Patent Description:
A variety of injuries and conditions require repair of soft tissue damage, or reattachment of soft tissue to bone and/or surrounding tissue. For example, when otherwise healthy tissue has been torn away from a bone, such as a shoulder rotator cuff tendon being partially or completely torn from a humerus (a rotator cuff tear), surgery is often required to reattach the tissue to the bone, to allow healing and a natural reattachment to occur. A number of devices and methods have been developed for performing these surgical repairs. Some of the more successful methods including the use of suture fixation members, such as suture anchors, which typically include an anchor body having one or more suture attachment feature and include a tissue or bone engaging feature for retaining the suture anchor within or adjacent to the tissue or bone. Depending on the specific injury, one or more suture anchors connected to, or interconnected by, one or more segment of suture, may be used to perform the repair.

Surgery can also be required when a tear occurs in the substance of a single type of tissue, for example in the meniscus of the knee (a meniscal tear). One method of repairing such a tear is to stitch it closed by passing a length of suture through the tissue and tying the suture. Suture can also be used in conjunction with one or more suture anchors to repair such tissue tears. Sutures can be fastened to suture anchors and to tissue using knots tied by the surgeon during a repair procedure, or using "knotless" devices and methods, where one or more anchors and one or more sutures can be connected and tensioned without the surgeon needing to tie knots during the surgery. Knotless anchoring is of particular utility for minimally invasive surgeries, such as endoscopic or arthroscopic repairs, where the surgeon remotely manipulates the suture at the surgical site using tools inserted through a small diameter cannula or endoscopic tube, which can make the knotting process difficult and tedious.

Additionally, it can be difficult to deliver and position the anchors at a desired angle and location relative to the tissue, such as by the anchors moving from an intended location and angular orientation because of the suture attached thereto being knotted, pulled, and/or tensioned during the surgery. Anchors not being desirably angled and located may result in anchors positioned at a compromised angle and location instead of a more desirable angle and location and/or may result in one or more failed attempts at anchor delivery before desired angle and location is achieved.

<CIT> describes an implant for correcting a deformity in or near a joint of a subject including an implant body having an internal lumen, a suture side hole or window extending through a wall of the implant body and providing access to the internal lumen through an exterior of the implant body, a tension assembly comprising a first bone anchor and a second bone anchor, wherein the first and second bone anchors are configured to be placed on opposite sides of the implant body, and an adjustable suture loop coupling the first bone anchor to the second bone anchor, wherein at least a portion of the at least one adjustable suture loop is positioned within the internal lumen of the implant body.

<CIT> describes devices for repairing meniscal tissue.

<CIT> describes a surgical implant system and method.

<CIT> describes a knotless suture construct. The construct is a "bridging knotless construct" that has a loop which is slidable and flexible and has an adjustable perimeter (length), a bridge (bridge region), a splice, a turning loop (eyelet), a fixed end connected to the bridge area and a tensioning limb. Tensioning the tensioning limb causes the construct to tighten against tissue (shortens the length of the flexible, slidable loop) and the splice holds the repair without knots.

Accordingly, there remains a need for improved tissue repair devices, systems, and methods.

In general, finger traps for collapsible suture loops are provided.

Embodiments of the invention are defined by the dependent claims.

The surgical device can have any number of variations. For example, the knot can be an overhand knot.

For another example, the tail of the suture can be configured to be pulled in a first direction toward the first anchor to tension the suture, and can be configured to be pulled in a second, different direction to tension the suture. In at least some embodiments, pulling the tail of the suture in the first direction can be configured to reduce a distance between the first and second anchors, and pulling the tail of the suture in the second direction can be configured to reduce the distance between the first and second anchors. In at least some embodiments, pulling the tail of the suture in the first direction can be configured to cause the suture to slide within the interior passage and through the knot, and pulling the tail of the suture in the second direction can be configured to cause the suture to slide within the interior passage and through the knot. In at least some embodiments, the suture can be slidable through the interior passage in only the first direction.

For yet another example, the second length can exit the interior passage before passing through the knot. For still another example, the first anchor can have a first hole through which the suture extends, and the second anchor can have a second hole through which the suture extends. For another example, the surgical device can include a second suture coupled to the second anchor and having the first suture looped therethrough so as to couple the suture to the second anchor. For still another example, the suture can be braided from a plurality of threads.

Embodiments of the surgical device of the present invention are illustrated in <FIG>. The surgical devices shown in <FIG> do not form part of the invention.

This invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:.

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 invention 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 invention.

Finger traps for collapsible suture loops are provided. In general, a suture coupled to an implant can be tensioned to facilitate desirable positioning of the implant relative to tissue in a patient's body. The suture can include a finger trap and a knot. In general, the finger trap is a hollow area of the suture through which the suture passes through itself and is configured to slide in a single direction when under tension. In an exemplary embodiment, the knot is located along a length of the suture that is closer than the finger trap to a tail of the suture that is being pulled to tension the suture. In this way, the knot can help guide the suture to slide through the finger trap in the single direction through which the suture is configured to freely slide through the finger trap regardless of the direction in which the suture tail is being pulled. The suture may thus be less likely to be damaged since it is prevented from sliding through the finger trap in a direction other than the single direction, and/or tensioning may be accomplished faster and/or easier since the suture tail can be pulled in any direction to tension the suture without a surgeon or other user first determining which is the single direction in which the suture should be pulled to properly slide through the finger trap.

In general, the implants discussed herein, also referred to herein as anchors, are configured to be implanted in a body of a patient. The implants are configured to couple to a suture and to be used in a tissue repair procedure, e.g., an arthroplasty at a joint such as the hip, knee, or shoulder, a meniscal repair procedure for repairing a meniscal tear at a knee, a rotator cuff repair procedure for repairing a torn rotator cuff at a shoulder, etc..

An implant can be absorbable or non-absorbable. An implant can be made from any of a variety of materials, e.g., Polyether ether ketone (PEEK), Polylactic acid or polylactide (PLA), BIOCRYL® RAPIDE®, stainless steel, etc. An implant can be formed by a variety of techniques, for example by an injection molding process such as overmolding or by a post-molding process such as post-molding machining. An implant can have any of a variety of sizes as appropriate for, e.g., use at a particular anatomical location and with a particular patient.

<FIG> illustrates one embodiment of an implant <NUM> configured to be implanted in a body of a patient to facilitate tissue repair. The implant <NUM> has an elongate, rectangular shape in this illustrated embodiment, but the implant <NUM> can have other shapes. The implant <NUM> has at least one passageway <NUM> formed therethrough that is configured to receive a suture <NUM> therethrough. In this illustrated embodiment, the implant <NUM> has two passageways <NUM>. Having a plurality of passageways <NUM> allows the suture <NUM> to be looped through the implant <NUM> as shown, for example, in <FIG> with the suture <NUM> passing in one direction through one of the passageways <NUM> and in an opposite direction through the other passageway <NUM> with a length <NUM> of the suture <NUM> extending between the passageways <NUM> on one side of the implant <NUM> and first and second tails <NUM>, <NUM> of the suture <NUM> extending from the other side of the implant <NUM>. The suture <NUM> in this illustrated embodiment is a single suture <NUM>, but the implant <NUM> and other implants discussed herein can be coupled to multiple sutures, e.g., with multiple sutures passing through the implant's at least one passageway.

The suture <NUM> can be any type of suture and can be made from any of a variety of materials, including natural materials and synthetic materials. Examples of materials for the suture <NUM> include polymers, such as polyglycolide, polypropylene, polyethylene terephthalate (PET), and polydioxanone, and fabrics, such as nylon and silk. The suture <NUM> can be bioabsorbable, partially bioabsorbable, or nonabsorbable, and can have a circular cross section or another cross section. In one embodiment, the suture <NUM> is partially bioabsorbable, comprising polyethylene as a nonabsorbable component, and polydioxanone as a bioabsorbable component.

The suture <NUM> can be formed from a single thread or from a plurality of threads. The plurality of threads can be coupled together to define a suture strand in any of a variety of ways, such as by being braided together. In an exemplary embodiment, the thread(s) that form the suture <NUM> are flexible to allow the suture <NUM> to be flexible, as in the illustrated embodiment. The threads that form the suture <NUM> can made from different materials, e.g., a first number of the threads being nylon and a second number of the threads being PET, or can all be made from the same material. A suture <NUM> formed from a plurality of threads can, in some embodiments, include a core around which the threads are arranged, such as by braiding. The core may provide the suture <NUM> with strength to help prevent the suture <NUM> from breaking, snapping, etc. The suture <NUM> can have any of a variety of sizes, such as a size in a range of about size #<NUM> to #<NUM>-<NUM>.

<FIG> shows another embodiment of an implant <NUM> that includes at least one passageway <NUM> therethrough, which is a single passageway <NUM> in this illustrated embodiment. <FIG> also shows a suture <NUM> extending through the passageway <NUM> by being looped therethrough to couple the suture <NUM> to the implant <NUM>.

<FIG> shows another embodiment of an implant <NUM> that includes at least one passageway <NUM> therethrough, which is a single passageway <NUM> in this illustrated embodiment. <FIG> also shows a suture <NUM> extending through the passageway <NUM>. The suture <NUM> has a knot <NUM> therein with a diameter greater than a diameter of the passageway <NUM> such that the knot <NUM> cannot be pulled or otherwise moved through the passageway <NUM>, thereby helping the suture <NUM> remain coupled to the implant <NUM>. In an embodiment in which an implant has a plurality of passageways, each of the passageways can have an associated suture extending therethrough with a knot therein.

<FIG> shows another embodiment of an implant <NUM> having a single suture <NUM> coupled thereto. The suture <NUM> in this illustrated embodiment is coupled to the implant <NUM> by having an end (or other portion) thereof attached thereto, such as by crimping, adhesion with an adhesive, being tied around the implant <NUM>, etc. If the implant <NUM> is coupled to a plurality of sutures, each of the sutures can be attached to the implant <NUM> in the same way (e.g., each attached thereto with adhesive, each tied around the implant, etc.) or in different ways (e.g., one suture adhered thereto with adhesive and another attached thereto by being tied there around, etc.).

Exemplary embodiments of implants are further described in <CIT> entitled "Meniscal Repair Devices, Systems, and Methods" filed October <NUM>, <NUM>.

Following delivery of an implant into a body of a patient, the suture(s) attached to the implant are tensioned to secure the implant in position relative to a target, e.g., a target tissue being repaired. The suture(s) being able to slide relative to the implant after the delivery of the implant into the patient's body facilitates the tensioning of the suture(s) and hence facilitates secure positioning of the implant within the patient's body to aid in proper healing.

<FIG> illustrate one technique for attaching a suture <NUM> to first and second implants <NUM>, <NUM> using a finger trap <NUM>. The finger trap <NUM> is an area of the suture <NUM> that is hollow and through which the suture <NUM> passes through itself, and when under tension is slidable uni-directionally in a first direction D1, and is locked from sliding in the other, opposite direction D2. The first implant <NUM> is coupled directly to the suture <NUM>, and the second implant <NUM> is coupled indirectly to the suture <NUM> with a second suture <NUM> that is looped through the suture <NUM>. After the implants <NUM>, <NUM> are positioned relative to a target tissue in a patient's body, the suture <NUM> can be tensioned by pulling on a tail 38t of the suture <NUM> in the first direction D1, as shown in <FIG>, which slides the suture <NUM> through the finger trap <NUM>. In some instances, the suture tail 38t may be tensioned by pulling thereon in the second direction D2 and/or in another direction other than the first direction D1 due to any number of factors such as space constraints at the surgical site, obscured visualization of the surgical site, a surgeon's angle of approach to the surgical site, etc. However, if the suture tail 38t is pulled in the second direction D2 and/or other direction other than the first direction D1 to tension the suture <NUM>, the suture <NUM> experiences stress that can cause any of one or more problems. For example, the suture <NUM> can break entirely such that the suture <NUM> cannot secure the implants <NUM>, <NUM> to the target tissue. For another example, individual threads forming the suture <NUM> can break without the entire suture <NUM> breaking, which may lead to complete breakage of the suture <NUM> at some future time and/or may result in one or both of the implants <NUM>, <NUM> not being properly positioned due to partial suture <NUM> failure. For yet another example, braided threads forming the suture <NUM> may become less tightly braided, which may result in decreasing the functional length of the finger trap <NUM> and in turn result in one or both of the implants <NUM>, <NUM> not being properly positioned due to the suture <NUM> being loosened. For still another example, the hollow suture area at the finger trap <NUM> can expand in diameter due to pulling in a direction other than the first direction D1, which may weaken the suture <NUM> at or near the finger trap <NUM> so as to increase the chance of future suture <NUM> breakage.

<FIG> illustrates another technique for attaching a suture <NUM> to first and second implants <NUM>, <NUM> using a finger trap <NUM>. The first implant <NUM> is coupled directly to the suture <NUM>, e.g., via a technique such as any of the techniques of <FIG>, and the second implant <NUM> is coupled indirectly to the suture <NUM> with a second suture <NUM> that is looped through the suture <NUM>. In other embodiments, the first and second implants <NUM>, <NUM> can be coupled to the suture <NUM> in other ways, e.g., both of the implants <NUM>, <NUM> being directly coupled to the suture <NUM>, both of the implants <NUM>, <NUM> being indirectly coupled to the suture <NUM>, or the first implant <NUM> being indirectly coupled to the suture <NUM> and the second implant <NUM> being directly coupled to the suture <NUM>. Also, a single suture <NUM> is coupled to the implants <NUM>, <NUM> in this illustrated embodiment, but as mentioned above, multiple sutures can be used.

The finger trap <NUM> is an area of the suture <NUM> that is hollow and through which the suture <NUM> passes through itself. The suture <NUM> in this illustrated embodiment when under tension is slidable uni-directionally in a first direction D3 through the finger trap <NUM> and is locked from sliding through the finger trap <NUM> in the other, opposite direction D4 because the tension collapses the finger trap <NUM> on the portion of the suture <NUM> passing therethrough. The suture <NUM> has a free end or tail 48t that extends from the finger trap <NUM>.

The suture <NUM> in this illustrated embodiment has a knot <NUM> formed therein. The knot <NUM> is located adjacent to the finger trap <NUM>, as shown in <FIG>, and is located on a side of the finger trap <NUM> from which the suture tail 48t extends. The knot <NUM> substantially abuts the finger trap <NUM> when adjacent thereto. A person skilled in the art will appreciate that although a small distance may exist between the knot <NUM> and the finger trap <NUM> such that the knot <NUM> does not abut the finger trap <NUM> so as to be in direct contact with the finger trap <NUM>, the knot <NUM> can nevertheless be considered to substantially abut the finger trap <NUM> due to any number of factors, such as manufacturing tolerance. As shown in <FIG>, the suture <NUM> has a first length extending from the first implant <NUM> toward the second anchor <NUM>. The first length of the suture <NUM> has the knot <NUM> and finger trap <NUM> formed therein, with the knot <NUM> being closer to the first anchor <NUM> than the finger trap <NUM> along the first length of the suture <NUM> and with the finger trap <NUM> being closer to the second anchor <NUM> than the knot <NUM> along the first length. The suture <NUM> also has a second length extending from the second implant <NUM> toward the first anchor <NUM> that passes through the finger trap <NUM>, e.g., passes through the hollow area of the suture <NUM>, and then passes through the knot <NUM> with the suture tail 48t extending from the knot <NUM>. The suture <NUM> also defines an adjustable loop <NUM> that includes partial portions of each of the suture's first and second lengths.

A partial portion of the first length of the suture <NUM> extends between the knot <NUM> and the first anchor <NUM>. This partial length of the suture <NUM> allows the suture <NUM> to extend through tissue with the first implant <NUM> on one side of the tissue and the knot <NUM> to be on or near the other side of the tissue, as discussed further below.

The suture <NUM> can be tensioned by pulling on the suture tail 48t to slide the suture <NUM> through the finger trap <NUM>. The suture <NUM> sliding through the finger trap <NUM> collapses the adjustable loop <NUM> and reduces a distance between the first and second anchors <NUM>, <NUM>. This tensioning may occur after the implants <NUM>, <NUM> are positioned relative to a target tissue in a patient's body to desirably position the implants <NUM>, <NUM> relative to the tissue, as discussed herein. The suture tail 48t may in some instances be pulled in the first direction D3, the first in which the suture <NUM> is configured to bi-directionally slide through the finger trap <NUM>. Pulling the suture <NUM> in the direction D3 of its uni-directional sliding will generally result in desirable movement and tensioning of the suture <NUM> without causing any damage to the suture <NUM>. In some instances, as mentioned above, the suture <NUM> may be tensioned by pulling on the suture tail 48t in the second direction D4 and/or in another direction other than the first direction D3 due to any number of factors. The knot <NUM> in the suture <NUM> is configured to reduce stress on the suture <NUM> and the finger trap <NUM> thereof when pulled through the finger trap <NUM> in a direction other than the first direction D3, thereby reducing chances of the suture <NUM> and the finger trap <NUM> thereof being damaged during the pulling of the suture tail 48t. The suture <NUM> and the finger trap <NUM> of <FIG> is thus less likely to be damaged than the suture <NUM> and the finger trap <NUM> of <FIG> which does not have a knot formed therein, and is easier to use than the suture <NUM> of <FIG> since the suture <NUM> of <FIG> can be pulled in any direction with minimal, if any, risk of damaging the suture <NUM> and the finger trap <NUM> thereof as the suture <NUM> slides through the finger trap <NUM>. In general, the knot <NUM> is configured to reduce stress on the suture <NUM> when pulled through the finger trap <NUM> by acting like a pulley. In response to the suture tail 48t being pulled, the suture <NUM> will first be pulled at the knot <NUM> and then at the finger trap <NUM>. In this way, the suture <NUM> may be directed through the finger trap <NUM> in the first direction D3 regardless of the direction in which the suture tail 48t is pulled. In other words, the knot <NUM> is configured to direct movement of the suture <NUM> through the finger trap <NUM> in the first direction D3, e.g., the suture's direction of uni-directional sliding. The knot's location along the suture <NUM> between the suture's free end 48t and the finger trap <NUM> facilitates this direction of suture movement through the finger trap <NUM>. The knot <NUM> is also configured to provide cinching force to the suture <NUM> in addition to cinching force already provided by the finger trip <NUM>, which may help hold the suture <NUM> in position post-tensioning.

<FIG> illustrates one embodiment of forming the construct of the suture <NUM> as shown in <FIG>. In this illustrated embodiment, the knot <NUM> is an overhand knot with the suture tail 48t passing through the knot <NUM>. In general, the overhand knot is a knot in which the free end 48t of the suture <NUM> is tied around itself. The suture <NUM> is thus tied around itself at a location between the finger trap <NUM> and the first anchor <NUM>. The overhand knot may be beneficial in surgical procedures due to its low profile, however, the knot <NUM> can have forms other than an overhand knot, such as a hitch knot or a bend knot. The knot <NUM> can be static (e.g., overhand half hitch), sliding (e.g., Duncan Loop), collapsing (e.g., cow hitch), etc..

The suture <NUM> in the illustrated embodiment of <FIG> includes a single knot <NUM>. In other embodiments, the suture <NUM> can include a plurality of knots <NUM> that form a stack or row of knots with a first knot <NUM> adjacent to the finger trap <NUM> similar to the knot <NUM> of <FIG> and with each of the one or more additional knots <NUM> being adjacent to the knot(s) on either side thereof along the suture's length.

The knot <NUM> in the illustrated embodiment of <FIG> is formed by the suture <NUM> itself. In other embodiments, another suture can be attached to the suture <NUM> to form the knot <NUM>, e.g., tied around the suture <NUM> to form the knot <NUM> thereon.

The implants coupled to at least one suture as described herein can be advanced through tissue in any of a variety of ways. For example, the implants and suture(s) can be delivered to a surgical site using one or more needles. The one or more needles can be configured to cut tissue (e.g., meniscus) to facilitate passage of the implant(s) associated therewith through the tissue since the implants may not be configured to cut tissue. An implant not being configured to cut tissue (e.g., the implant lacks a cutting surface) may help reduce chances of the implant inadvertently damaging tissue and/or other matter within the patient's body post-surgery.

In some embodiments, each of a plurality of implants coupled together with one or more sutures can be coupled to its own needle configured to advance its associated implant through tissue (e.g., meniscus in a meniscal repair procedure, rotator cuff tissue in a rotator cuff repair procedure, etc.) such that multiple needles are used to advance the implants through the tissue. Using multiple needles may require multiple incisions to be made in the patient, one incision for each needle, and may require an additional incision to facilitate the tying together of sutures threaded through tissue with the needles. In a meniscus repair procedure, for example, needles may be inserted through the sides of the knee instead of through the back of the knee in order to avoid possible damage to vital structures including veins and nerves at the back of the knee. In meniscus repair, use of multiple needles is generally referred to as an inside-out surgical technique. Exemplary embodiments of needles and use of multiple needles to deliver implants and sutures are further described in previously mentioned <CIT>.

In other embodiments, instead of using a plurality of needles to deliver a plurality of implants, each of a plurality of implants coupled together with one or more sutures can be coupled to a single needle configured to sequentially advance each of the implants through tissue (e.g., meniscus in a meniscal repair procedure, rotator cuff tissue in a rotator cuff repair procedure, etc.) such that only one needle is used to advance the implants through the tissue. Using a single needle may require only one incision to be made in the patient, which may provide any number of benefits over using multiple needles, such as improved cosmesis and less tissue trauma. In meniscus repair, use of a single needle is generally referred to as an all-inside surgical technique. Exemplary embodiments of single needles that can be used to deliver implants and sutures are further described in previously mentioned <CIT>.

A needle configured to deliver multiple implants can have a variety of sizes, shapes, and configurations. The needle can be made from any of a variety of materials, e.g., stainless steel, nitinol, etc. In an exemplary embodiment, the needle is a solid member and is flexible. The needle being solid may help provide structural stability to the needle. The needle being flexible may facilitate desired positioning of the needle relative to tissue through which it is desired to be advanced and/or may compensate for an angle of approach to the desired tissue not being ideal because the needle can be directed to tissue at another angle due to its flexibility. The needle, while flexible so as to allow flexing thereof has sufficient structural stability along its longitudinal length due to being solid and/or due to the material(s) from which the needle is made to allow the needle to be advanced longitudinally through tissue to deliver implant(s) therethrough. The needle can have a variety of sizes. In an exemplary embodiment, the needle has a maximum outer diameter of in a range of about <NUM> in. (<NUM>) to <NUM> in. (<NUM>), eg. , about <NUM> in. A distal tip of the needle can have a variety of configurations. In an exemplary embodiment, the distal tip of the needle can be sharp and configured to pierce through tissue, such as by being beveled or having a sharp triangular tip similar to a trocar tip. The needle having a sharp distal tip may facilitate penetration of the needle through tissue (e.g., meniscus, rotator cuff, etc.).

<FIG> illustrates one embodiment of a needle <NUM> configured to deliver a plurality of implants <NUM>, <NUM> coupled to a suture <NUM> (obscured in <FIG>) having a finger trap <NUM> and a knot <NUM> formed therein, such as the suture <NUM> of <FIG>. The implants <NUM>, <NUM> and the suture <NUM> can each have any of a variety of configurations, as discussed above. As also discussed above, the implants <NUM>, <NUM> can each be coupled to the suture <NUM> in any of a variety of ways. The needle <NUM> in this illustrated embodiment is flexible and has a sharp distal tip. <FIG> shows the needle <NUM> as part of a delivery system configured to deliver the implants <NUM>, <NUM>. The delivery system includes a movable handle <NUM>, a stationary handle <NUM>, a spacer <NUM> along which the movable handle <NUM> is configured to selectively slide proximally and distally, an actuator <NUM> in the form of a knob selectively slidable proximally and distally in a slot <NUM> formed in the movable handle <NUM>, a flexible tube <NUM> extending distally from the movable handle <NUM> and configured to slide in response to sliding movement of the actuator <NUM>, and an elongate shaft <NUM> extending distally from the stationary handle <NUM>.

<FIG> also shows first and second implants <NUM>, <NUM> coupled to the needle <NUM>. The first implant <NUM> is loaded on the needle <NUM> distal to the second implant <NUM> and is configured to be deployed from the needle <NUM> before the second implant <NUM> is deployed therefrom. The first and second implants <NUM>, <NUM> are each cannulated to allow the needle <NUM> to pass therethrough. A proximal end surface of the second implant <NUM> abuts a distal end surface of the tube <NUM>.

<FIG> illustrate one embodiment of use of the delivery system of <FIG> to deliver the implants <NUM>, <NUM> loaded thereon. <FIG> shows the delivery system with a distal end thereof (e.g., a distal end of the elongate shaft <NUM>) positioned adjacent tissue <NUM>. A distal end of the needle <NUM> can extend distally beyond the distal end of the shaft <NUM>, as shown in <FIG>, or the distal end of the needle <NUM> can be contained within an inner lumen of the elongate shaft <NUM> in which the needle <NUM> is slidably disposed.

<FIG> shows the needle <NUM> advanced through the tissue <NUM> with a distal tip of the needle <NUM> on a far side of the tissue <NUM>, the first implant <NUM> also on the far side of the tissue <NUM>, and the second implant <NUM> on a near side of the tissue <NUM> and still contained within the inner lumen of the elongate shaft <NUM> and having been pushed forward to keep its distance to the first implant <NUM>. The needle <NUM> and the first implant <NUM> have been advanced through the tissue <NUM> by moving the movable handle <NUM> distally toward and relative to the stationary handle <NUM>.

<FIG> shows the needle <NUM> retracted from the far side of the tissue <NUM> to the near side of the tissue <NUM> with the first implant <NUM> remaining on the far side of the tissue <NUM>. The needle <NUM> has been retracted back through the tissue <NUM> by moving the movable handle <NUM> proximally away from and relative to the stationary handle <NUM>.

<FIG> shows the second implant <NUM> having been advanced distally along the needle <NUM> by sliding the knob <NUM> distally in the slot <NUM> to slide the tube <NUM> distally and thereby push the second implant <NUM> distally. The tube <NUM> is now locked to the movable handle <NUM> (by detents, etc.), holding the second implant <NUM> in position on the needle <NUM> which is the initial position of the first implant <NUM>.

<FIG> shows the delivery system moved to another location relative to the tissue <NUM> with a distal end of the delivery system (e.g., the distal end of the elongate shaft <NUM>) positioned adjacent the tissue <NUM>. <FIG> shows the needle <NUM> advanced through the tissue <NUM> on the other side of the tissue <NUM> with the distal tip of the needle <NUM> on the far side of the tissue <NUM> and the second implant <NUM> also on the far side of the tissue <NUM>. The engaged tube <NUM> facilitates the advancement of the second implant <NUM> through the tissue <NUM> with the needle <NUM>. The needle <NUM>, the tube <NUM>, and the second implant <NUM> have been advanced through the tissue <NUM> by moving the movable handle <NUM> distally toward and relative to the stationary handle <NUM>. For clarity of illustration of the needle <NUM>, second implant <NUM>, and suture <NUM>, the tube <NUM> is shown in <FIG> in a distal, non-advanced position instead of its actual, advanced position with a distal end thereof abutting a proximal end of the second implant <NUM>.

<FIG> shows the needle <NUM> retracted from the far side of the tissue <NUM> to the near side of the tissue <NUM> with the second implant <NUM> remaining on the far side of the tissue <NUM> and with the suture <NUM> extending between the first and second implants <NUM>, <NUM>. The needle <NUM> has been retracted back through the tissue <NUM> by moving the movable handle <NUM> proximally away from and relative to the stationary handle <NUM>. Other methods for inserting and deploying first and second implants include, for example, OmniSpan® and TrueSpan™ instrumentation available from DePuy Mitek of Raynham, MA.

<FIG> shows the first and second implants <NUM>, <NUM> having been toggled into position against the tissue <NUM> by tensioning the suture <NUM>, e.g., by pulling the suture tail 122t to slide the suture <NUM> through the finger trap <NUM> and knot <NUM> and collapse an adjustable loop of the suture <NUM>. The suture's finger trap <NUM> and knot <NUM> are located outside of the tissue <NUM> on the near side thereof in <FIG> with the suture's tail 122t extending from the knot <NUM> so as to be accessible for use in tensioning, but the finger trap <NUM> and/or knot <NUM> may be partially or fully within the tissue <NUM> with the suture's tail 122t extending out of the tissue <NUM> before and after tensioning. The suture tail 122t can be trimmed after desired tensioning to allow removal of excess material from the patient's body. The tail 122t can be trimmed as close as possible to the knot <NUM> to reduce an amount of suture tail 122t remaining in the patient's body, which may minimize damage to the cartilage and/or other material adjacent thereto by rubbing thereagainst during post-surgery movement of the patient since the tail 122t will be minimally present, if present at all.

Claim 1:
A surgical device, comprising:
a first implantable anchor (<NUM>);
a second implantable anchor (<NUM>); and
a suture (<NUM>) coupled to the first and second anchors (<NUM>, <NUM>), the suture having a first length extending from the first anchor (<NUM>) toward the second anchor (<NUM>) and having a second length extending from the second anchor (<NUM>) toward the first anchor (<NUM>), the first length having a knot (<NUM>) formed therein and the first length having an interior collapsible passage (<NUM>), and the second length passing through the interior collapsible passage (<NUM>) formed in the first length and then passing through the knot (<NUM>) with a tail of the suture extending from the knot (<NUM>).