Patent Publication Number: US-2023149010-A1

Title: Soft tissue fixation repair methods using tissue augmentation constructs

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of, and claims priority to, U.S. patent application Ser. No. 15/419,342, filed Jan. 30, 2017, and entitled “SOFT TISSUE FIXATION REPAIR METHODS USING TISSUE AUGMENTATION CONSTRUCTS,” which claims priority to U.S. Provisional Patent Application Ser. No. 62/289,702, filed Feb. 1, 2016, and entitled “COMPRESSION STRIPS AND SCAFFOLDS FOR USE IN SOFT TISSUE FIXATION,” U.S. Provisional Patent Application Ser. No. 62/348,548, filed Jun. 10, 2016, and entitled “COMPRESSION CONSTRUCTS AND RELATED METHODS FOR USE IN SOFT TISSUE FIXATION,” and U.S. Provisional Patent Application Ser. No. 62/393,277, filed Sep. 12, 2016, and entitled “TISSUE AUGMENTATION CONSTRUCTS AND RELATED METHODS FOR USE IN SOFT TISSUE FIXATION,” all of which are incorporated by reference herein in their entireties. 
    
    
     FIELD 
     The present disclosure relates to systems, devices, and methods for securing soft tissue to bone, and more particularly relates to systems, devices, and methods that increase the area of coverage and/or compression between suture filament and tissue during procedures like rotator cuff repairs. 
     BACKGROUND 
     A common injury, especially among athletes and people of advancing age, is the complete or partial detachment of tendons, ligaments, or other soft tissues from bone. Tissue detachment may occur during a fall, by overexertion, or for a variety of other reasons. Surgical intervention is often needed, particularly when tissue is completely detached from its associated bone. Currently available devices for tissue attachment include screws, staples, suture anchors, and tacks. Currently available devices for patients of advancing age can be particularly insufficient due to degenerated tissue leading to inadequate suture-to-anchor fixation and further damage to the soft tissue. 
     Repair constructs made from one or more surgical filaments are typically used in soft tissue repair procedures, e.g., rotator cuff fixations, to secure the tissue in a desired location. The repair constructs are typically disposed through one or more portions of the tissue to be repaired, which can cause trauma to the tissue, and are often coupled to anchors disposed in bone to which the tissue is to be approximated. Further, in situations where the soft tissue has already begun to degenerate, the added pressure applied by the sutures can cause further damage to the tissue, for instance by causing abrasion of the tissue or “cheese-wiring,” which refers to one or more strings of tissue peeling away from the main tissue like a string of cheese peels away from a cheese block when a wire cheese slicer is used to separate cheese from the block. In other words, because the suture has a small surface area, and a significant amount of force is being applied to the soft tissue over the small surface area of the tissue, the suture may have a tendency to cut into the already compromised tissue, thus causing further damage. Currently available solutions to this problem include the application of a relatively large formation of allograft or xenograft, typically about 3 centimeters by about 3 centimeters, to the soft tissue after the repair has been performed but prior to tightening the soft tissue down with the suture. The application of the formation, however, is often expensive, necessitates many sutures, and requires a high skill level to operate and is thus used by only a select few surgeons. Further, the application of the relatively large formation can add a significant amount of time to a surgical procedure, on the order of an additional half hour to one hour per allograft or xenograft formation applied. 
     It is therefore desirable to provide systems, devices, and methods for use in soft tissue repair that are robust, strong, and promote healing, yet minimize the costs and time of the procedure. 
     SUMMARY 
     Systems, devices, and methods are generally provided for performing surgical procedures involving sutures, such as rotator cuff repairs, among other suture repair procedures. More specifically, the systems, devices, and methods are designed to allow a user to quickly add one or more tissue augmentation constructs or matrices onto suture being used to perform the tissue repair. The tissue augmentation constructs, which come in a variety of configurations, including but not limited to tapes, tubes, blocks, rings, tacks, washers, and patches, can expand a footprint of the sutures with which they are associated. The expanded footprint helps distribute force applied by the suture on the tissue across a greater surface area, can protect aspects of the system and/or tissue, provide bulk to otherwise compromised or degenerate tissue and/or tendon, and can help promote tissue growth and repair at the surgical site. 
     The tissue augmentation constructs can be associated with the suture(s) in an on-demand fashion so that a surgeon can quickly and easily expand the footprint of the sutures, or similarly purposed materials such as suture tape, being used based on the needs presented during the procedure. The constructs can be associated with suture using a variety of techniques, including disposing the constructs on the suture and threading the suture through the constructs, among other techniques. In some exemplary embodiments, a tissue augmentation construct is predisposed on a threader, and the threader is operable to associate a suture being used in the soft tissue repair with the tissue augmentation construct. Surgical procedures that utilize the tissue augmentation constructs provided for in the present disclosure are also provided, as are various manufacturing techniques and methods for forming tissue augmentation constructs. 
     In one exemplary embodiment, a surgical soft tissue repair system includes a first suture limb and a first tissue augmentation block. The tissue augmentation block is disposed on the first suture limb such that the first tissue augmentation block extends along a first length of the first suture limb. As a result, a tissue engaging surface area of the system along the first length is increased. The system can additionally include a second suture limb and a second tissue augmentation block. The second tissue augmentation block can be disposed on the second suture limb such that the second tissue augmentation block extends along a second length of the second suture limb. The second tissue augmentation block can further increase a second tissue engaging surface area of the system along the second length. The first suture limb and the second suture limb can be formed from a single suture. Alternatively, the first suture limb and the second suture limb can be formed from different sutures. 
     The first tissue augmentation block can have a number of different configurations. In one configuration, the first tissue augmentation block includes an opening that extends through the first tissue augmentation block with the first suture limb being disposed through the opening of the first tissue augmentation block such that the first tissue augmentation block freely passes along a length of the first suture limb in an unrestricted manner. In a second configuration, the first tissue augmentation block includes a tape having a substantially flat tissue-engaging surface with a width that is at least two times as large as a diameter of the first suture limb and a length that is substantially greater than the width of the tape. The first suture limb on which the tape is disposed extends through the substantially flat tissue-engaging surface of the tape at a plurality of locations along the length of the substantially flat tissue-engaging surface. Other configurations of tissue augmentation blocks are also provided for, including but not limited to bars and washers. In configurations where the system includes first and second tissue augmentation blocks, the first and second tissue augmentation blocks can have the same or different configurations. Further, in some embodiments, the first tissue augmentation block can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, the first tissue augmentation block includes collagen. The blocks can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. 
     In some embodiments, at least one additional tissue augmentation block can be disposed on the first suture limb. For example, each of an additional tissue augmentation block of the at least one additional tissue augmentation block and the first tissue augmentation block disposed on the first suture limb can include a washer. The washer can have an opening that extends through a thickness of the washer, and the first suture limb on which the washer is disposed can extend through the washer opening. The washer can be sized such that the thickness of the washer is substantially less than a length of the first suture limb on which the washer is disposed. 
     The system can also include a threader on which the first tissue augmentation block is disposed. The threader can include a distal end that is configured to receive the first suture limb and dispose the first tissue augmentation block onto the first suture limb as the threader is moved with respect to the first tissue augmentation block. The threader can more specifically include a collapsible opening at the distal end that is configured to receive the first suture limb, a proximal handle portion, and an elongate intermediate portion that extends between the collapsible opening and the proximal handle portion. The elongate intermediate portion can have the first tissue augmentation block disposed on it. The threader can be configured such that applying a force to the proximal handle portion advances the elongate intermediate portion and the collapsible opening in the direction of the applied force such that when the first suture limb is disposed within the collapsible opening, the applied force disposes the first tissue augmentation block onto the first suture limb. The system can further include an installation tool that has a handle portion and a cartridge. The cartridge can have a length and a width that is sized to receive and retain the first tissue augmentation block disposed on the threader, with the threader extending through the entire length of the cartridge. 
     In another exemplary embodiment, a soft tissue suture repair system includes a tissue augmentation block and a threader. The threader has a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end. The intermediate portion of the threader has the tissue augmentation block disposed on it. Further, the threader is configured to dispose the tissue augmentation block onto a suture by associating a suture with the distal receiving end and applying a force to the proximal handle to advance the distal receiving end towards the tissue augmentation block. 
     In some embodiments the threader can be configured such that the distal receiving end, and thus a suture associated therewith, passes through the tissue augmentation block in response to the application of the force to the proximal handle. Sometimes, the intermediate portion is a filament portion, a fiber, a thread, a wire, a cord, and/or some other flexible structure. Further, the system can include a suture that can be configured to be associated with the distal receiving end of the threader and can be configured to have the tissue augmentation block disposed on it. 
     The tissue augmentation block can have various configurations. In one configuration, the tissue augmentation block includes an opening that extends through the block and the intermediate portion of the threader can be disposed through the opening. In a second configuration, the tissue augmentation block includes a tape having a substantially flat tissue-engaging surface with a width that is at least two times as large as a diameter of the suture on which the tape is disposed, and a length that is substantially greater than the width of the tape. The intermediate portion of the threader on which the tape is disposed can extend through the substantially flat tissue-engaging surface of the tape at a plurality of locations along the length of the substantially flat tissue-engaging surface. Other configurations are also provided for, including but not limited to the tissue augmentation block including a bar or a washer. 
     The system can include an installation tool for disposing the tissue augmentation block on a suture. The installation tool can include a handle portion and a cartridge. The cartridge can have a length and a width that is sized to receive and retain the tissue augmentation block. Further, in some embodiments, the tissue augmentation block can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, biological autograft connective tissue, biological allograft connective tissue, biological xenograft connective tissue, human dermal matrix, porcine dermal matrix, bovine dermal matrix, periosteal tissue, pericardial tissue, and fascia, and in some embodiments, the tissue augmentation block include collagen. 
     In still another exemplary embodiment, a surgical kit for soft tissue repair includes one or more bone anchors, one or more sutures, one or more tissue augmentation blocks, and one or more threaders. Each tissue augmentation block is configured to be disposed on a suture limb of a suture of the one or more sutures. Further, at least one of the threaders is configured to dispose a tissue augmentation block of the one or more tissue augmentation blocks onto a suture of the one or more sutures. 
     In some embodiments the surgical kit can also include a drill for drilling a bone hole sized to receive a bone anchor of the one or more bone anchors. In various embodiments, the one or more tissue augmentation blocks can include a plurality of tissue augmentation blocks, and/or the one or more sutures can include a plurality of sutures, and/or the one or more bone anchors can include a plurality of bone anchors. 
     One of the one or more tissue augmentation blocks can include an opening extending through the block. The opening can be configured to have the suture limb extending through the tissue augmentation block when the tissue augmentation block is disposed on the suture limb such that the tissue augmentation block freely passes along a length of the suture limb in an unrestricted manner. Alternatively, one of the one or more tissue augmentation blocks can include a tape having a substantially flat tissue-engaging surface with a width that is at least two times as large as a diameter of the suture limb on which the tissue augmentation block is disposed and a length that is substantially greater than the width of the tape. The substantially flat tissue-engaging surface can be configured to have the suture limb extend through it at a plurality of locations along the length of the substantially flat tissue-engaging surface when the tissue augmentation block is disposed on the suture limb. Other configurations of the one or more tissue augmentation blocks are also provided for, including but not limited to bars and washers. The washers can be sized such that a thickness of the washer is substantially less than a length of a suture limb on which the washer is to be disposed. Further, in some embodiments, a tissue augmentation block of the one or more tissue augmentation blocks can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, one or both of the first and second augmentation blocks includes collagen. The blocks can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. 
     One or more of the threaders can include a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end. The threader can be configured to dispose one or more tissue augmentation blocks onto one or more sutures by associating one or more sutures with the distal receiving end and applying a force to the proximal handle to advance the distal receiving end towards the one or more tissue augmentation blocks. The distal receiving end can be configured such that the distal receiving end, and thus one or more sutures associated therewith, passes through one or more tissue augmentation blocks in response to the application of the force to the proximal handle. 
     In an exemplary method of soft tissue repair, the method includes attaching a first suture to soft tissue such that two suture limbs of the first suture extend from the soft tissue, disposing at least one tissue augmentation block on at least one of the first and second suture limbs, coupling the two suture limbs with at least one suture anchor disposed in bone, and tightening the suture limbs such that the tissue augmentation block(s) is directed towards the soft tissue. By disposing a tissue augmentation block on at least one of the two suture limbs, a surface area for engaging tissue associated with the respective suture limb is increased. One or more tissue augmentation blocks can be disposed on both suture limbs if desired. 
     In some embodiments the step of attaching a first suture to soft tissue such that two suture limbs of the suture extend from the soft tissue further comprises installing a medial row stitch. In such embodiments, the step of coupling the two suture limbs with at least one suture anchor disposed in bone can include installing a lateral row fixation. 
     In some embodiments the step of disposing at least one tissue augmentation block on at least one of the first and second limbs can include coupling a first limb of the two suture limbs to a threader associated with a first tissue augmentation block and applying a force to the threader associated with the first tissue augmentation block to dispose the first tissue augmentation block on the first limb. The method can further include coupling a second limb of the two suture limbs to a threader associated with a second tissue augmentation block and applying a force to the threader associated with the second tissue augmentation block on the second limb. 
     The tissue augmentation block(s) used in the methods can have a variety of configurations. For example, in some instances, one or more of the tissue augmentation blocks can include an opening extending through the block, and the opening can be configured to have one of the suture limbs extending therethrough when the tissue augmentation block is disposed on the respective suture limb such that the tissue augmentation block freely passes along a length of the suture limb in an unrestricted manner. By way of further non-limiting example, in some instances, one or more of the tissue augmentation blocks can include a tape having a substantially flat tissue-engaging surface with a width that is at least two times greater than a diameter of the suture limb on which the block is disposed, and a length that is substantially greater than the width of the tape. The substantially flat tissue-engaging surface can be configured to have the suture limb extend through it at a plurality of locations along the length of the substantially flat tissue-engaging surface when the tissue augmentation block is disposed on the suture limb. Other configurations of tissue augmentation blocks are also provided for, including but not limited to bars and washers. The washers can be sized such that a thickness of the washer is substantially less than a length of a suture limb on which the washer is to be disposed. Further, in some embodiments, one or more of the tissue augmentation blocks can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, one or both of the first and second augmentation blocks includes collagen. The blocks can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. 
     In some embodiments that include a second suture, the step of coupling the two suture limbs with at least one suture anchor disposed in bone can include coupling the two suture limbs with a first suture anchor of the at least one suture anchor. The method can additionally include attaching a second suture to the soft tissue such that a third suture limb and a fourth suture limb extend from the soft tissue. At least one second tissue augmentation block can be can be disposed on at least one of the third and fourth suture limbs, and the third and fourth suture limbs can be coupled with a second anchor of the at least one suture anchor disposed in bone. The method can further include tightening the third and fourth suture limbs such that the second tissue augmentation block is directed towards the soft tissue. By disposing a tissue augmentation block on at least one of the third and fourth suture limbs, a surface area for engaging tissue associated with at least one of the third and fourth suture limbs is increased. One or more tissue augmentation blocks can be disposed on both suture limbs if desired. 
     The step of disposing at least one tissue augmentation block on at least one of the first and second suture limbs can include disposing a first tissue augmentation block on the first suture limb and a second tissue augmentation block on the second suture limb in some instances. In some of those instances, the first and second suture limbs can be coupled together to form a mattress stitch. 
     In yet other embodiments the method can further include attaching a second suture to the soft tissue such that a third suture limb and a fourth suture limb extend from the soft tissue, disposing at least one second tissue augmentation block on at least one of the third and fourth suture limbs, and disposing at least one tissue augmentation block on each of the first and second suture limbs of the first suture. By disposing tissue augmentation blocks on the first, second, and at least one of the third and fourth suture limbs, a surface area for engaging tissue associated with the respective suture limbs are increased. The method can further include coupling the first and third suture limbs with a first suture anchor disposed in the bone, and coupling the second and fourth suture limbs with a second suture anchor disposed in the bone. In some embodiments, the second and third limbs can cross over each other. The method can further include tightening the first, second, third, and fourth suture limbs such that the tissue augmentation blocks are directed towards the soft tissue. 
     In still other embodiments, the method can further include attaching a second suture to the soft tissue such that a third suture limb and a fourth suture limb extend from the soft tissue. The first and second limbs of the first suture can be coupled together, for instance by using a first knot to tie them together. The at least one tissue augmentation block that is disposed on at least one of the first and second suture limbs can be slid over the first knot. The third and fourth suture limbs also can be coupled together, for instance by using a second knot to tie them together. At least one of the third and fourth suture limbs can extend above the at least one tissue augmentation block to help maintain a location of the at least one tissue augmentation block with respect to the soft tissue. 
     Sometimes the method can include attaching a second suture to the soft tissue at a location that is laterally displaced from a location of the first suture such that a third suture limb and a fourth suture limb extend from the soft tissue. Further, a tissue augmentation block of the at least one tissue augmentation block can be disposed on the first suture limb. The first and third suture limbs can be coupled together to form a mattress stitch, for instance by using a first knot to tie them together, and the tissue augmentation block of the at least one tissue augmentation block can be slid over the first knot. The second and fourth suture limbs also can be coupled together, for instance by using a second knot to tie them together. At least one of the second and fourth suture limbs can extend above the tissue augmentation block to help maintain a location of the tissue augmentation block with respect to the soft tissue. 
     In other embodiments, the first tissue augmentation block of the at least one tissue augmentation block can be disposed on the first suture limb. In some such embodiments, the method can include attaching a second suture to the soft tissue such that a third suture limb and a fourth suture limb extend from the soft tissue. A second tissue augmentation block of the at least one tissue augmentation block can be disposed on the fourth suture limb, thereby increasing a surface area for engaging tissue associated with the fourth suture limb. Further, a third tissue augmentation block of the at least one tissue augmentation block can be disposed on each of the second and third suture limbs. The first and second suture limbs can be coupled with a first suture anchor disposed in the bone, and the third and fourth suture limbs can be coupled with a second suture anchor disposed in the bone. The first, second, third, and fourth suture limbs can be tightened such that the first, second, and third tissue augmentation blocks can be directed towards the soft tissue. 
     Another exemplary method of soft tissue repair includes coupling a first suture limb of a first suture to a first threader having a first tissue augmentation block disposed thereon, the first suture being attached to a first suture implant disposed in bone in a body, and the first suture limb being coupled to tissue, and applying a force to the first threader to move the first threader with respect to the first tissue augmentation block such that the first suture limb is passed into the first tissue augmentation block to dispose the first tissue augmentation block onto a portion of the first suture limb. The first suture limb and the first tissue augmentation block are then disassociated from the first threader, and the first tissue augmentation block is advanced towards the first suture implant. A portion of the first suture limb is secured at a surgical site, and a location of the first tissue augmentation block and/or the first suture limb is adjusted with respect to the tissue. 
     In some embodiments, the first suture can be coupled to the tissue by forming a medial row stitch with the first suture. Further, in some instances the method can include coupling a second suture limb of the first suture to a second threader having a second tissue augmentation block disposed thereon, the second suture limb being coupled to tissue, and applying a force to the second threader to move the second threader with respect to the second tissue augmentation block such that the second suture limb is passed into the second tissue augmentation block to dispose the second tissue augmentation block onto a portion of the second limb. The second suture limb and the second tissue augmentation block can be disassociated from the second threader. The second tissue augmentation block can be advanced towards the first suture implant, and a portion of the second suture limb can be secured at the surgical site. In some embodiments in which the first suture includes both a first suture limb and second suture limb, the first and second suture limbs can be coupled together by way of a mattress stitch. 
     Various methods provided for can also include a second suture associated with a second suture implant. More specifically, a third suture limb of a second suture can be coupled to a third threader having a third tissue augmentation block disposed on it. The second suture can be attached to a second suture implant disposed in bone in a body, and the third suture limb can be coupled to tissue. A force can be applied to the third threader to move the threader with respect to the third tissue augmentation block. As a result, the third suture limb can be passed into the third tissue augmentation block to dispose the third tissue augmentation block onto a portion of the third suture limb. The third suture limb and the third tissue augmentation block can be disassociated from the third threader, and a portion of the third suture limb can be secured at the surgical site. A portion of the first suture limb of the first suture can be secured at the surgical site by coupling the first suture limb to a first lateral anchor, a portion of the second suture limb of the first suture can be secured at the surgical site by coupling the second suture limb to a second lateral anchor, and a portion of the third suture limb of the second suture can be secured at the surgical site by coupling the third suture limb to the second lateral anchor. Further, a portion of a fourth suture limb of the second suture can be secured at the surgical site by coupling the fourth suture limb to the first lateral anchor. 
     In some embodiments, the step of securing a portion of the first suture limb at the surgical site can include coupling a second suture limb of the first suture with the first suture limb using a first knot. Further, the step of adjusting a location of at least one of the first tissue augmentation block and first suture limb with respect to the tissue can include sliding the first tissue augmentation block over the first knot. In such embodiments, the method can also include coupling a third suture limb and a fourth suture limb of a second suture that extend from the tissue with a second knot. Further, at least one of the third and fourth suture limbs can extend above the first tissue augmentation block to help maintain a location of the first tissue augmentation block with respect to the tissue. 
     In some other embodiments, the step of securing a portion of the first suture limb at the surgical site can include coupling a third suture limb of a second suture that extends from the tissue with a first knot to form a mattress stitch. Further, the step of adjusting a location of at least one of the first tissue augmentation block and first suture limb with respect to the tissue can include sliding the first tissue augmentation block over the first knot. In such embodiments, the method can also include coupling the second suture limb of the first suture and a fourth suture limb of the second suture with a second knot. Further, at least one of the second and fourth suture limbs can extend above the first tissue augmentation block to help maintain a location of the first tissue augmentation block with respect to the tissue. Still further, a location of the second suture can be laterally displaced with respect to a location of the first suture. 
     In still some other embodiments, the method can include coupling a fourth suture limb of a second suture to a third threader having a third tissue augmentation block disposed on it. The fourth suture limb can be coupled to tissue. A force can be applied to the second threader to move the second threader with respect to the second tissue augmentation block so that the fourth suture limb is passed into the third tissue augmentation block. As a result, the third tissue augmentation block is disposed onto a portion of the fourth suture limb. The fourth suture limb and the third tissue augmentation block can be disassociated from the third threader. A portion of a third suture limb, which is also from the second suture, can be secured within the body by coupling the portion to a first suture anchor that is disposed in bone. A portion of the fourth suture limb can also be secured within the body by coupling it to the first suture anchor. The second tissue augmentation block can be disposed on the third suture limb, in addition to being disposed on the second suture limb. Further, securing portions of the first and second suture limbs at the surgical site can include coupling a portion of the respective first and second suture limbs to a second suture anchor disposed in bone. 
     The first tissue augmentation block, or any tissue augmentation block for that matter, can have a variety of configurations. For example, in some instances the first tissue augmentation block can have an opening extending through the block, and the opening can be configured to have one of the suture limbs extending therethrough when the first tissue augmentation block is disposed on the respective suture limb such that the first tissue augmentation block freely passes along a length of the suture limb in an unrestricted manner. By way of further non-limiting example, in some instances the first tissue augmentation block can include a tape having a substantially flat tissue-engaging surface with a width that is at least two times greater than a diameter of the suture limb on which the block is disposed, and a length that is substantially greater than the width of the tape. The substantially flat tissue-engaging surface can be configured to have the suture limb extend through it at a plurality of locations along the length of the substantially flat tissue-engaging surface when the tissue augmentation block is disposed on the suture limb. Other configurations of tissue augmentation blocks are also provided for, including but not limited to bars and washers. The washers can be sized such that a thickness of the washer is substantially less than a length of a suture limb on which the washer is to be disposed. Further, in some embodiments, the first tissue augmentation block, or again any tissue augmentation block for that matter, can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, one or both of the first and second augmentation blocks includes collagen. The blocks can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. 
     In one exemplary embodiment of a soft tissue repair system that includes a patch or scaffold, the system has a scaffold, a first threader, and a second threader. Each of the first and second threaders include a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end, and the intermediate portion of each threader has the scaffold disposed on it. The first and second threaders are configured to dispose the scaffold onto sutures by associating respective sutures with the respective distal receiving ends and applying a force to the respective proximal handles to advance the respective distal receiving ends towards the scaffold. 
     The first and second threaders can be configured so that their respective distal receiving ends, and thus suture(s) associated therewith, pass through the scaffold in response to the application of the force to the proximal handles. In some embodiments, the intermediate portion of each of the first and second threaders can include a filament portion, a fiber, a thread, a wire, a cord, and/or some other flexible structure. The proximal handles of the first and second suture threaders can be disposed on a first side of the scaffold, the distal receiving ends of the first and second threaders can be disposed on a second side of the scaffold, and the intermediate portions of the first and second threaders can extend from the first side to the second side in a pre-installation configuration. 
     In some embodiments, the intermediate portion of the first threader can be disposed more proximate to a first side of the scaffold than a second, opposite side of the scaffold, and the intermediate portion of the second threader can be disposed more proximate to the second, opposite side of the scaffold than the first side. Further, a third threader and a fourth threader can also be provided, with each including a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end. The intermediate portion of each of the third and fourth threaders can have the scaffold disposed on it. Further, the third and fourth threaders can be configured to dispose the scaffold onto sutures by associating respective sutures with the respective distal receiving ends and applying a force to the respective proximal handles to advance the respective distal receiving ends towards the scaffold. In some embodiments, the intermediate portion of the third threader can be disposed diagonally with respect to the scaffold such that the distal receiving end of the third threader is proximate to the distal receiving end of the first threader and the proximal handle of the third threader is proximate to the proximal handle of the second threader, and the intermediate portion of the fourth threader can be disposed diagonally with respect to the scaffold such that the distal receiving end of the fourth threader is proximate to the distal receiving end of the second threader and the proximal handle of the fourth threader is proximate to the proximal handle of the first threader. 
     The system can also include multiple sutures. For example, a first suture can be configured to be associated with the distal receiving end of the first threader and configured to have the scaffold disposed on it, and a second suture can similarly be configured to be associated with the distal receiving end of the second threader and configured to have the scaffold disposed on it. In some embodiments, the suture(s) can be coupled to the scaffold in a pre-installation configuration. By way of example, a first suture can be coupled to the scaffold at a first medial location on the scaffold and a second suture can be coupled to the scaffold at a second medial location on the scaffold. Each of the first and second sutures can include a hollow self-locking mechanism, and the intermediate portion of the first and second threaders can be disposed in the hollow self-locking mechanisms of the first and second sutures, respectively. Such a scaffold can include a flexible zone that is located at the first and second medial locations, with the flexible zone being configured to allow the scaffold to stretch. 
     In embodiments having the first and second sutures coupled to the first and second medial locations as described, a leading tail can extend from each of the hollow self-locking mechanisms of the first and second sutures, towards a first side of the scaffold. The leading tails can be configured to be coupled to the distal receiving ends of the first and second threaders disposed within the respective hollow self-locking mechanisms of the first and second sutures. In some embodiments, a trailing tail can extend from each of the hollow self-locking mechanisms of the first and second sutures, towards a second, opposite side of the scaffold. Each of the trailing tails can be configured to be coupled to a suture anchor, whether the same anchor or different anchors. In some other embodiments, the system can include trailing tails that are separate sutures than the first and second sutures. For example, a first trailing tail can be disposed more proximate to a second, opposite side of the scaffold than the first side of the scaffold, and can also be disposed more proximate to the hollow self-locking mechanism of the first suture than the hollow self-locking mechanism of the second suture. Similarly, a second trailing tail can be disposed more proximate to the second, opposite end of the scaffold than the first side of the scaffold, and can also be disposed more proximate to the hollow self-locking mechanism of the second suture than the hollow self-locking mechanism of the first suture. Each of the trailing tails can be configured to be coupled to a suture anchor, whether the same anchor or different anchors. 
     In some embodiments having the first and second sutures coupled to the first and second medial locations as described, third and fourth threaders and third and fourth sutures can also be provided. The third and fourth threaders can each include a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end. The intermediate portion of each of the third and fourth threaders can have the scaffold disposed on it, with the intermediate portion being associated with the third and fourth sutures. More specifically, the third and fourth sutures can be coupled to the scaffold proximate to the first and second medial locations, respectively. Each of the third and fourth sutures can include a hollow self-locking mechanism, and the intermediate portions of the third and fourth threaders can be disposed in the hollow self-locking mechanisms of the third and fourth sutures, respectively. Further, the third and fourth threaders can be configured to dispose the scaffold onto sutures by associating respective sutures with the respective distal receiving ends and applying a force to the respective proximal handles to advance the respective distal receiving ends towards the scaffold. In some embodiments, a leading tail can extend from each of the hollow self-locking mechanisms of the first, second, third, and fourth sutures. The leading tails of the first and second sutures can extend towards a first side of the scaffold, and the leading tails of the third and fourth sutures can extend towards a second, opposite side of the scaffold. The leading tails can be configured to be coupled to the distal receiving ends of the first, second, third, and fourth threaders disposed within the respective hollow self-locking mechanisms of the first, second, third, and fourth sutures. 
     In some embodiments that include a scaffold and first and second threaders, one or more additional threaders can be provided. For example, a third threader and a fourth threader can be provided. Each of the third and fourth threaders can include a proximal handle, a distal receiving end, and an intermediate portion extending between the proximal handle and the distal receiving end. The intermediate portion of each of the third and fourth threaders can have the scaffold disposed on it, with the third threader being configured to dispose the scaffold onto the same suture as the first threader and the fourth threader being configured to dispose the scaffold onto the same suture as the second threader. More particularly, the association of the third and fourth threaders with the same suture as the first and second threaders, respectively, can be configured to be achieved by associating the respective suture with the distal receiving end of the respective third and fourth threaders and applying a force to the proximal handle of the respective third and fourth threaders to advance the respective distal receiving end towards the scaffold. The third and fourth threaders can be disposed in the scaffold such that the distal receiving ends of the third and fourth threaders are disposed on a tissue-engaging face of the scaffold and the proximal handles of the third and fourth threaders are disposed on a face of the scaffold that is opposite of the tissue-engaging face. 
     A limb of the suture onto which the scaffold is disposed by the first and third threaders can include a first loop that extends from the tissue-engaging face, around an edge of the scaffold to the face of the scaffold that is opposed to the tissue-engaging face, and into the scaffold at a first location on the scaffold, and a limb of the suture onto which the scaffold is disposed by the second and fourth threaders can include a second loop that extends from the tissue-engaging face, around the edge of the scaffold to the face of the scaffold that is opposed to the tissue-engaging face, and into the scaffold at a second location on the scaffold in a post-installation configuration of the system. Alternatively, a limb of the suture onto which the scaffold is disposed by the first and third threaders can include a first loop that extends from the tissue-engaging face of the scaffold, to the face of the scaffold that is opposed to the tissue-engaging face, and into the scaffold at a first location on the scaffold that is offset from an edge of the scaffold, and a limb of the suture onto which the scaffold is disposed by the second and fourth threaders can include a second loop that extends from the tissue-engaging face of the scaffold, to the face of the scaffold that is opposed to the tissue-engaging face, and into the scaffold at a second location that is offset from the edge of the scaffold in a post-installation configuration of the system. 
     The scaffold can have a variety of configurations, shapes, and sizes, and can be made of a variety of materials. In some embodiments, the scaffold can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, the scaffold includes collagen. The scaffold can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. Still further, in some embodiments a first layer of the scaffold can include a biodegradable polymer, and a second layer of the scaffold can include an extracellular matrix. A thickness of the first layer can be greater than a thickness of the second layer. Further, in some embodiments, the scaffold can include one or more adjustable suture loops disposed on an edge of the scaffold, the adjustable suture loop(s) being configured to prevent the scaffold from unintentionally sliding with respect to a suture limb passed through the respective adjustable suture loop(s). 
     In another exemplary embodiment of a soft tissue repair system, the system includes a scaffold and two sets of suture limbs. The scaffold has a first layer of material, and includes a tissue-facing surface and a second surface that is opposed to the tissue-facing surface, as well as a medial edge and an opposed lateral edge. The first set of suture limbs includes a first suture limb and a second suture limb that are disposed through the scaffold between the tissue-facing surface and the second surface along a length of the scaffold that extends substantially between the medial and opposed lateral edges. The second set of suture limbs includes a third suture limb and a fourth suture limb that are disposed above the tissue-facing surface of the scaffold. The system is configured such that a terminal lateral end of one of the first and second suture limbs and a terminal lateral end of one or the third and fourth suture limbs are disposed proximate to each other on a first side of the scaffold, and a terminal lateral end of the other of the first and second suture limbs and a terminal lateral end of the other of the third and fourth suture limbs are disposed proximate to each other on a second side of the scaffold. The first and second sides of the scaffold are distinguished by being on opposite sides of a central longitudinal axis of the scaffold that extends between the medial and lateral edges. Further, at least one of the first and second suture limbs extends through the scaffold from the tissue-facing surface to the second surface and then, for that suture limb, forms at least one stitch that passes a terminal lateral end of the suture limb through the scaffold to and through the lateral edge. Optionally, a stitch of that nature, or similar to that nature, can also be formed with at least one of the third and fourth suture limbs. 
     The scaffold can include a second layer of material disposed above the first layer of material such that the second layer of material is disposed above the tissue-facing surface of the scaffold and the second layer of material includes the second surface of the scaffold. In such embodiments, the first suture limb and the second suture limb can be disposed between a top-most surface of the first layer of material that is opposed to the tissue-facing surface of the scaffold and a tissue-facing surface of the second layer of material that is opposed to the second surface of the scaffold. 
     In some embodiments, the first and second suture limbs can be disposed on opposite sides of the central longitudinal axis of the scaffold such that the first and second suture limbs do not intersect at locations at which the first and second suture limbs are disposed through the scaffold between the tissue-facing surface and the second surface. In some such embodiments, the third and fourth suture limbs can be disposed with respect to the central longitudinal axis of the scaffold such that the third and fourth suture limbs cross over the central longitudinal axis at least once and intersect each other at least once at a location at which the third and fourth suture limbs are disposed above each of the tissue-facing surface and the second surface. In some other such embodiments, the third and fourth suture limbs can be disposed on opposite sides of the central longitudinal axis of the scaffold such that the first and fourth suture limbs do not intersect at location at which the third and fourth suture limbs are disposed above each of the tissue-facing surface and the second surface and are in contact with the second surface. The first set of the suture limbs can be disposed further from the central longitudinal axis than the second set of the suture limbs for portions of the limbs that extend between the medial and lateral edges. Alternatively, the second set of the suture limbs can be disposed further from the central longitudinal axis than the first set of the suture limbs for portions of the limbs that extend between the medial and lateral edges. 
     In some other embodiments, the first and second suture limbs can be disposed with respect to the central longitudinal axis of the scaffold such that the first and second suture limbs cross over the central longitudinal axis at least once and intersect each other at least once at a location at which the first and second suture limbs are disposed through the scaffold between the tissue-facing surface and the second surface. In some such embodiments, the third and fourth suture limbs can be disposed with respect to the central longitudinal axis of the scaffold such that the third and fourth suture limbs also cross over the central longitudinal axis at least once and intersect each other at least once at a location at which the third and fourth suture limbs are disposed above each of the tissue-facing surface and the second surface. In some other such embodiments, the third and fourth suture limbs can be disposed on opposite sides of the central longitudinal axis of the scaffold such that the first and fourth suture limbs do not intersect at location at which the third and fourth suture limbs are disposed above each of the tissue-facing surface and the second surface and are in contact with the second surface. 
     The third and fourth suture limbs can be disposed above the second surface of the scaffold. Further, in some embodiments, the third and fourth suture limbs can be in contact with the second surface of the scaffold. Alternatively, the third and fourth suture limbs can be disposed through the scaffold between the tissue-facing surface and the second surface along a portion of a length of the scaffold that extends between the medial and opposed lateral edges. Further alternatively, the third and fourth suture limbs can partially extend above the second surface of the scaffold and partially through the scaffold. For instance, a portion of the third and fourth suture limbs extending between the medial and opposed lateral edges can be disposed above the second surface of the scaffold and another portion of the third and fourth suture limbs can be disposed through the scaffold between the tissue-facing surface and the second surface along the portion of the length of the scaffold that extends between the medial and opposed lateral edges. 
     The at least one stitch can include a loop in which the suture limb forming the loop passes around the medial edge and into the scaffold such that the terminal lateral end of the suture limb passes through the scaffold from the medial edge to and through the lateral edge. Alternatively, the at least one stitch can include a jog in which the suture limb forming the jog passes into the scaffold at an entry location on the second surface that is more proximate to the medial edge than the lateral edge along a longitudinal axis extending substantially parallel to the central longitudinal axis of the scaffold such that the terminal end of the suture limb passes through the scaffold approximately from the entry location to and through the lateral edge. At least one of the third and fourth suture limbs can also extend through the scaffold from the tissue-facing surface to the second surface and then, for that suture limb, form at least one stitch that passes a terminal lateral end of the suture limb through the scaffold to and through the lateral edge. The stitch can likewise be a loop or jog. 
     The first set of suture limbs can extend from a first mattress stitch and a second set of suture limbs can extend from a second mattress stitch. The system can further include at least one additional suture having a fifth suture limb and a sixth suture limb. In some embodiments, the fifth and sixth suture limbs can extend from a central medial mattress stitch, while in some other embodiments the fifth and sixth suture limbs can extend from a central lateral mattress stitch. In still further embodiments, suture limbs can extend from each of a central medial mattress stitch and a central lateral mattress stitch. Whether a central medial or lateral mattress stitch, the system can be configured such that a terminal lateral end of one of the fifth and sixth suture limbs can be disposed proximate to the terminal lateral ends of the respective first, second, third, and fourth suture limbs that are disposed on the first side of the scaffold, and a terminal lateral end of the other of the fifth and sixth suture limbs can be disposed proximate to the terminal lateral ends of the respective first, second, third, and fourth suture limbs that are disposed on the second side of the scaffold. 
     Exemplary methods of soft tissue repair that include using a patch or scaffold are also disclosed. One exemplary method includes passing each of a first suture limb and a second suture limb through soft tissue and attaching a scaffold to each of the first and second suture limbs. This results in a surface area for engaging tissue associated with each of the first and second suture limbs being increased. A first end of the scaffold is advanced to a location that is proximate to locations through which the first and second suture limbs pass through the soft tissue, and one or more suture tails are coupled to at least one suture anchor that is disposed in the bone to which the soft tissue is being attached. In some embodiments, the one or more suture tails are part of suture from which the first and second limbs are formed, while in other embodiments the one or more suture tails are separate sutures from sutures that form the first and second suture limbs. 
     The step of advancing a first end of the scaffold to a location that is proximate to locations through which the first and second suture passes through the soft tissue can included disposing a second, opposite end of the scaffold beyond the soft tissue such that it extends over bone to which the soft tissue is being attached. In some embodiments, the step of attaching a scaffold to each of the first and second suture limbs can include threading each of the first and second suture limbs from the first end of the scaffold to the second, opposite end of the scaffold, with the first suture limb being thread at a location that is more proximate to a first side of the scaffold than a second, opposite side of the scaffold and the second suture limb being thread at a location that is more proximate to the second, opposite side of the scaffold than the first side of the scaffold. In such embodiments, the step of coupling one or more suture tails with at least one suture anchor disposed in the bone to which the soft tissue is being attached can include coupling a first tail of the one or more suture tails with a first suture anchor disposed in the bone to which the soft tissue is being attached and coupling a second tail of the one or more suture tails with a second suture anchor disposed in the bone to which the soft tissue is being attached. The first suture limb can be of a first suture and the second suture limb can be of a second suture. In some embodiments, the step of attaching a scaffold to each of the first and second suture limbs can include disposing at least one of the first and second suture limbs through an opening of a loop disposed on an edge of the scaffold and collapsing the opening of the loop through which the first and/or second suture limbs are disposed around the respective limb(s) to prevent the scaffold from unintentionally sliding with respect to the limb(s) disposed through the opening. 
     In embodiments having the first suture and the second suture, threading the first suture limb from the first end of the scaffold to the second, opposite end of the scaffold can include coupling the first suture limb to a threader disposed in the scaffold and applying a force to the threader to dispose the scaffold onto the first suture limb. Similarly, threading the second suture limb from the first end of the scaffold to the second, opposite end of the scaffold can include coupling the second suture limb to a threader disposed in the scaffold and applying a force to the threader to dispose the scaffold onto the second suture limb. 
     In embodiments having the first suture and the second suture, the method can include installing a first medial row stitch using the first suture, and installing a second medial row stitch using the second suture. Further, the step of coupling one or more suture tails with at least one suture anchor disposed in the bone to which the soft tissue is being attached can include installing a lateral row fixation. 
     The step of attaching a scaffold to each of the first and second suture limbs can include disposing the first suture limb through the scaffold from a tissue-engaging face of the scaffold to a face of the scaffold that is opposed to the tissue-engaging face, with the disposing of the first suture limb occurring at a first location on the scaffold that is proximate to a proximal edge of the scaffold. The attachment step can further include passing the first suture limb around the proximal edge of the scaffold and into the scaffold through the proximal edge to form a first loop, and passing the first suture limb through the scaffold from the proximal edge to a distal edge of the scaffold. The step can also include disposing the second suture limb through the scaffold from the tissue-engaging face of the scaffold to the face of the scaffold that is opposed to the tissue-engaging face, with the disposing of the second suture limb occurring at a second location on the scaffold that is proximate to the proximal edge of the scaffold. The attachment step can still further include passing the second suture limb around the proximal edge of the scaffold and into the scaffold through the proximal edge to form a second loop, and passing the second suture limb through the scaffold from the proximal edge to the distal edge of the scaffold. 
     Alternatively, the step of attaching a scaffold to each of the first and second suture limbs can include disposing the first suture limb through the scaffold from a tissue-engaging face of the scaffold to a face of the scaffold that is opposed to the tissue-engaging face, with the disposing of the first suture limb occurring at a first location on the scaffold that is proximate to a proximal edge of the scaffold. The attachment step can further include passing the first suture limb back into the scaffold through the face of the scaffold that is opposed to the tissue-engaging face, with the passing of the first suture limb back into the scaffold occurring at a second location on the scaffold that is offset from the first location to form a first stitch. The attachment step can also include passing the first suture limb through the scaffold from the second location to a distal edge of the scaffold. The attachment step can still further include disposing the second suture limb through the scaffold from the tissue-engaging surface of the scaffold to the face of the scaffold that is opposed to the tissue-engaging face, with the disposing of the second suture limb occurring at a third location on the scaffold that is proximate to the proximal edge of the scaffold. The attachment step can also include passing the second suture limb back into the scaffold through the face of the scaffold that is opposed to the tissue-engaging face, with the passing of the second suture limb back into the scaffold occurring at a fourth location on the scaffold that is offset from the third location to form a second stitch. Still further, the attachment step can include passing the second suture limb through the scaffold from the fourth location to the distal edge of the scaffold. 
     The first suture can include a third suture limb and the second suture can include a fourth suture limb. In such embodiments, which also include the first and second suture anchors, the method can further include passing the third suture limb over the scaffold and coupling it to the second suture anchor, and passing the fourth suture limb over the scaffold and coupling it to the first suture anchor. Further, a first medial anchor to which the first suture is coupled and a second medial anchor to which the second suture is coupled can be installed such that the first and third suture limbs extend from the first medial anchor and the second and fourth suture limbs extend from the second medial anchor. 
     In other embodiments that include the third and fourth suture limbs, the method can include threading the third suture limb from the first end of the scaffold to the second, opposite end of the scaffold and coupling the third suture limb to the second suture anchor. Similarly, the fourth suture limb can be threaded from the first end of the scaffold to the second, opposite end of the scaffold and coupled to the first suture anchor. The resulting configuration can be a crossed configuration between the third and fourth suture limbs. Further, a first medial anchor to which the first suture is coupled and a second medial anchor to which the second suture is coupled can be installed such that the first and third suture limbs extend from the first medial anchor and the second and fourth suture limbs extend from the second medial anchor. 
     Carrying forward with some embodiments having four suture limbs, threading the first suture limb from the first end of the scaffold to the second, opposite end of the scaffold can include coupling the first suture limb to a threader disposed in the scaffold and applying a force to the threader to dispose the scaffold onto the first suture limb. Similarly, threading each of the second, third, and fourth suture limbs from the first end of the scaffold to the second, opposite end of the scaffold can include coupling the second, third, and fourth suture limbs to respective threaders disposed in the scaffold and applying a force to each of the threader to dispose the scaffold onto each of the second, third, and fourth suture limbs. 
     In some embodiments, the first suture limb can be coupled to a first medial location on the scaffold and can include a hollow self-locking mechanism with a first threader disposed in that hollow self-locking mechanism, and the second suture limb can be coupled to a second medial location on the scaffold and can include a hollow self-locking mechanism with a second threader disposed in that hollow self-locking mechanism. In such embodiments the method can include coupling a leading tail of the first suture limb to the soft tissue and subsequently to the first threader, and coupling a leading tail of the second suture limb to the soft tissue and subsequently to the second threader. The first and second threaders can be moved with respect to the hollow self-locking mechanisms of the respective first and second suture limbs to pass the leading tail of the first and second suture limbs through the hollow self-locking mechanisms of that same limb. The step of advancing a first end of the scaffold to a location that is proximate to locations through which the first and second limbs pass through the tissue can include applying a force to the leading tails for the first and second suture limbs after they have passed through the respective hollow self-locking mechanism to advance the first end of the scaffold. Further, the step of coupling the one or more suture tails with at least one suture anchor disposed in the bone to which the soft tissue is being attached can include coupling a first trailing tail of the one or more suture tails to one of a first and second suture anchor of the at least one suture anchor disposed in the bone to which the soft tissue is being attached, and coupling a second trailing tail of the one or more suture tails to the other of the first and second suture anchors of the at least one suture anchor disposed in the bone to which the soft tissue is being attached. In some embodiments, the first trailing tail is part of the first suture and the second trailing tail is part of the second suture. In some other embodiments, the first trailing tail and the second trailing tail are separate sutures than the first and second sutures. 
     In some other embodiments having four suture limbs, the first suture limb can be coupled to the scaffold at a first medial location on the scaffold and can include a hollow self-locking mechanism with a first threader disposed in that hollow self-locking mechanism, and the second suture limb can be coupled to the scaffold at a second medial location on the scaffold and can include a hollow self-locking mechanism with a second threader disposed in that hollow self-locking mechanism. Further, a third suture limb of a third suture can be coupled to the scaffold proximate to the first medial location on the scaffold and a fourth suture limb of a fourth suture can be coupled to the scaffold proximate to the second medial location on the scaffold. The third and fourth suture limbs can each include a hollow self-locking mechanism having third and fourth threaders disposed in the hollow self-locking mechanisms of the respective third and fourth limbs. In such embodiments the method can include coupling a leading tail of the first suture limb to the soft tissue and subsequently to the first threader, and coupling a leading tail of the second suture limb to the soft tissue and subsequently to the second threader. The first and second threaders can be moved with respect to the hollow self-locking mechanisms of the respective first and second suture limbs to pass the leading tail of the first and second suture limbs through the hollow self-locking mechanisms of that same limb. The step of advancing a first end of the scaffold to a location that is proximate to locations through which the first and second limbs pass through soft tissue can include applying a force to the leading tails for the first and second suture limbs after they have passed through the respective hollow self-locking mechanism to advance the first end of the scaffold. Further, the step of coupling the one or more suture tails with at least one suture anchor disposed in the bone to which the soft tissue is being attached can include coupling the leading tail of the third suture limb to a collapsible loop coupled to a first suture anchor of the at least one suture anchor disposed in the bone to which the soft tissue is being attached and subsequently to the third threader, and coupling the leading tail of the fourth suture limb to a collapsible loop coupled to a second suture anchor of the at least one suture anchor disposed in the bone to which the soft tissue is being attached and subsequently to the fourth threader. The third and fourth threaders can be moved with respect to the hollow self-locking mechanisms of the respective third and fourth suture limbs to pass the leading tail of the third and fourth suture limbs through the hollow self-locking mechanisms of that same limb. A force can be applied to the leading tails of the third and fourth suture limbs after they have passed through the respective hollow self-locking mechanism to advance the second, opposite end of the scaffold towards the bone to which the soft tissue is being attached. 
     In some embodiments, the scaffold can include at least one of: fabric, plastic, synthetic polymer, natural polymer, collagen, collagen scaffold, reconstituted collagen, a biological autograft, allograft, allogenic, xenogeneic, or xenograft, connective tissue including human dermal matrix, acellular porcine dermal matrix, acellular bovine dermal matrix, periosteal tissue, pericardial tissue, and/or fascia, and combinations thereof. In some embodiments, the scaffold includes collagen. The scaffold can be woven, non-woven, knitted, or manufactured using a variety of techniques known to those skill in the art or otherwise provided for herein. 
     Unless otherwise specified, the steps of the methods provided for in the present disclosure can be performed in any order. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG.  1 A  is a top view of one exemplary embodiment of a tissue augmentation construct; 
         FIG.  1 B  is a side view of the tissue augmentation construct of  FIG.  1 A ; 
         FIG.  2 A  is a perspective side view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  2 B  is a side view of the tissue augmentation construct of  FIG.  2 A  having a threader disposed therein; 
         FIG.  2 C  is a perspective view of the tissue augmentation construct of  FIG.  2 B ; 
         FIG.  2 D  is a front view of the tissue augmentation construct of  FIG.  2 A ; 
         FIG.  2 E  is a perspective view of yet another exemplary embodiment of a tissue augmentation construct; 
         FIG.  2 F  is a perspective view of still another exemplary embodiment of a tissue augmentation construct; 
         FIG.  2 G  is a side view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  2 H  is a side view of still another exemplary embodiment of a tissue augmentation construct; 
         FIG.  2 I  is a side view of yet another exemplary embodiment of a tissue augmentation construct; 
         FIG.  3    is a side view of one exemplary tissue augmentation construct installation tool, the tool having a tissue augmentation similar to the tissue augmentation construct of  FIG.  2 A  associated therewith; 
         FIG.  4    is a perspective view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  5    is a perspective view of still another exemplary embodiment of a tissue augmentation construct; 
         FIGS.  6 A- 6 C  are schematic sequential views of one exemplary embodiment for installing tissue augmentation constructs in a double row fixation; 
         FIGS.  7 A- 7 D  are schematic sequential views of another exemplary embodiment for installing tissue augmentation constructs in a double row fixation; 
         FIG.  8 A  is a schematic view of still another exemplary embodiment for installing tissue augmentation constructs in a double row fixation; 
         FIG.  8 B  is a schematic view of another exemplary embodiment for installing tissue augmentation constructs in a double row fixation; 
         FIG.  9    is a schematic view of yet another exemplary embodiment for installing tissue augmentation constructs in a double row fixation; 
         FIGS.  10 A- 10 E  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  2 G  in a double row fixation; 
         FIGS.  11 A- 11 C  are schematic sequential views of one exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  11 D  is a schematic view of another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  11 E  is a schematic view of still another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  11 F  is a schematic view of another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  12    is a schematic view of yet another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  13    is a schematic view of another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  14    is a schematic view of still another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIG.  15    is a schematic view of another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIGS.  16 A- 16 C  are schematic views of yet another exemplary embodiment for installing tissue augmentation constructs in a single row fixation; 
         FIGS.  17 A- 17 D  are schematic sequential views of one exemplary embodiment for repairing soft tissue; 
         FIGS.  18 A- 18 C  are schematic sequential views of another exemplary embodiment for repairing soft tissue; 
         FIG.  19    is a schematic view of still another exemplary embodiment for repairing soft tissue; 
         FIGS.  20 A- 20 C  are schematic sequential views of another exemplary embodiment for repairing soft tissue; 
         FIGS.  20 D- 20 F  are schematic sequential views of yet another exemplary embodiment for repairing soft tissue; 
         FIG.  21 A  is a schematic view of an exemplary embodiment of a tissue augmentation construct; 
         FIGS.  21 B- 21 F  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  21 A ; 
         FIG.  21 G  is a schematic view of another exemplary embodiment for installing the tissue augmentation constructs of  FIG.  21 A ; 
         FIG.  21 H  is a schematic view of an alternative exemplary embodiment of the tissue augmentation construct of  FIG.  21 A ; 
         FIG.  21 I  is a schematic view of another alternative exemplary embodiment of the tissue augmentation construct of  FIG.  21 A ; 
         FIGS.  22 A- 22 C  are schematic sequential views of one exemplary embodiment for manufacturing the tissue augmentation construct of  FIG.  2 A ; 
         FIG.  23 A  is a front view of a plurality of tissue augmentation constructs during an exemplary embodiment for manufacturing tissue augmentation constructs; 
         FIG.  23 B  is a top view of the plurality of tissue augmentation constructs of  FIG.  23 A ; 
         FIG.  23 C  is a front view of one tissue augmentation construct of the plurality of tissue augmentation constructs of  FIG.  23 A ; 
         FIG.  24 A  is a front view of a plurality of tissue augmentation constructs during another exemplary embodiment for manufacturing tissue augmentation constructs; 
         FIG.  24 B  is a top view of the plurality of tissue augmentation constructs of  FIG.  23 A ; 
         FIG.  24 C  is a front view of one tissue augmentation construct of the plurality of tissue augmentation constructs of  FIG.  23 A ; 
         FIG.  25    is a side view of one exemplary embodiment of a distal end of a tool for manufacturing the tissue augmentation construct of  FIG.  2 A ; 
         FIGS.  26 A- 26 C  are schematic sequential views of another exemplary embodiment for manufacturing a tissue augmentation construct; 
         FIG.  26 D  is a side view of one tissue augmentation construct that can result from the manufacturing process illustrated in  FIGS.  26 A- 26 C ; 
         FIG.  26 E  is a side view of an alternative tissue augmentation construct that can result from the manufacturing process illustrated in  FIGS.  26 A- 26 C ; 
         FIG.  26 F  is a top view of the tissue augmentation construct of  FIG.  26 E ; 
         FIGS.  26 G- 26 I  are schematic sequential views of yet another exemplary embodiment for manufacturing a tissue augmentation construct; 
         FIG.  27 A  is a schematic side view of one exemplary embodiment of a tunneling station for use in manufacturing a tissue augmentation construct; 
         FIGS.  27 B and  27 C  are side schematic views of a support of the tunneling station of  FIG.  27 A ; 
         27 D- 27 I are various exemplary embodiments of distal ends of lumen formation tools that can be used in conjunction with the tunneling station of  FIG.  27 A ; 
         FIGS.  27 J- 27 L  are schematic sequential views of one exemplary embodiment for manufacturing a tissue augmentation construct using the tunneling station of  FIG.  27 A ; 
         FIG.  27 M  is a schematic side view of another exemplary embodiment of a tunneling station for use in manufacturing a tissue augmentation construct; 
         FIG.  28    is a side view of one exemplary embodiment of a tissue augmentation construct; 
         FIG.  29 A  is a perspective view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  29 B  is a perspective view of the tissue augmentation construct of  FIG.  29 A  installed at a surgical site; 
         FIG.  30 A  is a side view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  30 B  is a top view of the tissue augmentation construct of  FIG.  30 A ; 
         FIGS.  30 C- 30 E  are schematic sequential views of an exemplary embodiment for manufacturing the tissue augmentation construct of  FIG.  30 A ; 
         FIG.  30 F  is a schematic view of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  30 A ; 
         FIGS.  30 G- 30 I  are schematic sequential views of one exemplary embodiment for installing a tissue augmentation construct similar to that of  FIG.  30 A ; 
         FIG.  30 J  is a perspective view of still another exemplary embodiment of a tissue augmentation construct, the tissue augmentation construct having collapsible loops disposed thereon; 
         FIG.  30 K  is a perspective view of the tissue augmentation construct of  FIG.  30 J  having suture limbs passed through the collapsible loops; 
         FIG.  30 L  is a schematic view of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  30 J ; 
         FIG.  31 A- 31 C  are schematic sequential views of a further exemplary embodiment for manufacturing a tissue augmentation construct; 
         FIG.  32 A  is a top view of still another exemplary embodiment of a tissue augmentation construct; 
         FIGS.  32 B- 32 E  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  32 A ; 
         FIGS.  32 F- 32 H  are schematic sequential views of one exemplary embodiment for installing a tissue augmentation construct similar to that of  FIG.  32 A ; 
         FIGS.  32 I- 32 J  are schematic sequential views of one exemplary embodiment for manufacturing the tissue augmentation construct of  FIG.  32 A ; 
         FIGS.  33 A- 33 E  are schematic top views of various exemplary embodiments of tissue augmentation constructs and suture configurations; 
         FIG.  34 A  is a top view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  34 B  is a side view of the tissue augmentation construct of  FIG.  34 A ; 
         FIGS.  34 C- 34 J  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  34 A ; 
         FIG.  34 K  is a schematic view of another exemplary embodiment for installing the tissue augmentation construct of  FIG.  34 A ; 
         FIG.  35 A  is a top view of still another exemplary embodiment of a tissue augmentation construct; 
         FIG.  35 B  is a side view of the tissue augmentation construct of  FIG.  35 A ; 
         FIGS.  35 C and  35 D  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  35 A ; 
         FIG.  36 A  is a top view of another exemplary embodiment of a tissue augmentation construct; 
         FIG.  36 B  is a side view of the tissue augmentation construct of  FIG.  36 A ; 
         FIGS.  36 C- 36 I  are schematic sequential views of one exemplary embodiment for installing the tissue augmentation construct of  FIG.  36 A ; 
         FIGS.  37 A- 37 E  are schematic sequential views of one exemplary embodiment for installing a tissue augmentation construct; 
         FIG.  38 A  is a top view of one exemplary embodiment of a tissue augmentation construct management device; 
         FIG.  38 B  is a bottom view of the tissue augmentation construct management device of  FIG.  38 A ; 
         FIG.  38 C  is a schematic side view of a release mechanism of the tissue augmentation construct management device of  FIG.  38 A ; 
         FIG.  38 D  is a schematic side view of an alternative exemplary release mechanism that can be used in conjunction with a tissue augmentation construct management device like the device of  FIG.  38 A ; 
         FIG.  38 E  is a top view of another exemplary embodiment of a tissue augmentation construct management device; 
         FIG.  38 F  is a perspective exploded view of the tissue augmentation construct management device of  FIG.  38 E ; 
         FIG.  38 G  is a top view of a threader of the tissue augmentation construct management device of  FIG.  38 A ; 
         FIG.  38 H  is a rear perspective view of the threader of  FIG.  38 G ; 
         FIGS.  39 A- 39 F  are schematic sequential views illustrating a method for using still another exemplary embodiment of a tissue augmentation construct management device; 
         FIG.  40    is a perspective view of another exemplary embodiment of a tissue augmentation construct management device; 
         FIG.  41 A  is a perspective view of another exemplary embodiment of a tissue augmentation construct; 
         FIGS.  41 B- 41 D  are various exemplary embodiments of distal ends of delivery tools that can be used with the tissue augmentation construct of  FIG.  41 A ; 
         FIG.  41 E  is a perspective view of the delivery tool of  FIG.  41 B  being used to deliver the tissue augmentation construct of  FIG.  41 A ; 
         FIG.  42 A  is a side cross sectional view of yet another exemplary embodiment of a delivery tool for delivering a tissue augmentation construct; 
         FIGS.  42 B and  42 C  are schematic sequential views of the delivery tool of  FIG.  42 A  being used to deliver a tissue augmentation construct; and 
         FIG.  43    is a schematic view of one exemplary embodiment of a suture leader. 
     
    
    
     DETAILED DESCRIPTION 
     Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present disclosure is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present disclosure. Further, in the present disclosure, like-numbered components of the embodiments generally have similar features. Additionally, to the extent that linear or circular dimensions are used in the description of the disclosed systems, devices, and methods, such dimensions are not intended to limit the types of shapes that can be used in conjunction with such systems, devices, and methods. A person skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. Sizes and shapes of the systems and devices, and the components thereof, can depend at least on the anatomy of the subject in which the systems and devices will be used, the size and shape of components with which the systems and devices will be used, and the methods and procedures in which the systems and devices will be used. 
     The figures provided herein are not necessarily to scale. Still further, to the extent arrows are used to describe a direction of movement, these arrows are illustrative and in no way limit the direction the respective component can or should be moved. A person skilled in the art will recognize other ways and directions for creating the desired result in view of the present disclosure. Additionally, a number of terms may be used throughout the disclosure interchangeably but will be understood by a person skilled in the art. By way of non-limiting example, the terms suture, filament, and flexible members may be used interchangeably, and includes other similarly purposed materials, such as suture tape. Further, to the extent the term “block” is used to describe some of the constructs and matrices provided for herein, the constructs and matrices are not limited to a square or a rectangle, or any shape having flat surfaces for that matter. Still further, to the extent the term “thread” is used to describe associating one component with another, the term is not limited to mean actually passing filament through another material. It can also include passing it through an opening (e.g., an opening formed in a body, as described below at least with respect to some tissue augmentation blocks), and thus can more generally mean associating one component with another. 
     Systems, devices, and methods for soft tissue repair are generally provided, with such systems or devices including but not being limited to: one or more surgical repair filaments and/or flexible members; one or more tissue augmentation constructs or matrices, which include strips, tubes, bars, tacks, washers, and/or patches, each of which is described in greater detail below; and one or more suture implants or similarly configured or purposed devices. The terms “tissue augmentation construct” and “tissue augmentation matrix” may also be interchangeably used with the terms “suture augmentation construct” and “suture augmentation matrix,” as well as more generally with the terms “augmentation construct” and “augmentation matrix,” and the terms “construct” and “matrix.” As described herein, the term “construct” refers to any implant associated with suture limbs to expand the footprint of the limb, the term “block” refers to a subset of constructs that includes strips or tapes, tubes, bars, washers, and other cannulated bodies, and the terms “tack” or “button,” and “patches” or “scaffold” are described in greater detail below (as are the terms strips, tapes, tubes, bars, and washers, among others). Surgical repair filaments or flexible members can come in a variety of configurations including in typical suture configurations and tape forms, and can be used in connection with a variety of types of suture implants, e.g., filament anchors, suture anchors, or bone anchors, including hard and soft anchors, to attach or reattach soft tissue to bone. The repair filaments can pass through soft tissue so that the soft tissue can be positioned in a desired location. The repair filaments are secured to anchors which, in turn, are fixed in bone. The tissue augmentation construct(s) can be associated with the surgical repair filaments to increase coverage and bulk to compromised or degenerate soft tissue, to increase a surface area along which compression between the suture repair filament and tissue being repaired is applied, and to help promote tissue growth and repair. While each of the repair filament, tissue augmentation construct, and suture implant is described as being part of the systems or devices, any one component can be provided for separately for use with the other components or other implants and devices used in surgical procedures. 
     While many different repair procedures can be enhanced by the present disclosures, in some exemplary embodiments the soft tissue repair devices and systems provided for herein can be used for rotator cuff fixation procedures. In rotator cuff fixation procedures a surgeon can reattach the rotator cuff to the bone by first threading a suture through the soft tissue such that two suture limbs extend from the tissue. The surgeon can thread each of the suture limbs through respective tissue augmentation constructs, and subsequently fix the suture limbs to one or more bone anchors proximate to the tissue. The tissue augmentation constructs increase the surface area, or footprint, of the system that contacts the soft tissue. This enlarged footprint may disperse any loading forces on the soft tissue, and, as a result, the tensioned suture may be less likely to abrade or otherwise damage the soft tissue, for instance by “cheese wiring.” Moreover, the tissue augmentation constructs can be easily and quickly threaded onto or otherwise associated with suture limbs during the procedure, which contrasts from existing systems that involved complicated, time-intensive approaches for associating xenograft or allograft formations with suture limbs. The resulting procedures thus allow for the tissue augmentation constructs to be added onto suture limbs in an on-demand fashion. Still further, the tissue augmentation constructs can be made from biocompatible materials (e.g., collagen), among other types of materials, such that during healing new bands of tissue growth can occur, further increasing the efficacy of the rotator cuff fixation procedure. In other non-limiting exemplary embodiments disclosed herein, the soft tissue repair devices and systems can be used in other soft tissue repair procedures for example, repair of torn anterior cruciate ligament (ACL), instability or glenoid procedures, meniscal repair, superior capsule reconstruction, and hip capsular closure, among others. Various methods of manufacturing the tissue augmentation constructs, as well as using installation tools and/or threaders to associate tissue augmentation constructs with operative sutures are also described. 
     Tissue Augmentation Constructs—Tissue Augmentation Blocks Having a Strip or Tape Configuration 
     One exemplary embodiment of a tissue augmentation construct, as shown a tissue augmentation block  10 , is provided for in  FIGS.  1 A and  1 B . In one exemplary embodiment, the tissue augmentation block  10  is a strip or tape configured to be threaded onto or otherwise associated with a suture limb  12   a.  More particularly, the tissue augmentation strip or tape  10  can have a substantially rectangular shape with a width W, length L, and thickness T, and includes a substantially flat, tissue-engaging surface  10   a  and/or  10   b.  As shown, the tape  10  is longer than it is wide and wider than it is thick. Typically the length L is substantially greater than the width W and the width W is substantially greater than the thickness T. Further, the width W can be greater than a diameter of a filament or suture with which the tissue augmentation tape  10  is associated, e.g., the suture limb  12   a,  thereby increasing the surface area of compression of the system or device used in the surgical repair. 
     A person skilled in the art will recognize that the dimensions of the length L, width W, and thickness T of the tissue augmentation strip  10  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. In some embodiments a ratio of the width W of the strip  10  to a diameter of the suture limb  12   a  can be approximately in the range of about 2:1 to about 20:1, and more particularly the width W can be at least three times greater than the diameter of the filament or suture with which the tissue augmentation strip  10  is associated in some instances. In embodiments in which the suture limb  12   a  is a suture tape, the width W of the tissue augmentation strip  10  can be at least two times greater than the diameter of the suture tape with which the strip is associated in some instances. A person skilled in the art will recognize that the ratio of the width of a tissue augmentation strip to diameter of the filament or related structure with which the strip is used can be any suitable ratio, depending, at least in part, on the type of filament or related structure being used, the type of strip or other construct being used, and the type of procedure being performed, and thus a ratio of width to diameter may be smaller or larger than those provided for herein. Further, in some embodiments a ratio of the width L of the strip  10  to the width W of the strip  10  can be approximately in the range of about 2:1 to about 20:1, and more particularly the length L can be at least three times greater than the width W in some instances, at least five times greater in some other instances, and at least ten times greater in some instances, although other L-W ratios are possible. Still further, the strip  10  can be substantially flat and approximately uniform. In some embodiments a ratio of the width W of the strip  10  to the thickness T of the strip  10  can be approximately in the range of about 2:1 to about 20:1, and more particularly the width W can be at least three times greater than the thickness T in some instances, at least five times greater in some other instances, and at least ten times greater in some instances, although other W-T ratios are possible. A variety of other sizes and shapes of the tissue augmentation tape strip  10 , including ratios of the dimensions of the tissue augmentation strip and associated components (e.g., the suture limb  12   a ) can be utilized without departing from the spirit of the present disclosure. 
     While ratios can be useful to help describe the relationship between the strip  10  and the filament limb  12   a,  and the relationship between the dimensions of the strip  10 , some exemplary, non-limiting dimensions for a tissue augmentation strip can also be useful in understanding the present disclosure. As mentioned above, these dimensions can be dependent on a variety of factors. In some embodiments, the length L can cover a significant portion, to almost an entire portion, of a length of tissue extending between a stitch made in tissue and a bone anchor used to help secure the tissue. In some embodiments, the length L can be approximately in the range of about 5 millimeters to about 1 centimeter, the width W can be approximately in the range of about 1 millimeter to about 5 millimeters, and the thickness T can be approximately in the range of about 0.5 millimeter to about 3 centimeters. Further, while the strip  10  is described as having a length, width, and thickness, and it is shown as being substantially flat in  FIG.  1 A ,  FIG.  1 B  illustrates that the strip  10  can be relatively flexible, for instance it can be bunched in portions by the suture limb  12  passing therethrough. Materials used to form the strip  10  are described in a later section of the present disclosure. 
     A number of techniques can be used to associate the tissue augmentation strip  10  with the suture limb  12   a.  As shown in  FIG.  1 B , the suture limb  12   a  is threaded from a top side  10   a  to a bottom side  10   b  and back to the top side  10   a  of the tissue augmentation strip  10 . The process of threading the suture limb  12   a  through the tissue augmentation strip  10  can be repeated as many times as desired. In some embodiments a suture threader can be threaded through the tissue augmentation strip  10  ahead of a procedure so that the operative suture can be threaded through the tissue augmentation strip in vivo during the procedure. Exemplary suture threaders are discussed below with regards to alternative tissue augmentation constructs. 
     While the tissue augmentation strip  10  of  FIG.  1 B  is shown having an exaggerated, wave-like profile when engaged with the suture limb  12   a,  in practice the tissue augmentation strip  10  can conform to the geometry of the soft tissue that it is contacting. By including the tissue augmentation strip  10  on the suture limb  12   a,  the suture limb  12   a  has a broader foot print, thus covering more surface area of the tissue. Further the tissue augmentation strip  10  may allow force applied to the tissue by the suture limb  12   a  to be distributed over a larger amount of surface area. The larger amount can be dependent on the surface area of the tissue augmentation strip  10 . Thus, in embodiments where the width of the tissue augmentation strip  10  is at least three times greater than the diameter of the suture limb  12   a,  the force of the suture limb  12   a  on the tissue may be distributed over an area that is at least three times greater than would otherwise be if no tissue augmentation strip  10  was associated with the suture limb  12   a.  The increased tissue surface area coverage and distributed force of the tissue augmentation strip  10  may result in a reduced pressure peak on the soft tissue. In use, it is either the surface  10   a  or the surface  10   b  that engages the tissue and may allow for the increased distribution. Where the soft tissue has become degenerated due to injury or age, a reduction in pressure can result in less chance of abrasion of the tissue. Further, the broader tissue coverage may enhance healing of otherwise compromised tissue. 
     The suture limb  12   a  used in conjunction with the tissue augmentation strip  10  can be any type of suture (e.g., braided filament, cannulated filament, mono filament, suture tape, etc.) and can have a size between about a #5 filament (about 20 gauge to about 21 gauge) and about a #3-0 filament (about 29 gauge to about 32 gauge). A person skilled in the art will recognize a variety of other filament types and sizes that can also be used in conjunction with the augmentation strip  10 , such as, if a suture tape is used. 
     Tissue Augmentation Constructs—Tissue Augmentation Constructs Having a Cannulated Portion 
     Another exemplary embodiment of a tissue augmentation construct, as shown a tissue augmentation block  110 , is provided for in  FIGS.  2 A- 2 D . Alternatively, tissue augmentation constructs, like block  110 , can be referred to generally as tissue augmentation constructs having a cannulated body. Tissue augmentation constructs having a cannulated body can include the tube  110 , bars  3010 ,  3010 ′, and washers  310 ,  410 . In one exemplary embodiment of augmentation blocks, the blocks can be a cannulated tube configured to be disposed on or otherwise associated with a suture limb  112   a.  More particularly, the augmentation tube  110  can have a substantially cylindrical, or ovoid, body with a bore or lumen  114  extending therethrough from a proximal-most end  110   p  to a distal-most end  110   d.  To the extent the block  110  is described as a tube, such description in no way limits the configuration of the tissue augmentation blocks to being tubes or having a tubular construction. A tube-like configuration is one of a variety of configurations of blocks provided for herein or otherwise derivable herefrom. Other non-limiting embodiments of blocks include but are not limited to bars and washers, as further described below. 
     Turning back to the cannulated nature of the block  110 , the bore  114  can be used, for example, to receive the suture limb  112   a  so that the block  110  and limb  112   a  can be associated with each other, as described in greater detail below. As shown, the block  110  has a length L′ that is greater than a diameter D, and in many instances substantially greater. Further, the diameter D can be greater than a diameter of a filament or suture with which the tissue augmentation block  110  is associated, e.g., the suture limb  112   a,  thereby increasing the surface area of tissue augmentation of the system or device used in the surgical repair. 
     A person skilled in the art will recognize that the dimensions of the length L′ and diameter D of the tissue augmentation tube  110 , as well as a diameter d of the bore  114 , can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. In some embodiments a ratio of the length L′ and the diameter D can be approximately in the range of about 2:1 to about 20:1, and more particularly the length L′ can be at least three times greater than the diameter D in some instances. Further, in some embodiments a ratio of the diameter D of the tube  110  to a diameter of the suture limb  112   a  can be approximately in the range of about 2:1 to about 20:1, and more particularly the diameter D can be at least three times greater than the diameter of the filament or suture with which the tissue augmentation tube  110  is associated in some instances. A variety of other sizes and shapes of the tissue augmentation tube  110 , including ratios of the dimensions of the tissue augmentation block and associated components (e.g., the suture limb  112   a ) can be utilized without departing from the spirit of the present disclosure. 
     While ratios can be useful to help describe the relationship between the tube  110  and the filament limb  112   a,  and the relationship between the dimensions of the tube  110 , some exemplary, non-limiting dimensions for a tissue augmentation tube can also be useful in understanding the present disclosure. As mentioned above, these dimensions can be dependent on a variety of factors. In some embodiments, the length L′ can cover a significant portion, to almost an entire portion, of a length of tissue extending between a stitch made in tissue and a bone anchor used to help secure the tissue. In some embodiments, the length L′ can be approximately in the range of about 5 millimeters to about 2 centimeter, and the diameter D can be approximately in the range of about 1 millimeter to about 5 millimeters. The size of the diameter d of the bore  114  can also depend on a variety of factors, including but not limited to the size of the limb to be passed therethrough. In some embodiments, the diameter d can be approximately in the range of about 0.75 millimeters to about 3 millimeters. 
     Alternative embodiments of tissue augmentation blocks  110  having cannulated portions are shown in  FIGS.  2 E,  2 F,  2 G,  2 H, and  2 I . Not all tissue augmentation blocks have cannulated portions, although that is a common feature of the blocks  110 ,  3010 ,  3110 ,  2810   a,    2810 ′,  2810 ″ provided for in  FIGS.  2 A- 2 I . Other configurations of tissue augmentation blocks do not have cannulated portions, or cannulated portions through which sutures limbs are passed, and thus other configurations can be associated with limbs using other techniques provided for herein otherwise known to those skilled in the art. 
     As discussed above, and shown in  FIGS.  2 E and  2 F , tissue augmentation bars  3010 ,  3110  can have a rectangular and/or square cross sectional shape. Other cross sectional shapes are possible and include, for example, triangular, quadrilaterals, pentagons, hexagons, octagons, etc. As shown in  FIG.  2 E , cannulated bar  3010  is configured to be disposed on or otherwise associated with a suture limb, as described above with respect to the cannulated tube  110 . More particularly, the bar  3010  can have a substantially rectangular body with a rectangular bore or lumen  3014  extending therethrough from a proximal-most end  3010   p  to a distal-most end  3010   d.  The bore  3014  can be used, for example, to receive the suture limb so that the bar  3010  and suture limb can be associated with each other, as described in greater detail below. It is contemplated that bore  3014  can be created through manufacturing techniques discussed below with respect to augmentation block  110 . 
     An alternative construction of tissue augmentation bar  3010 , tissue augmentation bar  3110 , is shown in  FIG.  2 F . As shown in  FIG.  2 F , the cannulated bar  3110  is configured to be disposed on or otherwise associated with a suture limb, as described above with respect to the cannulated blocks  110 ,  3110 . More particularly, the bar  3110  can have a substantially rectangular body with a rectangular bore or lumen  3114  extending therethrough from a proximal-most end  3110   p  to a distal-most end  3110   d.  The bore  3114  can be used, for example, to receive the suture limb so that the bar  3110  and suture limb can be associated with each other, as described in greater detail below. As shown, bar  3110  can be constructed of two portions of material,  3110   a,    3110   b.  The two pieces of material  3110   a,    3110   b  can be associated with each other by means of sutures  3124   a,    3124   b.  The pieces of material  3110   a,    3110   b  can be attached to each other such that lumen  3114  is formed using any manufacturing techniques discussed throughout the present disclosure. A variety of other sizes and shapes of the bars  3010 ,  3110  including ratios of the dimensions of the bar and associated components (e.g., the suture limb) can be utilized without departing from the spirit of the present disclosure. 
     Further alternative configurations of tissue augmentation blocks  2810   a,    2810 ′, and  2810 ″ are illustrated in  FIGS.  2 G,  2 H, and  2 I , respectively. As shown, the cannulated blocks  2810   a,    2810 ′,  2810 ″ can all be substantially the same as tissue augmentation block  110 , as shown in  FIGS.  2 A- 2 D . Alternatively, the cannulated blocks  2810   a,    2810 ′,  2810 ″ can have configurations substantially similar to the tissue augmentation bars  3010 ,  3110 . The cannulated blocks  2810   a,    2810 ′,  2810 ″ can have a length that is substantially longer than the tissue augmentation blocks  110 . In one exemplary embodiment, the block  2810   a  can have a length approximately in the range of about 15.0 millimeters to about 25.0 millimeters. Advantageously, blocks  2810   a,    2810 ′,  2810 ″ can have a length that can extend from lateral anchors medially up and over a soft tissue repair to provide for additional protection for the repair and additional scaffolding to aid in healing. 
     A number of techniques can be used to associate the tissue augmentation blocks  110 ,  3010 ,  3110 ,  2810   a,    2810 ′,  2810 ″ with a suture limb  112   a.  For example, as shown in  FIG.  2 A , the suture limb  112   a  is threaded or passed from the proximal-most end  110   p  to the distal-most end  110   d  of the tissue augmentation tube  110  without passing through, that is across, the body of the tube  110 . In other words, the suture limb  112   a  does not pass into a sidewall of the body that defines the lumen  114 . As such, the tube  110  is not coupled or attached to the suture limb  112   a,  and instead can freely pass along a length of the limb  112   a  unhindered or unrestricted. In other embodiments, the limb  112   a  can pass through, that is across, the body once or more to further secure a location of the tube  110  with respect to the limb  112   a,  thereby coupling or attaching the tube  110  to the suture limb  112   a.  A person skilled in the art will recognize a variety of other ways by which the tube  110  can be associated or coupled with the limb  112   a  without departing from the spirit of the present disclosure. 
     The tissue augmentation tube  110  can be threaded by hand on to the suture limb  112   a,  either at the surgical site, or outside of the body. Alternatively, as shown in  FIGS.  2 B and  2 C , the tissue augmentation tube  110  can have a threader  206  inserted through the bore  114  prior to the tissue augmentation tube  110  being threaded onto the suture limb  112   a.  The threader  206  can include a proximal handle portion  208 , an intermediate elongate portion  210 , and a distal suture-receiving end  212 . The proximal handle portion  208  can be configured to be easily gripped by a user, for instance by having a substantially rectangular shape as shown. Other shapes and features for gripping can be provided. The intermediate portion can be a filament portion  210  capable of having a tissue augmentation construct, e.g., the tissue augmentation tube  110 , associated therewith, thereby allowing the threader  206  to be flexible. The distal suture-receiving end  212  can have a distal opening  212  through which a suture to be associated with a augmentation strip, e.g., suture limb  112   a,  can be disposed. In the illustrated embodiment, the distal opening  212  is flexible and, in some embodiments, can be made of a wire, a fiber, a thread, a cord, and/or other flexible structure or other material having similar characteristics. Because the distal opening  212  is flexible, it can change shape before, during, and after use, and thus while in the illustrated embodiment it has a diamond or kite-shape, other configurations are possible. Further, the flexible nature of the opening  212  can allow the opening  212  to collapse around a suture disposed therein to strangulate or otherwise hold the suture during use. In some embodiments, the intermediate portion  210  can also be made of a wire, a fiber, a thread, a cord, and/or other flexible structure. The term wire is not intended to imply that the structure is made of metal, or has metal characteristics, but the intermediate portion  210  and the distal suture-receiving end  212  can be made of metal. 
       FIGS.  2 G- 2 I  provide for additional configurations of suture limbs being associated with tissue augmentation constructs. As shown in  FIG.  2 G , the construct  2810   a  can include two threaders disposed therethrough for associating the construct  2810   a  with at least one suture limb. As illustrated in  FIG.  2 G , a first threader  2809   a  can be disposed through the block  2810   a  from a top surface  2811   t  to a bottom surface  2811   a  such that the handle  2808   a  is proximate the top surface  2811   t  and the receiving end  2807   b  is proximate the bottom surface  2811   b.  The first threader  2809   a  can be disposed through the block  2810   a  such that it intersects the central lumen  2870  of the block  2810   a  substantially perpendicularly relative thereto. Alternatively, the threader  2809   a  can be disposed at any angle relative to the central lumen  2870 . The first threader  2809   a  can be disposed at the proximal end  2811   p,  or proximal half, of the block  2810   a.  A second threader  2809   b  can be disposed through a distal portion  2811   d  of the block  2810   a.  For example the second threader  2809   b  can extend from a distal end  2811   d  of the block  2810   a  through the lumen  2870  to a medial location  2870   m  of the lumen and out of the bottom  2811   b  of the block  2810   a.  In one exemplary embodiment the second threader  2809   b  can extend through the block  2810   a  such that a handle portion  2808   b  of the threader  2809   b  is proximate the distal end  2811   d  of the block  2810   a  and the receiving end  2807   b  of the threader extends out the bottom  2811   b  of the block  2810   a.  Alternatively, other suture threader configurations are contemplated as shown in  FIGS.  2 H and  2 I  and discussed below. 
     In one alternative suture threader configuration, as shown in  FIG.  2 I , block  2810 ′ can include a pre-threaded suture  2814 ′ in the proximal end  2811   p ′ of the block, obviating the need for a second threader. The pre-threaded suture  2814 ′ can be threaded into block  2810 ′ at a location that is substantially similar to the second threader  2809   b  of  FIG.  2 G . The pre-threaded suture  2014 ′ can be threaded into the block  2810 ′ either before or after the block is associated with a repair suture, not shown. In a further alternative configuration, as shown in  FIG.  2 H , block  2810 ″ can include two threaders  2809   a ″ and  2809   b ″. The threaders  2809   a ″,  2809   b ″ can be substantially similar to threaders  2809   a,    2809   b  discussed above. As shown, the second threader  2809   b ″ can be disposed through a central lumen  2870 ″, for example from the proximal terminal end  2811   p ″ to the distal terminal end  2811   d ″. Alternatively, the second threader  2809   b ″ can extend through any length of the central lumen  2870 ″. The second threader  2809   b ″ can associate suture limbs, not shown, with the block  2810 ″ using techniques provided for throughout the present disclosure. The suture limbs can each exit the block  2810 ″ at the distal end  2811   d ″ along with a repair suture limb to be subsequently anchored into the bone at a location laterally offset from the soft tissue repair. 
     In use, a force P 1  can be applied to the handle portion  208  to move the filament portion  210  and the distal opening  212  in the direction of the force P 1  with respect to the augmentation tube  110 . The distal opening  212 , and thus the suture limb  112   a  coupled thereto, can be drawn into and through the augmentation tube  110  by way of this movement, thus disposing the augmentation tube  110  onto the suture limb  112   a.  As the distal opening  212  enters the augmentation tube  110 , the opening  212  can be collapsed, e.g., compressed to a smaller width, around the suture limb  112   a  to strangulate the limb  112   a,  thus making it easier for the suture limb  112   a  to be drawn into a body of the augmentation tube  110 . Once the augmentation tube  110  is disposed on or is otherwise associated with the suture limb  112   a,  the suture limb  112   a  can be disassociated with the distal opening  212  and the threader  206  can be discarded or reused since it is no longer associated with either the augmentation tube  110  or the suture limb  112   a.  The combination of the suture limb  112   a  and the augmentation tube  110  can then be used in a variety of procedures, as detailed further below. The process of disposing the augmentation tube  110  onto the suture limb  112   a  can occur outside of the body or inside the body, including proximate to the surgical site. 
     Similar to the tissue augmentation strip  10 , by including the tissue augmentation tube  110  on the suture limb  112   a,  the suture limb  112   a  has a broader footprint, thus covering more surface area of the tissue. Further, the tube  110  may allow force applied to the tissue by the suture limb  112   a  to be distributed over a larger amount of surface area. The larger amount can be dependent on the surface area of the tissue augmentation tube  110 . Thus, in embodiments where the diameter of the tissue augmentation tube  110  is at least three times greater than the diameter of the suture limb  112   a,  the force of the suture limb  112   a  on the tissue may be distributed over an area that is at least three times greater than would otherwise be if no tissue augmentation tube  110  was associated with the suture limb  112   a.  The increased tissue surface area coverage and distributed force of the tissue augmentation tube  110  may result in a reduced pressure peak on the soft tissue. Where the soft tissue has become degenerated due to injury or age, an increased tissue surface area coverage and a reduction in pressure can result in less chance of abrasion of the tissue. Further, the broader tissue coverage may enhance healing of otherwise compromised tissue and/or provide bulk to otherwise compromised or degenerate tissue and/or tendon. 
     Threaders like the threader  206  can also be used in conjunction with an installation tool to assist in associating an augmentation construct with a suture.  FIG.  3    provides for a threader  206 ′ that is similar to the threader  206  except that the proximal handle portion  208 ′ and distal receiving end  212 ′ have a slightly different shape. As shown, the proximal handle portion  208 ′ is in the form of a gripping protrusion  208 ′ that has a diameter that is greater than a diameter of the intermediate filament portion  210 ′, thus allowing a user to easily grip the proximal handle portion  208 ′. A person skilled in the art will recognize that the proximal handle portion  208 ′ can have most any shape. Likewise, a shape of the distal receiving end  212 ′ can also have most any shape. In the illustrated embodiment, the distal receiving end  212 ′ is a distal opening  212 ′, but the opening is illustrated as being more rounded than the distal opening  212 . However, as explained above, because the distal opening  212 ′ can be flexible, even the illustrated embodiments can be manipulated into other shapes. 
     The installation tool  200 ′ can include a handle portion  202 ′ and a cartridge portion  204 ′. The handle portion  202 ′ can be long such that the installation tool  200 ′ can be inserted through a cannula into a surgical site inside of the body. Alternatively, the handle portion  202 ′ can be any suitable length. As shown in  FIG.  3   , the handle  202 ′ includes a proximate portion  202   p ′ and a distal portion  202   d ′. The distal portion  202   d ′ of the handle  202 ′ can be angularly offset from the proximal portion  202   p ′ to allow for the cartridge  204 ′ to be oriented in a favorable orientation to thread the augmentation tube  110 ′ onto the limb  112   a ′. Alternatively, the proximal portion  202   p ′ and the distal portion  202   d ′ can be in line with each other. 
     The distal portion  202   d ′ can be attached to a cartridge  204 ′ that is sized to receive an augmentation tube  110 ′ to be threaded onto suture limb  112   a ′. The cartridge  204 ′ can be cylindrical in shape, having an approximately circular cross section. Alternatively, the cartridge  204 ′ can have a triangular, rectangular, or any other shape and/or cross section. The cartridge  204 ′ can have a lumen  214 ′ extending therethrough from a first opening  216 ′ to a second opening  218 ′. The first opening  216 ′ can be larger than the second opening  218 ′. Alternatively, the first opening  216 ′ and the second opening  218 ′ can be any desired size. As shown in  FIG.  3   , the first opening  216 ′ can have a diameter that is substantially the same as the lumen  214 ′ such that the augmentation tube  110 ′ can be placed therethrough. The second opening  218 ′ can have a diameter that is sized to receive a relevant portion of the threader  206 ′ therethrough. 
     As shown in  FIG.  3   , a suture limb  112   a ′ is inserted through the opening  212 ′ and the threader  206 ′ can be operated in a manner similar to the threader  206  to dispose the augmentation tube  110 ′ onto the suture limb  112   a ′. For example, an operator can grasp the handle portion  208 ′ of the threader  206 ′ to pull the opening  212 ′ through the cannula  114 ′ of the augmentation tube  110 ′ by the application of a force F P ′. The handle  208 ′ can be pulled until the entirety of the threader  206 ′ and a distal portion of the suture limb  112   a ′ have passed through the second opening  218 ′. Once the suture limb  112   a ′ has been threaded through the augmentation tube  110 ′, the threaders  206 ′ can be discarded or reused and the installation tool can release the augmentation tube  110 ′ by actuation of a release mechanism (not shown). Alternatively, the augmentation tube  110 ′ can be held in the cartridge  204 ′ with an interference fit, such that no release mechanism is required. While reference is made to augmentation tube  110 ′ and suture limb  112   a ′, as noted above, the installation tool  200 ′ can be used in the same manner with augmentation strip  10  of  FIGS.  1 A- 1 B , as well as other constructs provided for herein. Further, while threaders are discussed as being used in conjunction with an installation tool, the threader itself can be considered an installation tool since embodiments provided for herein allow the threader to be used to associate a suture with a augmentation construct without using the installation tool  200 ′. 
     Tissue Augmentation Constructs—Tissue Augmentation Blocks Having a Washer, Disc, or Ring Configuration 
     An exemplary embodiment of a tissue augmentation construct, as shown a tissue augmentation block  310 , is provided for in  FIG.  4   . The augmentation block  310  has a configuration that can be described as a washer, disc, or ring, and the illustrated embodiment it is a square-shaped washer configured to be disposed on or otherwise associated with a suture limb  312   a.  For example, the washer  310  can have a substantially rectangular prism-shaped body with a bore or lumen  314  extending therethrough from a proximal-most end  310   p  to a distal-most end  310   d.  The bore  314  can be used, for example, to receive the suture limb  312   a  so that the washer  310  and limb  312   a  can be associated with each other, as described in greater detail below. As shown, the washer  310  has a length L B  and a width W B  which are substantially equal, and height T B  which is less than the length L B  and the width W B . Alternatively, the washer  310  can have a more elongated rectangular shape having a length L B  that is larger than the width W B . In a further alternative, the length L B , width W B , and the height T B  can be substantially equal, thereby forming a cube-shaped body. Further, the diameter d B  of the lumen can be greater than a diameter of a filament or suture with which the washer  310  is associated, e.g., the suture limb  312   a.  In other embodiments the suture limb  312   a  can be threaded through the washer  310  without a preformed lumen. Once the block is associated with the suture limb  312   a,  the block can increase the surface area of compression of the system or device used in the surgical repair due to the increased surface area of the block. 
     A person skilled in the art will recognize that the dimensions of the length L B , width W B , thickness or height T B , and diameter d B  of the washer  310  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. In some embodiments, the washer  310  can have a length L B  approximately in the range of about 3 millimeters to about 6 millimeters, a width W B  in the range of about 3 millimeters to about 6 millimeters, and thickness or height T B  approximately in the range of about 1 millimeter to about 3 millimeters. Alternatively, the length L B , width W B , and thickness or height T B  can all be substantially equal and have a dimension approximately in the range of about 2 millimeters to about 5 millimeters. One benefit to the smaller dimensions of the washer  310  is that a surgeon can load a plurality of the washers  310  onto a single suture limb, as described further below, to allow for precision application of the washers on areas of the damaged tissue where they are required. For example, precision application of the washers can include moving the washers along a length of a suture limb to more precisely direct where force from the suture limb will be distributed across a greater surface area. In view of the present disclosures, it is clear that the thickness or height of the washers  310  can be substantially less than a length of suture limb on which the washers  310  are disposed. Any number of washers  310  can be disposed on the suture limb, including but not limited to up to 30. In some exemplary embodiments, the number of washers  310  provided on a single suture limb is approximately in the range of about 2 blocks to about 8 blocks. 
     An alternative embodiment of an augmentation construct configured to be effectively used in conjunction with other similarly sized constructs on the same suture limb is illustrated in  FIG.  5   . As shown, the tissue augmentation construct is a tissue augmentation block  410  that has a configuration that can be described as a washer, disc, or ring. In the illustrated embodiment, it is a ring or circular-shaped washer. For example, the tissue augmentation washer  410  can have a bore or lumen  414  extending therethrough from a proximal-most face  410   p  to a distal-most face  410   d.  The bore  414  can be used, for example, to receive the suture limb  412   a  so that the washer  410  and limb  412   a  can be associated with each other, or alternatively, the limb  412   a  can be associated with the washer  410  by threading it through the body of the ring without any preformed hole or bore. 
     A person skilled in the art will recognize that the dimensions of the diameter D W , height H W , and bore diameter d W  of the washer  410  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. In some embodiments, the diameter D W  can be approximately in the range of about 3 millimeters to about 6 millimeters, height H W  can be approximately in the range of about 1 millimeter to about 3 millimeters, and bore diameter d W  can be approximately in the range of about 0.5 millimeters to about 2 millimeters. Similar to the washer  310 , in view of the present disclosures, it is clear that the thickness or height of the washer  310  can be substantially less than a length of suture limb on which the washers  410  are disposed. Any number of washers  410  can be disposed on the suture limb, including but not limited to up to 30. In some exemplary embodiments, the number of washers  410  provided on a single suture limb is approximately in the range of about 2 washers to about 8 washers. 
     One benefit of the washers  310 ,  410  is that a surgeon can pass both anterior and posterior sutures through the washers  310 ,  410 , as described further below, at the suture insertion point to prevent cheese wiring at the suture insertion point by the sutures. Further, the washers  310 ,  410 , can be used in conjunction with any of the tissue augmentation constructs disclosed, including by disposing one or more washers  310 ,  410  onto the same suture limb on which another tissue augmentation construct is already, or will be, disposed. 
     A number of techniques known to those skilled in the art can be used to associate the washers  310 ,  410  with the respective suture limbs  312   a,    412   a.  The suture limb  312   a,    412   a  can be threaded or passed from the proximal-most end  310   p,    410   p  to the distal-most end  310   d,    410   d  of the washers  310  or  410  without passing into and/or through the body of the washers  310 , or  410 , i.e., the suture limb  312   a,    412   a  extends directly through the lumen  314 ,  414 . Thus, like the tube  110 , the washers  310 ,  410  can freely pass along a length of the suture limb  312   a,    412   a  unhindered or unrestricted since they are not coupled or attached to the suture limb  312   a,    412   a.  In other embodiments, the limb  312   a,    412   a  can pass through the body once or more to further secure a location of the washers  310   410  with respect to the limb  312   a,    412   a.  A person skilled in the art will recognize a variety of other ways by which the washers  310 ,  410  can be associated with the limbs  312   a,    412   a  without departing from the spirit of the present disclosure. For example, the washers  310  or  410  can be threaded by hand on to the suture limb  312   a,    412   a  either at the surgical site, or outside of the body. Alternatively, one or more washers  310  or  410  can have a threader (not shown) inserted through the respective bores  314 ,  414  prior to the washers  310  or  410  being threaded onto the suture limb  312   a,    412   a.  The threader can be the same or similar to the threaders  206 ,  206 ′ described above and can be used to thread a suture limb  312   a,    412   a  through the washer  310  or  410  at a surgical site. 
     Similar to augmentation blocks  10 ,  110 , by including either, or both of, the washers  310  or  410  on a suture limb, force applied to the tissue by the suture limb is distributed over a larger amount of surface area. The larger amount is dependent on the surface area of the augmentation washer  310  or  410 , as well as the number of washers used. 
     Materials for Forming Augmentation Constructs 
     The constructs discussed above, e.g., the blocks  10 ,  110 ,  3010 ,  3110 ,  310 , and  410 , as well as those provided for further below (including various patches or scaffolds) can be made of one or more biocompatible, bioresorbable materials so that after implantation into a patient to replace or repair connective tissue, the strip gradually degrades or remodels over time. The resorption profile of the constructs can be sufficiently long to reinforce and provide structure to tissue during the regeneration or healing process. A person skilled in the art can determine a suitable resorption profile, depending, at least in part, on the desired use of the construct, and can tailor the resorption profile by varying the materials used to form the construct. 
     While many different materials can be used to form the tissue augmentation constructs, either alone or in combination with other materials, in some instances the material is a biocompatible polymer. Exemplary embodiments of suitable biocompatible materials synthetic polymers, natural polymers, and combinations of the two. As used herein, the term “synthetic polymer” refers to polymers that are not found in nature, even if the polymers are made from naturally occurring biomaterials. As used herein, the term “natural polymer” refers to polymers that are naturally occurring. In embodiments where the tissue augmentation constructs includes at least one synthetic polymer, suitable biocompatible synthetic polymers can include polymers selected from the group that includes aliphatic polyesters, poly(amino acids), copoly(ether-esters), polyalkylene oxalates, polyamides, tyrosine derived polycarbonates, poly(iminocarbonates), polyorthoesters, polyoxaesters, polyamidoesters, polyoxaesters containing amine groups, poly(anhydrides), polyphosphazenes, polyurethanes, poly(ether urethanes), poly(ester urethanes), poly(propylene fumarate), poly(hydroxyalkanoate), polydioxanone, poly-hydroxybutyrate-co-hydroxyvalerate, polyaminocarbonate, polytrimethylene, polyoxaamides, elastomeric copolymers, and combinations or blends thereof. Suitable synthetic polymers for use in the tissue augmentation constructs can also include biosynthetic polymers based on sequences found in collagen, a collagen scaffold, pulverized collagen pieces, elastin, thrombin, silk, keratin, fibronectin, starches, poly(amino acid), gelatin, alginate, pectin, fibrin, oxidized cellulose, chitin, chitosan, tropoelastin, hyaluronic acid, ribonucleic acids, deoxyribonucleic acids, polypeptides, proteins, polysaccharides, polynucleotides, and combinations or blends thereof. The types of materials that can be used to construct tissue augmentation constructs, either wholly or in part, include non-absorbable polymers selected from the group that includes, but is not limited to, polyethylene, polypropylene, polyetheretherketone (PEEK), polytetrafluoroethylene, silicone, rubber, or other biocompatible non-absorbable polymers, and combinations thereof. Natural polymers for the use in augmentation strip  10  can be selected from the group that includes but is not limited to a fibrin-based material, collagen-based material, a hyaluronic acid-based material, a cellulose-based material, a silk-based material, a gelatin-based material, a glycoprotein-based material, a cellulose-based material, a polysaccharide-based material, a protein-based material, a fibronectin-based material, a chitin-based material, a pectin-based material, an elastin-based material, an alginate based material, a dextran-based material, an albumin-based material, a natural poly(amino acids) based material, a decellularized tissue, purified extracellular matrix (ECM), a demineralized bone matrix, and combinations thereof. 
     Still further, virtually any type of tissue can be used to form the tissue augmentation constructs, including but not limited to autograft tissue and allograft tissue, as well as human allogeneic tissue and xenogeneic tissue, which includes porcine, bovine, and equine among others. The tissue used can be selected from biological connective tissues that include ligament tissue, tendon tissue, a modeled tendon, skin tissue, muscle tissue, periosteal tissue, pericardial tissue, synovial tissue, dermal tissue, an acellular porcine dermal matrix, an acellular bovine dermal matrix, fascia, small intestine tissue, embryonic tissue, amniotic tissue, placental tissue, periodontal tissue, peritoneum tissue, vascular tissue, blood, and combinations thereof. The materials used to form the tissue augmentation constructs can be cross-linked and non-crosslinked, and any material provided for herein can be used in conjunction with other materials, whether synthetic, natural, or a combination thereof. Still further, the tissue augmentation constructs, and/or materials used to form the tissue augmentation constructs, can be treated with platelet-rich plasma (PRP), bone marrow, cells, and other bone and/or tissue growth-promoting materials. 
     The material used to form the tissue augmentation constructs can be made and/or formed, using a variety of techniques. These techniques include, but are not limited to, knitting them and weaving them. The overall construction of the materials can be described as being woven, knitted, non-woven, and/or a foam, among other constructions resulting from techniques known to a person skilled in the art. Further, a combination of techniques can be used for a single construct, and/or a portion thereof. The formation techniques can be used with materials, e.g., synthetic polymers and other materials provided for above, as well as tissue. 
     Tissue Augmentation Kits 
     The filaments and tissue augmentation constructs provided for herein can be included together as part of a soft tissue repair kit. Such a kit can also include components such as a threader, installation tool, bone anchors, and/or a bone drill. For example, one exemplary embodiment of a kit can include one or more tissue augmentation constructs and one or more threaders. In some instances, the tissue augmentation constructs can be pre-disposed on the threaders. The tissue augmentation constructs can include any of the constructs provided for herein or otherwise derivable from the present disclosures, including but not limited to the tissue augmentation blocks  10 ,  110 ,  3010 ,  3110 ,  310 ,  410  and the tissue augmentation patches  2210 ,  2310 ,  2410 , and  2510 , which are described below. The threaders can include the threaders  206 ,  206 ′, as well as other threaders known to those skilled in the art or otherwise derivable from the present disclosures. In instances where tissue augmentation constructs are pre-disposed on the threader, the constructs can be disposed on the intermediate portion  208 ,  208 ′ of the threaders  206 ,  206 ′. 
     The kit can also include other components used in conjunction with tissue augmentation constructs and threaders, including but not limited to one or more sutures, such as the sutures  12   a,    112   a,  one or more installation tools, such as the installation tool  200 ′, one or more implants, e.g., bone anchors, and one or more bone drills. In some exemplary embodiments the kit can include a tissue augmentation block  10 ,  110 ,  3010 ,  3110 ,  310 ,  410  for every suture limb  12   a,    112   a,    312   a,    412   a  that will be anchored over the soft tissue. The types and configurations of the filaments, constructs, installation tools (which can include threaders as stand-alone installation tools), and bone anchors can be varied, thus providing the user options for use in any surgical procedure. Accordingly, any combination of blocks having a strip or tape configuration (e.g., strip  10 ), a cannulated tube configuration (e.g., tube  110 ), a cannulated bar configuration (e.g., bar  3010 , bar  3110 ), and a washer configuration (e.g., washer  310 , washer  410 ), can be mixed and matched by a surgeon, as desired, including by disposing them on the same suture limb. The selection of constructs to be used can depend, at least in part on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. 
     The threader and/or installation tool can be a single device used to associate tissue augmentation constructs to limbs multiple times, or multiple threaders and tools can be provided to allow multiple strip-limb combinations to be formed or to allow for different configurations preferred by different users. The threader and/or installation tool can be specifically adapted to be used with particular tissue augmentation constructs, procedures, and/or surgeon&#39;s preferences without departing from the spirit of the present disclosure. 
     To the extent implants such as anchors are provided as part of a kit, or used in conjunction with any of the disclosures provided for herein, the implants can be any type of implant known to those skilled in the art that are used for various types of tissue repair procedures. For bone anchors, the anchors can be of a hard construction or a soft construction, and in some instances they can be knotless anchors, meaning filaments associated therewith do not need to have knots tied by the surgeon during the surgical procedure to couple the tissue to the filament and/or the anchor. Some exemplary embodiments of hard suture anchors for use in the kits or more generally with the present disclosures include Healix Ti™ anchors that are commercially available from DePuy Synthes, as well as Healix Advance™ anchors, Helix Advance Knotless™ anchors, Healix BR™ anchors, Healix PEEK™ anchors, Healix Transtend™ anchors, Bioknotless® anchors, Gryphon® anchors, Fastin® anchors, Versalok® anchors, Microfix® anchors, Minilok™ anchors, MicroQuickanchors® anchors, and Tacit® anchors, each of which is also commercially available from DePuy Mitek, Inc. Some exemplary embodiments of soft suture anchors for use in the kits or more generally with the present disclosures include those described in U.S. Pat. No. 9,345,567 of Sengun, the content of which is incorporated by reference herein in its entirety. 
     To the extent the kit includes a bone drill, any type of bone drill known by those having skill in the art for forming bone holes in which anchors can be disposed can be provided. 
     Methods of Use—Rotator Cuff Repairs 
     Exemplary methods for using systems, devices, and kits of the type described herein are now described in greater detail. While the methods described herein generally relate to attaching soft tissue to bone, and in this section of the disclosure are primarily discussed with respect to rotator cuff repairs, a person skilled in the art will recognize other types of procedures and repairs with which the constructs and the methods related to the same can be used. Further, to the extent a particular type of tissue augmentation construct is illustrated in the following embodiments, a person skilled in the art would understand how to employ other tissue augmentation constructs provided for herein without departing from the spirit of the present disclosures. Likewise, any sutures or anchors provided for herein or otherwise known to those having skill in the art can be used, including knotless anchors. Still further, while in the illustrated embodiments the lengths of sutures and limbs may be approximately equal, any suture or limb can be any desired length, and thus lengths of sutures and limbs do not need to be equal. Likewise, to the extent the techniques described below discuss having a certain number of suture limbs (e.g., one, two, three, etc.) extending from or otherwise associated with a suture anchor to perform the tissue repair, a person skilled in the art, in view of the present disclosures, will understand how a different number of limbs can be used to perform the same, or a similar type, of repair. A benefit that results from each of the methods described herein is that the tissue augmentation constructs can be associated with the suture being used in the repair in an on-demand manner, thus allowing a surgeon to quickly and easily associate one or more tissue augmentation constructs with the repair suture(s) to form desired footprints for the repair. 
     Rotator Cuff Repairs—Double Row Applications 
     A first exemplary method of soft tissue repair using tissue augmentation blocks  110 , illustrated as blocks  110   a,    110   b,  in conjunction with a double row application or repair is shown in  FIGS.  6 A- 6 C . The method involves fixing a piece of soft tissue  130 , e.g., rotator cuff, with respect to bone  150 . If the tissue augmentation blocks  110   a,    110   b  are dried, the tissue augmentation blocks  110   a,    110   b  can require rehydrating ahead of the procedure. An incision can be made to perform the procedure using any one of a traditional open repair, an arthroscopic repair, or a mini-open repair. Once the surgeon has access to the surgical site and the tissue and bone have been prepared according to accepted surgical techniques, the surgeon can use a medial row stitch  140  to install the suture  112  in the soft tissue  130 . Alternatively, any known stitch can be used. As shown in  FIGS.  6 A- 6 C , the medial row stitch  140  results in two suture limbs  112   a,    112   b  extending outwardly from the soft tissue. 
     As shown in  FIG.  6 B , the tissue augmentation blocks  110   a,    110   b  are disposed on suture limbs  112   a,    112   b,  respectively. The tissue augmentation blocks  110   a,    110   b  can be threaded onto the suture limbs  112   a,    112   b  by hand, with an installation tool  200 ′ (not shown), and/or with a threader  206 ,  206 ′. As discussed above with reference to  FIG.  3   , if the installation tool  200 ′ is used, a suture limb  112   a  can be passed through the opening, or cinch loop,  212 , then the handle portion  208  can be pulled to pull the threader  206  and suture limb through the tissue augmentation block  110   a.  Likewise, if just a threader  206 ,  206 ′ is used, a force can be applied to the threader to draw the suture limb  112   a  into and through the tissue augmentation block. Once the suture limb  112   a  has been threaded in the tissue augmentation block  110   a,  the threader  206  can be removed, and, if the installation tool  200 ′ was used, the tissue augmentation block  110   a  released from the installation tool  200 ′. The tissue augmentation blocks  110   a,    110   b  can be threaded onto the suture limbs  112   a,    112   b  at the surgical site inside of the body. Alternatively, the tissue augmentation blocks  110   a,    110   b  can be threaded outside of the body. 
     Once the blocks  110   a,    110   b  have been threaded onto the suture limbs  112   a,    112   b,  they can be advanced in the direction D 1  along the respective suture limbs  112   a,    112   b.  In the illustrated embodiment, the blocks  110   a,    110   b  are disposed proximate to the medial stitch  140  because the length of the blocks  110   a,    110   b  is similar to the length of the distance extending between the medial stitch  140  and the end of the tissue  130 . However, in embodiments in which the length of the blocks  110   a,    110   b  is less than that distance, the blocks  110   a,    110   b  may not necessarily be proximate to the medial stitch  140 , but can extend along some portion of the length of the limbs  112   a,    112   b  extending between the medial stitch  140  and the end of the tissue  130 . After the blocks  110   a,    110   b  have been installed on the respective suture limbs  112   a,    112   b,  the free ends of the suture limb  112   a,    112   b  can be secured within the body. For example, the free ends of each suture limb  112   a,    112   b  can be coupled to respective anchors  160   a,    160   b,  as shown in  FIG.  6 C , which in some exemplary embodiments can be knotless anchors. The suture limbs  112   a,    112   b  can then be tightened to secure the soft tissue  130  to the bone  150  before the anchors  160   a,    160   b  are fully fixed in the bone  150 , thus completing the double row lateral fixation associated with the medial stitch  140 . 
     This procedure can be repeated as many times as required to satisfactorily fixate the soft tissue  130  to the bone  150 . The blocks  110   a,    110   b  provide a greater footprint for the limbs  112   a,    1112   b,  and they may provide a greater surface area to distribute the loading forces of the suture limbs  112   a,    112   b  onto the soft tissue  130 . While the patient is healing from the procedure, new bands of tendon like tissue can form around the suture limbs  112   a,    112   b  and into and around the blocks  110   a,    110   b  to result in a more robust tissue formation in the soft tissue and between the soft tissue and bone. For example, blocks made from collagen scaffold or acellular dermal matrix material can be capable of remodeling while the patient is healing from the procedure into tendon like tissue and integrate with the native tissue. The additional coverage of tendon like tissue across the soft tissue can increase the strength of the tissue-to-bone connection and may prevent further injury. 
     Another exemplary soft tissue repair method is provided for in  FIGS.  7 A- 7 D . As shown, soft tissue  1030  is fixated to bone  1050  using an alternative double row application. Once the surgeon has access to the surgical site and the tissue, bone, and blocks  1010   a - 1010   c  have been prepared according to accepted surgical techniques, including those provided for herein, the surgeon can use medial row stitches  1040 ,  1042  to install sutures  1012 ,  1016  respectively, in the tissue  1030 . The blocks  1010   a - 1010   c  can be similar to the blocks  110 ,  3010 ,  3110 , or similar to other blocks and constructs as provided for in the present disclosure. Further, any known stitch can be used. The medial row stitch  1040  results in two suture limbs  1012   a,    1012   b  extending outwardly from the soft tissue, and the second medial row stitch  1042  results in two suture limbs  1016   a,    1016   b  extending outwardly from the soft tissue. 
     As shown in  FIG.  7 A , the blocks  1010   a - 1010   c  are threaded onto suture limbs  1012   a,    1012   b,    1016   b,  respectively, using techniques provided for throughout the present disclosure. For example, as illustrated in  FIG.  7 A , the block  1010   a  is threaded onto suture limb  1012   a  with the threader  206 . Once the block  1010   a  has been threaded onto the suture limb  1012   a,  as shown in  FIG.  7 B , it can be advanced in the direction D 1 ′ along the suture limb  1012   a  until it is proximate the medial stitch  1040  since the length of the block  1010   a  is similar to the distance extending between the medial stitch  1040  and the end of the tissue  1030 . Similarly, blocks  1010   b,    1010   c  can be advanced along the suture limbs  1012   b,    1016   b  until they are proximate the medial stitches  1040 ,  1042 , respectively. The block  1010   a  can be advanced along the suture limbs with an instrument like a knot pusher  1080  or other instrument suitable for advancing the strip along the limb. 
     Once the blocks  1010   b,    1010   c  have been installed on the respective suture limbs  1012   b,    1016   b,  as shown in  FIG.  7 C , the free ends of suture limbs  1012   b,    1016   b  can be secured within the body, for instance by attaching them to the anchor  1060   b  in a lateral row fixation. Similarly, once the block  1010   a  has been installed on the suture limbs  1012   a,  the free ends of the suture limbs  1012   a,    1016   a  can be secured within the body, for instance, by attaching them to anchor  1060   a  in a lateral row fixation. As shown in  FIG.  7 C , the suture limbs  1012   b,    1016   b  are installed into the anchor  1060   b  before the suture limbs  1012   a,    1016   a  are installed into the anchor  1060   a,  such that suture limb  1016   a  rests atop the block  1010   b.  Alternatively, suture limb  1016   a  can be placed under suture limb  1012   b  by changing the order of fixation. The suture limbs  1012   a,    1012   b,    1016   a,    1016   b,  can be tightened to secure the soft tissue  1030  to the bone  1050  before the anchors  1060   a,    1060   b  are fully fixed in the bone  1050 , as shown in  FIG.  7 D . 
     An alternative exemplary method of soft tissue repair is illustrated in  FIGS.  8 A and  8 B . The method fixates soft tissue  1030 ′ to bone  1050 ′ with an alternative double row application using the washers  310 , as shown washers  310   a,    310   b,  and  310   c,  in place of blocks  10 ,  110 . The alternative double row application disclosed with respect to  FIGS.  8 A and  8 B  helps reduce added bulk that can occur when two constructs are stacked on top of each other when suture limbs cross each other as part of the repair design. Further, the use of washers in such formations helps reduce the possibility of any bunching that may occur when using constructs that are of a block configuration. Once the surgeon has access to the surgical site and the tissue, bone, and washers  310   a - 310   c  have been prepared according to accepted surgical techniques, including those provided for herein, the surgeon can use an initial mattress stitch to install sutures  1012 ′,  1016 ′ in the tissue  1030 ′. Alternatively, any known stitch can be used. A medial row stitch  1040 ′ in the tissue  1030 ′ results in two suture limbs  1012   a ′,  1012   b ′ extending outwardly from the tissue, and second medial row stitch  1042 ′ results in two suture limbs  1016   a ′,  1016   b ′ extending outwardly from the tissue. 
     While the following discussion is made only to suture limb  1012   a ′, for the sake of clarity, suture limbs  1012   b ′,  1016   a ′,  1016   b ′, can have washers  310  threaded thereon in substantially the same manner. Washers  310   a - 310   c  are threaded onto suture limb  1012   a ′, as illustrated in  FIG.  8 A . Alternatively, any number of washers  310  can be used on any of the suture limbs  1012   a ′,  1012   b ′,  1016   a ′,  1016   b ′. The washers  310   a - 310   c  can be threaded onto the suture limb  1012   a ′ by hand, with an installation tool, and/or with a threader using techniques provided for throughout the present application. Once washers  310   a - 310   c  have been threaded onto the suture limb  1012   a ′ they can be advanced along the suture limb  1012   a ′. In the illustrated embodiment washers  310   a - 310   c  are disposed such that they are equally spread out over the tissue  1030 ′ along the length of limb  1012   a ′. After the washers  310  have been installed on the respective suture limbs  1012   a ′,  1012   b ′,  1016   a ′,  1016   b ′, as shown in  FIG.  8 A , the free ends of the suture limbs  1012   a ′,  1016   a ′ and  1012   b ′,  1016   b ′ can be secured within the body, for instance, by attaching them to anchors  1060   a ′ and  1060   b ′, respectively. In the illustrated embodiment the suture limbs  1012   b ′,  1016   b ′ are coupled to the anchor  1060   b ′ before the suture limbs  1012   a ′,  1016   a ′ are coupled into anchor  1060   a ′, thus causing the suture limb  1016   a ′ to rest atop the suture limb  1012   b ′, although other configurations are possible without departing from the spirit of the present disclosure. The suture limbs  1012   a ′,  1012   b ′,  1016   a ′,  1016   b ′ can be tightened to secure the soft tissue  1030 ′ to the bone  1050 ′ before the anchors  1060   a ′,  1060   b ′ are fully fixed in the bone  1050 ′. 
     A further exemplary double row fixation method is illustrated in  FIG.  8 B . The method for fixing soft tissue  1030 ″ to bone  1050 ″ is substantially the same as the method illustrated in  FIG.  8 A  but it further includes the use of the circular washers  410 , as shown washers  410   a  and  410   b,  at a location of the medial stitch (not visible). The placement of the washers  410   a,    410   b  as shown provides protection of the stitches disposed beneath the washers  410   a,    410   b,  while also increasing the footprint of the suture limbs  1012   a ″,  1012   b ″,  1016   a ″,  1016   b ″ and allowing for the distribution of forces across a surface of the washers  410   a,    410   b  that would otherwise be applied directly to the tissue  1030 ″. In use, the washers  410   a,    410   b  can be threaded onto the respective suture limbs  1012   a ″,  1012   b ″,  1016   a ″,  1016   b ″ before the washers  310 ′ are threaded onto the suture limbs  1012   a ″,  1012   b ″,  1016   a ″,  1016   b ″. The double row fixation method can then be completed, for example, according to the process described above with regards to  FIG.  8 A . With respect to both the configurations illustrated in  FIGS.  8 A and  8 B , the greater an angle formed by the sutures extending from the anchors  1060   a ′,  1060   b ′ and the washers  410   a,    410   b,  the greater the stability of the repair. 
     A still further alternative method for securing soft tissue  1030 ′″ to bone  1050 ′″ using a double row fixation technique is illustrated in  FIG.  9   . Once the surgeon has accessed the surgical site and the tissue, bone, and blocks  1010   a ′″- d ′″ have been prepared according to the accepted surgical techniques, including those provided for herein, the surgeon can use initial mattress stitches  1040 ′″,  1042 ′″ to install sutures  1012   a ′″- c ′″ and  1016   a ′″- c ′″, respectively, in the tissue  1030 ′″. A first medial row anchor  1060   a ′″ can be inserted into the bone  1050 ′″ having three suture limbs  1012   a ′″- c ′″ extending therefrom, the three suture limbs  1012   a ′″- c ′″ being threaded through the tissue  1030 ′″ with a first medial row stitch  1040 ′″. A second medial row anchor  1060   b ′″ can be inserted into the bone  1050 ′″ having three suture limbs  1016   a ′″- c ′″ extending therefrom, the three suture limbs  1016   a ′″- c ′″ being threaded through the tissue  1030 ′″ with a second medial row stitch  1042 ′″. 
     As illustrated, block  1010   a ′″, which can be in the form of a strip, tube, or cannulated block, among other disclosed configurations, is threaded onto one of the suture limbs  1012   a ′″,  1016   a ′″ using techniques provided for throughout this disclosure, and suture limbs  1012   a ′″ and  1016   a ′″ are tied together with a knot to secure the tissue  1030 ′″ to the bone  1050 ′″. Furthermore, once the knot has been formed, the block  1010   a ′″ can be moved to cover the knot to reduce the possibility of tissue being damaged by the knot. Blocks  1010   b ′″,  1010   c ′″ can then threaded onto suture limbs  1012   b ′″,  1012   c ′″, respectively, using techniques provided for throughout this disclosure, and advanced to a location proximate the medial stitch  1040 ′″. Similarly, once blocks  1010   d ′″,  1010   e ′″ have been threaded onto the suture limbs  1016   b ′″,  1016   c ′″, they can be advanced to a location proximate the medial stitch  1042 ′″. After the blocks  1010   b ′″,  1010   d ′″ and  1010   c ′″,  1010   e ′″ have been installed on the respective suture limbs  1012   b ′″,  1016   b ′″ and  1012   c ′″,  1016   c ′″, the free ends of the suture limbs  1012   b ′″,  1016   b ′″ and  1012   c ′″,  1016   c ′″ can be secured within the body. For example, the free ends of each suture limb  1012   b ′″,  1016   c ′″ and  1012   c ′″,  1016   b ′″ can be coupled to the respective anchor  1062   a ′″ and  1062   b ′″. The suture limbs  1012   b ′″,  1012   c ′″,  1016   b ′″,  1016   c ′″, can be tightened to secure the soft tissue  1030 ′″ to the bone  1050 ′″ before the anchors  1062   a ′″,  1062   b ′″ are fully fixed in the bone  1050 ′″. 
     A further alternative double row fixation method of soft tissue repair is illustrated in  FIGS.  10 A- 10 E  using the tissue augmentation construct  2810   a  of  FIG.  2 G , along with an identically configured tissue augmentation construct  2810   b  (as shown in  FIG.  10 E ). The two constructs do not need to be identically configured, as they could be similarly configured and/or can have other configurations provided for herein or otherwise known to those skilled in the art. The method can fixate soft tissue  2830  to bone  2850  with an alternative extra-long block application to provide for additional coverage of the repair. 
     Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation blocks have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can insert a first anchor  2860   a  below the soft tissue  2830 . The first anchor  2860   a  can have two suture limbs  2812   a,    2812   b  extending therefrom. The two suture limbs  2812   a,    2812   b  can be passed through the soft tissue  2830  to begin to assist in fixating the soft tissue  2830  to the bone  2850 . A first mattress stitch  2840   a  can be made in the soft tissue  2030  medial to the first anchor  2860   a.  The first mattress stitch  2840   a  can result in two suture limbs  2814   a,    2814   b  extending out of the soft tissue  2830 . 
     The block  2810   a  can be threaded onto suture limbs  2812   a,    2814   a  using techniques provided for throughout the present disclosure. For example, the suture limb  2814   a  can be associated with the proximal end  2811   p  of the first block  2810   a  by advancing the first threader  2809   a  in a first direction D 1 , as shown in  FIG.  10 B  (the threader  2809   a  is not illustrated, but in view of the present disclosures, a person skilled in the art will understand how the threader  2809   a  can be operated to pass the suture limb  2814   a  through the proximal end  2811   p  of the first block  2810   a ). Further, the suture limb  2812   a  can be associated with an intermediate  2811   i  and distal portion  2811   d  of the block  2810   a  as shown by advancing the second threader  2809   b  in a second direction D 2 , as also shown in  FIG.  10 B . Although the respective threaders  2809   a,    2809   b  for the respective suture limbs  2814   a,    2812   a  are not illustrated, a person skilled in the art, in view of the present disclosures, will understand how the threaders can be operated to pass the respective suture limbs through portions of the first block  2810   a.  The block  2810   a  can then be advanced medially such that the proximal end  2811   p  of the block  2810   a  is proximate the first mattress stitch  2840   a,  as shown in  FIG.  10 C . This process can be repeated for the second block  2810   b  and its respective limbs  2816   a,    2818   b.  For example, a second anchor  2862   a  can be installed below the soft tissue  2830 , as shown in  FIG.  10 E , with the anchor  2862   b  having two repair suture limbs  2816   a,    2816   b  extending from it. The two repair limbs  2816   a,    2816   b  can be similarly passed through the soft tissue  2830  and a second mattress stitch  2840   b  (illustrated in  FIG.  10 E ) can be made in the soft tissue  2030 , medial to the second anchor  2862   a.  The second mattress stitch  2840   b  can result in two suture limbs  2818   a,    2818   b  extending out of the soft tissue  2830 . The resulting suture limbs  2816   a,    2816   b,    2818   a,    2818   b  can be associated with block  2810   b  to continue the tissue fixation repair. 
     After the blocks  2810   a,    2810   b  have been installed on the respective suture limbs  2812   a,    2814   a  and  2816   a,    2818   a,  the free ends of the suture limbs  2812   a,    2812   b,    2816   a,    2816   b  can be secured within the body. For example, the free ends of each suture limb  2812   a,    2816   b  and  2812   b,    2816   a  can be coupled to the respective anchor  2860   b  and  2862   b,  as shown in  FIGS.  10 C and  10 E . In the illustrated embodiment, suture limb  2812   b  and suture limb  2816   b  can be passed over the soft tissue  2830  to form an “X” configuration or shape such that suture limb  2812   b  is secured in the same anchor  2862   b  as suture limb  2816   a  and suture limb  2816   b  is secured in the same anchor  2860   b  as suture limb  2812   a.  Suture limbs  2812   a,    2816   a  can be disposed through the respective central lumens  2870   a,    2870   b  of the blocks  2810   a,    2810   b  to increase the footprint of the suture limbs  2812   a,    2816   a,  subsequently decreasing the likelihood of damaging the soft tissue  2830  as discussed above. Because the blocks  2810   a,    2810   b  have a sufficient length, they can be installed so that they extend medially over first and second repairs  2838   a,    2838   b,  as shown in  FIG.  10 E . The suture limbs  2812   a,    2812   b,    2816   a,    2816   b  can then be tightened to secure the soft tissue  2830  to the bone  2850  before the anchors  2860   b,    2862   b  are fully fixed in the bone  2850 . The two limbs  2814   a,    2814   b  can be tied together with a knot  2880   a,  and limbs  2818   a,    2818   b  can be tied together with a knot  2880   b  to secure the proximal ends  2811   p  of the respective blocks  2810   a,    2810   b  at a location medial of the repairs  2838   a,    2838   b,  as shown in  FIGS.  10 D and  10 E . A person skilled in the art will recognize a number of repairs that can be represented by the repairs  2838   a,    2838   b  in view of the present disclosure and the skilled person&#39;s knowledge. 
     Rotator Cuff Repairs—Single Row Applications 
     Another method of soft tissue repair is illustrated in  FIGS.  11 A- 11 C . The method fixates soft tissue  130 ′ to bone  150 ′ using a single row application. Once the surgeon has access to the surgical site and the tissue, bone, and blocks  110   a ′,  110   b ′ have been prepared according to accepted surgical techniques, including those provided for herein, the surgeon can use an initial mattress stitch to install suture  112 ′ in the soft tissue  130 ′. Alternatively, any known stitch can be used. The mattress stitch  140 ′ results in two suture limbs  112   a ′,  112   b ′ extending outwardly from the soft tissue. 
     As shown in  FIG.  11 B , the blocks  110   a ′,  110   b ′ are threaded on to suture limbs  112   a ′,  112   b ′, respectively, using techniques provided for throughout the present application. Once the blocks  110   a ′,  110   b ′ have been threaded onto the suture limbs  112   a ′,  112   b ′, they are advanced in the direction D 1 ′ along the respective sutures until they are proximate the mattress stitch  140 ′. As described above, the location of the strips with respect to the stitch  140 ′ can depend, at least in part, on the size of the blocks  110   a ′,  110   b ′ and the distance between the stitch  140 ′ and the end of the tissue  130 ′. After the blocks  110   a ′,  110   b ′ have been installed on the respective suture limbs  112   a ′,  112   b ′, the free ends of the suture limbs  112   a ′,  112   b ′ can be secured within the body, for instance, by attaching them to a single anchor  160 ′, as shown in  FIG.  11 C . The suture limbs  112   a ′,  112   b ′ can be tightened to secure the soft tissue  130 ′ to the bone  150 ′ before the anchor  160 ′ is fully fixed in the bone  150 ′, thus completing the single row fixation associated with the medial stitch  140 ′. In some exemplary embodiments a second anchor having two suture limbs extending therefrom, each limb having at least one tissue augmentation construct disposed thereon, can be implanted in a similar manner as the anchor  160 ′, limbs  112   a ′,  112   b ′, and blocks  110   a ′,  110   b ′ with respect to the same tissue  130 ′ and bone  150 ′ to provide a second securement system for the tissue. As with all of the various configurations provided for herein, any number and combination of implants, e.g., bone anchors, sutures, and tissue augmentation constructs can be used to secure soft tissue to bone. 
     Alternative single row applications are shown in  FIGS.  11 D- 11 F . In a first alternative single row application illustrated in  FIG.  11 D , a standard single row repair can be completed using two anchors  160   a ″,  160   b ″ installed in the bone  150 ″ below the tissue  130 ″. Anchors  160   a ″,  160   b ″ can each have two suture limbs  112   a ″,  112   b ″ and  116   a ″,  116   b ″ extending therefrom, respectively. Suture limbs  112   a ″ and  116   a ″ can be threaded through the soft tissue  130 ″ and used to bring the soft tissue  130 ″ into contact with the bone  150 ″. Sutures limbs  112   b ″ and  116   b ″ can similarly be threaded through the soft tissue  130 ″. 
     As shown in  FIG.  11 D , a tissue augmentation block  110 ″ can be threaded on to one of the suture limbs  112   b ″,  116   b ″ using techniques provided for throughout this disclosure and advanced to a desired location with respect to the tissue  130 ″. After the augmentation block  110 ″ has been installed on one of the suture limbs, the free end of each suture limb  112   b ″,  116   b ″ can then be tied together using a knot, not shown. Furthermore, the block  110 ″ can be moved into position such that it covers the knot, thereby minimizing any potential tissue abrasion by the knot, and is in contact with the tissue  130 ″. 
     A second alternative single row application is illustrated in  FIG.  11 E . Similar to the procedure of  FIG.  11 D , a standard single row repair can be completed using two anchors  160   a ′″,  160   b ′″ installed in bone  150 ′″ below tissue  130 ′″. As shown, a first suture  111 ′″ can be installed medially of the repair with a mattress stitch  140   a ′″, such that two suture limbs  111   a ′″,  111   b ′″ extend from the tissue  130 ′″, and a second suture  113 ′″ can be installed medially of the repair with a second mattress stitch  140   b ′″, such that two suture limbs  113   a ′″,  113   b ′″ extend from the tissue  130 ′″. In some instances, after the two mattress stitches  140   a ′″,  140   b ′″ have been installed in the tissue  130 ′″, anchors  160   a ′″,  160   b ′″ can be installed into the bone  150 ′″ below the tissue  130 ′″. Operative sutures  112 ′″,  114 ′″ can be used to couple the tissue  130 ′″ to the anchors  160   a ′″,  160   b ′″ respectively attached thereto according to accepted surgical practice. 
     Tissue augmentation blocks  110   a ′″- d ′″ can be threaded on to the suture limbs  111   a ′″,  111   b ′″,  113   a ′″,  113   b ′″ using techniques provided for throughout this disclosure and can be advanced along the respective sutures to desired locations. The free ends of the suture limbs  111   a ′″,  113   a ′″ and  111   b ′″,  113   b ′″ can be tied to, and tightened about, operative sutures  112 ′″,  114 ′″ respectively. 
       FIG.  11 F  illustrates a further alternative single row application. A first suture  111 ″″ can be installed medially with a mattress stitch  140   a ″″ such that two suture limbs  111   a ″″,  111   b ″″ extend from the tissue  130 ″″, and a second suture  113 ″″ can be installed with a second mattress stitch  140   b ″″ such that two suture limbs  113   a ″″,  113   b ″″ extend from the tissue  130 ″″. After the first and second sutures  111 ″″,  113 ″″ have been installed, first and second medial anchors  160   a ″″,  160   b ″″ are installed in the bone  150 ″″, below the tissue  130 ″″. Operative sutures  112 ″″,  114 ″″ coupled to anchors  160   a ″″,  160   b ″″, respectively, can be used to perform the repair such that the tissue  130 ″″ is brought into contact with the bone  150 ″″, according to accepted surgical practices. Once the tissue  130 ″″ has been repaired, blocks  110   a ″″- d ″″ can be installed onto suture limbs  111   a ″″,  111   b ″″,  113   a ″″,  113   b ″″ using techniques provided for throughout this disclosure. Free ends of the suture limbs  111   a ″″,  113   a ″″ and  111   b ″″,  113   b ″″ can be secured within the body, for instance, by attaching them to anchors  160   c ″″ and  160   d ″″, respectively. The suture limbs  111   a ″″,  111   b ″″,  113   a ″″,  113   b ″″ can be tightened to further secure the blocks  110   a ″″- d ″″ to the soft tissue  130 ″″ such that the repairs made with the sutures  112 ″″,  114 ″″ are covered by tissue augmentation blocks. 
     A further exemplary method of soft tissue repair is illustrated in  FIG.  12   . The method fixates a piece of soft tissue  1130 , e.g., rotator cuff, to bone  1150  using a single row fixation. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation block have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can use a mattress row stitch  1140  to install sutures  1112 ,  1114  and mattress row stitch  1142  to install sutures  1116 ,  1118  in the soft tissue  1130 . Sutures  1112 ,  1114  and  1116 ,  1118  are installed into anchors  1160   a,    1160   b,  respectively, below the tissue  1130  in the bone  1150 . As shown in  FIG.  12   , each of the mattress stitches  1140  and  1142  results in four suture limbs  1112   a,    1112   b,    1114   a,    1114   b  and suture limbs  1116   a,    1116   b,    1118   a,    1118   b  extending outwardly from the soft tissue. 
     At least one block  310 ′ can be threaded on at least one of the suture limbs of each suture  1112 ,  1114 ,  1116 ,  1118 . Block  310 ′ can be similar to block  310 , although one difference between the two is that a thickness of the block  310 ′ is greater than the thickness of block  310 . Alternatively, block  310 ′ can have any suitable dimension as desired for a given procedure. In some embodiments, each of the suture limbs  1112   a,    1114   a,    1116   a,    1118   a  can have a block  310 ′ threaded thereon using techniques provided for throughout the present disclosure, and then the two suture limbs of each pair can be tied together. For example, suture limbs  1112   a,    1112   b  can be tied together after block  310 ′ has been threaded thereon. After the suture limbs  1112   a,    1112   b  have been tied together, the block  310 ′ can be moved over the knot to buffer, or cover, the knot. This process can be repeated for each of the suture limb pairs  1114   a  and  1114   b,    1116   a  and  1116   b,  and  1118   a  and  1118   b.    
     A still further exemplary method of soft tissue repair is illustrated in  FIG.  13   . The method fixates a piece of soft tissue  1230 , e.g., rotator cuff, to bone  1250  using a single row rip-stop stitch. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation constructs have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can use a stitch  1240  to couple the sutures  1212 ,  1214  to anchor  1260   a  and a stitch  1242  to couple the sutures  1216 ,  1218  to anchor  1260   b.  Any known stitch can be used. As shown in  FIG.  13   , the stitch  1240  results in four suture limbs  1212   a,    1212   b,    1214   a,    1214   b  extending outwardly from the soft tissue, and the stitch  1242  also results in four suture limbs  1216   a,    1216   b,    1218   a,    1218   b  extending outwardly from the soft tissue. 
     A tissue augmentation block  1210  can be threaded on to one of the suture limbs associated with each mattress knot  1240 ,  1242  using techniques provided for throughout the present disclosure. The block  1210  in the illustrated embodiment is a construct similar to the bars  3010 ,  3110 . In the illustrated embodiment, the suture limbs  1212   a  and  1216   a  each have the block  1210  associated with it. Once each of the suture limbs  1212   a,    1216   a  has a block  1210  threaded thereon, the suture limbs  1212   a,    1216   a  can be tied together with a complementary suture limb  1212   b,    1216   b,  respectively. Furthermore, the block  1210  can be slid over the knot to buffer, or cover, the knot, as illustrated. Then the suture limbs  1214   a,    1214   b  can be tied together over the top of block  1210  to create a rip-stop stitch. Advantageously, suture limbs  1214   a,    1214   b,  once tied together will be prevented from tearing through the soft tissue  1230  because the block  1210  will act as a buffer thereby distributing the applied load. This process can be repeated for the second mattress stitch  1242 . 
       FIG.  14    illustrates a further method of soft tissue repair. The method provides for fixating a piece of soft tissue  1330 , e.g. rotator cuff, to bone  1350 , using an anterior-posterior mattress stitch extending between anchors. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation block have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can thread two limbs  1312   a,    1312   b  of a suture  1312  coupled to an anchor  1360   a  through tissue  1330 . Similarly, a second anchor  1360   b  can be implanted in the bone  1350  having suture limbs  1314   a,    1314   b  of a suture  1314  extending from the anchor  1360   b  through tissue  1330 . Any known stitch can be used. 
     One block  1310  can be threaded on to either of the suture limbs  1312   a,    1314   a  of either anchor  1360   a,    1360   b  using techniques provided for throughout the present disclosure. The illustrated block  1310  has a length approximately in the range of about 10 millimeters to about 20 millimeters, a width approximately in the range of about 2 millimeters to about 5 millimeters, and a height approximately in the range of about 1 millimeter to about 3 millimeters. Once the suture limb  1312   a  has a block  1310  threaded thereon, the suture limb  1312   a  can be tied together with the suture limb  1314   a.  Furthermore, after the suture limbs  1312   a,    1314   a  have been tied together, the block  1310  can be slid over the knot, not shown, to buffer, or cover, the knot. Then the suture limbs  1312   b,    1314   b  can be tied together over the block  1310 . Advantageously, the suture limbs  1312   b,    1314   b,  once tied together, will be prevented from tearing through the soft tissue  1330  because the block  1310  will act as a buffer between them distributing the applied load. 
     An alternative single row fixation method of soft tissue repair is illustrated in  FIG.  14   . The method fixates soft tissue  1430  to bone  1450  with an alternative, extra-long and extra-wide block application. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation blocks have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can fixate the soft tissue  1430  to the bone  1450  according to accepted surgical techniques to create the repairs  1438   a,    1438   b,  shown in phantom. Once the repairs  1438   a,    1438   b  are completed, a first mattress stitch  1440  is made through the soft tissue  1430 , medial to the soft tissue repair  1438   a,  and a second mattress stitch  1442  is made, medial to the repair  1438   b,  to install the sutures  1412  and  1414  in the soft tissue  1430 . The first mattress stitch  1440  results in two suture limbs  1412   a,    1412   b  extending outwardly from the soft tissue  1430 , and the second mattress stitch  1442  results in two suture limbs  1414   a,    1414   b  extending outwardly from the soft tissue. Alternatively, the stitches  1440 ,  1442  can be made before the repairs  1438   a,    1438   b  are performed. 
     The blocks  1410   a - 1410   c  have a configuration that can be considered to be a larger version of some other block configurations provided for herein. As shown, the blocks  1410   a - 1410   c  have a substantially rectangular shape, like the cannulated block configurations  3010 ,  3110  of  FIGS.  2 E and  2 F , but with a more substantial thickness. Other configurations of the blocks  1410   a - 1410   c,  particularly in view of the present disclosures, are also possible, including but not limited to configurations that are more akin to one or more of the tape strips  10 , the tubes  110 , and the washers  310 ,  410 , or combinations thereof. In one exemplary embodiment, the blocks  1410   a - 1410   c  can have a length approximately in the range of about 15 millimeters to about 25 millimeters, a width approximately in the range of about 4 millimeters to about 5 millimeters, and a thickness approximately in the range of about 1 millimeter to about 3 millimeters. 
     The blocks  1410   a,    1410   c  can be threaded onto suture limbs  1412   a,    1414   a  using techniques provided for throughout the present disclosure. In the illustrated embodiment, the block  1410   b  has two suture limbs, the suture limbs  1412   b  and  1414   b,  associated with it. While this latter configuration can also be achieved using the techniques provided for throughout the present disclosure, in one exemplary method, a single installation tool can be used to associate both suture limbs  1412   b,    1414   b  with the block  1410   b  at the same time. For example, the threader  206  (not shown) can be disposed in the block  1410   b  and can have both limbs passed through its distal opening  212  (not shown) before operating the threader as described above to associate the limbs  1412   b,    1414   b  with the block  1410   b.  Alternatively, the block  1410   b  can have two threaders disposed therethrough to thread the suture limbs  1412   b,    1414   b  individually therethrough. In a further alternative, a single threader can be threaded through the block  1410   b  to pull the suture limb  1412   b  through the block  1410   b,  and then the threader, or a different threader, can be inserted into the block  1410   b  to thread the suture limb  1414   b  through the block  1410   b.    
     Once the blocks  1410   a - 1410   c  have been threaded onto the suture limbs  1412   a,    1412   b,    1414   a,    1414   b  they can be advanced along the suture limbs  1412   a,    1412   b,    1414   a,    1414   b,  respectively, until they are proximate the medial stitches  1040 ,  1042 . One advantage of the blocks  1410   a - 1410   c  is that they can be sized to cover a substantial portion of a surgical site that includes a perimeter defined by the anchors  1460   a,    1460   b  and the mattress stitches  1440 ,  1442 . Other advantages of tissue augmentation constructs provided for herein are also applicable. After the blocks  1410   a - 1410   c  have been installed on the respective suture limbs, the free ends of the suture limbs  1412   a,    1412   b  and  1414   a,    1414   b  can secured within the body, for instance, by attaching them to anchors  1460   a  and  1460   b,  respectively. The suture limbs  1412   a,    1412   b,    1414   a,    1414   b,  can be tightened to secure the soft tissue  1430  to the bone  1450  before the anchors  1460   a,    1460   b  are fully fixed in the bone  1450 . 
     The various embodiments described above can be used in conjunction with any of the other embodiments described above such that some of the soft tissue is secured with a double-row application and some portions are secured with the single row application. Still further, any number of suture limbs and tissue augmentation blocks can be used during any particular procedure, including disposing multiple strips on a single limb and/or using only a single limb or more than two limbs. 
     Rotator Cuff Repairs—Partial Tear Repairs 
     An exemplary method of partial tear soft tissue repair is illustrated in  FIGS.  16 A- 16 C . The method fixates a piece of soft tissue  1530 , e.g. rotator cuff, to bone  1550  in a situation where a partial tear occurs. As shown in  FIG.  16 A , soft tissue  1530  is maintained in contact with the bone  1550  at  1530   d.  The length X shows what a “healthy” footprint of contact should be between the tissue  1530  and bone  1550 . This procedure can aid in the reattachment of the soft tissue to the bone to create a “healthy” footprint. Prior art procedures can result in a depression at the attachment point due to the necessary compression of the suture against the tissue, thus causing a weakening of the tissue, and more generally, the rotator cuff. 
     Once the surgeon has access to the surgical site and the tissue, bone, and the tissue augmentation construct have been prepared according to accepted surgical techniques, including those provided for herein, the surgeon can install an anchor  1560  into the bone  1550 . The anchor  1560  can have a suture  1512  coupled thereto having two suture tails  1512   a,    1512   b  extending therefrom that can be passed through the soft tissue  1530 . A block  1510  can be threaded onto at least one of the suture tails  1512   a,    1512   b.  The block  1510  can be any of the configurations provided for herein, including but not limited to the blocks  10 ,  110 ,  3010 ,  3110 ,  310 , and  410  and the patches  2210 ,  2310 ,  2410 , and  2510 , which are described below. The constructs  1510  can be threaded onto the suture limb  1512   a,  for example, using techniques provided for throughout the present disclosure, and advanced along the suture  1512   a  until it is proximate the tissue  1530 . After the construct  1510  has been installed on one of the suture limbs, the free end of each suture limb  1512   a,    1512   b  can then be tied together using a knot, not shown, to bring the damaged tissue  1530  into contact with the bone  1550 . The construct  1510  can then be moved into position such that it covers the knot and is in contact with the tissue  1530 . As shown in  FIG.  16 B , the construct  1510 , once installed, can add height to the depression to build back height to the repaired tissue  1530 . 
     Methods of Use—Non-Rotator Cuff Repairs 
     The present disclosure contemplates that the tissue augmentation constructs provided for herein have applications outside of rotator cuff repairs as augmentation constructs. Some, non-limiting examples of those alternative procedures are provided for below. These examples are by no means exhaustive. Further, a person having skill in the art will understand how some of the disclosures provided for in this non-rotator cuff repair section can be adapted for use in rotator cuff repair procedures. Each of the embodiments described below, including those discussed after the non-rotator cuff repairs (i.e., labrum repair or augmentation, ACL repair, Achilles repair, AC joint-repair, meniscal repair, and superior capsule reconstruction), are discussed with respect to using a tissue augmentation construct, which includes any of the blocks and patches disclosed herein or otherwise derivable from the present disclosure. A person skilled in the art, in view of the present disclosures, will understand how to adapt various tissue augmentation constructs for use in the various procedures. Further, in exemplary embodiments of each of the methods described in the present disclosure, collagen, for example, can be used as part of, or to form entirely or almost entirely, the construct. This allows the construct to grow in the area of the repair once healed. Other materials can also be used to form the constructs, including others that achieve a similar result as collagen. 
     Non-Rotator Cuff Repairs—Labrum Defect Corrections 
     One alternative procedure is illustrated in  FIGS.  17 A- 17 D . The method uses a tissue augmentation construct  1610 , or constructs, to fill in a gap where soft tissue  1630  has been damaged and torn from the bone  1650 . For example, as shown in  FIG.  17 A , a labrum  1630  can have a tear or defect  1635  where a portion of the bone  1650  is exposed. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation construct have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can install a first anchor  1660   a  into the bone at a proximal location  1635   p  of the tear  1635 . The first anchor  1660   a  has a suture  1612  installed therein. The tissue augmentation construct  1610  can be threaded onto the suture limb  1612  using techniques provided for throughout the present disclosure, and advanced along the suture until the tissue augmentation construct  1610  is proximate the proximal end of the tear  1635   p.  Any type of tool provided for herein or otherwise known to those skilled in the art can be used to advance the construct  1610  towards the anchor  1660   a,  including a knot pushing tool. The tissue augmentation construct  1610  can be approximately the same length as defect  1635  once implanted, and can be pre-cut and/or cut at the surgical site in real time to assure proper fit. 
     After the tissue augmentation construct  1610  has been installed on the suture limb  1612 , the free end of the suture limb  1612  can then be anchored down to the bone with a second anchor  1660   b,  such as a knotless-type fixation anchor. The tail of suture  1612  can be tightened before the anchor  1660   b  has been fully inserted into the bone. By locating the anchors  1660   a,    1660   b  and construct  1610  in these locations, the construct  1610  ends up on a back edge of the glenoid rather than on its face and the repair can be used to rebuild the labrum rather than just fix the defect, as was more typical in previous labrum repair procedures. In an alternative embodiment, separate sutures extending from each of the two anchors  1660   a,    1660   b  can be thread through the labrum on either side, the tissue augmentation construct  1610  can be disposed on one of the two sutures, the two sutures can be coupled together, e.g., using a knot. Furthermore, the tissue augmentation construct  1610  can be disposed over a location at which the two sutures are tied together to protect the location at which the sutures are coupled together. 
     Non-Rotator Cuff Repairs—ACL Repairs 
     Another alternative procedure is illustrated in  FIGS.  18 A- 18 C . The method uses a tissue augmentation construct  1710 , or constructs, to repair a torn ACL. For example, as shown in  FIG.  18 A , one bundle of the ACL  1702  is torn, or otherwise damaged. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation construct have been prepared according to accepted surgical techniques, the surgeon can begin the partial ACL repair. First, a bone tunnel  1704  is drilled through the femur  1706  and tibia  1707  next to the native, undamaged ACL  1708 . Next, a tissue augmentation construct  1710 , which as shown in  FIG.  18 B  has suture limbs  1712   a,    1712   b  extending from opposed ends, is prepared in the same manner as described above with regards to other embodiments. The construct  1710  can have a length approximately in the range of about 5 millimeters to about 100 millimeters. As shown in  FIG.  18 C , the construct  1710  can be threaded into the bone tunnel  1704  such that construct  1710  is in contact with the undamaged ACL  1708 . The suture limbs  1712   a,    1712   b  can be used to fix the construct  1710  within the bone tunnel according to known surgical techniques. 
     Alternatively, the construct  1710  can be used to augment an autograft implant. In situations where an autograft, or allograft, implant is too short, and/or too thin and not strong enough, to complete the repair, the construct  1710  can be sutured or otherwise coupled to the autograft implant to create an implant of the required size. In a further alternative, a construct having a lumen extending therethrough can be threaded over an autograft, or allograft, implant to further strengthen an autograft or allograft implant for an ACL repair. 
     Non-Rotator Cuff Repairs—Superior Capsule Reconstructions 
     Still another alternative procedure is illustrated in  FIG.  19   . The method can use at least one of tissue augmentation constructs  1810   a,    1810   b  to assist in anchoring down a superior capsule reconstruction graft  1820  over a humeral head  1802 . Once the surgeon has access to the surgical site and the tissue, bone, tissue augmentation constructs, and superior capsule reconstruction graft have been prepared according to accepted surgical techniques, including those provided for herein, the surgeon can affix one end of the graft  1820  to the glenoid rim  1804 . The surgeon can affix one end of the graft  1820  to the glenoid rim  1804  by installing a first medial anchor  1860   a  having a suture  1812   a  extending therefrom. A first tissue augmentation construct  1810   a  can be thread onto the suture  1812   a  using techniques provided for throughout the present disclosure, and the construct  1810   a  can be tightened against the graft  1820  using techniques provided for herein or otherwise known to those skilled in the art, such as for example, by tying suture  1812   a  to suture  1812   b,  not shown, both of which extend from the anchor  1860   a.  The pressure of the construct  1810   a  on the graft  1820  can hold the graft  1820  at a desired location with respect to the glenoid rim  1804 . An opposite end of the graft  1820  can be anchored proximate to the humeral head  1802  and a location and/or size of the graft  1820  adjusted so that the glenoid rim  1804  is brought into contact with the humeral head  1802  in accordance with techniques used in superior capsule reconstruction procedures. 
     While a number of different techniques can be used to couple the other end of the graft  1820  proximate to the humeral head  1802 , in the illustrated embodiment first and second lateral anchors  1862   a,    1862   b  are used in conjunction with a second tissue augmentation construct  1810   b  to make the repair. More particularly, in one exemplary embodiment, at least one of the anchors  1862   a,    1862   b  can have a suture  1812   b  associated therewith and the second tissue augmentation construct  1810   b  can be disposed on at least a portion of the suture  1812   b  using techniques provided for in the present disclosure. The suture  1812   b  can extend between the two anchors  1862   a,    1862   b,  against using any of the techniques provided for herein or otherwise known to those skilled in the art, and the construct  1810   b  can be tightened down against the graft  1820  to help maintain a location of the graft  1820  with respect to the humeral head  1802  while allowing the construct  1810   b  to better distribute any force applied by the suture  1812   b  across the surface area of the construct  1810   b.  Any number of tissue augmentation constructs can be used in the repair, and in alternative embodiments tissue augmentation constructs may only be used in conjunction with coupling the graft  1820  with only one of the glenoid rim  1804  and the humeral head  1802 . 
     Repairing Soft Tissue by Closing Gaps—Rotator Cuff and Non-Rotator Cuff Examples 
     Two exemplary embodiments for closing gaps or voids in tissue are illustrated in  FIGS.  20 A-F . The first illustrated embodiment, as shown in  FIGS.  20 A- 20 C , relates to a rotator cuff margin convergence, and the second, as shown in  FIGS.  20 D- 20 F , a hip capsular closure. However, a person skilled in the art will recognize other types of procedures these embodiments can be applied to in practice without departing from the spirit of the present disclosure. 
       FIG.  20 A  shows rotator cuff tissue  1930  having a void or gap  1905 . First and second sutures  1912   a,    1912   b  can be associated with first and second constructs  1910   a,    1910   b  using techniques provided for throughout the present disclosure. As shown in  FIG.  20 B , a first free end of the first suture  1912   b  can be threaded into the rotator cuff tissue  1930  on a first side of the void  1905  and threaded back through the rotator cuff tissue  1930  on the opposite side of the void  1905 . The first free end can be tied to the second free end to bring edges  1930   a,    1930   b  of the void  1905  together. This process can be repeated for the second suture  1912   b  to complete the repair, as shown in  FIG.  20 C . The tissue augmentation constructs  1912   a,    1912   b  can provide the many benefits provided for herein, including but not limited to increased surface area through which forces from the sutures  1912   a,    1912   a  can be distributed, protection of a knot used to couple free ends of the sutures  1912   a,    1912   b,  and providing a scaffold for new tissue to grow to create a stronger repair between the edges  1930   a  and  1930   b,  with the scaffold essentially becoming a new layer of tissue on top of the existing rotator cuff tissue  1930 . 
       FIG.  20 D  shows hip capsular tissue  1930 ′ having a void or gap  1905 ′. First and second sutures  1912   a ′,  1912   b ′ can be associated with first and second constructs  1910   a ′,  1910   b ′ using techniques provided for throughout the present disclosure. As shown in  FIG.  20 E , a first free end of the first suture  1912   a ′ can be threaded into the hip capsular tissue  1930 ′ on a first side of the void  1905 ′ and threaded back through the hip capsular tissue  1930 ′ on the opposite side of the void  1905 ′. The first free end can be tied to the second free end to bring edges  1930   a ′,  1930   b ′ of the void  1905 ′ together. This process can be repeated for the second suture  1912   b ′ to complete the repair, as shown in  FIG.  20 F . As with the tissue augmentation constructs  1912   a,    1912   b,  the tissue augmentation constructs  1912   a ′,  1912   b ′ can provide the many benefits provided for herein, including the highlighted benefits provided for with respect to the constructs  1912   a,    1912   b.    
     Tissue Augmentation Constructs—Collagen Tacks/Buttons 
     Another exemplary embodiment of a tissue augmentation construct is illustrated in  FIGS.  21 A and  21 B . The tissue augmentation construct, as shown a tack or button  2010 , has a generally cylindrical shape that is configured to be disposed on or otherwise associated with a suture  2012 . More particularly, the tissue augmentation tack  2010  can have a substantially cylindrical body with a bore or lumen  2014  extending therethrough from a proximal-most end  2010   p  to a distal-most end  2010   d.  The bore  2014  can be used, for example, to receive the suture  2012  by means of a stitch  2013  so that the tack  2010  and suture  2012  can be associated with each other, as described in greater detail below. In alternative embodiments, the suture  2012  can be passed through the tack  2010  without a pre-defined lumen being formed in a body of the tack  2010 , and/or the suture  2012  can be wrapped around or otherwise coupled to the tack  2010  without passing through it. As shown, the tack  2010  has a height H T  that is less than a diameter D T . Further, the diameter D T  can be greater than a diameter of a filament or suture with which the tack  2010  is associated, e.g., the suture  2012 , thereby increasing the footprint of the suture  2012  and the surface area of tissue augmentation of the system or device used in the surgical repair. 
     The suture  2012  can be any type of suture provided for herein or otherwise known to those skilled in the art. In the illustrated embodiment, the suture  2012  includes a self-locking mechanism  2015  associated with an intermediate portion  2012   i  of the suture  2012 , a collapsible loop  2040  extending from one side of the self-locking mechanism  2015 , and fixed and tensioning tails  2012   f  and  2012   t  extending from an opposite side of the self-locking mechanism  2015 . The self-locking mechanism  2015  can take a variety of forms, and in the illustrated embodiment it has a finger-trap-like configuration formed by passing a first limb of the suture  2012  through a portion of a second limb of the suture  2012  before having the first limb exit the second limb to result in the fixed and tensioning tails  2012   f,    2012   t.  The fixed tail  2012   f  can be wrapped around and/or coupled to the tack  2010 , and as shown a stitch  2013  is used to help manage the fixed tail  2012  and attach it to the tack  2010 . The tensioning tail  2012   t  can be used to help adjust a diameter of the collapsible loop  2040 . 
     The collapsible loop  2040  can be coupled to an implant, e.g., a bone anchor  2060 , and a diameter of the loop  2040  can be adjusted by moving the self-locking mechanism  2015  proximally away from the anchor  2060  and distally towards the anchor  2060  as shown in the illustrated embodiment, for instance by applying a force proximally away from the anchor  2060  to the tensioning tail  2012   t.  The anchor  2060  can be a low profile anchor so that the anchor  2060  can more easily pass through tendon. A person skilled in the art will recognize various suitable low profile anchors that can be used in conjunction with the present disclosure, including some such anchors that are provided for above, e.g., Gryphon® and Healix Transtend™ anchors. 
     A number of other suture configurations are possible, including some disclosed further below and others known to those skilled in the art. Some suture configurations that can be incorporated into this design include but are not limited to those disclosures provided for in U.S. Pat. No. 8,821,544, entitled “Surgical Filament Snare Assemblies,” and U.S. Pat. No. 9,060,763, entitled “Systems, Devices, and Methods for Securing Tissue, the content of each which is incorporated by reference herein in their entireties. 
     A person skilled in the art will recognize that the dimensions of the height H T  and diameter D T  of the tissue augmentation tack  2010 , as well as a diameter of the bore  2014 , can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. In some embodiments a ratio of the diameter D T  of the tack  2010  to a diameter of the suture limb  2012  can be approximately in the range of about 2:1 to about 100:1, and more particularly the diameter D T  can be at least three times greater than the diameter of the filament or suture with which the tissue augmentation tack  2010  is associated in some instances. A variety of other sizes and shapes of the tissue augmentation tack  2010 , including ratios of the dimensions of the tack and associated components (e.g., the suture  2012 ) can be utilized without departing from the spirit of the present disclosure. 
     While ratios can be useful to help describe the relationship between the tack  2010  and the filament  2012 , and the relationship between the dimensions of the tack  2010 , some exemplary, non-limiting dimensions for a tissue augmentation tack can also be useful in understanding the present disclosure. As mentioned above, these dimensions can be dependent on a variety of factors. In some embodiments, the height H T  can be approximately in the range of about 1 millimeter to about 1 centimeter, and the diameter D T  can be approximately in the range of about 1 millimeter to about 10 millimeters. The size of the diameter d of the bore  2014  can also depend on a variety of factors, including but not limited to the size of the limb to be passed therethrough. In some embodiments, the diameter d can be approximately in the range of about 0.5 millimeters to about 3 millimeters. Alternatively, bore  2014  may not be present and the filament  2012  can be passed through the tack  2010  without a bore. The tack  2010  can be made from any of the materials provided for above with respect to the other tissue augmentation constructs, including but not limited to collagen. 
     In some embodiments, as shown in  FIG.  21 B , an inserter tool  2070  can be used to install the anchor  2060  in a trans-tendon approach into a preformed bone bore in a bone  2050 . The inserter tool  2070  can have a releasable mechanism (not shown) at a distal end  2070   d  that can releasably engage the anchor  2060  such that after installation of the anchor into bone  2050 , the inserter tool can be removed. For example, the releasable mechanism can be a compression fit, a thread to engage the anchor  2060 , a ball detent, or other releasable mechanisms that can be associated with the inserter tool  2070  in view of the present disclosures or otherwise known by those skilled in the art. 
     In use, the inserter tool  2070  can be used to insert the anchor  2060  through the tendon, or other soft tissue,  2030 , as shown in  FIG.  21 C . The surgeon can then remove the inserter tool  2070  from the anchor  2060 , after is has been secured into the bone  2050  below the tendon  2030 , as shown in  FIG.  21 D . Once the anchor  2060  is secure in the bone  2050 , tension can be applied to the tensioning tail in the direction T 1 , as shown in  FIG.  21 E . As the tensioning tail  2012   t  is pulled, the diameter of the suture loop  2040  is reduced and the tack  2010  is brought into contact to the tendon  2030  to compress the tendon  2030  against the bone  2050 . The self-locking mechanism  2015  maintains a location of the tensioning tail  2012   t  to keep the construct in a locked configuration. The tensioning tail can then be trimmed. 
     Numerous advantages result from the use of the tissue augmentation tack  2010 . As illustrated in  FIG.  21 E , the resulting configuration is one in which the tack  2010  is disposed on top of the tissue  2030 , and there are no hard components and/or knots exposed. This decreases the possibility of tissue abrasion, among other benefits. The same types of benefits provided for with other constructs provided for herein are also equally applicable. For example, when the tissue augmentation tack  2010  is made of collagen or other types of tissue-growth-promoting materials, the repair can result in a tissue remodel such that no component but the suture remains. Further, after the tack  2010  is advanced towards the anchor  2060  and secured at the tissue  2030 , no suture management is really required post-procedure. 
     Alternatively, if two tensioning tacks  2010   a,    2010   b  are used, as shown in  FIG.  21 F , the tensioning tacks  2010   a,    2010   b  can be installed in the same manner as described above with regards to  FIGS.  21 A- 21 E . Instead of trimming the tails  2012   t _ 1 ,  2012   t _ 2 , the tensioning tails  2012   t _ 1 ,  2012   t _ 2  can be secured into a lateral row anchor  2062  to provide further compression of the tissue  2030  against the bone  2050 . In a further alternative method, as shown in  FIG.  21 G , the two tensioning tails  2012   t _ 1 ′ and  2012   t _ 2 ′ can be tied together with a knot  2018 . The knot  2018  can be covered by one or more additional tissue augmentation constructs as provided for herein. 
     Other non-limiting alternative embodiments of the tack  2010  are illustrated in  FIGS.  21 H and  21 I  as tacks  2010 ′ and  2010 ″, respectively, the alternatives focusing on other types of self-locking mechanisms associated with the respective sutures,  2012 ′,  2012 ″. The configuration of the suture  2012 ′ includes a self-locking sliding knot  2015 ′ configured to selectively restrict the movement of the tensioning tail  2012   t ′ relative to the tack  2010 ′. A person skilled in the art will recognize many different types of self-locking knots  2015 ′ that can be used in conjunction with the tack  2010 ′. 
     A further alternative tack  2010 ″ is shown in  FIG.  21 I . The tack  2010 ″ has substantially the same dimensions as the tack  2010 , and can be made of substantially the same materials. The tissue augmentation tack  2010 ″, however, has two bores  2014   a ″,  2014   b ″ extending from a proximal most surface  2010   p ″ to a distal-most surface  2010   d ″. The two bores  2014   a ″,  2014   b ″ can be parallel to one another, as shown in  FIG.  21 I , however other alternative configurations are contemplated. In some embodiments, no bores may exist and instead suture can be passed through or otherwise associated with the tack  2010 ″ as provided for herein or otherwise known to those skilled in the art. 
     The suture  2012 ″ used in conjunction with the tack  2010 ″ can be similar to the suture  2012 , but as shown it is manipulated into a configuration having two self-locking mechanisms  2015   a ″ and  2015   b ″ and two loops  2040   a ″ and  2040   b ″. The self-locking mechanisms  2015   a ″ and  2015   b ″ can be formed as described above or as otherwise known to those skilled in the art. In the illustrated embodiment, the self-locking mechanisms  2015   a ″ and  2015   b ″ have a finger-trap-like configuration formed by passing a first limb of the suture  2012 ″ through a portion of a second limb of the suture  2012 ″ before having the first limb exit the second limb to result in fixed and tensioning tails  2012   f _ 1 ″,  2012   f _ 2 ″ and  2012   t _ 1 ″ and  2012   t _ 2 ″. As shown, the fixed tails  2012   f _ 1 ″ and  2012   f _ 2 ″ can be coupled to the tack  2010 ″ using one or more stitches  2013 ″, and tensioning tails  2012   t _ 1 ″ and  2012   t _ 2 ″ can extend from the proximal-most end  20120   p ″ of the tack  2010 ″. The loops  2040   a ″ and  2040   b ″ can both be coupled to a suture implant, as shown an anchor  2060   a ″, and as described above, the tensioning tails  2012   t _ 1 ″ and  2012   t _ 2 ″ can be operable to adjust a diameter of the respective loops  2040   a ″ and  2040   b ″. Although in the illustrated embodiment the self-locking mechanisms  2015   a ″ and  2015   b ″ are shown as having a finger-trap-like configuration, other types of self-locking mechanisms, including sliding knots, can be used in place of the illustrated self-locking mechanisms  2015   a ″ and  2015   b″.    
     Methods of Manufacturing Tissue Augmentation Constructs 
     The tissue augmentation constructs provided for herein can be manufactured using a number of different techniques, some of which are provided for below. Other techniques known to those skilled in the art or developed subsequent to the present disclosure, particularly in view of the present disclosure, can also be used to manufacture the various configurations of tissue augmentation constructs disclosed. 
     Methods of Manufacturing Tissue Augmentation Constructs—Blocks Having a Tape Configuration 
     In one exemplary embodiment of making a tissue augmentation tape or strip  10 , the material being used to make the strip  10  can be cut into a desired shape. For example, in embodiments in which the strip is being manufactured from either autograft tissue, allograft tissue, or xenograft tissue, if the tissue is harvested prior to the procedure, the fresh tissue can be cut into the desired shape, e.g., for the strip  10 , a generally rectangular shape having a length L, a width W, and a thickness T as shown in  FIG.  1 A . Whether the strip is made from harvested material or not, acquisition of the material to make the strip can be achieved using any techniques known to those skilled in the art. In accordance with the present disclosure, the tape or strip  10  can have any shape, for example the tissue can be cut into an oval shape, a circular shape, a triangular shape, etc. Further, the tissue need not be cut with a traditional scalpel or scissors. In some instances it can be sized with the use of a punch, a computer numerical control machine, a laser cutter, or other known manufacturing techniques. 
     Once the tissue is formed into the desired shape, a threader can be associated with the strip  10 . For example, similar to the suture limb  12   a  as shown in  FIG.  1 B , an intermediate filament portion  210  of the threader  206  can be threaded through the strip  10  with the use of a running stitch. The stitch can pass back-and-forth across the body of the tape strip  10  as many times as desired. In alternative embodiments, the intermediate filament portion  210  of the threader  206  can just pass from one of the tape strip  10  to the other without ever passing out of the body. After the threader  206  has been installed, the strip  10  can be dried for packaging. Alternatively, the threader  206  can be inserted after the tissue has been dried. Further, the strip  10  need not be dried. 
     Methods of Manufacturing Tissue Augmentation Constructs—Blocks Having Tube Configurations 
     An exemplary embodiment for making a tissue augmentation tube  110  is illustrated in  FIGS.  22 A- 22 C . The material being used to make the tube  110  can be harvested or otherwise acquired using techniques known to those skilled in the art. The material can then be shaped using any of the techniques described above with respect to the strip  10 , elsewhere herein, or otherwise known to those skilled in the art. As shown in  FIG.  22 A , a piece of material  120  can be harvested having a length L′ and a width W′. The width W′ can be equal to approximately D*π, were D is the diameter of the tube  110 , as shown in  FIG.  2 B . As shown in  FIG.  22 A , the piece of material  120  can be generally rectangular, having a first end  120   a  and a second end  120   b  with the width W′ extending therebetween. Alternatively, the piece of material  120  can have any shape. 
     Once the piece of material  120  has been cut out, the first and second ends  120   a,    120   b  can be brought proximate to one another and subsequently attached to one another, thereby forming a tube. As shown in  FIGS.  22 B and  22 C , the first and second ends  120   a,    120   b  are attached using a suture, or filament,  122  to stitch the ends together. Alternatively, the first and second ends  120   a,    120   b  can be attached to one another with the use of glue, collagen bond, staples, light curing, crosslinking, mechanical interlock, dehydration, or other techniques for attaching soft tissue to soft tissue known to those skilled in the art. A threader  206  can be inserted into the tube  110  before the two ends  120   a,    120   b  are attached, or after. The tube  110  can be dried for packaging. Alternatively, the tube  110  can be maintained in a hydrated form, without dehydrating the block  110  (this is the case with any construct discussed herein or otherwise derivable therefrom). An alternative method for manufacturing a tissue augmentation tube is provided for in  FIGS.  23 A- 23 C . In this method, multiple tubes  110   a - 110   c  can be made at a time from a single material, or as shown two pieces of material, one piece disposed above the other. 
     As shown, a first piece of material  130   a  and a second piece of material  130   b  are placed one on top of the other. Similar to earlier embodiments, the material  130   a,    130   b  can be acquired, sized, and shaped using any techniques provided for herein or otherwise known to those skilled in the art. As shown in  FIG.  23 B , first and second pieces of material  130   a,    130   b  can have a length L′ and a width that is determined as a function of the number of tubes  110   a - 110   c  desired. Specifically, each tube  110  has a diameter, or width, D, as noted above. Therefore, the piece of material can have a width that is equal to the number of tubes  110  desired multiplied by D. Alternatively, the manufacturing can be planned to allow for a select amount of space to be formed between each strip that is formed. In some embodiments, a single piece of material (not shown) having a generally rectangular shape can be used, with the piece being folded in half to create a first piece of material and a second piece of material as shown, one layered upon the other. 
     Once the two pieces of material  130   a,    130   b  have been cut to the desired size, pins  132   a - 132   c  can be placed therebetween. The pins  132   a - 132   c  can be placed approximately parallel to one another and perpendicular to a long edge  131  of the material. The pins  132   a - 132   c  can be spaced such that there is sufficient space between each pin  132   a - 132   c  to allow for attachment and separation of the individual tubes  110   a - 110   c.    
     As shown in  FIGS.  23 A- 23 C , the first and second pieces of material  130   a,    130   b  are attached using sutures  134  to stitch the two pieces together to form a tube around the pin  132   a.  Alternatively, the first and second pieces of material  130   a,    130   b  can be attached to one another with the use of glue, collagen bond, staples, light curing, or other known techniques. Once all of the tubes  110   a - 110   c  have been stitched, the individual tubes  110   a - 110   c  can be cut along lines L 1  and L 2 . The lines L 1  and L 2 , as shown in  FIG.  23 B , are approximately parallel to the pins  132   a - 132   c.  Once the individual tubes  110   a - 110   c  have been cut, the pins  132   a - 132   c  can be removed, as shown in  FIG.  23 C , leaving a bore or lumen  114   a.  A threader  206  can be associated with the lumen  114   a  in manners provided for herein with respect to the lumen  114  of the tube  110  to pass a suture limb through the lumen. 
     This methods of manufacturing tubular constructs can also be used in similar manners to manufacture cannulated constructs like the bars  3010 ,  3110  illustrated in  FIGS.  2 E and  2 F . In such instances, the pins  132   a - 132   c  can be removed once the cannulations are formed using them, and the two layers of material  130   a ′,  130   b ′ can be lightly compressed, or can relax by themselves, towards each other. As a result, the lumen  114   a ′ can transform from a tubular shape, as shown in  FIG.  23 C , to a slit shaped lumen  114   a ′, as shown in  FIGS.  2 E and  2 F . As described above, the overall shape of the construct  3010 ,  3110  can be generally rectangular prisms. In the construction of the construct  3010 ,  3110 , for example, the use of pins  132   a ′- 132   c ′ may be omitted altogether. Alternatively, the pins  132   a ′- 132   c ′ may be replaced with skewer blades, not shown, so that the shape of the lumen  114   c ′ starts as a slit rather than starting with a tubular shape. 
     A further alternative method for manufacturing a tissue augmentation tube is provided for in  FIGS.  24 A- 24 C . This method also allows for multiple tube  110   a ′- 110   c ′ to be made at a time from a single material, or from multiple pieces of material if desired. As shown, a piece of material  130 ′ can have a length L″ and a width that is determined based upon the number of tubes desired. Specifically, each tube  110   a ′- 110   c ′ has a diameter, or width, D′. Therefore, the piece of material can have a width that is equal to the number of augmentation blocks  110 ′ desired multiplied by D′. Alternatively, the width can include an additional space X between each tube  110 ′, which can be accounted for when forming the size of the piece of material  130 ′. As with any of the embodiments provided for herein, a thickness of the material can vary, depending on a variety of factors, including but not limited to the size and shape of the other components and tissue with which the tube is being used, the anatomy of the patient, and the type of procedure being performed. In some exemplary embodiments, a thickness T′ as illustrated in  FIG.  24 A , can be approximately in the range of about 0.5 millimeter to about 10 millimeters. 
     Once the piece of material  130 ′ has been cut to the desired size, pins  132   a ′- 132   c ′ can be inserted through the piece of material  130 ′ from a first edge  130   a ′ to a second edge  130   b ′. The pins  132   a ′- 132   c ′ can be inserted such that they are approximately parallel to one another and approximately perpendicular to the first and second edges  130   a ′,  130   b ′ of the material  130 ′. The pins  132   a ′- 132   c ′ can be spaced such that there is sufficient space between each pin  132   a ′- 132   c ′ to allow for separation. The pins  132   a ′- 132   c ′ can be sized to have a diameter that is approximately equal to the diameter of the resulting lumen  114 ″. 
     Alternatively, as shown in  FIG.  25   , a trocar  2802  can be used to form a lumen  114 ″ in a piece of material. Trocars are generally known to those skilled in the art, and thus a detailed description related to trocars is unnecessary. In fact, in the illustrated embodiment, only a distal end of the trocar  2802  is shown, the distal end including a tip  2804  and a shaft  2806  with which the tip  2804  is associated, e.g., coupled. A distal-most end of the tip  2804  is pointed and sharp, and is thus configured to puncture tissue. The shaft  2806  of the trocar distally extends from a housing (not shown) to help guide the trocar in the material. 
     The trocar  2802  is unique in comparison to other trocars because the shaft  2806  has a gradually increasing diameter in a proximal direction P, i.e., towards the housing. More particularly, the tip  2804  has a, substantially constant, diameter D P1  approximately in the range of about 0.10 millimeters to about 1 millimeter, with, as shown, the distal-most tip having a diameter that is even smaller than D P1 . The shaft  2806  has a gradually increasing diameter, starting from the first diameter D P1  and terminating at a second diameter D P2  approximately in the range of about 0.5 millimeters to about 5 millimeters. Other dimensions are certainly possible, depending, at least in part, on the desired lumen size, the instruments with which the trocar will be used, and surgeon preference. 
     The gradually increasing diameter of the shaft  2806  allows for more precise lumen formation in tissue. By starting with a trocar having a shaft that has a smaller diameter proximate to the distal tip  2804 , it is easier to position and advance the trocar  2802  in soft biological tissue. In use, the tip  2804  can be positioned, for example, on the first edge of a piece of material and advanced by applying pressure and/or twisting the trocar  2802  as it is advanced towards a second side of the tissue to form an initial lumen. As the trocar  2802  is advanced distally towards the second side, a size of the opening that it forms increases gradually, from D P1  to D P2 . This is different than typical trocars, which generally have a single size shaft associated with a distal tip. 
     Turning back to  FIGS.  24 A- 24 C , once all of the pins  132   a ′- 132   c ′ have been inserted, the individual tubes  110   a ′- 110   c ′ can be cut along lines C 1 -C 6 . The lines C 1 -C 6 , as shown in  FIG.  24 B , are approximately parallel to the pins  132   a ′- 132   c ′. Once the individual tubes  110   a ′- 110   c ′ have been cut, the pins  132   a ′- 132   c ′ can be removed, as shown in  FIG.  24 C , leaving a lumen  114   a ′. A threader  206  can be associated with the lumen  114   a ′ in manners provided for herein. 
     The methods of manufacture illustrated herein need not be performed in the order prescribed. For example, with respect to the methods of  FIGS.  23 A- 23 C  and  FIGS.  24 A- 24 C , the pins  132   a - 132   c  and  132   a ′- 132   c ′ can be removed before the tubes  110   a - 110   c  and  110   a ′- 110   c ′ are cut apart. Further, the tubes  110   a - 110   c  and  110   a ′- 110   c ′ can be dried at any suitable point during the manufacturing process. Moreover, this process can be used to create any number of blocks having any number of shapes or configurations, including but not limited to tubular or rectangular, for example a single tissue augmentation block  110   a  and  110   a ′, two augmentation blocks, or more than three augmentation blocks. Still further, the manufacturing technique provided for with respect to various manufacturing embodiments can be modified in view of the present disclosures to manufacture other tissue augmentation constructs. By way of non-limiting example, blocks having a tape or strip configuration can be formed in view of the present disclosures, thereby allowing multiple strips to be formed from a single piece of material and/or multiple pieces of material stacked on top of each other if such additional thickness and/or additional material is desired. The techniques can likewise be adapted for forming augmentation washers, such as by forming the disclosed blocks  110 ,  3010 , or  3110 , and then cutting them along their length to form washers. 
     Methods of Manufacturing Tissue Augmentation Constructs—Coring 
     In some embodiments of the various tissue augmentation constructs disclosed, including blocks, strips, tubes, bars, washers, patches, and tacks, one or more lumens or cannulations may be formed in a body of the construct. Some techniques for forming such lumens that involve using pins are provided above. Another exemplary technique for creating such lumens involves coring, as shown and described with respect to  FIGS.  26 A- 26 I . 
     As shown in  FIG.  26 A , a precut portion of a construct  2110  having a length L 1  and a width W 1  can be prepared to be cored. A tool can be used to core the construct  2110 , such as a coring tube  2132 . The coring tube  2132  can have a handle  2134  at a proximal end and a hollow tube  2136  at a distal end. The hollow tube  2134  of the coring tube  2132  can have a distal edge  2138  that can be sharpened or serrated to create a clean cut. The hollow tube  2134  can have a diameter d 1  that is less than the W 1  of the construct. The diameter d 1  can be chosen based on the suture size desired for a given procedure. 
     As shown in  FIG.  26 B , the coring tube  2132  can be advanced in the direction S while being rotated in the direction R. The rotation and linear translation of the tool  2132  can provide for a cleaner cut; however, the tool can be pushed through only in the direction S, without any rotation. As shown in  FIG.  26 C , once the distal end of the coring tube  2132  has been advanced along the entire length of the construct  2110 , it can be removed in an opposite direction S′, thereby removing the portion of material  2110   a  and leaving a circular lumen  2114 . As shown in  FIG.  26 D , a plurality of lumens  2114   a - 2114   c  can be created in a single construct  2110 . Alternatively, the construct of  FIG.  26 D  can be cut into strips that run parallel to the lumens  2114   a - 2114   c,  thereby forming multiple constructs with each including only one lumen. In a further alternative embodiment, as shown in  FIGS.  26 E and  26 F , at least two bores  2114   d,    2114   e  can be created in a construct  2110  such that they intersect at some location  2120  in the construct. 
     In alternative coring embodiments, illustrated in  FIGS.  26 G- 26 I , a curved lumen  2114 ′ can be created using the coring tube  2132 ′. As shown in  FIG.  26 G , a generally U-shaped construct  2110 ′ having first and second generally curved shaped edges  2110   a ′,  2110   b ′ and two straight edges  2110   c ′,  2110   d ′, is prepared to be cored. Similar to the embodiment of  FIG.  26 A- 26 C , a coring tube  2132 ′ is used to core out a lumen  2114 ′ through the construct that enters and exits along edge  2110   a ′. In  FIG.  26 H , the lumen  2114 ′ is shown as being substantially linear. Once the lumen  2114 ′ has been created, the construct can be stretched, or otherwise rearranged, such that the edges  2110   a ′- d ′ are all substantially straight to create a generally rectangular construct  2110 ′, as shown in  FIG.  26 I . 
     Method of Manufacturing Tissue Augmentation Constructs—Tunneling Station 
     In a further alternative method of manufacturing, a construct formation tunneling station is provided. As shown in  FIG.  27 A , a construct formation tunneling station  3200  can include a stage  3220  for holding a tissue augmentation construct, a lumen formation tool  3224  for forming a lumen in the construct, and a guide  3228  for helping to locate the lumen formation tool  3224  with respect to the construct being held by the stage  3220 . 
     In an exemplary embodiment, the construct stage  3220  can support and guide a piece of material  3230  from which constructs can be formed. The construct stage  3220  can be a self-centering compression stage to maintain a piece of material  3230  at a fixed height through the stage  3220 . The self-centering of the construct stage  3220  can be accomplished according to accepted manufacturing techniques. The construct stage  3220  can include two stages  3220   a,    3220   b  which are able to move towards and away from one another, Y 1 , Y 2  to self-center and compress the material  3230 . Alternatively, only one stage  3220   a,    3220   b  can translate, or the stages  3220   a,    3220   b  can be fixed relative to one another. The first stage  3220   a  can have a distal face  3219   a  that is opposed to the proximal face  3219   b  of the second stage  3220   b.  Each of the distal face  3219   a  and the proximal face  3219   b  can include semi-circular reliefs  3221   a,    3221   b  that are able to accommodate the material  3230  upon insertion of the lumen formation tool  3222 , as shown in  FIGS.  27 B and  27 C . The construct stage  3220  can include mechanisms, not shown, to advance the material  3230  in a direction Z to automate the manufacturing process, for instance, as described below with respect to  FIG.  27 J . 
     The construct formation tunneling station  3200  can include a lumen formation tool  3224  that can include a guide  3228  and a cutting tool  3222 . In the illustrated embodiment, the guide  3228  can generally include a lumen  3227  and can be fixed relative to the construct stage  3220  by connectors  3226   a,    3226   b  to ensure that the relative orientation of the tool  3224  and the stage  3220  remains fixed such that the orientation of the lumen within a construct formed by the jig station  3200  is within accepted manufacturing tolerances from construct to construct. Alternatively, the guide  3228  can be secured to the stage  3220  with only one connector, or more than two connectors. Further, while the lumen forming tool  3224  is shown physically connected to the construct stage  3220 , alternatively, the tool  3224  and the stage  3220  can be separate pieces that are fixed relative to one another, e.g., attached to the same work table, to ensure proper lumen forming alignment. 
     A cutting tool  3222  can be disposed within the guide  3228 , including by being removably and replaceably associated with the guide  3228 , such that the tool  3222  can freely rotate R and translate X within the guide  3228 . In some embodiments, the tool  3222  can be a needle as shown in  FIG.  27 D . Alternatively, the cutting tool can be a spear, as shown in  FIG.  27 E , for example a Premier Edge MVR knife available from Oasis Medical of Glendora, Calif. The spear can include a proximal stem portion  3222   p  having a substantially circular cross sectional shape and a distal spear portion  3222   d.  The distal spear portion can have a plurality of straight sharp edges  3223 . The plurality of straight sharp edges  3223  can have a smooth transition from the proximal stem portion  3222   p  of the tool. 
     In further alternative embodiments the cutting tool  3222  can have a number of alternative designs. For example, a trocar as shown in  FIG.  27 F , a drill bit as shown in  FIG.  27 G , a coring tube as shown in  FIG.  27 H , or a straight blade as shown in  FIG.  27 I . Each of the alternative tools can be used to create a lumen within a construct  3210  according to accepted manufacturing techniques provided for throughout the present disclosure. 
     In an exemplary method of use, multiple tubes  3210   a - 3210   d  can be made at a time from a single length of material, or from multiple pieces of material if desired. As shown, a piece of material  3230  can have a length L and a width W. The width W of the material can be the length of the resulting construct while the length L can be determined based upon the number of constructs desired. Specifically, each construct  3210   a - 3210   d  has a diameter, or width, D. Therefore, the piece of material can have a length L that is equal to the number of constructs  3210  desired multiplied by D. Alternatively, the length L can include an additional space between each construct  3210 , which can be accounted for when forming the size of the piece of material  3230 . As with any of the embodiments provided for herein, a thickness of the material can vary, depending on a variety of factors, including but not limited to the size and shape of the other components and tissue with which the construct is being used, the anatomy of the patient, and the type of procedure being performed. 
     Once the piece of material  3230  is advanced into the stage  3220 , the lumen forming tool  3224  can be actuated such that the cutting tool  3222  can be inserted through the piece of material  3230  from a first edge  3230   a  to a second edge  3230   b,  as shown in  FIGS.  27 I-K . Depending on the type of cutting tool  3222  used, the lumen forming tool  3224  can either translate the tool  3222  in a direction X, or rotate and translate the tool  3222  in the directions X and R into the material  3230 . Actuation of the cutting tool  3222  can be performed automatically with an actuator. Alternatively, the cutting tool  3222  can be manually actuated by a user. The cutting tool  3222  can then be retracted leaving a lumen  3214   a - 3214   c.  The material  3230  can then be advanced, in the direction Z, a predetermined distance and the process can be repeated to create additional constructs. Individual constructs  3210   a - 3210   d  can then be separated from the piece of material  3230  as shown in  FIGS.  27 K and  27 L . For example, the individual constructs  3210   a - 3210   d  can be separated by means of a punch  3290   a - 3290   d  or other cutting mechanisms as provided for throughout the present disclosure. 
     An alternative construct forming jig station  3200 ′, as illustrated in  FIG.  27 M , can provide for parallel lumen formation. As shown in  FIG.  27 M , the stage  3220 ′ can accommodate a larger length L′ of the material  3230 ′. For example, as illustrated in  FIG.  27 M , the stage  3220 ′ can accommodate a length required to create three constructs. Alternatively, the stage  3220 ′ can extend to accommodate any number of constructs. The stage  3220 ′ can, similar to the stage of the jig station  3200 , have semi-circular reliefs and can be self-centering. Similar to the embodiment of  FIGS.  27 A- 27 L , the station  3220 ′ can include a plurality of lumen forming tools  3224   a ′,  3224   b ′,  3224   c ′ that are each aligned in parallel with each other. Alternatively, the plurality of tools  3224   a ′,  3224   b ′,  3224   c ′ can be oriented at any angle relative to one another. The lumen forming tools  3224   a ′,  3224   b ′,  3224   c ′ are aligned such that each of the respective cutting tools  3222   a ′,  3222   b ′,  3222   c ′ each translate towards the stage in parallel directions. In the illustrated embodiment three lumen forming tools  3224   a ′,  3224   b    3224   c ′ are shown, however any number of lumen forming tools can be provided for. After each of the lumen forming tools  3224   a ′,  3224   b ′,  3224   c ′ have been actuated and retracted to create lumens  3214   a ′,  3214   b ′,  3214   c ′ in the material  3230 ′, the material  3230 ′ can be advanced in the direction D′. The individual constructs  3210   a ′,  3210   b ′,  3210   c ′ can be separated according to techniques provided for herein. Alternatively, constructs that include a plurality of lumens can be cut from the material to form patches or scaffolds, as discussed further below. 
     Methods of Manufacturing Tissue Augmentation Constructs—General Methods 
     The embodiments described above represent some specific techniques associated with manufacturing blocks having particular configurations, e.g., strips, tubes, bars, and washers. More general techniques such as coring are also provided. Such techniques can be adapted by a person skilled in the art for use in other configurations of tissue augmentation constructs in view of the present disclosures. Still further, the present disclosure provides for even more general techniques and methods that can be used to form the various tissue augmentation constructs disclosed herein derivable from the present disclosures. The methods provided for in this section can be used as standalone methods, in conjunction with each other, and/or in conjunction with the other manufacturing techniques provided for in the present disclosure. 
     In some embodiments, the constructs can be fully, or partially, manufactured by phase separation techniques, lyophilization, knitting, weaving, electrospinning, rapid prototyping (e.g., 3-D printing) or combinations of thereof. In order to facilitate tissue in growth, perforations can be created in the construct using thermal, electrical, or/and mechanical means, among others. For example, the perforations can be created by a laser or a sharp object such as a needle, punch, or die. The size of a perforation can be any suitable size, but preferably, the perforations are sized to allow tissue in-growth. More preferably, the perforations size can be approximately in the range of about 50 microns to about 2000 microns, and even more preferably, approximately in the range of about 50 microns to about 1000 microns. 
     In some embodiments, a biological tissue including, but not limited to, an allograft or xenograft tissue, may, optionally, be incorporated within the various tissue augmentation constructs, thus forming a two-layer construct. The combination of a biological tissue within the various tissue augmentation constructs can provide for enhanced biological performance and mechanical performance of a resulting construct. 
     For example, as shown in  FIG.  28   , a construct  2710  (as shown a patch or scaffold, which is described in greater detail below) can include a reconstituted collagen matrix or a biodegradable polymer,  2702  or any of the other materials described herein for use in a tissue augmentation construct (e.g., autograft, xenograft, pulverized collagen pieces, porcine dermis, etc.), and a biological component, such as an extracellular matrix (ECM)  2704 , attached to one side of the matrix  2702  using techniques known to those skilled in the art. The reconstituted collagen matrix or biodegradable polymer can be, or can be part of, a first layer, and the biological component can be, or can be part of, a second layer, with a thickness and a surface area of the first layer being larger, and as shown substantially larger, than a thickness and a surface area of the second layer. In other embodiments, the biological component, e.g., the ECM  2704 , can be disposed on opposed sides of the matrix  2702  and/or coated or soaked onto the matrix  2702 . A person skilled in the art will recognize a number of different attachment options that can be used to couple the ECM(s)  2704  to the matrix  2702 , including but not limited to gluing and stitching. The inclusion of the ECM  2704  or other biological component can help integrate the augmentation construct with the tissue with which the construct is being used. In one exemplary embodiment, the matrix  2702  can have a thickness T 1  approximately in the range of about 1 millimeter to about 4 millimeters, and the ECM layer can have a thickness approximately in the range of about 80 microns to about 3 millimeters. 
     In some embodiments, a biological component can be coated onto the tissue augmentation construct, or incorporated in the tissue augmentation construct. If a biological component is coated onto the tissue augmentation construct, the biological component is preferably associated with at least a portion of the construct. For example, the biocompatible construct can include an adhesion agent for anchoring the suspension of the biological component to a scaffold. The adhesion agent can be an anchoring agent, a cross-linking agent (i.e., chemical or physical), and combinations thereof. Suitable anchoring agents can include, for example, hyaluronic acid, fibrin glue, fibrin clot, collagen gel, alginate gel, gelatin-resorcin-formalin adhesive, mussel-based adhesive, dihydroxyphenylalanine (DOPA) based adhesive, chitosan, transglutaminase, poly(amino acid)-based adhesive, cellulose-based adhesive, polysaccharide-based adhesive, synthetic acrylate-based adhesives, platelet rich plasma (PRP), platelet poor plasma (PPP), clot of PRP, clot of PPP, Matrigel, Monostearoyl Glycerol co-Succinate (MGSA), Monostearoyl Glycerol co-Succinate/polyethylene glycol (MGSA/PEG) copolymers, laminin, elastin, proteoglycans, and combinations thereof. 
     Cross-linking can be achieved using physical means and chemical agents. Examples of chemical agents used to cross-link can include dehydrothermal (DHT) treatment, divinyl sulfone (DVS), polyethylene glycol divinyl sulfone (VS-PEG-VS), hydroxyethyl methacrylate divinyl sulfone (HEMA-DIS-HEMA), formaldehyde, glutaraldehyde, aldehydes, isocyanates, alkyl and aryl halides, imidoesters, N-substituted maleimides, acylating compounds, carbodiimide, hexamethylene diisocyanate, 1-Ethyl-3-[3-dimethylaminopropyl]carbodiimide hydrochloride (EDC or EDAC), hydroxychloride, N-hydroxysuccinimide, light (e.g., blue light and UV light), pH, temperature, and combinations thereof. 
     The biological components can be one or more effectors that promote healing and/or regeneration of the affected tissue at the site of injury. The biological component of a construct can include heterologous or autologous growth factors, proteins, matrix proteins, peptides, antibodies, antibiotics, anti-inflammatories, therapeutic agents, chemotactic agents, antimicrobial agents, antibiotics, anti-inflammatory agents, compounds that minimize or prevent adhesion formation, compounds or agents that suppress the immune system, cell attachment mediators, biologically active ligands, integrin binding sequence, enzymes, cytokines, glycosaminoglycans, polysaccharides, viruses, virus particles, nucleic acids, analgesics, cells, platelets, platelet rich plasma (PRP), minced extracellular particles, minced tissue fragments, hydroxyapatite, tricalcium phosphate, bioactive glass, biphasic calcium phosphate, calcium sulfate, other bone and/or tissue growth-promoting materials, and combinations thereof. 
     As described herein, in some embodiments the tissue augmentation construct can have one or more through holes or bores extending therethrough. The through hole(s) can be a slit or a passage with different cross-sectional shapes, for example, circular, elliptical, square, rectangular, etc. The through hole(s) can be created by any tool that can remove materials including mechanical, thermal, or electrical tools. Alternatively, the through hole(s) can be a slit(s) that can be created by any tool that results in the separation of two surfaces. 
     In some embodiments, the construct can be made of more than one layer. The layers of the construct can be made of the same material or different materials. The layers can be bonded or fused together using sutures, mechanical, electrical, and chemical fastening techniques. Examples of bonding or fusing can include, for example, tissue welding, staples, rivets, tissue tacks, darts, screws, pins, arrows, cross-linking, vacuum pressing, compression, compression combined with dehydration, vacuum pressing combined with dehydration, or a biological adhesive or a combination of thereof. Dehydration in this context can include, for example, freeze-drying (i.e., lyophilization). Biological adhesives can include, for example, fibrin glue, fibrin clot, collagen gel, alginate gel, gelatin-resorcin-formalin adhesive, mussel-based adhesive, dihydroxyphenylalanine (DOPA) based adhesive, chitosan, transglutaminase, poly(amino acid)-based adhesive, cellulose-based adhesive, polysaccharide-based adhesive, synthetic acrylate-based adhesives, platelet rich plasma (PRP), platelet poor plasma (PPP), clot of PPP, Matrigel, Monostearoyl Glycerol co-Succinate (MGSA), Monostearoyl Glycerol co-Succinate/polyethylene glycol (MGSA/PEG) copolymers, laminin, elastin, hyaluronic acid, proteoglycans, and combinations thereof. 
     In some embodiments the construct can include a reinforcing material. The reinforcing material can be comprised of any absorbable or non-absorbable textile having, for example, woven, knitted, warped knitted (i.e., lace-like), non-woven, and braided structures. In one embodiment, the reinforcing material can have a mesh-like structure. Mechanical properties of the material can be altered by changing the density or texture of the material, the type of knit or weave of the material, the thickness of the material, or by embedding particles in the material. 
     Mechanical properties of the reinforcing material can additionally be altered by creating sites within the construct where fibers are physically bonded with each other or physically bonded with another agent, such as, for example, an adhesive or a polymer. The fibers used to make the reinforcing component can be, for example, monofilaments, yarns, threads, braids, or bundles of fibers. These fibers can be made of any biocompatible material including, but not limited to, bioabsorbable materials such as polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), polydioxanone (PDO), trimethylene carbonate (TMC), copolymers or blends thereof. The fibers can also be made from any biocompatible materials based on natural polymers including silk and collagen-based materials. Alternatively, the fibers can also be made of any biocompatible fiber that is nonresorbable, such as, for example, polyethylene, nylon, polyester, polyethylene terephthalate, poly(tetrafluoroethylene), polycarbonate, polypropylene, polyurethane, and poly(vinyl alcohol). 
     In another embodiment, the construct may incorporate hydroxyapatite, tricalcium phosphate, Bioglass, biphasic calcium phosphate, calcium sulfate, other bone-promoting materials within the whole construct or localized in a portion of the construct where bone regeneration is desired. Bioglass is a silicate containing calcium phosphate glass, or calcium phosphate glass with varying amounts of solid particles added to control resorption time. Bioglass is one example of materials that can be spun into glass fibers and used as a reinforcing material. Bioglass can also be incorporated into the construct in a powder form. Suitable solid particles may be added include iron, magnesium, sodium, potassium, and combinations thereof. 
     In some embodiments, both the biocompatible construct and the reinforcing material may be formed from a thin, perforation-containing elastomeric sheets with pores or perforations to allow tissue in-growth. A sheet can be made of blends or copolymers of polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), and polydioxanone (PDO). 
     The construct can be formed partially or completely from a polymeric foam component, having pores with an open cell pore structure. The pore size can vary, but preferably, the pores are sized to allow tissue in-growth. In some embodiments, the pore size is approximately in the range of about 40 microns to about 1000 microns, and in other embodiments, the pore size is approximately in the range of about 50 microns to about 500 microns. The polymeric foam component can be made from natural or/and synthetic materials, such as reconstituted collagen. The polymeric foam can be non-crosslinked or crosslinked. The polymeric foam component can, optionally, contain a reinforcing component, such as for example, textiles as discussed above. In some embodiments, the polymeric foam component can contain a reinforcing component which can be integrated with the reinforcing component such that the pores of the foam component penetrate the mesh of the reinforcing component and interlock with the reinforcing component. 
     In some embodiments the polymeric foam component of the tissue implant may be formed as a foam by a variety of techniques well known to those having skill in the art. For example, the polymeric starting materials may be foamed by lyophilization, supercritical solvent foaming, which is described at least in European Patent Application No. 464,163, the contents of which is incorporated by reference herein in its entirety, gas injection extrusion, gas injection molding or casting with an extractable material (e.g., salts, sugar, or similar suitable materials). 
     A polymeric foam component of engineered tissue repair implant devices of the present disclosure may be made by a polymer-solvent phase separation technique, such as lyophilization. A polymer solution can be separated into two phases by any one of the four techniques: (a) thermally induced gelation/crystallization; (b) non-solvent induced separation of solvent and polymer phases; (c) chemically induced phase separation, and (d) thermally induced spinodal decomposition. The polymer solution can be separated in a controlled manner into either two distinct phases or two bi-continuous phases. Subsequent removal of the solvent phase usually leaves a porous structure with a density less than the bulk polymer and pores in the micrometer ranges. Additional information about the solvent phase is provided in Microcellular Foams via Phase Separation, J. Vac. Sci. Technol., A. T. Young, Vol. 4(3), May/June 1986, the contents of which is incorporated by reference herein in its entirety. 
     The steps involved in the preparation of these foams include, for example, choosing the right solvents for the polymers to be lyophilized and preparing a homogeneous solution. Next, the polymer solution can be subjected to a freezing and vacuum drying cycle. The freezing step phase can separate the polymer solution and vacuum drying step can remove the solvent by sublimation and/or drying, leaving a porous polymer structure or an interconnected open cell porous foam. Suitable solvents that may be used in the preparation of the foam component can include, for example, formic acid, ethyl formate, acetic acid, hexafluoroisopropanol (HFIP), cyclic ethers (e.g., tetrahydrofuran (THF), dimethylene fluoride (DMF), and polydioxanone (PDO)), acetone, acetates of C2 to C5 alcohols (e.g., ethyl acetate and t-butylacetate), glyme (e.g., monoglyme, ethyl glyme, diglyme, ethyl diglyme, triglyme, butyl diglyme and tetraglyme), methylethyl ketone, dipropyleneglycol methyl ether, lactones (e.g., γ-valerolactone, δ-valerolactone, β-butyrolactone, γ-butyrolactone), 1,4-dioxane, 1,3-dioxolane, 1,3-dioxolane-2-one (ethylene carbonate), dimethlycarbonate, benzene, toluene, benzyl alcohol, p-xylene, naphthalene, tetrahydrofuran, N-methylpyrrolidone, dimethylformamide, chloroform, 1,2-dichloromethane, morpholine, dimethylsulfoxide, hexafluoroacetone sesquihydrate (HFAS), anisole, and mixtures thereof. Among these solvents, one exemplary solvent is 1,4-dioxane. A homogeneous solution of the polymer in the solvent is prepared using standard techniques. 
     The applicable polymer concentration or amount of solvent that may be utilized can vary with each system. In one embodiment, the amount of polymer in the solution can vary from about 0.5% to about 90% by weight. In another embodiment, preferably, the amount of polymer in the solution can vary from about 0.5% to about 30% by weight. The amount of polymer in the solution can vary depending on factors such as the solubility of the polymer in a given solvent and the final properties desired in the foam. 
     In embodiments of the construct that include a polymeric foam, solids may be added to the polymer-solvent system to modify the composition of the resulting polymeric foam surfaces. As the added particles settle out of solution to the bottom surface, regions will be created that will have the composition of the added solids, not the foamed polymeric material. Alternatively, the added solids may be more concentrated in desired regions (i.e., near the top, sides, or bottom) of the resulting tissue augmentation construct, thus causing compositional changes in all such regions. For example, concentration of solids in selected locations can be accomplished by adding metallic solids to a solution placed in a mold made of a magnetic material (or vice versa). 
     A variety of types of solids can be added to the polymer-solvent system. In one embodiment, the solids are of a type that will not react with the polymer or the solvent. The added solids can have an average diameter of less than about 2 millimeters. In other embodiments, added solids can have an average diameter of about 50 microns to about 1000 microns. The solids can be present in an amount such that they will constitute from about 1 volume to about 50 volume percent of the total volume of the particle and polymer-solvent mixture (wherein the total volume percent equals 100 volume percent). 
     Exemplary solids include, for example, particles of demineralized bone, calcium phosphate particles, Bioglass particles, calcium sulfate, or calcium carbonate particles for bone repair, leachable solids for pore creation and particles of bioabsorbable natural polymers, bioabsorbable synthetic polymers, non-bioabsorbable materials, minced extracellular particles, minced tissue fragments, or any biocompatible materials that is not soluble in the solvent system. 
     Exemplary leachable solids include, for example, nontoxic leachable materials such as salts (e.g., sodium chloride, potassium chloride, calcium chloride, sodium tartrate, sodium citrate, and the like), biocompatible mono and disaccharides (e.g., glucose, fructose, dextrose, maltose, lactose and sucrose), polysaccharides (e.g., starch, alginate, chitosan), water soluble proteins (e.g., gelatin and agarose). Leachable materials can be removed by immersing the foam with the leachable material in a solvent in which the particle is soluble for a sufficient amount of time to allow leaching of substantially all of the particles. The solvent can be chosen so that it does not dissolve or detrimentally alter the foam. One preferred embodiment can include water as the extraction solvent, for example distilled-deionized water. Such a process is described further in U.S. Pat. No. 5,514,378, the contents of which is incorporated by reference herein in its entirety. Preferably the foam will be dried after the leaching process is complete at low temperature and/or vacuum to minimize hydrolysis of the foam unless accelerated absorption of the foam is desired. 
     Non-bioabsorbable materials can include, for example, bioinert ceramic particles (e.g., alumina, zirconia, and calcium sulfate particles), polymers such as polyethylene, polyvinylacetate, polymethylmethacrylate, polypropylene, poly(ethylene terephthalate), silicone, polyethylene oxide, polyethylene glycol, polyurethanes, polyvinyl alcohol, natural polymers (e.g., cellulose particles, chitin, and keratin), and fluorinated polymers and copolymers (e.g., fluoride, polytetrafluoroethylene, and hexafluoropropylene). In one embodiment, it is possible to add solids (e.g., barium sulfate) that will render the tissue implants radio opaque. Those solids that may be added also include those that will promote tissue regeneration or healing, as well as those that act as buffers, reinforcing materials or porosity modifiers. 
     As discussed above, polymeric foam components can contain a reinforcing component. The construct can be made by injecting, pouring, or otherwise placing, the appropriate polymer solution into a mold set-up comprised of a mold and the reinforcing elements of the present disclosure. The mold set-up can be cooled in an appropriate bath or on a refrigerated shelf and then lyophilized, thereby providing a reinforced construct. 
     In embodiments that utilize a polymeric foam, one or more of the biological components provided for throughout the present disclosure can be added either before or after the lyophilization step. In the course of forming the polymer foam component, it can be beneficial to control the rate of freezing of the polymer-solvent system. The type of pore morphology that is developed during the freezing step is a function of factors such as the solution thermodynamics, freezing rate, temperature to which it is cooled, concentration of the solution, and whether homogeneous or heterogeneous nucleation occurs. The orientation of the polymeric fibers can be regulated be controlling the pore orientation. The pores orientation in the polymeric form component can be customized, for example, by controlling the temperature gradient induced during the freezing cycle. Controlling the orientation of fibers can result in an improvement in the mechanical properties in the direction that the fibers are oriented. 
     The required general processing steps for a construct that uses polymeric foam can include the selection of the appropriate materials from which the polymeric foam will be made. The processing steps can additionally include selection of the materials of the reinforcing components if used. If a mesh reinforcing material is used, the proper mesh density should be selected. Further, the reinforcing material should be properly aligned in the mold, the polymer solution should be added at an appropriate rate and, preferably, into a mold that is tilted at an appropriate angle to avoid the formation of air bubbles, and the polymer solution must be lyophilized. 
     In embodiments that utilize a mesh reinforcing material in a polymeric foam, for example, the reinforcing mesh should be selected to be of a certain density. That is, the openings in the mesh material should not be so small so as to impede proper bonding between the foam and the reinforcing mesh as the foam material and the open cells and cell walls thereof penetrate the mesh openings. Without proper bonding the integrity of the layered structure can be compromised, leaving the construct fragile and difficult to handle. The density of the mesh can determine the mechanical strength of the construct. The density of the mesh can vary according to the desired use for tissue repair. In addition, the type of weave used in the mesh can determine the directionality of the mechanical strength of the construct, as well as the mechanical properties of the reinforcing material, such as for example, the elasticity, stiffness, burst strength, suture retention strength, and ultimate tensile strength of the construct. By way of non-limiting example, the mesh reinforcing material in a foam-based biocompatible construct of the present disclosure can be designed to be stiff in one direction, yet elastic in another, or alternatively, the mesh reinforcing material can be made isotropic. 
     During lyophilization of the reinforced foam in those embodiments that utilize a mesh reinforcing material in a polymeric foam, several parameters and procedures can be helpful to produce implants with the desired integrity and mechanical properties. For example, if reinforcement material is used, it can be beneficial to maintain the reinforcement material substantially flat when placed in the mold. To ensure the proper degree of flatness, the reinforcement (e.g., mesh) can be pressed flat using a heated press prior to its placement within the mold. Further, in the event that reinforcing structures are not isotropic, it can be desirable to indicate this anisotropy by marking the construct to indicate directionality. The marking can be accomplished by embedding one or more indicators, such as dyed markings or dyed threads, within the woven reinforcements. The direction or orientation of the indicator can, for example, indicate to a surgeon the dimension of the implant in which physical properties are superior. 
     In embodiments that utilize polymeric foam, as noted above, the manner in which the polymer solution is added to the mold prior to lyophilization can help contribute to the creation of a tissue implant with adequate mechanical integrity. Assuming that a mesh reinforcing material will be used, and that it will be positioned between two thin (e.g., approximately 0.75 millimeters) shims, the mesh can be positioned in a substantially flat orientation at a desired depth in the mold. The polymer solution can be poured in a way that allows air bubbles to escape from between the layers of the foam component. The mold can be tilted at a desired angle and pouring is effected at a controlled rate to best prevent bubble formation. A number of variables will control the tilt angle and pour rate. For example, the mold should be tilted at an angle of greater than about one degree to avoid bubble formation. In addition, the rate of pouring should be slow enough to enable any air bubbles to escape from the mold, rather than to be trapped in the mold. 
     In those embodiments that utilize a mesh reinforcing material in a polymeric foam, the density of the mesh openings can be an important factor in the formation of the construct with the desired mechanical properties. For example, a low density, or open knitted mesh material, can be used. One example of such a material is a 90:10 copolymer of glycolide and lactide, sold under the tradename VICRYL, which is available from Ethicon, Inc. of Somerville, N.J. One exemplary low density, open knitted mesh is Knitted VICRYL VKM-M, which is also available from Ethicon, Inc. of Somerville, N.J. Other materials can include but are not limited to polydioxanone and a 95:5 copolymer blend of lactide and glycolide. 
     In embodiments that utilize a polymeric foam, a through opening can be created by placing a rod in the polymeric foam solution/slurry before it has set. After the polymeric form is formed, the rod can be removed. For example, if the polymeric foam is made by lyophilization, the rod is removed after the freeze and vacuum drying cycle. The rod can have any desired shape. 
     The polymeric foam component can, optionally, contain one or more layers made of the materials discussed above. In one embodiment, the foam component can be integrated with the material(s) by creating pores in the materials and then the polymeric foam component penetrate the pores created in the materials(s) and interlock with the material(s). In another embodiment, pores are formed in materials of two layers, and the two layers are put together to best align the pores. The two layer combination can be placed in a polymeric solution or slurry, and the polymeric foam can be formed by one of the methods provided for herein or otherwise known to those skilled in the art. 
     In some embodiments, a construct can be formed from an expanding media that can advantageously provide added compression at the repair site. One non-limiting example of such a construct  2910  is shown in  FIG.  29 A , in which the construct is a patch or scaffold (as described in greater detail below). For example, the construct  2910  can be formed from a woven or braided mesh having a core  2904  surrounded or sandwiched between two layers  2902   a,    2902   b.  The two layers  2902   a,    2902   b  can be referred to as a jacket. The core  2904  can be made from a variety of materials that are capable of expanding, such as silicone loaded with salt, sodium polyacrylate, polyacrylamide copolymer, polyurethanes, and other absorbent polymers and hydro gels, while the jacket  2902   a,    2902   b  can be more rigid so that the core can compress against the jacket as it expands in use. Non-limiting exemplary materials that can be used to form the jacket  2902   a,    2909   b  include fabric and filament such as polyethylene, polypropylene, polyester, poly(ethylene terephthalate), nylon, polyurethanes and silk. Further non-limiting exemplary materials that can be used to form the jacket  2902   a,    2902   b  include bioabsorbable materials such as polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), polydioxanone (PDO), trimethylene carbonate (TMC), copolymers or blends thereof. Some materials that can be used in conjunction with the construct include, but are not limited to, those disclosed and provided for in U.S. Pat. No. 8,870,915, entitled “Joining Element,” the contents of which is incorporated by reference herein in its entirety. The construct  2910  can have a length L P  and a thickness T P , as shown in  FIG.  29 A , and can include at least one suture limb  2911  for affixing the construct to one or more repair sites. In the illustrated example the construct  2910  includes four suture limbs  2911 ,  2912 ,  2913 ,  2914  associated with it. The limbs can be from the same or different sutures. 
     In use, as shown in  FIG.  29 B , the construct  2910  can be placed over the repair sites  2938   a,    2938   b,  and the suture limbs  2911 ,  2912 ,  2913 ,  2914  can be fixed within respective anchors  2961 ,  2962 ,  2963 ,  2964 . As with other disclosures, the repairs associated with the repair sites  2938   a,    2938   b  can be any type of repair provided for herein or otherwise known to those skilled in the art. The construct  2910  can be further affixed to a location medial of the repairs  2938   a,    2938   b  with sutures, staples, or other devices and components used to fixate tissue with respect to bone. As shown, sutures  2940   a - 2940   c  provide the fixation. The construct  2910  can be exposed to an aqueous solution, for example after installation, such that the silicone and salt filled core can absorb the fluid to cause the construct to expand in at least one dimension and contract in at least one other dimension based on the configuration of the construct  2910 . In the illustrated example, the expansion causes the construct  2910  to increase in thickness T P  while contracting and decreasing across its length L P . The decrease in the length L P  after the construct  2910  is installed can increase the compressive forces to the soft tissue  2930  to bring the tissue into more uniform contact with the bone  2950  due, at least in part, to the limited space for fixation of the construct  2910 , the configuration of the construct  2910 , and the surface geometry of the attachment site. One skilled in the art will appreciate that a configuration of a construct having a core, capable of expanding, sandwiched between layers or a jacket can be used with other construct configurations provided for herein, including those that are not necessarily a patch or scaffold, to provide for added compressive forces at repair sites. A further discussion of tissue augmentation patches and scaffolds is provided below. 
     Unless specified otherwise, any of the materials, and any of the techniques disclosed for forming materials, can be used in conjunction with any of constructs provided for herein. This includes any combination of materials. Likewise, the manufacturing techniques disclosed can generally be used, or adapted to form the various constructs provided for herein. The use of materials and manufacturing techniques for various tissue augmentation constructs is within the spirit of the present disclosure. 
     Tissue Augmentation Constructs—Tissue Augmentation Patches 
     Tissue augmentation constructs can also come in form of a patch or scaffold that can be associated with one or more limbs of suture to increase a footprint of the one or more limbs and to provide additional surface area across which forces to be distributed, among other benefits articulated throughout the present disclosure, e.g., enhancing healing of otherwise compromised tissue and/or providing bulk to otherwise compromised or degenerate tissue and/or tendon. The patches can be disposed on, or even attached or coupled, to the suture rather than just sitting on top of operative sutures. Further, the instant patches can be delivered to the surgical site and threaded onto sutures using a suture threader as described herein, thereby obviating the need for extensive suturing of each edge of a patch. A number of different techniques can be used to associate the illustrated patches with suture, including threading the suture through the patch and/or disposing the suture in between layers of a scaffold. The patch can then be disposed proximate to a surgical site as described. Methods of manufacturing a scaffold or patch, and methods of installing various scaffolds and patches, are also provided for below. The systems and methods disclosed herein allow for quick, easy, and affordable techniques for preventing damage to tissue by tensioned suture. Like the other constructs described above, a surgeon can apply the patch(es) in an on-demand manner to create desired suture footprints for the repair. A person skilled in the art will recognize that the disclosures provided for herein related to tissue augmentation blocks, e.g., by way of non-limiting example, the materials used to form the tissue augmentation blocks  10 ,  110 ,  3010 ,  3110 ,  310 ,  410 , among other constructs, can be applied to the patches discussed below. 
     One exemplary embodiment of a tissue augmentation construct  2210  having a patch or scaffold configuration is provided for in  FIGS.  30 A and  30 B . As shown, the tissue augmentation patch  2210  has a rectangular-shaped body and can be disposed on or otherwise associated with suture limbs  2212   a,    2212   b.  In the illustrated embodiment the patch  2210  includes bores or lumens  2214   a,    2214   b  are formed in the body and extend therethrough from a proximal-most end  2210   p  to a distal-most end  2210   d.  The bores  2214   a,    2214   b  can be used, for example, to receive the suture limbs  2212   a,    2212   b  so that the patch  2210  and limbs  2212   a,    2212   b  can be associated with each other. As shown in  FIG.  30 B , the patch  2210  can be pre-threaded with suture threaders  2206   a,    2206   b.  The threaders  2206   a,    2206   b  are of a similar nature as the threader  206 ′, and can also be configured in a manner akin to the threader  206  or in manners otherwise known to those skilled in the art and/or derivable from the present disclosures. As shown, the patch  2210  has a length L P  that is substantially equal to a width W P , and it also has a thickness T P . Further, the thickness T P  can be greater than a diameter of a filament or suture with which the tissue augmentation patch  2210  is associated, e.g., the suture limb  2212   a.    
     A person skilled in the art will recognize that the dimensions of the length L P , the width W P , and the thickness T P  of the tissue augmentation patch  2210 , as well as a diameter of the bores  2214   a,    2214   b,  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. Some exemplary, non-limiting dimensions for a tissue augmentation patch  2210  can be useful in understanding the present disclosure. 
     In some embodiments, the length L P  can cover a significant portion, to almost an entire portion, of a length of tissue extending between a stitch made in tissue and a bone anchor used to help secure the tissue. In some embodiments, the length L P  and width W P  can be approximately in the range of about 10 millimeters to about 50 millimeters, and the thickness T P  can be approximately in the range of about 0.5 millimeters to about 5 millimeters. The size of the diameter of the bores  2214   a,    2214   b  can also depend on a variety of factors, including but not limited to the size of the limb to be passed therethrough. In some embodiments, the diameter can be approximately in the range of about 0.5 millimeters to about 3 millimeters. 
     A number of techniques known to those skilled in the art can be used to associate the patch  2210  with the suture limbs  2212   a,    2212   b.  Suture limbs  2212   a,    2212   b  can be threaded or passed from the proximal-most end  2210   p  to the distal-most end  2210   d  of the patch  2210  without passing across the body of the patch  2210 , i.e., without passing through sidewalls that define the bores  2214   a,    2214   b.  As a result, the patch  2210  can freely pass along a length of the limbs  2212   a,    2212   b  unhindered or unrestricted. In other embodiments, the limbs  2212   a,    2212   b  can pass across the body once or more, e.g., like the embodiment of the strip or tape  10  illustrated in  FIG.  1 B , to further secure a location of the patch  2210  with respect to the limbs  2212   a,    2212   b.  In still other embodiments, the limbs  2212   a,    2212   b  can be passed through the patch  2210  from the proximal-most end  2210   p  to the distal-most end  2210   d  by passing through the body while only entering and exiting the body one time, for instance when no bores  2214   a,    2214   b  are provided. Of course, the limbs  2212   a,    2212   b  do not necessarily have to extend all the way to the proximal-most or distal-most ends  2210   p,    2210   d,  but instead can enter and or exit the patch  2210  at some other location across its surface area. A person skilled in the art will recognize a variety of other ways by which the patch  2210  can be associated with the limbs  2212   a,    2212   b  without departing from the spirit of the present disclosure. 
     The tissue augmentation patch  2210  can be threaded by hand on to the suture limbs  2212   a,    2212   b,  either at the surgical site, or outside of the body. Alternatively, as shown in  FIG.  30 B , the threaders  2206   a,    2206   b  can be operated to associated the suture limbs  2212   a,    2212   b  with the patch  2210 , with the operation being akin to either the threader  206  or the threader  206 ′ described above, and thus including proximal handle portions  2208   a,    2208   b,  intermediate elongate portions  2207   a,    2207   b,  and distal suture-receiving ends  2209   a,    2209   b.  Accordingly, the tissue augmentation patch  2210  can be associated with the intermediate elongate portions  2207   a,    2207   b,  as shown by passing the intermediate elongate portions  2207   a,    2207   b  through the lumens  2214   a,    2214   b,  and the limbs  2212   a,    2212   b  can be coupled to the distal suture-receiving ends  2209   a,    2209   b.  The proximal handle portions  2208   a,    2208   b  can be grasped and pulled away from the tissue augmentation patch  2210  to advance the limbs  2212   a,    2212   b  towards and into the patch  2210 . After the patch  2210  has been successfully associated with the limbs  2212   a,    2212   b,  the threaders  2206   a,    2206   b  can be disassociated with the limbs  2212   a,    2212   b  and the tissue augmentation patch  2210  and can be either discarded or re-used. 
     Similar to the earlier described tissue augmentation strips, associating the tissue augmentation patch  2210  with the suture limbs  2212   a,    2212   b  increases the footprint of the suture limbs  2212   a,    2212   b  and may allow force applied to the tissue by the suture limbs  2212   a,    2212   b  to be distributed over a larger amount of surface area, i.e., the surface area of the patch  2210 . The increased distributed force of the tissue augmentation patch  2210  may result in a reduced pressure peak on the soft tissue. Where the soft tissue has become degenerated due to injury or age, an increased tissue surface area coverage and a reduction in pressure can result in less chance of abrasion of the tissue. Further, the larger surface area of the tissue augmentation patch  2210  can provide for a larger scaffold for new tissue to generate over the repair to further strengthen the repair site. The broader tissue coverage provided by the patch  2210  may enhance the healing of otherwise compromised tissue and/or provide bulk to otherwise compromised or degenerate tissue and/or tendon. 
     Methods of Manufacturing Tissue Augmentation Constructs—Tissue Augmentation Patches 
     The tissue augmentation patch  2210  can be manufactured using a number of different techniques, some of which have been previously discussed above with regards to the tissue augmentation blocks  10 ,  110 . In one exemplary embodiment of making a tissue augmentation patch, illustrated by  FIGS.  30 C- 30 E , the material being used to make the patch  2210  can be harvested or otherwise acquired using techniques known to those skilled in the art. The material can then be shaped using any of the techniques described above, for instance those described with respect to the strip  10 , or otherwise known to those skilled in the art in view of the present disclosures. A piece of material can be harvested having a length L P , a width 2W P , and a thickness ½T P . The width 2W P  can be double the resulting width W P  of the patch  2210  and the thickness ½T P  can be half of the thickness of the resulting patch  2210 . As shown in  FIG.  30 D , the piece of material  2220  can have a first end  2220   a  and a second end  2220   b  with the width 2W P  extending therebetween. Alternatively, the piece of material  2220  can have any shape. 
     Once the piece of material  2220  has been cut out, two pins  2222   a,    2222   b  can be placed onto the same side of the material, approximately ¼ of the width 2W P  away from the first and second ends  2220   a,    2220   b,  respectively. The two ends  2220   a,    2220   b,  can be folded over the respective pins  2222   a,    2222   b,  and brought proximate to one another and subsequently attached to one another, thereby forming the patch  2210 . As shown in  FIGS.  30 C and  30 D , the four rows of stitches  2224   a - 2224   d  can be stitched into the folded patch such that they are substantially parallel to one another. Further, the first and the fourth stitches  2224   a,    2224   d  can be located substantially parallel to and proximate the pins  2222   a,    2222   b,  respectively. Still further, the stitches  2224   a,    2224   d  can create the two lumens  2214   a,    2214   b  that are held open by the pins  2222   a,    2222   b.  After the stitching is complete, the pins  2222   a,    2222   b  can be removed, leaving the patch  2210  as shown in  FIG.  30 E . Alternatively, no pins are required to manufacture the patch  2210 . The second and the third stitches  2224   b,    2224   c  can be located substantially parallel to and proximate the two ends  2220   a,    2220   b.  Further alternatively, in place of stitches, the material  2220  can be secured to itself with the use of glue, collagen bond, staples, light curing, or other techniques known to those skilled in the art for attaching soft tissue to soft tissue and provided for throughout the present disclosure. In embodiments that include threaders predisposed in the patch  2210 , threaders  2206   a,    2206   b  can be inserted into the lumens  2214   a,    2214   b  before the two ends  2220   a,    2220   b  are attached, or after. Like the other constructs provided for herein, the patch  2220  can be dried for packaging at any suitable point during the manufacturing process. 
     An alternative method of manufacturing the patch  2210  can include harvesting a piece of material that can be harvested having a length L P , a width W P , and a thickness T P . The piece of material  2220  can have a first end  2220   a  and a second end  2220   b  with the width W P  extending therebetween. A first pin  2222   a  can be inserted, or pierced, into the material  2220  proximate and parallel to the first end  2220   a  to create a first lumen  2214   a.  A second pin  2222   b  can be inserted, or pierced, into the material  2220  proximate and parallel to the second end  2220   b  to create a second lumen  2214   b.  In a further alternative, a coring tube can be used in place of the pins  2222   a,    2222   b,  as described above with respect to  FIGS.  26 A- 26 I . The patch  2210  can be made from any of the materials provided for above with respect to the blocks  10 ,  110 ,  3010 ,  3110 ,  310 , and  410 , and any other constructs, noted above. Furthermore, the patch  2210  can have any shape, including rectangular, trapezoidal, ovoid, circular, square, pentagonal, hexagonal, octagonal, etc. 
     A further alternative method of manufacturing a patch  3320  can include the use of a parallel production tunneling station  3300 , similar to the tunneling stations  3200 ,  3200 ′ of  FIGS.  27 A- 27 M . As shown in  FIG.  31 A , a stage  3320  can accommodate a larger length L of the material  3330 . For example, as illustrated in  FIG.  31 A , the stage  3320  can accommodate two patch constructs  3310   a,    3310   b.  Alternatively, the stage  3320  can extend to accommodate any number of constructs. The stage  3320  can, similar to the stage of the tunneling station  3200 ′, have a plurality of semi-circular reliefs that can be aligned with lumen formation tools  3324   a,    3324   b,    3324   c,    3324   d,  and the stage  3320  can be self-centering. 
     Similar to the tunneling stations  3200 ,  3200 ′ of  FIGS.  27 A- 27 M , the tunneling station  3300  can include a plurality of lumen formation tools  3324   a,    3324   b,    3324   c,    3324   d.  In the illustrated embodiment, the lumen formation tools  3324   a,    3324   b  forms a first station  3323   a,  and the lumen formation tools  3324   c,    3324   d  forms a second station  3323   b.  As shown, the lumen formation tools  3324   a,    3324   b  can be angularly offset from one another, for example approximately up to about 30 degrees from one another. In one embodiment, the lumen formation tools  3324   a,    3324   b  can be angularly offset from one another approximately 16 degrees from one another. The lumen formation tools  3324   c,    3324   d  of the second station  3323   b  can be similarly offset relative to one another, or alternatively, can be angularly offset at a different angle. The second station  3323   b  can be disposed on an opposite side of the stage  3320  from the first station  3323   a,  thus providing for easier parallel lumen formation. In an alternative embodiment, each of the lumen forming tools  3324   a,    3324   b,    3324   c,    3324   d  can be aligned in parallel with each other. The lumen formation tools  3324   a,    3324   b,    3324   c,    3324   d  can be aligned such that each of the respective cutting tools  3322   a,    3322   b,    3322   c,    3322   d  can translate towards the stage to create the lumens  3314   a,    3314   b,    3314   c,    3314   d  in the material  3330 . In the illustrated embodiment, two lumen formation stations  3323   a,    3323   b  are shown, however any number of lumen forming stations can be provided. 
     After each of the lumen formation tools  3324   a,    3324   b,    3324   c,    3324   d  has been actuated and retracted to create lumens  3314   a,    3314   b,    3314   c,    3314   d  in the material  3330 , the material  3330  can be advanced in the direction D as shown in  FIG.  31 A . The individual constructs  3310   a,    3310   b,    3310   c  can then be separated by means of a punch  3190   a - 3190   c,  or other cutting mechanisms as provided for throughout the present disclosure or otherwise known to those skilled in the art. The resulting constructs  3310   a,    3310   b,    3310   c,    3310   d  are illustrated in  FIGS.  31 B and  31 C , with the resulting patches  3310   a,    3310   b,    3310   c,    3310   d  having a generally trapezoidal shape. A person skilled in the art will recognize that any number of patch shapes can be formed in view of the present disclosures. For example, the lumen formation tools  3324   a,    3324   b,    3324   c,    3324   d  can be parallel to each other to create patches having parallel lumens and a rectangular shape. 
     Methods of Use—Tissue Augmentation Patches 
     One exemplary method of installing a tissue augmentation patch  2210  is illustrated in  FIG.  30 F . The illustrated method provides for a piece of soft tissue  2230 , e.g., rotator cuff, fixated to bone  2250 . Either a single row or a double row repair can be used. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation patch have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can perform a tissue repair (not visible because it is underneath the patch  2210 ) according to accepted surgical techniques. As shown in  FIG.  30 F , a suture  2212  extending from an anchor (not shown) used in the repair is installed into the tissue  2230  medially from the repair such that two suture limbs  2212   a,    2212   b  extend out from the tissue  2230 . 
     The tissue augmentation patch  2210  can be threaded onto the suture limbs  2212   a,    2212   b  using techniques provided for throughout the present disclosure, and subsequently advanced along the respective suture limbs  2212   a,    2212   b  until it is proximate a medial stitch  2242 . After the tissue augmentation patch  2210  has been installed on the suture limbs  2212   a,    2212   b,  the free end of each suture limb  2212   a,    2212   b  can be secured within the body. For example, the free ends of each suture limb  2212   a,    2212   b  can be coupled to respective anchors  2260   a,    2260   b  in a lateral row fixation. The suture limbs  2212   a,    2212   b  can then be tightened to secure the patch  2210  against the repair before the anchors  2260   a,    2260   b  are fully fixed in the bone  2250 . 
     The tissue augmentation patch  2210  can provide a greater footprint for the suture limbs  2212   a,    2212   b  and a greater surface area to distribute the loading forces of the suture limbs  2212   a,    2212   b  onto the soft tissue  2230 . While the patient is healing from the procedure, the patch can remodel into tendon-like tissue and integrate with the underlying native tissue. The additional coverage of tendon-like tissue across the soft tissue can increase the strength of the soft tissue to bone connection and may prevent further injury. 
     Another exemplary method of installing a tissue augmentation patch  2210 ′ is provided for in  FIGS.  30 G- 30 I , this time illustrating a piece of soft tissue  2230 ′, e.g., rotator cuff, being fixated to bone  2250 ′ using a double row repair. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation patch have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can install first and second medial anchors  2260   a ′,  2260   b ′ in the bone  2250 ′. The first and second medial anchors  2260   a ′,  2260   b ′ have sutures  2212 ′,  2216 ′ associated therewith. As shown in  FIG.  30 G , sutures  2212 ′ and  2216 ′ can have suture limbs  2212   a ′,  2212   b ′ and  2216   a ′,  2216   b ′ extending from the respective anchors  2260   a ′ and  2260   b ′, with the limbs being threaded through the tissue  2230 ′, for example using one or more medial stitches  2242   a ′,  2242   b′.    
     The patch  2210 ′ can have similar properties as the patch  2210  and can be threaded onto the suture limbs  2212   a ′,  2216   a ′ using techniques provided for throughout the present disclosure. The patch  2210 ′ can subsequently be advanced in the direction D 1  along the respective suture limbs  2212   a ′,  2216   a ′, as shown in  FIG.  30 H , until it is proximate the medial stitches  2242   a ′,  2242   b ′. After the patch  2210 ′ has been installed on the suture limbs  2212   a ′,  2216   a ′, the free end of each of the suture limbs  2212   b ′,  2216   b ′ can be placed over the patch  2210 ′ in an X- or crossed configuration as shown in  FIG.  30 I . Then the suture limbs  2212   a ′,  2216   b ′ can be installed into lateral anchor  2262   a ′, and the suture limbs  2212   b ′,  2216   a ′ can be installed into lateral anchor  2262   b ′ in a lateral row fixation. The suture limbs  2212   a ′,  2212   b ′,  2216   a ′,  2216   b ′ can then be tightened to secure the soft tissue  2230 ′ to the bone  2250 ′ before the lateral anchors  2262   a ′,  2262   b ′ are fully fixed in the bone  2250 ′. The same benefits described above with respect to the method of using the patch  2210  are equally applicable to this embodiment of using the patch  2210 ′. Further, the crossed nature of the suture configuration provides additional stability for holding the tissue  2230 ′ at the desired location with respect to the bone  2250 ′. 
     A further exemplary embodiment of installing a tissue augmentation patch  2210 ″ is illustrated in  FIGS.  30 J-L  and can be used with either a single or double row repair described above with regards to  FIGS.  30 F-I . The illustrated patch  2210 ″ has been threaded onto suture limbs  2212   a ″,  2216   a ″ according to techniques provided for throughout the present disclosure. The illustrated method provides for forming collapsible loops  2212   l ″,  2216   l ″ and associated knots  2270   a ″,  2270   b ″ disposed on a distal end  2210   d ″ of the patch  2210 ″. The collapsible loops  2212   l ″,  2216   l ″ and associated knots  2270   a ″,  2270   b ″ can be formed on respective suture limbs  2212   a ″,  2216   a ″ after the suture limbs have been threaded through the patch  2210 ″. In one exemplary embodiment the knots can be, for example, sliding knots, figure eight knots, or finger traps, among other knot types. The knots  2270   a ″,  2270   b ″ can be larger than the associated lumens through which the suture limbs  2212   a ″,  2212   b ″ are threaded through such that the knots  2270   a ″,  2270   b ″ cannot be pulled through. The knots  2270   a ″,  2270   b ″ can be formed after the patch  2210 ″ has been advanced in the direction D 1  until it is proximate the soft tissue  2230 ″. 
     After the loops  2212   l ″,  2216   l ″ have been formed, the suture limb  2216   b ″ can be guided through the loop  2212   l ″ and the suture limb  2212   b ″ can be guided through the loop  2216   l ″, as illustrated in  FIG.  30 K . Once the suture limbs  2212   b ″,  2216   b ″ have been threaded through the suture loops  2212   l ″,  2216   l ″, the suture limbs are beneficially maintained in a desired configuration. The suture limbs  2212   a ″,  2216   b ″ can then be installed into a lateral anchor  2262   a ″, and the suture limbs  2212   b ″,  2216   a ″ can be installed into a lateral anchor  2262   b ″ in a lateral row fixation. At this point, the collapsible loops  2212   l ″,  2216   l ″ can be collapsed by the application of a force on suture limbs  2212   a ″,  2216   a ″, thereby securing suture limbs  2212   b ″,  2216   b ″ in an X- or crossed configuration as shown in  FIGS.  30 K and  30 L . The suture limbs  2212   a ″,  2212   b ″,  2216   a ″,  2216   b ″ can then be tightened to secure the soft tissue  2230 ″ to the bone  2250 ″ before the lateral anchors  2262   a ″,  2262   b ″ are fully fixed in the bone  2250 ″. One benefit of the knots  2270   a ″,  2270   b ″ and loops  2212   l ″,  2216   l ″ is that the patch  2210 ″ can be prevented from sliding laterally towards anchors  2262   a ″,  2262   b ″ and fixed relative to the bone  2250 ″ and  2230 ″. By collapsing the loops  2212   l ″,  2216   l ″ around the sutures limbs  2212   a ″,  2212   b ″,  2216   a ″,  2216   b ″, unintentional sliding of the patch  2210 ″ with respect to the sutures limbs  2212   a ″,  2212   b ″,  2216   a ″,  2216   b ″ can be prevented. The loops and knots can be beneficially applied to any of the constructs provided for herein to prevent lateral sliding and to retain the construct after implantation, including but not limited to tissue augmentation blocks and tissue augmentation patches. 
     Tissue Augmentation Constructs—Additional Tissue Augmentation Patches, Methods of Using the Same, and Methods of Manufacturing the Same 
     Another exemplary embodiment of a tissue augmentation construct  2310  having a patch or scaffold configuration is illustrated in  FIG.  32 A . As shown, the tissue augmentation patch  2310  has a rectangular-shaped body and is generally similar in nature and construction to the tissue augmentation patch  2210 . The patch  2310  differs in that it includes additional lumens  2314   a - 2314   d  extending therethrough from a proximal-most end  2310   p  to a distal-most end  2310   d  for having threaders  2306   a - 2306   d,  and thus suture limbs  2312   a,    2312   b,    2316   a,    2316   b  after operating the threaders  2306   a - 2306   d,  disposed therein. Optionally the threaders  2306   a - 2306   d  may not be used and the suture limbs  2312   a,    2312   b,    2316   a,    2316   b  may be associated with the patch  2310  using any technique provided for herein or otherwise known to those skilled in the art. As shown in  FIG.  32 A , the lumens  2314   a,    2314   d  can be substantially parallel to the sides of the patch  2310  that extend between the proximal-most end surface  2310   p  and the distal-most end surface  2310   d,  and the lumens  2314   b,    2314   c  can form a substantially X-shaped or crossed configuration. When the threaders  2306   a  and  2306   b  are associated with the patch  2310  in the illustrated embodiment, or in other embodiments illustrated herein having a patch with two threaders associated therewith, an intermediate portion  2307   a  of the first threader  2306   a  can be disposed at a location that is more proximate to a first side  2310   a  of the patch  2310  than a second, opposite side  2310   b  of the patch and an intermediate portion  2307   b  of the second threader  2306   b  can be disposed at a location that is more proximate to the second side  2310   b  than the first side  2310   a.  When the threaders  2306   c  and  2306   d  are also associated with the patch  2310 , an intermediate portion  2307   c  of the third threader can be disposed diagonally with respect to the patch  2310  such that a distal receiving end  2309   c  of the third threader  2306   c  is proximate to a distal receiving end  2309   a  of the first threader  2306   a,  while a proximal handle  2308   c  of the third threader  2306   c  is proximate to a proximal handle  2308   b  of the second threader  2306   b,  and an intermediate portion  2307   d  of the fourth threader can be disposed diagonally with respect to the patch  2310  such that a distal receiving end  2309   d  of the fourth threader  2306   d  is proximate to a distal receiving end  2309   b  of the second threader  2306   b,  while a proximal handle  2308   d  of the fourth threader  2306   d  is proximate to a proximal handle  2308   a  of the first threader  2306   a.    
     A person skilled in the art will recognize that in any embodiments in which multiple threaders are used in conjunction with a construct, a location of the proximal and distal ends of the threaders can be different than the illustrated embodiments, depending, at least in part, on the type of procedure being performed, the components being used to perform the procedure, and the preferences of the user. Thus, in any illustrated embodiments, locations of the proximal and distal ends of the threaders can be switched in other embodiments. Further, in any of the illustrated embodiments, a location of any threader with respect to a tissue augmentation construct prior to using the threaders to associate a suture with the tissue augmentation construct is considered a pre-installation configuration, and after a threader has been used to associate a suture with a tissue augmentation construct and subsequently removed, such a configuration is considered a post-installation configuration. 
     As shown, the patch  2310  has a length L P ′ that is substantially equal to a width W P ′, and it also has a thickness T P ′. Further, the thickness T P ′ can be greater than a diameter of a filament or suture with which the tissue augmentation patch  2310  is associated, e.g., the suture limb  2312   a.  In other embodiments, the suture limbs  2312   a,    2312   b,    2316   a,    2316   b  can extend through the lumens  2314   a - 2314   d  without necessarily having been disposed in the lumens  2314   a - 2314   d  using threaders. The limbs  2312   a,    2312   b,    2316   a,    2316   b  can extend in the same hybrid parallel and crossed configuration illustrated and described with respect to the locations of the threaders  2306   a - 2306   d.    
     A person skilled in the art will recognize that the dimensions of the length L P ′, the width W P ′, and the thickness T P ′ of the tissue augmentation patch  2310 , as well as a diameter of the bores  2314   a - 2314   d,  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. Alternatively, the patch  2310  can have any other shape (e.g., rectangular, trapezoidal, ovoid, circular, square, pentagonal, hexagonal, octagonal, etc.) and the lumens  2314   a - 2314   d  can follow any path (e.g., they can follow edges). The exemplary, non-limiting dimensions provided above for the patch  2210  can also be applicable to the size of the patch  2310 , with the understanding that other dimensions are possible. Likewise, a number of techniques known to those skilled in the art can be used to associate the patch  2310  with the suture limbs  2312   a,    2312   b,    2316   a,    2316   b,  and the techniques described above with respect to the patch  2210  can be adapted for use in conjunction with the patch  2310 . Thus, in view of the present disclosures, a person having skill in the art will understand how to operate the threaders  2306   a - 2306   d  to associate the suture limbs  2312   a,    2312   b,    2316   a,    2316   b  with the patch  2310 . 
     One exemplary method of installing the patch  2310  is provided for in  FIGS.  32 B- 32 E . The illustrated method provides for a piece of soft tissue  2330 , e.g., rotator cuff, fixated to bone  2350 . Either a single row or a double repair can be used. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation patch have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can perform single row repairs  2340   a,    2340   b  of the tissue  2330  according to accepted surgical techniques. Alternatively, one repair can be made to the tissue  2330 , or more than two repairs can be completed. As shown in  FIG.  32 C , a first suture  2312  can be inserted into the tissue  2330  medially from the repairs  2340   a,    2340   b  such that two suture limbs  2312   a,    2312   b  extend out from the tissue  2230 , and likewise, a second suture  2316  can be inserted into the tissue  2330  medially from the repairs  2340   a,    2340   b  such that two suture limbs  2316   a,    2316   b  extend out from the tissue  2230 . In the illustrated embodiment, the sutures  2312 ,  2316  are inserted into the tissue  2330  using mattress stitches  2342   a,    2342   b,  respectively, though other stitches can be used. 
     As shown in  FIG.  32 D , the suture limbs  2312   a,    2312   b,    2316   a,    2316   b  are threaded into lumens  2314   a - 2314   d,  respectively, using techniques provided for throughout the present disclosure, e.g., operating the threaders  2306   a - 2306   d,  and the patch  2310  can be advanced along the respective suture limbs  2312   a,    2312   b,    2316   a,    2316   b  until the proximal end  2310   p  is proximate the medial stitches  2342   a,    2342   b.  After the patch  2310  has been installed on the suture limbs  2312   a,    2312   b,    2316   a,    2316   b,  the free end of each suture limb  2312   a,    2316   b  can be secured within the body. For example, as shown in  FIG.  32 E , the free ends of each suture limb  2312   a,    2316   b  and  2312   b,    2316   a  can be coupled to lateral anchor  2362   a  and  2362   b,  respectively, in a lateral row fixation. The suture limbs  2312   a,    2312   b,    2316   a,    2316   b  can then be tightened to secure the patch  2310  against the repair  2340  before the lateral anchors  2360   a,    2360   b  are fully fixed in the bone  2350 . 
     Another exemplary method of installing a tissue augmentation patch  2310 ′ is provided for in  FIGS.  32 F- 32 H , this time illustrating a piece of soft tissue  2330 ′, e.g., rotator cuff, being fixated to bone  2350 ′ using a double row repair. Once the surgeon has access to the surgical site and the tissue, bone, and patch have been prepared according to accepted surgical techniques including those provided for herein, the surgeon can install first and second medial anchors  2360   a ′,  2360   b ′ in the bone  2350 ′. The first and second medial anchors  2360   a ′,  2360   b ′ have sutures  2312 ′,  2316 ′ associated therewith. As shown in  FIG.  32 F , sutures  2312 ′ and  2316 ′ can have suture limbs  2312   a ′,  2312   b ′ and  2316   a ′,  2316   b ′ extending from the respective anchors  2360   a ′ and  2360   b ′, with the limbs being threaded through the tissue  2330 ′, for example using one or more medial stitches  2342   a ′,  2342   b′.    
     The patch  2310 ′ can have similar properties as the patch  2310  and can be threaded onto suture limbs  2312   a ′,  2312   b ′,  2316   a ′,  2316   b ′ using techniques provided for throughout the present disclosure. The patch  2310 ′ can subsequently be advanced along the suture limbs  2312   a ′,  2312   b ′,  2316   a ′,  2316   b ′ until the proximal end  2310   p ′ is proximate the medial stitches  2342   a ′,  2342   b ′, as shown in  FIGS.  32 G and  32 H . After the patch  2310 ′ has been installed on the suture limbs  2312   a ′,  2312   b ′,  2316   a ′,  2316   b ′, the free ends of each of the suture limbs  2312   a ′,  2316   b ′ and  2312   b ′,  2316   a ′ can then be installed into respective lateral anchors  2362   a ′ and  2362   b ′ in a lateral row fixation. The suture limbs  2312   a ′,  2312   b ′,  2316   a ′,  2316   b ′ can then be tightened to secure the patch  2310 ′ against the repair  2340 ′ before the lateral anchors  2360   a ′,  2360   b ′ are fully fixed in the bone  2350 ′. The same benefits described above with respect to the method of using the patch  2210 ′ are equally applicable to the embodiments of using the patches  2310  and  2310 ′, including the benefits resulting from the crossed nature of the suture configuration. Additional benefits of these two embodiments will also be clear to those having skill in the art in view of the present disclosures. 
     The patch  2310  can be manufactured using a number of different techniques, some of which have been previously discussed above at least with regards to the tissue augmentation blocks  10 ,  110  and other constructs. The patch  2310 , and thus also the patch  2310 ′, can be made from any of the materials provided for above with respect to the tissue augmentation blocks  10 ,  110 ,  3010 ,  3110 ,  310 , and  410 , and/or other constructs described herein. In one exemplary embodiment of making a patch, illustrated by  FIGS.  32 I and  32 J , the material being used to make the patch  2310  can be harvested or otherwise acquired using the same techniques as described above with respect to the patch  2210 . As shown in  FIG.  32 I , the piece of material  2320  can have a first end  2320   a  and a second end  2320   b  with the width 2W P ′ extending therebetween. Alternatively, the piece of material  2320  can have any shape. 
     Once the piece of material  2320  has been cut out, the two ends  2320   a,    2320   b,  can be folded over approximately ¼ of the width 2W P ′ away from the first and second ends  2320   a,    2320   b,  respectively, and brought proximate to one another and subsequently attached to each other, thereby forming the patch  2310 . As shown in  FIG.  32 J , the patch  2310  is stitched together to form the folded patch. The stitching  2324   a - 2324   d  is performed such that the two parallel lumens  2314   a,    2314   b  are created in combination with the X shaped lumens  2314   c,    2314   d.  The first stitch  2324   a  can be substantially V-shaped, having both ends located at the distal most end  2310   d  of the patch  2130  and the vertex of the V-shape pointing towards the proximal most end  2310   p  of the patch  2130 . The second stitch  2324   b  can be substantially V-shaped, having both ends located at the proximal most end  2310   p  of the patch  2130  and the vertex of the V-shape pointing towards the distal most end  2310   d  of the patch  2130 . The third and fourth stitches  2324   c,    2324   d  can be substantially triangular in shape and can be substantially mirror images of the other to define the lumens  2314   a,    2314   d.  Alternatively, pins can be placed along where the lumens  2314   a - 2314   d  are to be located, and then the patch  2310  can be stitched together to manufacture the patch  2310 . The pins can be removed once the patch is manufactured. Further alternatively, in place of stitches the material  2320  can be secured to itself with the use of glue, collagen bond, staples, light curing, or other techniques for attaching soft tissue to soft tissue known to those skilled in the art and provided for throughout the present disclosure. 
     In embodiments that include threaders predisposed in the patch  2310 , threaders  2306   a - 2306   d  can be inserted into the lumens  2314   a - 2314   d  before the two ends  2320   a,    2320   b  are attached, or after. The patch  2320  can be dried for packaging at any suitable point during the manufacturing process. Further alternatives for forming the patch  2310  in accordance with the present disclosures include but are not limited to harvesting a piece of material and using pins to pierce or puncture it to create the lumens  2314   a - 2314   d,  as described at least with respect to  FIGS.  30 C- 30 E , and/or using a coring device or tube to create the lumens  2314   a - 2314   d,  as described at least with respect to  FIGS.  26 A- 26 I . 
     Many more configurations of patches and sutures are within the scope of the present disclosures. Configurations can be derived from making adjustments to various parameters or variables provided for and discussed throughout the present application. Some parameters or variables that can be changed to provide for various configurations include: (1) the number of layers used to form the patch (e.g., one layer, two layers); (2) the orientation of a first set of suture limbs with respect to each other and the patch (e.g., across the patch in a manner in which the limbs are not intersecting, across the patch in a manner in which the limbs intersect each other); (3) a location of a second set of suture limbs with respect to the patch (e.g., on top of the patch, through the patch); (4) the orientation of the second set of suture limbs with respect to each other and the patch (e.g., across the patch in a manner in which the limbs are not intersecting, across the patch in a manner in which the limbs intersect each other); (5) the inclusion of one or more “stitches” with the first set of suture limbs, referred to herein as “loops” and “jogs,” to fixate the patch with respect to at least one suture limb; (6) whether the second set of suture limbs is disposed in lumens formed in the patch; (7) whether additional sutures are provided (e.g., medial center suture, lateral center suture); and (8) a location of the first set of suture limbs with respect to the second set of suture limbs (e.g., inside of the second set of suture limbs, outside of the second set of suture limbs). 
     A small sample of some patch configurations illustrating options for the above-listed parameters or variables is shown in  FIGS.  33 A- 33 E . Some configurations can be better than others in aiding patch delivery and/or aiding the attachment of the patch to soft tissue. One skilled in the art will understand that the various parameters can be mixed and matched to arrive at a large number of configurations, many of which are not explicitly illustrated herein, but are derivable based on the understanding provided about each of the variables and the constructs more generally as disclosed in the present application. To assist in understanding some of the options associated with the above-listed parameters, each parameter is discussed in more detail below with a limited number of example configurations illustrated. However, it is contemplated that the instant disclosure encompasses each discrete combination of parameters in conjunction with many of the different patch configurations provided for in the present disclosure. Further, like reference numbers are used across each of the examples illustrated in  FIGS.  33 A- 33 E  as the parameters are interchangeable across various configurations using the same materials (e.g., patch, sutures, and anchors). 
     One parameter that can be changed to achieve various patch configurations is the number of layers that form each patch. For example, each patch can include a single layer of material with lumens being formed in the single layer for disposing suture limbs therethrough, as illustrated in  FIGS.  26 D- 26 F,  30 A,  30 B, and  31 A- 31 C . The single layer can include a tissue-facing or tissue-engaging surface, also referred to herein as a bottom side  3410   d  of the patch  3410 , and a second surface that is opposed to the tissue-facing surface (e.g., the surface that is visible in  FIGS.  33 A- 33 E ), also referred to herein as a top side  3410   p  of the patch  3410 . Alternatively, each patch can include two or more layers of material stitched together to form a single patch with lumens being formed between two or more layers for disposing suture limbs therethrough, as illustrated in  FIGS.  32 A- 32 J . When a second layer is used, each layer includes a tissue-facing surface and a second surface that is opposed to the tissue-facing surface. In such embodiments, the tissue-facing surface of the patch is formed by the tissue-facing surface of the bottom, or more distal, patch, and the second surface of the patch that is opposed to the tissue-facing surface is formed by the second surface of the top, or more proximal, patch. Even in patches that include multiple layers, a lumen can be formed in a single layer. In embodiments where the patch includes two layers, the stitching can form lumens as described with reference to  FIGS.  32 A- 32 J . For the sake of simplicity, a first set of suture limbs  3412 ,  3414  and a second set of suture limbs  3416 ,  3418  will be referenced in the following discussion, however a single set may be used. As discussed above, in embodiments where two layers of material are used, each layer can be formed from different materials to provide a variety of advantages, including but not limited to: the overall thickness of the patch configuration may not limited by a biological source, a level of cellular activity can be controlled (e.g., a high tissue integration layer on a tissue facing side and an adhesion barrier layer on the opposite side), and other material characteristics can be varied between each layer (e.g., toughness, biologic/synthetic, thick/thin, high-/low-porosity, etc.). 
     As shown in  FIG.  33 A , two inverted mattress stitches  3440   a,    3440   b  can be formed in the soft tissue, medial to any repairs (the repairs not being shown). More particularly, a first suture  3411   a  can be used to form a first inverted mattress stitch  3440   a  and a second suture  3411   b  can be used to form a second inverted mattress stitch  3440   b.  The first mattress stitch  3440   a  can result in suture limb  3412  and suture limb  3416  extending therefrom, and the second mattress stitch  3440   b  can result in suture limb  3414  and suture limb  3418  extending therefrom. For the purposes of discussion only, suture limbs  3412  and  3414  are defined as a first set of suture limbs, and suture limbs  3416  and  3418  are defined as a second set of suture limbs. For the sake of simplicity, each of the embodiments shown in  FIGS.  33 A- 33 E  illustrates two mattress stitches and therefore a discussion will not be repeated for each figure. 
     Further, as shown in each embodiment, the suture limbs  3412 ,  3414  of the first set of suture limbs are generally through the patch  3410 . This can include configurations in which the suture limbs  3412 ,  3414  extend through the patch  3410  for an entire length of the patch, that is from the medial edge  3410 M to the opposed lateral edge  3410 L, or configurations in which the suture limbs  3412 ,  3414  extend through the patch  3410  for a portion of the length. Generally the suture limbs  3412 ,  3414  extend along a length that extends substantially between the medial and opposed lateral edges  3410 M,  3410 L. For example, as shown in  FIG.  33 D , the suture limbs  3412 ,  3414  do not extend the entire length of the patch  3410 , but do extend a substantial portion of that length. The substantial portion of the length can be at least about 50 percent of the length, or alternatively at least about 75 percent of the length, or further alternatively at least about 90 percent of the length. 
     As the suture limbs  3412 ,  3414 , and the suture limbs  3416 ,  3418  are passed through the patch, they are passed by leading a terminal end of the suture limb through, above, and/or below a portion of the patch  3410 . The terminal end that is described as being passed through the patch in the illustrated embodiments can be considered a terminal lateral end since that is the end that is being passed towards the lateral edge  3410 L and towards illustrated anchors  3460   a,    3460   b.  When terminal lateral ends are described as being coupled to an anchor, a person skilled in the art will recognize that it is not the terminal lateral end of the suture limb itself that necessarily is attached to the anchor because when associating a suture with an anchor, the terminal end may extend some distance beyond the anchor, for instance as a result of tying the suture to the anchor. Thus, a description of a terminal lateral end of a suture limb being attached or otherwise coupled to an anchor does not require that the very end of the suture itself is touching or coupled directly to the anchor. Rather, it just indicates that some portion of that limb that a person skilled in the art would understand in view of the present disclosure qualifies as a terminal end of the system when forming the patch-suture configuration is the described terminal lateral end. Further, as shown, the anchors  3460   a,    3460   b  are disposed on opposite sides of a central longitudinal axis  3410   c  extending between the medial and lateral sides  3410 M,  3410 L of the patch  3410 . Generally, when the terminal lateral ends of the various suture limbs are being associated with the anchor, the terminal lateral ends can be described as being proximate to each other. A person skilled in the art will recognize that even if the terminal lateral ends are associated with different anchors on the same side of the scaffold, and/or associated with one or more other fixtures (including but not limited to bone, tissue, and medical implants) on the same side of the scaffold, the terminal lateral ends of the suture limbs on that side can still be described as being proximate to each other in view of the present disclosure. 
     A second parameter that can be changed to achieve various patch configurations relates to the orientation of the first set of suture limbs with respect to each other and the patch. For example, each of the first set of suture limbs  3412 ,  3414  can be disposed across the patch  3410  from a medial edge  3410 M to a lateral edge  3410 L in a manner such that the limbs do not intersect each other, as shown in  FIG.  33 A . In the illustrated embodiment, the limbs  3412 ,  3414  extend substantially parallel to respective outer side edges  3410 S,  3410 T of the patch  3410  and are disposed on separate halves of the central longitudinal axis  3410   c.  This configuration can provide for added securement of the edges  3410 S,  3410 T when the limbs  3412 ,  3414  are extended over the edges. A person skilled in the art will recognize that the limbs  3412 ,  3414  can be oriented in many other manners with respect to each other and the patch  3410  without causing them to intersect. For example, the first set of suture limbs  3412 ,  3414  can be disposed across the patch  3410  from the medial edge  3410 M to the lateral edge  3410 L in a manner such that the limbs extend substantially straight across the patch  3410  and are thus substantially parallel to one another. Examples of limbs configured in such a manner are illustrated at least in  FIGS.  30 A- 30 L  (e.g., limbs  2212   a  and  2212   b,  limbs  2212   a ′ and  2216   a ′, and limbs  2212   a ″ and  2216   a ″). 
     In a further alternative, the first set of suture limbs  3412 ,  3414  can be disposed across the patch  3410  from the medial edge  3410 M to the lateral edge  3410 L in a manner such that the limbs do intersect each other. For example, the limbs  3412 ,  3414  can be disposed across the patch  3410  to form an “X” configuration or shape, like the limbs  2212   b ′ and  2216   b ′ of  FIG.  30 I , the limbs  2312   b,    2316   b  of  FIGS.  32 A- 32 E , the limbs  2312   b ′,  2316   b ′ of  FIGS.  32 F- 32 H , and limbs  3416  and  3418  of  FIG.  33 B  (which are described as the second set of limbs but are referenced for purposes of generally showing an intersecting configuration). This configuration can provide for a more distributed compression over a larger area of the construct. A person skilled in the art will recognize that the limbs  3412 ,  3414  can be oriented in many other manners with respect to each other and the patch  3410  while still intersecting each other. Further, to the extent the limbs  3412 ,  3414  are described as being disposed across the patch, they can extend across a top surface of the patch, through the patch (e.g., through a single layer, disposed between two layers), or a combination of both across the top surface of the patch and through the patch. Additionally, the limbs  3412 ,  3414  do not have to be oriented in a similar manner. For example, the limb  3412  can extend substantially parallel to the outer side edge  3410 S, or extend substantially straight across the patch  3410  with the limb  3412  remaining on one side of the central longitudinal axis  3410   c,  while the limb  3414  extends more diagonally such that it crosses over the central longitudinal axis  3410   c.    
     A third parameter that can be changed to achieve various patch configurations relates to a location of a second set of suture limbs with respect to the patch. For example, the second set of suture limbs  3416 ,  3418  can be disposed through the patch as they extend from the medial edge  3410 M to the lateral edge  3410 L, similar to the orientation of the limbs  2312   b  and  2316   b  and limbs  2312   b ′ and  2316   b ′ of  FIGS.  32 A- 32 J . Advantageously, when at least one suture limb is disposed through the patch, the patch can be more secure after installation. Alternatively, the second set of suture limbs  3416 ,  3418  can be disposed over a top surface of the patch  3410 , similar to the orientation of the limbs  2212   b  and  2216   b,  limbs  2212   b ′ and  2216   b ′, and limbs  2212   b ″ and  2216   b ″ of  FIGS.  30 A- 30 L . In some instances, some portion of any second limbs can extend through the patch while some other portion extends on top of the patch, and the configuration of this parameter for any limb does not have to be the same as any other limb. 
     A fourth parameter that can be changed to achieve various patch configurations relates to the orientation of the second set of suture limbs with respect to each other and the patch. For example, each of the second set of suture limbs  3416 ,  3418  can be disposed across the patch  3410  from the medial edge  3410 M to the lateral edge  3410 L in a manner such that the limbs do not intersect each other, or in a manner such that they do intersect. Such configuration possibilities are similar to those discussed above with respect to the second parameter, which was for the orientation of the first set of suture limbs with respect to each other and the patch. Further, in some instances the second suture limbs  3416 ,  3418  may not extend over or through the patch  3410 , but rather, may extend around and/or adjacent to the patch  3410 . First suture limbs  3412 ,  3414  can also be configured in a manner in which at least a portion of them extend around and/or adjacent to the patch  3410  rather than on top of or through the patch. 
     By way of non-limiting example,  FIG.  33 A  illustrates an embodiment in which the second set of limbs  3416 ,  3418  do not intersect and extend around and adjacent to the patch  3410 ; thus, the limbs  3416 ,  3418  do not extend over or through the patch  3410 . By way of further non-limiting examples,  FIGS.  33 C and  33 E  each illustrate embodiments in which the second set of limbs  3416 ,  3418  do not intersect and extend on top of the patch  3410 . As shown in  FIG.  33 D , it is possible to combine various orientations across the length extending between the medial and lateral edges  3410 M and  3410 L. For example, as shown the limbs  3416 ,  3418  do not intersect, but the orientation of the limbs with respect to the patch  3410  changes as the limbs extend between the medial and lateral edges  3410 M and  3410 L. More particularly, as shown, a first portion  3416   p   1 ,  3418   p   1  of each of the limbs  3416 ,  3418  extends around and/or adjacent to the patch  3410 , a second portion  3416   p   2 ,  3418   p   2  of each of the limbs  3416 ,  3418  extends on top of the patch  3410 , and a third portion  3416   p   3 ,  3418   p   3  of each of the limbs  3416 ,  3418  extends through the patch  3410 . The orientation of the first set of suture limbs  3412 ,  3414  can likewise have different configurations across their length. 
       FIG.  33 B , on the other hand, provides for an embodiment in which the second set of suture limbs  3416 ,  3418  do intersect. As shown, the limbs  3416 ,  3418  are disposed across the patch  3410  (as shown, through the patch), to form an “X” configuration or shape, like the limbs  2212   b  and  2216   b ′ of  FIG.  301   , the limbs  2312   b,    2316   b  of  FIGS.  32 A- 32 E , and the limbs  2312   b ′,  2316   b ′ of  FIGS.  32 F- 32 H . An “X” configuration can provide for a more distributed compression over a larger area of the construct. A person skilled in the art will recognize that the limbs  3416 ,  3418  can be oriented in many other manners with respect to each other and the patch  3410  while still intersecting each other. Further, while in the illustrated embodiment of  FIG.  33 B  the limbs  3416 ,  3418  extend through the patch  3410 , they can also extend across a top surface of the patch and/or around or adjacent to the patch, or any combination thereof. Likewise, limbs extending through the patch can extend through a single layer and/or be disposed between two layers. 
     A fifth parameter that can be changed to achieve various patch configurations relates to the inclusion of one or more “stitches” in conjunction with the first set of suture limbs. As described in the present disclosure, these “stitches” can be referred to as “loops,” as shown and described with respect to  FIG.  33 C , and “jogs,” as shown and described with respect to  FIG.  33 D . As described in greater detail below, the stitches for loops and jogs both involve passing a terminal end of the suture limb through at least a portion of the patch (e.g., through a proximal-most surface of the patch) and then to and through the lateral edge of the patch. Loops can involve the suture limb passing an entire length of the patch extending between the medial and lateral edges, while jogs can involve the suture limb passing through a portion of the length that is not necessarily the entire length (although it can be a substantial portion of the length). The loops and jogs are used to help fixate the patch with respect to at least one suture limb. 
     As illustrated in  FIG.  33 C , a loop stitch or loop  3444   a  can be formed by passing a suture limb  3412  from the bottom side  3410   d  of the patch  3410 , which faces the soft tissue  3430 , to the top side  3410   p  of the patch  3410  at a location  3408   a  proximate to the medial edge  3410 M. The location  3408   a  can be a preformed lumen, or it can be a lumen formed while advancing the suture limb  3412  through the patch  3410 , for instance because the material of the patch  3410  is braided such that the limb  3412  can be passed through it. The patch  3410  can include at least one lateral lumen  3407   a,    3407   b  that extends from the medial edge  3410 M to the lateral edge  3410 L. Alternatively, the lumens  3407   a,    3407   b  may not be preformed or exist and may instead just be locations within the patch  3410  through which filament can be passed, for instance between two layers or through a single layer that has a material conducive to having a material passed therethrough. The suture  3412  can then be threaded medially to enter the lumen  3407   a  at the medial edge  3410 M and extend through the lumen to the lateral edge  3410 L. Once tension is applied to the loop  3444   a  and the loop is brought into contact with the patch  3410 , the suture limb  3412  can be fixed relative to the patch  3410  such that the patch  3410  will not drift along the suture  3412  after implantation. The loop  3444   a  can also provide for additional stability during patch installation. This process can be repeated for suture limb  3414  to form a second loop stitch or loop  3444   b.  The loops  3444   a,    3444   b  can be formed in vivo, or alternatively can be formed before the patch is introduced into the surgical site using patch delivery systems described below. The free end of each suture limb  3412 ,  3416  and  3414 ,  3418 , also referred to herein as terminal lateral ends, can then be secured within the body using techniques provided for throughout the present disclosure. For example, as shown in  FIG.  33 C , the free ends of each suture limb  3412 ,  3416  and  3414 ,  3418  can be coupled to lateral anchor  3460   a  and  3460   b,  respectively, in a lateral row fixation. The suture limbs  3412 ,  3414 ,  3416 ,  3418  can then be tightened to secure the patch  3410  against the repair before the lateral anchors  3460   a,    3460   b  are fully fixed in the bone  3450 . 
     Alternatively, in place of a loop, the suture limb  3412  of the first set of suture limbs  3412 ,  3414  can be used to form a jog. As illustrated in  FIG.  33 D , a jog stitch or jog  3446   a  can be formed by passing the suture limb  3412  from the bottom side  3410   d  of the patch  3410  to the top side  3410   p  of the patch  3410  at a location  3408   a  proximate to the medial edge  3410 M, and then advancing the suture limb  3412  towards the outer edge  3410 S before passing the suture limb  3412  back into the patch  3410  from the top side  3410   p  and towards the bottom side  3410   d.  The suture limb  3412  can then be advanced towards the lateral side  3410 L. In the illustrated embodiment, the suture limb  3412  is passed through a lateral lumen  3407   a  that extends from the medial edge  3410 M to the lateral edge  3410 L. Alternatively, the lumen  3407   a,  and/or its illustrated counterpart lumen  3407   b,  may not be preformed or exist and may instead just be locations within the patch  3410  through which filament can be passed, for instance between two layers or through a single layer that has a material conducive to having a material passed therethrough. Like with the embodiment in  FIG.  33 C , the location  3408   a  can be a preformed lumen, or it can be a lumen formed while advancing the suture limb  3412  through the patch  3410 , for instance because the material of the patch  3410  is braided such that the limb  3412  can be passed through it. As shown, the portion of the limb  3412  extending through the patch  3410  extends a substantial portion of the length of the limb that extends between the medial and lateral edges  3410 M and  3410 L, but not the entire length. 
     When forming the jog  3446   a,  the suture  3412  can be advanced towards the outer edge  3410 S any desired distance based, at least in part, on the size of the patch  3410  and desired configuration of the patch and suture combination. By way of non-limiting example, in some embodiments the jog  3446   a  can extend substantially perpendicular to the central longitudinal axis  3410   c  and can have a length approximately in the range of about 1.0 millimeters to about 5.0 millimeters away from the location  3408   a.  Once tension is applied to the jog  3446   a  and the jog  3446   a  is brought into contact with the patch  3410 , the suture limb  3412  can thus be fixed relative to the patch  3410  such that the patch  3410  will not drift along the suture limb  3412  after implantation. The jog  3446   a  can also provide for additional stability during patch installation. A second jog stitch  3446   b  can be formed with the second limb  3414 . The jog stitches  3446   a,    3446   b  can be formed in vivo, or alternatively can be formed before the patch  3410  is introduced into the surgical site using patch delivery systems described below. Alternately, the two sutures of the first set of sutures  3412 ,  3414  can be associated with the patch  3410  with different stitches, or no additional stitches. Further, in some instances, a combination of loops and jogs can be used. 
     A sixth parameter that can be changed to achieve various patch configurations relates to whether the second set of suture limbs is disposed in lumens formed in the patch, or alternatively, through portions of the patch through which the first set of suture limbs is passed. One illustration of such a configuration is illustrated in  FIG.  33 D . As shown, the second set of suture limbs  3416 ,  3418  can be introduced into the respective lumens  3407   a,    3407   b  of the patch  3410 , along with one of the suture limbs  3412 ,  3414  of the first set of suture limbs. This occurs at a location  3409   a,    3409   b  that is lateral to the medial edge  3410 M of the patch  3410 . This configuration of the second set can provide for a further securing of the patch in an anterior-posterior direction. A person skilled in the art will recognize a location at which the second, or first, set of suture limbs is disposed within the patch  3410  can vary without departing from the spirit of the present disclosure. 
     A seventh parameter that can be changed to achieve various patch configurations is the inclusion of additional sutures, such as central medial sutures or central lateral sutures, to provide additional securement of the patch at discrete locations from the lumens. For example, as shown in  FIG.  33 E , one or more central medial inverted mattress stitches  3470  can be made in the soft tissue  3430  medial to the patch  3410 . In the illustrated embodiment, the stitch  3470  is approximately in-line with the first and second mattress stitches  3440   a,    3440   b,  although other configurations, locations, and number of stitches are possible without departing from the spirit of the present disclosure. The central medial inverted mattress stitch  3470  can be generally aligned with a center of the patch  3410  in some instances, such as the illustrate embodiment. The central medial stitch  3470  can result in suture limbs  3472   a,    3472   b  extending therefrom. The suture limbs  3472   a,    3472   b  can be disposed over a proximal face  3410   p  of the suture patch  3410  and secured with suture anchors  3460   a,    3460   b,  respectively, according to techniques provided for herein. 
     Alternatively, or in addition to the central medial inverted mattress stitch  3470 , a central lateral mattress stitch  3474  can be pre-loaded onto the patch at a location in the lateral half of the patch. Alternatively, the central lateral mattress stitch  3474  can be formed in the patch  3410  in vivo. The central lateral mattress stitch  3474  can be generally aligned with a center of the patch  3410 . Like the medial inverted mattress stitch, a number of different configurations, locations, and number of stitches are possible, and in the illustrated embodiment the inverted mattress stitch  3474  results in suture limbs  3476   a,    3476   b  extending from the patch  3410 . In the illustrated embodiment, the suture limbs  3476   a,    3746   b  are disposed over the proximal face  3410   p  of the suture patch  3410  and are additionally secured in suture anchors  3460   a,    3460   b.  Both the central medial stitch and lateral central stitch can provide for additional compression of the patch against the soft tissue to aid in healing. While the patch  3410  illustrated in  FIG.  33 E  illustrates both a central medial mattress stitch and a central lateral mattress stitch in the same embodiment, in other embodiments only one or neither may be provided. Further, other locations for additional stitches are also possible without departing from the spirit of the present disclosure. 
     An eighth parameter that can be changed to achieve various patch configurations is a location of the first set of suture limbs with respect to the second set of suture limbs. More particularly, this parameter relates to whether the limbs of the first set of suture limbs are disposed inside or outside of the limbs of the second set of suture limbs, where outside represents being further from the central longitudinal axis  3410   c.  In the embodiments illustrated in  FIGS.  33 A and  33 D , the first set of suture limbs is disposed inside of the second set of suture limbs, while in the embodiments illustrated in  FIGS.  33 B,  33 C, and  33 E , the first set of suture limbs is disposed outside of the second set of suture limbs. More particularly with respect to  FIG.  33 D , the first set of suture limbs is disposed inside the second set of suture limbs until they converge at the location  3409   a,  at which point they are substantially aligned. Thus, the orientation of the first set of suture limbs with respect to the second set of suture limbs can change between the medial and lateral edges  3410 M,  3410 L, including having some portion that is inside the other and some portion that is outside of the other. Further, a person skilled in the art will recognize that not each limb of the set of limbs needs to be disposed in the same respect, meaning that some limbs of the first set of limbs can be disposed inside of one or more limbs of the second set of limbs, and likewise some limbs of the first set of limbs can be disposed outside of one or more limbs of the second set of limbs in the same patch configuration. 
     Notably, most any of the aforementioned parameters or variables can be mixed and matched in one or more patch configurations without departing from the spirit of the present disclosure. Accordingly, there are many different configurations that can result from the present disclosure. The term “most any” is used because a person skilled in the art will recognize that, depending on the value of some of these parameters, some of the other parameters may not be adjustable, and a person skilled in the art will recognize as such in view of the present disclosures and the skilled person&#39;s knowledge.  FIGS.  33 A- 33 E  represent a small sampling of possible configurations intended to illustrate various configurations based on the eight parameters identified in the present disclosure. Each of the illustrated configurations can be used in conjunction with various procedures.  FIG.  33 C  represents one particularly useful configuration in that it provides for the stability provided for by the loops  3444   a,    3444   b,  provides for a configuration in which the first set of limbs are disposed approximately straight through the patch  3410  to provide additional securement of the edges  3410 S,  3410 T. Further, the configuration is additionally particular useful because the second set of limbs are disposed approximately straight (as opposed to crossed in an “X” configuration or shape) over the patch  3410  to aid in the medialization of the patch and ease of tensioning of the limbs, the four limbs decrease the likelihood of undesirable “cheese-wiring,” and the configuration does not include additional stitches or the like, making it easier and/or quicker to perform than some options that include additional stitches. 
     Still another exemplary embodiment of a tissue augmentation construct  2410  having a patch or scaffold configuration is illustrated in  FIGS.  34 A and  34 B . As shown, the patch  2410  has a rectangular-shaped body having generally rounded corners. Alternatively, the patch  2410  can have any shape, for example circular. The patch  2410  can be disposed on or otherwise associated with sutures  2412 ,  2416 . As shown, the patch  2410  has a length L P ″ that is substantially equal to a width W P ″, and it also has a thickness T P ″. 
     A person skilled in the art will recognize that the dimensions of the length L P ″, the width W P ″, thickness T P ″ of the augmentation patch  2410  can depend on a variety of factors, including but not limited to the size of the filament with which it is to be associated, the anatomy of the patient, and the type of procedure being performed. The exemplary, non-limiting dimensions provided above for the patch  2210  can also be applicable to the size of the patch  2410 , with the understanding that other dimensions are possible. Likewise, a number of techniques known to those skilled in the art can be used to associate the augmentation patch  2410  with the sutures  2412 ,  2416 . Nevertheless,  FIGS.  34 A and  34 B  illustrate one exemplary method for using suture threaders  2406   a,    2406   b  to associate the patch  2410  with the sutures  2412 ,  2416 . 
     As shown in  FIG.  34 A and  34 B , the sutures limbs  2412 ,  2416  are threaded to the patch  2410  at medial locations  2411   a,    2411   b  of the patch, respectively, to secure the sutures  2412 ,  2416  relative to the patch  2410  in a pre-installation configuration. In the illustrated embodiment the medial locations  2411   a,    2411   b  are located approximately midway between opposing sides  2410   a,    2410   b  of the patch  2410 , although other locations are possible. The sutures  2412  and  2416  can be stitched, or otherwise threaded, onto the patch  2410  such that two suture limbs  2412   a,    2412   b  and  2416   a,    2416   b,  respectively, extend from a proximal surface of the patch  2410 . The suture limb  2412   a  and  2416   a  can each have a first portion that includes a hollow self-locking mechanism  2470   a  and  2470   b  having a lumen  2472   a  and  2472   b  extending therethrough. In the illustrated embodiment the self-locking mechanisms  2470   a,    2740   b  are finger-trap-like configurations, although other self-locking mechanisms provided for herein or otherwise known to those skilled in the art in view of the present disclosures can also be used. 
     The self-locking mechanisms  2470   a  and  2470   b  can each have a length that is less than the distance extending between the side  2410   a  of the patch  2410  and the respective stitches  2411   a  and  2411   b.  The suture threaders  2406   a,    2406   b  can be inserted through the respective self-locking mechanisms  2470   a,    2470   b  such that a proximal handle portion  2408   a,    2408   b  is located proximate to the respective medial locations  2411   a,    2411   b,  and the distal suture-receiving ends  2409   a,    2409   b  are located more proximate to the side  2410   a  than the side  2410   b.  The suture limbs  2412   a,    2416   a  can have respective leading tails  2413   a,    2413   b  extending from the self-locking mechanisms  2470   a,    2740   b.  As shown, the leading tail  2413   a,    2413   b  of each suture  2412 ,  2416  can be threaded from a proximal side  2410   p  to the distal side  2410   d  of the patch  2410 , at a location that is more proximate to the side  2410   a  than the side  2410   b.  Further, as illustrated, the suture limbs  2412   b,    2416   b  are threaded from the proximal side  2410   p  to the distal side  2410   d  of the patch  2410 , at a location that is more proximate to the side  2410   b  than the side  2410   a,  thereby forming trailing tails. A person skilled in the art will recognize a variety of other ways by which the patch  2410  can be associated with the sutures  2412 ,  2416  without departing from the spirit of the present disclosure. 
       FIGS.  34 C- 34 J  provide for one exemplary method of installing the tissue augmentation patch  2410  to help secure a piece of soft tissue  2430 , e.g., rotator cuff, to bone  2450  using a single row repair  2432 . Like the many other methods provided for herein, the patch  2410  and related techniques can also be used in other types of repairs, such as double row repairs. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation patch have been prepared according to accepted surgical techniques including those provided for herein, as shown in  FIG.  34 C , the tissue  2430  can be fixed to the bone  2450  using a suture  2403  coupled to an anchor  2404  that inserted into the bone  2450 . While one suture  2403  and one anchor  2404  are shown, a plurality can be used in order to effectively fix the tissue  2430  relative to the bone  2450 . Further, in the illustrated embodiment only the components associated with one of the threaders and sutures is visible because of the point of view illustrated, but a person skilled in the art will understand that the other threader and suture can be operated in a similar manner. Reference may be made to both components, even though only one is visible, for ease of description. 
     Once the tissue  2430  has been fixated to the bone  2450 , the leading tails  2413   a,    2413   b  can be stitched into the tissue, medial of the repair, as shown in  FIG.  34 D . In the illustrated embodiment, the leading tails  2413   a,    2413   b  are threaded into, and back out of, the tissue  2430  using, for example, a mattress stitch  2442   a.  As shown in  FIG.  34 E , the leading tail  2413   a  can be coupled to the suture-receiving end  2409   a  of the suture threader  2406   a,  and the suture threader  2406   a  can be subsequently operated as provided for in the present disclosure to advance the leading tail  2413   a  into the lumen  2472   a  of the self-locking mechanism  2470   a.  A similar action can be taken with respect to the leading tail  2413   b  so that it becomes disposed in the lumen  2472   b  of the self-locking mechanism  2470   b,  although, as indicated above, this is not visible in the point of view illustrated. After distal ends of the tails  2413   a,    2413   b  have been passed through the respective self-locking mechanisms  2470   a,    2740   b  such that the distal ends are visible and able to be grabbed by a user, as shown in  FIG.  34 F , the threaders  2406   a,    2406   b  can be disconnected from the tails  2413   a,    2413   b  and disposed of and/or prepared for future use. In the illustrated embodiment, the self-locking mechanisms  2470   a,    2470   b  can operate such that the respective leading tails  2413   a,    2413   b  can only advance in one direction, or can optionally be selectively lockable. 
     As shown in  FIG.  34 G , the operator can apply a force F P  to the leading tails  2413   a,    2413   b  to advance the patch  2410  towards the mattress stitch  2442   a.  More specifically, as the force F P  is applied to the leading tail  2413   a,  a loop  2415   a  defined by the self-locking mechanism  2470   a  is collapsed, as illustrated by the resulting configuration in  FIG.  34 H . A similar result occurs when the force F P  is applied to the leading tail  2413   b.    
     The patch  2410  is an installed location, as shown in  FIG.  34 H , when the repair  2432  has been covered by the patch  2410 . More particularly, the illustrated installed configuration shows that the side  2410   a  of the patch  2410  is proximate to the mattress stitch  2442   a.  As a result, when the side  2410   b  of the patch  2410  is coupled to a location in the body, the patch  2410  is able to bend over as shown and more securely protect and integrate with the tissue  2430 . This is because the patch  2410  can stretch to provide for a tighter fit. The patch  2410 , in combination with the sutures  2412 ,  2416 , operate together as a single continuous suture or belt, which can better share the load than using multiple stitches. A person skilled in the art will recognize that other lengths of the patch  2410 , other locations for the medial stitches  2411   a,    2411   b,  and other locations for a distal terminal end of the self-locking mechanisms  2472   a,    2742   b,  among other factors, can be adjusted to achieve other installed configurations in accordance with the present disclosures. Alternatively, the patch  2410  can be located medial to the repair  2432 , or any other location that is desired for a given procedure. 
     Any number of techniques for securing a location of the side  2410   b  of the patch  2410  within the body can be used, including those provided for herein. In the illustrated embodiment, after the patch  2410  has been installed onto the tissue  2430 , as shown in  FIGS.  34 I and  34 J , the leading tail  2413   a  and the trailing tail  2412   b  are coupled to the anchor  2460   a  and the leading tail  2413   b  and trailing tail  2416   b  are coupled to the anchor  2460   b.  The leading tails  2413   a,    2413   b  and the trailing tails  2412   b,    2416   b  can then be tightened to secure the patch  2410  against the repair before the anchors  2460   a,    2460   b  are fully fixed in the bone  2450 . Once the patch  2410  is secured within the body, the patch  2410  does not generally flex much or move so that way the patch  2410  can protect and heal in manners described throughout the present application with respect to augmentation constructs generally. Alternatively, the trailing tails  2412   b,    2416   b  can both be secured to the patch  2410  at a location proximate the anchors  2406   a,    2406   b  to allow for the patch to stretch over the tissue. 
     In an alternative method, the leading tail  2413   b  and the trailing tail  2412   a  can be coupled to the anchor  2460   a  and the leading tail  2413   a  and the trailing tail  2416   b  can be coupled to the anchor  2460   b,  as shown in  FIG.  34 K . Such a configuration provides for a crossed pattern that can provide benefits as described above when discussing crossed patterns. In yet a further alternative embodiment, the leading tails  2413   a,    2413   b  can be cut proximate to where they exit the self-locking mechanisms  2470   a,    2470   b,  respectively, such that only the trailing tails  2412   b,    2416   b  are secured into the anchors  2406   a,    2406   b,  respectively. This is because in certain self-locking mechanism configurations, such as the finger-trap-like configuration illustrated, allows the trailing tails  2412   b,    2416   b  to carry the load. A person skilled in the art, in view of the present disclosures, will further recognize that various suture sizes and configurations can be adjusted in view of the flexible patch  2410  to help share the load. 
     The tissue augmentation patch  2410  can be manufactured using a number of different techniques which have been previously discussed above with regards to tissue augmentation constructs, including but not limited to the tissue augmentation patches  2210 ,  2310 . Further, the patch  2410  can be made from any of the materials provided for above with respect to the patches  2210 ,  2310 , including materials that promote healing and tissue growth, for example collagen. As a result, while the patient is healing from the procedure, the patch can remodel into tendon-like tissue and integrate with the underlying native tissue. The additional coverage of tendon like tissue across the soft tissue can increase the strength of the soft tissue to bone connection and may prevent further injury. 
     Another exemplary embodiment of a tissue augmentation construct  2510 having a patch or scaffold configuration is illustrated in  FIGS.  35 A- 35 D . The patch  2510  has a shape and size similar to that of the patch  2410 , and can be disposed on or otherwise associated with sutures  2512   a,    2512   b,    2516   a,    2516   b.  A number of techniques provided for throughout the present disclosure can be used to couple or otherwise associate the patch  2510  with the sutures  2512   a,    2512   b,    2516   a,    2516   b.  As shown in  FIG.  35 A , the sutures  2512   a,    2516   a  are threaded to the patch  2510  at medial locations  2511   a,    2511   b  of the patch, respectively, to secure the sutures  2512   a,    2516   a  relative to the patch  2510 . The medial locations  2511   a,    2511   b,  can be similar to the comparable medial locations  2411   a,    2411   b  of the patch  2410 , and thus can lead to some of the same benefits described above. The sutures  2512   a,    2516   a  can be stitched or otherwise fixed onto the patch  2510  such that the sutures  2512   a,    2516   a  extend from a proximal surface of the patch  2510 . First portions of the sutures  2512   a,    2516   a  can each include a hollow self-locking mechanism  2570   a,    2570   b  having a lumen  2572   a,    2572   b  extending therethrough. In the illustrated embodiment the self-locking mechanisms  2570   a,    2570   b  are finger-trap-like configurations, although other self-locking mechanisms provided for herein or otherwise known to those skilled in the art in view of the present disclosures can also be used. 
     The self-locking mechanisms  2570   a,    2570   b  can have lengths that are less than the distance extending between the side  2510   a  of the patch  2510  and the respective medial locations  2511   a,    2511   b.  Suture threader  2506   a,    2506   b  can be inserted through respective lumens  2572   a,    2572   b  of the self-locking mechanisms  2570   a,    2572   b  and can be configured in a similar manner as the suture threaders  2406   a,    2406   b  described above. The sutures  2512   a,    2516   a  can include leading tails  2513   a,    2513   b  which, as shown, can extend respectively from the self-locking mechanisms  2570   a,    2570   b.  As shown in  FIGS.  35 A and  35 B , the leading tails  2513   a,    2513   b  are threaded from a proximal side  2510   p  to the distal side  2510   d  of the patch  2510 , at a location that is proximate to the side  2510   a  of the patch  2510 . 
     Unlike the previous embodiment of the tissue augmentation construct  2410  in which the trailing tails were part of the filament used to form the self-locking mechanisms and the leading tails, trailing tails of the tissue augmentation construct  2510  are separate filaments that are not part of the filaments used to form the self-locking mechanisms  2570   a,    2570   b  or the leading tails  2513   a,    2513   b.  As shown, the suture  2512   b  is a trailing tail that includes a mattress stitch at a location that is proximate to the side  2510   b  of the patch  2510 , and the suture  2516   b  is a trailing tail that includes a simple stitch at a location that is also proximate to the side  2510   b.  More particularly, each of the trailing tails  2512   b  and  2516   b  pass from a proximal side  2510   p  of the patch  2510  to a distal side  2510   d  of the patch  2510 . By providing separate leading and trailing tails, a user can have additional control over the construct  2510  since the tails can operate independently. It can, for example, enhance the stretching of the construct  2510  that occurs at either end  2510   a,    2510   b.  Notably, this embodiment illustrates some non-limiting ways by which sutures can be associated with tissue augmentation constructs, and thus in other embodiments both trailing tails  2512   b,    2516   b  can use similar stitches. A person skilled in the art will recognize a variety of other ways by which the patch  2510  can be associated with the sutures  2512   a,    2512   b,    2516   a,    2516   b  without departing from the spirit of the present disclosure. 
     The method of installing the tissue augmentation patch  2510 , which is illustrated in  FIGS.  35 C and  35 D  by way of an installed configuration, can be similar to the method described above with respect to the patch  2410 , and the installed configuration is illustrated without including the steps leading thereto. As shown, the medial locations  2511   a,    2511   b  of the patch  2510  are proximate to an edge of the tissue  2530 , and the edge  2510   b  is disposed proximate to anchors  2560   a,    2560   b  by way of the trailing tails  2512   b,    2516   b  being coupled and tightened thereto. Alternatively, the patch  2510  can be located medial to the repair, or any other location that is required for the procedure. 
     Yet another exemplary embodiment of a tissue augmentation construct  2610 haivng a patch or scaffold configuration is illustrated in  FIGS.  36 A- 36 I . The patch  2610  has a shape and size similar to that of the patches  2410  and  2510 , and can be disposed on or otherwise associated with sutures  2612 ,  2616 . A number of techniques provided for throughout the present disclosure can be used to couple or otherwise associate the patch  2610  with the sutures  2612 ,  2616 . As shown in  FIG.  36 A , the sutures limbs  2612 ,  2616  are threaded into the patch at medial locations  2611   a,    2611   b  of the patch  2610 , respectively, to secure the sutures  2612 ,  2616  relative to the patch  2610 . The medial locations  2611   a,    2611   b,  can be similar to the comparable medial locations  2411   a,    2411   b  of the patch  2410 , and thus can lead to some of the same benefits described above. 
     The suture  2612  can be stitched or otherwise fixed onto the patch  2610  such that two suture limbs  2612   a,    2612   b  extend from a proximal surface  2610   p  of the patch  2610 . Each of the suture limbs  2612   a  and  2612   b  can have a first portion that includes a hollow self-locking mechanism  2670   a,    2670   b  having a lumen  2672   a,    2672   b  extending therethrough, respectively. In the illustrated embodiment the self-locking mechanisms  2670   a,    2670   b  are finger-trap-like configurations, although other self-locking mechanisms provided for herein or otherwise known to those skilled in the art in view of the present disclosures can also be used. 
     The self-locking mechanisms  2670   a,    2670   b  can have lengths that are less than the distance extending between the respective sides  2610   a,    2610   b  of the patch  2610 , as shown, and the medial location  2611   a.  Suture threaders  2606   a,    2606   b  can be inserted through respective lumens  2672   a,    2672   b  of the self-locking mechanisms  2670   a,    2672   b  and can be configured in a similar manner as the suture threaders  2406   a,    2406   b  described above. The suture limbs  2612   a,    2612   b  can include leading tails  2613   a,    2613   b  which, as shown, can extend respectively from the self-locking mechanisms  2670   a,    2670   b.  As shown in  FIGS.  36 A and  36 B , the leading tails  2613   a,    2613   b  are threaded from the proximal side  2610   p  to the distal side  2610   d  of the patch  2610 , at location that are proximate to the respective sides  2610   a,    2610   b  of the patch  2610 . 
     The suture  2616  can be stitched or otherwise fixed onto the patch  2610  in substantially the same manner as the suture  2612 , and thus includes self-locking mechanisms  2670   c,    2670   d  associated with suture limbs  2616   a,    2616   b,  with the self-locking mechanisms  2670   c,    2670   d  having leading tails  2613   c,    2613   d  extending therefrom, respectively. As shown in  FIG.  36 A , the resulting patch  2610  can be symmetrical with regards to a first axis A 1  and a second axis A 2 . A person skilled in the art will recognize a variety of other ways by which the patch  2610  can be associated with the sutures  2612 ,  2616  without departing from the spirit of the present disclosure. 
       FIGS.  36 C- 36 I  provide for one exemplary method of installing the tissue augmentation patch  2610  to help secure a piece of soft tissue  2630 , e.g., rotator cuff, to bone  2650  using a single row repair. Like the many other methods provided for herein, the patch  2610  and related techniques can also be used in other types of repairs, such as double row repairs. Once the surgeon has access to the surgical site and the tissue, bone, and tissue augmentation patch have been prepared according to accepted surgical techniques including those provided for herein, as shown in  FIG.  36 C , the tissue  2630  can be fixed to the bone  2650  using a suture  2603  coupled to an anchor  2604  that inserted into the bone  2650 . While one suture  2603  and one anchor  2604  are shown, a plurality can be used in order to effectively fix the tissue  2630  relative to the bone  2650 . Further, in the illustrated embodiment only the components associated with one of the sutures is visible because of the point of view illustrated, but a person skilled in the art will understand that the other suture and related components can be operated in a similar manner. 
     Once the tissue  2630  has been fixated to the bone  2630 , the leading tails  2613   a,    2613   c  can be stitched into the tissue, medial of the repair, as shown in  FIG.  36 C . As shown, the leading tail  2613   a  is threaded into, and back out of, the tissue  2630  using, for example, a mattress stitch  2642   a.  The leading tail  2613   a  can then be coupled to the distal suture-receiving end  2609   a  of the suture threader  2606   a,  and the suture threader  2606   a  can be subsequently operated as provided for in the present disclosure to advance the leading tail  2613   a  into the lumen  2672   a  of the self-locking mechanism  2670   a,  thereby forming a loop  2615   a.  After the distal end of the tail  2613   a  has been passed through the self-locking mechanisms  2670   a  such that the distal end is visible and able to be grabbed by a user, as shown in  FIG.  36 D , the threader  2606   a  can be disconnected from the tail  2613   a  and disposed of and/or prepared for future use. In the illustrated embodiment, the self-locking mechanism  2670   a  can operate such that the leading tail  2613   a  can only advance in one direction, or can optionally be selectively lockable. The leading tail  2613   c  can be similarly threaded through the self-locking mechanism  2670   c,  in conjunction with the threader  2606   c.    
     An anchor  2660   a  can be inserted into the bone  2650 , laterally offset from the repair anchor  2604 , having a collapsible loop  2662   a  and a tensioning tail  2664   a  associated therewith. The tensioning tail  2664   a  can be used to collapse the collapsible loop  2662   a  towards the anchor  2660   a.  The leading tail  2613   c  can be similarly threaded through the self-locking mechanism  2670   c,  and a second lateral anchor  2660   b  ( FIG.  361   ) and collapsible loop (not visible) can be similarly installed into the bone  2650 . 
     As shown in  FIGS.  36 E and  36 F , the trailing tail  2613   b  can be looped through the collapsible loop  2662   a  and then coupled to the distal suture-receiving end  2609   b  of the suture threader  2606   b.  The suture threader  2606   b  can be subsequently operated as provided for in the present disclosure to advance the trailing tail  2613   b  into the lumen  2672   b  of the self-locking mechanism  2670   b,  thereby forming a loop  2615   b.  After the distal end of the tail  2613   b  has been passed through the self-locking mechanisms  2670   b  such that the distal end is visible and able to be grabbed by a user, as shown in  FIG.  36 F , the threader  2606   b  can be disconnected from the tail  2613   b  and disposed of and/or prepared for future use. In the illustrated embodiment, the self-locking mechanism  2670   b  can operate such that the leading tail  2613   b  can only advance in one direction, or can optionally be selectively lockable. The leading tail  2613   d  can be similarly threaded through the self-locking mechanism  2670   d,  in conjunction with the threader  2606   d.    
     As shown in  FIG.  36 G , the collapsible loop  2662   a  can be collapsed towards the anchor  2660   a,  thereby bringing a portion of the loop  2615   b  towards anchor  2660   a.  The trailing tail  2613   d  can be similarly looped through a collapsible loop (not shown) associated with the anchor  2660   b  to bring a portion of that collapsible loop towards the anchor  2660   b,  as seen at least in  FIG.  36 I . 
     As shown in  FIG.  36 H , the operator can apply a force F P  to the leading tail  2613   a,  trailing tail  2613   b,  leading tail  2613   c,  and trailing tail  2613   d  to advance the patch  2610  towards the repair. The patch  2610  is in an installed location, shown in  FIG.  36 H , when the repair has been covered by the patch  2610 , similar to the installed configuration described above with respect to the patch  2410 , and when slack in the loops  2615   a - 2615   d  has been removed. Thus, adjustments to positioning of the patch  2610  and related components can also be achieved in manners similar as described with respect to the patch  2410 . After the patch  2610  has been installed onto the tissue  2630 , as shown in  FIGS.  36 H and  36 I , the excess portion of the tails  2613   a - 2613   d  that extend out of the self-locking mechanisms  2670   a - 2670   d  can be cut to remove excess material. 
     Tissue Augmentation Patch Delivery Tools 
     Tools that aid in the delivery and suture management of tissue augmentation constructs can reduce the complexity and time involved with the procedures are also provided for in the present disclosure. Some such tools, including threaders and the installation tool  200 ′, are provided for above. The disclosure in this section focuses on some delivery tools that can be used in conjunction with patches or scaffolds, although a person skilled in the art will recognize how many different constructs provided for herein can be used in conjunction with various delivery tools and systems provided for herein without departing from the spirit of the present disclosure. In other words, just because the disclosures provided below primarily illustrate delivery tools used in conjunction with patches or scaffolds, other tissue augmentation constructs can also be used in conjunction with delivery tools of the nature provided for, even if some modifications by a skilled person would be desirable and/or necessary to accommodate the different configurations. Such modifications would be possible in view of the present disclosures and knowledge of the skilled person. The tools for delivering scaffolds as illustrated include construct management folding cards ( FIGS.  37 A- 37 E ), construct management release cartridges ( FIGS.  38 A- 38 E ), construct management deconstructable boxes ( FIGS.  39 A- 39 F ), construct management boxes configured to mount to a cannula ( FIG.  40   ), and construct delivery insertion tools ( FIGS.  41 A- 41 E and  42 A- 42 C ). 
     One exemplary embodiment of a construct management folding card is illustrated in  FIGS.  37 A- 37 E . As shown in  FIG.  37 A , a construct management folding card  3520  can secure or otherwise hold a patch or scaffold  3510  having threaders  3509   a - 3509   d  disposed in the patch for implantation at a surgical site. The card  3520  can include a bottom patch securing portion  3524  and a top flap  3522 . The top flap  3522  can be folded over, as shown along a crease  3526 , the bottom portion  3524  to protect the patch  3510  and threaders  3509   a - 3509   d  during transport. While in the illustrated embodiment the card  3520  utilizes a folding configuration with a crease to protect the patch, many other configurations of a card that protects the patch can be used without departing from the spirit of the present disclosure, including embodiments provided for herein or otherwise derivable therefrom. For example, the bottom portion  3524  and the top flap  3522  can be separate pieces that are coupled together using any number of techniques known to those skilled in the art. The card  3520  can be formed of any suitable material including plastics, cardboard, and metals. 
     A plurality of threaders for associating filament with the patch  3510  are also provided. The threaders can include a tab or handle  3508   a - 3508   d,  a filament  3507   a - 3507   d  attached therethrough, and a loop  3506   a - 3506   d  at the end of the filament. For example, a suture limb can be associated with the loop and a user can draw the filament, and therefore the loop and suture limb associated therewith, through the patch by grasping the tab. In some embodiments, the threaders  3509   a - 3509   d  can be disposed through the patch  3510  in a manner that enables the suture limbs  3512   a,    3514   a  to form loops  3540   a,    3540   b  at the medial edge  3510 M of the patch  3510 , like the loops  3440   a,    3440   b  illustrated in  FIG.  33 C . Any number of patch-threader and patch-filament configurations are possible for the construct, and in the illustrated embodiment the filament  3507   a  of the first threader  3509   a  is disposed in the patch  3510  approximately parallel to a first outer side edge  3510   a  of the patch  3510 , and the filament  3507   b  of the second threader  3510   b  is disposed in the patch  3510  at an approximately 45 degree angle relative to the filament  3510   a.  The third and fourth threaders  3510   c,    3510   d,  and their associated filaments  3507   c,    3507   d,  are disposed proximate the second outer side edge  3510   b  of the patch in a similar fashion as shown. 
     In use, as shown in  FIGS.  37 B- 37 E , once the surgeon has access to the surgical site, for example through the cannula  3590 , and the surgical site has been prepared according to accepted surgical techniques, the suture limbs  3512   a,    3512   b,    3514   a,    3514   b  can be brought outside the patient through the cannula  3590 . The top flap  3522  of the card can be unfolded to expose the patch  3510  and the suture threaders  3509   a - 3509   d.  As discussed above, a loop  3540   a  can be formed by first inserting the suture limb  3512   a  through the second threader  3509   b  and pulling the threader in a direction P 1  from a distal side  3510   d  to a proximal side  3510   p  of the patch  3510 , as shown in  FIG.  37 B . The suture limb  3512   a  can then be disposed through the first threader  3509   a  and advanced through a lumen, not shown, from the medial edge  3510 M of the patch to the lateral edge  3510 L of the patch in a direction P 2 , as shown in  FIG.  37 C . 
     As illustrated in  FIG.  37 D , the top flap  3522  can be removed from the card  3520  and the card  3520  can be turned over to provide access to the threaders  3509   c,    3509   d.  In the illustrated embodiment, access is initially limited to the first two threaders  3509   a,    3509   b  to prevent a user from unintentionally associating the suture limb  3512   a  with threaders  3509   c,    3509   d.  Alternatively, the card  3520  may not include the top flap  3522  thereby providing access to all of the threaders  3509   a - 3509   d  at the same time. In the illustrated embodiment, the flap  3522  is detached along the crease, for instance by providing a perforation along the crease, although many techniques known to those skilled in the art for separating one portion of a card or paper from another can be used. Suture  3514   a  can be threaded through the patch  3510  using threaders  3509   c,    3509   d  to create a second loop  3540   b  using the technique provided for suture  3512   a.  Once the suture limbs  3512   a,    3514   a  have been threaded into the patch  3510 , as shown in  FIG.  37 E , the patch  3510  can be removed from the bottom portion  3524  and can be introduced into the surgical site to complete the repair, according to accepted surgical techniques including those provided for herein. Slack in suture limbs  3512   a,    3514   a  can be created when introducing the patch construct into the surgical site. The suture limbs  3512   a,    3512   b,  and  3514   a,    3514   b,  respectively, are part of single sutures that can be disposed in the soft tissue with an inverted mattress stitch, not shown. The loop stitches  3540   a,    3540   b  can fix the respective suture limbs  3512   a,    3514   b  relative to the patch. As such, application of force F on one of the suture limbs  3512   b,    3514   a  of each pair can remove slack from the other limbs  3512   a,    3514   a  of the pair as the suture slides through the mattress stitch. Thus, the slack, not shown, can be reduced by applying the force F on the two free suture limbs  3512   b,    3514   b  to pull slack out of the surgical site. In alternative embodiments, the threaders  3509   a - 3509   d  can be disposed through the patch  3510  in many other configurations, including but not limited to those provided above, to create any of the aforementioned configurations (e.g., forming a jog instead of a loop). Further, although a patch  3510  is shown, any construct can be advantageously used with the construct management cards of the nature described with respect to  FIGS.  37 A- 37 E . The construct management folding card  3520  can be disposed after use or reused as provided for herein. 
     One exemplary embodiment of a construct management release cartridge is illustrated in  FIGS.  38 A- 38 D . As shown, a construct management release cartridge  3620  can secure or otherwise hold a patch or scaffold  3610  having threaders  3609   a,    3609   b  disposed in the patch for implantation at a surgical site. The cartridge  3620  can releasably secure the patch  3610  and its associated threaders  3609   a,    3609   b  by using a release mechanism  3660  to expose the patch  3610 . The release mechanism  3660  can advantageously prevent the construct  3610  from being released before the user is ready to insert the construct  3610 . In the illustrated embodiment, the cartridge  3620  includes two threaders  3609   a    3609   b  configured to thread suture limbs  3612   a,    3612   b  through the construct. For example, a single threader  3609   a  can be used to thread a single suture limb  3612   a  into the patch. The threader  3609   a  can have a  3608   a  handle disposed on a first side  3620   a  of the cartridge  3620  and a suture receiving end  3607   a  exiting on a third side  3620   c.  The intermediate portion of the threader  3609   a  can be disposed in a track  3624   a  of the cartridge  3620 . The track  3624   a  can define a path for forming a loop when a suture limb  3612   a  is disposed through the patch  3610 , similar to the loop of  FIG.  33 C . Alternatively, a single threader, or more than two threaders, can be disposed through the patch  3610 . As shown in the illustrated embodiment, the second threader  3610   b  can similarly have a handle  3608   b  disposed at the first side  3620   a  of the cartridge and a suture receiving end  3607   b  exiting on a fourth side  3620   d.  The second threader  3609   b  can be disposed in a second track  3624   b.    
     The release mechanism  3660  can be disposed proximate a second side  3620   b,  which can be opposite a first side  3610   a.  The release mechanism  3660  can generally include a release button  3662  and retaining features  3664   a,    3664   b.  As illustrated in  FIG.  38 C , the release button  3662  and retaining features  3664  can be a unitary piece that can be actuated to move in a proximal/distal direction D. In one embodiment, as shown in  FIG.  38 C , the retaining features  3664   a,    3664   b  can be J or hook shaped to retain the threader or suture limb in the cartridge. For example, the distal end  3665   a,    3665   b  of the retaining feature  3664   a,    3664   b  can, in a locked configuration, be disposed against the distal side  3620   d  of the cartridge such that the suture limb  3612   a  is retained by the cartridge  3620 . Upon actuation of the release button  3662 , the distal ends  3665   a,    3665   b  of the retaining features  3664   a,    3664   b  can be offset from the distal side  3620   d  to permit the suture limbs to be released. The release button  3662  can be disposed on the proximal side  3620   p  of the cartridge and the retaining features  3664   a,    3664   b  can be disposed on the distal side  3620   d  of the cartridge. The retaining features  3664   a,    3644   b  can retain the patch  3610  in the cartridge by holding the threaders  3609   a,    3609   b,  or suture limbs  3612   a,    3612   b,  until the operator is ready to install the patch  3610 . An alternative release mechanism  3660 ′ is illustrated in  FIG.  38 D  and can include a pivotable release button  3662 ′ that can flex in a direction D′ to release a suture limb  3612   a,  shown in phantom. The cartridge  3620 ′ can include a proximal portion  3620   p ′ that has an approximately 10 degree draft to aid guiding a suture  3612   a ′ during release. The alternative cartridge  3620 ′ can further include an overhang  3666 ′ that can prevent accidental release. 
     In use, first and second suture limbs  3612   a,    3612   b  can be threaded onto the patch  3610  by application of a force on the handles  3608   a,    3608   b  of the respective threaders  3609   a,    3609   b  using techniques provided for throughout the present disclosure. Once the first and second suture limbs  3612   a,    3612   b  have been threaded into the patch  3610 , for instance, by forming loops (not shown), the limbs  3612   a,    3612   b  can be retained in the cartridge  3620  by the retaining features  3664   a,    3664   b.  A user can then activate the release button  3662  to disengage the retaining features  3664   a,    3664   b  to free the loops, and thus the patch  3610 , from the cartridge  3620 . The patch  3610  and suture limbs  3612   a,    3612   b  can then be advanced into the surgical site and the soft tissue repair can be completed using techniques provided for throughout the present disclosure or otherwise known to those skilled in the art. 
     An alternative construct delivery cartridge  3720  similar to the cartridge  3620  of  FIGS.  38 A- 38 D  is illustrated in  FIGS.  38 E and  38 F . Similar to the cartridge  3620 , cartridge  3720  can retain a patch  3710  and threaders, as shown two threaders  3709   a,    3709   b  disposed in threading tracks  3724   a,    3724   b.  In an alternative to the release mechanisms  3660 ,  3660 ′, the cartridge consists of a bottom portion  3720   a  and a top patch retaining portion  3720   b.  Once the suture limbs (not shown) are threaded into the patch  3710  using techniques provided for throughout the present disclosure or otherwise known to those skilled in the art in view of the present disclosure, the top patch retaining portion  3720   a  of the cartridge can be removed from the bottom retaining portion  3720   b  to release the patch  3710  and suture limbs from the cartridge  3720 , as shown in  FIG.  38 F . For example, in some embodiments, a finger hold  3780  can be disposed on the top portion  3720   a  to provide a user a means for releasing the top portion  3720   a  from the bottom portion  3720   b.  Any number of configurations for attaching one component to another can be used to releasable couple the top portion  3720   a  to the bottom portion  3720   b,  including but not limited to any number of male-female mating elements. For example, the top portion  3720   a  can include a retaining lip on a distal surface, not shown, that can retain the bottom portion  3720   b.  Alternatively, the top portion  3720   a  and the bottom portion  3720   b  can be releasable coupled via an interference fit. The patch  3710  and suture limbs can then be advanced into the surgical site and the soft tissue repair can be completed using techniques provided for throughout the present disclosure. 
     The threaders provided for with respect to the delivery tools of  FIGS.  37 A- 38 F , as well as provided for elsewhere in the present disclosure, can have a number of different configurations.  FIGS.  38 G and  38 H  provide for one, non-limiting exemplary embodiment. As shown, the threader  3809  has a handle  3807  associated with an intermediate portion  3810  that includes a suture receiving end  3808 . The intermediate portion  3810  can be manufactured from a flexible strand of nylon, or other flexible and durable materials. In some instances, the intermediate portion  3810  can be formed from a doubled over thread having a first half  3810   a  and a second half  3810   b.  The handle portion can have any shape that is ergonomically designed to aid a user in removing the threader  3809  from an associated construct. The handle can include a plurality of ridges  3830   a - 3830   c  that can extend across the handle  3807  to provide a user added grip. Alternatively, the handle  3807  can include any number of ridges or other surface features to enhance the grip of a user on the handle. In the illustrated embodiment, the handle portion  3807  has three lumens  3804   a - 3804   c  extending from a first side  3807   a  to a second side  3807   b.  The openings  3806   a - 3806   c  of the lumens  3804   a - 3804   c  on the second side  3807   b  can be formed in a recess  3830 , as shown in  FIG.  38 H . The lumens and openings help allow the intermediate portion  3810 , and thus the suture receiving end  3808 , to be associated with the handle portion  3807 , as illustrated. Further, the handle can include a notch  3832  formed between the first and second lumens  3804   a,    3804   b  for retaining the intermediate portion  3810 . 
     To manufacture the threader  3809 , the free end  3810   f  of the intermediate portion  3810  can be threaded from the first side  3807   a  of the handle  3807  through first lumen  3804   a  to the second side  3807   b  of the handle. The intermediate portion  3810  can then be threaded into the second lumen  3804   b  from the second side  3807   b  of the handle thereby creating a first loop  3812   a.  The free end  3810   f  can be then threaded through the second lumen  3804   b  to the first side  3807   a  of the handle, into the third lumen  3804   c,  over the first end  3807   a,  through to the second side  3807   b  of the handle. The free end  3810   f  of the intermediate portion can then be threaded through the first loop  3812   a.  Tension can be applied to suture receiving end  3808  of the intermediate portion  3810  to tighten the portion of the intermediate portion  3810  threaded through the handle  3807  until the slack has been removed. When the slack has been removed, the free end  3810   f  of the intermediate portion can be locked in place in the notch  3832 . The portion of the intermediate portion  3810  that is disposed on the second side  3807   b  of the handle  3807 , after the slack has been removed, can be disposed entirely in the recess. The first loop  3812   a  and the locked portion of the free end  3810   f  can be disposed in the notch  3830  without the need for any additional knots or retaining features. Advantageously, the intermediate portion  3810  of the threader  3809  can easily be replaced due to wear. 
     One exemplary embodiment of a construct management deconstructable box  3920  is illustrated in  FIGS.  39 A- 39 F . The box  3920  can be configured to secure a construct, such as a patch or scaffold  3910 , to enable the construct to be easily associated with operative sutures, as shown sutures  3912   a,    3912   b,    3914   a,    3914   b.  The box  3920  can generally include a base portion  3924 , a first top compartment  3922   a,  a second top compartment  3922   b,  and a retaining button  3926 . The box  3920  can be configured to hold the patch  3910  and one or more threaders within in it, and in the illustrated embodiment the box  3920  has two threaders  3909   a,    3909   b  disposed within it. The patch  3910  can be pre-threaded with the first and second threaders  3909   a,    3909   b  and two suture limbs  3918   a,    3918   b.  The patch  3910  can be initially retained in the box  3920  by the first and second top compartments  3924   a,    3924   b  and the push button  3926 . The slots  3924   a,    3924   b  can be disposed along a top surface of the respective first and second top compartments  3922   a,    3922   b  proximate a first side  3920   a  of the box  3920 . The handles of the threaders  3909   a,    3909   b  can be accessible from the second side  3920   b  of the box  3020 . The two suture limbs  3918   a,    3918   b  can be retained in securing slots  3928   a,    3928   b  disposed in the respective first and second top compartments  3924   a,    3924   b.  The retaining button  3926  can be pushed inward to retain the patch  3910  in the box during the threading operation. For example, when the button  3926  is actuated, the button can be retained in the bottom portion  3924 . In some embodiments, the retaining button  3936  can extend upward past the surfaces of the first and second top compartments in an unengaged configuration, as shown in phantom in  FIG.  39 A , and the top surface of the button  3926   t  can be flush with the top surfaces of the first and second compartments  3923   a,    3923   b,  as shown in  FIG.  39 B . A person skilled in the art will recognize that many other configurations of a deconstructable box are possible, and thus although the present disclosure provides for a single base portion, two top compartments, and a push button, any number of base portions, top compartments, and push buttons can be used together to achieve the same results without departing from the spirit of the present disclosure. 
     In use, as shown in  FIGS.  39 B- 39 F , four operative sutures  3912   a,    3912   b,    3914   a,    3914   b  can exit through a cannula  3990  ( FIG.  39 D ) from a surgical repair site. A first pre-threaded suture  3918   a  can be released from the first slot  3929   a  of the first top compartment  3922   a  and secured to a first operative suture  3912   b,  for instance using a knot  3913   a.  In one embodiment approximately 40.0 millimeters to 60.0 millimeters of slack can be left in the first pre-threaded suture  3918   a  after the knot  3913   a  is tied. The first top compartment  3922   a  can then be released from the base portion  3924 , as shown in  FIG.  39 C . Next, for example, a leading side of the of the first operative suture can then be threaded through a cuff feature  3911   a  ( FIG.  39 F ) with the first pre-threaded suture  3918   a.  The patch  3910  can include first and second cuffs  3911   a,    3911   b  that are fixed to the top surface  3910   t  of the patch  3910  to retain operative sutures  3912   b,    3914   b  for fixing the location of the patch  3910  once installed in the surgical site, as shown in  FIG.  39 F . The second operative suture  3912   a  can then be threaded into the patch  3910  with the threader  3909   a  using techniques provided for throughout the present disclosure, as shown in  FIG.  39 D . This process can then be completed with the third and fourth operative sutures  3914   a,    3914   b  and the second top compartment  3922   b  removed, as shown in  FIG.  39 E , these components operating in a similar fashion as those described in conjunction with the removal of the first top compartment  3922   a.  Once the operative sutures  3912   a,    3912   b,    3914   a,    3914   b  have been threaded onto the respective cuffs  3911   a,    3911   b  and the patch  3910 , the retaining button  3926  can be released from the base portion  3924  by application of opposing force F 2 , F 3  to sides  3926   a,    3926   b  of the button  3926 . The patch  3910  is thus released from the box  3920 , as shown in  FIG.  39 F . The patch  3910  and suture limbs  3912   a,    3912   b,    3914   a,    3914   b  can then be advanced into the surgical site and the soft tissue repair can be completed using techniques provided for throughout the present disclosure. 
     In alternative embodiments, any number of threaders can be disposed through the constructs of the various construct management cards, cartridges, and boxes to achieve any of the disclosed construct embodiments provided for herein. In a further alternative embodiment, delivery tools like the construct management cards, cartridges, and boxes of  FIGS.  37 A- 40   , as well as other delivery tools provided for herein, can be mounted directly onto a cannula to free a hand of the operator during the suture threading of a construct. For example,  FIG.  40    provides a construct cartridge  4022  having two construct retaining buttons  4026   a,    4026   b  and two threaders  4009   a,    4009   b.  The retaining buttons  4026   a,    4026   b  can be depressed to retain a construct disposed therein during a threading operation. The illustrated construct cartridge  4022  can be directly mounted to the proximal end  4090   p  of the cannula  4090  such that the construct disposed therein, not shown, can be threaded by the operative suture limbs while fixed relative to the cannula  4090 . The cartridge  4022  can be removably associated with the proximal end of the cannula  4090  with any known releasable interfaces. Alternatively, any of the delivery tools provided in the present disclosure, including the construct management cards, cartridges, and boxes of  FIGS.  37 A- 40   , can be removably mounted to the cannula  4090 . 
     Additional tools for delivering constructs into a surgical site through a cannula, or other opening, are illustrated in  FIGS.  41 A- 41 E . As noted above, tissue augmentation constructs can include patches or scaffolds  4110 . In some embodiments, a patch  4110  can include two suture limbs  4112   a,    4114   a  associated with a proximal end  4110   p  of the patch and two suture limbs  4112   b,    4114   b  associated with a distal end  4110   d.  Alternatively, the patch  4110  can include two suture limbs disposed through respective lumens in the patch, not shown, from the proximal end  4110   p  to the distal end  4110   d.  In some embodiments, the patch  4110  can include an opening  4120 , the opening having a construction that includes but is not limited to a hole, slot, or slit disposed proximate the distal end  4110   d  of the patch. The opening can be configured to receive a delivery tool. For example, a tool  4130  having a shaft  4132  and a distal patch engaging end  4136  can be used in conjunction with the opening  4120 . In the illustrated embodiment, the tool  4130  resembles a femoral aimer. As shown in  FIG.  41 B , the distal patch engaging end  4136  can include an offset extension  4137  and a shelf  4138  at the distal terminal end of the tool  4130 . In an alternative embodiment shown in  FIG.  41 C , the tool  4130 ′ can be similar to a Gryphon anchor inserter (available from DePuy Synthes of Raynham, Mass.), and can have an extension  4137 ′ that is substantially axially aligned with a central longitudinal axis A 1  the shaft  4132 ′. In a further alternative embodiment, as shown in  FIG.  41 D , the tool  4130 ″ can have a tapered end  4137 ″ having a maximum diameter that is larger than the diameter of the hole  4120  in the patch  4110 . A person skilled in the art will recognize many other configurations of tools that can be used in conjunction with patches in view of the present disclosure. 
     In use, the patch  4110  can be inserted into the surgical site using the tool  4130 , or alternative embodiments of such tools provided for herein or otherwise derivable from the present disclosures. The patch  4110  can be inserted distal end  4110   d  first. The offset extension  4137  can be inserted into the hole  4120  of the patch  4110  until the shelf  4138  is in contact with a surface of the patch  4110  such that the tool  4130  cannot advance through the hole  4120 . The tool  4130  can then be used to advance the patch  4110  through a cannula or incision site to push the patch  4110  into the surgical site. The tool  4130  can then be disengaged from the patch  4110  and removed from the patient by moving it in the proximal direction. An additional tool may be used to hold the patch in place while the delivery tool  4130  is removed, or alternatively, a location at the surgical site can be used to help hold the patch at the desired location. A person skilled in the art will recognize how a patch can be disconnected from the tool in conjunction with a surgical procedure in view of the present disclosures. The patch  4110  can then be installed according to techniques provided for herein. 
     A further alternative delivery tool, as described a delivery needle tool  4230 , is illustrated in  FIGS.  42 A- 42 C . In contrast to the tools of  FIGS.  41 A- 41 E , the delivery needle  4230  can be actuated to unload, or release, an associated patch  4210 . The delivery needle  4230  can include an outer sleeve  4232  and a retractable needle  4234  slidably disposed within the outer sleeve  4232 . The outer sleeve  4232  can have a central lumen  4233  extending from a proximal most end  4232   p  to a distal most end  4232   d  of the sleeve  4232  through which the needle  4234  can be slidably disposed. A handle portion  4236  of the needle  4234  can be proximate the proximal end  4232   p  of the sleeve  4232  and an insertion end  4238  of the needle can be proximate the distal end  4232   d  of the sleeve  4232 . The insertion end  4238  of the needle  4234  can have constant diameter, or, as illustrated, can be tapered. The needle  4234  can be slidably disposed within the sleeve  4232  so that the needle  4234  can be retracted proximally within the sleeve such that the insertion end  4238  is entirely received within the lumen  4233 . The sleeve  4232  can have a diameter D 1  that is larger than the diameter D 2  of the needle  4234 . The diameters D 1 , D 2  of the sleeve  4232  and the needle  4234  can depend on a variety of factors, including but not limited to the size of an opening of a patch with which the tool is to be associated, the anatomy of the patient, and the type of procedure being performed. 
     In use, the patch  4210  can be inserted into the surgical site using the tool  4230 . The patch  4210  can be substantially similar to the patch  4110  and include an opening  4220  at a distal end  4210   d  thereof. The patch  4210  can be inserted through the cannula or incision site distal end  4210   d  first. The insertion end  4238  of the needle  4234  can be inserted into the hole  4220  of the patch  4210  until the distal end  4232   d  of the outer sleeve  4232  is in contact with a surface of the patch  4210  such that the tool  4230  cannot advance through the hole  4220 , as shown in  FIG.  42 B . The tool  4230  can be used to advance the patch  4210  through a cannula or incision site to push the patch  4210  into the surgical site. Once the patch  4210  is at the desired location, a user can grasp the handle  4236  of the needle  4232  to retract the insertion end  4238  of the needle  4232  relative to the sleeve  4232 . Thus, the insertion end  4238  can be removed from the hole  4220  until the distal most end  4238   d  of the insertion end  4238  is disposed in the sleeve  4234  such that the tool can be disengaged from the patch  4210  and removed from the patient. The patch  4210  can then be installed according to techniques provided for herein. 
     Tissue Augmentation Construct—Suture Leader 
       FIG.  43    provides for another exemplary embodiment of a tissue augmentation construct, as shown a suture leader  2701 . A suture leader  2701  can be placed on a distal end of a suture  2712 . The suture leader can have a first section  2704  having a diameter D 1  and a second section  2706  having a diameter D 2 . As shown, D 1  is larger than D 2 . The smaller diameter of D 2  can allow for the second section  2706  to be folded in half and more easily pulled through a lumen of a tissue augmentation construct while allowing the operative first portion  2704  to have the necessary diameter and strength to complete the repair. The suture leader  2701  can be integral with the suture  2712 , or can be an additional end-cap that is installed over a distal-most end or proximal-most end of the suture  2712 . The suture leader  2701  can be used with any of the above mentioned embodiments of tissue augmentation constructs and related methods, other medical procedures, and in applications outside of the medical field. 
     One skilled in the art will appreciate further features and advantages of the present disclosure based on the above-described embodiments. Accordingly, the disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. Further, although the systems, devices, and methods provided for herein are generally directed to surgical techniques, at least some of the systems, devices, and methods can be used in applications outside of the surgical field. All publications and references cited herein are expressly incorporated herein by reference in their entirety.