Abstract:
An assembly for coupling a first portion of an anatomy to a second portion of the anatomy includes an anchor having an anchor body and a first and second bores through the anchor body. A first adjustable suture construct having a body portion passes through the first bore of the anchor and includes first and second adjustable loops slidable relative to a passage portion defined in the body portion of the first adjustable suture construct. A similar second adjustable suture construct passes through the second bore of the anchor.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 13/412,127 filed on Mar. 5, 2012, which is a divisional of U.S. patent application Ser. No. 12/196,407 filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 filed on Mar. 20, 2012, which is a continuation-in-part application of: (1.) U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, now U.S. Pat. No. 7,601,165 filed on Oct. 13, 2009; (2.) U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851 filed on Mar. 22, 2011; (3.) U.S. patent application Ser. No. 12/014,340 filed on Jan. 15, 2008, now U.S. Pat. No. 7,905,904 filed on Mar. 15, 2011; (4.) U.S. patent application Ser. No. 11/935,681 filed on Nov. 6, 2007, now U.S. Pat. No. 7,905,903 filed on Mar. 15, 2011; (5.) U.S. patent application Ser. No. 11/869,440 filed on Oct. 9, 2007, now U.S. Pat. No. 7,857,830 filed on Dec. 28, 2010; (6.) U.S. patent application Ser. No. 11/784,821 filed on Apr. 10, 2007; (7.) U.S. patent application Ser. No. 11/347,661 filed on Feb. 3, 2006, now U.S. Pat. No. 7,749,250 filed on Jul. 6, 2010; and (8.) U.S. patent application Ser. No. 11/347,662 filed on Feb. 3, 2006, now abandoned. The disclosures of the above applications are incorporated herein by reference. 
    
    
     FIELD 
     The present disclosure relates to a method and apparatus for stabilizing tissue and, more particularly, to a method of coupling soft tissue to a bone and for stabilizing anatomical features. 
     BACKGROUND 
     The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
     It is commonplace in arthroscopic procedures to employ sutures and anchors to secure soft tissues to bone. Despite their widespread use, several improvements in the use of sutures and suture anchors may be made. For example, the procedure of tying knots may be very time consuming, thereby increasing the cost of the procedure and limiting the capacity of the surgeon. Furthermore, the strength of the repair may be limited by the strength of the knot. This latter drawback may be of particular significance if the knot is tied improperly as the strength of the knot in such situations may be significantly lower than the tensile strength of the suture material. 
     To improve on these uses, sutures having a single preformed loop have been provided.  FIG. 1  represents a prior art suture construction. As shown, one end of the suture is passed through a passage defined in the suture itself. The application of tension to the ends of the suture pulls a portion of the suture through the passage, causing a loop formed in the suture to close. Relaxation of the system, however may allow a portion of the suture to translate back through the passage, thus relieving the desired tension. 
     It is an object of the present teachings to provide an alternative device for anchoring sutures to bone and soft tissue. The device, which is relatively simple in design and structure, is highly effective for its intended purpose. 
     SUMMARY 
     To overcome the aforementioned deficiencies, a method for configuring a braided tubular suture and a suture configuration are disclosed. The method includes passing a first end of the suture through a first aperture into a passage defined by the suture and out a second aperture defined by the suture so as to place the first end outside of the passage. A second end of the suture is passed through the second aperture into the passage and out the first aperture so as to place the second end outside of the passage. 
     A method of surgically implanting a suture construction into a tunnel formed in a bone is disclosed. A suture construction is formed by passing the suture through a bore defined by a locking member. A first end of the suture is passed through a first aperture within the suture into a passage defined by the suture and out a second aperture defined by the suture so as to place the first end outside of the passage and define a first loop. A second end of the suture is then passed through the second aperture into the passage and out the first aperture so as to place the second end outside of the passage, and define a second loop. The first and second ends and the first and second loops are then passed through the tunnel. Soft tissue is then passed through the first and second loops. Tension is applied onto the first and second ends to constrict the first and second loops about the soft tissue. 
     In another embodiment, a method of surgically implanting a suture is disclosed. The suture is passed through a bore defined by a first fastener. A suture construction is formed by passing the suture through a bore defined by a locking member. A first end of the suture is passed through a first aperture within the suture into a passage defined by the suture and out a second aperture defined by the suture so as to place the first end outside of the passage and define a first loop. A second end of the suture is then passed through the second aperture into the passage and out the first aperture so as to place the second end outside of the passage, and define a second loop. A second fastener is coupled to at least one of the first and second loops. After the fastener is coupled to the patient, tension is applied onto the first and second ends to constrict at least one of the first and second loops. 
     In another embodiment a method of surgically implanting a soft tissue replacement for attaching two bone members is disclosed. First and second tunnels are formed in first and second bones. A pair of locking members having a first profile which allows insertion of the locking members through the tunnel and a second profile which allows engagement with the positive locking surface upon rotation of the locking members is provided. The suture construction described above is coupled to the locking members. The first and second ends and the first and second loops of the construction and the locking member are threaded through the first and second tunnels. Tension is applied to the suture construction to engage the locking members and pull the first and second bones together. 
     In another embodiment an assembly for coupling a first portion of an anatomy to a second portion of the anatomy is disclosed. The assembly includes an anchor having an anchor body and a first and second bores through the anchor body. A first adjustable suture construct having a body portion passes through the first bore of the anchor and includes first and second adjustable loops slidable relative to a passage portion defined in the body portion of the first adjustable suture construct. A similar second adjustable suture construct passes through the second bore of the anchor. 
     In another embodiment, a method of coupling a first portion of an anatomy to a second portion of the anatomy is disclosed. The method includes forming a first bore in a first bone of the anatomy, forming a second bore in a second bone of the anatomy, and positioning a first anchor relative to the first bore. A second anchor is positioned relative to the second bore. First and second adjustable suture constructs extend from the second anchor. Each of the first and second adjustable suture constructs have corresponding body portions and are positioned between the first and second bones. The first and second adjustable suture constructs are coupled with corresponding first and second ligament replacements. At least one end of the first adjustable suture construct is tensioned to tension the first ligament replacement and adjust a size of first and second adjustable loops slidably passing through a longitudinal interior bore defined in a passage portion of the body portion of the first adjustable suture construct. Similarly, at least one end of the second adjustable suture construct is tensioned to tension the second ligament replacement. 
     Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
    
    
     
       DRAWINGS 
       The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way. 
         FIG. 1  represents a prior art suture configuration; 
         FIGS. 2A and 2B  represent suture constructions according to the teachings; 
         FIG. 3  represents the formation of the suture configuration shown in  FIG. 2A ; 
         FIGS. 4A and 4B  represent alternate suture configurations; 
         FIGS. 5-7  represent further alternate suture configurations; 
         FIG. 8  represents the suture construction according to  FIG. 5  coupled to a bone engaging fastener; 
         FIGS. 9-10 and 11A-11B  represent the coupling of the suture construction according to  FIG. 5  to a bone screw; 
         FIGS. 12A-12E  represent the coupling of a soft tissue to an ACL replacement in a femoral/humeral reconstruction; 
         FIGS. 13A-13D  represent a close-up view of the suture shown in  FIGS. 1-11B ; 
         FIGS. 14A-14C, 15A-15C, 16A-16C, 17A-17C, and 18A-18C  represent fasteners used in the teaching herein; 
         FIG. 19  represents the preparation of the femoral and humerus according to the teachings herein; 
         FIGS. 20 and 21  represent suture constructions; 
         FIGS. 22A-22D  represent the use of the suture construction of  FIG. 21  to couple a soft tissue construction to a femoral/humeral tunnel; 
         FIGS. 23 and 24  represent the coupling of soft tissue to an ulna; 
         FIG. 25  represents the coupling of soft tissue to a humerus; and 
         FIGS. 26-28  represent the stabilization of bony structures utilizing suture constructions taught herein. 
     
    
    
     DETAILED DESCRIPTION 
     The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. 
       FIG. 2A  represents a suture construction  20  according to the present teachings. Shown is a suture  22  having a first end  24  and a second end  26 . The suture  22  is formed of a braided body  28  that defines a longitudinally formed hollow passage  30  therein. First and second apertures  32  and  34  are defined in the braided body  28  at first and second locations of the longitudinally formed passage  30 . 
     Briefly referring to  FIG. 3 , a first end  24  of the suture  22  is passed through the first aperture  32  and through longitudinal passage  30  formed by a passage portion and out the second aperture  34 . The second end  26  is passed through the second aperture  34 , through the passage  30  and out the first aperture  32 . This forms two loops  46  and  46 ′. As seen in  FIG. 2B , the relationship of the first and second apertures  32  and  34  with respect to the first and second ends  24  and  26  can be modified so as to allow a bow-tie suture construction  36 . As described below, the longitudinal and parallel placement of first and second suture portions  38  and  40  of the suture  22  within the longitudinal passage  30  resists the reverse relative movement of the first and second portions  38  and  40  of the suture  22  once it is tightened. 
     The first and second apertures are formed during the braiding process as loose portions between pairs of fibers defining the suture  22 . As further described below, the first and second ends  24  and  26  can be passed through the longitudinal passage  30  multiple times. It is envisioned that either a single or multiple apertures can be formed at the ends of the longitudinally formed passage. 
     As best seen in  FIGS. 4A and 4B , a portion of the braided body  28  of the suture  22  defining the longitudinal passage  30  can be braided so as to have a diameter larger than the diameter of the first and second ends  24  and  26 . Additionally shown are first through fourth apertures  32 ,  34 ,  42 , and  44 . These apertures can be formed in the braiding process or can be formed during the construction process. In this regard, the apertures  32 ,  34 ,  42 , and  44  are defined between adjacent fibers in the braided body  28 . As shown in  FIG. 4B , and described below, it is envisioned the sutures can be passed through other biomedically compatible structures. 
       FIGS. 5-7  represent alternate constructions wherein a plurality of loops  46   a - d  are formed by passing the first and second ends  24  and  26  through the longitudinal passage  30  multiple times. The first and second ends  24  and  26  can be passed through multiple or single apertures defined at the ends of the longitudinal passage  30 . The tensioning of the ends  24  and  26  cause relative translation of the sides of the suture  22  with respect to each other. 
     Upon applying tension to the first and second ends  24  and  26  of the suture  22 , the size of the loops  46   a - d  is reduced to a desired size or load. At this point, additional tension causes the body of the suture  22  defining the longitudinal passage  30  to constrict about the parallel portions of the suture  22  within the longitudinal passage  30 . This constriction reduces the diameter of the longitudinal passage  30 , thus forming a mechanical interface between the exterior surfaces of the first and second parallel portions as well as the interior surface of the longitudinal passage  30 . 
     As seen in  FIGS. 8-10 and 11A-11B , the suture construction can be coupled to various biocompatible hardware. In this regard, the suture construction  20  can be coupled to an aperture  52  of the bone engaging fastener  54 . Additionally, it is envisioned that soft tissue or bone engaging members  56  can be fastened to one or two loops  46 . After fixing the bone engaging fastener  54 , the members  56  can be used to repair, for instance, a meniscal tear. The first and second ends  24 ,  26  are then pulled, setting the tension on the loops  46 , thus pulling the meniscus into place. Additionally, upon application of tension, the longitudinal passage  30  is constricted, thus preventing the relaxation of the tension caused by relative movement of the first and second parallel portions  38 ,  40 , within the longitudinal passage  30 . 
     As seen in  FIGS. 9-10 and 11A-11B , the loops  46  can be used to fasten the suture construction  20  to multiple types of prosthetic devices. As described further below, the suture  22  can further be used to repair and couple soft tissues in an anatomically desired position. Further, retraction of the first and second ends allows a physician to adjust the tension on the loops between the prosthetic devices. 
       FIG. 11B  represents the coupling of the suture construction according to  FIG. 2B  with a bone fastening member. Coupled to a pair of loops  46  and  46 ′ is tissue fastening members  56 . The application of tension to either the first or second end  24  or  26  will tighten the loops  46  or  46 ′ separately. 
       FIGS. 12A-12E  represent potential uses of the suture constructions  20  in  FIGS. 2A-7  in an ACL repair. As can be seen in  FIG. 12A , the longitudinal passage portion  30  of suture construction  20  can be first coupled to a fixation member  60 . The member  60  can have a first profile which allows insertion of the member  60  through the tunnel and a second profile which allows engagement with a positive locking surface upon rotation. The longitudinal passage portion  30  of the suture construction  20 , member  60 , loops  46  and ends  24 ,  26  can then be passed through a femoral and tibial tunnel  62 . The fixation member  60  is positioned or coupled to the femur. At this point, a natural or artificial ACL  64  can be passed through a loop or loops  46  formed in the suture construction  20 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46 , thus pulling the ACL  64  into the tunnel. In this regard, the first and second ends are pulled through the femoral and tibial tunnel, thus constricting the loops  46  about the ACL  64  (see  FIG. 12B ). 
     As shown, the suture construction  20  allows for the application of force along an axis  61  defining the femoral tunnel. Specifically, the orientation of the suture construction  20  and, more specifically, the orientation of the longitudinal passage portion  30 , the loops  46 , and ends  24 ,  26  allow for tension to be applied to the construction  20  without applying non-seating forces to the fixation member  60 . As an example, should the loops  24 ,  26  be positioned at the member  60 , application of forces to the ends  24 ,  26  may reduce the seating force applied by the member  60  onto the bone. 
     As best seen in  FIG. 12C , the body portion  28  and parallel portions  38 ,  40  of the suture construction  20  remain disposed within to the fixation member  60 . Further tension of the first ends draws the ACL  64  up through the tibial component into the femoral component. In this way, suture ends can be used to apply appropriate tension onto the ACL  64  component. The ACL  64  would be fixed to the tibial component using a plug or screw as is known. 
     After feeding the ACL  64  through the loops  46 , tensioning of the ends allows engagement of the ACL with bearing surfaces defined on the loops. The tensioning pulls the ACL  64  through a femoral and tibial tunnel. The ACL  64  could be further coupled to the femur using a transverse pin or plug. As shown in  FIG. 12E , once the ACL is fastened to the tibia, further tensioning can be applied to the first and second ends  24 ,  26  placing a desired predetermined load on the ACL. This tension can be measured using a force gauge. This load is maintained by the suture configuration. It is equally envisioned that the fixation member  60  can be placed on the tibial component  66  and the ACL pulled into the tunnel through the femur. Further, it is envisioned that bone cement or biological materials may be inserted into the tunnel  62 . 
       FIGS. 13A-13D  represent a close-up of a portion of the suture  20 . As can be seen, the portion of the suture defining the longitudinal passage  30  has a diameter d 1  which is larger than the diameter d 2  of the ends  24  and  26 . The first aperture  32  is formed between a pair of fiber members. As can be seen, the apertures  32 ,  34  can be formed between two adjacent fiber pairs  68 ,  70 . Further, various shapes can be braided onto a surface of the longitudinal passage  30 . 
     The sutures are typically braided of from 8 to 16 fibers. These fibers are made of nylon or other biocompatible material. It is envisioned that the suture  22  can be formed of multiple type of biocompatible fibers having multiple coefficients of friction or size. Further, the braiding can be accomplished so that different portions of the exterior surface of the suture can have different coefficients of friction or mechanical properties. The placement of a carrier fiber having a particular surface property can be modified along the length of the suture so as to place it at varying locations within the braided constructions. 
       FIGS. 14A-14C, 15A-15C, 16A-16C, 17A-17C, and 18A-18C  represent various fasteners which can be used with the suture constructions of  FIGS. 1-7 .  FIGS. 14A-14C  represent an elongated anchor  70  defining a suture accepting bore  72 . As described below, the anchor  70  has a first profile  79  which allows the anchor  70  to be passed through a bore defined in a bone. The anchor  70  can be rotated so as to have a second profile  74  to allow engagement with a patient. The fastener  70  has a tissue engaging surface  76  which is configured to engage either soft tissue or bone. Examples of this can be found in the form of a toggle lock in co-assigned and co-pending U.S. patent application Ser. No. 10/864,900, incorporated herein by reference. 
     As shown in  FIGS. 15A-15C and 16A-16C , the fasteners  78  and  80  can have a generally cylindrical body  82  defining a through bore  84 . Disposed across the through bore  84  is a transverse pin  86  which is configured to slidably bear the suture construction. Optionally, the fastener can have an outer engagement rib or flange  83  which is configured to engage the periphery of an aperture formed in the bone. The cylindrical body  82  can have an outside diameter which is less than the diameter of the bore in the bone. 
     As shown in  FIGS. 17A-17C and 18A-18C , the fasteners  90  and  92  can have a general planar button configuration having a plurality of suture accepting through bores  93 . These bores  93  can slidably or fixably accept the suture  22 . The button can have a diameter greater than the diameter of the tunnel formed in the bone. It is envisioned the fasteners  90  and  92  can have flat or curved bearing surfaces. In this regard, the bearing surface of the fasteners  90  and  92  can have a convex bearing shape. 
       FIGS. 19-21 and 22A-22B  represent the use of the suture construction to couple a bone-tendon-bone graft construction  100  within a femoral/tibial tunnel  102 . As shown in  FIG. 19 , the tunnel  99  can have a first portion  103  with a first diameter  107  and a second portion  109  having second smaller diameter  108  within the femur. As described below, the second diameter  108  can be used to couple the bone-tendon-bone construction  100  to the tunnel. 
     As shown in  FIGS. 20 and 21 , a loop of suture  96  is passed through a collapsible tube  98 . The collapsible tube or a pair of loops formed by a suture  22  is positioned within the bore  72  of a first fastener  70 . As described above, the collapsible tube  98  can be a portion of the suture  22 , or can be a separate member. 
     As seen in  FIG. 21 , to form the suture construction  73 , the suture  22  is passed through the first bore  72  defined by the first fastener  70 . The suture  22  can then be passed through a second bore defined by a second fastener  70  or a suture loop  77 . In any of the embodiments, the collapsible tube  98  can be a portion of the suture. A first end  26  of the suture  22  is passed through a first aperture  34  defined by the collapsible tube  98  into a passage portion  30  defined by the collapsible tube  98  and out a second aperture  36  defined by the collapsible tube  98  so as to place the first end outside of the passage portion  30  and form a first loop. A second end  26  of the suture  22  is passed through the second aperture  36  into the passage portion  30  and out the first aperture  34  so as to place the second end  26  outside of the passage portion  30  and form a second loop  47 . At this point, the passage portion  30  can optionally be positioned within the first bore  72  of the fastener  70  or the loop of the suture  22 . 
     As seen in  FIGS. 22A and 22B , the construction  73  is coupled to a bone-tendon-bone construction  100  using the loop of suture  77  or a fastener. The bone-tendon-bone implant  100  can be formed of an allograph-tendon construction or artificial bone-tendon or bone-tendon-bone prosthetic assembly. It is envisioned the physician can intraoperatively determine the desired graft or graft assembly length and appropriate graft tension. 
     After fixing the suture construction to the bone-tendon-bone construction  100  by for example a through pin  111 , the bone-tendon-bone construction  100  is installed into the tunnel  102  formed in a femur and tibia  104 ,  105 . As described above with respect to  FIG. 12A , the suture construction  73  of  FIG. 21  can be fed through the femoral tunnel  102 . The bone-tendon-bone construction  100  is then put into the tunnel  102 . A first portion  106  of the bone-tendon-bone construction  100  is coupled to a tibial tunnel using a fastener  101  positioned within the tunnel. A second portion of the bone-tendon-bone construction  100  is pulled taught into the femoral tunnel by tensioning the ends  24  and  26  of the suture construction  73 . The portion  113  of the bone-tendon-bone construction  100  can be coupled to the femur using a transverse or parallel bone engaging screw  101 . 
     As seen in  FIGS. 22C and 22D , a pair of suture constructions  22  and  22 ′ are coupled to a pair of soft tissue replacements  64  and  64 ′ using the loops of suture  77 ,  77 ′ or a fastener. The pair of soft tissue replacements  64  and  64 ′ can be formed of artificial of harvested tendon material. It is envisioned the physician can intraoperatively determine the desired graft or graft assembly length and appropriate graft tension. 
     After fixing the suture constructions  22  and  22 ′ to a toggle lock (see  FIG. 22D ) and the pair of soft tissue replacements  64  and  64 ′ are implant into the tunnel  102  formed in a femur and tibia  104 ,  105 . As described above with respect to  FIG. 12A , the suture constructions  22  and  22 ′ of  FIG. 21  can be fed through the femoral tunnel  104 . The pair of soft tissue replacements  64  and  64 ′ are then pulled into the tunnel  104  by applying tension onto the ends  24 - 26 ′ of the suture constructions. A first portion  106  of the pair of soft tissue replacements  64  and  64 ′ is coupled to a tibial tunnel  105  using a fastener  101  such as a WASHERLOK™ tibial fixation as provided by Biomet Sports Medicine positioned within the tunnel. A second portion of the pair of soft tissue replacements  64  and  64 ′ is pulled taught into the femoral tunnel by tensioning the ends  24  and  26  of the suture construction  73 . The portion  113  of the pair of soft tissue replacements  64  and  64 ′ can be coupled to the femur using a transverse or parallel bone engaging screw  101 . It is envisioned the suture ends  24  and  26  can be passed though a medial portal  25  to facilitate the tensioning of the pair of soft tissue replacements  64  and  64 . 
     Alternatively, after insertion into the femoral tunnel  102 , as seen in  FIG. 12B , an appropriate amount of tension is applied to the pair of soft tissue replacements  64  and  64 ′ by applying tension to the ends  24  and  26  of the suture construction. A fastener  101  is engageably driven between the ends of pair of soft tissue replacements  64  and  64 ′ and the internal surface of the bore formed in the tibia. This locks the pair of soft tissue replacements  64  and  64 ′ to the bone. 
       FIG. 23  represents the coupling of a flexor tendon  110  to the humerus. Shown is the ulna  112  having a through bore  114 . The through bore  114  can accept the suture construction  73  shown in  FIG. 21 . As described above with respect to the ACL replacement shown in  FIG. 12A , the suture construction  73  is fed through the tunnel  114  formed in the ulna  112 . A soft tissue graft  110  is fed through the pair of loops  46 ,  47  formed by the suture construction  73 . The ends  24 ,  26  of the suture  22  are then pulled so as to pull the soft tissue graft  110  to or into the tunnel  114 . A second end of the soft tissue graft  118  can be coupled to a bore  120  formed in a lateral epicondyle  122  of the humerus. A soft tissue engaging fastener  101  can be used to couple a soft tissue  110  to the bore  120 . After engagement of the soft tissue fastener  101 , the tension of the soft tissue  110  can be adjusted by the tensioning of the suture construction  73 . 
     Similarly, as shown in  FIG. 24 , the bicep brachii tendon  130  can be coupled to the ulna  112  using the suture construction  73  shown in  FIG. 21 . In this regard, a bore  114  is formed in the ulna. The fixation member  70  is then positioned or coupled to the ulna  112 . At this point, a natural or artificial bicep brachii tendon  130  can be passed through a loop or second fastener  70  or the loops  46 ,  47  formed in the suture construction  73 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46 ,  47 , thus pulling the tendon  64  to or into the bore  114 . The constricting the loops  46 , 47  then fasten the bicep brachii tendon  130  to the ulna  112 . It is envisioned a bone coupling fastener  101  can be used to fix the soft tissue  130  to the ulna. 
       FIG. 25  shows the coupling of soft tissue  140  to the head of the humerus. Defined in the humerus is a bore  114  configured to support the suture construction  73 . This bore can further have a transverse passage  134 . The transverse passage  134  can have at least one loop of the suture construction  73  disposed therethrough so as to allow the coupling of soft tissue to or through the transverse passage  134 . The longitudinal passage portion  30  of suture construction  73  can be first coupled to a fixation member  70 . The member  70  has a first profile which allows insertion of the member  70  through the tunnel and a second profile which allows engagement with a positive locking surface upon rotation. The longitudinal passage portion  30  of the suture construction  73 , member  70 , loops  46  and ends  24 ,  26  can then be passed through the tunnel. 
     The fixation member  70  is positioned or coupled to the humeral head. At this point, a natural or artificial bicep tendon  140  can be passed through a loop or loops formed in the suture construction  73 . Tensioning of the first and second ends  24  and  26  applies tension to the loops, thus pulling the tendon  140  to or into the transverse passage  134 . In this regard, the first and second ends are pulled through the tunnel  114 , thus constricting the loops about the tendon  140  and pulling the tendon  140  or soft tissue to the transverse tunnel  134 . Optionally, a soft tissue fastening screw can be used to fix the tendon  140  to the transverse passage  134 . 
     As shown in  FIGS. 26-28 , the suture construction  73  as shown in  FIGS. 1-7  can be used to couple and position bony elements of a patient.  FIG. 26  shows the coupling of a coracoid process  137  to the spine of scapula  139 . In this regard, a pair of coaxial bores  138  and  140  are formed within the coracoid process  137  and spine of scapula  139 . A pair of anchors  70 , such as those shown in  FIGS. 14A-14C, 15A-15C, 16A-16C, 17A-17C, and 18A-18C , are coupled to a suture construction  73  such as the one shown in  FIG. 2A or 4A . A first fastener  70  is fed through the aperture formed in the spine of scapula while the second fastener  70 ′ is fed through the bore  140  formed in the coracoid process  137 . Tension is applied to the ends  24  and  26  of the suture construction  73 , pulling the bony structures into proper position. The suture construction of  FIGS. 1-7  allow for the alignment compression and/or positioning of the bone elements without the need to form knots. 
     Similarly, as shown in  FIG. 27 , the lunate  142  and scaphoid  144  can be drawn together using the construction  73  shown in  FIG. 26 . In this regard, it is envisioned that both the lunate  142  and scaphoid  144  can have appropriate bores  138  and  140  formed therein. These bores accept the suture construction  73  as shown in  26  to allow stabilization of the patient&#39;s anatomy. 
     As shown in  FIG. 28 , the radius  146  and ulna  148  can be coupled together by the use of a pair of axial suture accepting passages  138  and  140 . In this configuration, the suture construction uses a first fastener  70  which is configured to pass through the passages  138  and  140 . Additionally, the fastener  92  shown in  FIGS. 18A-18C  can be used as a load bearing member and bear against the ulna  148  and the application of tension to the ends  24  and  26  of the suture construction  73  tightens the suture construction and stabilizes the bones of the joint. 
     The description of the invention is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. For example, any of the above mentioned surgical procedures is applicable to repair of other body portions. For example, the procedures can be equally applied to the repair of wrists, elbows, ankles, and meniscal repair. The suture loops can be passed through bores formed in soft or hard tissue. It is equally envisioned that the loops can be passed through or formed around an aperture or apertures formed in prosthetic devices e.g. humeral, femoral or tibial stems. Such variations are not to be regarded as a departure from the spirit and scope of the invention.