Patent Publication Number: US-2019167250-A1

Title: Suture anchor

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 14/822,761, filed Aug. 10, 2015 entitled “Suture Anchor”, which is a continuation of U.S. patent application Ser. No. 13/674,825 filed Nov. 12, 2012, entitled “Suture Anchor” which issued on Sep. 15, 2015 as U.S. Pat. No. 9,131,937, which claims the benefit of U.S. Provisional Application No. 61/560,694, filed Nov. 16, 2011, entitled “Transosseous Attachment Device” and U.S. Provisional Application No. 61/597,138, filed Feb. 9, 2012, entitled “Osseous Attachment Device”, all of which are hereby incorporated by reference in their entirety. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to suture anchors and their method of use. 
     BACKGROUND 
     A variety of surgical procedures require the attachment of something relative to a surgical site. For example, in surgery relating to the skeletal system, it is often advantageous to attach soft tissue, suture, implants, and/or other items in or adjacent to a joint. For example, ligaments, tendons, fascia, other capsular material, and/or muscle may be attached to an adjacent bone to affect a repair of a joint. Such joints may include any joint in a patient&#39;s body such as the joints of the hands and feet, ankle, wrist, knee, elbow, hip, shoulder, and spine. For example, it is often advantageous to pass a suture through a portion of a bone to form a transosseous attachment to the bone. 
     SUMMARY 
     Aspects of the invention provide devices and methods to attach one or more sutures to a bone. 
     In one aspect of the invention, a suture anchor includes a suture retaining feature or features able to retain first and second portions of a suture passed transosseously through a bone. For example, a suture passing through a bone may have first and second free portions and a single suture anchor according to the present invention may include a suture retaining feature able to secure both free portions of the suture to the bone. In another example, a single suture anchor may include multiple suture retaining features able to secure both free portions of the suture to a bone. 
     In another aspect of the invention, a suture anchor includes a first body able to receive a portion of a suture in relative sliding relationship and a second body receivable by the first body to lock the portion relative to the first body. The second body may lock the portion of suture by trapping the portion between the first and second bodies. The portion of suture may include a single end, a pair of ends, a bight, or other portion of the suture. 
     In another aspect of the invention, a suture anchor includes a first body able to receive first and second portions of a suture in relative sliding relationship. A second body is receivable by the first body to lock the first and second portions relative to the first body. The second body may lock the first and second portions one at a time or simultaneously. The second body may lock the first and second portions at a single position on the first body or at separate discrete positions on the first body. For example, first and second portions of a suture may be placed through an opening in the first body and simultaneously locked by trapping the portions between the first and second body. In another example, first and second portions of a suture may be placed through separate openings in the first body and simultaneously locked. In another example, first and second portions of a suture may be placed through separate openings in the first body and sequentially locked. 
     In another aspect of the invention, a suture anchor includes a first body having a suture retainer and a suture includes at least one loop engageable with the suture retainer. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various examples of the present invention will be discussed with reference to the appended drawings. These drawings depict only illustrative examples of the invention and are not to be considered limiting of its scope. 
         FIG. 1  is a partial side sectional view of an illustrative implant and method according to the present invention; 
         FIGS. 2 and 3  are partial side sectional views of an illustrative implant and method according to the present invention; 
         FIGS. 4 and 5  are partial side sectional views of an illustrative implant and method according to the present invention; 
         FIG. 6  is a partial side sectional view of an illustrative implant and method according to the present invention; 
         FIG. 7  is a partial side sectional view of an illustrative implant and method according to the present invention; 
         FIG. 8  is a partial side sectional view of the implant of  FIG. 7  in use in an alternative method; 
         FIG. 9  is a partial side sectional view of an illustrative implant and method according to the present invention; 
         FIG. 10  is a perspective view of an illustrative implant according to the present invention; 
         FIG. 11  is a perspective view of the implant of  FIG. 10 ; 
         FIG. 12  is a side elevation view of the implant of  FIG. 10 ; 
         FIGS. 13-15  are sectional views taken along line  13 - 13  of  FIG. 12  showing an aspect of the operation of the implant of  FIG. 10 ; 
         FIGS. 16-20  are partial side sectional views showing a method of using the implant of  FIG. 10 ; 
         FIG. 21  is a partial side sectional view of the implant of  FIG. 10  in use in an alternative method. 
     
    
    
     DESCRIPTION OF THE ILLUSTRATIVE EXAMPLES 
     Minimally invasive surgery is surgery used to gain access to deeper parts of the human body through small incisions. Such surgery may range from mini-open surgery to arthroscopic surgery. Mini-open surgery is generally understood to mean surgery performed through small incision(s) under direct vision as opposed to arthroscopic (or endoscopic) surgery where surgery is performed through one or more stab incisions in which the arthroscope (or endoscope) is used for visualization. In arthroscopic surgeries, the size of the stab incisions generally range from 1 mm to 10 mm. The illustrative examples depict arthroscopic surgical techniques but it is to be understood that the techniques could be performed in any minimally invasive or open technique. The following illustrative examples depict implants and techniques to pass a suture through a portion of the head of the humeral bone at the shoulder of a human patient and fix the suture there to repair damaged soft tissue associated with the shoulder joint. Instruments and techniques according to the present invention may be used to anchor a suture to any bone, at surgical sites anywhere in a patient&#39;s body, and for any purpose. The terms “suture” and “suture strand” are used herein to mean any strand or flexible member, natural or synthetic, able to be passed through a bone tunnel and useful in a surgical procedure. The term “transverse” is used herein to mean to cross at an angle; i.e. not parallel. The term includes, but is not limited to right angles. The term “bight” is used herein to mean a bend or loop formed in the intermediate portion of a suture. 
     A human left shoulder joint is used to provide context for illustrative examples of a surgical technique. The subacromial space, between the humeral head and the undersurface of the acromion, is a potential space for surgical repair. This space is partially occupied by the subacromial bursa. Soft tissue layers overlie the shoulder joint. These layers define a soft tissue zone including the skin, subcutaneous tissue, muscles and bursal tissue. Instruments are inserted through the soft tissue zone via stab incisions and access canulae can be inserted through these stab incisions to facilitate the insertion and withdrawal of surgical instruments. The thickness of this soft tissue zone varies by patient and by location from a few millimeters to several centimeters. 
     Referring to  FIG. 1  an osseous attachment device includes an implant  100  having an elongated shaft  102  extending from a proximal end  104  to a distal end  106  along an axis  108 . The shaft  102  engages an elongated flexible strand to hold it relative to a bone. For example,  FIG. 1  depicts a bone  120  and soft tissue  122  to be attached to the bone  120  adjacent a skeletal joint; e.g. a proximal humerus and a portion of a rotator cuff. An elongate flexible strand  124  such as a suture having first and second ends  126 ,  128  is passed through the soft tissue  122  and into the bone  120  at a desired attachment site. The implant  100  is inserted into the bone  120  to capture and retain the ends  126 ,  128  to hold the soft tissue  122  adjacent the bone  120 . 
     For example, in a shoulder repair procedure, an elongate strand  124  in the form of at least one closed suture loop may be passed through the soft tissue  122  of the rotator cuff and the first end  126  of the loop placed in the bone  120  such as by placing it into a preformed tunnel or impacting it into the bone on a driver to simultaneously form a tunnel and insert the first end  126 . In the illustrative embodiment of  FIG. 1 , the first end  126  is positioned in first tunnel  129 . A hook  110  is formed adjacent the proximal end  104  of the implant  100  with a hook opening facing distally. The hook  110  is engaged with the second end  128  and inserted into the bone along a path intersecting the first end  126 . The implant  100  and second end  128  may for example be impacted directly into the bone to simultaneously form a second tunnel  130  and insert the implant, or alternatively, they may be inserted into a preformed tunnel. In the illustrative embodiment of  FIG. 1 , one or more, optional barbs  112  project from the shaft  102  outwardly and distally. When the implant  100  intersects the first end  126 , one or more of the barbs  112  engage the first end  126  such that when insertion of the implant  100  is complete, the implant  100  engages and secures both ends of the elongate strand  124  to retain the elongate strand in the bone  120  and secure the soft tissue  122  with the first end being secured distally and the second end being secured proximally. Alternatively, the barbs  112  may be omitted and the shaft  102  alone pass through the suture loop to constrain it within the bone. With the use of a preformed loop, the soft tissue attachment is accomplished without the need for the user to tie any knots. 
     Referring to  FIGS. 2 and 3 , an osseous attachment device includes a locking implant  200  and an elongated member  220 . In the illustrative embodiment of  FIGS. 2 and 3 , the implant  200  is in the form of an interference screw. The implant  200  includes an elongated tapered body  202  extending from a wider, proximal end  204  to a narrower, distal end  206  along an axis  208 . A spiral thread  210  is formed on the exterior of the body  202  and the body includes an axial through passage  212 . In the illustrative embodiment of  FIG. 2 , the separate elongated member  220  is in the form of a suture carrier that includes an elongated shaft  222  extending from a proximal end  224  to a distal end  226 . The distal end  226  may be tapered or otherwise sharpened to ease insertion into bone. A transverse opening  230  is formed through the shaft near the distal end  226 . An optional groove or reduced diameter region may be provided proximal of the opening  230  to ease in cutting or breaking the elongated member  220  to a desired length. The passage  212  of the implant and shaft  222  of the elongated member are sized for axial translating engagement. The elongated member  220  is used to capture the ends of an elongated flexible strand and the implant  200  is used to lock the elongated flexible strand to hold the elongated flexible strand adjacent to a bone. 
     For example, in a shoulder repair procedure, an elongate strand  240  in the form of at least one suture defining a first end  242  in the form of a loop, or bight, and having second ends  244 , may be passed through the soft tissue  246  of the rotator cuff. The first end  242  is inserted into the bone  248  such as by placing it into a preformed tunnel  243  or impacting the elongate strand  240  into the bone on a driver to simultaneously form a first tunnel and insert the first end  242 . The second ends  244  are passed through the transverse opening  230  of the elongated member  220  and the elongated member  220  and second ends  244  are inserted into the bone along a path that intersects the first end  242 . The elongated member  220  and second ends  244  may for example be impacted directly into the bone to simultaneously form a second tunnel and insert elongated member  220  and second ends  244 , or alternatively, they may be inserted into a preformed second tunnel  245 . When the elongated member  220  intersects the first end  242 , the distal end  226  of the elongated member  220  captures the first end  242  distally and prevents it from being withdrawn upwardly through the bone such that the first end  242  is retained distally in the bone. The second ends  244  may then be pulled to feed slack through the transverse opening  230  and tension the elongated strand  240  and approximate the soft tissue to the bone. The locking implant  200  is then engaged with the proximal end of the elongated member  220  and advanced into the bone  248 . The locking implant  200  presses the elongated strand  240  against the bone in an interference engagement to lock the second ends  244  in the second tunnel  245 . The locking implant also prevents the elongated member  220  from exiting the second tunnel  245  thus the locking implant locks both ends of the elongated strand  240  relative to the bone  248  and secures the soft tissue  246 . The soft tissue attachment is accomplished without the need for the user to tie any knots. 
     Referring to  FIGS. 4 and 5 , an osseous attachment device includes a locking implant  300  and a suture carrier  320  similar to that of  FIGS. 2 and 3 . In the illustrative embodiment of  FIGS. 4 and 5 , the implant  300  is in the form of an interference screw having a cylindrical body  302  extending from a proximal end  304  to a distal end  306  along an axis  308 . A spiral thread  310  is formed on the exterior of the body  302 . In the illustrative embodiment of  FIGS. 4 and 5 , the separate suture carrier  320  is in the form of a ring having an aperture  322 . The suture carrier  320  is used to capture the ends of an elongated flexible strand and the locking implant  300  is used to lock the elongated flexible strand to hold the elongated flexible strand adjacent to a bone. While a suture carrier has been shown in the form of a ring it may have other forms such as a sphere, rod, or other suitable shape that can receive a suture in sliding relationship. 
     For example, in a shoulder repair procedure, as shown in  FIGS. 4 and 5 , an elongate strand  340  in the form of at least one suture defining a first end  342  in the form of a loop, or bight, and having second ends  344 , may be passed through the soft tissue  346  of the rotator cuff. The first end  342  is inserted into the bone  348  such as by placing it into a preformed first tunnel  343  or impacting the elongate strand  340  into the bone on a driver to simultaneously form a tunnel and insert the first end  342 . The second ends  344  are passed through the aperture  322  of the suture carrier  320  and the suture carrier  320  and second ends  344  are inserted into the bone along a path that intersects the first end  342 . The suture carrier  320  and second ends  344  are passed through the loop of the first end  342 . Applying tension to the elongated strand  340  causes the loop of the first end  342  to close around the second ends  344  and trap the suture carrier  320  in the bone such that the ends  342 ,  344  are retained in the bone. Further pulling on the second end  344  causes slack to feed through the suture carrier and tension the strand  340  to approximate the soft tissue to the bone. The locking implant  300  is then advanced into the bone  348 . The locking implant  300  presses the elongated strand  340  against the bone in an interference engagement to lock the elongated strand  340  relative to the bone  348  and secure the soft tissue  346 . The soft tissue attachment is accomplished without the need for the user to tie any knots. 
     Referring to  FIG. 6 , an osseous attachment device includes an implant  400 . In the illustrative embodiment of  FIG. 6 , the implant  400  is in the form of an interference screw. The implant  400  includes an elongated body  402  extending from a proximal end  404  to a distal end  406  along an axis  408 . A spiral thread  410  is formed on the exterior of the body  402 . A head  412  is formed near the proximal end  404  and defines a distally facing shoulder  414  at the junction of the head  412  and body  402 . The implant  400  is used to capture both ends of an elongated flexible strand  420  and hold the elongated flexible strand  420  adjacent to a bone. 
     For example, in a shoulder repair procedure, as shown in  FIG. 6 , an elongated strand  420  in the form of at least one suture having first ends  422  and a second end  424  defining a loop, may be passed through the soft tissue  426  of the rotator cuff. The first end  422  is inserted through the bone  428 . The second end  424  is engaged with the distal end  406  of the implant  400 . The first end  422  may be tensioned to remove slack and press the soft tissue against the bone. The distal end  406  of the implant  400  may be braced against the bone or engaged with the bone tunnel to facilitate tensioning the strand  420 . The implant  400  is then driven into the bone to lock the ends  422 ,  424  relative to the bone. The second end  424  is trapped beneath the head  412  adjacent the shoulder  414  of the implant  400  and the first end is trapped between the thread  410  and bone  428 . 
     Referring to  FIGS. 7 and 8 , an osseous attachment device includes an implant  500 . The implant includes an elongated body  502  extending from a proximal end  504  to a distal end  506  along an axis  508 . An axial bore  510  extends into the body  502  proximally to distally. A transverse body aperture  512  extends through the body and intersects the axial bore  510 . A head  514  is formed near the proximal end  504  and defines a distally facing shoulder  516  at the junction of the head  514  and body  502 . The head  514  is interrupted by opposed grooves aligned with the aperture  512 . Opposed flat surfaces  518  on the exterior of the body are aligned with the grooves and the aperture  512  and the grooves and flat surfaces  518  provide clearance to allow a suture to slide between the body  502  and a bone tunnel wall. The exterior of the body further includes annular projections  520  on opposite sides of the body  502  between the flat surfaces  518 . The annular projections engage a bone tunnel wall to retain the implant  500  in the bone tunnel. The axial bore  510  is threaded proximally and receives a piston-like plunger  522  in axial threaded engagement such that the plunger is responsive to rotation to move between a first position in which the plunger  522  distal end is substantially not overlapping the transverse body aperture  512  and a second position in which the plunger  522  overlaps at least a portion of the transverse body aperture  512 . 
     The implant  500  is used to capture both ends of a strand and hold the strand adjacent to a bone. For example, in a shoulder repair procedure, as shown in  FIG. 7 , an elongated strand  550  in the form of at least one suture having a first end  552  and a second end  554  defining a loop, may be passed through the soft tissue  556  of the rotator cuff. The first end  552  is inserted through the bone  558 . The second end  554  is looped around the body  502  such as by inserting the implant  500  through the loop of the second end  554  until the loop comes to rest against the shoulder  516 . The first end  552  is passed through the aperture  512 . The first end is then passed along the flat surface  518  and through the groove in the head. The implant  500  is inserted into the bone until the shoulder  516  abuts the bone  558 . The first end  552  of the strand  550  is tensioned to remove slack and press the soft tissue against the bone. The plunger  522  is advanced toward the transverse aperture  512  until the distal end of the plunger  522  traps the second end  554  of the strand in the axial bore  510  such that the first end  552  is fixed distally in the aperture  512  and the second end  554  is trapped proximally under the shoulder  516 . 
       FIG. 8  illustrates an alternative method of using the implant  500 . In the illustrative method of  FIG. 8 , both ends  552 ,  554  of the suture are passed through the transverse aperture  512  of the implant  500  and along the flat surface  518  and through the groove in the head. The implant  500  is inserted into the bone until the shoulder  516  abuts the bone  558 . The ends  552 ,  554  of the strand  550  are tensioned to remove slack and press the soft tissue against the bone. The plunger  522  is advanced toward the transverse aperture  512  until the distal end of the plunger  522  traps the ends  552 ,  554  of the strand distally in the aperture  512  intersecting the axial bore. 
     Referring to  FIG. 9 , an osseous attachment device includes an implant  600  similar to that of  FIGS. 7 and 8  except that the implant  600  of  FIG. 9  includes a transverse aperture  602  through the implant body  604  and a transverse aperture  606  through the plunger  608  and the plunger  608  is advanced by pressing it into the body  604  rather than by threading. In this example, the first end  610  of the suture strand is passed through the body aperture  602  and the second end  612  is passed through the plunger aperture  606 . When the plunger  608  is advanced in the body  604 , the distal end of the plunger traps the first end  610  in the body aperture  602  and the plunger aperture  606  and head  614  trap the second end  612 . The relationship between the plunger length and positions of the apertures  602 ,  606  may be adjusted to provide for simultaneous locking of the suture ends, distal locking of the first suture end  610  before proximal locking of the second suture end  612 , or proximal locking of the second suture end  612  before distal locking of the first suture end  610 . 
     Referring to  FIGS. 10-15 , an osseous attachment device includes an elongate implant body  700  and a plunger  750  receivable in the body  700 . The implant body extends from a proximal end  702  to a distal end  704  along an axis  706 . An axial passage  708  extends into the body proximally to distally along the axis  706 . First and second transverse apertures  710 ,  712 , forming a distal aperture pair, extend through the body  700  distally and intersect the axial passage  708 . The apertures  710 ,  712  are offset toward opposite sides of the axis  706  and the second aperture  712  is offset proximally from the first aperture  710 . Third and fourth transverse apertures  714 ,  716 , forming a proximal aperture pair, extend through the body  700  proximally and intersect the axial passage  708 . The apertures  714 ,  716  are offset toward opposite sides of the axis  706  and the fourth aperture  716  is offset distally from the third aperture  714 . The body  700  has radially extending ridges  718  that taper distally to aid in retaining the body in a tunnel. Opposed flats  720 ,  722  extend along opposite sides of the body  700  adjacent the apertures  710 ,  712 ,  714 ,  716  to provide clearance for suture ends extending alongside the body  700 . A head  724  formed near the proximal end extends radially outwardly beyond the body diameter and includes radially extending ridges  726 . Opposed flats  728 ,  730  extend along opposite sides of the head  724  in circumferential alignment with the body flats  720 ,  722  and apertures  710 ,  712 ,  714 ,  716  but spaced radially outwardly from the axis  706  farther than the flats  720  and  722 . Alignment slots  732 ,  734  are formed on the distal end of the head to provide a rotational alignment keyway for a driver (not shown). The distal end  704  of the body tapers distally to ease insertion into a tunnel. 
     The plunger  750  includes an elongated body  752  extending from a proximal end  754  to a distal end  756  along an axis  758 . The distal end of the plunger tapers distally to ease insertion into the body  700  and separate suture strands as will be more fully described below. The plunger  750  has faceted sides  705  defining elongated vertices, or ridges  707 , at the intersection of adjacent facets. The plunger  750  is receivable in the passage  708  in axial translating relationship. 
     One or more suture strands may be passed through the apertures  710 ,  712 ,  714 ,  716  and locked with the plunger  750 . The plunger can lock any number of suture strands passing through any number of the apertures. Referring to  FIG. 13 , a suture strand  760 ,  762  has been passed through each of apertures  710  and  712 . The plunger  750  has been advanced distally into the passage  708  until the distal end  756  of the plunger  750  is just short of touching the suture strands  760 ,  762 . As can be seen in  FIG. 13 , since the apertures  710 ,  712  are offset outwardly from the axis  706 , the tapered distal end  756  of the plunger, which is coaxial with axis  706 , is directed between the strands  760 ,  762 . 
     Referring to  FIG. 14 , the plunger has been advanced further distally and the distal end  756  has moved between the strands  760 ,  762  and begun pressing them outwardly toward the side wall of passage  708 . 
     Referring to  FIG. 15 , the plunger  750  has been advanced fully into the passage  708  and tightly compresses the strands  760 ,  762  between the plunger sides and passage  708  such that the suture strands are locked firmly relative to the body  700 . The plunger  750  presses the strands sideways into the sidewall of passage  708  and the suture strands are highly compressed by the ridges  707 . Since the ridges  707  are able to slide smoothly over the sutures while compressing them, the advancing plunger  750  locks the suture strands without dragging the sutures substantially axially along the passage  708  and therefore the suture strands are locked with little or no change in the suture tension. 
       FIGS. 16-19  depict an illustrative example of a method of using the implant of  FIGS. 10-15  in a surgical procedure to secure a portion of a rotator cuff to a proximal humerus using knotless transosseous suture fixation. 
     Referring to  FIG. 16 , first and second intersecting bone tunnels  770 ,  772  have been formed in the head of a humeral bone  774  of a shoulder joint. Suture strands  776  have been passed through the bone tunnels with first ends  780  exiting superiorly from the first bone tunnel and passing through a portion of the rotator cuff  778  and second ends  782  exiting laterally from the second bone tunnel  772 . The first ends  780  have been passed through the proximal apertures  714 ,  716  of the implant body  700  and the second ends  782  have been passed through the distal apertures  710 ,  712 . The second bone tunnel  772  is sized to be a press fit with the ridges  718  of the body  700 . 
     Referring to  FIG. 17 , the body  700  has been inserted into the second bone tunnel  772  up to the base of the head  724 . In this position, the suture ends  780 ,  782  may be pulled to remove slack from the suture strands  776  and the strands will slide easily through the bone tunnels and implant body  700 . 
     Referring to  FIG. 18 , the body  700  has been further inserted into the second bone tunnel  772  so that the head is flush with the bone and the head compresses the suture strands between the head and bone. Since the head  724  extends radially outwardly farther than the body  700 , driving the head into the bone will compress the suture strands as shown in a provisionally locked state. In this state, the sutures will not slip easily but a user can supply sufficient force to the ends  780 ,  782  to overcome the frictional provisional lock and perform a final tensioning of the suture strands  776 . The plunger  750  is shown aligned with the passage  708  ready to be inserted after final tensioning of the suture strands  776  is completed. 
     Referring to  FIG. 19 , the plunger  750  has been inserted partway into the passage  708  so that the suture ends  780  passing through the proximal aperture pair are locked but the suture ends  782  passing through the distal aperture pair can still be tensioned if desired. In this way the plunger  750  provides a sequential locking action relative to the proximal and distal apertures. 
     Referring to  FIG. 20 , the plunger  750  has been fully seated locking all of the suture strands and the loose suture ends have been cut off flush with the bone. 
       FIG. 21  illustrates an alternative method of using the implant  700  in which separate suture strands are passed through separate portions of a soft tissue and the loose ends of each strand are secured using the distal and proximal pairs of apertures respectively. A first suture strand  800  is attached to the rotator cuff  778  such as by way of a mattress stitch or other suitable stitch. The ends  802  of the first suture strand  800  have been passed through the distal apertures  710 ,  712  of the implant body  700 . A second suture strand  804  is attached to the rotator cuff  778  such as by way of a mattress stitch or other suitable stitch. The ends  806  of the second suture strand  804  have been passed through the proximal apertures  714 ,  716  of the implant body  700 . The implant body  700  is inserted into the bone tunnel  772  and the sutures tensioned and secured as describe in the previous illustrative example. 
     The foregoing examples have illustrated various embodiments of devices and methods useful to attach an elongated strand to a bone by forming a tunnel through the bone, passing the strand through the bone, and then capturing both ends of the strand with a single implant. The embodiments have been illustrated in use to repair a rotator cuff of a shoulder joint but it will be understood that the devices and methods are applicable at other surgical sites to attach other implant and tissues to bone. For example, the devices and methods may be used to attach sutures, tendons, ligaments, cables, implant anchor portions, and/or other objects to bone at surgical locations throughout a patient&#39;s body. The devices and methods have been shown in use with first and second transverse, linear, intersecting bone tunnels. However, the devices may be used with single linear tunnels through a bone, curved tunnels, three or more intersecting bone tunnels, and/or other bone tunnel configurations in which it is desired to lock with a single device multiple suture ends. 
     In the illustrative examples, anchors have been shown securing suture portions at various locations of the anchor. For example, some of the examples have described or depicted fixation at a proximal portion of the anchor and/or at a distal portion of the anchor. The proximal and distal portions of the anchor may refer to distinct proximal and distal ends of the anchor. The proximal and distal portions may refer to relative regions of the anchor such as the proximal one half and distal one half of the anchor, the proximal one third and distal two thirds of the anchor, the proximal two thirds and distal one third or the anchor, or some other fractional part referring to distinct relative zones. 
     The different illustrative examples have been shown with various forms of bone fixation including threads and annular ridges of varying size and shape. These different forms of fixation may be interchanged within the scope of the invention. For example, where ridges are shown, threads may be substituted and where threads are shown, ridges may be substituted. Any other form of fixation known in the art may also be substituted including but not limited to a smooth press fit. 
     Some of the illustrative examples have included a plunger receivable within an implant body to lock a suture portion relative to the implant body. In these illustrative examples, the plunger has been shown as engaging the implant body for axial translation by threading, ratcheting, or smooth press fitting into the implant body. These engagement arrangements may be interchanged among the different plunger embodiments. Furthermore, other features for retaining the plunger within the implant body may be incorporated on the plunger and/or within the implant body including ridges, grooves, bumps, surface textures, and/or other retaining features. Furthermore, while the illustrative examples have depicted plungers that are moveable from a proximal position to a distal position in which the suture portion is secured, the plunger may also be moveable from a distal position to a proximal position in which the suture portion is secured. For example, a plunger may be disposed in the implant body distal to a transverse opening and be pulled proximally to secure a suture in the transverse opening. 
     Various examples have been illustrated and described. The various examples may be substituted and combined and other alterations made within the scope of the invention.