Abstract: The present invention provides a novel split barbed fixation device for tenodesis, soft tissue reattachment of tendons and ligaments to bones. The insertion device is adapted for an entirely arthroscopic approach while achieving fixation strength with ultimate pullout resistance comparable to interference screws. The device includes an integrated tendon grasper that provides for easy manipulation of the tendon arthroscopically while eliminating the need for external whip stitching of the tendon, thereby reducing preparation time. The device further includes elements that prevent the fixation implant from being destabilized or rotating during deployment and manipulation, including: a depth limiting sheath, a first implant retainer, a first implant retaining step, a tendon grasping needle tube, and an implant keyway for mating the implant to the tube.

Abstract: A tissue graft suspension device includes a platform member, a graft connecting element coupled to the platform member such that a portion of the graft connecting element forms a loop for attachment to a tissue graft, and an enclosure member coupled to the loop of the graft connecting element and configured to enclose a biologic material. The enclosure member defines an opening configured to receive the biologic material. The graft connecting element and the enclosure member are configured such that, during use, the tissue graft is coupled to the loop and in contact with the enclosure member.

Abstract: A buckle useful for cortical fixation has a graft retention loop slidably affixed thereto for movement from a first position adjacent a first end of the buckle to a second position at about the midpoint of the buckle. The buckle, with a graft over the loop, is drawn up lengthwise through a bone tunnel through a tibia and then flipped sideways to rest against the surface of the bone with the loop and graft depending back into the tunnel. The sliding attachment of the loop permits flipping of the buckle minimizes the flipping distance, which is the excess amount of the loop which must be pulled free of the tunnel to allow the buckle to be flipped sideways.

Abstract: Described herein are methods and devices for use in repair of a patient's anterior cruciate ligament (ACL). These methods (and devices for performing them) allow the repair, rather than merely replacement, of the ACL. For example, described herein are anchoring devices that may be inserted into a bone and may anchor a scaffolding/support (e.g., graft) material within the bone so that the torn or damaged end of the ACL may be secured to the scaffolding/support material within the femoral notch. These anchoring devices and method of using them are particularly well suited for use with the continuous suture passers described herein, since these suture passers may allow access to previously inaccessible regions of the knee (or other body regions).

Abstract: A system and method for sharing and absorbing energy between body parts. In one aspect, the method involves identifying link pivot locations, fixing base components and minimally invasive insertion techniques. In one particular aspect, the system facilitates absorbing energy between members forming a joint such as between articulating bones.

Abstract: An anchor assembly for autologous or artificial tendon grafts comprises an insertion element and a stabilizing element. The insertion element has a stem and a head containing an aperture large enough to receive a graft. The stabilizing element is adapted to be embedded in bone, and comprises a sleeve with a cavity arranged to receive and hold the insertion element stem. In use, the stabilizing element is affixed in the bone, and the stem of the insertion element is placed therein. A tendon graft may be secured to the insertion element either before or after its placement in the stabilizing element. Two such anchors may be linked with one or multiple grafts, in either a two-ply or four-ply arrangement.

Abstract: Systems, methods and devices for tensioning posterior cruciate ligaments during cruciate or bi-cruciate ligament-sparing arthroplasty. Non-limiting examples of such systems may include at least one series of tibial inserts of equal size; the at least one series of tibial inserts having at least one set of tibial inserts of equal thickness. The at least one set of tibial inserts of equal thickness may include at least two tibial inserts having different geometries in a posterior portion, the different geometries being configured to change the tension in the posterior cruciate ligament (PCL). The different geometries in the posterior portions of the tibial inserts are configured so as to allow the posterior cruciate ligament to be tensioned or loosened independently of the tibial insert thickness and/or size.

Abstract: Various embodiments are directed to a sheath for covering one or more components of an extra-articular implantable mechanical energy absorbing system. The sheath is generally an elongated structure having an inner space extending the length thereof. In use, the sheath can exclude the energy absorbing system from surrounding tissue and facilitate creating a capsule for its operation. Materials and dimensions are selected to achieve these purposes. The ends of the sheath include various attachment mechanisms for securing the sheath to one or more components of an extra-articular implantable mechanical energy absorbing system.

Abstract: An apparatus for anchoring at least two graft ligaments within a longitudinal bone tunnel includes a longitudinal sleeve having at least two radially spaced ligament-contacting surfaces located in lateral opposition to a sleeve inner lumen. The sleeve is configured for at least partial insertion into the bone tunnel with each graft ligament positioned laterally adjacent a different ligament-contacting surface. The graft ligaments are at least partially located between the bone tunnel and the sleeve. An actuating member has longitudinally separated proximal and distal actuating member ends. An asymmetrically offset profile is defined by at least one of the sleeve and the actuating member. The asymmetrically offset profile has a plurality of longitudinally spaced engagement thresholds. The actuating member is inserted longitudinally into the sleeve to cause frictional engagement of each graft ligament with both the bone tunnel and at least one ligament-contacting surface.

Abstract: Surgical repair systems and techniques for plantar plate repairs. The surgical repair systems and methods reconstruct the plantar plate through a dorsal incision. The surgical repair system embodies a variety of instruments that provide visualization and access to the plantar plate using suture to complete the repair. The repair system may include some or all of the following instruments: a metatarsal head pusher employed in open surgical space, to move the “capital fragment” in a controlled manner; a suture retriever instrument and a suture retriever funnel (sleeve); a suture passer such as a Mini Scorpion DX and accompanying needle, or a variety of shaped Micro Suture Lassos; a measuring guide; and a small joint distractor.

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 multi-region device for repair, regeneration or reconstruction in articular tissue injury such as torn ligaments and tendons is provided. The device comprises at least one degradable material and biocompatible non-degradable polymeric fiber-based material, in a three-dimensional braided scaffold. The two end sections are designed for attachment of the device at the site of implantation and are designed to allow bone cell ingrowth, and one or more middle regions are designed to allow ligament or tendon cell ingrowth.

Abstract: Methods and instruments for repairing soft tissues of a skeletal joint such as for example of the foot or hand are presented.

Abstract: Disclosed are medical devices and methods for tendon, ligament, and soft tissue repair. A method includes introducing a first segment having a delivery assembly into a first soft tissue, and removing the delivery assembly to expose an opening of a hollow body of the first segment. The method also includes introducing a second segment having a second delivery assembly and a second body into a second soft tissue, guiding the second delivery assembly through the opening, and advancing the second body into the hollow body, thereby joining the first soft tissue and the second soft tissue.

Abstract: Methods and devices are provided for fixing a ligament graft in a bone tunnel. In general, the methods and devices involve affixing a ligament graft within a bone tunnel using an adhesive. A fixation device can be inserted through the ligament graft in a direction transverse to an axis of the tunnel to maintain the ligament graft in contact with the adhesive. The fixation device can be removed when the adhesive is cured such that the ligament graft is fixed in the tunnel.

Abstract: A system for reconstructing a ligament by fixing at least one graft ligament strand in a bone tunnel is provided. The system a retainer configured for disposition in the bone tunnel, the retainer including a crosshole for receiving a locking pin and a mounting shoulder formed about the crosshole, and a cap removably attached to the retainer for capturing the at least one graft ligament strand by compressing the at least one graft ligament strand between the cap and the retainer, wherein the cap includes at least one locking member configured to engage the mounting shoulder of the retainer to facilitate gripping of the at least one graft ligament strand between the cap and the retainer.

Abstract: The present invention relates to a bone-tendon-bone graft and components. Embodiments of the present invention comprise an intermediate bone block that is used to adjustably secure soft tissue (e.g., tendon) in a patient. Embodiments of intermediate bone blocks of the present invention are used singly or in combination with one or more bone blocks to form a bone block assembly for securing soft tissue. The present invention further relates to an assembled bone-tendon-bone graft for implantation in humans comprising the intermediate bone block and a length of soft tissue. A bone-tendon-bone graft comprises a length of soft tissue extending from a first assembled bone block to a second bone block and then doubles back to said first assembled bone block. Depending upon the embodiment, the second bone block fixedly or slideably attaches to the length of soft tissue and facilitates it doubling back to the first assembled bone block.

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: A material fixation system is particularly adapted to improve the tendon-to-bone fixation of hamstring autografts, as well as other soft tissue ACL reconstruction techniques. The system is easy to use, requires no additional accessories, uses only a single drill hole, and can be implanted by one person. Additionally, it replicates the native ACL by compressing the tendons against the aperture of the tibial tunnel, which leads to a shorter graft and increased graft stiffness. It is adapted to accommodate single or double tendon bundle autografts or allografts. It also provides pull out strength measured to be greater than 1000 N.

Abstract: An adjustable construct for fixation of a tendon or ligament graft in a tunnel. The construct comprises a flexible, adjustable loop connected to tissue (for example, graft, ligament or tendon). The adjustable loop may be integrated with an additional tissue supporting device (for example, a wedge or a plug). The tissue is secured within a bone socket/tunnel by adjusting the length of the flexible adjustable loop.

Abstract: A surgical method for anterior cruciate ligament reconstruction includes creating a bone tunnel in a head of a femur of a patient. A connective tissue is inserted into the bone tunnel. A shape memory polymer plug is inserted into the bone tunnel. The plug has a first configuration for insertion and a second configuration for affixation that has a radially expanded dimension that presses the connective tissue against a side wall of the bone tunnel to affix the connective tissue in the bone tunnel. The plug changes from the first configuration to the second configuration in response to an activation temperature equal to or greater than a temperature of the femur.

Abstract: An adjustable button/loop device for securing biologic material in bone, such as for ACL reconstruction. The device has a pair of button/loop constructs, each including a flexible, adjustable loop integrated with a fixation device (for example, a wedge). Biologic material (for example, soft tissue, graft, ligament or tendon) is secured to the two fixation devices, and the construct is inserted into a pair of bone sockets/tunnels, such as into a tunnel in the tibia and a socket in the femur. The biologic material is secured within the bone by passing the buttons though respective bone sockets/tunnels, flipping and seating the buttons outside the bone, and then adjusting the lengths of the flexible adjustable loops passing through the buttons and the respective fixation devices, with the graft extending between the fixation devices thereby appropriately secured in the bone.

Abstract: Disclosed are medical devices and methods for tendon, ligament, and soft tissue repair. A method includes introducing a first segment having a delivery assembly into a first soft tissue, and removing the delivery assembly to expose an opening of a hollow body of the first segment. The method also includes introducing a second segment having a second delivery assembly and a second body into a second soft tissue, guiding the second delivery assembly through the opening, and advancing the second body into the hollow body, thereby joining the first soft tissue and the second soft tissue.

Abstract: A graft attachment device includes a platform member, a ratchet mechanism, and a graft connecting element. The ratchet mechanism includes a rack member and a pawl member coupled to the rack member. The rack member has a first end, a second end, and teeth between the first end and the second end. The platform member is coupled to the first end. The pawl member is configured to engage with the teeth of the rack member such that movement of the pawl with respect to the rack member and the platform member is free in a first direction towards the first end of the rack member while being limited in a second direction towards the second end of the rack member. The second direction is opposite the first direction. The graft connecting element is coupled to the pawl member and configured for attachment to a graft.

Abstract: Devices, systems and methods for fixation of tendon to bone are described. An exemplary surgical implant is a modified bone anchor that is able to grasp the tendon and hold it firmly in a bone tunnel. Once deployed, the anchor delivers lateral compression to the tendon, providing direct tendon to bone compression to facilitate healing. The anchor has different versions which allow it to be attached to the tendon prior to insertion into the bone tunnel, or be inserted between tendon arms when the surgical procedure dictates. The resulting tendon to bone compression allows for the firm fixation in a manner markedly simpler than traditional techniques. A modification of this anchor can also allow the anchor to grasp and hold suture. This variation facilitates the technique for knotless rotator cuff repair.

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: Methods and devices are provided for fixing a ligament graft in a bone tunnel. In general, the methods and devices involve affixing a ligament graft within a bone tunnel using an adhesive. A fixation device can be inserted through the ligament graft in a direction transverse to an axis of the tunnel to maintain the ligament graft in contact with the adhesive. The fixation device can be removed when the adhesive is cured such that the ligament graft is fixed in the tunnel.

Abstract: A method for anchoring a portion of material to bone is disclosed. One such method comprises affixing the portion of material to a neck of a fastener, and driving the fastener into the bone such that the portion of material becomes fixed to the bone.

Abstract: The present teachings provide for a graft fixation assembly including a base member, a compression member, and a fastener. The base member includes a bone engaging surface and a first graft engaging surface opposite to the bone engaging surface. A plurality of first fixation members extend from the bone engaging surface and are configured to be impacted into bone. The compression member includes a second graft engaging surface and an outer surface opposite to the second graft engaging surface. The fastener is configured to secure the compression member relative to the base member such that a graft between the base member and the compression member is compressed therebetween and secured to the graft fixation assembly.

Abstract: Systems for single tunnel, double bundle anterior cruciate ligament reconstruction include implant constructs and instruments. The implant constructs provide a combination of cortical fixation and bone tunnel aperture fixation. The implant constructs separate a graft into distinct bundles. The instruments are used to prepare shaped bone tunnels to receive the implant constructs and graft bundles. The instruments are also used to exercise and insert the ligament graft constructs. Methods for reconstructing the antero-medial and postero-lateral bundles of the anterior cruciate ligament may rely on a single femoral tunnel, single or double tibial tunnels, and one or more ligament grafts.

Abstract: A graft retainer device and method for substantially retaining a portion of a graft with respect to a bone of a patient. The device comprises a body; and a retaining element for retaining a graft with respect to the body. A surgical screw fastener device can be use with the graft retainer device for pulling a graft through a tunnel defined in the bone. The graft can includes any one or more of the set comprising: a transplant tendon, an artificial tendon, a transplant ligament, and an artificial ligament.

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 guide apparatus including a body having a proximal end, a distal end, a hole formed therethrough, and a central axis defined therethrough, and a projection member coupled to the distal end of the body. An outer diameter of the body is larger than an outer diameter of the projection member. Further, the projection member does not obstruct a pathway defined by the hole.

Abstract: A graft attachment apparatus including at least two separately formed filament loops, and a fixation member comprising at least one opening configured to receive the at least two separately formed filament loops. The at least two separately formed filament loops are coupled to the fixation member. Further, each of the at least two separately formed filament loops are continuous loops.

Abstract: An instrument for placing a graft into a bone tunnel comprises an elongated shaft having a forked distal end comprising a pair of tines. A suture spans a space defined between the tines whereby the graft may be positioned between the tines and against the suture so as to be manipulated into the bone tunnel. The tendon folds about the suture, the suture having a releasable tension such that the instrument can be removed from the bone, leaving the tendon behind without the tendon hanging up on the suture.

Abstract: Methods and devices are provided for implanting a cross-pin through a bone tunnel, such as in an arthroscopic surgical procedure. In general, the methods and devices allow a cross-pin hole to be formed in a medial side of a knee bone such that it intersects a bone tunnel formed in the knee bone. In one embodiment, a cross-pinning guide device is provided that can be configured to angularly position the cross-pin hole relative to the bone tunnel to allow the cross-pin hole to intersect the bone tunnel without passing through another side, e.g., a lateral side, of the knee bone. The knee bone can be a femur or a tibia such that the cross-pin hole and the bone tunnel can each be entirely formed in the femur or in the tibia.

Abstract: An apparatus and method is disclosed for performing a surgery, such as an orthopedic surgery. The apparatus can include a guide portion and an alignment portion. The guide portion can assist in positioning the alignment portion to assist in aligning an implant. The implant can be aligned and positioned to hold a graft relative to a bone portion.

Abstract: Methods and instruments for reconstructing soft tissues of a skeletal joint such as for example of the foot or hand are presented.

Abstract: Distensible ligaments and distensible ligament systems are provided, including apparatuses, systems, devices, hardware, methods, and combinations for distensible systems.

Abstract: Methods and instruments for repairing soft tissues of a skeletal joint such as for example of the foot or hand are presented.

Abstract: Improved bone anchors are disclosed for anchoring one or more sutures attached to soft tissue to a bone. The bone anchor has an anchor body that extends between a distal and a proximal end. A bore is formed axially in the anchor body and opens at the proximal end. One or more pins are fixed within the bore of the anchor body. One or more sutures can be looped on the pins for anchoring soft tissue to bone. The anchor body has a socket within the bore for receiving a driver tool. The distal end of the anchor body forms a non-threaded extension, which stabilizes the bone anchor, and helps prevent lateral movement during use. In one embodiment, the anchor body has coarse threads for engaging soft bone tissue and fine threads for engaging hard bone tissue.

Abstract: A graft fixation system for fixing graft material in a bone tunnel includes an expandable fixation member having a graft receiving eyelet disposed proximate its distal end, opposed bone engaging elements disposed about its periphery, and an expansion plug receiving opening defined in its proximal end. The system also includes an expansion plug having a diameter greater than the diameter of the expansion plug receiving opening so that forceble insertion of the expansion plug into the expansion plug receiving opening causes an expansion of the expandable fixation member driving the opposed bone engaging elements apart so as to fix the bone engaging elements, as well as the graft material, in a bone tunnel.

Abstract: Methods are described wherein bone constructs of a patient are used to arthroscopically attach sutures to torn or dysfunctional tissue. A suture or multiple sutures are passed through intersecting/bisecting tunnels formed in the bone. An end of the suture extends from each of the tunnels, and the ends are used to secure the tissue to the bone, such as by arthroscopic tying of the ends, and pulling the tissue against the bone. Devices for performing the methods are also described.

Abstract: Disclosed herein is processed dermis graft for use in orthopedic surgical procedures. Specifically exemplified herein is a processed dermis graft comprising one or more bone blacks having a groove cut into the surface thereof, wherein said groove is sufficient to accommodate a fixation screw. Also disclosed is a method of processing dermis that results in a dermis derived implant suitable to replace a tendon or ligament in a recipient in need thereof. Other compositions and applications of a dermis derived implant, and methods of manufacture and use, are disclosed.

Abstract: The present disclosure provides an implantable medical device comprising a composite graft material including a first biologic component, such as an acellular tissue matrix, and a second non-biologic component.

Abstract: A surgical device includes a member having first and second opposing surfaces. The member includes an intermediate portion in which the first surface has a recessed surface portion. The intermediate portion defines a hole extending from the recessed surface portion to the second surface. End portions extend from the intermediate portion, and each end portion defines a hole extending from the first surface to the second surface. The member has a tapered surface portion on the second surface. The surgical device includes a second member sized to be received within the recessed surface portion. A method includes locating a tissue fixation device at an opening to a bone hole, and increasing the size of the tissue fixation device by placing the tissue fixation device within a larger device.

Abstract: Embodiments disclosed herein provide a device for securing a ligature to an osseous structure, the device comprising a first part, a second part, a flexible elongate member for engaging the osseous structure, a closure element, and a deformable element between the first and second parts for holding open a gap G between them. The flexible elongate member is threaded through an orifice in the first part and the gap G. The closure element is configured for clamping the first and second parts against each other, overcoming the resilience of the deformable element, so as to frictionally lock the flexible elongate member threaded through the gap G. Embodiments disclosed herein also provide a method for using the device.

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 tensioner system for use in tensioning graft strands in a knee reconstruction procedure can include a handle assembly, a tensioner assembly coupled relative to the handle assembly, and a drive shaft slidably received through and supported by the handle assembly. The tensioner assembly can include an arm support member rotatably coupled to the handle assembly and first and second arm members each rotatably coupled to lateral sides of the arm support member. Each arm member can include at least one graft attachment area adapted to be coupled to a graft strand. The arm support member can be configured to rotate about an axis perpendicular to a longitudinal axis of the tensioner system and perpendicular to an axis of rotation of each of the arm members. The drive shaft can include proximal and distal ends that extend beyond respective proximal and distal ends of the handle assembly.

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.