Patent Publication Number: US-2007100350-A1

Title: Suture anchor cartridge holder, suture anchor cartridge and associated method

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
      Cross reference is made to the following applications: DEP5495 titled, “CARTRIDGE SUTURE ANCHOR DELIVERY DEVICE, SUTURE ANCHOR DELIVERY DEVICE AND ASSOCIATED METHOD” and DEP5605 titled “MULTIPLE SUTURE ANCHOR DELIVERY DEVICE, SUTURE ANCHOR DELIVERY KIT AND ASSOCIATED METHOD” filed concurrently herewith which are incorporated herein by reference.  
     TECHNICAL FIELD OF THE INVENTION  
      The present invention relates generally to the field of orthopaedics, and more particularly, to an implant for use in arthroplasty.  
     BACKGROUND OF THE INVENTION  
      The skeletal system includes many long bones that extend from the human torso. These long bones include the femur, fibula, tibia, humerus, radius and ulna.  
      A joint within the human body forms a juncture between two or more bones or other skeletal parts. The ankle, hip, knee, shoulder, elbow and wrist are just a few examples of the multitude of joints found within the body. As should be apparent from the above list of examples of joints, many of the joints permit relative motion between the bones. For example, the motion of sliding, gliding, and hinge or ball and socket movements may be had by a joint. For example, the ankle permits a hinge movement, the knee allows for a combination of gliding and hinge movements and the shoulder and hip permit movement through a ball and socket arrangement.  
      The joints in the body are stressed or can be damaged in a variety of ways. For example, the gradual wear and tear is imposed on the joints through the continuous use of a joint over the years. The joints that permit motion have cartilage positioned between the bones providing lubrication to the motion and also absorbing some of the forces direct to the joint. Overtime, the normal use of a joint may wear down the cartilage and bring the moving bones in a direct contact with each other. In contrast, in normal use, a trauma to a joint, such as the delivery of a large force, from an accident for, example, an automobile accident, may cause considerable damage to the bones, the cartilage or to other connective tissue such as tendons or ligaments.  
      Arthropathy, a term referring to a disease of the joint, is another way in which a joint may become damaged. Perhaps the best known joint disease is arthritis, which is generally referred to a disease or inflammation of a joint that results in pain, swelling, stiffness, instability, and often deformity.  
      There are many different forms of arthritis, with osteoarthritis being the most common and resulting from the wear and tear of a cartilage within a joint. Another type of arthritis is osteonecrosis, which is caused by the death of a part of the bone due to loss of blood supply. Other types of arthritis are caused by trauma to the joint while others, such as rheumatoid arthritis, Lupus, and psoriatic arthritis destroy cartilage and are associated with the inflammation of the joint lining.  
      During the lifetime of a patient, it may be necessary to perform a total shoulder replacement procedure on the patient as a result of, for example, disease or trauma. In a total shoulder replacement procedure, a humeral component having a head portion is utilized to replace the natural head portion of the arm bone or humerus. The humeral component typically has an elongated intramedullary stem which is utilized to secure the humeral component to the patient&#39;s humerus. In such a total shoulder replacement procedure, the natural glenoid surface of the scapula is resurfaced or otherwise replaced with a glenoid component that provides a bearing surface for the head portion of the humeral component.  
      As alluded to above, the need for a shoulder replacement procedure may be created by the presence of any one of a number of conditions. One such condition is the deterioration of the patient&#39;s scapula in the area proximate to the glenoid surface as a result of, for example, glenohumeral arthritis. In such a condition, the erosion of the patient&#39;s scapula is generally observed posteriorly on the glenoid surface. Such erosion of the scapula renders treatment difficult, if not impossible, with a conventional glenoid prosthesis.  
      One alternative to implanting a metallic and/or plastic glenoid is the positioning of a biological scaffold in the form of an implant including a biological agent over the natural glenoid to promote healing and regrowth of the natural glenoid. Various biological agents are available for including in the scaffolding to resurface the glenoid. One such product is manufactured from the extra cellular matrix of vertebras. Such an extra cellular matrix is more fully described in U.S. Pat. Nos. 4,902,508; 4,956,178; 5,372,821; and 5,995,110, and incorporated herein in their entireties by reference. One such product utilizing an extra cellular matrix is in the form of a multi-layer sheet derived from swine intestine submucosa (hereinafter referred to as “SIS”), and sold by DePuy Orthopaedics, Inc., Warsaw, Ind., under the trademark Restore®. The Restore® patch is typically secured to the glenoid cavity by sutures which are secured to the glenoid and to the Restore® patch.  
      The securing of soft tissue and such extra cellular matrix sheets to the tissues is a slow and time-consuming process. Typically, a suture is anchored into the bone with a suture anchor and the suture is then threaded to the soft tissue. Due to the size of the Restore® patch, multiple anchors are preferably utilized with attached sutures to obtain proper securement of the Restore® patch to the glenoid fossa.  
      Currently, when multiple suture anchors are to be implanted in the body, for example, for use with the extra-cellular matrix patch such as the Restore® patch, the surgeon is required to place the anchors in a specific pattern one anchor at a time. The requirement to place the anchors in a pattern one anchor at a time leaves great room for human inaccuracy in the procedure. This problem is particularly apparent when implanting a glenoid-resurfacing patch. The patch must be properly secured. Sutures that are anchored to bone, for example a glenoid, are typically used. For a glenoid patch, multiple suture anchors are required for proper securement. To secure multiple sutures anchors, the surgeon must first drill and place all anchors one at a time and in a defined pattern orientation. This process is slow and time consuming.  
      It should be appreciated that the time a patient is in a surgical environment should be minimized. Therefore, this slow and tedious process increases the length of time required for the patient in the surgery room. Further, the surgeon may place the sutures in a pattern that may be less than the ideal pattern due to difficulty in accessing the glenoid fossa.  
      The present invention is adapted to overcome at least some of the aforementioned problems.  
     SUMMARY OF THE INVENTION  
      The multiple suture anchor delivery system of the present invention allows for accurate placement of multiple suture anchors in a unique array. A preloaded cartridge, for example, may contain a set number of suture anchors in an array designed for ideal placement of the suture anchors. The cartridge may be loaded into an instrument capable of implanting all the anchors at once into the body. The cartridge will then be ejected and discarded, allowing for a new cartridge to be loaded into the instrument.  
      According to the present invention, the glenoid fossa may be prepared by first drilling a pattern of holes into the glenoid fossa. After the holes are prepared, all the suture anchors may be implanted at once by placing them in the suture anchor cartridge and then into the installation instrument. This procedure allows for simplicity, efficiency and user friendliness to the surgeon.  
      A preloaded cartridge with a defined orientation for all the suture anchors is provided. This preloaded cartridge will slide, for example, over a slot in the main shaft of the cartridge assembly device. The preloaded cartridge will be pressed within the cartridge assembly device and may, for example, be locked into the assembly device. The assembly device may include an anatomically shaped glenoid contact surface and may be placed against the glenoid bone surface. The assembly device may include an internal spring and provide for implanting all the suture anchors into the glenoid cavity at once. The internal spring may be used to return the cartridge to the starting position to permit the cartridge to be easily ejected from the cartridge holder.  
      According to one embodiment of the present invention, there is provided a suture anchor delivery device for use in performing surgery on tissue of a patient. The suture anchor delivery device includes an applicator and a cartridge removably secured to the applicator. The suture anchor delivery device further includes an anchor operatively associated with the cartridge.  
      According to another embodiment of the present invention there is provided a suture anchor delivery kit for use in performing surgery on tissue of a patient. The suture anchor delivery kit includes a suture applicator and a cartridge, removably secured to said applicator. The delivery kit also includes an anchor removably secured to said cartridge.  
      According to a further embodiment of the present invention, there is provided a method for delivering sutures on tissue on a glenoid fossa of a scapula of a patient. The method includes the steps of providing an anchor with attached sutures for attachment to bone and providing a cartridge for receiving the anchor. The method also includes the steps of providing a holder for holding the cartridge and assembling the anchor into the cartridge. The method further includes the step of assembling the cartridge into the holder. The method also includes the steps of positioning the holder over the implant and actuating the holder to advance the cartridge and the anchor through the implant and into the scapula. The method also includes the steps of positioning the implant on the glenoid fossa and using the sutures to secure the implant to the scapula.  
      According to another embodiment of the present invention there is provided a suture anchor cartridge holder for use with an anchor cartridge in performing surgery on tissue of a patient. The suture anchor cartridge holder includes a applicator that is adapted to receive at least a portion of the anchor cartridge. The suture anchor cartridge holder also includes a guide operatively associated with the applicator and adapted to receive at least a portion of the anchor cartridge.  
      According to another embodiment of the present invention there is provided a suture anchor cartridge for use in performing surgery. The suture anchor cartridge is adapted for insertion into a suture anchor cartridge holder. The suture anchor cartridge includes a body and an anchor. The anchor is operatively associated with the body.  
      According to a further embodiment of the present invention, there is provided a method for securing an implant onto a glenoid fossa of a scapula. The method includes the steps of providing an anchor with attached sutures for attachment to bone and providing a cartridge including at least one anchor having at least one suture attached thereto. The method includes the steps of providing a holder for holding the cartridge and assembling the cartridge into the holder. The method further includes the steps of positioning the implant on the glenoid fossa and positioning the holder over the implant The method includes the steps of actuating the holder to advance the cartridge and the anchor into the scapula and using the sutures to secure the implant to the scapula.  
      According to a further embodiment of the present invention, there is provided a suture anchor delivery device for use in performing surgery on tissue of a patient is provided. The suture anchor delivery device includes an applicator and a plurality of anchors. Each of the anchors is operatively associated with the applicator.  
      According to another embodiment of the present invention, there is provided a suture anchor delivery kit for use in performing surgery on tissue of a patient. The suture anchor delivery kit includes an applicator and a plurality of anchors. Each of the anchors is operatively associated with the applicator.  
      According to another embodiment of the present invention, there is provided a method for securing an implant onto bone. The method includes the steps of providing a first anchor with attached sutures for attachment to bone and providing a second anchor with attached sutures for attachment to bone. The method also includes the steps of providing an applicator holding the first and second anchors and assembling the anchor into the applicator. The method also includes the step of positioning the applicator over the implant. The method also includes the step of actuating the applicator to advance the anchor into the bone. The method also includes the steps of positioning the implant on the bone and using the sutures to secure the implant to the bone.  
      The technical advantages of the present invention include the ability to implant multiple suture anchors at once. For example, according to one aspect of the present invention, a suture anchor cartridge assembly for use in performing surgery on tissues of a patient is provided. The suture anchor cartridge assembly includes a body and a cartridge removably secured to the body. A plurality of anchors is installed into the cartridge. The cartridge assembly is positioned over the implant site and the body and cartridge advance the plurality of anchors simultaneously into the implant site. Thus, the present invention provides for the ability to implant multiple anchors at once.  
      The technical advantages of the present invention further include the ability to accurately position a plurality of anchors. For example, according to another aspect of the present invention, a suture anchorage cartridge is provided. The suture anchor cartridge is adapted for insertion into a holder. The suture anchor cartridge includes a body and a plurality of pre-positioned and spaced apart anchors that are placed in particular positions in the body. Thus, the present invention provides for accurately positioning a plurality of anchors in a fixed spaced apart relationship.  
      The technical advantage of the present invention also includes the ability to securely place the anchors. For example, according to yet another aspect of the present invention, a suture anchor cartridge assembly is provided for performing surgery on tissues of a patient. The suture anchor cartridge assembly includes a body, a cartridge and an anchor. The body includes a surface closely conforming to the surface where the anchors are to be placed, as well as a inserting rod that may be positioned with a stop to accurately and securely place the anchor relative to the position in the body where it is to be placed. Thus, the present invention provides for securely placing the anchors in the body.  
      The technical advantages of the present invention also include the ability to quickly load or refill an anchor cartridge to repair subsequent surgeries. For example, according to yet another aspect of the present invention, a suture anchor cartridge assembly for use in performing surgery on a patient is provided. The cartridge assembly includes a body and a cartridge removably secured to the body. Anchors are operatively associated or positioned on the cartridge. The cartridge may be quickly removed from the body after the anchors have been separated from the cartridge. A second or new cartridge may be easily positioned onto the body, so that a subsequent use of the body may occur. Thus, the present invention provides for the ability to quickly load a cartridge into the applicator.  
      The technical advantages of the present invention also include the ability to sterilize the cartridge assembly. For example, according to another aspect of the present invention, the suture anchor cartridge assembly may include a body, a cartridge and an anchor, each of which may be sterilizable. The cartridge may be pre-loaded with the anchors with the cartridge and anchor pre-sterilized. The body may include components that are readily disassembled. The body may be resterilizable and be made of sterilizable components that are sterilizable from a commonly available sterilizing technique, such as by an autoclave. Thus, the present invention provides for a suture anchor cartridge assembly that may be sterilized.  
      The technical advantages of the present invention further include the ability to provide for a disposable cartridge. By providing a disposable cartridge that includes preassembled anchors, the cartridge when spent, may be disposed. Thus, the amount of effort or time by the surgery team may be minimized to merely inserting a new cartridge into a sterile cartridge holder or body. Thus, the present invention provides for a disposable cartridge.  
      Other technical advantages of the present invention will be readily apparent to one skilled in the art from the following FIGS., descriptions and claims. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  is a perspective view of a multiple suture anchor cartridge applicator assembly according to an embodiment of the present invention;  
       FIG. 1A  is a perspective view of a suture anchor cartridge applicator assembly according to another embodiment of the present invention having a solitary anchor;  
       FIG. 1B  is a perspective view of a multiple suture anchor cartridge applicator assembly according to another embodiment of the present invention having two anchors;  
       FIG. 1C  is a perspective view of a multiple suture anchor cartridge applicator assembly according to another embodiment of the present invention having three anchors;  
       FIG. 2  is an perspective view of a multiple suture anchor cartridge for use in the multiple suture anchor cartridge applicator assembly of  FIG. 1 ;  
       FIG. 3  is a plan view of a suture anchor for use in the multiple suture anchor cartridge of  FIG. 2  in position over the cartridge of  FIG. 2 ;  
       FIG. 4  is a perspective view of the multiple suture anchor cartridge applicator of the multiple suture anchor cartridge applicator assembly of  FIG. 1 ;  
       FIG. 5  is a perspective view of the cartridge guide and plunger shaft of the multiple suture anchor cartridge applicator of  FIG. 4 ;  
       FIG. 5A  is a bottom view of the cartridge guide of  FIG. 4 ;  
       FIG. 5B  is a front view of the cartridge guide of  FIG. 4 ;  
       FIG. 5C  is an end view of the cartridge guide of  FIG. 4 ;  
       FIG. 5D  is a perspective view of a multiple suture anchor cartridge applicator assembly according to another embodiment of the present invention having a guide with relief areas;  
       FIG. 5E  is a perspective view of a multiple suture anchor cartridge applicator assembly according to another embodiment of the present invention having a small central guide;  
       FIG. 5F  is a perspective view of the pin for securing the spring of the multiple suture anchor cartridge applicator assembly of  FIG. 1 ;  
       FIG. 5G  is a perspective view of the spring of the multiple suture anchor cartridge applicator assembly of  FIG. 1 ;  
       FIG. 5H  is a perspective view of an alternate biasing member that may be used with the multiple suture anchor cartridge applicator assembly of  FIG. 1 ;  
       FIG. 5I  is a perspective view of a multiple suture anchor cartridge applicator assembly in the expanded position according to an embodiment of the present invention having a guide with relief for over the columns assisting in viewing the glenoid fossa;  
       FIG. 5J  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 5J  in the retracted position;  
       FIG. 6  is a perspective view of the base of the multiple suture anchor cartridge applicator of  FIG. 4 ;  
       FIG. 7  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 1  showing the cartridge in a partially assembled position;  
       FIG. 8  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 1  showing the cartridge in a fully assembled position;  
       FIG. 8A  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 1  showing the cartridge in a position as it begins its contact with the glenoid fossa;  
       FIG. 9  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 1  showing the cartridge in a fully inserted position for engagement with the glenoid;  
       FIG. 10  is a perspective view of a glenoid patch after the suture anchor cartridge applicator assembly of  FIG. 1  has been deployed into the patch;  
       FIG. 11  is an enlarged exploded plan view of a suture anchor of  FIG. 3  for use in the multiple suture anchor cartridge of  FIG. 2  in position over the cartridge of  FIG. 2 ;  
       FIG. 12  is a side view of the suture anchor of  FIG. 11 ;  
       FIG. 13  is an anterior/posterior view of the multiple suture anchor cartridge applicator assembly of  FIG. 1  shown in position above the glenoid prior to utilization of the applicator;  
       FIG. 14  is an medial/lateral view of the a glenoid patch of  FIG. 10  in position over the glenoid after deployment of the sutures by the applicator assembly of  FIG. 1 ;  
       FIG. 15  is a perspective view of a multiple suture anchor cartridge applicator assembly according to an embodiment of the present invention having a small central guide;  
       FIG. 16  is a perspective view of a multiple suture anchor cartridge applicator assembly according to an embodiment of the present invention having a guide with relief between the columns for assisting in viewing the glenoid fossa;  
       FIG. 16A  is a perspective view of a multiple suture anchor cartridge applicator assembly in the expanded position according to an embodiment of the present invention having a guide with relief for over the columns assisting in viewing the glenoid fossa;  
       FIG. 16B  is a perspective view of the multiple suture anchor cartridge applicator assembly of  FIG. 16A  in the retracted position;  
       FIG. 17  is a plan view of a kit for use in performing total shoulder arthroplasty in accordance with another embodiment of the present invention;  
       FIG. 18  is a flow chart of a method for performing total shoulder arthroplasty in accordance with another embodiment of the present invention;  
       FIG. 19  is a flow chart of another method for performing total shoulder arthroplasty in accordance with another embodiment of the present invention; and  
       FIG. 20  is a flow chart of another method for performing total shoulder arthroplasty in accordance with another embodiment of the present invention. 
    
    
      Corresponding reference characters indicate corresponding parts throughout the several views. Like reference characters tend to indicate like parts throughout the several views.  
     DETAILED DESCRIPTION OF THE INVENTION  
      Embodiments of the present invention and the advantages thereof are best understood by referring to the following descriptions and drawings, wherein like numerals are used for like and corresponding parts of the drawings.  
      According to the present invention, referring now to  FIG. 1 , a suture anchor delivery device  10  is shown. The suture anchor delivery device  10  is adapted for use in performing surgery on tissue  2  of patient  4 . The suture anchor delivery device  10  includes an applicator  12  and a cartridge  14 . The cartridge  14  is removably secured to the applicator  12 . An anchor  16  is removably associated with the cartridge  14 . The suture anchor delivery device  10  of  FIG. 1  may be utilized to secure a solitary anchor  16  or may be used for multiple anchors. It should be appreciated that the use for a single anchor with the use of a cartridge may have value, such as easy anchor replacement or accurate anchor placement with the delivery device.  
      For example, and referring to  FIG. 1A , a suture anchor delivery device  10 A is shown. The suture anchor delivery device  10 A includes an applicator  12 A and a cartridge  14 A. The cartridge  14 A is removably secured to the applicator  12 A. An anchor, for example, anchor  16 A, is operatively associated with the cartridge  14 A and, may as is shown in  FIG. 1A , may be removably secured to the cartridge  14 A. The suture anchor delivery device  10 A of  FIG. 1A  is advantageous in that through the use of a cartridge, the anchor may be quickly and reliably removed and positioned on the applicator  10 A. Further, the applicator  10 A may include locating features such that the anchor may be accurately positioned in the patient  4 , both in anatomical position and in its depth.  
      According to another embodiment of the present invention, and referring now to  FIG. 1B , it should be appreciated that the suture anchor delivery device of the present invention may be utilized with multiple anchors. When the suture anchor delivery device is used with multiple anchors, advantages such as the accurate position of the first anchor with respect to the second anchor, as well as, the ability to insert both anchors simultaneously, may be accomplished with the present invention. The suture anchor delivery device  10 B of  FIG. 1B  includes an applicator  12 B and a cartridge  14 B removably secured to the applicator  12 B. The suture anchor delivery device  10 B further includes a first anchor  16 B. The suture anchor delivery device  10 B also includes a second anchor  18 B spaced from the first anchor  16 B.  
      Referring now to  FIG. 1C , yet another embodiment of the present invention is shown as suture anchor delivery device  10 C. The suture anchor delivery device  10 C is similar to the suture anchor delivery device  10  of  FIG. 1 , except that the suture anchor delivery device  10 C includes three spaced apart anchors. For example, the suture anchor delivery device  10 C includes an applicator  12 C and a cartridge  14 C. The cartridge  14 C is removably secured to the applicator  12 B. The suture anchor delivery device  10 C includes a first anchor  16 C operatively associated with the cartridge  14 C. The suture anchor delivery device  10 C further includes a second anchor  18 C that is also operatively associated with the cartridge  14 C and spaced from the first anchor  16 C. The suture anchor delivery device  10  further includes a third anchor  20 C that is operatively associated with the cartridge  14 C and spaced from the first anchor  16 C and the second anchor  18 C.  
      Referring again to  FIG. 1 , the suture anchor delivery device  10  of  FIG. 1  includes a second anchor  18 , a third anchor  20 , and a fourth anchor  22 . The first anchor  16 , the second anchor  18 , the third anchor  20 , and the fourth anchor  22  are spaced apart from each other and may form any pattern that is optimal for the securing of an implant  6 .  
      The implant  6  may be any implant that may be at least partially secured to the patient by a suture secured to a suture anchor. For example, and as is shown in  FIG. 1 , the first anchor  16 , the second anchor  18 , the third anchor  20 , and the fourth anchor  22  may be spaced from each other in a rectangular pattern.  
      It should be appreciated that the anchors  16 ,  18 ,  20  and  22  may be spaced apart in any pre-selected pattern. Such a pattern may be a geometric pattern different that a rectangular, for example, a square, a rhombus, a parallelogram, a trapezoid. It should also be appreciated that the number of anchors may be other than 1, 2 or 4. If the number of anchors is 3, 5 or greater than 5, many different pre-selected patterns may be chosen. Such patters may be geometric or non-geometric. For example, such geometric patterns may include a triangle, for example, a right triangle, an isosceles triangle. For example, such geometric patterns may include a pentagon, a hexagon etc. Oval, elliptical and round patterns may also be used.  
      Suture anchor delivery device  10  of  FIG. 1 , may include a portion  24  of the applicator  12 , which is used to cooperate with the implant  6  or an implant patient site  8  of the patient  4 , such as a glenoid fossa.  
      The suture anchor delivery device  10  may further include a guide  26  which may be operatively associated with the applicator  12  and with the cartridge  14 . The guide  26  may be utilized to guide or direct the anchors  16 ,  18 ,  20 , and  22  as they are inserted in bone, for example, glenoid  8  of the patient  4 . The implant  6  is then attached to the glenoid using the anchored sutures. The guide  26  may alternatively be utilized to guide or direct the anchors  16 ,  18 ,  20 , and  22  as they are inserted through the implant  6  and then into the glenoid  8  of the patient  4 . The guide  26  may, as is shown in  FIG. 1 , include the portion  24  for cooperation with the patient.  
      For example, the guide  26  may include the portion  24  in the form of a closely conforming surface  28  having a shape similar to that of the glenoid fossa  8  of the patient, where the anchors are to be installed.  
      The guide  26  may be utilized to guide the anchors  16 ,  18 ,  20  and  22  in any suitable manner. For example, and as is shown in  FIG. 1 , the guide  26  serves as a guide or bushing plate for positioning the anchors by being in cooperation with portions of the cartridge  14  that support the anchors.  
      The guide  26  may be used to assist in guiding the anchor  16  in any suitable manner. For example, and as is shown in  FIG. 1 , the cartridge  14  is used to assist in the guide  26  in positioning the first anchor  16 . For example, and as is shown in  FIG. 1 , the cartridge  14  includes a base  30  to which a generally cylindrically shaped first column  32  extends normally or perpendicularly from top face  34  of the base  30 . The first anchor  16  is secured to the first column  32 . Similarly, a second column  34  extends normally from top face  34  of the base  30  and is used to support second anchor  18 . A third cylindrical column  38  extends normally from top face  34  of the base  30  and is used to support the third anchor  20 . Further, a fourth column  40  having a generally cylindrical shape extends normally from top face  34  of the base  30  and is used to secure fourth anchor  22 .  
      The guide  26 , as is shown in  FIG. 1 , includes openings, for example, first opening  42 , which is sized to receive the external cylindrical periphery of the first column  32 . Similarly, the guide  26  further includes a second opening  44  sized to receive the second column  36 . Likewise, the guide  26  includes a third opening  46  for receiving the third column  38 . The guide  26  further includes a fourth opening  48  for receiving the fourth column  40 . The columns  32 ,  36 ,  38  and  40  cooperate with the openings  42 ,  44 ,  46  and  48 , to provide for an accurate and steady positioning of the first anchor  16 , the second anchor  18 , the third anchor  20 , and the fourth anchor  22 , as they are inserted into the implant  6  and into the bone  8 .  
      As shown in  FIG. 1 , the guide  26  is slidably connected to the applicator  12 . By permitting the guide  26  to slide relative to the applicator  12 , the anchors  16 ,  18 ,  20  and  22  are permitted to move into their respective openings  42 ,  44 ,  46  and  48  of the guide  26 . The sliding motion of the guide  26  relative to the applicator  12  may occur in any suitable fashion.  
      For example, and as is shown in  FIG. 1 , the applicator  12  includes a body  50  defining a longitudinal opening  52  extending centrally along longitudinal centerline  54  of the applicator  12 . A plunger shaft  56  is centrally positioned in opening  52  along centerline  54  and fixably attached to the guide  26 . The plunger shaft  56  is adapted to slidably fit in the longitudinal opening  52  of the body  50 .  
      The plunger shaft  56  may, as is shown in  FIG. 1 , be biased outwardly in the direction of arrow  58 , such that the guide  26  is biased to be separated from the cartridge  14 . The biasing of the plunger shaft  56  in the direction of arrow  58  may be accomplished by any suitable manner. For example, the applicator  12  may include a biasing member  60 , which is used to urge the plunger shaft  56  and attach to guide  26  in the direction of arrow  58  away from the body  50 . Biasing member  60  may be in the form of a resilient member. For example, the resilient member  60  may be, for example, a spring or a rubberized material. As shown in  FIG. 1 , the biasing member  60  is in the form of a helical spring that is fitted within the longitudinal opening  52  of the body  50 .  
      The plunger shaft  56  may be restrained such that a portion of the plunger shaft  56  remains in contact with the body  50  of the applicator  12 . For example, the plunger shaft  56  may include a transverse opening  62  for receiving a pin  64 . The pin  64  may extend from the transverse opening  62  into a pair of diametrically opposed longitudinally elongated slots or openings  66  formed in the hollow body  50 . The pin  64  is permitted to move longitudinally within the slots  66 . The pin  64  restrains a portion of the plunger shaft  56  within the longitudinal opening  52  of the body  50 .  
      The pin  64  cooperating with the slot  66  in the body  50  limits the rotational movement of the plunger shaft  56  with respect to the body  50 . This limit on the rotational movement provides that the columns  32 ,  36 ,  38  and  40 , which support the anchors  16 ,  18 ,  20  and  22 , are in rotational alignment with their respective openings  42 ,  44 ,  46  and  48 . Thus, the cartridge  14  may extend into the openings  42 ,  44 ,  46  and  48  to assist in the release of the anchors  16 ,  18 ,  20  and  22  into the glenoid fossa  8 .  
      As shown in  FIG. 1 , the body  50  may include a circular base  68  for providing a surface for holding and urging the applicator  12  in the direction of arrow  58 , such that the anchors  16 ,  18 ,  20  and  22  may be driven into the glenoid fossa  8 . The body  50  of the applicator  12  may further include a pocket  70  for receiving the cartridge  14 . The pocket  70  may be formed by, for example, a circular flange  72  extending outwardly from the body  50  of the applicator  12 . The flange  72  with a cylindrical ring that may extend axially from the outer periphery of the flange  72  in the direction of arrow  58 . The flange  72  and the ring  74  form the pocket  70  for receiving the cartridge  14 . The pocket  70  preferably has a shape compatible with receiving the cartridge  14  and may closely conform to the cartridge  14 .  
      When utilizing the applicator  12 , the closely conforming surface  28  of the guide  26  is placed against glenoid fossa  8  and the outer surface  76  of the body base  68  is pushed open to advance the body  50  in the direction of arrow  58  along longitudinal axis  54  until the anchors  16 ,  18 ,  20 , and  22  begin to engage with the glenoid fossa  8 . Then, the body  50  of the applicator  12  is held and a tool, for example, a mallet is used to strike the outer surface  76  of the body base  68  to drive or engage the anchors into the glenoid fossa  8 .  
      The suture anchor delivery device  10  of the present invention may be made of any suitable durable material that is sterilizable and compatible with the human body. For example, the guide  26  and the plunger shaft  56  may be made of any suitable durable material and may be integral with each other or may be permanently secured to each other. The guide  26  and the plunger shaft  56  may be made of, for example, a durable plastic, a composite, or a metal. If made of a metal, the guide  26  and the plunger shaft  56  may be of, for example, a cobalt chromium alloy, a titanium alloy, or a stainless steel alloy.  
      The body  50  of the applicator  12  of the suture anchor delivery device  10  may likewise be made of any suitable durable material and may be made of, for example, a plastic, a metal, or a composite material. If made of a metal, the body  50  may be made of, for example, a cobalt chromium alloy, a stainless steel alloy, or a titanium alloy.  
      The pin  64  and the spring  60  may be made of any suitable material, for example, a metal. If made of a metal, the pin  64  and the spring  60  may be made of, for example, a cobalt chromium alloy or a stainless steel alloy.  
      Referring now to  FIG. 2 , the suture anchor cartridge  14  is shown in greater detail. The suture anchor cartridge  14  is for use in performing surgery. The suture anchor cartridge is adapted for insertion into the suture anchorage cartridge holder  12  of  FIG. 1 . The suture anchorage cartridge  14  includes a body  78  and a first anchor  16  operatively associated with the body  78 . The body  78  may be integral or may, as is shown in  FIG. 2 , include the base  30 , as well as first column  32  extending perpendicularly from top face  34  of the base  30 . It should be appreciated that the cartridge  14  may be adapted for a solitary anchor or for a multiple array of anchors.  
      For example in  FIG. 2 , four spaced apart anchors are shown representing a generally rectangular pattern. In addition to the first anchor  16 , which extends from first column  32 , the second anchor  18  extends from second column  36 . Similarly, third anchor  20  extends from third column  38  and fourth anchor  22  extends from fourth column  40 . The columns  32 ,  36 ,  38  and  40  may be integral with the base  30  or may be fixably secured to the base  30 . The anchors  16 ,  18 ,  20  and  22  are removably secured to the columns  32 ,  34 ,  38  and  40 , respectively, by any suitable manner.  
      The cartridge  14  may, as shown in  FIG. 2 , include a central opening or slot  80  for receiving the plunger shaft  56  of the applicator  12  (see  FIG. 1 ). The central opening or slot  80  has a width and depth sufficient to provide clearance to the shaft  56  of the applicator  12 .  
      The cartridge  14  may be made of any suitable durable material and may, for example, be made of a combination of plastic components, composite components or metals. Since the cartridge  14  may be a disposable item, the use of low cost materials such as plastics or composites may be preferred. The base  30  may, for example, may be made of a durable plastic, for example, polyethylene. The columns  32 ,  36 ,  38  and  40  may likewise be made of a plastic or due to their small size, may be made of a more high-strength material, for example, a metal. If made of a metal, the columns may be made of, for example, cobalt chromium alloy, stainless alloy, or titanium alloy. The anchors, for example, the first anchor  16 , the second anchor  18 , the third anchor  20  and the fourth anchor  22 , may, for example, be made of a metal. For example, the anchors may be made of a stainless steel.  
      The cartridge  14  is adapted for insertion into the pocket  70  of the applicator  12  of  FIG. 1 . Since the cartridge  14  is adapted to be fitted into applicator  12 , the base  30  of the cartridge  14  includes an external periphery  79 , which preferably mates with the pocket  70  of the applicator  12 .  
      Referring now to  FIG. 3 , an anchor, for example, first anchor  16  is shown in greater detail. The first anchor  16  may include a plurality of suture holes  82  for receiving sutures  84 . The sutures  84  are preferably pre-fitted to the suture holes  82  of the anchor  16  and are deployed with the anchor  16  when the anchor delivery device  10  is utilized. The first anchor  16  is fitted to the first column  32  in any suitable manner. For example, and as is shown in  FIG. 3 , the first anchor  16  includes an internal cavity  86  for receiving stem  88  extending from column  32 . The stem is slidably fitted into the cavity  86  such that the anchor  16  may be released from the stem  88  and the cartridge  14  after it has deployed into the glenoid fossa  8 .  
      Referring now to  FIG. 4 , the suture anchor cartridge holder or applicator  12  of the device  10  is shown in greater detail. The applicator  12 , as is shown in  FIG. 4 , has the plunger shaft  56  extended to receive the cartridge  14  into the applicator  12 . The suture anchor cartridge holder or applicator  12  is for use with the anchor cartridge such as anchor cartridge  14  of  FIG. 2  for use in performing surgery on tissue of a patient. The suture anchor cartridge holder  12  includes the body  50 . The body  50  is adapted to receive a portion of the anchor cartridge  14  (see  FIG. 2 ). The suture anchor cartridge holder  12  further includes the guide  26 . The guide  26  is operatively associated with the body  50  and is adapted to receive a portion of the anchor cartridge  14  (see  FIG. 2 ).  
      The applicator  12  may provide such that the guide  26 , as is shown in  FIG. 4 , includes the portion  24  for cooperation with the tissues of the patient. The guide  26  may include the surface  28  for closely conforming to the tissues of the patient. As shown in  FIG. 4 , the applicator  12  may be provided such that the guide  26  is slidably connected to the body  50 . For example, the plunger shaft  56  extending from the guide  26  slidably fits in longitudinal opening  52  of the body  50 .  
      The applicator  12  may be provided, as is shown in  FIG. 4 , such that the portion  24  engages with the tissue of the patient and the guide  26  and the body  50  are configured to have a first relationship  90 , as shown in  FIG. 9 , in which a portion of the cartridge  14  extends beyond the surface  28  of the guide. The guide  26  and the body  50  also have the second relationship  92 , as shown in  FIG. 7 , in which the cartridge  14  is positioned below surface  28  of the guide  26 .  
      As shown in  FIG. 4 , the applicator  12  includes biasing mean  60 . The biasing mean  60  urges the cartridge in the direction of arrow  58 . As shown in  FIG. 4 , the biasing mean  60  is in the form of a spring. As shown in  FIG. 4 , the applicator  12  includes the guide  26 . The guide  26  includes an internal wall defining an opening, for example, first opening  42 , for the passage of at least a portion of cartridge  14 , for example, the first anchor  16  and the first column  32 , through at least a portion of the first opening  42  (see  FIG. 1 ).  
      As shown in  FIG. 4 , the body  50  of the applicator  12  includes the pocket  70 , which forms a cavity in the body  50 . The pocket  70  is adapted for receiving at least a portion of the cartridge  14 .  
      Referring now to  FIG. 5 , plunger/guide component  94  is shown. The plunger/guide component  94  includes the guide  26  and the integral plunger shaft  56 , which extends from the guide  26 . The guide  26  includes the first opening  42 , the second opening  44 , the third opening  46 , and the fourth opening  48 . The guide  26  further includes closely conforming surface  28  for positioning on the glenoid fossa  8 . The plunger shaft  56  may include, as is shown in  FIG. 5 , spaced apart parallel flats  96  for receiving the cartridge  14  (see  FIG. 2 ).  
      Referring now to  FIGS. 5A, 5B  and  5 C, the closely conforming surface  28  of the guide  26  is shown in greater detail. The closely conforming surface  28  of the guide  26  includes a periphery  98 , which preferably mates with the periphery of the glenoid fossa  8 .  
      The periphery  98 , may, as is shown in  FIG. 5A , include spaced apart parallel faces  51 , which are separated by a distance W. The periphery  98 , further defined by arcuate end portions  53  and  55 . The first arcuate end portion  53  is defined by radius R extending from origin  57 . Similarly, the second arcuate portion  55  is defined by radius R extending from origin  59 . The arcuate end portions  53  and  55  are spaced apart by the length L.  
      Referring now to  FIGS. 5B and 5C , the closely conforming surface  28  of the guide  26  is adapted to conform to the natural glenoid fossa  8  of the scapula  7  (see  FIG. 13 ).  
      For example, and referring now to  FIG. 5B , the closely conforming surface  28  is defined by radius R 2  extending from origin  61 . Similarly, in the opposed plane and referring now to  FIG. 5C , the closely conforming surface  28  may be defined by radius R 3  extending from origin  63 .  
      Referring now to  FIG. 5D , the suture anchor delivery device of the present invention may be in the form of suture anchor delivery device  10 D. The delivery device  10 D includes a plunger guide component  94 D that is slightly different than the plunger guide component  94  of  FIG. 5 . For example, and as is shown in  FIG. 5D , the plunger guide component  94 D includes a plunger shaft  56 D similar to the plunger shaft  56  of  FIG. 5 . The plunger guide component  94 D of the delivery device  10 D includes a guide  26 D, which is slightly different from the guide  26 D of the plunger guide component  94  of  FIG. 5 . The guide  26 D includes relief portions  67 D positioned between lobes  69 D surrounding the openings  42 D,  44 D,  46 D and  48 D formed in the guide  26 . Relief portions  67 D assist in the visibility of the glenoid fossa when positioning the suture anchor delivery device  10 D against the glenoid fossa of the patient.  
      Referring now to  FIG. 5F , the pin  64  is shown. The pin  64  may have a simple cylindrical shape and is adapted to fit into the transverse opening  62  of the plunger shaft  56  (see  FIG. 1 ). The pin  64  may be made of any suitable durable material and, for example, may be made of a metal. If made of a metal, the pin  64  may be made of, for example, a cobalt chromium alloy, a stainless steel alloy, or a titanium alloy.  
      Referring now to  FIG. 5G , the spring  60  of the suture anchor delivery device  10  is shown in greater detail. The spring  60  may be a simple cylindrical helical spring and may be made of any suitable durable material. The spring  60  may be made of spring steel provided the steel is made of a sterilizable material.  
      Referring now to  FIG. 5H , an alternate biasing member for use in a suture anchor delivery device of the present invention is shown as rubber biasing member  60 H. The rubber biasing member  60 H may be in the form of a cylindrical natural rubber or synthetic rubber member. The synthetic rubber member  60 F preferably has a cylindrical shape similar to the spring  60  of  FIG. 5G  and may be used to replace the spring  60 , provided that the rubber biasing member  60 F has a similar spring constant.  
      Referring now to  FIG. 5I , the suture anchor delivery device of the present invention may be in the form of suture anchor delivery device  10 F. The delivery device  10 F includes a plunger guide component  94 F that is slightly different than the plunger guide component  94  of  FIG. 5 . For example, and as is shown in  FIG. 5F  in its relaxed extended position, the plunger guide component  94 F includes a plunger shaft  56 F similar to the plunger shaft  56  of  FIG. 5 . The plunger guide component  94 F of the delivery device  10 F includes a guide  26 F, which is slightly different from the guide  26 F of the plunger guide component  94  of  FIG. 5 . The guide  26 F includes relief portions  67 F positioned in alignment with columns  32 F. Lobes  69 F are formed in the guide  26 F between the relief portions  67 F. Relief portions  67 F assist in the visibility of the glenoid fossa when positioning the suture anchor delivery device  10 F against the glenoid fossa of the patient.  
      Referring now to  FIG. 5J , the suture anchor delivery device  10 F of  FIG. 5I  is shown in its contracted position. In this position the columns  32 F are show in position in the relief portions  67 F.  
      Referring not to  FIG. 6 , the body  50  of the applicator  12  of  FIG. 4  is shown in greater detail. The body  50  includes the body base  68  extending from a first end of the body  50  and the pocket  70  formed in the opposed end of the body  50 . The body  50  defines the central longitudinal opening  52  formed in the body  50 . The body  50  defines a first ejection hole  71  and a spaced apart second ejection hole  73 . The ejection holes  71  and  73  are used to assist in ejecting the cartridge  14  from the body  50  after the cartridge  14  has been used.  
      Referring now to  FIGS. 7, 8 ,  8 A and  9 , the utilization of the suture anchor delivery device  10  is shown. Referring first to  FIG. 7 , the suture anchor cartridge applicator  12  is shown in the extended or open position, also described as the first position, for installing the cartridge  14 . The cartridge  14  is inserted in the direction of arrow  79  with the flats  96  formed on the plunger shaft  56  of the applicator  12  in alignment with slot  80  formed in the base  30  of the cartridge  14 . The cartridge  14  is advanced in the direction of arrow  79  until the base  30  of the cartridge  14  is fully seated against the plunger shaft  56 . Cartridge  14  is then advanced axially in the direction of arrow  81  advancing the base  30  of the cartridge  14  into the pocket  70  formed in the body  50  of the applicator  12 . It should be appreciated that internal periphery  83  of ring  74  is slightly larger than external periphery  85  of the base  30  of the cartridge  14 .  
      Referring now to  FIG. 8 , suture anchor delivery device  10  is shown in the second position  92 . In the second position  92 , the cartridge  14  is advanced in the direction of arrow  81  until the base  30  of the cartridge  14  has fully seated against the body  50  of the applicator  12 .  
      While the suture anchor delivery device  10  is in the second position  92 , as is shown in  FIG. 8 , the suture anchor delivery device  10  is positioned against the anatomy, for example the glenoid fossa, of the patient with the closely conforming surface  28  of the guide  26  in position against the glenoid fossa. Once the anchor delivery device  10  is in position against the glenoid fossa, the body  50  and the cartridge  14  are advanced in the direction of arrow  87 , advancing the suture anchors  16 ,  18 ,  20  and  22  toward the glenoid fossa.  
      Referring now to  FIG. 8A , the suture anchor delivery device  10  is shown positioned with the body  50  and the cartridge  14  advanced in the direction of arrow  87  to third position  92 A until the suture anchors  16 ,  18 ,  20  and  22  are in alignment with the closely conforming surface  28  of the guide  26 . At this point, the body  50  may not be easily advanced in the direction of arrow  87 . At this point, it may be necessary to strike the surface  76  of the base  68  of the body  50  with an instrument, for example, a mallet (not shown), to fully secure the anchors  16 ,  18 ,  20  and  22  into the glenoid fossa.  
      Referring now to  FIG. 9 , the suture anchor delivery device  10  is shown with the cartridge fully extended in the direction of arrow  87 , such that the suture anchors  16 ,  18 ,  20  and  22  are fully seated into the glenoid fossa. It should be appreciated that less of the columns,  32 ,  36 ,  38  and  40  then shown in  FIG. 9  may, in fact, be positioned above the surface  28 . As long as a portion of the columns is exposed, the anchors can be deployed. At this point, the suture anchor delivery device  10  may be removed from the glenoid fossa in the direction of arrow  81 . The biasing member or spring  60  assists in the movement of the body  50  in the direction of arrow  81  away from the guide  26 .  
      It should be appreciated that the suture anchors  16 ,  18 ,  20  and  22  are removed from the columns  32 ,  36 ,  38  and  40 , such that the cartridge  14  now only includes the cartridge base  30  as well as the columns  32 ,  36 ,  38  and  40 . The cartridge  14  may either be sterilized and refilled with new suture anchors or discarded. For simplicity, the cartridge  14  may be discarded.  
      Referring now to  FIG. 10 , the implant  6  is shown with the suture anchors deployed in bone, for example, the glenoid, below the implant  6 . The implant may be placed over the glenoid after the suture anchors are deployed in bone, or the implant may be placed over the glenoid and the suture anchors may be deployed through the implant  6  and then into the glenoid. For example, and as is shown in  FIG. 10 , the implant  6  is in the form of a patch or scaffold. Such a patch or scaffold is in, for example, the form of a biological material. For example, an extracellular matrix in the form of, for example, an SIS patch. Such a patch is provided by DePuy Orthopaedics, Inc., Warsaw, Ind., in the trade name of the Restore® patch. The implant  6  has a shape or size similar to that of the glenoid fossa and is positioned over the glenoid fossa to receive the suture anchors, for example, first suture anchor  16 , second suture anchor  18 , third suture anchor  20  and fourth suture anchor  22 . The suture anchor  16  may include suture pairs attached to the respective suture anchors. For example, the first suture anchor  16  may include a first suture anchor pair  89 , the second suture anchor  18  may include a second suture pair  91 . Similarly, the third suture anchor  20  may include a third suture pair  93 . Similarly, the fourth suture anchor  22  may include a fourth suture pair  95 .  
      Referring now to  FIGS. 11 and 12 , the first suture anchor  16  is shown in greater detail. The first suture anchor  16  includes a body  17  defining suture holes  82  for receiving sutures  84 . The sutures  84  may form a suture pair or group  89 . The body  17  further defines the cavity  86 , which may have a generally cylindrical shape.  
      The cavity  86  is adapted to slidably receive stem  88  extending from the first column  32 . The slidable fit of the stem  88  to the cavity  86  provides for the release of the suture anchor  16  from the cartridge  14  when the suture anchor  16  engages the glenoid fossa. The suture anchor  16  may include a cutting edge  97  along the periphery of the body  17  of the first suture anchor  16  for engaging the glenoid fossa.  
      Referring now to  FIG. 13 , the suture anchor delivery device  10  is shown in position by the patient being installed in the direction of arrow  99 . The suture anchors are then ready to be deployed either directly into glenoid fossa  8  of the scapula  7  or alternatively through the implant  6  and into glenoid fossa  8  of the scapula  7 .  
      Referring now to  FIG. 13A , the implant  6  is shown in greater detail. The implant  6  has a generally oval shape and a shape that conforms to the general shape of the glenoid fossa, in that it is to be implanted against the glenoid fossa. The implant  6  may be in the form of a biological material having a layer or a plurality of layers in forming a sheet. The implant  6  may be in the form of, for example, a vertebral extracellular matrix product, for example, a SIS processed material. Such material is more fully described in U.S. Pat. Nos. 4,902,508; 4,956,178; 5,372,821; and 5,955,110 and assigned to Purdue Research Corporation. Such a product is provided by DePuy Orthopaedics, Inc. and sold as the Restore® patch.  
      Referring now to  FIG. 14 , the Restore® patch  6  is shown positioned in the glenoid cavity  8  of the scapula  7 . The Restore® patch  6  is secured to the glenoid fossa  8  of the scapula  7  by, for example, the four spaced apart suture anchors. For example, the first suture anchor  16 , the second suture anchor  18 , the third suture anchor  20  and the fourth suture anchor  22 . The Restore® patch  6  is further secured to the glenoid cavity  8  through the use of sutures  84  that are secured to the anchors  16 ,  18 ,  20  and  22 .  
      While the present invention may be practiced with a cartridge, it should be appreciated that the suture anchor delivery device of the present invention may have embodiments, including those with cartridges. It should be appreciated that within the scope of the present invention, a suture anchor delivery device for delivering a plurality of sutures may be provided without a cartridge. For example, and referring now to  FIG. 15 , yet another embodiment of the present invention is shown as suture anchor delivery device  110 . The suture anchor delivery device  110  is utilized for performing surgery on tissues of a patient. The suture anchor delivery device  110  includes an applicator  112 , as well as a plurality of suture anchors  116 . Each of the suture anchors  116  is operatively associated with the applicator  112 . The applicator  112  as shown in  FIG. 15 , includes a body  150 .  
      The body  150  may, as is shown in  FIG. 15 , include a central body position  127 , as well as a base  168  extending from a first end of the central body portion  127  and a head  129  extending from the opposed end of the central body portion  127 . The suture anchors  116  are removably secured to the head  129  of the applicator  112 . For example, the head  129  may include a plurality of stems  188  positioned on the surface of the head  129 . Each of the suture anchors  116  matingly receives one of the stems  188 , which provides for a removable securement of the suture anchors  116  to the applicator  112 . The applicator  112  is positioned against the glenoid fossa with the suture anchors  116  positioned over the implant. The implant is positioned between the suture anchors  116  and the glenoid fossa. The base  150  is struck with, for example, a mallet, and the suture anchors  116  are released from the applicator  112 .  
      Referring now to  FIG. 16 , yet another embodiment of the present invention is shown as suture anchor delivery device  210 . The suture anchor delivery device  210  of  FIG. 16 , like the suture anchor delivery device  110  of  FIG. 15 , does not include a cartridge. The suture anchor delivery device  210  includes a applicator  212 . The applicator  212  is utilized to receive a plurality of suture anchors  216 .  
      The applicator  212  includes a body  250 . The body  250  includes a tubular portion  227 . Extending from the tubular portion  227  is a body base  268 . Opposed to the body base  268  is a head  229 . A plurality of columns  232  extend outwardly and in parallel from the head  229 . Each of the columns  232  include a stem  288  for receiving the suture anchors  216 . The stems  288  provide for a removable securement of the suture anchors  216 . The applicator  212  further includes a guide  226  for cooperation with the glenoid fossa. The guide  226  is movably oriented axially.  
      The guide  226 , as is shown in  FIG. 16 , is connected to a plunger shaft  256 . The plunger shaft  256  is moveably fitted in the tubular portion  227  of the body  250 . A spring  260  is utilized to urge the guide  226  away from the body  250 . Relief areas  267  are formed in the guide  226  for receiving the columns  232  and the suture anchors  216 , which are attached to the columns  232 .  
      When utilizing the suture anchor delivery device  210  of  FIG. 16 , the guide  226  is positioned against the implant and the glenoid fossa. The body base  268  is advanced toward the glenoid fossa, causing the suture anchors  216  and the columns  232  to advance through the openings  242 ,  244 ,  246 , and  248  formed in lobes  269 . Relief areas  267  of the guide  226  permit viewing of the suture anchors  216  as they engage in the glenoid fossa.  
      Referring now to  FIG. 16A , yet another embodiment of the present invention is shown as suture anchor delivery device  210 A. The suture anchor delivery device  210 A of  FIG. 16A , like the suture anchor delivery device  210  of  FIG. 16 , does not include a cartridge. The suture anchor delivery device  210 A includes a applicator  212 A. The applicator  212 A is utilized to receive a plurality of suture anchors  216 A.  
      The applicator  212 A includes a body  250 A. The body  250 A includes a tubular portion  227 A. Extending from the tubular portion  227 A is a body base  268 A. Opposed to the body base  268 A is a head  229 A. A plurality of columns  232 A extend outwardly and in parallel from the head  229 A. Each of the columns  232 A include a stem  288 A for receiving the suture anchors  216 A. The stems  288 A provide for a removable securement of the suture anchors  216 A. The applicator  212 A further includes a guide  226 A for cooperation with the glenoid fossa. The guide  226 A is movably oriented axially.  
      The guide  226 A, as is shown in  FIG. 16A , is connected to a plunger shaft  256 A. The plunger shaft  256 A is moveably fitted in the tubular portion  227 A of the body  250 A. A spring  260 A is utilized to urge the guide  226 A away from the body  250 A. Relief areas  267 A are formed in the guide  226 A between lobes  269 A for receiving the columns  232 A and the suture anchors  216 A, which are attached to the columns  232 A.  
      When utilizing the suture anchor delivery device  210 A of  FIG. 16A , the guide  226 A is positioned against the implant and the glenoid fossa. The body base  268 A is advanced toward the glenoid fossa, causing the suture anchors  216 A and the columns  232 A to advance through the relief areas  267 A of the guide  226 A and permitting the suture anchors  216 A to engage in the glenoid fossa. The relief areas aid in viewing the columns  232 A and the suture anchors  216 A as they engage the glenoid.  
      Referring now to  FIG. 16B , the suture anchor delivery device  210 A of  FIG. 16A  is shown in its contracted position. In this position the columns  232 A are show in position in the relief portions  267 A.  
      Referring now to  FIG. 17 , yet another embodiment of the present invention is shown as kit  300  for installing suture anchors to a patient. The suture anchor delivery kit includes the applicator  12  of  FIG. 4  as well as the cartridge  14  of  FIG. 2 . The suture anchor delivery kit further includes the anchors as shown in  FIG. 2 , for example, the first anchor  16 , the second anchor  18 , the third anchor  20 , and the fourth anchor  22 . The suture anchor delivery kit  300  may further include a second cartridge  314  similar to the first cartridge  14 . The second cartridge  314  may be utilized after the first cartridge  314  has been utilized.  
      Referring now to  FIG. 18 , yet another embodiment of the present invention is shown as surgical procedure or surgical method  400 . The surgical procedure  400  is for use in securing surgical suture anchors into a patient. The method  400  includes a first step  410  of providing an anchor with attached sutures for attachment to bone. The method  400  further includes a second step  412  of providing a cartridge for receiving the anchor. The method  400  further includes a third step  414  of providing a holder for holding the cartridge as well as a fourth step  416  of assembling the anchor into the cartridge. The method  400  further includes a fifth step  418  of assembling the cartridge into the holder. The method  400  further includes a sixth step  420  of positioning the holder over the bone and an seventh step  422  of actuating the holder to advance the cartridge and the anchor into the bone. The method  400  further includes a eighth step  424  of positioned the implant on the bone and a ninth step  426  of using the sutures to secure the implant to the bone. It should be appreciated the steps of the method  400  may be reordered as the surgeon deems advisable. For example the eighth step  424  of positioning the implant on the bone may be performed before the sixth step  418  of positioning the holder over the bone.  
      Referring now to  FIG. 19 , yet another embodiment of the present invention is shown as surgical procedure  500 . The surgical procedure  500  is for implanting a suture anchor into a patient. The method  500  includes a first step  510  of providing an anchor with attached sutures for attachment to bone. The method  500  further includes a second step  512  of providing a cartridge, including at least one anchor having at least one suture attached to the anchor. The method  500  further includes a third step  514  of providing a holder for holding the cartridge, and a fourth step  516  of assembling the cartridge into the holder. The method  500  further includes a fifth step  518  of positioning the implant on the glenoid fossa and a sixth step  520  of positioning the holder over the implant. The method  500  further includes a seventh step  522  of actuating the holder to advance the cartridge and the anchor into the scapula. The method  500  further includes an eighth step  524  of utilizing the sutures to secure the implant to the scapula. It should be appreciated the steps of the method  500  may be reordered as the surgeon deems advisable. For example the fifth step  518  of positioning the implant on the glenoid fossa may be performed after the seventh step  522  of actuating the holder to advance the cartridge and the anchor into the scapula.  
      Referring now to  FIG. 20 , yet another embodiment of the present invention is shown as surgical procedure or surgical method  600 . The surgical procedure  600  is for implanting a suture anchor into a patient. The method  600  includes a first step  610  of providing a first anchor with attached sutures for attachment to bone. The method  600  includes a second step  612  of providing a second anchor with attached sutures for attachment to bone and a third step  614  of providing an applicator holding the first and second anchors.  
      The method  600  further includes a fourth stem  616  of assembling the anchor into the applicator and a sixth step  618  of positioning the applicator over the bone. The method  600  also includes a seventh step  620  of actuating the applicator to advance the anchor into the bone and an eighth step  622  of positioning the implant on the bone. The method  600  also includes a ninth step  624  of using the sutures to secure the implant to the bone. It should be appreciated the steps of the method  600  may be reordered as the surgeon deems advisable. For example the eighth step  622  of positioning the implant on the bone may be performed before the sixth step  618  of positioning the applicator over the bone.  
      Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions, and alterations can be made therein without departing from the spirit and scope of the present invention as defined by the appended claims.