Patent Publication Number: US-2013253526-A1

Title: System, method, and apparatus for an anterior portal guide for partial thickness rotator cuff repair

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 61/613,472, filed Mar. 20, 2012, which is hereby incorporated by reference herein in its entirety, including but not limited to those portions that specifically appear hereinafter, the incorporation by reference being made with the following exception: In the event that any portion of the above-referenced provisional application is inconsistent with this application, this application supersedes said above-referenced provisional application. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     Not Applicable. 
     BACKGROUND 
     1. The Field of the Present Disclosure 
     The present disclosure relates generally to surgical tools, and more particularly, but not necessarily entirely, to a jig for rotator cuff repair. 
     2. Description of Related Art 
     The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint. Injuries to the rotator cuff can result in pain and reduced movement of the arm. One common injury to the rotator cuff is a torn tendon. Torn tendons may include full thickness tears, in which the tendon is torn all the way through the tendon, and partial thickness chairs, in which the tendon is not completely torn. 
     A torn rotator cuff tendon is often repaired surgically. Historically, rotator cuff repairs were performed through an open incision. More recently, arthroscopic surgery has been used in rotator cuff repair. Arthroscopic surgery is much less invasive than traditional forms of surgery and can result in quicker recovery times and better outcomes. 
     In arthroscopic repair of a full thickness tear, a suture anchor may be inserted into the humerus for attaching the torn tendon. The tendon is then tied to this anchor using sutures, after which it becomes secured to the surrounding bone. Proper placement of the anchor is critical to a successful outcome. 
     In arthroscopic repair of a partial thickness tear, determination of a desirable anchor placement location is restricted by the still connected portion of the tendon. In order to properly place the suture anchor to repair the partial thickness tear, surgeons often complete the partial thickness tear to create a full thickness tear. After completing the tear, the surgeon can more easily determine the desired anchor placement location. While completing the tear of a partial thickness tear allows the surgeon to correctly place the suture anchor in a desired location on the humerus, the additional tear results in longer recovery times and less desirable outcomes. 
     Some surgeons have developed skills for placing suture anchors in desirable locations in partial thickness to rotator cuff tear repairs. Blind placement accuracy requires a significant amount of practice and can result in less desirable outcomes while the surgeon is developing this skill. Consequently, many surgeons do not attempt blind placement, instead relying on completing partial thickness tears to more easily access the desired anchor location. 
     Since the difficulty associated with blind placement of suture anchors has resulted in many partial thickness tears being converted to full thickness tears, many patients are subjected to a longer recovery times and potentially less desirable results. Consequently, a way for improving blind placement accuracy without requiring additional difficult skill development is desirable. 
     The features and advantages of the present disclosure will be set forth in the description which follows, and in part will be apparent from the description, or may be learned by the practice of the present disclosure without undue experimentation. The features and advantages of the present disclosure may be realized and obtained by means of the instruments and combinations particularly pointed out in the appended claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The features and advantages of the disclosure will become apparent from a consideration of the subsequent detailed description presented in connection with the accompanying drawings in which: 
         FIG. 1  is a perspective view of one embodiment of a an anchor placement jig made in accordance with the principles of the present disclosure; 
         FIG. 2  is a side view of the anchor placement jig of  FIG. 1 ; 
         FIG. 3  is a side view of an alternative embodiment of an anchor placement jig; 
         FIG. 4  is a top view of one embodiment of a target of the anchor placement jig of  FIG. 1 ; 
         FIG. 5  is a side view of one embodiment of the target of the anchor placement jig of  FIG. 1 ; 
         FIG. 6  is a front view of the anchor placement jig of  FIG. 1 ; 
         FIG. 7  is a front view of an alternative embodiment of an anchor placement jig; 
         FIG. 8  is an posterior view of bone and muscle tissue in a patient&#39;s shoulder with one embodiment of an anchor placement jig; 
         FIG. 9A  is an anterior view of a partial thickness tear of a rotator cuff tendon with a positioned target of one embodiment of an anchor placement jig; 
         FIG. 9B  is an anterior view of a partial thickness tear of a rotator cuff tendon with a suture anchor installed in the humerus; 
         FIG. 9C  is an anterior view of a repaired partial thickness tear of a rotator cuff tendon; 
         FIG. 10  is a flowchart diagram showing one embodiment of a method for repairing a partial thickness rotator cuff tear using an anchor placement jig; 
         FIG. 11  is a side view of one embodiment of an anchor placement jig; 
         FIG. 12  is a side view of an instrument for use with the anchor placement jig depicted in  FIG. 11 ; 
         FIG. 13  is a cross-sectional view of the instrument installed into a cannulated target arm of the anchor placement jig depicted in  FIG. 11 ; and 
         FIG. 14  is an end view of the cannulated target arm of the anchor placement jig depicted in FIG  11 . 
     
    
    
     DETAILED DESCRIPTION  
     For the purposes of promoting an understanding of the principles in accordance with the disclosure, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the disclosure is thereby intended. Any alterations and further modifications of the inventive features illustrated herein, and any additional applications of the principles of the disclosure as illustrated herein, which would normally occur to one skilled in the relevant art and having possession of this disclosure, are to be considered within the scope of the disclosure claimed. 
     Before the present systems, methods, and apparatuses for an anchor placement jig are disclosed and described, it is to be understood that this disclosure is not limited to the particular configurations, process steps, and materials disclosed herein as such configurations, process steps, and materials may vary somewhat. It is also to be understood that the terminology employed herein is used for the purpose of describing particular embodiments only and is not intended to be limiting since the scope of the present disclosure will be limited only by the appended claims and equivalents thereof. 
     It must be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. 
     In describing and claiming the present disclosure, the following terminology will be used in accordance with the definitions set out below. 
     As used herein, the terms “comprising,” “including,” “containing,” “characterized by,” and grammatical equivalents thereof are inclusive or open-ended terms that do not exclude additional, unrecited elements or method steps. 
     As used herein, the term “proximal” shall refer broadly to the concept of a nearest portion. For example, the grip is the proximal-most portion of the anchor placement jig because it is the nearest portion when the anchor placement jig is in use. 
     As used herein, the term “distal” shall generally refer to the opposite of proximal, and thus to the concept of a further portion, or a furthest portion, depending upon the context. 
     Applicant has discovered that proper placement of a suture anchor in an arthroscopic repair of a partial thickness rotator cuff tear can be more easily and consistently achieved through the use of an anchor placement jig. Applicant has thus conceived of an anchor placement jig that includes a target that can be positioned at a desired location on the humerus. The jig may also include a guide to direct insertion and installation of a suture anchor. The guide is aligned with the target, such that a suture anchor installed using the guide is installed at the target. 
     Referring now to the drawings,  FIG. 1  is a perspective view of one embodiment of an anchor placement jig  100  made in accordance with the principles of the present disclosure. The anchor placement jig  100  includes a frame  102 , a guide  104 , and a target  106 . The anchor placement jig  100  facilitates insertion of a suture anchor at a position near the target  106 . 
     The frame  102 , in some embodiments, includes a vertical grip  108 , a guide arm  110 , and a target arm  112 . The frame  102  holds the guide  104  in a position aligned with the target  106  such that a suture anchor installed using the guide  104  is positioned at or near the target  106 . 
     In some embodiments, the frame  102  includes a vertical grip  108 . The vertical grip  108  provides a structure that a surgeon may use to comfortably hold the frame  102  while using the anchor placement jig  100 . The vertical grip  108  may be essentially perpendicular to one or more other elements of the frame  102 . In some embodiments, the vertical grip  108  is contoured to make holding and manipulating the anchor placement jig  100  more comfortable. 
     The frame  102 , in some embodiments, includes a guide arm  110 . The guide arm  110  extends to a distal end of the frame  102  and provides a connection point for the guide  104 . The guide arm  110  may be substantially perpendicular to the vertical grip  108 . In some embodiments, the guide arm  110  is substantially straight. 
     In certain embodiments, the frame  102  includes a target arm  112 . The target arm  112  extends to a distal end of the frame  102  and provides a connection point for the target  106 . The target arm  112  may be substantially perpendicular to the vertical grip  108 . In some embodiments, the target arm  112  is substantially straight. The target arm  112  may be thinner at a distal end of the target arm  112  than it is at a proximal end of the target arm  112 . The target arm  112  may include a step where the thickness of the target arm  112  changes. The target arm  112  may include a tapered region where the thickness of the target arm  112  changes. The target arm  112  may include a taper extending substantially the entire length of the target arm  112 . 
     The frame  102  may include any material strong and rigid enough the hold the guide  104  in a position aligned with the target  106 . For example, the frame  102  may include stainless steel, such as a precipitation hardened stainless steel. Other examples of materials suitable for use in the fame  102  include titanium, composite materials such as carbon fiber in a polymer matrix, or a rigid polymer material. 
     The guide  104 , in one embodiment, guides a suture anchor to a position near or within the target  106 . In one embodiment, the guide  104  is a barrel or tube, having a cylindrical wall and a hollow center with openings at the top and the bottom. The guide  106  is disposed at a distal end of the frame  102 . The guide  106  is disposed at the distal end of the guide arm  110 , in some embodiments. 
     The target  106 , in one embodiment, is positionable at a desired location for installing a suture anchor. While the target  106  is positioned at the desired location, a suture anchor may be guided to the target  106  via the guide  104 . The target  106  is disposed at a distal end of the frame  102 . The target  106  extends from the distal end of the target arm  112 , in some embodiments such that the target  106  may or may not be fixedly connected to the distal end of the target arm  112 . 
     In some embodiments, the anchor placement jig  100  includes a guide rotation adjustment mechanism  114 . The guide rotation adjustment mechanism  114  is releasable such that the guide  104  may be rotated about the target  106 . As the guide  104  is rotated, it remains aligned with the target  106 . The guide rotation adjustment mechanism  104  is securable such that the guide  104  does not rotate, but remains in a secured position. By rotating the guide  104  to a desired position via the guide rotation adjustment mechanism  104 , the surgeon may adjust the position in which the anchor placement jig  100  is held while in use. The adjustable position may improve comfort for the surgeon or allow better control of placement of the target  106 . 
       FIG. 2  is a side view of the anchor placement jig  100  of  FIG. 1 . The anchor placement jig  100  includes a guide  104 , a target  106 , a vertical grip  108 , a guide arm  110 , and a target arm  112 . The guide  104 , target  106 , vertical grip  108 , guide arm  110 , and target arm  112  are similar to same numbered components described in relation to  FIG. 1 . 
     In certain embodiments, the guide arm  110  has a guide arm length  202  defined from the connection point of the guide arm  110  with the guide  104  to the connection point of the guide arm  110  to other components of the anchor placement jig  100 . In certain embodiments, the guide arm length  202  is between eight and ten inches. In one embodiment, the guide arm length  202  is approximately nine inches. 
     The target arm  112  has a target arm length  204  defined from the connection point of the target arm  112  with the target  106  to the connection point of the target arm  204  to other components of the anchor placement jig  100 . In certain embodiments, the target arm length  204  is between seven and nine inches. In one embodiment, the target arm length  204  is approximately eight inches. 
     In some embodiments, the guide arm  110  and the target arm  112  are substantially parallel along at least a portion of the guide arm  110  and at least a portion of the target arm  112 . In one embodiment, the guide arm  110  and the target arm  112  are substantially parallel along substantially their entire lengths. 
     The guide arm  110  and the target arm  112  may be separated by a clearance distance  206  along at least a portion of their respective lengths. The clearance distance  206  allows for clearance of the anchor placement jig  100  around the tissues covering the humerus during arthroscopic surgery. In one embodiment, the target arm  112  may be separated by a clearance distance  206  along substantially their entire lengths. The clearance distance  206 , in some embodiments, is between two and four inches. In one embodiment, the clearance distance  206  is approximately three inches. 
     The guide  104 , in some embodiments, defines a guide axis  208  that runs substantially along the center of the guide  104  along the longest dimension of the guide  104 . The guide axis  208  may run substantially along the path that the suture anchor is installed following the guide  104 . In some embodiments, the guide axis  208  is substantially straight. The guide arm  110  may define a long axis of the guide arm  210 . The long axis of the guide arm  210  may run substantially along the longest dimension of the guide arm  110 . 
     In some embodiments, the guide axis  208  and the long axis of the guide arm  210  form a guide angle  212 . The guide angle  212 , in some embodiments, is substantially ninety degrees. In an alternative embodiment, the guide angle  212  is less than ninety degrees. In one embodiment, the guide angle  212  is approximately seventy degrees. 
       FIG. 3  is a side view of a system  300  for repairing a partial thickness rotator cuff tear. The system  300  includes an anchor placement jig  302 , a suture anchor  304 , and a driver  306 . The system  300  facilitates placement of a suture anchor  304  to repair a partial thickness rotator cuff tear. 
     The anchor placement jig  302 , in one embodiment, includes a frame  308 , a guide  310 , and a target  312 . The guide  310  and the target  312  are connected to and held in place by the frame  308 . The guide  310  is aligned with the target  312 . In one embodiment, the guide  310  does not rotate with respect to the frame  308 . In some embodiments, the guide  310  is adjustable in an “up” and “down” direction, meaning that the distance between the guide  310  and the target  312  may be adjusted. 
     The suture anchor  304 , in one embodiment, is a bone anchor with an attachment point for one or more sutures. The suture anchor  304  may be any type of suture anchor. For example, the suture anchor  304  may be a metal anchor with a screw mechanism, in which the suture anchor  304  is rotated to fix the suture anchor  304  in the humerus. In some embodiments, the suture anchor  304  includes biodegradable material that dissolves in the body over time. In one embodiment, the suture anchor  304  is an interference fit suture anchor that is secured by pressing into the humerus. 
     The suture anchor  304  may include a suture connection point for attaching one or more sutures. The suture connection point may be any type of connection point. For example, the suture connection point may be an eyelet. 
     The suture anchor  304  may include any number or type of sutures. For example, the suture anchor  304  may include four sutures made of nylon. In one embodiment, the suture anchor  304  includes two sutures with each suture having two ends threaded through an eyelet. 
     In some embodiments, the driver  306  is a tool for installing the suture anchor  304 . The driver  306  may be a cannulated driver such that sutures connected to the suture anchor  304  may be threaded through the driver  306  during installation. The driver  306  may interface with the suture anchor  304  to rotate the suture anchor  304  for installation. In an alternative embodiment, the driver  306  interfaces with the suture anchor  304  to press the suture anchor  304  for installation. 
     In some embodiments, the suture anchor  304  is installable through the guide  310  using the driver  306 . The guide  310  directs the suture anchor  304  to the target  312 . By placing the target  312  at a desired location on the humerus, then guiding the suture anchor  304  to the target  312  using the guide  310 , surgeons can accurately place the suture anchor  304  in a desired location and orientation. 
       FIG. 4  is a top view of one embodiment of a target  106  of the anchor placement jig  100  of  FIG. 1 . The target  106  includes a perimeter structure  402 . The target  106  is a structure that indicates a location where a suture anchor  304  installed via the guide  104  will be placed. 
     The target  106 , in some embodiments, is formed into a hook configuration. The perimeter structure  402  may be curved such that the perimeter structure  402  forms a hook. The perimeter structure  402  may at least partially surround a space at the center of the perimeter structure  402  to form an aperture  404 . 
     The aperture  404  may be sized to receive a suture anchor  304 . The aperture  404  may be substantially the same size as a cross-section of the suture anchor  304  or larger than a cross section of the suture anchor  304 . In some embodiments, an interior border of the perimeter structure  402  defines the aperture  404 . In some embodiments, the aperture  404  is substantially circular, having a center  406  and a diameter  408 . In one embodiment, the diameter  408  is between one eighth of an inch (⅛″) and one half of an inch (½″). The aperture  404 , in one embodiment, has a maximum diameter of one quarter inch (¼″). 
     In an alternative embodiment, the aperture  404  is non-circular. For example, the aperture  404  may be substantially elliptical. In another example, the aperture  404  may be polygonal. 
     The perimeter structure  402  in some embodiments, has a perimeter clearance  410 . The perimeter clearance  410  may be defined by a distance between the interior border of the perimeter structure  402  and the exterior border of the perimeter structure  402 . In one embodiment, the perimeter clearance  410  is substantially constant throughout the entire perimeter structure  402 . In an alternate embodiment, the perimeter clearance  410  varies along the perimeter structure  402 . In one embodiment, the perimeter clearance  410  is between one sixty fourth of an inch ( 1/64″) and one sixteenth of an inch ( 1/16″) in at least one location along the perimeter structure  402 . In one embodiment, the perimeter clearance  410  is approximately one thirty second of an inch ( 1/32″). The perimeter clearance  410  may be relatively small in order to place the aperture  404  in a location relatively close to tissues in the shoulder, such as a connected portion of a partially-torn tendon. 
     In certain embodiments, the perimeter structure  402  does not entirely surround the aperture  404 . The portion of the aperture  404  that is not surrounded by the perimeter structure  402  defines a gap  412 . In one embodiment, the gap  412  is sized such that it forms an opening through which a suture constrained at both ends may be passed. The constrained suture may be passed into the aperture  404  or out of the aperture  404  via the gap. 
     In one embodiment, the target  106  is connected to the frame  102  such that the target  106  is constrained relative to the frame  102 . In another embodiment, the target  106  is rotatable around an axis running the length of the target arm  112 . In a further embodiment, the target  106  is removable from the frame  102 . In some embodiments, the target  106  may be selected from a plurality of different-sized targets to match a desired size of suture anchor, and the selected target  106  may be removably attached to the frame  102 . 
       FIG. 5  is a side view of one embodiment of the target  106  of the anchor placement jig  100  of  FIG. 1 . The target  106  includes a perimeter structure  402 . The target  106  is a structure that indicates a location where a suture anchor  304  installed via the guide  104  will be placed. 
     In some embodiments, the perimeter structure  402  has a height  502 . The height  502  is defined by a distance between a superior border and an inferior border of the perimeter structure  402 . In one embodiment, the height  502  is substantially constant along the perimeter structure  402 . In another embodiment, the height  502  varies along the perimeter structure  402 . The height  502 , in some embodiments, is between one sixty fourth of an inch ( 1/64″) and one sixteenth of an inch ( 1/16″). In some embodiments, the height  502  is approximately one thirty second of an inch ( 1/32″). In certain embodiments, the height  502  is relatively small in order to place the aperture  404  in a location relatively close to tissues in the shoulder, such as a connected portion of a partially-torn tendon. 
       FIG. 6  is a front view of the anchor placement jig  100  of  FIG. 1 . The anchor placement jig  100  includes a guide rotation adjustment mechanism  114  including a rotation track  602  and a rotation adjustment release  604 . The guide rotation adjustment mechanism  114  allows the guide  104  to be rotated around the target  106  while maintaining the guide  104  in alignment with the target  106 . The guide rotation adjustment mechanism  114  allows the surgeon to place the anchor placement jig  100  in a position to improve surgeon comfort while placing the target  106  in a desired location. 
     The rotation track  602  provides a pathway for the guide  104  to travel while rotating around the target  106 . The rotation track  602  may include one or more curved slots to accept one or more elements of the guide  104 . The rotation track  602  may orient the guide  104  such that it is aligned with the target  106  in all positions along the rotation track  602 . In one embodiment, the rotation track  602  includes one or more elements that follow a constant rotation radius  606  from the target  106 . 
     The rotation adjustment release  604 , in one embodiment, is a release that allows the guide  104  to travel along the rotation track  602  in response to the rotation adjustment release  604  being released. The guide  104  may be fixed to one location on the rotation track  602  in response to the rotation adjustment release  604  being engaged. For example, the rotation adjustment release  604  may be a screw that engages a surface of the rotation track  602  when engaged. The screw may further not engage the rotation track  602  when the screw is unscrewed, thus freeing the guide  104  to travel along the rotation track  602 . 
     In some embodiments, the guide  104  is further adjustable via an insertion adjustment release  608 . The insertion adjustment release  608  allows the guide  104  to be adjusted closer to or further from the target  106  in response to the insertion adjustment release  608  being released. The guide  104  may be fixed to a particular distance from the target  106  in response to the insertion adjustment release  608  being engaged. For example, the insertion adjustment release  608  may be a screw that engages a surface of the guide  104  when engaged. The screw may further not engage the guide  104  when the screw is unscrewed, thus freeing the guide  104  to travel closer to or further from the target  106 . 
       FIG. 7  is a front view of an alternative embodiment of an anchor placement jig  700 . The anchor placement jig  700  includes a guide  702  having a hexagonal engagement structure  704 . The hexagonal engagement structure  704  is engageable via a tool, such as a wrench. In an alternative embodiment, the guide  702  may have a round engagement structure. In some embodiments, the engagement structure is textured. 
       FIG. 8  is an posterior view of bone and muscle tissue in a patient&#39;s shoulder with one embodiment of an anchor placement jig  802 . The anchor placement jig  802  is partially inserted through an anterior portal such that the target of the anchor placement jig  802  is positioned in a desired location on the humerus  804 . The desired location may be a location where a tendon  806  will be attached to the humerus  804 . 
       FIG. 9A  is an anterior view of a partial thickness tear  900  of a rotator cuff tendon  902  with a positioned target  904  of one embodiment of an anchor placement jig. The partial thickness tear  900  includes a connected portion  906  of the tendon  902  and a torn portion  908  of the tendon  902 . The connected portion  906  remains connected to the humerus  910 , while the torn portion  908  is no longer connected to the humerus  910 . 
     The target  904  may be positioned on the humerus  906  in a desired location  912  for attaching the torn portion  908  of the tendon  902  to the humerus  910 . The target  904  is positioned at the desired location  912  by passing the target  904  through a portal. In one embodiment, the target  904  is passed through an anterior portal. 
       FIG. 9B  is an anterior view of a partial thickness tear  900  of a rotator cuff tendon  902  with a suture anchor  914  installed in the humerus  910 . In some embodiments, the suture anchor  914  is installed in the humerus  910  by guiding it to the target  904  using a guide of a suture anchor placement jig. The suture anchor  914  may have one or more attached sutures  916 . The sutures  916  may be retrievable through the portal by withdrawing the target  904 . In one embodiment, the sutures  916  are drawn through the torn portion  908  of the tendon  902 . 
       FIG. 9C  is an anterior view of a repaired partial thickness tear  900  of a rotator cuff tendon  902 . The sutures  916  may be tied such that the torn portion  908  of the tendon  902  is drawn into and held in contact with the humerus  910 . The torn portion  908  may then reattach to the humerus  910 , repairing the partial tear. 
       FIG. 10  is a flowchart diagram showing one embodiment of a method  1000  for repairing a partial thickness rotator cuff tear using an anchor placement jig. The method  1000  is in certain embodiments a method of use of the system and apparatus of  FIGS. 1-9 , and will be discussed with reference to those figures. Nevertheless, the method  1000  may also be conducted independently thereof and is not intended to be limited specifically to the specific embodiments discussed above with respect to those figures. 
     In some embodiments, an abrasion region on the humerus is abraded  1002 . Abrading  1002  the abrasion region may remove extraneous material and stimulate the abrasion region to encourage attachment of the torn portion  910  of the tendon  902 . In one embodiment, the abrasion region is located at the desired location  912  for placing the suture anchor  914 . In some embodiments, the abrasion region includes the desired location  912  for placing the suture anchor  914 . 
     An anchor placement jig is provided  1004  for placing the suture anchor  914  in the desired location  912 . The anchor placement jig may include a target  904  and a guide aligned with the target  914 . 
     The target  904  is inserted  1006  through a portal in the patient. In some embodiments, the target  904  is inserted  1006  through an anterior portal. The target is positioned  1008  at the desired location  912  of the humerus  910 . In some embodiments, the position of the target  904  is viewed through an arthroscopic surgery camera. The surgeon may position  1008  the target  904  while viewing the output of the arthroscopic surgery camera. 
     The suture anchor  914  is inserted  1010  through the guide of the anchor placement jig and further through an aperture of the target  904 . The guide directs the suture anchor  914  to the target  904  and through the aperture of the target  904  to the desired location  912  on the humerus  910 . 
     The suture anchor  914 , positioned by the anchor placement jig, is attached  1012  to the humerus  910  in the desired location  912 . The suture anchor  914  may be attached  1012  using any method, including, but not limited to rotating the suture anchor  914  and pressing the suture anchor  914 . 
     In some embodiments, one or more sutures  916  connected to the suture anchor  914  are retrieved  1014  using the target  904 . The sutures  916  may be retrieved  1014  by withdrawing the target  904  from the portal. 
     A needle may be inserted  1016  through the torn portion  908  of the tendon  902  and positioned near the suture anchor  914 . The position of the needle relative to the tendon  902  and the suture anchor  914  may be viewed through an arthroscopic surgery camera. In some embodiments, the needle is an eighteen gauge needle. A loop may be passed  1014  through the needle to a position near the suture anchor  914 . The loop may be used to retrieve  1020  one or more sutures  916  connected to the suture anchor  914 . In some embodiments, steps  1016  through  1020  may be repeated one or more times to thread sutures  916  through the torn portion  908  of the tendon  902  in a plurality of locations. 
     The sutures  916  may be tightened  1022  on the torn portion  908  of the tendon  902  to draw the torn portion  908  into contact with the abrasion region. The sutures  916  may then be tied  1024  to secure the torn portion  908  on the abrasion region. 
     Referring now to  FIG. 11 , a side view of an anchor placement jig  1100  made in accordance with the principles of the present disclosure is shown. The anchor placement jig  1100  includes a frame  1102 . The frame  1102  may include a guide arm  1110  and a target arm  1112 . The guide arm  1110  and the target arm  1112  may be separated by a distance similar to that of the anchor placement jig  100  described above. The guide arm  1110  and the target arm  1112  may extend from a vertical grip  1108 . The vertical grip  1108  may take the same form, and have the same function as, the vertical grip  108  described above. In addition, the target arm  1112  may extend through the vertical grip  1108 . 
     Disposed on the free end of the guide arm  1110  may be a guide  1104 . The guide  1104  may be in a position aligned with an anchor target area  1105  such that a suture anchor installed using the guide  1104  is correctly positioned at or near the anchor target area  1105 . The guide  1104  may be positionable in the same manner as the guide  104  described above. The guide  1104  may include a guide barrel. In an embodiment, the target arm  1112  may be cannulated to allow passage of an instrument  1120 . 
     Referring now to  FIGS. 11 and 12 , there is depicted an instrument  1120  pursuant to an embodiment of the present disclosure. The instrument  1120  may include an elongated portion  1122 . In an embodiment, the elongated portion  1122  may include a rigid rod or a flexible member, or any suitable elongate member. Disposed on a proximal end of the elongated portion  1122  may be a grip  1124 . It will be appreciated that the grip  1124  allows a surgeon to manipulate the position of the instrument  1120  in the cannulated target arm  1112 . 
     In an embodiment, it is to be understood that the instrument  1120  is part of the frame  1102 , and thus constitutes a moveable portion of the frame  1102 . In an embodiment, the instrument  1120  is therefore part of the frame  1102  when it resides within the cannulated target arm  1112  as shown in  FIG. 13 , and when it is free of and does not reside within the cannulated target arm  1112 , as shown in  FIG. 12 . 
     Extending from the end of the instrument  1120  may be a tool head  1126 . In an embodiment, the tool head  1126  may be a target, similar in form and function to the target  106  described above. It will be appreciated that the target may be any structure that indicates the target location for the guide  1104 . In an embodiment, the tool head  1126  may take the form of a hook. In an embodiment, the tool head  1126  may take the form of a suture grabber. In an embodiment, the tool head  1126  may take the form of tool heads suitable for use in minimally invasive surgery, such as micro-tools, suture grabbers, bayonets, scissors, blades, forceps, distractors, spreaders, and clamps. In an embodiment, the tool head  1126  may include a light or an endoscopic camera. 
     Referring now to  FIGS. 11 and 13 , the cannulated target arm  1112  may have a distal end  1113  and a proximal end  1115 . The cannulated target arm  1112  may have an aperture at both the distal end  1113  and the proximal end  1115  connected by a hollow passageway  1117 . The tool head  1126  of the instrument  1120  may be inserted in the aperture in the proximal end  1115  of the target arm  1112  and exit the aperture at the distal end  1113  of the target arm  1112 . It will be further appreciated that the distal end  1113  of the target arm  1112  may be inserted into a patient during surgery. 
     Referring now to  FIGS. 13 and 14 , where like reference numerals depict like components, the maximum width  1130  of the tool head  1126  may be less than an inner diameter  1132  of the target arm  1112 . In an embodiment, the diameter  1132  ( FIG. 14 ) of the cannulation, or the inner diameter of the target arm  1112 , may be between 3 millimeters (mm) and 8 mm, or about 4 mm. In an embodiment, an outer diameter  1134  ( FIG. 14 ) of the target arm  1112  may be between 4 mm and 10 mm, or about 5 mm. 
     Referring now to  FIGS. 11 ,  13  and  14 , a foot  1150  may be disposed on a distal end of the target arm  1112 . The foot  1150 , which may be placed on body tissue, may offset the target arm  1112  from the body tissue, such as a bone or tendon, to prevent tissue damage and to facilitate surgical repair. In an embodiment, the foot  1150  may provide an offset  1136  ( FIG. 14 ) of between 1 mm and 10 mm. It will be appreciated that the cannulated target arm  1112  may eliminate the need for a separate cannulated member that provides access to the surgical site. This may be beneficial because the cannulated target arm  1112  may have a smaller diameter than the separate cannulated member. 
     Referring now back to  FIG. 11 , the anchor target area  1105  may be located proximate the distal end  1113  of the target arm  1112 . In an embodiment, a guide axis  1208  through the guide  1104  passes proximate the distal end  1113  of the target arm  1112 . As used in this paragraph, the term “proximate” may mean within one-half of an inch of the distal end  1113  of the target arm  1112 . As used in this paragraph, the term “proximate” may also mean within one inch of the distal end  1113  of the target arm  1112 . As can be further observed, the tool head  1126  extends from the distal end  1113  of the target arm  1112 . For example, the tool head  1126  of the instrument  1120  may provide a target that extends from the distal end  1113  of the target arm  1112 . 
     In an embodiment, the present disclosure may provide a kit comprising an embodiment of an anchor placement jig according to the present disclosure, one or more suture anchors sized to pass through a barrel of a guide of the anchor placement jig, a suture anchor driver, and optionally one or more instruments with tool heads sized to be inserted through a cannulated target arm, if present, of the anchor placement jig, where all of the foregoing a placed in a sterilized container or package. In use, a surgeon may open the kit during surgery to facilitate repair of a rotator cuff injury. 
     In the foregoing Detailed Description, various features of the present disclosure are grouped together in a single embodiment for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed disclosure requires more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive aspects lie in less than all features of a single foregoing disclosed embodiment. Thus, the following claims are hereby incorporated into this Detailed Description of the Disclosure by this reference, with each claim standing on its own as a separate embodiment of the present disclosure. 
     It is to be understood that the above-described arrangements are only illustrative of the application of the principles of the present disclosure. Numerous modifications and alternative arrangements may be devised by those skilled in the art without departing from the spirit and scope of the present disclosure and the appended claims are intended to cover such modifications and arrangements. Thus, while the present disclosure has been shown in the drawings and described above with particularity and detail, it will be apparent to those of ordinary skill in the art that numerous modifications, including, but not limited to, variations in size, materials, shape, form, function and manner of operation, assembly and use may be made without departing from the principles and concepts set forth herein.