Abstract:
A method and apparatus for surgically repairing a tear in soft tissue is disclosed. A plurality of collapsible tubes are positioned about the suture. The collapsible tubes are pushed through soft tissue and orthopedic mesh on opposite sides of a tear in soft tissue. When tension is applied to the suture, the tubes are compressed to fix the suture to the soft tissue and draw the soft tissue portions together.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation-in-part application of U.S. patent application Ser. No. 12/478,802 filed on May 29, 2009, and is a continuation-in-part application of U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, and is a continuation-in-part application of U.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006, and is a continuation-in-part application of U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008, and is a continuation-in-part application of U.S. patent application Ser. No. 12/014,340 filed on Jan. 15, 2008, and is a continuation-in-part application of U.S. patent application Ser. No. 11/935,681 filed on Nov. 6, 2007, and is a continuation-in-part application of Ser. No. 11/869,440 filed on Oct. 9, 2007, and is a continuation-in-part application of Ser. No. 11/784,821 filed on Apr. 10, 2007, and is a continuation-in-part application of Ser. No. 11/347,661 filed on Feb. 3, 2006, and is a continuation-in-part application of Ser. No. 11/347,662 filed on Feb. 3, 2006. This application is also a continuation-in-part of U.S. patent application Ser. No. 12/196,405 filed on Aug. 22, 2008, U.S. patent application Ser. No. 12/196,407, filed on Aug. 22, 2008, and U.S. patent application Ser. No. 12/196,410, filed on Aug. 22, 2008. The disclosure of the above applications is incorporated herein by reference. 
     
    
     FIELD 
       [0002]    The present disclosure relates to method of coupling soft tissue to a bone and, more particularly, to a method of implanting an ACL within a femoral tunnel. 
       BACKGROUND 
       [0003]    The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
         [0004]    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. 
         [0005]    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. 
         [0006]    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 
       [0007]    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. 
         [0008]    A method of surgically implanting a suture construction in a femoral tunnel 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 femoral 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 to pull the soft tissue into the tunnel. 
         [0009]    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. 
         [0010]    In another embodiment a method of surgically implanting a soft tissue replacement for attaching two bone members is disclosed. A first and second tunnel is formed in first and second bones. A locking member having a first profile which allows insertion of the locking member through the tunnel and a second profile which allows engagement with the positive locking surface upon rotation of the locking member is provided. The suture construction described above is coupled to the locking member. 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. Soft tissue is threaded through the first and second loops so as to engage bearing surfaces on the first and second loops. The locking member is then engaged. 
         [0011]    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 
         [0012]    The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way. 
           [0013]      FIG. 1  represents a prior art suture configuration; 
           [0014]      FIGS. 2A and 2B  represent suture constructions according to the teachings; 
           [0015]      FIG. 3  represents the formation of the suture configuration shown in  FIG. 4A ; 
           [0016]      FIGS. 4A and 4B  represent alternate suture configurations; 
           [0017]      FIGS. 5-7  represent further alternate suture configurations; 
           [0018]      FIG. 8  represents the suture construction according to  FIG. 5  coupled to a bone engaging fastener; 
           [0019]      FIGS. 9-11B  represent the coupling of the suture construction according to  FIG. 5  to a bone screw; 
           [0020]      FIGS. 12A-12E  represent the coupling of a soft tissue to an ACL replacement in a femoral/humeral reconstruction; 
           [0021]      FIGS. 13A-13D  represent a close-up view of the suture shown in  FIGS. 1-11C ; 
           [0022]      FIGS. 14-16  represent fixed length textile anchors; 
           [0023]      FIGS. 17-21  represent adjustable length textile anchors according to the teachings herein; 
           [0024]      FIGS. 22-24  represent alternate adjustable length textile anchors; 
           [0025]      FIGS. 25-27  represent alternate suture configurations; 
           [0026]      FIG. 28  represents the preparation of the tibia and femur to accept the anchors disclosed in  FIGS. 14-24 ; 
           [0027]      FIGS. 29A and 29B  represent the coupling of an ACL replacement in a femoral/tibial reconstruction using the textile anchor of  FIG. 18 ; 
           [0028]      FIGS. 30A and 30B  represent the coupling of an ACL replacement in a femoral/tibial reconstruction using the textile anchor of  FIG. 17 ; 
           [0029]      FIGS. 31A and 31B  represent the coupling of an ACL replacement in the femoral/tibial reconstruction using the textile anchor of  FIG. 15 ; 
           [0030]      FIGS. 32A and 32B  represent the coupling of an ACL replacement in a femoral/humeral reconstruction using the textile anchor of  FIG. 16 ; 
           [0031]      FIG. 33  represents a suture construction having a plurality of collapsible tubes; 
           [0032]      FIGS. 34A-34C  represent a tool used to surgically implant the suture construction shown in  FIG. 33 ; 
           [0033]      FIGS. 35A-35C  show the suture construction of  FIG. 33  coupled to an orthopedic mesh; 
           [0034]      FIGS. 36A-36C  represent the use of an orthopedic mesh to repair a soft tissue tear; 
           [0035]      FIGS. 37A-39D  represent various methodologies of coupling the suture constructions of  FIG. 33  to soft tissue; and 
           [0036]      FIGS. 40-45  represent an alternate suture construction. 
       
    
    
     DETAILED DESCRIPTION 
       [0037]    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. 
         [0038]      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 . 
         [0039]    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 once it is tightened. 
         [0040]    The first and second apertures are formed during the braiding process as loose portions between pairs of fibers defining the suture. 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. 
         [0041]    As best seen in  FIGS. 4A and 4B , a portion of the braided body  28  of the suture 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. 
         [0042]      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 with respect to each other. 
         [0043]    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 defining the longitudinal passage  30  to constrict about the parallel portions of the suture 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 . 
         [0044]    As seen in  FIGS. 8-11 , 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 . 
         [0045]    As seen in  FIGS. 9-11B , 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. 
         [0046]      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. 
         [0047]      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 ). 
         [0048]    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. 
         [0049]    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. The suture construction has loops  46  and  46 ′ with a first length which allows rotation of the fixation member  60 . Application of tension onto the ends  24 ,  26  of the sutures pulls the fixation member  60  into position and the loops  46  and  46 ′ into a second length. In this position, rotation of the locking member in inhibited. 
         [0050]    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 . 
         [0051]      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 . 
         [0052]    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. 
         [0053]      FIGS. 14-16  represent collapsible anchors  70 ,  72 ,  74  according to the present teachings. The anchors are deformable from a first cross section to a second engaging cross section. The anchors  70 ,  72 ,  74  are biocompatible materials for example polymer or a knit or woven textile such as a braided nylon material. Disposed within a collapsible tube  76  is a closed loop of suture material  78  which may form a portion of the collapsible tube  76 . Optionally, this collapsible tube  76  can be slidable with respect to the closed loop of suture material  78 . The collapsible tube  76  is further collapsible to form a fabric mass  110  (see for example  FIG. 29B ). 
         [0054]    The suture material  78  can be passed through a pair of openings  83  in the collapsible tube  76  a single time to form a single soft tissue bearing surface  80 . Additionally, (see  FIG. 15 ), the closed loop of the suture material  78  can be looped over itself and passed through the collapsible flexible tube  76  to form a pair of soft tissue bearing surface portions  82 . In each of the embodiments shown, the collapsible tube  76  defines at least one tube bearing surface. 
         [0055]      FIG. 16  represents a closed loop of suture  78  passed through an aperture  77  defined in a body  79  of the collapsible tube  76 . In this regard, the suture  78  is passed through a first open end  95  of the tube  78  and through the aperture  77  leaving a portion  81  of the collapsible tube  76  which can be used to assist in the insertion of a graft to a patient (see  FIG. 32A ). 
         [0056]      FIGS. 17-19  represent adjustable sized loops of suture material  78  disposed within the collapsible tube  76  so as to form a suture anchor assembly  84 ,  86 ,  88 .  FIG. 17  shows the suture material  78  passed several times through the collapsible tube  76 . By applying tension to the ends  90  and  92  of the suture material  78 , the loops of the suture material constrict. If placed adjacent to a bearing surface (not shown), the end  94  and  96  of the collapsible tube  76  are brought together, thus collapsing the tube to form a collapsed material or fabric mass  110 . It is envisioned a portion of the suture material  78  can be passed through the collapsible tube  76  to help maintain the position of the suture with respect to the collapsible tube  76 . 
         [0057]      FIGS. 18 and 19  show the loops of the suture construction of  FIG. 4   a  within a collapsible tube  76 . The tubular portion of the construction of  FIG. 4   a  can be disposed either within or outside of the collapsible tube  76 . As with the embodiment shown in  FIGS. 14-16 , translation of the tube  76  with respect to the suture material  78  can cause the ends  94  of the tube  76  to be brought together to compress the loops into a fabric mass  110 . 
         [0058]      FIGS. 20 and 21  show the loops of  FIGS. 2B ,  4 A or  5  disposed within the collapsible tube  76 . Shown are the ends and loops disposed at least partially through a portion  100  of the tube  76 . Tensioning of the ends  24 ,  26  causes the portions  100  of the tube  76  to collapse to form a mass  110 , while leaving other portions  85  uncollapsed. The outer uncollapsed portion  85  can function as a bearing surface to assist in the collapse of portion  100  when portion  100  is subjected to compressive loads. 
         [0059]      FIG. 21  shows an embodiment where suture loops are passed through the sidewalls of the collapsible tube  76 . Optionally, the loops  46  and  47  as well as the ends  24  and  26  can be passed through together. This construction can be used in situations where a large collapsed mass  110  is needed 
         [0060]      FIG. 22  shows the loop of  FIG. 2B  having a pair of collapsible tubes  76 . The collapsible tubes  76  are disposed about the loops  46  and  46 ′ and will collapse upon application of tension to the ends of the suture construction in a manner which places compressive loads onto the ends of the tube  76 . It is envisioned that these collapsible tubes  76  can be collapsed simultaneously or staggered in time as needed by a treating physician. It is also envisioned that the loop construction can be used to pull adjacent portions of a patient&#39;s anatomy together. 
         [0061]      FIG. 23  depicts the loop construction shown in  FIG. 2A  having its loops disposed through a pair of co-joined crossed collapsible tubes  76 . If placed adjacent to a bearing surface, the ends of the co-joined tubes come together, thus increasing in cross-section. This forms the fabric mass  110 . This construction can be used in situations where a large collapsed mass is needed. 
         [0062]      FIG. 24  shows the complex suture construction which embodies a pair of suture constructions of  FIG. 2A  coupled together using a collapsible tube  76 . The ends of the suture  22  can be passed though a pair of passages  30  and  30 ′ formed in the suture material  22 . Portions of the suture  22  are looped through each other to form a pair of locked loops  112 . This construction can be used to provide a static seat for a graft bearing surface. 
         [0063]      FIGS. 25-27  represent alternate suture constructions where the ends of the sutures  22  are fed multiple times through holes  105  defined within longitudinal passage  30  of the suture to form adjustable loops  46 . In situations where relaxation of a tightened construction is to be minimized, the ends can be passed in and out of the passage  30  several times. In this regard, the first and second ends are positioned so as to be parallel and adjacent to each other in the passage  30 . 
         [0064]      FIGS. 26 and 27  represent constructions where the first and second ends  24  and  26  a passed through the same passage  30 , but do not overlap and are not adjacent. This construction may be useful for joining pairs of members. This construction would be useful to bind pairs of appendages such as fingers. 
         [0065]      FIG. 28  represents the formation of a femoral tunnel shown as a tunnel  62  having a varying diameter. Disposed within either the femoral or tibial tunnel  62  are a first portion  102  having a first diameter and a second portion  104  having a second diameter larger than the first diameter. Defined on an exterior surface of either the tibia or femur is a bearing surface  103 , which is configured to interface with the fabric mass  110  of compressed textile material to prevent the relative motion of the fabric mass  110 , and thus the suture construction with respect to the bone. This bearing surface can be machined or natural. 
         [0066]      FIGS. 29A and 29B  represent potential uses of the suture construction  86  in  FIG. 18  in an ACL repair. As can be seen in  FIG. 29A , the longitudinal passage portion  30  of suture construction  86  can be first coupled to a collapsible tube  76 . The tube  76  can have a first profile which allows insertion of the tube  76  through the tunnel  62  and a second cross-sectional profile which allows engagement with a positive locking surface  103  upon collapse of the collapsible tube  76  into the fabric mass  110 . The longitudinal passage portion  30  of the suture construction  84 , tube  76 , loops  46  and ends  24 ,  26  can then be pulled through a femoral and tibial tunnel  62 . The tube  76  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  or can be supported by the passage portion  30 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46  and  47 , thus pulling the ACL  64  into the tunnel. In this regard, the first and second ends are pulled through the femoral and tibial tunnel  62 , thus constricting the loops  46  about the ACL  64 . 
         [0067]    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 and collapses the tube  76  to form a locking fabric mass  110  outside the bone or tunnel  62 . The ACL  64  could be further coupled to the femur or tibia using a transverse pin or plug. As shown in  FIG. 29B , 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. As described above, 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 . The longitudinal passage  30  resists relaxation or reverse movement of the suture. 
         [0068]    As best seen in  FIG. 29B , the body portion  28  and parallel portions  38 ,  40  of the suture construction  86  remain disposed within the femoral tunnel  62 . 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 either before or after the application of the tension to the suture  22 . Additionally, tension can be set on the ACL  64  after the collapsible tube  76  has been compressed. 
         [0069]      FIGS. 30A and 30B  represent potential uses of the suture constructions  84  in  FIG. 17  in an ACL repair. As can be seen in  FIG. 30A , the longitudinal passage portion  30  of suture construction  86  can be first disposed within the tube  76 . The tube  76  has a first profile which allows insertion of the tube  76  through the tunnel and a second collapsed profile which allows engagement with a positive locking surface  103 . The collapsible tube  76  of the suture construction  84 , member  60 , and loops  46 ,  47  can then be passed through a femoral and tibial tunnel  62  using a suture  108 . The tube  76  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 ,  47  formed in the suture construction  84 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46 ,  47  thus pulling the ACL  64  into the tunnel. In this regard, the first and second ends  26  and  24  are pulled through the femoral and tibial tunnel, thus constricting the loops  46  about the ACL  64  (see  FIG. 30B ) and collapsing the tube  76  to form the anchoring mass  110 . Force applied to graft  64  along axis  61  in the distal direction will seat tube  76  and form anchoring mass  110 . 
         [0070]    As shown, by holding the suture construction in place  108 , the suture construction  84  allows for the application of force along an axis  61  defining the femoral tunnel  62 . Specifically, the orientation of the suture construction  84  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  86  without applying non-seating forces to the tube  76 . As an example, should the loops  24 ,  26  be positioned at the tube  76 , application of forces to the ends  24 ,  26  may reduce the seating force applied by the tube  76  onto the bone. 
         [0071]    As best seen in  FIG. 30B , the loop portions  46 ,  47  of the suture construction  84  remain disposed within to the tunnel  62 . 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  60  adjacent the suture construction  84 , as is known. 
         [0072]    Alternatively, as shown in  FIG. 30B , 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 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 . 
         [0073]      FIGS. 31A and 31B  represent potential uses of the suture construction  70  in  FIG. 14  in an ACL repair. The suture material  78  of suture construction  70  can be first coupled to a collapsible tube  76 . The collapsible tube  76  can have a first profile which allows insertion of the construction  70  through the tunnel and a second profile which allows engagement with a positive locking surface  103  upon its compression. Prior to attachment to the femur, a natural or artificial ACL  64  can be passed through a loop or loops  46  formed in the suture material  78 . Suture construction  70  can then be passed through a femoral and tibial tunnel  62 . The tube  76  is positioned or coupled to the femur. Tensioning of the first and second ends  112  and  114  of the soft tissue applies tension to the loop  76 , thus collapsing the tube  76  to form the fabric mass  110 . Tension can be applied to the soft tissue which can then be fastened to the tibia using a fastener  60 . 
         [0074]      FIGS. 32A and 32B  represent potential uses of the suture constructions  74  in  FIG. 16  in an ACL repair. The loop of suture  78  is coupled to a collapsible tube  76 . The construction  74  can have a first profile which allows insertion of the tube  76  through the tunnel and a second profile which allows engagement with a positive locking surface upon compression. The suture portion  78  of the suture construction  74 , tube  76 , and soft tissue  64  can then be passed through a femoral and tibial tunnel  62 . The tube  76  is positioned or coupled to the femur  103  and collapsed by the application of tension to the soft tissue  64 . 
         [0075]    As best seen in  FIG. 32B , the anchoring mass  110  of the suture construction  72  remains disposed outside the femoral tunnel. Tension is applied to the ends of the ACL  64  up through the tibial component into the femoral component. In this way, ends of the ACL  112 ,  114  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. 
         [0076]      FIG. 33  represents a suture construction  100  according to the present teachings. The suture construction  100  is formed of a suture  102  having a plurality of collapsible tubes  104  disposed thereon. The collapsible tubes  104  can be knit suture material or a polymer tube. Formed on one or both ends of the suture  102  can be a knot  106 . Optionally, the collapsible tube  104  can be coupled to the suture  102  using a stitch  108 , to prevent translation of the collapsible tube  104  with respect to the suture  102 . 
         [0077]      FIGS. 34A-34C  represent a tool  110  used to couple the suture construction  100  with soft tissue. In this regard, the tool  110  has a sharpened end  112  configured to pierce soft tissue  124 . Disposed adjacent the sharpened end  112  is a recess  114  configured to support a collapsible tube  104 . Disposed within the recess  114  is a collapsible tube holding member  116 . This member  116  can be a flange or a retractable member which selectively engages the collapsible tube  104  to hold the collapsible tube within the recess  114 . Disposed within the tool  100  is an actuatable member  118 . The actuatable member  118  functions to deploy or deliver the collapsible tube  104  from the holding member  116  of the recess  114 . This generally occurs after the collapsible tube  104  has been pressed through the soft tissue  124 . 
         [0078]    As shown in  FIG. 34C , the sharpened end  112  can be pressed through soft tissue  124 , thus positioning the collapsible tube  104  on an obverse side of the soft tissue  124 . Application of force by the drive member  120  onto the actuatable member  118  causes an engagable member  122  to deliver the collapsible tube  104  from the recessed portion  114  of the tool  110 . the engagable member  122  can be formed of Nitonol or can be pivotably coupled to the actuatable member  118 . At this point, the sharpened end can be removed from the soft tissue  124 , leaving the compressible tube and its associated suture  102  therethrough. 
         [0079]    As shown in  FIGS. 35A-35C , multiple collapsible tubes  104  on the suture  102  can be inserted through multiple apertures formed within the soft tissue  124 . Additionally shown is an implantable orthopedic mesh  130 . As best seen in  FIG. 35B , the sharp end  112  of the tool  110  can be fed through a single aperture  128  formed in a layer of soft tissue  120  such as skin. The sharp end  112  is pressed through several apertures within the soft tissue  124  and through apertures within the implantable orthopedic mesh  130 . The application of tensional force onto the suture  102  allows the ends  131  of the collapsible tubes  104  to engage the orthopedic mesh  130 . This allows the collapsible tube  104  to form a loop structure locking the suture to the mesh  130 . Further, the mesh is coupled to the soft tissue  124 , bone, skin, tendon, xenograft, allograft and autograft. 
         [0080]    As best seen in  FIG. 35C , once the collapsible tube  104  has been positioned through the orthopedic mesh  130 , the needle is withdrawn to allow the engagement of the next collapsible tube  104  within the recess  114  of the tool  110 . The tool  110  is moved to position the sharp end  112  in a desired location on the soft tissue  124 . Pressure is then applied to the tool  110  forming a hole within the soft tissue  124 . 
         [0081]    As described above, once the recess portion  114  is passed through the soft tissue  124  or the orthopedic sports mesh  130 , the actuator  118  can be used to decouple the collapsible tube  104  from the recessed portion  114 . 
         [0082]    The sports mesh can be one sold by Biomet Sports Medicine as Sport Mesh™. This allows the removal of the tool  110  while leaving collapsible tube  104  and associated suture  102  on the obverse side of the soft tissue  124  and the orthopedic mesh  130 . The orthopedic mesh can be formed of resorbable materials. 
         [0083]    As shown in  FIGS. 36A-36C , the construction in  FIGS. 35A-35C  and, particularly, the orthopedic mesh  130  can be used to repair torn soft tissue  124 . In this regard, it is envisioned the mesh  130  can be placed over a muscle tear  132 . A series of collapsible tubes  104  are disposed over a suture  102  and can be coupled to the soft tissue by pushing the collapsible tubes  104  through the soft tissue  124  and the mesh  130 . Tension can be applied to the suture  102  to collapse the collapsible tube  104 , thus coupling the sports mesh  130  to the two portions of soft tissue  124  which are being repaired. 
         [0084]    As best seen in  FIGS. 36B and 36C , several different stitching techniques can be used to couple multiple collapsible tubes  104  along the periphery of the orthopedic mesh  130  on either side of a tear  132 . The orthopedic mesh  130  functions to distribute loads along the muscle  124 , thus allowing the torn muscle  132  to heal properly. 
         [0085]    As seen in  FIG. 36C , sutures  134  can be added between the loops of collapsible tubes  104 . It is envisioned that this functions to transfer loads from one portion of the muscle to a second, thus allowing the muscle tear  132  to heal more rapidly and compress the tear  132 . 
         [0086]      FIGS. 37A-39D  represent various methods of inserting the suture constructions shown above into soft tissue.  FIGS. 37A and 37B  represent a collapsible tube having a single and double suture and constructions. These constructions are being threaded through a soft tissue  124 , using a speed pass suture retriever from Biomet Sports Medicine. A passage is formed within a soft tissue  124  using the speed pass suture retriever has a deployable portion which can grab a suture and pull it through the passage. At this point, the suture construction having a suture  102  and collapsible tube is positioned within the speed pass and pulled through the aperture formed within the soft tissue  124 . Tension is applied to the suture  102 , thus collapsing the collapsible tube  104 . 
         [0087]    As seen in  FIGS. 38A and 38B , by using a curved speed pass instrument, a pair of apertures can be formed within the soft tissue. The speed pass instrument is then used to pull the suture construction through the two apertures formed in the soft tissue  124 . Alternatively, the suture construction may be pressed within the speed pass  125  and released (pushed out) after the speed pass  125  has pierced the soft tissue. 
         [0088]    As seen in  FIGS. 38A and 38B , the speed pass having a corkscrew shape can be used to form a pair of apertures in soft tissues which are generally perpendicular to the tool threading direction. In each of these conditions, tension is applied to the sutures  102  to compress the tubes  104 . It is envisioned the speed pass can be used to feed the suture constructions through the orthopedic mesh as described above. 
         [0089]      FIGS. 40-45  represent a tool  140  used to couple the suture construction  100  with soft tissue. In this regard, the tool  140  has a sharpened end  142  configured to pierce soft tissue  124 . Disposed adjacent to the sharpened end  142  is a first portion  144  configured to support a collapsible tube anchor  146 . Adjacent to the first portion  144  is a second portion  148  which can support a plurality of collapsible tube anchors  146 . Disposed between the first  144  and second portions  148  is a generally conical portion  150 . As shown in  FIG. 41 , the conical portion  150  facilitates movement of the collapsible tubes  146  from the second portion  148  to the first portion  144 . Defined between the conical portion  150  and the first portion  144  is a generally flat or planar support surface  152 . The flat surface  152  is configured to support and apply axial forces to an end  154  of the collapsible tube anchor  146 . 
         [0090]    As best seen in  FIG. 43 , the conical portion  150  can have an oblong cross-section. This cross-section can help facilitate the passing of the suture through the soft tissue. The sharpened end  142  can be passed through soft tissue  124 , thus placing the collapsible tube  146  on an obverse side of the soft tissue  124 . At this point, the sharpened end  142  can be passed through another soft tissue layer, a shorts mesh, or skin. 
         [0091]    As shown in  FIG. 45 , the tool  140  can be withdrawn leaving the collapsible tube  146  on the obverse side of the soft tissue. Force can then be applied to the suture  156 , as described above, to collapse the collapsible tube  146 . 
         [0092]    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.