Abstract: In some examples, a tether head assembly of a delivery system includes an inner retainer and an outer retainer that defines an aperture comprising a receptacle configured to receive an attachment member of a medical device, a passageway, and a groove. The inner retainer is movable within the groove between a second position in which the passageway is dimensioned to receive the attachment member and a first position in which the passageway is dimensioned to prevent passage of the attachment member. In some examples, a tether handle assembly defines a channel, a force transmitter within the channel, a slidable member partially received within a first end of the channel and a button partially received within a second end of the channel. Distally-directed force applied to the button may cause the force transmitter to apply proximally-directed force to the slidable member, moving the slidable member and an attached pull wire proximally.

Abstract: In one embodiment, a multi-layer suture fastener that includes a generally disc-shaped body defining a plurality of axially spaced-apart layers. Each layer can include an inner axial surface and an outer axial surface. A suture opening can extend from the inner axial surface to the outer axial surface of each layer. The suture openings can have an open configuration and a closed configuration. One or more lines of suture can be passed through the suture openings when in the open configuration. The suture openings can be placed in the closed configuration. In the closed configuration, the one or more lines of suture can be restricted by radial surfaces of the suture opening from sliding through the suture openings in at least one longitudinal direction of the one or more lines of suture.

Abstract: A method for securing suture to bone comprises drilling a hole in a desired portion of bone at a desired procedural site, passing a strand of suture through a portion of soft tissue to be approximated to the portion of bone, and extending the free suture ends proximally from the soft tissue. The suture is loaded into an anchor implant. Using an inserter, on a distal end of which is attached the anchor implant, the anchor implant is manipulated into the bone hole. The suture is then tensioned to a desired level by pulling on the free suture ends, after the anchor implant is positioned in the bone hole. The free suture ends are wrapped about a suture cleat on an inserter handle once the desired tension level is achieved. A proximal anchor component is moved distally to engage with a distal anchor component to lock the anchor in place within the bone hole, and to lock the suture in place within the anchor. Then, the inserter is removed from the procedural site.

Abstract: Disclosed herein are annular prosthetic devices, such as annuloplasty rings, that include suture clips integrated into or mounted within an annular frame. The clips can quickly secure to sutures to obviate the need to tied knots in the sutures during implantation. Embodiments comprise an annular frame having an open central region and a plurality of suture clips spaced angularly apart around the frame. Each of the suture clips can comprise two opposing tabs that extend toward each other such that the suture clip forms a gripping region between ends of the tabs and the gripping region is configured to grip a suture inserted through the suture clip between the two tabs. The annular frame and the plurality of suture clips can be formed from a single piece of flat material with the suture clip tabs being formed by laser cutting the piece of flat material, or the suture clips can be movable along a track formed in the annular frame.

Abstract: An apparatus and method are provided for a syndesmosis treatment construct configured to be placed into a cinched configuration that presses a first bone against a second bone. The syndesmosis treatment construct comprises a proximal fixator to contact the first bone and a distal fixator to contact the second bone. A first suture and a second suture are parallelly looped through the proximal fixator and oppositely looped through the distal fixator. Distal ends of the first and second sutures are fixated within a washer disposed between the proximal fixator and the first bone. Proximal ends of the first and second sutures are passed through openings in the washer and through the proximal fixator. Pulling of the proximal ends by a practitioner places the syndesmosis treatment construct into a cinched configuration. Any of various suitable suture knots may be formed so as to fixate the cinched configuration.

Abstract: Generally, a suturing system including apparatus and methods for reinforcing a substrate through which a thread passes. Specifically, embodiments of a thread carrier which passes through a substrate reinforcement element adjoining a substrate to reinforce the substrate at a first location and at a second location through which the thread passes.

Abstract: A surgical sheath system having a sheath with a hollow shaft; and a head coupled to and in fluid communication with the hollow shaft, the head having a first mounting feature for coupling a first surgical device; and a second mounting feature for coupling a second surgical device, the second surgical device being a different type of surgical device than the first surgical device.

Abstract: Knotless suture anchors and methods are provided for affixing soft tissue to a bone. One exemplary embodiment of a suture anchor includes an insertion rod, a distal tip member removably coupled to a distal end of the insertion rod, the distal tip member having a suture engagement feature configured to have a plurality of suture limbs slidably coupled to the tip member, and a proximal main member having an elongated cylindrical body with one or more bone-engaging features disposed on its outer surface and a longitudinal lumen extending from a proximal end to a distal end. The suture anchor can also include two suture limb holding surfaces to maintain two suture limbs a distance apart from each other. Other exemplary embodiments, as well as methods for affixing soft tissue to a bone, are also provided.

Abstract: Surgical constructs and methods of use for tissue repair, in which the surgical constructs include a soft fixation device formed of flexible material, the soft fixation device having a head portion formed of a bunching material for anchoring the soft fixation device in a bone tunnel, and a tail portion for pulling the soft fixation device into the bone tunnel. The surgical constructs include one ore repair flexible strands coupled to the head portion of the soft fixation device for engaging tissue to be repaired.

Abstract: Arcuate fixation members with varying configurations and/or features are provided, along with additional components for use therewith in provided intervertebral implants. The arcuate fixation members may be of different lengths, cross sectional geometries, and/or cross sectional areas. Applications of intervertebral implants utilizing arcuate fixation members are particularly suitable when a linear line-of-approach for delivering fixation members is undesirable.

Abstract: Medical devices for applying a cinch to a suture and methods for making and using such devices are disclosed. An example medical device may include an elongated shaft including a proximal region and a distal region. The distal region may define a lumen having a lumen dimeter, and a distally facing end surface. The medical device may also include an outer cinch member defining a bore and having an outer surface defining a shoulder. An elongated inner shaft may extend through and be longitudinally movable within the lumen and the bore and including a distal end section. An inner cinch member may be engaged with the distal end section of the elongated inner shaft.

Abstract: Methods for affixing soft tissue to an implant. The implant has a soft tissue attachment structure that includes a surface defining one or more troughs, and either at least one ingrowth plate spanning a portion of the trough and defining a suture tunnel between the ingrowth plate and trough for receiving a suture, or fixation bridges spanning a portion of the one or more troughs, each fixation bridge and respective trough defining a suture tunnel for receiving suture. Systems for performing the method are also disclosed.

Abstract: Exemplary embodiments of a tissue repair device to repair tissue by deploying implants, comprising: a selector knob is configured to allow a user to change from a default position to a first position, position is indicated by a window positioned on a handle; a depth control knob is configured to adjust an exposure length of a needle under a depth control sheath to an appropriate or desired length to deploy a first implant and a second implant to secure with a tissue, a deployment knob is configured to push a pusher rod to deploy first implant from needle for delivering of a flexible member to secure tissue, deployment knob is configured to automatically spring back to a pre-specified position after deploying first implant from needle, deployment knob configured to push pusher rod to deploy second implant from needle for delivering of flexible member to secure tissue.

Abstract: An assembly includes a flexible fixation member, a suture, and a delivery device. The fixation member includes a body with two terminal ends. A suture passes through the flexible fixation member at various points along a length of the body such that portions of the fixation member are slidable relative to the suture and configurable to form a cluster within a surgical site. The delivery device includes a tubular member, an elongated inserter, and a trigger. The elongated inserter is slidably disposed within the tubular member. The inserter has a forked distal end configured to receive a portion of the flexible fixation member and the suture. The trigger is finger-engagable and fixedly coupled to the proximal end of the inserter. It is configured to advance and retract the inserter relative to the tubular member. The trigger includes a retention member for retaining a proximal end portion of the suture.

Abstract: An insertion device includes an elongate member and a stylet. The elongate member has a proximal end portion, a distal end portion, and defines a lumen therethrough. The stylet has a distal end portion, a proximal end portion, and is slidably coupled to the elongate member. The stylet is configured to move from a first position to a second position with respect to the elongate member. The distal end portion of the stylet is configured to removably couple a mesh carrier thereto. A portion of the distal end portion of the stylet is disposed outside of the lumen of the elongate member when the stylet is in its first position and is disposed within the lumen when the stylet is in its second position.

Abstract: Disclosed herein are methods and devices for securing soft tissue to a rigid material such as bone. A bone anchor is described that comprises an anchor body with expandable tines and a spreader that expands the tines into bone. Also disclosed is a bone anchor that comprises a base and a top such that suture material may be attached to apertures in the anchor top or else compressed between surfaces on the base and top to secure the suture to the anchor. Also described is an inserter that can be used to insert the bone anchor into bone and move the spreader relative to the anchor body attach suture material. Also described is an inserter that can be used to insert the bone anchor into bone and move the anchor top relative to the anchor body or anchor base to attach to or clamp suture material there between.

Abstract: Various exemplary devices, systems, and methods for knotless anchor temporary suture capture are provided. In general, an inserter tool is configured for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool is configured to insert an anchor into a bone of a patient to secure a soft tissue relative to the bone. A suture coupled to the soft tissue is secured relative to the bone by being trapped between an exterior surface of the anchor and a bone surface defining a hole in the bone in which the anchor is positioned. The inserter tool and the anchor are configured to cooperate with one another to temporarily capture and lock the suture with respect to the anchor and the inserter tool before the anchor is secured in the bone hole.

Abstract: An aortic closure device for trans-caval procedures having a deployment assembly having a housing, a release tube, and a delivery tube disposed within the release tube, a tamper disposed within the delivery tube, a sealing element, a suture assembly, and an actuator.

Abstract: Disclosure herein are knotless suture anchor constructs and methods of use thereof. The suture anchor constructs can include a bone anchor and a suture. The bone anchor can include a suture anchoring member and can define a cavity and a longitudinal passage extending from a trailing end of the bone anchor at least partially therethrough to the cavity. The suture anchoring member can be located in the cavity. The suture can be coupled to the suture anchoring member and can include a tensioning portion, a repair portion, and an intermediate portion. The intermediate portion can form a suture loop extending along the longitudinal passage.

Abstract: A method of tissue repair that includes installing a surgical construct in a bone hole. The surgical construct has a fixation device that is preloaded with a primary flexible strand. After installing the surgical construct in the bone hole, the method includes coupling at least one secondary flexible strand to the primary flexible strand for subsequent use in repairing the tissue.

Abstract: An embodiment includes a chordal replacement system comprising: a pledget coupled to a first suture length and at least one of a first needle and a first ferrule; a second suture length coupled to the pledget and at least a second needle; and a third suture length coupled to the pledget and at least a third needle; wherein the second and third suture lengths are not monolithic with each other and do not constitute a single suture. Other embodiments are described herein.

Abstract: A device configured for use during a surgical procedure. The device can optionally include any one or combination of a first foot and a spine. The first foot can form at least a first edge at a first longitudinal end of the device. The first foot can be configured to seat the device on a tissue of a patient. The spine can be connected to the first foot and can have a longitudinal length extending from first foot toward a second longitudinal end of the device. The spine can include an eyelet adjacent to but offset from the first foot.

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.

Abstract: Methods and devices for securing soft tissue to a rigid material such as bone. A tissue capture anchor is described that comprises an anchor body and a spreader such that tissue may be captured or compressed between outside surfaces on the anchor and spreader and inside surfaces of a bone hole to secure the tissue within the hole. A bone anchor is described that comprises an anchor body with expandable tines and a spreader that expands the tines into bone. The spreader captures tissue via a suture loop at the distal end of the bone anchor. Also described is an inserter that can be used to insert the anchor into bone and move the spreader within the anchor to expand the anchor and capture the tissue between the anchor and the bone. Methods are described that allow use of single bone anchor to secure tissue to bone or also to use more than one bone anchor to provide multiple lengths of suture material to compress a large area of soft tissue against bone.

Abstract: A knotless tensionable fixation system may be utilized for performing surgical methods for repairing tissue defects within a joint. An exemplary surgical method may include fixating a graft over top of the tissue defect with the knotless tensionable knotless fixation system. The knotless tensionable fixation system may include a plurality of knotless suture anchors, the graft, and a reinforcement construct. The reinforcement construct may establish a fixed segment of material over the graft after being secured in place by the plurality of knotless suture anchors.

Abstract: A gastrointestinal tissue approximation clip system for approximating tissue defects, which includes an applicator that is sized to travel through an instrument channel of an endoscope; first and second tissue approximation clips that are transported to first and second locations of a tissue defect respectively by the applicator to approximate the tissue defect; first and second sutures attached to the first and second tissue approximation clips respectively; a clip approximation means for approximating the first and second tissue approximation clips. The clip approximation means and the first and second tissue approximation clips are sized to travel through the instrument channel, and the first and second tissue approximation clips are adapted to be detachably coupled to the applicator.

Abstract: A suture suspension system including a flexible backstop extending along a longitudinal axis and having two ends positioned in a first direction in an undeployed configuration. A length of suture can be positioned through the flexible backstop and forms a bridge connecting and creating suspension between a first body to a second body. In a deployed configuration, the two ends of the flexible backstop are positioned in a second direction different from the first direction. The system may also include an anchoring body having the length of suture woven therethrough. A portion of the anchoring body is positioned on a distal surface of a second body and a portion of the flexible backstop is positioned on a proximal surface of the first body.

Abstract: A suture anchor and methods of use thereof are disclosed. The suture anchor comprises an anchor body having a slot formed in the body and a passage extending through the body in a first direction. The passage is sized to permit a suture to traverse the body through the passage. The suture anchor also has a shaft with a sharp portion, and the slot and the passage intersect within the anchor body. The shaft is movable relative to the anchor body within the slot from a first position in which the sharp portion and the passage do not intersect, to a second position in which the sharp portion and the passage intersect. The shaft can penetrate a suture or multiple suture strands to fix the suture or suture strands relative to the suture anchor.

Abstract: A quadricep graft suspension construct, having a button loop, including a generally rectangular button, defining four apertures, including an innermost pair of apertures; and a suture loop looping through the innermost pair of apertures. The construct also has a graft holding assembly, including a reinforcement of first fibers braided with two second fibers, and wherein the first fibers have a first and second lengthwise end and the second fibers continue separately, extending from the first lengthwise end to form a pair of first tails and from the second lengthwise end to form a pair of second tails and wherein the first tails are jointly swaged to a needle. And wherein the graft holding assembly is affixed to the suture loop at a position opposed to the button at least in part by the second tails being joined together about the suture loop and further including packaging holding the needle.

Abstract: This invention relates to devices that join a pair of edges. Previously, suture assemblies used holes perpendicular to a vertical plane. Embodiments of the present invention use a first pad tunnel (130) between a first pad lower plane opening (126) and a first pad upper plane opening (122). A first pad tunnel major axis (132) passes through a first pad upper plane opening center (124) and a first pad lower plane opening center (128). For reference a first pad orthogonal axis (134) passes through the first pad upper plane opening center (124) orthogonal to the first pad upper plane (118) and the first pad lower plane (120). A first pad angle (?1) is measured clockwise from the first pad orthogonal axis (134) to the first pad tunnel major axis (132). The first pad angle is at least five degrees but no more than 175 degrees.

Abstract: Systems, methods, and devices for bony fusion are disclosed. A threaded cannulated implant may be inserted into a target space, such as in the sacroiliac joint. The implant may have a distal section, a proximal section, and a central section between the distal section and the proximal section. The distal section may comprise cutting threads and flutes for self-drilling the implant into bone. The proximal section may be configured to couple to an insertion instrument for the implant. The central section may have a lattice structure through which bone graft may flow to promote bone ingrowth. A solid core region may be located inwards from the lattice structure. The central section may also have openings through the core region to connect the lattice structure to the cannula.

Abstract: Tissue repair systems which use knotless all-suture anchors and have the ability to lock multiple repair sutures within the anchor construct. The anchor construct includes a tension suture wrapped or looped upon itself to create an open eyelet, through which multiple repair sutures originating in soft tissue are passed. The location of the eyelet may be anywhere inside the all-suture anchor or adjacent to the exterior of the anchor body. Tensioning of the tension suture causes the eyelet to restrict movement of the repair sutures and secures them within or against the anchor body.

Abstract: An implantable device for aiding in generating connective tissue between a pair of anatomical structures in a mammalian body is provided. The device includes an elongate, flexible tether which can be secured between the anatomical structures and which carries a scaffold which is generally porous so as to be capable of promoting tissue ingrowth and collagen deposition along its length. The scaffold extends along the tether for a sufficient distance so that it is securable in at least close proximity to an anatomical structure at either end. The pores in the scaffold extend through the scaffold and each has a diameter in the range of about 10 ?m to about 200 ?m. The length of the tether is selected to be a desirable maximum distance between the anatomical structures along a desired path when secured therebetween.

Abstract: Methods and devices are provided for repairing a tear in a meniscus. A pair of fixation member each entailing a preformed knot configuration coupled together by a suture length. The fixation members are placed on the meniscal tissue with the suture length spanning the tear, the knot configurations are expanded to form anchoring knots and the suture length is shortened to close the tear.

Abstract: An example method is provided for maintaining stability to an injury defined by a separation of two bones (e.g., the tibia and fibula), the separation being an injured distance greater than a pre-injury distance between the two bones in a first human patient. The method may include delivering a first apparatus for approximation of the two bones in the first human patient comprising the injury, the first apparatus including a flexible segment disposed between a first anchor and a second anchor. The method may further include maintaining, by the first apparatus, a restored distance between the two bones in the first human patient after a repetitive dynamic loading, the restored distance approximately equal to the pre-injury distance.

Abstract: Meniscal repair devices, systems, and methods are provided.

Abstract: Tissue fixation and repair constructs and methods of repair using the same are provided. An exemplary tissue fixation and repair construct can include a first implantable anchor coupled to a suture having a fixed tail and a tensioning tail. The fixed tail can include an overhand knot located distally adjacent to the finger trap, such that the overhand knot substantially abuts the finger trap when adjacent thereto, a fixed stopper knot configured to prevent further movement of the fixed tail through a second implantable anchor when the second implantable anchor is placed onto the suture, and a finger trap. The tensioning tail can be passed through the finger trap and overhand knot, and can be used to adjust the tension of the tissue fixation and repair construct when the first implantable anchor and the second implantable anchor are inserted into bone.

Abstract: An apparatus for suturing tissue, comprising: a needle having a beveled opening and housing multiple anchors, wherein each of said anchors comprises an elongated tubular body and a loop connected to said tubular body, and wherein a thread is threaded sequentially through the loops; and a pushrod configured to push each of said anchors towards the opening of said needle, to extract each respective anchor from the opening.

Abstract: A system for fixating a bone includes a buckle having a plurality of lock bars and a hook. A cord may connect the hook with an opposite end of the buckle and around a bone. The buckle may include lock bars on the opposite end of the buckle to receive the cord and allow a frictional resistance to a loosening of the cord around the bone to facilitate a reduction of a fracture of the bone.

Abstract: A gastrointestinal tissue approximation clip (“GI TAC”) system for approximating tissue defects, the GI TAC system including an applicator that is sized to travel through an instrument channel of an endoscope; a plurality of tissue approximation clips that are transported to a plurality of locations about a tissue defect by the applicator; a suture coupled to at least one of the tissue approximation clips; and a clip approximation means for approximating the tissue approximation clips. The clip approximation means and the tissue approximation clips are sized respectively to travel through the instrument channel, and the tissue approximation clips are adapted to be detachably coupled to the applicator.

Abstract: A suture threader configured to thread sutures through suture holes in a bone plate, including: a base; a plurality of hooks attached to the base, wherein the plurality of hooks are arranged at positions on the base corresponding the suture holes on the bone plate.

Abstract: A implant delivery system for securing an implant to an anchor. The implant delivery system includes a driver including a shaft, a biasing body having a first end region configured to engage said driver and a second end region configured to engage a portion of an implant, and a suture extending between the anchor and the shaft of the driver. The driver may be rotated to reduce the length of the suture between the driver and the anchor and generate a biasing force urging the implant into engagement with the anchor. The biasing force is substantially not transmitted to the bone.

Abstract: A method of endovascularly delivering and implanting a medical assembly for minimally invasively implanting an atrial sealing skirt in the heart at an atrial sealing skirt deployment site, sealing the top brim against a respective atrial floor of the heart, and anchoring the atrial sealing skirt on an intracardiac wall at an implantation site and tethering the anchor and the sealing skirt.

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: Various devices, systems, and methods are provided for securing soft tissue to bone. In one exemplary embodiment, a two-piece inserter tool is provided that includes a tip portion that is configured to be removably coupled to a handle portion. A distal portion of the tip portion can be configured to be coupled to a suture anchor, and the tip portion and the anchor can be passed through a continuous suture loop prior to mating the tip portion to the handle portion.

Abstract: Suture passer systems for tissue suspension and tissue compression are described. The system can include a shaft and a needle, wherein the needle is freely rotatable with respect to the shaft. The suture may include an overmolded segment. Methods of placing one or more implants, sutures, fastener, bone anchors and other devices are also described. The methods include moving tissue, including the superior pharyngeal constrictor muscle, palatopharyngeal arch, and palatoglossal arch. The methods include hyoid bone suspension.

Abstract: A bolster system having a first bolster device, a second bolster device, and an adjustable tether that includes a one-way pre-tied slideable adjustment knot. The adjustment knot is at a first position prior to insertion of the first bolster device into a passageway in one or more bones. The second bolster device includes a body portion having an outer portion that is sized to be received in the passageway and/or in an aperture of a bone plate. The body portion also includes a channel that is sized to accommodate recessed and/or embedded placement of the pre-tied slideable adjustment knot. The second bolster device can also include an oversized plate portion that abuts against a cortex of a bone or a wall of a bone plate. The second bolster device can also include a threaded member or retention tab that lockingly secures the second bolster device to a bone plate.

Abstract: A fixation device for graft placement and ligament suspension. The fixation device includes a strand of suture having a first limb and a second limb with a midpoint therebetween. The suture includes a first splice in the first limb and a second splice in the second limb. A first free end of the first limb extends through the second splice, forming a first loop with a diameter. A second free end of the second limb extends through the first splice, forming a second loop with a diameter. Tensioning the first free end reduces the diameter of the first loop and tensioning the second free end reduces the diameter of the second loop. The fixation device may include a button having the first and second limbs of suture woven therethrough such that the first and second free ends extend proximally from the button and the loops extend distally from the button.

Abstract: Embodiments related to surgical anchors are described. In some embodiments, a surgical anchor may include a selectively removable blocker which may prevent one or more barbs of the surgical anchor from engaging with adjacent tissue until the selectively removable blocker is removed.

Abstract: In one embodiment, a multi-layer suture fastener that includes a generally disc-shaped body defining a plurality of axially spaced-apart layers. Each layer can include an inner axial surface and an outer axial surface. A suture opening can extend from the inner axial surface to the outer axial surface of each layer. The suture openings can have an open configuration and a closed configuration. One or more lines of suture can be passed through the suture openings when in the open configuration. The suture openings can be placed in the closed configuration. In the closed configuration, the one or more lines of suture can be restricted by radial surfaces of the suture opening from sliding through the suture openings in at least one longitudinal direction of the one or more lines of suture.