Abstract: The combination of: a) a bone implant having a body with a first portion that overlies an outer bone surface and first and second projections; and b) a bone implant handling instrument comprising: a guide assembly; and an implant advancing assembly. With a part of the bone implant handling instrument bearing against at least one bone part, the bone implant can be guided by the instrument in substantially a straight line in a first direction, while being maintained in substantially a same orientation with respect to the straight line, between a starting position and an operative position. The implant advancing assembly has at least one part that is movable against the bone implant to advance it into the operative position wherein the first and second projections are advanced into one or more bone parts and the first portion of the body overlies an outer bone surface.

Abstract: A pedicle screw tulip head extender. The extender can include an upper body portion joined to a lower body portion. The upper body portion can have two opposing arms extending upwardly from a curved lower surface to define a substantially U-shaped interior channel having a first channel axis, the curved lower surface defining an access opening extending through the upper body portion in a direction generally perpendicular to the first channel axis. The lower body portion can extend downwardly as a protrusion from the upper body portion and can be joined to the upper body portion and can have first and second sides, the first and second sides being substantially planar and parallel and separated by an interior portion, the first and second sides defining a protrusion height and a protrusion width. A screw can be disposed in the interior portion and have external threads defining a thread diameter greater than the protrusion width.

Abstract: A pedicle screw assembly including a bone fastener having a lower end for engaging bone and an upper end remote from the lower end; a head having a rod-receiving channel attached to the upper end of said bone fastener; a spinal rod insertable into the rod-receiving channel of said head, said spinal rod having an outer surface extending between first and second ends thereof, wherein at least one of the first and second ends has a reduced diameter section. A spinal rod having an outer surface extending between a first end and a second end thereof; wherein the outer surface of said spinal rod has a reduced diameter section at at least one of the first and second ends.

Abstract: An expandable intervertebral cage device includes a first base plate and a second base plate, a proximal block with internal threading that mechanically couples the first base plate and the second base plate, and a distal block comprising an internal passage. The device has exactly two arm assemblies, one on each side. Each arm assembly includes a first arm mechanically coupled to the first base plate and the distal block, and a second arm is mechanically coupled to the second base plate and the distal block. A screw is arranged partially within the internal threading of the proximal block and passes through the internal passage of the distal block, such that rotation of the screw relative to the proximal block causes a change in distance between the proximal block and the distal block, and a corresponding change in the spacing and lordosis of the device.

Abstract: An inserter for attaching a modular yoke to a bone screw and for providing an indication of attachment, comprises a tubular body having a central lumen, distal and proximal ends, and an attachment portion for releasable attachment to a yoke having a bottom opening for receipt of a head of said bone screw. The inserter includes an inner shaft having a distal end configured to be received into the yoke, the shaft being axially movable within the lumen from first to second axial positions in response to the introduction of the bone screw head into the yoke bottom opening. An indicator button supported by the body is movable in response to axial movement of the shaft from a first indicator position indicating the first axial position of the shaft relative to the body to a second indicator position indicating the second axial position of the shaft relative to the body.

Abstract: A system to be used for transmitting ultrasonic vibration, the system including a sonotrode designed to vibrate in a stationary wave having at least one node position between the distal end and the proximal end of the sonotrode, and a guide shaft with a through opening. During operation the sonotrode extends through the through opening of the guide shaft and the distal end of the guide shaft is situated on a distal side of the most distal node position of the sonotrode. The sonotrode and the guide shaft are adapted to each other for radial clearance between the sonotrode and the guide shaft to be a minimum for a sonotrode portion comprising the most distal node position.

Abstract: Total knee replacement is the standard treatment for advanced knee osteoarthritis. An improved method of treating an osteochondral defect for knee osteoarthritis of dogs is provided, which is a composite tissue for treating or preventing disease, disorder, or condition associated with an osteochondral defect with new technique. The new technique of custom made instruments and implants for dog and small animals is applied for different breeds of dogs regardless of their sizes and weights. The tool is a custom made instrument, which is based on capture of image based (CT of computed X-ray) to be transferred to electronic 3D model and apply 3D preoperative planning to design the tools are used to perform the knee surgery.

Abstract: A surgical extractor that includes a first arm and a second arm, a linkage assembly connected to the first and second arms, and a driven shaft operatively engaged with the linkage assembly for moving the linkage assembly between first and second positions. The surgical extractor further includes a tensioning shaft engageable with the driven shaft for moving the driven shaft relative to the linkage assembly.

Abstract: An embodiment includes a system comprising: a tulip including a slot to receive a linkage, first and second side walls that define a portion of the slot, and a ring that couples the first side wall to the second side wall; wherein the ring couples to the first side wall at a thinned first proximal fulcrum and to the second side wall at a thinned second proximal fulcrum and the ring pivots about the first and second proximal fulcrums when the ring is forced proximally; wherein the first side wall includes a first sidewall projection that projects past the first proximal fulcrum and the second side wall includes a second sidewall projection that projects past the second proximal fulcrum. Other embodiments are described herein.

Abstract: An orthopedic broach is disclosed. The orthopedic broach includes a cutting tip and a broach handle. The broach handle includes a lever, a spring, and a latch. The lever is movably coupled to the handle and to an end of the spring. The latch is movably coupled to the handle and the opposite end of the spring. In use, the lever is movable from an opened position, where the latch is positioned in a released position, so that the cutting tip can be inserted into the handle, to a closed position where the latch is moved to an engaged position wherein the cutting tip is securely coupled to the latch, and thus the handle. The handle includes a spring stop to prevent the spring from further deflection to prevent the latch from moving to the released position and thus prevent decoupling of the cutting tip when excessive forces are applied.

Abstract: A clip-on reducer tool assembly for seating a spinal fixation rod in a rod receiving implant, the tool assembly has an outer sleeve. The outer sleeve has a proximal end with a cylindrical portion having a threaded opening, a first leg extension extending therefrom to a distal end, and a second leg extension joined to the first leg extension at an intermediate location between the distal end and proximal end. The second leg extension extends from the distal end toward the proximal end to a lever end spaced from the cylindrical portion. The leg extensions at the distal end have grasping members to engage an outer surface of a rod receiving implant and a fulcrum proximally located near the intermediate location configured to enlarge the space between the leg extension at the distal end as the lever end is depressed inwardly relative to a longitudinal axis of the outer sleeve.

Abstract: An inserter connects to an implant which has two rotatable actuators for adjusting two different parameters of the insert. The inserter has a handle and a frame extending from the handle. A hollow tube is supported by the frame and has an end that can be connected and disconnected from the implant when the tube is rotated. A stem is passed through the tube, and another stem is supported by the frame. Each of the stems has an end that is connectable to an actuator of the implant, and an opposite end connectable to a tool driver. When the tool driver rotates a stem connected to the implant, a parameter of the implant is changed. The stems can be removed for cleaning or for replacement with a different type of stem. The two parameters can be a height of different sides of the implant.

Abstract: An orthopaedic surgical instrument may include an elongated body with an implant end and an impactor end. A latch lever may be pivotally coupled to the elongated body. The latch lever may be moveable between an open position and a latched position in which the latch lever is retained within the body. An acetabular shell component may be rigidly attached to the implant end of the elongated body. An automated surgical impactor may be attached to the impactor end.

Abstract: An insertion device for deploying an implant includes an elongated main body having a distal locking portion for coupling to the implant and a proximal handle portion. The main body defines a central passage and the distal locking portion has outer ridges and slots to allow the outer ridges to flex radially inward when mounting to the implant. A plunger slides in the central passage for movement between an unlocked position for mounting the implant on the distal locking portion, a locked position for locking the implant on the distal locking portion, and an insertion instrument deployed position for deploying the actuation plunger to move the blades from the stowed position to the deployed position. A spike cap drive rotatably mounts on the main body having a socket end for engaging a drive nut on the implant to, in turn, move the spike cap.

Abstract: A surgical instrument comprises a first member including a drive engageable with a first mating surface of a bone fastener. A second member is rotatable relative to the first member and includes an engagement element connectable with a second mating surface of the bone fastener. A part is disposed with the first member and being alternately connectable with an actuator and an adaptor attachable with an image guide. Systems, surgical adaptors, spinal implants and methods are disclosed.

Abstract: A handset for an ultrasonic device for bone cement removal and/or osteotomy operations comprises a handset body which encloses ultrasound generating means including at least one piezoelectric transducer and a horn, connection means configured to connect the handset to a tool to which the ultrasounds generated by the ultrasound generating means are transmitted, a duct for circulation of a cooling medium, the duct extending at least partially on the outside of the handset, a triggering element whose activation causes the activation of the ultrasound generating means, and a control lever coupled to the handset body at a connection point, the control lever being configured to activate the triggering element by means of its movement about the connection point.

Abstract: Systems, devices, and methods suitable for use with procedures performed at least partially percutaneously are provided. In some procedures, two or more access devices for providing access to adjacent surgical locations within a patient are used. Certain embodiments of the access device comprise an elongate body having a distal end with one or more cutouts. The cutouts on adjacent access devices are generally aligned with each other to permit passage of a portion of a fixation element from one access device to the other access device. A fastener with an elongated removable head may be delivered to the surgical site through the access device. After a distal end of the fastener is secured to the surgical site, a portion of the elongated housing is detached from the remainder of the fastener and removed from the patient.

Abstract: An acetabular cup extractor is provided that is designed for extracting medical device implants. The acetabular cup extractor includes a fastener for securing to an implant and a cutting assembly. The cutting assembly further includes a blade spaced and movably connected to the fastener and a handle operatively connected to the blade.

Abstract: Various surgical devices and methods are disclosed herein. Also disclosed is multi-component prosthesis, which can be used as an ankle prosthesis. One of the disclosed surgical alignment systems includes a guide arm, a ratchet arm frame configured to be coupled slidably to the guide arm, a ratchet arm configured to be coupled to the ratchet arm frame, and a sagittal sizing guide body configured to be coupled to the ratchet arm. The sagittal sizing guide body includes a first radiopaque object disposed at a first position and a second radiopaque object disposed at a second position that is spaced apart from the first position.

Abstract: A surgical driver apparatus includes a housing and an inner driver shaft having a proximal end secured within the housing and a distal end extending out from a first side of the housing. The inner driver shaft is configured to rotate with respect to the housing. The surgical driver apparatus further includes an outer driver shaft and an idler driver shaft. The outer driver shaft is positioned coaxial with the inner driver shaft and configured to rotate independently from the inner driver shaft. The idler driver shaft is configured to transmit torque to the outer driver shaft. Additionally, the surgical driver apparatus includes a driver key comprising a driving feature and a counter-driving feature. The driver key is configured to engage a second side of the housing in one of a plurality of orientations configured to rotate the inner driver shaft and/or the outer driver shaft.

Abstract: A geared cam expandable spinal implant. Rotational motion of a rotating portion is translated into linear motion of a yoke, which moves geared cams at the distal end of the implant to mate with, and walk along, teeth of corresponding racks. The walking of the gear cam teeth along the rack teeth creates a regular rate of implant expansion, reduces initial excessive expansion force applied to the implant, and provides fine adjustment of the expansion rate and force.

Abstract: An inserter connects to an implant which has two rotatable actuators for adjusting two different parameters of the insert. The inserter has a handle and a frame extending from the handle. A hollow tube is supported by the frame and has an end that can be connected and disconnected from the implant when the tube is rotated. A stem is passed through the tube, and another stem is supported by the frame. Each of the stems has an end that is connectable to an actuator of the implant, and an opposite end connectable to a tool driver. When the tool driver rotates a stem connected to the implant, a parameter of the implant is changed. The stems can be removed for cleaning or for replacement with a different type of stem. The two parameters can be a height of different sides of the implant.

Abstract: An implant extractor that includes an elongated body having a proximal end for attachment to an extraction device, a first arm extending from the elongated body, and a second arm pivotably connected to the first arm. The second arm includes a moment arm for generating a torque about a distal end of the second arm. The implant extractor further includes a force applicator operatively connected to the first arm and the moment arm to apply a force to one or more of the first and second arms.

Abstract: The present invention involves a system and methods for assembling and implanting a vertebral body implant. The vertebral body implant includes, but is not necessarily limited to, an expandable core body and endplates that can be attached at both ends. Endplates of various shapes, sizes and angles are attachable to the expandable core so that a suitable vertebral body implant can be implanted between vertebrae.

Abstract: Systems and method of using a surgical driver instrument are provided. The driver instrument includes a driver shank having a proximal end including a head connector for a bone construct. The instrument includes an inner sleeve having a length and configured to receive the driver shank therein and a handle member having a first end and a second end. The inner sleeve and the driver shank have a non-threaded connection. The instrument includes an outer sleeve connected to the second end and concentric with the inner sleeve and a sleeve actuator assembly coupled to the handle member. The sleeve actuator assembly includes a first position where a portion of the length of the inner sleeve extends out from the handle member and a second position where the portion of the length of the inner sleeve that is extended from the handle member is retracted into the handle member.

Abstract: A disposable insertion instrument for inserting an implant includes a handle assembly, a drive assembly, and a plunger assembly. The drive assembly comprises an inner shaft and a spring received within an outer sleeve. A locking pin and drive lobes on the inner shaft cooperate to reversibly lock the drive assembly in a retracted position. A medical implant may be attached to the instrument via an adapter located at a distal end of the drive assembly. Following insertion of the medical implant into a patient, the disposable insertion instrument may be discarded.

Abstract: An artificial replacement disk assembly comprised of a core in between two endplates. The endplates have outer surfaces that match the surface morphologies of the corresponding vertebral endplates. The endplates may have textured inner surface to form a strong fusion with the core during the fabrication process. The thick solid endplates strongly fused to the core create a very resilient implant. Gripping structures on the endplates may permit easy manipulation of the assembly during surgical procedures.

Abstract: A bone graft delivery system and method for using same to deliver graft material into a surgical site. The method includes the steps of providing a hollow tube configured to receive the graft material, releasably attaching an implant to a distal end of the hollow tube so as to communicate with at least one opening in the distal end of the hollow tube, the implant being configured to receive the graft material delivered through the hollow tube; placing the implant within the surgical site; advancing the graft material through the hollow tube; conveying graft material through the hollow tube into an interior of the implant, whereby the implant is at least substantially filled with the graft material; and discharging the graft material through at least one opening in the implant into the surgical site, whereby the surgical site is at least substantially filled with the graft material.

Abstract: A surgical instrument comprises a first member including a drive engageable with a first mating surface of a bone fastener. A second member is rotatable relative to the first member and includes an element engageable with a second mating surface of the bone fastener. An actuator is connected with the second member and includes visual indicia of engagement of the element with the second mating surface. Systems, spinal implants and methods are disclosed.

Abstract: Tools and methods for expanding a precursor hole in a host material to receive a fixture. The precursor hole is enlarged by a rotary tool having helical flutes and interposed lands. The flutes have a negative rake angle. The lands each have a working edge that cuts the host material when the tool is rotated in a cutting direction, and that condenses the host material when the tool is rotated in a densifying direction. The body of the rotary tool has a stopper section that plugs the hole when a certain depth is reached. When the tool is used with a copious wash of irrigating fluid at or below the necessary depth, hydraulic pressure builds inside the precursor hole. The hydraulic pressure can be advantageously exploited in cutting mode to autograft a slurry of host material particles into the sidewalls of the hole and create an incipient densifying crust.

Abstract: A facet screw system and method includes an implant assembly having a screw with a removable head, a locking nut, and a collet. An insertion instrument is used to insert the screw, compress the facet joint, locks the implant, and breaks off the head of the screw providing a lower profile implant.

Abstract: Guides, implants, devices, instruments, systems, and assemblies for achieving bone fusion are disclosed. A bone fusion system, including an implant template, a guide wire for insertion through the implant template, a bone plate for receiving the guide wire, and an alignment guide apparatus for coupling to the bone plate. Methods of using a bone fusion system for achieving bone fusion are also disclosed.

Abstract: An intervertebral implant inserter, comprising: a) a elongated central body having a distal end, a proximal end, an outer surface, and a longitudinal throughbore therethrough, b) upper and lower blades, each blade having a distal end portion and a base portion, the base portion of each blade pivotally coupled to the elongated central body, c) a shaft having a longitudinal axis, wherein the shaft is advanceable within the throughbore and rotatable about the longitudinal axis, the shaft having a distal end forming a pusher having an acicular transverse cross-section, d) upper and lower endplates respectively detachably connected to the distal end portion of a respective blade.

Abstract: An inserter for attaching a modular yoke to a bone screw and for providing an indication of attachment, comprises a tubular body having a central lumen, distal and proximal ends, and an attachment portion for releasable attachment to a yoke having a bottom opening for receipt of a head of said bone screw. The inserter includes an inner shaft having a distal end configured to be received into the yoke, the shaft being axially movable within the lumen from first to second axial positions in response to the introduction of the bone screw head into the yoke bottom opening. An indicator button supported by the body is movable in response to axial movement of the shaft from a first indicator position indicating the first axial position of the shaft relative to the body to a second indicator position indicating the second axial position of the shaft relative to the body.

Abstract: Exemplary embodiments of apparatuses and methods of an expandable fusion device are provided. In one embodiment, an intervertebral implant can be provided, having a first endplate having an upper surface and a lower surface, a second endplate having an upper surface and a lower surface. A first side wall extends from the first endplate and a second side wall extends from the second endplate and are configured to engage one another to provide a selective variable height between the first endplate and the second endplate. The first side wall and the second side wall form a substantially hollow portion substantially enclosed by the first endplate, second endplate and the side walls. The substantially hollow portion is configured to receive bone growth inducing material.

Abstract: A method to guide in preparation of a bone relies on an instrument having a shaft with a working end and a stop member. The shaft is free to translate along an axis. Surgical planning data is registered to the bone to determine intra-operative coordinates of the desired axis and depth. The instrument holder is positioned by the bone so the stop member contacts the instrument holder to prevent translating beyond the desired depth. Alternatively, an arm is manipulated to align the instrument with the desired axis. The working end rests on the bone to define a linear separation to the desired depth. By proximally translating the instrument holder to contact the stop member and distally translating the instrument holder along the shaft, the stop member physically stops translating beyond the desired depth. A surgical system for performing the methods is provided; a reamer or impactor are also disclosed.

Abstract: A tool assembly for extracting a liner from a prosthesis comprising an impactor and a faceplate. The impactor can be configured to receive and transmit a force. The faceplate can be configured to deliver the force from the impactor to the prosthesis to separate the liner from a shell of the prosthesis.

Abstract: The invention involves a cannula suitable for the implantation of intervertebral implants into the spine area of an animal, particularly humans. The first end of the dynamically expanding cannula includes a rectangular or oval shaped cannula portion formed from a sandwich style assembly. The second end of the dynamically expanding cannula includes a connection assembly for securing the sandwich construction together. Once inserted, a backing assembly can be removed and a flexible expansion member can be displaced by an implant while a slide guides the implant to create a dynamic opening through which the implant travels to the disc space. A lever is supplied as a portion of the expansion assembly for removing the expansion member after insertion of an intervertebral implant.

Abstract: The knee joint prosthesis includes a tibial component and a femoral component. The tibial component has a top surface, a bottom surface opposite to the top surface and a first slot passing through the top surface and the bottom surface for accommodating a cruciate ligament. The tibial component has at least one first protrusion disposed on the bottom surface, and the first protrusion has a plurality of first through holes. The femoral component is carried by the tibial component and has a second slot for accommodating the cruciate ligament. The femoral component has at least one second protrusion disposed on a surface thereof opposite to the tibial component, and the second protrusion has a plurality of second through holes. The first protrusion has a first rear and front portions, and a width of the first protrusion gradually becomes thicker from the first rear portion toward the first front portion.

Abstract: An orthopedic device for implanting between adjacent vertebrae comprising: an arcuate balloon and a hardenable material within said balloon. In some embodiments, the balloon has a footprint that substantially corresponds to a perimeter of a vertebral endplate. An inflatable device is inserted through a cannula into an intervertebral space and oriented so that, upon expansion, a natural angle between vertebrae will be at least partially restored. At least one component selected from the group consisting of a load-bearing component and an osteobiologic component is directed into the inflatable device through a fluid communication means.

Abstract: A spinal marking system includes a marker having a threaded member and a flexible member connected to the threaded member. The flexible member has a length longer than that of the threaded member. The system also includes a navigation tool having a shaft configured to connect to the threaded member. The navigation tool also includes a navigation array connected to the shaft. The navigation array having a plurality of fiducials that are configured to communicate with a robotic system.

Abstract: An implantable tendon protection system includes a body adapted to be implanted within a bursa overlying a tendon of a patient to protect the tendon. The body may be fixed to the tendon with adhesive, sutures, staples, and/or anchors. A surgical kit is provided with such a tendon protection system and an insertion cannula. Methods of protecting a tendon of a patient are also disclosed.

Abstract: Typically, surgical intervention is required to remedy abnormalities of the vocal cords. However, surgical intervention often causes a laryngeal web, or glottic web, to form which impairs the sound quality of the vocal cords. The prosthesis and methods of the invention effectively eliminate regrowth of a laryngeal web after surgery over all other prior art devices and methodologies. During the operative procedure, the prosthesis may be inserted through a surgically created hole in a laryngeal web allowing a laryngeal bridge to assist in holding the prosthesis in position. Following surgery, after the vocal cords heal, the prosthesis may then be removed, and the laryngeal bridge also removed. In the case of an anterior procedure, the prosthesis produces a sharp anterior commissure without any glottic web. The prosthesis and method greatly reduce the recurrence of a laryngeal web.

Abstract: Embodiments are directed to spinal treatments and, more particularly, to a trial inserter tool compatible with detachable trial heads for use in spinal surgery. In a preferred embodiment, the present invention provides a system for sizing an implant to be used in posterior lumbar interbody fusion surgery. The system may comprise a trial inserter tool, wherein the trial inserter tool comprises: a body, wherein the body is an elongated tubular, wherein the body comprises a first end and a second end; an actuation device, wherein the actuation device is disposed on the body between the first end and the second end; and a hooked support member that extends from the second end of the body; and a trial head disposable on the hooked support member.

Abstract: A rod reducer including a housing defining an opening, a body member defining an opening and a slot, a shaft disposed through the opening of the housing and coupled to the opening of the body member, an anvil including a linkage extending therefrom, the linkage coupled to the body member and the anvil, a plurality of arm members, and a biasing element disposed between the body member and the anvil. A pin of the linkage is slidably disposed within the slot, and the biasing element is configured to bias the anvil distally with respect to the body member. Rotation of the shaft translates into linear movement, relative to the housing, of the shaft, the body member, and the anvil. The arm members are coupled to the housing and movable towards a parallel configuration as the anvil is advanced away from the housing to engage a bone screw.

Abstract: A surgical driver apparatus includes a housing and an inner driver shaft having a proximal end secured within the housing and a distal end extending out from a first side of the housing. The inner driver shaft is configured to rotate with respect to the housing. The surgical driver apparatus further includes an outer driver shaft and an idler driver shaft. The outer driver shaft is positioned coaxial with the inner driver shaft and configured to rotate independently from the inner driver shaft. The idler driver shaft is configured to transmit torque to the outer driver shaft. Additionally, the surgical driver apparatus includes a driver key comprising a driving feature and a counter-driving feature. The driver key is configured to engage a second side of the housing in one of a plurality of orientations configured to rotate the inner driver shaft and/or the outer driver shaft.

Abstract: A system and method for allowing any surgeon, including those surgeons who perform a fewer number of a replacement procedure as compared to a more experienced surgeon who performs a greater number of procedures, to provide an improved likelihood of a favorable outcome approaching, if not exceeding, a likelihood of a favorable outcome as performed by a very experienced surgeon with the replacement procedure. Force sensing is included to aid in quantifying installation of an implant, particularly a cup into a pelvic bone.

Abstract: The combination of: a) a bone implant having a body with a first portion that overlies an outer bone surface and first and second projections; and b) a bone implant handling instrument comprising: a guide assembly; and an implant advancing assembly. With a part of the bone implant handling instrument bearing against at least one bone part, the bone implant can be guided by the instrument in substantially a straight line in a first direction, while being maintained in substantially a same orientation with respect to the straight line, between a starting position and one operative position. The implant advancing assembly has at least one part that is movable against the bone implant to advance it into the operative position wherein the first and second projections are advanced into one or more bone parts and the first portion of the body overlies an outer bone surface. A method of placing the bone implant is also provided.

Abstract: A system and method for providing a spinal implant having a main body, a proximal anchor, a distal anchor, and an internal plunger. The proximal anchor comprises a nut having an internal bore. The distal anchor comprises a plurality of wings having a first closed configuration and a second open configuration. The internal plunger is housed within a central bore of the main body. The distal end of the internal plunger is operatively connected to the first wing and the second wing to selectively move the wings between the first closed configuration and the second open configuration, and vice versa.

Abstract: A system and method for providing a spinal implant having a main body, a proximal anchor, a distal anchor, and an internal plunger. The proximal anchor comprises a nut having an internal bore. The distal anchor comprises a plurality of wings having a first closed configuration and a second open configuration. The internal plunger is housed within a central bore of the main body. The distal end of the internal plunger is operatively connected to the first wing and the second wing to selectively move the wings between the first closed configuration and the second open configuration, and vice versa.