Abstract: A ligament incorporated into a prosthetic joint exhibiting a plasticized, elongated and deformable material. A fibrous material is internally disposed within the deformable material, the fibrous material terminating in first and second enlarged bead portions arranged in proximity to enlarged pocket defined ends associated with the deformable materials. First and second bones define a joint region therebetween, the deformable end pockets and bead portions being inserted through associated holes defined in joint proximate locations associated with the bones, so that actuation of a projection location of the fibrous material causes the bead portions to outwardly deflect the end pockets, resulting in the ligaments being anchored in place between the bones.

Abstract: A method for reconstructing a knee ligament and for performing a tibial osteotomy on the knee in a single procedure, the method comprising: forming a bone tunnel through the tibia at a location appropriate for the ligament reconstruction, disposing a graft ligament in the bone tunnel, and securing the graft ligament in the bone tunnel, and forming a wedge-like opening in the bone at a location appropriate for the tibial osteotomy, positioning an osteotomy implant in the wedge-like opening in the bone, and securing the osteotomy implant in the wedge-like opening in the bone; wherein the osteotomy implant is secured in the wedge-like opening in the bone with a fastener which extends through the implant and into the bone tunnel.

Abstract: A method and apparatus for re-attaching the labrum of a hip joint.

Abstract: A surgical method for loading ligament grafts into a joint. A longitudinal socket formed in a bone is intersected by a transverse pin. A flexible strand is drawn with the pin through the bone. A looped portion of the strand is diverted so as to protrude out of the entrance to the longitudinal socket. The ends of the strand remaining accessible on either side of the bone. The ligament graft is captured within the strand loop protruding from the entrance to the socket. The strand is retracted into the socket, drawing the graft into the socket by pulling on the accessible ends of the flexible strand. The graft is fixed in the socket using a transverse implant.

Abstract: This invention relates generally to orthopedic implants for reconstruction of severed, ruptured, or damaged ligaments. More particularly, this invention relates to an improved elastic replacement ligament made from metallic wires in a braided construction for replacement of a natural ligament of the body such as the anterior cruciate ligament of the knee.

Abstract: A jamming retainer for fixing a ligament in a bone tunnel without excessive sideways pressure on the ligament that may result in tissue necrosis the jamming retainer including a substantially rigid body with a bore or loop for receiving a ligament or tendon and a bore or ring for receiving a suture for towing the jamming retainer and ligament or tendon through a bone tunnel. Once positioned, the jamming retainer is fixed in the bone tunnel with an interference screw.

Abstract: A surgical implant (22) used to fix a ligament transplant (18) adapted to connect two bones on either side of a joint. The ligament transplant is fixed in a tunnel (10, 16) pierced from the outer cortical wall of a first bone and extending through a pre-determined depth of a second bone. The implant includes a first end (24) to be fixed to the transplant and a second end in the form of a hook (26) adapted to rest on an outer periphery (28) of the first bone's cortical part at the tunnel's inlet. The hook includes two lugs (30 and 32) adapted to be disposed on either side of the tunnel inlet so the hook rests on solid bone and not on bone having a reduced thickness at the tunnel's position, the axes of the lugs preferably being orthogonal to the hook's plane. One such implant is particularly suitable for replacing the knee's anterior cruciate ligament.

Abstract: An all-inside double-socket ACL reconstruction technique, according to which a femoral socket and a closed tibial socket are provided to accommodate retrograde fixation of at least one graft (for example, a semitendonosus allograft) within the sockets. The closed tibial socket is formed by using a retrograde drill device provided with a retrograde drill cutter detachable from a retrograde drill guide pin. The femoral socket may be formed by the retrograde drill method or by a conventional method, and may be carried out before or after the formation of the tibial socket. The graft is secured in the knee by employing a transversal implant, or by employing an interference screw, and/or a continuous loop/button construct.

Abstract: A device for tethering an implant device along the posterior spine of a human has first and second elements, as well as a means for fixing, in a quick connect manner, the first and second elements to each other. The first element is adapted for being secured to an interspinous ligament and the second element is adapted for attachment to the implant device. The first element may be a beam that is adapted for placement through the interspinous ligament in a direction substantially horizontal to a long axis of the spine.

Abstract: Sheaths for implantable fixation devices and methods of using the sheaths are disclosed. Sheaths have a flexible body with a perforated wall, and an interior of the body is sized and shaped to receive the fixation device. Sheaths include a plurality of flexible or inflexible tubes arranged to form a ring, where the central cavity defined by the ring is sized and shaped to receive the fixation device.

Abstract: A graft harness for securing a ligament in a bone tunnel takes the form of a shaped plug having a proximal end and a distal end. A radial groove is formed in the distal end of the plug which accepts a looped ligament graft. A suture passageway formed through the plug transverse to the groove accepts a length of suture. The proximal end of the plug features a concave configuration adapted to accept the distal end of an interference screw. A ligament graft is secured in a bone tunnel using the graft harness by seating the looped graft within the groove to form a harness/graft construct, passing a length of suture through the suture passageway, and drawing the harness/graft construct into the tunnel using the length of suture looped through the suture passageway. The graft is secured primarily using an interference screw which engages the concave proximal end of the harness. The harness provides secondary fixation of the graft in the bone tunnel.

Abstract: A knitted prosthetic device has at least two knitted sections, where each knitted section has at least one row of fiber. The knitted prosthetic device also has at least one intra-articular section disposed between the at least two knitted sections. In addition, the at least one intra-articular section has at least one single continuous fiber traversing the at least one intra-articular section and the at least two knitted sections, where the at least one single continuous fiber forms a plurality of traverses extending between the at least two knitted sections. In particular, embodiments may be used as ligament prostheses by anchoring each of the at least two knitted sections to a bone section of a patient. Such embodiments may be constructed from a strong polymer, preferably, but not limited to, silk, where the polymer provides ligament support but bioresorbs as load bearing responsibilities are transferred to tissue resulting from in-growth.

Abstract: A method of reconstructing a ruptured anterior cruciate ligament in a human knee. Femoral and tibial tunnels are drilled into the femur and tibia. A transverse tunnel is drilled into the femur to intersect the femoral tunnel. A filamentary loop is threaded through the femoral tunnel and tibial tunnel and partially through the transverse tunnel. A replacement graft is formed into a loop and moved into the tibial tunnels using a surgical needle and suture. A flexible filamentary member is simultaneously moved along with the loop into the femoral and transverse tunnels. The filamentary member is used as a guide wire in the transverse tunnel to insert a cannulated cross-pin to secure a top of the looped graft in the femoral tunnel.

Abstract: Methods for tendon and ligament repair using a scaffolding matrix material. The scaffolding matrix material is an off-the-shelf organic dermis from an unknown source which has been extra-operatively prepared so as to be devoid of viable cells which normally express antigens, and to promote natural healing of soft tissue via revascularization and repopulation. The scaffolding matrix material is used to join ruptured tendons or ligaments together and to join ligaments to bone.

Abstract: A securing element is intended for connecting a ligament to a bone part of a human or animal. The securing element comprises a wire or thread which is intended to be connected to the ligament. A clamping element of the securing element clamps' at least one part of the wire or thread in a releasable manner, for which purpose the clamping element comprises a first clamping part and a second clamping part. The first clamping part is provided with a conical first surface and the second clamping part is provided with a corresponding conical second surface on a side facing the first clamping part, in order for the at least one part of the ligament coupling element to be clamped between the first and second surfaces. The clamping element can be actuated from outside the body.

Abstract: A cancellous externally threaded pulley anchor for transporting an anterior cruciate ligament graft into the distal femur from the intra-articular surface during a surgical repair of the anterior cruciate ligament. A method using this device eliminates the need to pierce the lateral femoral skin during the surgery and also prevent interference with other surgical instruments and the knee and thigh holder, the anchor providing a pulley for the force insertion of the ligament graft into a femoral bone tunnel after the anchor is installed within the femoral bone tunnel by pulling the unattached end of the suture while the other end of the suture is secured to the ligament graft.

Abstract: A surgical anchor device for the repair of a torn ligament or tendon, primarily the anterior cruciate ligament in the knee, is used to affix the ligament within a femoral bone tunnel in the distal portion of the femur from the intra-articular surface, the device providing a pulley for a suture, wherein a free end of the suture may be pulled away from the device to draw the suture attached to the ligament graft within the femoral bone tunnel securing the ligament graft within the bone tunnel. Installation of the device is provided by insertion of the device through a tibial hole, through the femoral tunnel out of the lateral femoral cortex, pulling the attached sutures simultaneously to flatten the device against the lateral femoral cortex, attaching one end of the suture to the ligament graft and pulling the other end of the suture until the graft is situated properly within the femoral bone tunnel and tying the free end of the suture to retain the graft within the femoral bone tunnel.

Abstract: A method of repairing separations in the capsular labrum structure, in which the head of the humerus bone separates from the glenoid cavity of the glenoid, by: producing a first plurality of anchor points in an anterior face of the rim of the glenoid; producing a second plurality of anchor points in a corresponding anterior face of the neck of the glenoid; and utilizing the first and second plurality of anchor points for attaching the tendons to the glenoid. Also described is an apparatus for use in repairing separations in a capsular labrum structure including a drill guide having a proximal end formed with a handle, and a distal end formed with a surface configured for engaging a posterior face of the neck of the glenoid to properly fix the position of the drill guide with respect to the glenoid.

Abstract: A system for manipulating energy transferred by members defining a joint. The system includes a first attachment structure configured to be attached to a first member of the joint and a second attachment structure configured to be attached to a second member of the joint. There is also an adjustable energy absorbing device attached to the first attachment structure and second attachment structure, wherein adjusting the energy absorbing device changes the load manipulating characteristics of the energy absorbing device.

Abstract: An expanding plug for tendon fixation features two resilient arms configured to expand radially to achieve interference fixation of a graft tendon inside of a bone tunnel. The tendon graft is assembled to the expanding bolt and situated within a bone tunnel. Passing suture is used to pull the expanding plug into the tunnel in a first direction. Pulling the expanding plug in a second direction (which is opposite the first direction) deploys the resilient arms and places the expanding plug in the deployed configuration.

Abstract: The present invention is directed towards a prosthetic anchor (36) including a central layer (1) through which embedded fibers (2), such as artificial tendons, pass in defined pathways (4), a ‘deep’ surface membrane (7) which interfaces with a hard structure, whether that is a prosthesis, a bone, or other hard tissue, and a ‘superficial’ surface membrane (8) which interfaces adjacent tissue and may be configured to adhere or not to adhere to that tissue. The central layer (1) is positioned intermediate the surface membranes (7, 8) which are mechanically and/or adherently attached thereto. Also, non-limiting examples of methods of fabrication and of affixing the anchor (36) to a relatively rigid structure, natural or prosthetic, in a human or animal body with improved stress distribution in the fixed tension member end are taught.

Abstract: A textile prosthesis comprising a unitary body of predetermined shape having structural integrity, the body including at least one anchorage body portion for attachment to an anatomical body part, the body being composed of a combination of binding yarns and tensile load bearing filaments, the binding yarns being located at least in the or in each of said anchorage body portions and being interconnected to one another by sewn stitches, the tensile load bearing filaments being located inbetween said stitches so as to be constrained to extend through said unitary body along predetermined pathways extending in one or more predetermined directions so as to render the body resistance to stretch when a tensile load is applied in said one or more predetermined directions.

Abstract: An “all-inside double-bundle” ACL reconstruction technique, according to which two femoral sockets and two closed tibial sockets are provided to accommodate retrograde fixation of two grafts (for example, two semitendonosus allografts) within the four sockets. At least one of the tibial sockets is formed by using a retrograde drill device provided with a retrograde drill cutter detachable from a retrograde drill guide pin. The femoral tunnels or sockets may be formed by the retrograde drill method or by a conventional method, and may be carried out before or after the formation of the tibial sockets. The grafts (for example, two semitendonosus allografts) are secured in the knee by employing a continuous loop/button construct provided with a button, preferably of titanium alloy, and a continuous loop of suture attached to the button.

Abstract: A system and method are provided for forming a connective tissue construct, such as a tendon construct, in vitro. A substrate is provided with at least two anchors secured thereto in spaced relationship. Fibroblast cells are provided on the substrate in the absence of a synthetic matrix, where at least some of the cells are in contact with the anchors. The cells are cultured in vitro under conditions to allow the cells to self-organize and become confluent between the anchors, where the anchors are receptive to the cells and allow the cells to attach thereto while permitting the cells to detach from the substrate to form a three-dimensional connective tissue construct.

Abstract: The disclosure describes implantable bioprosthesis having an implantable construct with a multi-fiber array of collagen fibers attached together.

Abstract: The present technology is related to the field of bone-tendon-bone implants, grafts, and components thereof, for implantation in mammals, particularly for implantation in humans. More particularly, the present technology relates to assembled implants that comprise a length of tendon and at least two bone components or intermediate bone blocks that are assembled to form a bone-tendon-bone implant, and methods of making such implants. In some embodiments, implants of the present technology provide a first grip on the tendon prior to implantation and a second grip during or after implantation. In some embodiments, bone block assemblies or intermediate bone blocks of the present technology have a first geometric configuration prior to implantation and a second geometric configuration during or after implantation.

Abstract: An implant and method for the repair of a tendon or a ligament along at least one load direction. The implant includes at least one first anchor portion and at least one tension member oriented along a load direction. The first anchor portion preferably has a larger surface area of engagement with the tendon or ligament to spread loads across more tissue. The tension member is preferably secured to the first anchor portion with an overlapping attachment. Tension on the tension member is preferably adjustable by the surgeon.

Abstract: A technique and reconstruction system for ligament employing a button/loop construct with a drill pin. The drill pin has a shaft with a proximal and a distal end. A pin tip provided at the distal end of the shaft has a width greater than the shaft diameter. The pin tip helps cut a wider tunnel for fixation of ligaments/grafts in reconstructive surgeries. The shaft of the drill pin is provided with a laser marks for measurement of intraosseous length.

Abstract: Sheaths for implantable fixation devices and methods of using the sheaths are disclosed. Sheaths have a flexible body with a perforated wall, and an interior of the body is sized and shaped to receive the fixation device. Sheaths include a plurality of flexible or inflexible tubes arranged to form a ring, where the central cavity defined by the ring is sized and shaped to receive the fixation device.

Abstract: This invention is generally directed to methods and materials for connective tissue repair. The invention is more specifically related to methods and materials for the repair of tendons and ligaments, especially in the hand. Methods and materials for rotator cuff repair are also disclosed. The use of extraoperatively obtained scaffolding matrices is promoted when reapproximating the connective tissue.

Abstract: A soft tissue fixation system, most typically applicable to orthopedic joint repairs, such as anterior cruciate ligament (ACL) knee repair procedures, comprises an implant which is placeable in a tunnel disposed in a portion of bone, wherein the tunnel is defined by walls comprised of bone. A first member is deployable outwardly to engage the tunnel walls for anchoring the implant in place in the tunnel, and a second member is deployable outwardly to engage tissue material to be fixed within the tunnel. The second member also functions to move the tissue material outwardly into contact with the tunnel walls to promote tendon-bone fixation. Extra graft length is eliminated by compression of the tendon against the bone at the aperture of the femoral tunnel, which more closely replicates the native ACL and increases graft stiffness. The inventive device provides high fixation of tendon to bone and active tendon-bone compression.

Abstract: A method and apparatus for performing a surgical repair may involve fixation of a repair material, such as a ligament or tendon in knee ligament repair procedure, to an internal cortical contact area in a bone. The cortical bone contact area may be located immediately adjacent an opening in the bone's surface through which the repair material extends. The repair material may be engaged with the contact area by way of a fixation device, such as a device that is attached to the repair material and functions as a stop member. An illustrative fixation device may include an annular portion with an aperture through with the repair material passes. The repair material may be attached to a securing portion that extends from the annular portion.

Abstract: This invention relates to a kit for an intervertebral connection system comprising an intervertebral motion disc and a ligament having: i) a central portion, ii) first and second end portions, and iii) first and second conformable portions.

Abstract: A radially expandable sheath is provided having a substantially closed distal end with at least two sidewalls extending proximally therefrom and defining a central lumen. Each sidewall can have a substantially concave outer surface adapted to seat a graft member, and each side wall is at least partially separated by a longitudinally oriented slot that extends from a proximal end along a substantial length of each sidewall. The slot preferably terminates at a position just proximal to the distal end. The device can also include a sheath expander that is adapted to be disposed in the central lumen of the radially expandable sheath and that is configured to flex the sidewalls to radially expand the sheath so as to fix a graft member within a bone tunnel.

Abstract: An interference screw comprising: an open helical coil having a proximal end and a distal end aligned along a longitudinal axis and defining an internal volume, with the internal volume communicating with the region exterior to the open helical coil through the spacing between the turns of the open helical coil; and at least one runner disposed within the internal volume and connected to multiple turns of the open helical coil.

Abstract: A novel fixation system for fixing a graft ligament in a bone tunnel. The fixation system comprises an interference screw comprising a body having a distal end and a proximal end, screw threads extending longitudinally along the body, and a transversely-extending region formed in the body for receiving a transverse pin therein, whereby to securely lock the interference screw, and hence the graft ligament, to the bone. In accordance with a further feature of the present invention, there is provided a method for attaching a graft ligament to a bone, the method comprising the steps of: (i) drilling a tunnel in the bone; (ii) positioning the graft ligament in the bone tunnel; (iii) placing an interference screw in the bone tunnel so as to force the graft ligament laterally against the opposite side of the bone tunnel; and (iv) advancing a transverse pin transversely through the bone and through the interference screw so as to securely lock the interference screw, and hence the graft ligament, to the bone.

Abstract: A radially expandable sheath is provided having a substantially closed distal end with at least two sidewalls extending proximally therefrom and defining a central lumen. Each sidewall can have a substantially concave outer surface adapted to seat a graft member, and each side wall is at least partially separated by a longitudinally oriented slot that extends from a proximal end along a substantial length of each sidewall. The slot preferably terminates at a position just proximal to the distal end. The device can also include a sheath expander that is adapted to be disposed in the central lumen of the radially expandable sheath and that is configured to flex the sidewalls to radially expand the sheath so as to fix a graft member within a bone tunnel.

Abstract: A device serves for blocking a tendon graft in a drilled hole. An element is connected to said tendon graft which can be expanded radially. The element has a cylindrical body which is divided by an oblique cut into two wedge-shaped bodies initially connected to one another via a predetermined break point.

Abstract: A textile prosthesis comprising a unitary body of predetermined shape having structural integrity, the body including at least one anchorage body portion for attachment to an anatomical body part, the body being composed of a combination of binding yarns and tensile load bearing filaments, the binding yarns being located at least in the or in each of said anchorage body portions and being interconnected to one another by sewn stitches, the tensile load bearing filaments being located inbetween said stitches so as to be constrained to extend through said unitary body along predetermined pathways extending in one or more predetermined directions so as to render the body resistance to stretch when a tensile load is applied in said one or more predetermined directions.

Abstract: A graft ligament anchor comprises a graft ligament engagement member disposed in an opening in a bone, the graft ligament engagement member being arranged to receive a graft ligament alongside the engagement member, and a locking member for disposition in the opening, and at least in part engageable with the graft ligament engagement member. Movement of the locking member in the opening causes the locking member to urge the engagement member, and the graft ligament therewith, toward a wall of the opening, to secure the graft ligament to the wall of the opening.

Abstract: A method and construct for joint repair in which attachment of a double bundle graft ligament approximates anatomic orientation using interference fixation in a single bone tunnel. The double bundle graft features separable strands. A threaded screw is inserted between the separable strands and provides interference fixation of the graft against radially opposing walls defining the bone tunnel. Attachment of the graft using separated strands more closely approximate the configuration of the native ligament. The resulting reconstruction exhibits mechanical functionality that more accurately mimics that of the intact joint, with a minimum of associated tissue morbidity.

Abstract: A bioabsorbable interference screw having a tapered profile which extends along substantially the entire length of the screw. The tapered profile makes the screw easy to insert while providing superior fixation resulting from a progressively increasing diameter. Upon insertion, the screw engages cortical bone at the back end of the bone tunnel and fills all but 5-10 mm. of the tunnel, thereby providing increased fixation strength while also promoting fast healing. The screw includes a head provided with a specially designed drive socket with radially extending slots at its outer end for receiving corresponding protrusions on the shaft of screwdriver. The drive socket optimizes the torque capacity of the screw. To maintain wall thickness, the socket has a taper corresponding to the tapered outer profile of the screw. The taper of the socket also permits easy insertion of the tip and shaft of the driver into the screw.

Abstract: The invention is directed toward a bone-tendon-bone assembly extended between two shaped cancellous bone blocks and a method of inserting same in a joint. Each substantially cylindrically shaped cancellous bone block has a central through going bore, a flat exterior longitudinal surface and a channel longitudinally cut in the exterior of the bone block body opposite the flat longitudinal surface. A tendon replacement member is inserted through the central through going bore around the end of each block and looped back along the flat longitudinal side with each block being in a reversed orientation position as to the other block. A channel cut in the exterior surface of each block is adapted to receive an interference screw to keep the block anchored in a bone tunnel previously cut in the respective bones of a joint.

Abstract: A radially expandable sheath is provided having a substantially closed distal end with at least two sidewalls extending proximally therefrom and defining a central lumen. Each sidewall can have a substantially concave outer surface adapted to seat a graft member, and each side wall is at least partially separated by a longitudinally oriented slot that extends from a proximal end along a substantial length of each sidewall. The slot preferably terminates at a position just proximal to the distal end. The device can also include a sheath expander that is adapted to be disposed in the central lumen of the radially expandable sheath and that is configured to flex the sidewalls to radially expand the sheath so as to fix a graft member within a bone tunnel.

Abstract: A surgical method for loading ligament grafts into a joint. A longitudinal socket formed in a bone is intersected by a transverse pin. A flexible strand is drawn with the pin through the bone. A looped portion of the strand is diverted so as to protrude out of the entrance to the longitudinal socket. The ends of the strand remaining accessible on either side of the bone. The ligament graft is captured within the strand loop protruding from the entrance to the socket. The strand is retracted into the socket, drawing the graft into the socket by pulling on the accessible ends of the flexible strand. The graft is fixed in the socket using a transverse implant.

Abstract: A sheath for organizing soft tissue includes a first tube having a flexible body sized and shaped to receive a fixation device, and a second tube coupled to the first tube having a flexible body sized and shaped to receive a soft tissue graft. A method for implanting soft tissue in a bone tunnel includes coupling a soft tissue graft to a sheath assembly; and positioning the sheath assembly relative to the soft tissue graft based on a measured depth of a bone tunnel. A set of surgical devices for implanting soft tissue grafts in a bone tunnel includes a sheath assembly, a measurement device for measuring the depth of the bone tunnel, a securing element configured to secure the sheath assembly to the soft tissue graft at a position determined by the measured bone tunnel depth, and a tensioning device configured to organize a plurality of soft tissue grafts.

Abstract: An apparatus and method for fixation of a soft tissue ligament graft in a bone tunnel using a graft harness/bolt assembly. The graft harness/bolt assembly includes a harness for supporting a looped graft, and a bolt configured to be received in, and securely engage, the harness, the inserted bolt spreading the legs of the harness to engage the walls of a bone tunnel. The bolt includes a transverse hole for receiving a suture strand, which is used to draw and fixate the graft harness assembly into the bone tunnel.

Abstract: There is disclosed a radially expandable knotless tissue anchor including an expandable outer member defining a bore and an inner member slidably positioned within the bore. Relative longitudinal movement of the inner member relative to the expandable member causes a portion of the expandable member to expand radially outwardly. The tissue anchor further includes a length of suture material having a first end affixed to a distal end of the inner member and a second end preferably affixed to a suturing needle. A transverse bore is provided adjacent the distal end of the inner member. There is also disclosed a method of knotlessly anchoring a section of tissue to a section of bone having a bore drilled therethrough. The method includes passing the suture through the tissue and positioning the expandable member and a section of tissue within the interior of the bore drilled in bone.

Abstract: A protective device for use with an interference screw used to attach a soft tissue graft within a bone tunnel reduces the tendency of the interference screw to undesirably snag a soft tissue graft and/or sutures when screwed into a bone tunnel. The protective device has an angled face that corresponds to an angled face of the interference screw and threads that correspond to the threads of the interference screw. When used together, the protective device effectively completes the part of the interference screw that is removed to form the angled face. This, in turn, reduces or eliminates any sharp edges that would otherwise catch or snag the tissue graft and/or sutures as the interference screw is screwed into a bone tunnel during a joint repair procedure. The protective device may be included within a kit together with a correspondingly sized and shaped interference screw, and optionally with a driver.

Abstract: An apparatus and method for fixation of a soft tissue graft. The apparatus may include a member having a first surface and a second surface. Each of the surfaces extend a distance relative to one another. A member is operable to resist movement of the apparatus relative to an anatomical portion. An interference member may be provided to fixedly associate the apparatus with the anatomical structure.