Patent Publication Number: US-10758221-B2

Title: Scaffold for spring ligament repair

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 14/095,639, filed on Dec. 3, 2013, and issued as U.S. Pat. No. 9,918,827 on Mar. 20, 2018, which claims the benefit of U.S. Provisional Application No. 61/783,976, filed on Mar. 14, 2013. 
     The entire disclosure of the above applications are incorporated herein by reference. 
    
    
     FIELD 
     The subject disclosure is generally directed towards ligament repair and/or augmentation, and particularly to an augment construct that is configured to replace or augment a spring ligament in a foot. 
     BACKGROUND 
     This section provides background information related to the present disclosure which is not necessarily prior art. 
     A spring ligament is an anatomical ligament that interconnects various portions of a foot. Generally, the spring ligament may interconnect at least a navicular and a calcaneus. Various branches of the spring ligament, however, may also extend to connect or interconnect the calcaneus with the first cuneiform. 
     Injury to the spring ligament may lead to various issues, such as flat-foot deformities. Injuries to the spring ligament may not generally be diagnosed or repaired until various auxiliary issues present themselves, such as flat-foot deformities. Repairing a defect in the spring ligament, therefore, may lead to prevention of various afflictions. 
     SUMMARY 
     This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features. 
     A ligament construct may be manufactured to repair or replace a selected ligament. For example, a spring ligament replacement or augment may include a synthetic scaffold that may be formed or manufactured to generally replace the spring ligament. The synthetic scaffold may be formed of polyester, polyethylene, resorbable materials, or combinations thereof. The synthetic scaffold may be formed of a woven or braided polyester or polyethylene material that is formed into selected configuration or shape to replace the spring ligament. 
     Selected suture anchoring systems and tensioning systems may be used to fixedly connect the ligament augment to the anatomy. For example, a Juggerknot™ soft anchor or suture anchor may be used to provide an anchor adjacent to or inside of a bone member. Alternatively, a ToggleLoc™ hard suture anchor may be used. A suture tensioning system, such as the Ziploop™ suture tensioning system may be used to draw the scaffold into the bone, and tension the augment relative to the bone while the Juggerknot™ anchor system is used to anchor the construct. It is understood, however, that the tensioning system may be used in combination with any appropriate anchor, such as an interference screw or other bone anchor system. 
     The scaffold may be used to replace the spring ligament. For example, a user may identify a spring ligament tear or removal from a bone portion and identify a need for an augment or ligament replacement. The spring ligament construct may then be fixed relative to the bone, such as with an appropriate anchor and tensioning system. The anchors may include the Juggerknot™ soft anchor system. The construct may then be maintained relative to the bone for a procedure and/or fixed to the remaining portion of the spring ligament to assist in augmenting the remaining spring ligament portions. 
     Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary 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 illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure. 
         FIG. 1A  is a top plan view of a ligament construct connected to suture, according to various embodiments; 
         FIG. 1B  is a side plan view of the ligament construct of  FIG. 1A  connected to suture; 
         FIG. 2A  is a top plan view of a ligament construct according to various embodiments; 
         FIG. 2B  is a side plan view of the ligament construct of  FIG. 2A  connected to suture; 
         FIG. 3  is a top plan view of a ligament construct according to various embodiments; 
         FIG. 4  is a detail view of a portion of a ligament construct connected to a suture and an anchor, according to various embodiments; 
         FIG. 5  is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone; 
         FIG. 6  is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone and calcaneus bone; 
         FIG. 7A  is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone; 
         FIG. 7B  is a bottom plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone; 
         FIG. 8  is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a cuneiform, a navicular bone, and a calcaneus bone, according to various embodiments; 
         FIG. 9  is a top plan view of a ligament construct connected to a suture, according to various embodiments; and 
         FIG. 10  is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone, talus bone, and calcaneus bone, according to various embodiments. 
     
    
    
     Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings. 
     DETAILED DESCRIPTION 
     Example embodiments will now be described more fully with reference to the accompanying drawings. 
     With reference to  FIGS. 1A and 1B , a ligament augment or replacement construct  20  is illustrated. The ligament construct  20  may be formed of selected materials, such as a woven or braided polyester or polyethylene material. Additionally, various absorbable materials may be included or used to form the construct  20 , such as polylactic acid or other selected materials. The construct  20  may be formed of a woven material and/or formed of a solid material of a selected type. The construct  20 , according to various embodiments, may be resilient with little to no elasticity. Thus, the length of the construct  20  may be selected and maintained during implantation. Also, the construct  20 , therefore, may be tensioned and maintain a tension after implantation. 
     The construct  20  may include a selected length  22  that extends between a first end  24  and a second end  26 . The two ends  24 ,  26  may be formed by folding terminal end regions  28  and  30  over and towards a center of the construct  20 . The terminal ends  28 ,  30  may be folded onto a body portion  36  of the construct  20 . The terminal ends  28 ,  30  may be stitched, sonically welded, or otherwise fixed with a mechanism  32 ,  34  to the main body portion  36  of the construct. The folding over of the terminal ends  28 ,  30  may form passages, also referred to as eyelets, a loop, or open regions  40  and  42  near the ends  24 ,  26  of the construct  20 . The passages, as discussed herein, may be engaged or coupled to sutures and/or anchor members. 
     The main body portion, or selected portions of the construct  20 , may have a thickness  44  based upon various characteristics of the construct  20 , such as strength, rigidity, elasticity, and the like. Moreover, it is understood that if the construct  20  is formed of a braided, woven, or other appropriate material that the thickness  44  may decrease under a load between the two eyelet portions  40 ,  42 . The thickness  44 , however, may be defined by one or more strands of a woven material 
     According to various embodiments, the eyelets  40 ,  42  may be formed around suture and one or more suture constructs including a first suture construct  50  and a second suture construct  52 ; and; or the suture constructs  50 ,  52  may be formed within the eyelets  40 ,  42  and around the construct  20 . The suture constructs  50  and  52  may be separate, but substantially identical and interconnected with the separate eyelets  40 ,  42  for fixation of the construct  20  relative to a selected anatomy, as discussed further herein. The suture constructs  50 ,  52  may be similar to the suture constructs disclosed in U.S. Pat. No. 8,118,836, issued Feb. 21, 2012; U.S. Pat. App. Pub. No. 2011/0098727, published on Apr. 28, 2011; or U.S. Pat. App. Pub. No. 2012/0095470, published on Apr. 19, 2012; all incorporated herein by reference. 
     Generally, the suture constructs may include respective anchors that may be formed as tubes  54 ,  56  through which a suture or selected filament  58 ,  60  passes. The suture  58 ,  60 , when acted upon by a user, may cause the tubes  54 ,  56  to form an anchoring mass as knots or soft anchors to hold the construct  20  in a selected position. The anchoring mass can be formed on an exterior surface of a bone or formed within a bone surface, as discussed further herein. The suture anchors may include the Ziploop™ constructs to allow for slip tensioning of a portion positioned relative to the Ziploop suture construct and a Juggerknot™ anchor portion that may be formed by the respective tubes  54 ,  56 . Each of the Ziploop™ suture construct and the Juggerknot™ soft anchor portion are sold by Biomet, Inc. 
     The sutures  58 ,  60  may further pass through a body or passage portion  70 ,  72  where two suture ends of each suture construct  50 ,  52  extend from the respective passage portions  70 ,  72 . Each of the sutures  50 ,  52  has the respective passage portion  70 ,  72  and each defines a respective through-passage through the passage portions  70 ,  72 . Each suture construct  50 ,  52  further has two ends  76 ,  78  and  80 ,  82 . For each suture construct the first end  76 ,  80  is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and the second end  78 ,  82  is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture. It is understood, according to various embodiments, the first and third aperture may be the same aperture as may the second and fourth aperture. Thus, each passage portion may include 2, 3, or 4, or a selected number of apertures into the through-passage of the passage portion. Each of the two suture ends  76 ,  78  and  80 ,  82  may be acted upon by a user to collapse the respective anchors  50 ,  56  to form the soft anchoring masses and tension the construct  20  between two points of the anchors  54  and  56 , as discussed further herein. 
     The anchor assemblies  50 ,  52  including the anchors  54 ,  56 , also referred to as tubes, which may generally include a collapsible tube that is a closed loop of suture material that is formed into the tube shape. According to various embodiments, the tube assembly  54 ,  56  may be slideable relative to the suture loops or filaments  58 ,  60 . Briefly, although disclosed in the U.S. Pat. No. 8,118,836, incorporated herein by reference, the suture assemblies  50 ,  52  may include the suture portions  58 ,  60  that pass through openings  55 ,  57  of the respective tubes  54 ,  56 . Alternatively, the suture portions may pass out an aperture that is not at the openings  55 ,  57  such that one or both ends of the tubes  54 ,  56  form flaccid or unbound ends. 
     Generally, the suture portions  58 ,  60  may be single or continuous suture filaments that extend through the respective tubes,  50 ,  56  in the respective braided bodies  70 ,  72  of the suture assemblies  50 ,  52 . The suture assemblies  50 ,  52 , therefore, may be manipulated by a user to generate a soft anchor, as discussed herein, by collapsing the respective tubes  50 ,  56 , and tensioning the construct  20  relative to selected areas of a subject by moving the ends  76 - 82  to tension the construct  20  relative to the respective anchors formed by the tubes  54 ,  56 . The anchors  54 ,  56  collapse under a force, such as a tensile force, provided by or through the respective suture portions  58 ,  60  to form soft or anchor masses in respective areas, as discussed further herein. The tubes  54 ,  56  may form the anchors by collapsing the tubes  54 ,  56  relative to a positive or adjacent surface of the tube  54 ,  56 . 
     With reference to  FIGS. 2A and 2B , a construct  100  is illustrated. The construct  100  may be similar to the construct  20  in general construction. For example, the construct  100  may be formed of a woven selected material, such as polyester or polyethylene. Additionally, the construct  100  may be formed from a selected material including bio-absorbable materials that may be absorbed into a selected anatomy over time and allow for ingrowth of various tissues to replace portions of the construct  100 . 
     The construct  100 , however, may also be formed in a substantially elongated and rectangular construct including a length  102  from a first end  100   a  to a second end  100   b  of about 4 centimeters (cm) to about 10 cm, and further including 4 cm to about 8 cm. Additionally, the construct  100  may include a width  104  that is about 0.5 cm to about 4 cm, including about 1-3 cm, and further including about 1 cm to about 2 cm. The construct  100 , as illustrated in  FIG. 2B , may further include a thickness  106  that is about 0.5 millimeters (mm) to about 4 mm, and further including about 1 mm to about 3 mm. 
     The construct  100  may include one or more bores  110  formed from a first side to a second side through the thickness  106  of the construct  100 . The bores  110  may be formed in a selected configuration, such as near a perimeter of the construct  100 . The bores  110  are generally formed at or near both of the ends  100   a ,  100   b  of the construct  100 . Thus, the ends  100   a ,  100   b  of the construct  100  can be engaged and tensioned relative to selected anchoring regions, as discussed herein. The bores  110  may allow for passage of selected anchor assemblies, such as an anchor assembly  120 , as discussed further herein. Any appropriate anchoring assembly, such as the construct  50 , however, may also be used. 
     The anchor assembly  120  may pass through one or more of the throughbores  110  to allow for fixation of the construct  100  relative to a selected subject. The bores  110  may be throughbores formed through the construct  100  through various techniques such as puncturing, drilling, ultrasonic welding or puncturing, or other appropriate mechanisms. Also, the through bores  110  may be formed between braided or woven fibers of the construct  100 . Regardless, the bores  110  may be throughbores formed through the entire thickness  106  of a construct  100  to allow for passage of anchor assemblies  120 . 
     The anchor assembly  120  may be an anchor assembly including an anchor assembly as disclosed in U.S. Pat. No. 8,118,836, incorporated herein by reference. The anchor assembly  120  may include various portions similar to the anchor assemblies  50 ,  52  described above. Generally, the anchor assembly  120  may include a first collapsible anchor  122  (also referred to as a tube) and a second collapsible anchor  124  (also referred to as a tube) which are disposed about or around respective suture loops  126  and  128  that are a part of a single elongated suture of the anchor assembly  120 . As tension is applied on the respective suture loops  126 ,  128 , the anchors  122 ,  124  collapse and may form anchoring masses relative to selected portions of a subject, similar to the anchors  54 ,  56  discussed above. It is understood that the respective suture anchors  122 ,  124  may be collapsed simultaneously and/or at staggered times, as selected and/or desired by a user. 
     The suture loops  126 ,  128  are portions of a suture  130  that further include suture ends  132  and  134 . The suture ends may be gasped or manipulated by a user to collapse the tubes  122 ,  124  to form the soft anchors. Additionally, the suture  130  may be passed through a passage portion  140  having a through-passage as discussed above and as disclosed in U.S. Pat. No. 8,118,836, incorporated herein by reference. The suture ends  132 ,  134  may be manipulated to move the passage portion  140  relative to the tubes  122 ,  124 . As discussed above, the movement of the passage portion  140  relative to the tubes  122 ,  124  may tension the construct  100  relative to the tubes  122 ,  124  when the tubes are collapsed against a respective positive surface, such as a bone surface. Accordingly, the construct  100  may be tensioned relative to a bone surface as discussed further herein by pulling on the ends  132 ,  134  of the suture loop  130 . 
     With reference to  FIG. 3 , a construct  170 , according to various embodiments, is illustrated. The construct  170  may include various dimensions, such as a length  172  that may be about 3 cm to about 10 cm, including about 4 cm to about 8 cm. The construct  170  may further include a height  174  that includes a selected height of about 1 cm to about 4 cm, including about 2-3 cm. The height  174  may include a height or a length of arm portions  176  and  178  that extend from a main body portion  180  of the construct  170 . The main body portion  180 , however, may include an end  182  that may include a height  184  having a dimension of about 0.5 cm to about 2 cm, and further including a height of about 1 cm. 
     The construct  170  may be similar in construction to the constructs  20  and  100 , as discussed above. Accordingly, the construct  170  can include any selected portion to interconnect with a suture and/or anchor assembly. For example, an eyelet can be formed near the terminal ends of the construct and/or throughbores may be formed through the construct  170 . For example, a suture construct  52   a  that includes an anchor  56   a  can be coupled to an eyelet formed by folding over a terminal end and fixing it with a fixing structure  183  near the first end  182 . The suture construct can be similar or identical to the suture construct  52 . It is understood that each arm  176 ,  178  can include a fold formed eyelet and one or more throughbores and individual coupled suture constructs, according to various embodiments. 
     The construct  170 , however, may include the single end  182  and the two arms  176  and  178  extending from an area at the second end of the construct  170 . As discussed herein, the first end  182  may engage a first bone member or portion while the two arms  176  and  178  may engage separate bone members or constructs as discussed herein. Thus, at each arm  176 ,  178  and the first end  182  a suture construct including an anchor portion can be connected. Fixation of the construct  172  to selected bone portions may include various suture anchors and assemblies  50 ,  52  and  120  as discussed above. Accordingly, the construct  170  may be fixed relative to a selected portion of a subject similar to the fixation or anchoring mechanisms as discussed above. 
     With reference to  FIGS. 1A-1B , discussed above, and additional reference to  FIG. 4 , the construct  20 , or construct according to various embodiments as discussed above, may be engaged or associated with an anchor assembly  190 . The anchor assembly  190  may include a fixation member  192 , such as a Toggleloc™ anchor, sold by Biomet, Inc., that is rigid. The rigid fixation member  192  may include that illustrated and disclosed in U.S. Patent Application Publication No. 2012/0116452 and U.S. Pat. No. 7,695,503, both incorporated herein by reference. In addition, the anchor  192  may be interconnected or associated with a suture assembly  202 , similar to the suture assemblies  50 ,  52  discussed above. The suture assembly  202  may include a passage portion  204  to which a continuous suture  206  is passed. The continuous suture  206  may include a continuous loop of suture that passes through the passage portion  204 . The passage portion  204  may be formed through the anchor  192 , as illustrated in  FIG. 4 . 
     The construct  20  may also be formed around the filament or loop portions of the suture portion  208  to engage the construct  20  relative to the anchor  192 . The construct  20  may have the eyelet  42  formed by suturing or interconnecting an end  30  of the construct  20  with a suture portion  34 . The construct  20 , therefore, may be held relative to the anchor  192  with the suture assembly  202 . Generally, the anchor  192  may include an elongated arm portion  220  and an eyelet or interconnection portion  222  to engage the suture assembly  202 . 
     Accordingly, it is understood that the construct, according to various embodiments including the construct  20 , the construct  100 , and the construct  170 , may be interconnected with a selected anchor or connecting portion. The connecting portion may include soft anchors, such as those illustrated with the suture assembly  50  or the suture anchor assembly  120 . Additionally, a hard or rigid fixation member may include the fixation member  192  illustrated in  FIG. 4 . 
     The ligament construct, according to various embodiments as discussed above, may be provided relative to a selected portion of a subject, such as a foot  300  of a subject, illustrated in  FIG. 5 . The foot  300  of the subject may include various anatomical bone portions, such as those generally known in the art. For example, the foot  300  may include phalange members  302 , metatarsal members  304 , a medial (first tarsal) cuneiform  306 , a navicular  308 , a talus  310 , and a calcaneus  312 . The foot  300  may be connected or articulated with other boney portions, such as a tibia and a fibula, as is generally understood in the art. 
     With additional reference to  FIG. 5 , the various boney portions of the foot  300  may be interconnected with a construct, including the various embodiments of a construct as discussed above. For exemplary purposes, the construct  20  is illustrated and discussed. It is understood, however, that the construct  100  may be used relative to the foot  300  including the suture assembly  50 ,  52  and/or the anchor suture assembly  120 , as discussed above. Nevertheless, for illustration of a selected procedure to replace a spring ligament or augment a spring ligament in a foot  300 , the construct  20  is discussed further herein. 
     As illustrated in  FIG. 5 , the navicular  308  may be configured to include a throughbore  320  through which the anchor  54  may be passed and collapsed upon an exterior bone surface of the navicular  308  to form the anchoring mass or portion  54 ′, such as a soft anchor, relative to the navicular bone  308 . The anchor portion  54 ′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tube  54  may allow the anchoring mass to be formed by the application of a tensile force with the suture  58 . The bore  320  may be formed to allow for passage and receipt of at least a portion of the construct  20  into a portion of the bore  320 . The drawing or tensioning of the construct  20  into the bore  320  may be performed with the suture assembly  52  by drawing or tensioning the suture ends  76 ,  78  and drawing the construct  20  into the bore  320 . The formation of the bore  320  and tensioning of the construct  20  into the bore  320  will be discussed further in relation to the calcaneus  312  in a bore  340  formed therein, discussed further herein. 
     With a continuing reference to  FIG. 5 , the calcaneus  312  may have a bore  340  formed therein including a plurality of diameters. For example, a first or small drill/pin  342  may be passed through or drilled through the calcaneus  312  to form a small bore or first bore passage  344 . A second or larger drill bit  349  (the larger drill bit  349  may be cannulated) may be passed over the small bit  342  to form a second or larger bore  352 . Accordingly, the bore  340  formed through the calcaneus  312  may include a first diameter bore  344  and a second diameter bore  352 . The bore  320  formed in the navicular  308  may include a similar large diameter bore portion and a small diameter bore portion. The large diameter bore portion may receive a portion of the construct  20  while the small diameter bore portion may allow for passage of the suture construct  50 ,  52  to allow for movement of the respective tubes  54 ,  56  to a second portion of the respective bone to form the soft anchor relative thereto. Moreover, a shoulder or ledge  320   a ,  340   a  is formed within the respective bores  320 ,  340  due to the different diameters. 
     With reference to  FIG. 6 , the anchor assembly, including the suture anchor assembly  52  that is connected to an end of the construct  20 , may be passed through the bore  340  formed to the calcaneus  312 , or selected bone portion. The suture assembly  52  and/or only the anchor  56  alone may be passed through the bore  340 . An appropriate passing member may interconnect with the anchor  56  and/or the suture ends  80 ,  82  to push or pull the suture assembly through the bore  340  formed to the calcaneus  312 . The construct  20  interconnected with the suture anchor assembly  52 , however, may be moved relative to the calcaneus  312  to allow for passage of the suture anchor assembly  52  through the bore  340  formed through the calcaneus  312 . 
     As illustrated in  FIG. 6 , the construct  20  may be pulled into the bore  320  formed in the navicular  308  and the anchoring portion  54 ′ may be formed relative to the navicular  308  by tensioning the anchor  54  relative to the navicular  308 , as is generally understood in the art. The suture assembly  52  may then be moved through the bore  340  formed through the calcaneus  312 , as illustrated in  FIG. 6 . It is understood, however, that the suture assembly  52  may be first passed through the calcaneus  312  prior to passage of the suture assembly  50  through the navicular  308 . The order of placing the anchors relative to individual bone portions is exemplary, and not intended to be limiting. After forming the bore  340  through the calcaneus  312 , the suture assembly  52  may be passed through the calcaneus  312 . According to various embodiments, the anchors, including the soft anchors, can be formed on the surface of the bone portions at all selected anchoring points. Then each end of the construct can be alternatingly tightened to substantially ensure uniform tensioning of the construct  20 . 
     The passage of the suture assembly  52  through the calcaneus  312  may generally be in the direction of arrow  313 . The passage of the suture assembly  52  may be according to appropriate mechanisms, such as pulling the suture assembly  52  through the bore  340  or pushing the suture assembly  52  through the bore  340 . Generally, however, the anchor  56  may be passed through a distal cortical bone portion  391   a , as illustrated in  FIG. 7A , and a second cortical bone portion  391   b , is also illustrated in  FIG. 7A . The bore  340  may further be formed through both of the cortical bone portions  391   a  and  391   b  and further through the cancellous bone portion  389 , therebetween. 
     Accordingly, a soft anchor may be formed by the anchor  56  on an exterior distal surface of the cortical bone portion of the calcaneus  312 . The anchor  56  may be formed by drawing the construct  20  into the large bore portion  352 , by manipulating the ends of the suture filaments  80 ,  82 , to form the soft anchor  56 ′. The construct  20  may then be tensioned and drawn into the bore  340 . 
     With continuing reference  FIGS. 5 and 6 , and additional reference to  FIGS. 7A and 7B , the construct  20  may be tensioned into the bore  320  formed within the navicular  308  and the bore  340  formed in the calcaneus  312 . The bore  320  in the navicular  308  may include a large bore portion  320   a  and a small bore portion  320   b  similar to the large bore  352  and the small bore portion  344  formed through the calcaneus  312 . The large bore portion, of both the navicular  308  and the calcaneus  312 , may include a diameter  352   a  such as about 4 mm to about 6 mm. The small bore portion of both the calcaneus  312  and the navicular  308  may include a diameter  344   a  of about 2 mm to about 4 mm. It is understood, however, that the bore formed through the respective bone portions may be any appropriate diameter to receive the constructs positioned within the respective bore portions and interact with the anchor members positioned relative to the bone portions. 
     The anchor portion  54 ′ formed by the tube  54  and anchor portion  56 ′ formed by the tube  56  may be formed on an exterior surface of the bone portions  308 ,  312  such as on an exterior surface of the cortical bone thereof. The anchor portions  54 ′,  56 ′ can fix or anchor the construct  20  relative to the bone portions. The anchor portions  54 ′,  56 ′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tubes  54 ,  56  may allow the anchoring mass to be formed by the application of a tensile force with the suture  58 ,  60 . The construct  20  may then be tensioned relative to the anchor portions  54 ′,  56 ′ to form a selectively tensioned construct  20  relative to the two bones of the navicular  308  and the calcaneus  312  to augment or replace the spring ligament. 
     The soft anchors  54 ′,  56 ′ however, may be formed within the respective bone portions  308  and  312  relative to a cancellous bone portions  389  and  367  to engage the proximal cortical bone portions  391   b  and  369  of the respective bone members  308  and  312 . Accordingly, the soft anchor portions  54 ′,  56 ′ need not be formed on the exterior surface of the respective bone member  308  and  312  to anchor the construct  20  relative to the respective bone portions  308  and  312 . Rather, the bone anchors or construct anchors may be formed within the bone surfaces to provide for fixation of the construct  20  relative to the respective bone members  308  and  312 . Formation of an anchor assembly within the bone member may be formed as discussed above and with an anchor assembly as disclosed in U.S. Patent Application 2011/0098727, published Apr. 28, 2011, incorporated herein by reference. The formation of the soft anchor  54 ′,  56 ′ may be substantially similar, save that the soft anchor is formed within the tunnel  340  and  320  of the respective bone members. 
     The construct  20  may be positioned relative to respective bone portions, such as the calcaneus  312  and navicular  308 , as discussed above and illustrated in various figures, including  FIGS. 6-7B . The construct  100  may be similarly positioned between two selected bone portions, such as the calcaneus  312  and navicular  308 . According to various embodiments, the construct  170  may be interconnected with two or more bones portions of the foot  300 , as illustrated in  FIG. 8 . The construct  170 , including the main body portion  180 , the arm member  178 , and the arm member  176  may be connected or positioned relative to the navicular  308  and the first cuneiform  306 . Additionally, the end of  182  of the main body  180  may be positioned relative to the calcaneus  312  of the foot  300 . 
     The fixation of the construct  170  relative to the respective bone portions may be with the suture anchor construct, such as the suture anchor construct  52 . Accordingly, each of the ends of the construct  170  may be coupled to bone portions with a suture anchor such as the suture anchor at  56   a  relative to the first cuneiform, a suture anchor  56   b  relative to the navicular  308 , and a suture anchor  56   c  relative to the calcaneus  312 . It is understood, however, that the various anchor of fixation members may be positioned relative to the respective boney members, including the first cuneiform  306 , navicular  308 , and the calcaneus  312 , to fix the construct  170  relative thereto. For example, the suture anchor assembly  120  may be interconnected with the construct  170  to anchor relative to the selected bone portions in addition to the anchor fixation member  190 , as illustrated in  FIG. 4 . 
     Accordingly, a ligament construct may be provided to augment and/or replace the spring ligament. The ligament construct, therefore, can interconnect various portions of the foot  300 , including the calcaneus  312  and the navicular  308 . In various embodiments, the first cuneiform  306  may also be interconnected relative to the navicular  308  and the calcaneus  312 . The interconnection of the respective honey portions of the foot  300  may be provided to augment or replace the spring ligament of the foot  300 . The spring ligament to the foot  300  may be further augmented by interconnecting the respective construct, such as the construct  20  or the construct  170 , with the spring ligament. The interconnection of the construct relative to the spring ligament may be provided by further suturing the construct to the spring ligament. For example, the construct may be sutured directly to the spring ligament by generally known suture techniques such as threading or knotting the appropriate construct to a portion of the spring ligament that is remaining in the foot  300 . For example, the spring ligament may be interconnected by the navicular bone  308  portion and the augment may be sutured to the spring ligament that remains connected at the bone portion. Accordingly, it is understood that the construct, as discussed above, may be provided to replace or augment the spring ligament in the foot  300 . Moreover, the construct may be interconnected with a respective bone portion of the foot  300 , according to various embodiments, including those discussed above. The construct, such as the construct  20 , the construct  100 , or the construct  170  may be formed through various weaving and molding techniques to provide an appropriate construct to replace or augment the spring ligament in the foot  300 . 
     With reference to  FIGS. 9 and 10 , a deltoid ligament in the foot  300  can interconnect a tibia  321  relative to the foot  300 . The deltoid ligament can interconnect the tibia  320  relative to the calcaneus  312 , the navicular  308 , and a talus  322 . The tibia  321 , the talus  322 , the navicular  308  and the calcaneus  312  can be interconnected with a construct  350 , as illustrated in  FIG. 9 . The ligament construct  350  can include construct bodies  350   a  and  350   b  that are formed similar to the ligament construct  20 , as discussed above. Accordingly, the construct bodies  350   a  and  350   b  can be formed as substantially elongated members extending between first and second respective ends and can be formed of a woven polymer material and/or a solid material. 
     According to various embodiments, the first construct body  350   a  can extend from a first end  360  that has a first eyelet formed by folding over and fixing (e.g. via suturing or sonically welding) with a fixing member or system  362  a terminal end of the main body to an internal position of the body  350   a . Positioned through the eyelet at the first end  360  can be a first suture construct  364 . The first suture construct  364  can be similar to the suture construct  50  discussed above, and will not be described here in detail. Nevertheless, the suture construct  364  can include a collapsible tube  366  that is formed around a suture  368  that passes through a passage portion  370  with first and second suture ends  372  and  374  extending therefrom. As discussed above, the suture construct  364  can be positioned relative to a bone portion, as discussed further herein, to allow the collapsible tube  366  to form an anchoring mass by drawing or pulling on the suture end  372  and  374 . 
     The first construct body  350   a  may extend from the first end  360  to a second end  380  that also has an eyelet that may be formed by fixing a terminal end at the second end  380  with a fixation portion  382 . A second suture construct  390  can also be passed through the eyelet that includes a collapsible tube  394  formed around a suture  396 . The suture  396  can have a passage portion  398  through which the suture passes and a first end  400  and a second end  402  extends therefrom. Again, the suture construct  390  can be used to tension and anchor the first body  350   a  relative to selected boney portions, as discussed further herein. 
     Additionally, passed or formed through the eyelet at the second end  380  can be the second construct body  350   b . The second construct body  350   b  can extend from a first end  420  that forms an eyelet by having a terminal end portion fixed a distance from the terminal end with a fixation mechanism  422 . Passed through the eyelet formed at the first end  420  can be a third suture construct  430 , similar to the suture constructs  364  and  390 . Accordingly, the suture construct  430  can include a collapsible tube  432  that is formed around a suture  434  that passes through a passage body or portion  436  with a first terminal end  438  and a second terminal end  440  extending therefrom. Again, the suture construct  430  can be used to fix or anchor the second body portion  350   b  by forming the collapsible tube  432  into an anchor mass by pulling on the terminal suture ends  438  and  440 . 
     The second construct body  350   b  may extend from the first end  420  to a second end  450  that may also include a second eyelet formed by fixing a terminal end a distance from the terminal end with a fixation portion  452 . A fourth suture construct  460  can also be passed through the eyelet formed at the second end  450 . The fourth suture construct  460  can include a collapsible tube  462  that is formed over a suture  464 . The suture  464  can include a passage portion  466  from which extends a first terminal suture end  468  and a second terminal suture end  470 . Therefore, the fourth suture construct  460  can also be used to form an anchoring mass by drawing the terminal suture ends  468  and  470  as discussed above. 
     The augment or replacement construct  350  can be used to interconnect at least a tibia  321 , talus  322 , navicular  308 , and calcaneus  312  by positioning the respective suture constructs,  390 ,  430 ,  460 , and  364  in bone tunnels formed in the respective bone portions. Without repeating the procedure discussed above for forming the bone tunnels, bone tunnels can be formed in and/or through each of the bone portions similar to a manner as discussed above. Accordingly, a first tunnel  500  can be formed in the tibia  321  and the collapsible tube  394  can be formed into the anchoring mass  394 ′ on an exterior surface of the tibia  321 . A portion of the construct  350  can then be tensioned or drawn into the tunnel  500 , as discussed above. A second tunnel  520  can be formed through the talus  322  and the collapsible tube  432  can be formed into the anchoring mass  432 ′ on an exterior surface of the talus  322 . A portion of the construct  350  can be tensioned into the tunnel  520 , as discussed above. A third tunnel  530  can be formed in the calcaneus  312  and an anchor mass  366 ′ can be formed from the collapsible tube  366  and the construct can be tensioned into or onto the calcaneus  312 , as discussed above. 
     A fourth tunnel  540  can be formed into the interior talus or, alternatively, into the navicular  308  (shown in phantom at  540 ′). It is understood, however, that if the alternative tunnel  540 ′ is formed in the navicular  308  the tunnel  540  may also be formed in an anterior portion of the talus  322  to allow connection of the navicular  308  and the talus  322 . The suture construct can be similar to the anchor  120 , illustrated in  FIG. 2B , to allow for interconnection with a tunnel formed in the anterior portion of the talus  322 . Accordingly, it is understood that the construct  350  can be provided to interconnect a plurality of bone portions of the foot  300  including interconnection with a leg bone portion, such as the tibia  321 . Moreover, it is understood that the suture constructs can be provided in various configurations to allow for fixing of the ligament or tendon construct  350  to the respective bone portions. 
     It is understood that the various embodiments of the ligament constructs including the eyelets discussed above can be formed in substantially similar manner and interchanged for various purposes. Moreover, a selected eyelet can be formed in an appropriate manner for selected procedures, as is understood by one skilled in the art. Moreover, forming the eyelets in various manners can be used for productions, efficiencies and/or costs and specific procedures. 
     The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and may be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure. The terminology used herein is for the purpose of describing particular example embodiments only and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise.