Abstract:
A method, system and apparatus for augmenting the surgical repair of soft tissue injuries, in which a first end of a bridge member attaches to a first portion of healthy tissue, and a second end of the bridge member attaches to a second portion of healthy tissue. The bridge member (or bridge members) used to augment the soft tissue repair may be interconnected or function independently. Flexibility and elasticity of the bridge member are determined by the situation and may be altered to improve healing. The device may be used in arthroscopic procedures, and may be manufactured in a variety of lengths, or may be manufactured one length and be cut to the desired length, or otherwise altered to provide an optimal length of the bridge member.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This is a divisional of U.S. application Ser. No. 10/358,616, filed 5 Feb. 2003, entitled “System and Method for Use in Repairs of Injured Soft Tissue,” which is incorporated herein by reference and to which priority is claimed. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to an apparatus and method for repairing torn or avulsed soft tissue. More particularly, the present invention relates to an apparatus and method for providing a connection between healthy bone or soft tissue and selected other healthy bone or soft tissue to accommodate a stable, secure attachment that selectively immobilizes or minimizes movement of intervening injured soft tissue so that the soft tissue may properly heal. 
     2. Description of Related Art 
     A relatively common type of injury, especially in connection with sports, is injury in which soft tissue is torn or avulsed from the bone. This type of injury occurs in connection with many types of orthopedic injuries, such as torn or ruptured tendons and/or ligaments. In the shoulder, this type of injury often takes the form of a torn rotator cuff in which a portion of the rotator cuff tendons tear within themselves or avulse from their insertion into the bone. The present invention has been designed primarily for use in repair of torn rotator cuffs, and the description and discussion below will therefore focus on repair of rotator cuffs and the application of the invention to make such repairs. It will be apparent to those of ordinary skill in the art, however, in view of the following discussion and disclosure, that the present invention may be used for selected other orthopedic applications having similar parameters. 
       FIGS. 1 and 2  are views of a shoulder with typical torn rotator cuffs. In particular,  FIGS. 1 and 2  are superior views of a shoulder with a tear associated with the supraspinatus muscle as it inserts into the humerus. The subscapularis muscle and the coracoid process are also shown in  FIG. 1  for reference. The tear  1  shown in  FIG. 1  is a simple tear, in which the tear  1  is generally perpendicular to the line of action of the muscle. 
     In  FIG. 2 , the tear  1  is more complex than the tear  1  in  FIG. 1  because the injury in  FIG. 2  has one or more branches  2  of the tear  1  parallel to the line of action of the muscle fibers, in addition to the main tear  1 , which is substantially normal to the line of action of the muscle fibers. 
     In general, a torn rotator cuff, such as those shown in  FIGS. 1 and 2 , can lead to pain, weakness and loss of function. In many cases, the rotator cuff is repaired by surgically reconnecting the edges of the torn muscle or tendon. Repairs may also include reconnecting the edges of any interstitial tear in the tendons, as well as approximating or reattaching the torn edge of the soft tissue to the bone where it originated. As will be discussed in greater detail below, it is believed that the more common current and previous methods of repairing tears to soft tissue and the avulsion of soft tissue from bone include, but are not limited to, sutures, tacks or screws with spiked washers and staples. 
     Suture fixation of the tendon is believed to be the most common and classic method for approximating soft tissue to bone, and is generally accomplished by one of two different methods. In the first method, the sutures are typically passed through drill holes in the tuberosities and tied over a cortical bone bridge. In the second method, a suture anchor is typically employed where a device is fixed into a blind bone tunnel. Typically, the suture anchor has a suture eyelet on its trailing end, which provides for passage of suture through it. Recent studies have shown that on the bone side of the repair, suture anchor fixation is equal to or stronger than that of bone tunnels. 
     In both methods, the soft tissue side may be repaired by proper suture fixation. The torn free edge of the tendon, however, can be poor quality tissue if it is subjected to the degenerative process that is commonly involved in these tears. Some studies have shown that the soft tissue side of the repair when utilizing suture anchors can be the weakest link of the overall repair. A common mode of failure on the soft side of the repair is the result of suture pullout or the pulling of sutures through the muscle or tendon. 
     In order to lessen the risk of failure from pullout of the sutures from the soft tissue, several studies have been done testing various suture techniques and configurations. The so-called simple suture in which a single pass of the suture is made through the soft tissue is often believed to be the weakest configuration. This is commonly used, however, for arthroscopic repair of a tear because of its simplicity. Other more complicated techniques, such as the modified Mason-Allen stitch generally known to those skilled in the art, call for weaving the suture back and forth in the tissue, accessing the more normal tissue proximal to the tear. While this is a stronger construct, there is a concern of strangulating the tissue with multiple weaves, resulting in necrosis of the tendon. Also, this technique does not lend itself to arthroscopic repair of the tear. 
     Other methods used to combat the problem of suture tearing through tendon include soft tissue buttons (described in U.S. Pat. Nos. 5,306,290, 5,951,590, 6,074,409, and the “Tissue Button” by Arthrex), plates (such as described in U.S. Pat. No. 6,093,201) or washers (such as described in U.S. Pat. Nos. D0,404,128 and 6,206,886) that increase the effective surface area of the suture contact with the soft tissue and also aid in pressing the soft tissue against the bone at the repair interface. This tendon augmentation has been shown to resist failure perpendicular to the tendon fibers but may not reduce tendon shear parallel to the fibers, which is the failure mode when sutures tear through tendon. 
     Several other devices and techniques offer an alternative to suture fixation. These include screws, screws with spiked washers, tacks, and staples. Screw and tack fixation has been shown to allow adequate fixation of tendon to bone. The soft tissue side of the repair is addressed by using either a broad flat head as part of the screw as in the “Headed Bio-Corkscrew” by Arthrex, or using a separate spiked washer to engage the soft tissue as in the “Biocuff” by Bionix. Tacks such as the smooth and spiked “Suretac” by Acufex address the soft tissue side identically. Examples of devices in these categories are described in U.S. Pat. Nos. 5,013,316; 5,380,334; 5,601,558; 5,370,661; 6,096,060; 5,167,665; 5,893,856; and 5,013,316. Spiked washer technology (as described in U.S. Pat. Nos. 4,988,351; D0,374,287; D0,374,286; D0,368,777) with screw fixation to bone has a long history in other applications such as knee ligament reconstruction and conceivably offers some advantage in resisting pullout of the screw shank through those tendon fibers parallel to the direction of pull of the tendon. All of these methods are imperfect in that the point of fixation of the soft tissue is generally at the free torn edge, which, as noted above, can be of poor quality. 
     Security of tissue fixation is arguably the most important element in rotator cuff repair. The soft tissue side of the repair has been shown to be the weak link in the overall repair construct utilizing modern techniques. Current methods of obtaining fixation on the soft tissue side of the rotator cuff repair site appear to be limited in their effectiveness by several factors. The free torn edge of the tendon is relatively poor in quality as it is involved in the degenerative process leading to the tear. Arthroscopically placed simple sutures and all the non-suture devices discussed above gain fixation at this free torn edge. More complicated weaving sutures can overcome this problem by accessing more proximal tissue, which is healthier, thicker and stronger, but, as noted above, this may be at the expense of tissue necrosis and certainly does not lend itself to arthroscopic techniques. An additional concern is the range of motion through which a muscle is expected to function. 
       FIGS. 3A and 3B  are superior views of a shoulder during internal and external rotations. From these figures it may be appreciated that soft tissues may experience wide ranges of motion and therefore may undergo dramatic variations in stresses. In addition to internal and external rotation, the shoulder may be moved through adduction and abduction motions (not shown), creating a wide variation in possible stresses at a particular point. It will be appreciated by those of ordinary skill in the art that a surgical repair of injured soft tissue, such as the tears shown in  FIGS. 1 and 2 , may require more complex repair methods and systems because of the different requirements at various points along the injured site. It would therefore be desirable to have a device adaptable to varying muscle requirements, and configurable to different attachment points or parts of the body being repaired. Accordingly, in order to overcome the apparent shortcomings of the currently available devices, a device is needed that securely fixes the soft tissue to the bone or other healthy soft tissue while augmenting the initial soft tissue side of the connection. 
     SUMMARY OF THE INVENTION 
     The present invention overcomes the disadvantages discussed above by providing an apparatus for use in repairing injured soft tissue in human beings, comprising a bridging member having a selected length adapted to provide a connection between a first point of attachment to healthy tissue or bone on a first side of a soft tissue injury and a second point of attachment to similarly healthy tissue or bone on an opposing, second side of such a soft tissue injury. The bridging member thereby provides a means to span the injured or degenerated tissue to provide secure connections to healthy attachment points that will hold the injured soft tissue in place and allow healing. 
     More particularly, the present invention provides a bridge member having a selected length adapted to provide connection between a first point of attachment on a first side of a soft tissue injury and a second point of attachment on the opposing side of such a soft tissue injury. The bridge member has a first connector end adapted for accommodating connection between the bridge member and a selected part of the body such as a bone or healthy soft tissue. The bridge member further comprises a second connector end adapted for accommodating connection between the bridge member and a second selected part of the body such as bone or healthy, soft tissue. 
     In a preferred aspect of the present invention, the first connector end of the bridge member is adapted for attachment to bone or soft tissue by means of suture tunnels or a suture anchor. In these embodiments, the bridging member is attached at the first connector end to the bone or healthy soft tissue and has a length selected to extend from the attachment point to other bone or healthy soft tissue. 
     In a more preferred alternative of this aspect of the invention, the second connector end includes an aperture sized and adapted to receive a soft tissue cleat such as is described in my co-pending patent application, U.S. patent application Ser. No. 09/963,132, which is hereby incorporated herein by reference for all purposes. The second end of the bridge member may then be attached to healthy soft tissue by means of the soft tissue cleat to provide a stable attachment between the two attachment points that will substantially immobilize the injured soft tissue to permit healing and repair. 
     In an alternative aspect of the present invention, the bridge member is comprised of a material and is shaped so that the bridge member is substantially rigid once it is fixed between the two attachment points. In this alternative embodiment, the bridge member acts to substantially immobilize the intervening soft tissue for repair. 
     In another alternative embodiment of the present invention, the bridge member is adapted for lateral and torsional flexing of the bridge member once it is secured between the bone and the soft tissue. In this embodiment, the bridge member does not permit movement along the longitudinal axis of the bridge member and only permits moderate movement in response to torsional or lateral flexing of the bridge member with movement of the healthy soft tissue to which it is attached. 
     In another alternative embodiment of the present invention, the bridge member is adapted for selected, elastic longitudinal stretching of the bridge member after attachment. The ability for the bridge member to change length, thereby changing the stress on the injured soft tissue, may promote blood flow, increase range of motion, and minimize atrophy. 
     In yet further alternative embodiments of the present invention, each of the connector ends may be adapted or modified to accommodate other means of connection between an anchor member and the body, that are known to those of ordinary skill in the art or will be known to those of skill in the art in view of the present disclosure. That is, the bridge member may be adapted to accommodate use of buttons, plates, screws, etc. in order to provide attachment between two healthy parts of the body and avoid attachment to degenerative or injured soft tissue. 
     Accordingly, the present invention overcomes the previously discussed problems by providing a means for obtaining a secure, stable attachment from healthy bone tissue or healthy soft tissue to other healthy soft tissue, thereby minimizing the possibility or likelihood of harm to damaged soft tissue that is the subject of repair. This and other advantages of the present invention will be further illustrated by the following description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The following drawings form part of the present specification and are included to further demonstrate certain aspects of the present invention. The invention may be better understood by reference to one or more of these drawings in combination with the detailed description of specific embodiments presented herein. 
       It is to be noted, however, that the appended drawings illustrate only exemplary embodiments of the invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective embodiments. In addition, although the figures may depict embodiments wherein the components represent different devices or locations, they can be combined into a single device or location. In addition, a single component may be comprised of a combination of components. 
         FIG. 1  is a superior view of the shoulder and rotator cuff demonstrating a tear in the rotator cuff 
         FIG. 2  is a superior view of the shoulder and rotator cuff demonstrating a tear in the rotator cuff. 
         FIGS. 3A and 3B  are superior views of the shoulder and rotator cuff in full internal rotation and full external rotation, respectively. 
         FIG. 4  is an isometric view of one embodiment of a bridge member. 
         FIG. 5  is an isometric view of another embodiment of a bridge member. 
         FIG. 6  is an isometric view of another embodiment of a bridge member. 
         FIG. 7  is an isometric view of another embodiment of a bridge member. 
         FIG. 8  is an isometric view of another embodiment of a bridge member. 
         FIG. 9  is a cross-sectional view demonstrating the use of a bridge member according to one embodiment of the present invention in a repair of a rotator cuff tear utilizing suture fixation and bone tunnels. 
         FIG. 10  is a cross-sectional view demonstrating the use of a bridge member according to one embodiment of the present invention in a repair of a rotator cuff tear utilizing a soft tissue cleat and a screw. 
         FIG. 11  is a cross-sectional view demonstrating the use of a bridge member according to one embodiment of the present invention in a repair of a rotator cuff tear utilizing soft tissue cleats. 
         FIG. 12  is a cross-sectional view illustrating the use of a bridge member according to one embodiment of the present invention in a repair of a rotator cuff tear utilizing a suture anchor and a soft tissue cleat. 
         FIG. 13  is a superior view of the shoulder as shown in  FIG. 1  with the torn rotator cuff repaired using interrupted sutures and augmented with an embodiment of the present invention. 
         FIG. 14  is a superior view of the shoulder, as shown in  FIG. 2  with the torn rotator cuff repaired using interrupted sutures and augmented with an embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The present invention overcomes the shortcomings of current soft tissue repair techniques by incorporating one or more bridge members of selected length to accommodate proper attachment across injured tissue in connection with the repair of such tissue. For illustrative purposes of this document, embodiments of the present invention and methods for using embodiments of the present invention are described as it may be used to repair rotator cuff tears. Those skilled in the art will recognize that the present invention is capable of repair of other soft tissue injuries without departing from the spirit or scope of the present invention. 
     Referring to  FIG. 4 , the present invention generally comprises a bridge member  10  that includes a bridging section  12  to which is attached a first connector end  14  and a second connector end  16 . The bridging section  12  is adapted with a selected length adequate to span the injured tissue and to provide attachment to healthy attachment points. The bridging section  12  may be comprised of any of a number of materials that are appropriate for use in the human body and provide the desired flexibility, elasticity or rigidity for a particular application. Examples of materials that may be used to construct the bridging section  12  include, but are not limited to, polyethylene, an orthopedic plastic manufactured under the trade name DELRIN, bioabsorbable materials, and biologic materials, and/or combinations of these materials. Ideally, the bridging section  12  has a cross section adapted for non-injurious contact with the injured tissue to minimize the possibility of cutting or otherwise further injuring the tissue, and furthermore having a minimal thickness to reduce the volume of the device when in place in the body. The particular thickness and width in cross-sectional shape of the bridging section  12  may be varied with the material that is used to construct the bridging member  10  in order to provide the requisite strength for a given application. It is believed that this element of design will be known to those of ordinary skill in the art in light of the present disclosure. 
     In designing the bridging section  12 , different degrees of flexibility or elasticity may be desirable. For example, in some repair situations, it may be beneficial for the bridge member  10  to be substantially rigid. In other situations, it may be beneficial for healing if the bridge member  10  has some degree of flexibility, such as lateral or torsional flexibility. Further, in some situations, it may be beneficial for the bridge member  10  to have some degree of elasticity, so that a selected degree of the stretching of the bridge member  10  longitudinally is permitted. Such flexibility or elasticity may be desirable to permit limited movement of the spanned tissue—both the injured tissue and the healthy tissue—to stimulate blood flow and to permit healing. Accordingly, it is contemplated under the present invention that the material of which the bridging section  12  is comprised will be selected to provide the desired degree of flexibility and/or elasticity for a particular application for a particular type of repair. 
     Referring still to  FIG. 4 , the bridge member  10  further includes a first connector end  14  attached to the bridging section  12 . The first connector end  14  is adapted to accommodate attachment of the bridge member  10  to bone or healthy tissue. Therefore, first connector end  14  may take a number of suitable shapes providing appropriate apertures or attachment members to enable attachment of the bridge member  10  to the bone or healthy tissue. In the preferred embodiment, the first connector end  14  has a generally flat, circular shape as shown in  FIG. 4  in order to provide sufficient material strength to support the connection between the bone and the healthy tissue and the bridging section  12 . In the preferred embodiment, the first connector end  14  further has an aperture  13  adapted to receive an attaching device such as a suture or a mechanical fastener. As will be appreciated in light of the present disclosure, aperture  13  is sized and configured to be complementary with the anticipated attaching device for the particular application. 
     As with the bridging section  12 , the first connector end  14  may be comprised of any of a number of materials suitable for use in human beings. For example, the first connector end  14  may be comprised of metal or orthopedic plastic. Because the first connector end  14  must accommodate the secure attachment of the bridge member  10  to healthy bone or tissue, in the preferred embodiment, the first connector end  14  will be substantially rigid or have only moderate flexibility in order to provide a stable attachment point with the bone or healthy tissue. 
     The first connector end  14  may be connected to the bridging section  12  in a number of ways suitable for providing a non-detachable connection between the first connector end  14  and the bridging section  12 . In the preferred embodiment, it is contemplated that the bridge member  10  will be formed as a unitary body such that the bridging section  12 , the first connector end  14 , and the second connector end  16  are all integrally formed as a single piece. 
     Referring still to  FIG. 4 , the bridge member  10  also includes a second connector end  16  adapted to enable attachment of the bridge member  10  to a different, opposing section of healthy bone or tissue from the bone or tissue to which the first connector end  14  was secured. In the simplest preferred embodiment, the second connector end  16  has a shape and configuration similar to the first connector end  14  and includes an aperture  15  as shown in  FIG. 4 . In the simplest embodiment, the second connector end  16  is made of the same material that is similar to the material that is used to make the bridging section  12  and the first connector end  14  and, in a preferred aspect of this embodiment, is formed as part of a unitary body with the bridging section  12  and the first connector end  14 . 
     As discussed above, the length of the bridging section  12  and of the bridge member  10  is selected to enable the device of the present invention to be attached at two healthy attachment points and span injured tissue. The necessary length and shape of the bridge member  10 , therefore, will vary with the particular application and the extent of the injury to be repaired. Referring to  FIGS. 5 ,  6 ,  7 , and  8 , there are shown alternative embodiments of the present invention that are designed to accommodate the repair of situations of differing lengths and shapes. 
     For example, in the embodiment shown in  FIG. 5 , the bridge member  10  comprises an elongated second connector end  16  having a plurality of apertures designated as  15   a ,  15   b , and  15   c , selectively positioned along the length of the second connector end  16 . In use, the bridge member  10  can be severed before the attachment aperture  15   c  or before the attachment aperture  15   b  depending upon the overall length that is needed for the bridge member  10 . 
     Referring to  FIG. 6 , there is shown an alternative that is similar in nature to the embodiment shown in  FIG. 5 . In particular, the embodiment shown in  FIG. 6  comprises a plurality of apertures  15   a ,  15   b ,  15   c ,  15   d , and  15   e , all disposed along the length of the second connector end  16  to accommodate the selective attachment of the bridge member  10  across soft tissue of a determined length. 
     Referring still to  FIGS. 5 and 6 , the bridge member  10  may further include surface fasteners  18  on any surface that is intended to contact soft tissue. The surface fasteners  18  may take the form of spikes, barbs, or other mechanical features that penetrate the soft tissue and/or enhance fixation at the bone/tendon interface. In  FIGS. 5 and 6 , the surface fasteners  18  are depicted by way of example as many spikes. 
     Referring still to  FIGS. 4-8 , the embodiments shown depict bridge member  10  having a first connector end  14  that is generally circular in shape and a second connector end  16  that varies in length. It is to be understood by those skilled in the art that the shapes and lengths of the attachment ends may be varied in selectively determining the length of the attachment member in accordance with the present invention. Just as the shape and length of the respective attachment ends  14  and  16  may be varied to provide greater flexibility in terms of length and use, the shape and configuration of the apertures  13  and  15  may also be varied to accommodate different means of fastening. For example, an end may be configured to have an aperture of suitable diameter and have additional selectively spaced apertures of smaller diameter to accommodate the use of a soft tissue cleat to attach the end to soft tissue. Similarly, the holes  13  or  15  may be varied in size to accommodate use of sutures, screws, or other attaching devices. 
     Referring now to  FIGS. 7 and 8 , there are shown alternative embodiments having irregularly shaped or multiple attachment ends  16  to accommodate multiple points of fixation and to accommodate the spanning of more complex injury sites. It will be appreciated, based upon the present disclosure, that other geometric configurations could be utilized to provide differing numbers of extensions and differing lengths to address particular injuries. 
       FIG. 9  is a view of a shoulder soft tissue repair site illustrating use of a bridge member  10  in accordance with one embodiment of the present invention. In this example, the bridge member  10  attaches to healthy soft tissue  45  on the proximal side of the injury using sutures  25 , spans the injured tissue, and reattaches the injured tissue to the healthy bone tissue  47  at a second point of attachment through the use of sutures  27  and bone tunnels  29 . 
     In particular, the sutures  25  attach a first connector end  14  of the bridge member  10  to the healthy rotator cuff tissue  45  proximal to the torn edge of the injured tissue, where the tissue is thicker and stronger. Additionally, spikes  18  (not shown) on the undersurface of the bridge member  10  may be used to enhance fixation of the bridge member  10  to the soft healthy tissue  45 . 
     Typically, in this repair, one or more tunnels  29  are drilled through bone tissue  47  at a second point of attachment. Suture  27  passes through one tunnel  29 , through a portion of the rotator cuff soft tissue  45 , through an opening or other feature in the bridge member  10  and through a second tunnel  29  in the bone  47 . The suture  27  is tied over the outside of the bone  47  over a cortical bridge between the tunnels  29 . The soft tissue  45  is thereby reattached to the bone  47  using a bridge member  10  to augment the soft tissue side of the repair. 
       FIG. 10  is a view of another example of a shoulder soft tissue repair site in which rotator cuff tissue  45  is reconnected to healthy bone tissue  47  using a bridge member  10  in accordance with one embodiment of the present invention. In this example, reattachment of the avulsed tissue  45  is accomplished using a soft tissue cleat  23  to connect the bridge member  10  to a portion of healthy soft tissue  45 , and screw  51  to connect to the bridge member  10  and reattach the avulsed tissue  45  to the bone tissue  47 . 
     In particular, first connector end  14  of the bridge member  10  is of a design adapted to accommodate connection to a soft tissue cleat  23 , such as described in co-pending U.S. patent application Ser. No. 09/963,132. In this embodiment, the soft tissue cleat  23  connects a first connector end  14  of a bridge member  10  to a healthy portion of the rotator cuff tissue  45  proximal to the torn edge, where the tissue is thicker and stronger. Spikes  24  on the soft tissue cleat  23  may be utilized to enhance fixation of the bridge member  10  to the healthy soft tissue  45 . 
     As disclosed in co-pending U.S. patent application Ser. No. 09/963,132 and as shown in  FIG. 10 , the soft tissue cleat  23  is used for coapting soft tissue of the rotator cuff tissue  45  and the connection end  14  of the bridging member  10 . The soft tissue cleat  23  includes a first disc or side  26  and a second disc or side  28 . The first disc  26  is attached to the second disc  28  to coapt an area of soft tissue  45  at the connection end  14  of the bridging member  10 . The first disc  26  has a plurality of fixed-length projections or spikes  24  and  25  extending perpendicularly from the bottom surface of the first disc  26 . The projections or spikes  24  and  25  of the first disc  26  are configured to perforate the soft tissue  45 . The second disc  28  has at least one indention  29  configured to receive a portion of at least one of the projections or spikes  25 . This at least one spike  25  is positioned through the aperture  15  in the connection end  14  and is securely joined to the indentation  29  in the second disc  28 . In one aspect of the present invention, the indention  29  in the second disc  28  has a mechanical locking mechanism for securely joining to the at least one spike  25  of the second disc  26 . 
     The bridge member  10  spans the torn edge of the rotator cuff  45  to a portion of healthy bone tissue  47 , where screw  51  is used to attach the second connector end  16  of bridge member  10  to the bone  47 . In this embodiment, bridge member  10  is adapted to accommodate connection to screw  51  and operable to facilitate reattachment of avulsed soft tissue  45  to the bone  47 . 
       FIG. 11  is a view of a soft tissue repair in which portions of soft tissue  45  are reconnected using tissue anchors, such as, but not limited to, soft tissue cleats as described in copending U.S. patent application Ser. No. 09/963,132, on both sides of the injury. In this embodiment, both first and second connector ends  14  and  16  are of a design adapted to accommodate connection to a soft tissue cleat  23 , such as described in co-pending U.S. patent application Ser. No. 09/963,132. 
     The soft tissue cleat  23  connects the bridge member  10  to a healthy portion of the rotator cuff tissue  45  where the tissue  45  is thicker and stronger. Spikes (not shown) on the soft tissue cleat  23  and spikes (not shown) on the undersurface of the second connector end  16  of the bridge member  10  may be included to enhance fixation of the bridge member  10  to the healthy soft tissue  45 . The bridge member  10  spans the torn portion of the rotator cuff to a second point of attachment on the opposite side of the injury site in another portion of healthy soft tissue  45 . Reconnection of the portions of the soft tissue  45  is thereby accomplished with bridge member  10  and soft tissue cleats  23  to provide augmentation to the soft tissue repair. 
       FIG. 12  is a cross-sectional view of a soft tissue repair site in which a bridge member  10  according to one embodiment of the present invention, a tissue anchor  23 , and a suture anchor  50  are utilized in order to reattach an avulsed rotator cuff tissue to the proximal humerus  47 . 
     In this example, a soft tissue cleat  23 , such as described in co-pending U.S. patent application Ser. No. 09/963,132, securely attaches a first connector end  14  of the bridge member  10  to the healthy rotator cuff muscle  45  proximal to the torn edge of the injured tissue where the tissue is thicker and stronger. Spikes  24  on the soft tissue cleat  23  enhance fixation of the bridge member  10  to the healthy soft tissue  45 . 
     The bridge member  10  spans the injury site and is adapted for connection to the bone tissue  47  by means of a suture anchor  50  and sutures  46 . Typically, the suture anchor  50  is engaged into bone  47 . The suture  46  passes through an aperture of suture anchor  50 , through a selected portion of tissue  45  that has avulsed from the bone  47 , and through an aperture  15  in the second connector end  16  of bridge member  10 , such that the soft tissue  45  is affixed to the bone  47 . In this manner, the soft tissue  45  is supported through the healing process with the bridge member  10  facilitating reattachment of the avulsed soft tissue  45  to the bone  47 . The rotator cuff is thereby repaired using a bridge member  10  and soft tissue cleat  23  to augment the construct. 
     Advantageously, embodiments of the present invention may provide improved pullout strength due in part to a moment generated by the bridge member  10  in contact with a soft tissue cleat  23 . In some embodiments, the moment is generated on the soft tissue cleat  23  when the muscle  45  contracts. The moment typically causes the soft tissue cleat  23  to tilt with respect to the line of action of the muscle pull, such that portions of the soft tissue cleat  23  are compressed into the soft tissue  45 . The result of a tilted fastener is a larger surface area than that of any penetrating sutures, posts, or barbs, contacting the soft tissue to increase pullout strength. Therefore, a larger surface area of a soft tissue cleat  23 , tilted at some angle, may be advantageous for enhancing the fixation and pullout strength of the soft tissue cleat  23 . With the tilt, a central fixation peg or peripheral projections or both, and portions of the all contribute to the overall pullout strength of the repair. Without the tilt, the only surface areas resisting pullout are those of a central fixation peg or peripheral projections or both. 
       FIG. 13  is a view of a shoulder with a tear in a rotator cuff similar to the tear illustrated in  FIG. 1 , repaired using a bridge member  10  according to one embodiment of the present invention similar to the system shown in  FIG. 12 . In addition to repairing the tear (accomplished here by a technique of interrupted sutures), the repair is augmented with a bridge member  10  similar to those shown in  FIGS. 9 and 11 , and a soft tissue cleat  23 . Those of skill in the art will appreciate the improved stability and strength of the repaired injury augmented by a bridge member  10 , which in this figure comprises a bifurcated second connector end  16  to distribute forces or to accommodate variations in stress occurring from motion of the shoulder. 
       FIG. 14  is a view of an injured rotator cuff as shown in  FIG. 2 . In this case, the edges of the torn rotator cuff have been reconnected using interrupted sutures  46 . In addition, the repair has been augmented utilizing a system of interconnected bridge members  10 . In various aspects of this embodiment, bridge members  10  are connected at a single attachment point on one end and their other ends are spaced at different attachment points in healthy soft tissue  45  on the other side of the injury. Furthermore, bridge members  10  are connected to each other and connected to healthy soft tissue  45  on the same side of the injury, which may provide even more strength and stability to the repair. In this manner, the present invention may be used to emulate the structure or function of a trestle. 
     Advantageously, the use of a bridge member with current tissue anchors, sutures, and particularly soft tissue cleats may shorten the amount of time needed to perform a repair procedure. It will be obvious in view of the present disclosure and description that the present invention provides a secure connection for repairing soft tissue injuries, in a convenient form. Therefore, instead of the surgeon spending time suturing through soft tissue or connecting a suture to a tissue anchor on the bony side of the repair, the surgeon is able to focus on optimum placement for anchoring devices and connecting the ends to the appropriate anchoring device. 
     The present invention has been disclosed in connection with specific embodiments. However, it will be apparent to those of skill in the art that variations from the illustrated embodiments may be undertaken without departing from the spirit and scope of the present invention. For example, a soft tissue cleat, screw, or suture anchor may be incorporated into an attachment end. Additionally, embodiments of the present invention may be attached to attachment points not located in healthy soft tissue. Furthermore, the present invention may be adapted to accommodate connection to other mechanical fasteners such as staples or tacks to facilitate secure connections. These and other variations will be apparent to those skilled in the art in view of the above disclosure and are within the spirit and scope of the invention. 
     As used in this specification and in the appended claims, it should be understood that the word “a” does not preclude the presence of a plurality of elements accomplishing the same function.