Abstract: A locking suture construct having suture material with a first end and a second end, each attached to a first body in a slidable manner, a constricting member formed in the second end of the suture material, and a bight in the suture material between the first end and the second end. The bight can be pulled through the constricting member around a second body to create a locking loop. The first end and the second end are passed through the locking loop. Pulling the first end increases a perimeter of the locking loop and moves the constricting member toward the second body. When the constricting member reaches the second body, pulling the first end reduces the perimeter of the locking loop and moves/rotates the constricting member around the second body toward the first body to hold the first body in relative position to the second body.

Abstract: A system for securing a length of filament in working communication with tissue. The system includes a first filamentary sleeve having a length along a longitudinal axis and a passageway therethrough. The passageway is dimensioned to allow slidable movement therein of a length of filament. Also included within the system is and a filament engagement device that includes a pathway. The pathway has a first configuration and second configuration, wherein a portion of the length of filament is slidable within the pathway when the pathway is in the first configuration and is restricted from sliding when the pathway is in the second configuration.

Abstract: Methods and devices described herein facilitate ablation patterns on the heart within a pericardial sac and without opening or deflating the lungs.

Abstract: Methods for whip-stitching soft tissue with a needle and a looped suture avoid placing the tissue graft through the suture loop, which also eliminates the need for passing a tissue clamp through the suture loop. The methods described herein can also include combinations of the techniques described.

Abstract: A method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. A bone engaging fastener is coupled to bone. A second fastener is coupled to a suture construction. The second fastener is coupled to the first fastener. Soft tissue is coupled to the suture construction.

Abstract: A suture anchoring device for fixing a soft tissue to a bone tissue is disclosed that enables the exchange of sutures between anchors after implantation. The suture anchoring device may include a body that is inserted into the bone tissue, a suture exchange fitting situation within a passage formed within the body, and one or more pre-loaded sutures looped through the suture exchange fitting and projecting proximally from a proximal opening formed in the body. Surgical kits and surgical methods for performing various repair procedures using one or more suture anchoring device are also disclosed.

Abstract: A wound closure apparatus can be a self-contained device for delivery and deployment of a wound plug. The apparatus can include a post and a wound plug. The post can have a top end, a bottom end, and an interior channel located between the top end and the bottom end. The bottom end of the post can include a plurality of perforations extending from the interior channel to an outer surface of the post. The wound plug can include a body and a bladder, the bladder disposed around the body. In an assembled configuration of the wound closure apparatus, the bottom end of the post is positioned through an opening of the bladder such that the bladder can receive a fluid through the interior channel and the plurality of perforations.

Abstract: A method for securing a flexible member may include forming a bore in a bone; inserting an anchor into the bore, the anchor including a passage and being coupled to a flexible member; slideably positioning a first load distributing member along the flexible member; inserting the first load distributing member into the bore such that the flexible member engages the first load distributing member; and applying tension to a portion of the flexible member to secure the anchor and load distributing member within the bone.

Abstract: A suture anchor has a tubular body having an axial bore therethrough with one or more purchase enhancements on an exterior surface of the body adapted to enhance purchase of the body within a bone hole. These are preferably screw threads. A distal nose of the suture body has a smooth exterior surface. A length of suture passes down along the exterior surface over the purchase enhancements, over the distal nose, and up into the bore. The smooth exterior surface of the distal nose allows tension of the suture to be held by the engagement of the nose within the bone hole thus making it easier to obtain proper tension as the remaining portion is engaged into the bone hole to provide final fixation.

Abstract: Suture constructs and methods for soft tissue to bone repairs. The suture construct is a soft, suture-based anchor which is self-cinching and has a specific, accordion-type configuration (i.e., with the ability to fold from a first, extended position to a second, folded or compressed position). The suture-based anchor may be formed essentially of a flexible material such as a high strength surgical suture, suture chain, or suture.

Abstract: Described are methods and apparatus for use in supporting tissue in a patient's body. In some embodiments, the patient's breast or another tissue is supported. One method involves introducing a superior soft tissue anchor into a patient, the anchor having an inferiorly facing total surface area; and introducing at least one inferior soft tissue anchor into the patient, such that the at least one inferior soft tissue anchor is suspended from the superior soft tissue anchor, the sum of all of the at least one inferior soft tissue anchors having a superiorly facing total surface area. The inferiorly facing total surface area of the superior anchor can be greater, such as at least two times greater than the superiorly facing total surface area of the at least one inferior anchor.

Abstract: A knotless suture anchor assembly for engaging a bone tunnel and holding suture therein to knotlessly secure said suture to soft tissue including an elongated generally cylindrical hollow outer member having an axial lumen, an outer surface with projections for engaging the wall of the bone tunnel, a distal end and a proximal end; and an elongated, generally cylindrical inner member having an axis, a proximal end and a distal end, the distal end having a transverse passage for receiving suture therethrough, the transverse passage having a proximal and distal end and adapted to receive a plurality of sutures in said eyelet, the inner member adapted to move coaxially relative to the outer member between a distal, suture-unlocked position and a proximal, suture-locked position.

Abstract: A one-piece knotless suture anchor with a breakaway distal tip is disclosed. The suture anchor includes a thin section connecting a distal anchor portion and proximal anchor portion. The thin section has a cutaway geometry allowing it to break in a repeatable manner. Force from a driver breaks the thin section connecting the distal and proximal anchor portions. The proximal anchor portion slides distally over the elongated member (either distal or proximal to the distal eyelet) and a repair suture is pinched between the distal and proximal anchor portions, or in between the bone tunnel walls and outer diameter of the sleeve, thereby fixing the repair suture in place without tying an arthroscopic knot.

Abstract: Various devices, systems, and methods for knotless suture anchors are provided. In general, a guide device can be cannulated and can be configured to slidably receive therein an inserter tool configured to deliver a suture anchor into a hole formed in bone, such as with a drill advanced through the guide device. The guide device with the inserter tool therein can be configured to be held as a unit by one hand of a person, e.g., a surgeon or other medical personnel.

Abstract: A suture anchor retaining a suture is fixated in hard tissue, in particular in bone tissue, using any per se known method and is then secured using a securing element including a material having thermoplastic properties, which is liquefied in situ and made to penetrate the hard tissue in which the suture anchor is fixated. The securing element is e.g. a thermoplastic plug or thermoplastic sleeve which is anchored above the suture anchor in a mouth area of the same hard tissue opening. Alternatively the securing element is a thermoplastic pin which is introduced into an inner cavity of the suture anchor, wherein the material having thermoplastic properties is liquefied in this cavity and, in a liquid state is pressed through passages connecting the cavity with outer surfaces of the anchor.

Abstract: Systems and methods for soft tissue to bone repairs, without knot tying. The soft tissue repair systems include self-cinching constructs with a fixation device, a flexible coupler and an optional shuttle/pull device attached to the flexible strand. An accordion-style weave region is formed by pulling on the shuttle/pull device subsequent to the fixation device being secured into the bone, to allow desired tensioning of soft tissue to be fixated or repaired relative to the bone and secured self-locking of the construct.

Abstract: A suture anchor assembly and methods of use will now are disclosed for the repair of human or animal tissue defects. The suture anchor assembly is capable of being inserted into a tissue such as bone while also being able to create an expanded profile when subjected to a retrograde force. This expanded profile anchors the suture anchor assembly into the tissue by a changing of position or shape of elements of the suture anchor assembly relative to other assembly elements and the tissue. Embodiments of the suture anchor assembly and methods are capable of precisely positioning assembly elements in the tissue to effectively repair the defects. Some embodiments of the suture anchor assembly are configured to allow for a tissue suture to be anchored without having to knot the tissue suture.

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

Abstract: Methods and devices for securing soft tissue to a rigid material such as bone are disclosed herein. A bone anchor is described that comprises a base and a top such that suture material may be 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 anchor top relative to the anchor base to clamp suture material there between. Also described is a soft-tissue and bone piercing anchor and associated inserter. Methods are described that allow use of the bone anchors to provide multiple lengths of suture material to compress a large area of soft tissue against bone.

Abstract: Devices and methods to attach soft tissue to bone include, for example, forming a bone tunnel in a bone, passing a suture through soft tissue, and inserting an anchor in the bone tunnel, wherein a distal portion of the anchor is positioned underneath the soft tissue, a proximal portion of the anchor is positioned beyond an edge of the soft tissue, the suture first portion extends from the distal portion of the anchor to the soft tissue, and the suture second portion extends from the proximal portion of the anchor to the soft tissue.

Abstract: A suture anchor assembly including a suture anchor that incorporates a harder distal tip with a softer proximal body. The tip and body of the suture anchor are connected via a threaded plug, which also serves to connect the suture anchor to an inserter.

Abstract: A self-drilling, self-tapping bone screw is described in which the bone screw has a drill tip free of threads and having a length at least as great as about the thickness of a proximal cortical bone layer, with the drill tip having opposed lands and a helical flute between each of the lands with each of the lands having a cutting edge configured to cut bone as the drill tip is rotated into the bone with the flutes conveying the bone debris away from the drill tip, where a lead thread begins to self-tap internal threads in the proximal cortical bone layer after the drill tip has drilled through the proximal cortical bone layer so as to avoid stripping the threads formed in the bone layer. A method of installation is also disclosed.

Abstract: Methods, systems and apparatuses for soft tissue repair including a device for anchoring sutured tissue to bone are disclosed. In one example, a device can include a body and a member. The body can have a wall with an outer surface thereof configured to engage the bone of a patient. The body can define an inner passage extending generally from a proximal end thereof to a distal end thereof. The body can have a slit formed by the wall, the slit extending at least a portion of a proximal-distal length of the wall. The member can be configured to be disposed within the body and can be moveable along the inner passage relative to the body between a first position and a second position. The member can be configured with a second passage to receive and pass a suture through the member when the member is in the first position.

Abstract: A barbed suture including a body with barbs on the periphery, a pointed end, and an anchor at one end to resist movement of the suture in the direction of the pointed end is provided. One or more limbs on the anchor may be provided, which may be arcuate, of varying lengths, and of varying distribution about the periphery of the suture body. Other anchor designs are provided. Methods of placing single-directional and bi-directional barbed sutures to approximate the tissue on each side of a wound and to position and support tissue in the absence of a wound, as in cosmetic surgery, are provided, and may include terminal J-stitches or S-stitches. Methods of placement may be made with sharp, pointed ends, which may be needles, or insertion devices. Sinusoidal patterns of sutures that have amplitudes generally perpendicular to the resultant holding force of the suture are provided.

Abstract: Methods and devices for transvascular prosthetic chordae tendinea implantation are disclosed. A catheter is advanced into the left atrium. A helical ventricular anchor subassembly is advanceable through the catheter, having a ventricular suture extending proximally through the catheter. A leaflet anchor subassembly is advanceable through the catheter, having a leaflet suture extending proximally through the catheter. From an atrium side, the leaflet anchor subassembly can be anchored to a superior surface of a mitral valve leaflet and a leaflet anchor can be advanced into the mitral valve leaflet to secure the mitral valve leaflet to the leaflet suture. The ventricular anchor subassembly secures the ventricular anchor to a ventricular wall. The leaflet suture and the ventricle suture may be tensioned and connected by a suture lock to form an artificial chordae.

Abstract: Described herein are devices and methods for delivering implants that include multiple coupled anchors. The anchors are secured to tissue using a multi-opening guide tunnel that is configured to releasably retain one or more portions of the implant located between two of the anchors. The releasable retention of one or more intervening portions of the implant maintains the position of the implant and the guide tunnel until the implant is secured to the tissue. The multi-opening guide tunnel permits securement of the multiple anchors without requiring repositioning of the guide tunnel for each anchor.

Abstract: A knotless anchor for attachment of tissue to bone includes a rigid anchor body and a suture extending there from. The suture is hollow and includes a fixed limb portion secured to the rigid anchor body. A soft suture tunnel extends in a longitudinal direction through the fixed limb portion of the suture. A free suture limb is passed through the tissue, back to the anchor, and through the soft suture tunnel, thereby creating a closable suture loop around the tissue. Tension applied to the free suture limb closes the suture loop, and approximates the tissue to the anchor body. When the anchor is deployed in a bone hole, external features of the anchor body grip the walls of the bone hole and simultaneously compress the suture, thereby preventing tissue pull-out. Anchor assemblies and methods of tissue fixation are also disclosed.

Abstract: A readily implantable knotless suture anchor that de-couples the angle of insertion of the anchor from the tissue passage step and other steps of conventional procedures. An anchor provides an internal locking mechanism configured such that: suture knots do not have to be tied; suture and tissue tension can be easily adjusted intraoperatively; and suture passage and tensioning can be done at a variety of positions and angles. A method includes: passing a first suture through a patient's tissue and then through a loop of a shuttle suture; pulling the free end of the shuttle suture until the first suture passes through an internal suture locking mechanism; applying tension in the first suture until adequate tension is achieved with respect to the tissue; automatically engaging an internal locking member; and securing the first suture against further relative movement with respect to the anchor.

Abstract: A suture anchor for knotless fixation of tissue. A swivel suture anchor has an anchor tip for receiving a suture strand, for surgical tissue repair without requiring suture knots. Tension on the repair constructs is adjustable. The swivel anchor is secured in a hole in bone by advancing a fixation device, such as a cannulated interference screw, over the body of the anchor.

Abstract: Disclosed systems for implanting annuloplasty rings and other prosthetic devices can comprise a plurality of microanchors, sutures threaded through the microanchors, the sutures passing through the prosthetic device, individual microanchor guides, such as tubes or spears, for each microanchor that contain the microanchors during delivery and allow for positioning and deployment of the microanchors into annular tissue. The systems can also comprise a bracket that is temporarily coupled to the prosthetic device, holds the plurality of microanchor guides in position relative to one another and relative to the prosthetic device, and/or guides the sutures passing through the prosthetic device. The prosthetic device can include suture locking mechanisms to secure the prosthetic device to the sutures and to the implanted microanchors after the deployment devices have been removed.

Abstract: An apparatus can include a first flexible member having first and second ends and a first body extending therebetween that defines a first passage portion. A second flexible member can include first and second ends and a second body extending therebetween that defines a second passage portion. The first end of the first flexible member can pass into and through the second passage portion in a first direction such that the first end extends outside of the second passage portion. The first end of the second flexible member can pass into and through the first passage portion in a second direction such that the first end of the second flexible member extends outside of the first passage portion to form a self-locking adjustable flexible member construct. Applying tension to the first ends can draw the passage portions and corresponding second ends toward each other.

Abstract: Devices and methods for reinforcing tissue grafts are described herein. In one embodiment, an implant is described that includes a proximal end portion having a through-hole formed therein, a distal end portion, and a reinforcing insert disposed in the through-hole. The insert includes a proximal face, a distal face opposed to the proximal face, a first upper surface extending between the proximal and distal faces and having a generally convex shape that abuts against at least a portion of a sidewall of the through-hole, and a second lower surface extending between the proximal and distal faces and having a generally concave shape. The second lower surface and portions of the sidewall of the through-hole not abutted by the first upper surface form a reinforced through-hole of the implant.

Abstract: A wicking component is integrated into an arthroscopically deployable bone anchor, and is intended to improve soft tissue-to-bone repair. Once deployed, the fibrous wick component extends from within the bone tunnel, out of the hole, and to the bone-tendon interface on the bone surface. The tissue is approximated against the bone, sandwiching the wick material between the bone and tissue. The wick component is ideally a polymeric fibrous or tissue-based scaffold that provides a pathway for cells (autologous bone marrow constituents and blood) to travel from within the bone to the soft tissue-bone interface, accelerating and promoting the healing response. The system provides a biomimetic structure that stimulates the extracellular matrix to encourage cell attachment and potentially improve the healing response. The wick component does not need to be integrated into a suture anchor and installed when the suture anchor is deployed.

Abstract: A multi-suture knotless anchor and related method for securing soft tissue, such as tendons, to bone are described. The suture anchor includes a body, a sleeve, and an outer deformable bone locking structure. The bone locking structure has a first low profile configuration for insertion into the bone, and a second larger profile configuration for engaging the bone when actuated. The bone anchor and methods permit a suture attachment that lies beneath the cortical bone surface and does not require tying of knots in the suture.

Abstract: A suture having a first end for penetrating tissue, an elongated suture body having a periphery; a plurality of retainers on the periphery, and a second end having a variable loop of variable circumference, wherein the variable loop includes a fixed loop slidably engaging the elongated body for slidingly varying the circumference of the variable loop, and wherein the first end may pass through the variable loop to secure tissue as an anchor, the anchor preventing movement of the suture in the direction of deployment of the first end.

Abstract: Systems and methods for providing fixation of soft tissue (for example, ligament) to bone by employing a novel multi-piece device. The novel multi-piece device is a ligament fixation system consisting of a larger collar that is initially impacted into a bone aperture, and a smaller plug/bullet-shaped part that is impacted into the larger collar. During ligament repair/reconstruction, the graft is inserted into a bone tunnel with sutures from the graft extending outside the tunnel. The sutures are passed through a collar of the multi-part device and the collar is then inserted into the bone tunnel. The graft suture strands may be tensioned. Subsequently, the smaller plug/bullet-shaped part is impacted into the collar thereby maintaining the tension on the graft sutures. The plug/bullet-shaped part is tightened after the desired tension on the suture is achieved.

Abstract: Knots and methods of forming knots made of flexible material for use in a surgical environment are described. The knots include one or more ways to unlock at least a portion of the knot.

Abstract: The present invention discloses methods for producing a surgical suture having a reduced cross-sectional area portion from monofilaments fibers of various polymeric and metallic materials. Also disclosed are novel sutures having novel tips. Novel suture tipping apparatuses are also disclosed. The monofilament is subjected to the application of thermal treatment coupled with application of mechanical shaping of the fiber element to produce a deformed cross sectional portion of the suture body. The deformed suture body region is subsequently subjected to a trimming operation within a punching/stamping die. The reduced section of the suture body region and is severed to form a suture having a reduced-cross sectional area end portion. Preferably, each reduced region is severed approximately in the center of the trimmed reduced cross sectional area portion to form a suture having both ends of a reduced cross-sectional area.

Abstract: An anchor for securing suture to tissue, the anchor comprising: an elongated body having a distal end and a proximal end, the distal end having a distal slot extending proximally into the elongated body, and the proximal end having a proximal slot extending distally into the body; the distal slot comprising a wide section and a narrow section, wherein the wide section has a width such that the suture is slidably accommodated therein and the narrow section has a width such that the suture is bound therein, and further wherein the wide section is disposed distally of the narrow section.

Abstract: An apparatus for anchoring a tensile member to bone includes a housing with first and second ends and a hollow interior space. A collet is disposed in the interior space, the collet defining a central bore for accepting a tensile member therethrough, and an exterior surface. A sleeve has opposed interior and exterior surfaces and is disposed in the interior space axially adjacent to the collet, and is movable axially between first and second positions. At least one of the exterior surface of the collet and the interior surface of the sleeve is tapered and the sleeve and the collet are arranged such that movement of the sleeve from the first position to the second position will cause the interior surface of the sleeve to bear against the exterior surface of the collet, causing the collet to swage radially inwards around and against the tensile member, without moving axially.

Abstract: Delivery systems and methods for deploying an implantable device are disclosed, which can include a delivery device having an outer tubular member and an inner assembly. The inner assembly is disposed within and is slidably movable relative to the outer tubular member. The inner assembly can include a pusher at a distal portion. The pusher abuts and restricts proximal movement, relative to the inner assembly, of a crimped implantable device within the outer tubular member. The pusher can include a slot to accommodate a suture binding mechanism of the implantable device. The delivery device can include a tip disposed at a distal end. The tip includes a tip transition zone. The inner sheath and outer tubular member can each have sections of distinct rigidity along their lengths with transition zones between the sections. A transition zone of the outer tubular member and a transition zone of the inner sheath can be longitudinally offset.

Abstract: Suture anchors and associated methods are disclosed having suture securing features able to lock suture ends extending from a body tissue, such as from a bone tunnel.

Abstract: An implant or endoprosthesis suitable to be implanted in human or animal tissue includes two (or more than two) parts to be joined in situ. Each one of the parts includes a joining location, the two joining locations facing each other when the device parts are positioned for being joined together, wherein one of the joining locations includes a material which is liquefiable by mechanical vibration and the other one of the joining locations includes a material which is not liquefiable by mechanical vibration and a structure (e.g. undercut cavities or protrusions) suitable for forming a positive fit connection with the liquefiable material. The joining process is effected by pressing the two device parts against each other and by applying ultrasonic vibration to one of the device parts when the two parts are positioned relative to each other such that the two joining locations are in contact with each other.

Abstract: Tissue securement fibers of reduced cross sectional area and methods of making them are disclosed. The fibers comprising reduced cross sectional areas provide higher degrees of flexibility by providing discrete bending zones most useful in applications when the fiber is bent at an included angle less than 180°, more particularly when the included angle is less than 90°.

Abstract: Various devices, systems, and methods for anchoring sutures are provided In general, a suture anchor can include a groove formed in an exterior surface thereof and configured to seat a suture at least partially therein. The suture can be configured to automatically become seated in the groove during the advancement of the anchor into bone, such as by being rotated therein using a driver tool. The suture and the groove can have cooperating sizes such that the suture seated in the groove extends radially outward therefrom to be partially located outside of the anchor. This external portion of the suture can be press fit between the anchor and the bone, thereby securing both the anchor and the suture to the bone. This securing can occur as part of driving the anchor into bone.

Abstract: Methods and systems are provided for securing tissue to bone. A surgical system can include a driver device, an elongate shaft receivable within the driver device and having a dilator feature at its distal end, and a capture suture extending through the shaft such that the capture suture's terminal end portions extend to a more proximal position on the driver and the capture suture forms a loop that extends through an opening formed through a side of the shaft. The loop is configured to receive at least one retention suture therethrough and can be tightened by pulling the capture suture's terminal ends, thereby coupling the retention suture with the suture anchor. Once the shaft is inserted into bone and the loop with the retention suture is closed, the suture anchor is driven distally towards the dilator features and into the bone to secure the retaining suture in the bone.

Abstract: A method of fixing surgical suture to tissue includes loading an anchor into a delivery guide and locating a fixation device outside of the delivery guide, with the anchor and the fixation device attached by a suture. The method includes providing an anchor deployment component coupled with the delivery guide and located proximal to the anchor, with a spring mechanism located between a distal portion of the anchor deployment component and the anchor. The method includes moving the anchor deployment component in a distal direction through the delivery guide, pushing the anchor out of the delivery guide, and delivering the anchor into tissue.

Abstract: A deformable or flexible suture anchor having apertures secures a suture to a skeletal structure via holes drilled through the skeletal structure, and passing the suture therethrough. A deformable structure permits the anchor to resiliently deform or bend for passing through an aperture, and resume a size larger than the passed aperture for securement on an opposed side of the aperture.

Abstract: This disclosure relates to surgical fixation systems and methods. A surgical fixation system can include a fixation device, a loop connected to the fixation device, a graft carried by the loop, and a reinforcement material. Surgical fixation systems can be used in various tissue reconstruction procedures, including but not limited to, ACL and PCL reconstructions. The graft and the reinforcement material may be tensioned independently of one another to avoid stress shielding the graft.

Abstract: Various methods and devices are provided for a graft fixation device for fixing a graft member within a bone tunnel. In one embodiment, a graft fixation device is provided having a radially expandable sheath adapted to be disposed within a bone tunnel, and a sheath expander adapted to be received within the radially expandable sheath to expand the sheath and thereby anchor a graft between the sheath and the bone tunnel. In an exemplary embodiment, the graft fixation device is particularly useful to affix a graft within a femoral tunnel.