprises a first jaw, a second jaw, an anvil, a staple cartridge, a firing member, a first adjunct, a second adjunct, a first pair of restraint members, and a second pair of restraint members. The staple cartridge comprises a staple cartridge deck, staple cavities, staples, and staple drivers. The staple cartridge deck comprises a stepped profile. The first adjunct comprises a strain relief portion. The second adjunct comprises a strain relief portion configured to extend over the staple cartridge deck and a stepped profile that is fitted to the stepped profile of the staple cartridge deck. The first pair of restraint members are configured to releasably attach the first adjunct to the anvil. The second pair of restraint members are configured to releasably attach the second adjunct to the staple cartridge.