Abstract: In accordance with the present invention there is provided a needle and suture assembly for attaching one piece of tissue to another piece of tissue. The assembly includes a helical needle having proximal and distal ends, a strain relief element having a greater flexibility than a flexibility of the needle attached to the proximal end of the needle, and a suture attached to the strain relief element.

Abstract: A suture member for joining the first and second sides of a cut in body tissue, such suture member having an elongated body member in one embodiment with a needle and thread member disposed at one end thereof and with externally activatable adhesive disposed on the suture member. The adhesive is activated by application of high-frequency radiation directed through the body tissue to retain the suture member securely in the body tissue.

Abstract: A surgical cable system is provided which includes a surgical cable and a passer for passing the cable around a bone to which the cable is to be secured. The cable includes a main cable having a lead cable attached to one end of the main cable and a fastener preattached to the first end of the main cable. The lead cable has an enlargement (a bead) affixed to its free end. The passer includes a curved probe and a recess or cavity is provided in the probe near its tip and a slot extends from the cavity to the tip of the probe. The cavity is sized to accept the enlargement of the lead cable and the slot is sized to receive the lead cable so that as the probe is withdrawn (pulled) from under the bone, the lead cable and the main cable are pulled under the bone so as to minimize the space required to pass the cable. The lead cable and a portion of the main cable may then be inserted in the fastener.

Abstract: A suture applying device comprises a shaft having a nose piece attached at its distal end. The shaft and the nose piece are separated by a transition region, and a needle entry lumen in the shaft permits a flexible needle to be introduced in the distal direction. The needle is able to cross the transition region and penetrate tissue held therein and enter into a return lumen in the nose piece. The return lumen is U-shaped and acts to bend the flexible needle as it is advanced. In this way, the needle passes from the nose piece through the transition region in a proximal direction, and is able to pass through tissue within the transition region generally on the opposite side of a tissue puncture from the first suture passage. The needle then exits from the device, permitting the suture attached to the needle to be drawn fully through the device. The suture may then be tied in order to close and seal the tissue penetration.

Abstract: An apparatus and method for ultrasonically forming a surgical suture tip from a length of unfinished surgical suture material. The apparatus includes a first tipping die having a first face for contacting a portion of the length of unfinished surgical suture material. A second tipping die having a second face is also provided. The first and second die also having extending therefrom a first member and a second member. The first and second dies cooperate with the first and second members to form a length of suture. At least one mechanical actuator is provided for moving the first face of the first tipping die and the third face of the first member toward the second face of the second tipping die and the fourth face of the second member. A second actuator vibrates at least one of the first and second tipping dies at an ultrasonic frequency of about 15 KHz to about 70 KHz.

Abstract: A suture loop is formed in a hollow braided suture by feeding one end of a length of suture through a part in the braid of the suture and into the inner lumen formed by the hollow braid. The braided configuration of the suture allows it to be expanded in diameter by pushing and reduced in diameter by pulling. Said end of suture is passed continuously through said inner lumen forming a loop of suture with a single tail. The loop may be tightened by pulling on said first end of the suture while pushing on said outer hollow braid. The loop may be locked by extending or pulling on said outer hollow braid to reduce its diameter and lock it down around said first end of the suture.

Abstract: A suture for joining the first and second sides of a cut in body tissue, such suture having an elongated body member with a needle and thread member disposed at one end thereof and retention structure which can include adhesive to retain such body member when drawn into place in the body tissue.

Abstract: Synthetic absorbable medical devices made totally or in part from a random polymer comprising glycolide, lactide, trimethylene carbonate, and caprolactone are provided. The polymer can be fabricated into a monofilament which exhibits physical characteristics equivalent to or superior than gut sutures.

Abstract: An apparatus for inserting a staple into torn tissue such as the meniscus of the knee. The apparatus includes a pair of shafts individually movable in a longitudinal directing which are actuable from a handle mechanism. The shafts are movable sequentially so that the shafts disjunctively advance the prongs of the staple which is releasably held adjacent distal end portions of the shafts. A further embodiment of the device consists of a pair of needles detachably secured to a pair of anchoring members having a plurality of barb-like projections extending outwardly therefrom. The anchoring members are joined by a suture which connects adjacent the trailing ends of the anchoring members opposite the penetration end of the needles.

Abstract: An apparatus and method for ultrasonically forming a surgical suture tip from a length of unfinished surgical suture material. The apparatus includes a first tipping die having a first face for contacting a portion of the length of unfinished surgical suture material. A second tipping die having a second face is also provided. The first and second die also having extending therefrom a first member and a second member. The first and second dies cooperate with the first and second members to form a length of suture. At least one mechanical actuator is provided for moving the first face of the first tipping die and the third face of the first member toward the second face of the second tipping die and the fourth face of the second member. A second actuator vibrates at least one of the first and second tipping dies at an ultrasonic frequency of about 15 KHz to about 70 KHz.

Abstract: A rejuvenation method includes subcutaneous implanting an inert material at the rejuvenation area. Golden threads are used as the inert material. The golden threads are implanted in subdermal space at the level of the derma inner edge. The golden threads are implanted along and/or across wrinkles and skin folds of the rejuvenation area catching skin regions behind the rejuvenation area. The golden thread input and output sites are placed in skin regions located behind the rejuvenation area. The skin is first marked with marker lines the length of which is greater than the rejuvenation area, and the inert material is implanted under these lines. The marker lines may be applied so as to intersect and to form a net. The golden thread input and output sites are placed in site of intersection of the marker lines forming the net. The golden thread is employed in conjunction with a resolving polyglycol thread. Rejuvenation is applied to skin areas on cheeks, chin, near eyes, on arms and/or thighs.

Abstract: A surgical needle or surgical incision member is provided including a body portion defining first and second longitudinal ends, a radiused tissue penetrating portion adjacent at least one longitudinal end of the body portion having a radius of approximately 0.005 to 0.015 inches, suture attachment structure formed in the body portion and a suture attached to the suture attachment structure. A method of suturing is also provided wherein the surgical needle may be passed through tissue while minimizing trauma to adjacent bony structures or the like.

Abstract: Generally described, the present invention comprises a medical device for implantation in biological tissue and a method of making the medical device. The medical device comprises an organic compound forming at least a portion of the medical device and a beta radiation emitting element chemically bonded to the organic compound of the medical device. The beta emitter preferably causes the medical device to generate a beta radiation greater than 0.0002 .mu.Ci/cm. The beta radiation emitting element can be tritium preferably incorporated into the organic compound of the medical device by a Wilzbach process. The Wilzbach process involves an entropic exchange of the beta emitting element for elemental hydrogen in a vacuum sealed reaction chamber. On the other hand, the beta radiation emitting element may comprise Carbon 12, or other similar beta emitter, which is incorporated directly into the backbone of the organic compound prior to manufacturing the medical device from the organic compound.

Abstract: Method and apparatus for suturing and ligating anatomical tissue utilizes one or more knotting elements carried by a length of filamentous suture material for tying the suture material to create one or more adjustably tensioned stitches. The knotting elements are carried by the suture material at fixed spaced positions or can be movable along the suture material, and suture instruments are provided to facilitate the formation of a plurality of stitches, particularly during endoscopic procedures.

Abstract: A wound suturing assembly and method of use employing elastically precurved suture needles for piercing a patient's tissue to suture closed a wound. The needles are ejected out of the assembly and whereupon they assume a pre-curved shape and in the process curve back to pierce the tissue a second time prior to reentering the assembly. Each needle carries a length of suture through the wound so that the sutures can be tied and the wound tightly sealed.

Abstract: A surgical fastener for fixation of graft tendon in a bone hole comprising a screw having a head, neck, and shank, and a washer disposed about the neck. The tendon is attached to the washer so as to ensure that the tendon is immobilised between the head of the screw and the wall of the bone hole thereby reducing pistoning under load and reducing graft failure. In one embodiment, the fastener includes a bone plug disposed about the neck of the screw between the head and the washer, the neck being adapted to laterally press the bone plug and thereby immobilise a tendon attached to the washer between the bone plug and the wall of the bone hole. In another embodiment, the invention consists in a surgical staple having two substantially parallel legs, a transverse head member and a washer which holds a loop of tendon under the staple when it is inserted into a bone.

Abstract: Methods are disclosed for binding together human or animal tissue using one-way sutures having barbs on their exterior surfaces, allowing passage of a needle-drawn suture in one direction through tissue, but not in the opposite direction. In closing a wound, the sutures are passed through tissue at each of the opposed sides of the wound, forming suture pairs in which trailing ends of the sutures are juxtaposed in the wound. The number of suture pairs is selected in accordance with the size of the wound. The wound is closed and ends of the sutures of each suture pair are secured together, which may be by heat bonding or surgical knots. In a variation of this procedure double-armed sutures are used. In another variation detachable needles are used to leave the barbed sutures below the skin. The invention avoids loop stitching, minimizing scarring.

Abstract: A radioactive suture for inhibiting an intimal hyperplastic response comprises a needle and a suture material having a radioactive beta-emitting element. This radioactive element is preferably chemically bonded to an organic substrate of the suture material. It is preferred that the radioactive suture material generates a beta radiation greater than 0.0002 uCi/cm. A first preferred method for producing the radioactive suture comprises the steps of placing the suture needle and the suture material in a sealed reaction chamber. Once the suture is in the reaction chamber, an ionized beta radiation emitting element, preferably ionized tritium, is introduced into the chamber. While in the chamber, an entropic exchange process begins wherein the beta radiation emitting element is exchanged for hydrogen molecules in the organic suture material. Once the desired level of tritium or other beta radiation emitting element is incorporated in the suture material, the reaction chamber is flushed.

Abstract: The invention is directed to a microsurgical needle for use in microsurgical techniques. The distal segment of the needle is straight with a circular cross section, and has a sharpened tip with a triangular cross section having three sharp edges for cutting rather than tearing tissue during penetration. The middle segment of the needle has an acutely angled arched shape, and a transitional cross section which transitions between a squared cross section of the main shaft segment and the circular cross section of the straight distal segment. The main shaft segment of the needle has a generally squared cross section, and forms a broadly curved or arched shaft segment which may be easily gripped by a needle holder. The proximal end of the needle forms a suture attachment segment, and may be circular in cross section. The shape of the needle provides an easy angle, better stability, superior tissue alignment, and better control than conventional. needles, while the point is designed to minimize tissue trauma.

Abstract: A surgical suturing needle is disclosed for use in limited space applications as well as a method for its use. The needle has an arcuate body and a relatively straight shank extending therefrom. The shank and arcuate body form an abrupt angle therebetween. The surgical suturing needle has a pointed tip on one end of the arcuate body and suture attachment structure formed in the shank. The method of using the surgical needle to join a pair of vascular tissue sections together includes penetrating into a lumen of a first vascular tissue section, advancing the pointed tip into the lumen of a second vascular tissue section and out through a side wall thereof, grasping the pointed tip and drawing the needle substantially parallel to an outer surface of the second vascular tissue section to thereby move the surgical suturing needle and an attached length of suture material through the first and second vascular tissue sections.

Abstract: An enhanced knotless suture anchor assembly having a snag element or recess attached to, or formed in, an anchor assembly, for capturing a looped section of the suture element for enhanced knotless surgical soft tissue reattachment to bone, and an unique method for using a plurality of anchors and attachments to provide such attachment or reattachment.

Abstract: A surgical fastener in the form of a ferruled loop, instrument and method are provided for constructing a graft to artery anastomosis and other soft tissue anastomoses, particularly by minimally invasive (or endoscopic) surgery. The ferruled loop fastener is comprised of a needle, a suture and a ferrule. The needle and suture member allow this fastener to be sewn through, for example, a graft and artery to be joined. The ferrule member allows a ferruled loop to be formed without knotting the suture member, and that serves as a suture stitch to fasten the graft and artery together. The instrument holds the needle and ferrule at its distal end, and controls in the handle allow manipulation of the needle and controllable application of the fastener. The method employs the ferruled loop and instruments to join soft tissues and to construct graft to artery anastomoses.

Abstract: A sternotomy suture comprises a loop which passes around a split sternum and is twisted until double cabling begins at which point the suture is fastened to itself. The loop preferably comprises a single strand of wire with one end welded to an intermediate point of said strand leaving a portion available for connection to the needle. A curved needle having a cutting tapered point is swaged to the free end of the single strand. Initially the wire is passed around the split sternum and the needle then removed with a pair of diagonal cutting pliers. A twisting tool, having a handle and a hooked portion, passes through the two free loops on opposite sides of the sternum. Twisting force is applied to the tool and transmitted through the hook to the suture causing it to twist and cable. The suture reaches its critical length L.sub.crit when the loop is fully cabled but before double cabling begins. At the onset of double cabling the loop reaches its maximum tension T.sub.crit.

Abstract: A system for anchoring tissue to bone includes a suture anchor, a first loop of suture thread attached to the suture anchor, a suture needle and a second loop of suture thread which is attached to the suture needle, the first and second suture loops are interlocked with one another. The suture needle can be of a conventional type useful in open surgical procedures, or a type useful in closed surgical procedures that is formed on the end off an elongate tool. A method for anchoring soft tissue to bone using the system is also provided.

Abstract: The surgical suturing assembly of the present invention protects a user from accidental puncture wounds. A surgical needle is contained within a rigidly-walled protective casing, having a proximate end defining a first aperture through which the needle is inserted. The casing tapers distally to define a second aperture for passage and limiting protrusion of the sharp tip of the needle. The casing defines a pair of openings near the distal end, through which openings the needle shaft is exposed when the sharp tip extends through the second aperture. Upon insertion of the needle, the casing is plugged by a suture guide that engages the first aperture, the suture guide having an eye for threading onto the suturing thread. When plugged, the suture guide functions to slidingly retain a needle within the casing. In use, a surgeon grasps the suturing needle assembly where the exposed section of the needle shaft contacts the casing.

Abstract: A surgical fastener for fixation of graft tendon (26) in a bone hole comprising a screw (10) having a head (11), neck (12), and shank (13), and a washer (17) disposed about the neck. The tendon (26) is attached to the washer (17) so as to ensure that the tendon (26) is immobilised between the head (11) of the screw (10) and the wall of the bone hole thereby reducing pistoning under load and reducing graft failure. In one embodiment, the fastener includes a bone plug (38) disposed about the neck (12) of the screw (10) between the head (11) and the washer (17), the neck (12) being adapted to laterally press the bone plug (38) and thereby immobilise a tendon (26) attached to the washer between the bone plug (38) and the wall of the bone hole. In another embodiment, the invention consists in a surgical staple (60) having two substantially parallel legs (61), a transverse head member (62) and a washer (66) which holds a loop of tendon (26) under the staple (60) when it is into a bone.

Abstract: A medical electrical lead which may be introduced using a thorascope and is used to electrically stimulate tissue, such as a heart. The lead of the present invention has a "ski-shaped" needle, a strand of between 1-5 cm. attached to the needle, an electrode attached to the strand, and an insulated lead body attached to the electrode. In addition, a test wire is also attached to the needle to permit the electrical characteristics of tissue to be ascertained before the lead is fully inserted. In an alternate embodiment the strand may feature a fixation helix. Due to the shape of the needle and the relatively short strand, the lead is particularly suitable for implantation to a heart using minimally invasive techniques, such as through a trocar.

Abstract: A method for repairing a torn meniscus includes inserting at least two anchoring members into the meniscus. Each anchoring member includes a dart and at least one suture. The darts are embedded in the meniscal tissue distal to the plane of the meniscal tear, the anchoring member being inserted transversely through and across the plane of the tear. The sutures of the two anchoring members extend from the anchoring members through and across the plane of the tear and out of the meniscus. The sutures are tied together and the knot formed is drawn into contact with the surface of the meniscus with sufficient tension to approximate the tear.

Abstract: A surgical needle is provided including a body portion defining first and second longitudinal ends, the body portion includes a central portion having a first cross-sectional area and end portions adjacent the central portion having a smaller second cross-sectional area. A tissue penetrating portion is provided adjacent at least one end portion. Transition portions are provided intermediate the central portion and the end portions and taper from the first cross-sectional area to the second cross-sectional area. Suture attachment structure is formed in the central portion and a suture is attached to the suture attachment structure. A method of suturing is also provided wherein the surgical needle may be passed through tough tissue while minimizing bending of the surgical needle.

Abstract: A method for attaching a multifilament suture having a sheath and core structure to a surgical incision member includes removing a length of core material from an end portion of the suture, and inserting the coreless sheath into the surgical incision member aperture. The coreless sheath of the end portion may optionally be tipped prior to insertion into the surgical incision member.

Abstract: A delimited portion of suture material is immersed into a freezing media, such as liquid nitrogen, until the delimited portion is frozen. The frozen delimited portion is cut to provide a stiffened, non-brooming suture tip suitable for insertion into a needle bore. The cut, frozen suture tip is inserted into a needle and the needle is crimped to attach the suture to the needle. After attachment, the frozen suture tip returns to ambient temperature, reversing the effects of freezing the suture portion so that the suture adjacent the needle is as flexible as the remainder of the suture.

Abstract: A surgical, orthopaedic cable attachment apparatus and method for the surgical repair or fusion of orthopaedic anatomical structures is constructed from a length of flexible cable formed of a braided polymeric material having a first and second end portion. A first loop is formed in the first end portion of the cable with a second loop is formed, being placed around or through the bone parts to be tied. After the second loop is place around the selected bone parts, the free cable end is passed through the first loop and pulled tight to define a tightened position. The free cable end can have a needle. The free end is then secured to the cable by splicing for example, to hold the cable in the tightened position.

Abstract: A surgical incision member is provided including a body portion defining first and second longitudinal ends, tissue penetrating portion adjacent each longitudinal end of the body portion, suture attachment structure intermediate the tissue penetrating portions, and a suture attached to the suture attachment structure. A method is also provided wherein the suture is attached to the surgical incision member by adhesives or by crimping.

Abstract: A surgical, orthopaedic cable attachment apparatus and method for the surgical repair or fusion of orthopaedic anatomical structures is constructed from a length of flexible cable formed of a braided polymeric material having a first and second end portion. A first loop is formed in the first end portion of the cable with a second loop is formed, being placed around or through the bone parts to be tied. After the second loop is place around the selected bone parts, the free cable end is passed through the first loop and pulled tight to define a tightened position. The free cable end can have a needle. The free end is then secured to the cable by splicing for example, to hold the cable in the tightened position.

Abstract: A method for producing a detachable surgical needle-suture combination of the type incorporating a fluid swellable suture material is capable of producing needle-suture attachments which conform to the prescribed minimum pull-out forces for detachable needle-suture combinations as set forth in the U.S. Pharmacopeia. Generally, the method includes the steps of providing a surgical needle and a fluid swellable suture, immersing an end portion of the suture into a liquid solution whereby the suture end portion swells and assumes an expanded condition, positioning the suture end portion in its expanded condition into an aperture formed in the blunt end of the needle and swaging the blunt end of the needle to cause deformation of at least a portion of the blunt end and engagement with the suture end portion to effect needle-suture attachment.

Abstract: A delimited portion of suture material is immersed into a freezing media, such as liquid nitrogen, until the delimited portion is frozen. The frozen delimited portion is cut to provide a stiffened, non-brooming suture tip suitable for insertion into a needle bore. The cut, frozen suture tip is inserted into a needle and the needle is crimped to attach the suture to the needle. After attachment, the frozen suture tip returns to ambient temperature, reversing the effects of freezing the suture portion so that the suture adjacent the needle is as flexible as the remainder of the suture.

Abstract: A soft tissue repair system and method are provided. The soft tissue repair system includes a barbed suture anchoring member attached to at least one suture member. A suture retaining member engages the suture member such that the length and tension of the suture may be selectively adjusted before the suture is permanently engaged in the retaining member. In use, the barbed suture anchoring member and suture member are inserted into the soft tissue repair site and across a tear. The suture member extends back through the original entry side of the tear. A retaining member is applied to the suture member followed by tensioning of the suture member to draw the sides of the tear into apposition. Following tensioning, the retaining member is permanently affixed to the suture member to maintain the selected tension and length of the suture member.

Abstract: The present invention relates to an apparatus for attaching surgical sutures to eyeless surgical needles. The apparatus includes a frame for positioning and maintaining the needle while the suture is being attached and a rotating die system which selectively impacts the needle to secure the suture thereto.

Abstract: A siliconized surgical needle is provided which requires significantly less force to effect tissue penetration than a standard siliconized needle.

Abstract: The present invention comprises an improved device and method for plicating tissue. The apparatus of the present invention employs a ligament of expanded polytetrafluoroethylene or similar material which is of sufficient width to allow it to be retained in place by sewing through it using conventional sutures. The present invention is particularly applicable to the repair of heart valves where it can be relatively rapidly installed around a weakened heart valve yet is not susceptible to "guitar string" pull-out or similar problems.

Abstract: A method, system and apparatus for suturing tissue in an anatomical cavity during an endoscopic procedure includes a suturing instrument extending through a portal in the anatomical cavity wall for manipulating a needle to penetrate the tissue to form a looped portion of a length of suture material at an exit point in the tissue and to back the needle out of the tissue, and an anchor applier instrument extending through another portal in the anatomical cavity wall for positioning an anchor in engagement with the looped portion of the suture material to allow the suture material to be tensioned and secured to adjustably approximate the tissue.

Abstract: A generally sickle shaped needle having a short shank is disclosed. An optional perpendicularly aligned grooved needle holder may be utilized in combination with the needle to rapidly close deeply lying trocared fascial wounds to prevent sequela and hernia formation after laparascopic surgery.

Abstract: A surgical sewing needle, including a generally arcuate needle body having a first end for receiving suture material and a second end which forms a sharp point, the needle body being flexible between closed and open positions, the first end protecting the second end in the closed position to prevent the sharp point from unintentional punctures, the needle body being biased such that the first and second ends are separated from each other in the open position to facilitate suturing.

Abstract: A method and apparatus for tipping surgical sutures which includes winding the suture around a drum while continuously monitoring the suture diameter in x and y directions and adjusting the tension on the suture to control the suture diameter as it is being wound. The drum is then placed in an apparatus which passes selected portions of the suture through a mist of cyanoacrylate tipping agent generated by ultrasonic atomization. The tipping agent quickly cures and the tipped portion of the suture may be cut to create a tipped end for insertion into a surgical needle to form a needle suture device.

Abstract: A suture guide used for inserting a suture into a hole of an eyeless needle positioned between an upper guide and a lower guide. This suture guide comprises a first guide member having a certain plane and the second guide member having a first plane positioned lower than the plane of the first guide member and a second plane crossing the first plane, This suture guide also has fixing means combining the first guide member and the second member together to form a guide having a guiding corner with the plane of the first guide member and the second plane of the second member and the guide disposed next to the lower mold to face the guiding corner to the hole of the eyeless needle. A positioning mechanism of a suture guide for inserting a suture into a hole of an eyeless needle positioned between an upper guide and a lower guide is desirable for the suture guide.

Abstract: A needle suture combination and attachment method is disclosed wherein a surgical suture is attached to a surgical needle by inserting the suture tip into a tapered axial hole formed in the barrel section through the needle blunt end face and swaging the needle barrell section. The swage commences at a point away from the end of the needle end face. The needle suture attachment of the invention does not require closely corresponding suture and needle hole diameters, and advantageously achieves reliable needle-suture attachment with reduced needle inventory. Process and equipment maintenance are also reduced.

Abstract: Blunt tip surgical needles which significantly reduce the probability of skin penetration of the gloved hand of an operator are disclosed. In one embodiment, the blunt tip needle includes a tip portion which terminates in a bulbous blunt tip. In another embodiment, the needle tip portion includes a ball socket and a ball rotatably disposed therein.

Abstract: An apparatus is disclosed for attaching a surgical needle having a generally cylindrical end portion defining an elongated aperture having a generally circular cross-section and a suture having a generally elongated end portion of generally circular cross-section corresponding in dimension to the elongated aperture of the needle. The apparatus includes a pair of dies, each having a die face with an inner die surface portion. The inner die surface portion includes at least one generally planar crimping surface having an arcuate recess formed therein which extends along at least a portion of the planar crimping surface.

Abstract: An implant assist apparatus is disclosed for implanting material such as a suture in tissue to reapproximate or reinforce the tissue. A cannula is provided having a hollow body and an open proximal and distal end. Point means is detachably fixed to the open proximal end of the cannula for penetrating tissue. A method of implanting the material in tissue for reapproximating or reinforcing the tissue with the implant assist apparatus is also disclosed whereby a length of the implant material is attached to a guide wire for partial containment within the cannula. The cannula with detachable point is passed into the tissue at an entry point remote from one side of the defect and out an exit point on the opposite side remote from the defect such that the distal end of the hollow body extends from the entry point and a proximal end extends from the exit point.

Abstract: A device for repairing torn tissue or muscle such as the meniscus of the knee. The device consists of a pair of needles detachably secured to a pair of anchoring members having a plurality of barb-like projections extending outwardly therefrom. The anchoring members are joined by a suture which connects the ends of the anchoring members opposite the needles.