Patent Document

CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional of U.S. patent application Ser. No. 13/278,341 filed on Oct. 21, 2011, which is a continuation of U.S. patent application No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3, 2012; which is a continuation-in-part of: (1.) U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009; (2.) U.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006, now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010; (3.) U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851 issued on Mar. 22, 2011; (4.) U.S. patent application Ser. No. 12/014,340 filed on Jan. 15, 2008, now U.S. Pat. No. 7,905,904 issued on Mar. 15, 2011; (5.) U.S. patent application Ser. No. 11/935,681 filed on Nov. 6, 2007, now U.S. Pat. No. 7,905,903 issued on Mar. 15, 2011; (6.) U.S. patent application Ser. No. 11/869,440 filed on Oct. 9, 2007, now U.S. Pat. No. 7,857,830 issued on Dec. 28, 2010; (7.) U.S. patent application Ser. No. 11/784,821 filed on Apr. 10, 2007; (8.) U.S. patent application Ser. No. 11/347,661 filed on Feb. 3, 2006, now U.S. Pat. No. 7,749,350 issued on Jul. 6, 2010; (9.) U.S. patent application Ser. No. 11/347,662 filed on Feb. 3, 2006, now abandoned. 
         [0002]    This application is also a continuation-in-part of U.S. patent application Ser. No. 13/412,105 filed on Mar. 5, 2012, which is a continuation-in-part of: (1.) U.S. patent application Ser. No. 12/196,405 filed on Aug. 22, 2008, now U.S. Pat. No. 8,128,658 issued on Mar. 6, 2012; (2.) U.S. patent application Ser. No. 12/196,407, filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20, 2012; and (3.) U.S. patent application Ser. No. 12/196,410, filed on Aug. 22, 2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012. 
         [0003]    The disclosures of the above applications are incorporated herein by reference. 
     
    
     FIELD 
       [0004]    The present disclosure relates to method of coupling soft tissue and, more particularly, to a method of coupling soft tissue to a bone. 
       BACKGROUND 
       [0005]    The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
         [0006]    It is commonplace in arthroscopic procedures to employ sutures and anchors to secure soft tissues to bone. Despite their widespread use, several improvements in the use of sutures and suture anchors may be made. For example, the procedure of tying knots may be very time consuming, thereby increasing the cost of the procedure and limiting the capacity of the surgeon. Furthermore, the strength of the repair may be limited by the strength of the knot. This latter drawback may be of particular significance if the knot is tied improperly as the strength of the knot in such situations may be significantly lower than the tensile strength of the suture material. 
         [0007]    To improve on these uses, sutures having a single preformed loop have been provided.  FIG. 1  represents a prior art suture construction. As shown, one end of the suture is passed through a passage defined in the suture itself. The application of tension to the ends of the suture pulls a portion of the suture through the passage, causing a loop formed in the suture to close. Relaxation of the system, however may allow a portion of the suture to translate back through the passage, thus relieving the desired tension. 
         [0008]    It is an object of the present teachings to provide an alternative device for anchoring sutures to bone and soft tissue. The device, which is relatively simple in design and structure, is highly effective for its intended purpose. 
       SUMMARY 
       [0009]    This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features. 
         [0010]    The present teachings provide for a method for coupling soft tissue to bone. The method includes the following: forming a first bore in a bone; forming a second bore in the bone; positioning a first anchor in the first bore, the first anchor having a first self-locking adjustable suture construct extending therefrom, the first construct including a first adjustable loop, a second adjustable loop, and a pair of first ends; positioning a second anchor in the second bore, the second anchor having a second self-locking adjustable suture construct extending therefrom, the second construct including a third adjustable loop, and a second end; positioning the first adjustable loop relative to the soft tissue; positioning the second adjustable loop about the third adjustable loop; and tensioning the pair of first ends and the second end to pull the first adjustable loop against the soft tissue, couple the second adjustable loop to the third adjustable loop, pull the second adjustable loop against the soft tissue, and pull the third adjustable loop against the soft tissue to thereby couple the soft tissue to the bone. 
         [0011]    The present teachings also provide for a method for coupling soft tissue to bone that includes the following: inserting a first anchor in a first bone bore, the first anchor having a first self-locking adjustable suture construct extending therefrom, the first construct including a first adjustable loop, a second adjustable loop, and a pair of first ends; inserting a second anchor in a second bone bore, the second anchor having a second self-locking adjustable suture construct extending therefrom, the second construct including a third adjustable loop, and a second end; positioning the first adjustable loop relative to the soft tissue; compressing a first coupling element connected to the first adjustable loop against the soft tissue by tensioning the pair of first ends; and connecting the second adjustable loop to the third adjustable loop with a second coupling element and compressing both the second adjustable loop and the first adjustable loop against the soft tissue by tensioning the pair of first ends and the second end. 
         [0012]    The present teachings further provide for a method for coupling soft tissue to bone including: positioning a first anchor in a first bone bore, the first anchor having a first self-locking adjustable suture construct extending therefrom, the first construct including a first adjustable loop, a second adjustable loop, and a pair of first ends; positioning a second anchor in a second bone bore, the second anchor having a second self-locking adjustable suture construct extending therefrom, the second construct including at least a third adjustable loop, and at least one second end; positioning the first adjustable loop about a first portion of the soft tissue; collapsing a first coupling element connected to the first adjustable loop against the soft tissue by tensioning the pair of first ends; collapsing a second coupling element connected to the third adjustable loop against the second adjustable loop to couple the second adjustable loop to the third adjustable loop by tensioning the second end; and compressing the second adjustable loop and the third adjustable loop against the soft tissue by tensioning both the pair of first ends and the second end. 
         [0013]    Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     
       DRAWINGS 
         [0014]    The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way. 
           [0015]      FIG. 1  represents a prior art suture configuration; 
           [0016]      FIGS. 2A and 2B  represent suture constructions according to the teachings; 
           [0017]      FIG. 3  represents the formation of the suture configuration shown in  FIG. 2A ; 
           [0018]      FIGS. 4A and 4B  represent alternate suture configurations; 
           [0019]      FIGS. 5-7  represent further alternate suture configurations; 
           [0020]      FIG. 8  represents the suture construction according to  FIG. 5  coupled to a bone engaging fastener; 
           [0021]      FIGS. 9-11B  represent the coupling of the suture construction according to  FIG. 5  to a bone screw; 
           [0022]      FIGS. 12A-12E  represent the coupling of a soft tissue to an ACL replacement in a femoral/humeral reconstruction; 
           [0023]      FIGS. 13A-13D  represent a close-up view of the suture shown in  FIGS. 1-11B ; 
           [0024]      FIGS. 14A and 14B  represent the coupling of the suture construction of  FIG. 2A  and  FIG. 4  to bone; 
           [0025]      FIGS. 15A-15G  represent the coupling of soft tissue to a bone according to the present teachings; 
           [0026]      FIGS. 16A-16D  represent the coupling of soft tissue to a bone using alternate teachings; 
           [0027]      FIGS. 17A-17E  represent the coupling of soft tissue to a bone using alternate teachings; 
           [0028]      FIGS. 18A-18C  represent the coupling of soft tissue to a bone using multiple collapsible loop structures; 
           [0029]      FIGS. 19A-19C  represent the coupling of soft tissue to a bone using yet alternate teachings; 
           [0030]      FIGS. 20A and 20B  represent a meniscal repair according to the present teachings; 
           [0031]      FIG. 21  represents an insertion tool with associated fastener and soft tissue anchor; 
           [0032]      FIG. 22  represents an insertion sleeve associated with the tool shown in  FIG. 21 ; 
           [0033]      FIGS. 23-31  represent the repair of a rotator cuff using a tool shown in  FIG. 21 ; 
           [0034]      FIGS. 32-38  represent alternate methods for tying a suture anchor to the fastener; 
           [0035]      FIG. 39  represents the suture anchor coupled to a two-piece fastener; and 
           [0036]      FIGS. 40-44  represent an alternate system and method of coupling soft tissue to the bone. 
       
    
    
     DETAILED DESCRIPTION 
       [0037]    The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. 
         [0038]      FIG. 2A  represents a suture construction  20  according to the present teachings. Shown is a suture  22  having a first end  24  and a second end  26 . The suture  22  is formed of a braided body  28  that defines a longitudinally formed hollow passage  30  therein. First and second apertures  32  and  34  are defined in the braided body  28  at first and second locations of the longitudinally formed passage  30 . 
         [0039]    Briefly referring to  FIG. 3 , a first end  24  of the suture  22  is passed through the first aperture  32  and through longitudinal passage  30  formed by a passage portion and out the second aperture  34 . The second end  26  is passed through the second aperture  34 , through the passage  30  and out the first aperture  32 . This forms two loops  46  and  46 ′. As seen in  FIG. 2B , the relationship of the first and second apertures  32  and  34  with respect to the first and second ends  24  and  26  can be modified so as to allow a bow-tie suture construction  36 . As described below, the longitudinal and parallel placement of first and second suture portions  38  and  40  of the suture  22  within the longitudinal passage  30  resists the reverse relative movement of the first and second portions  38  and  40  of the suture once it is tightened. 
         [0040]    The first and second apertures are formed during the braiding process as loose portions between pairs of fibers defining the suture. As further described below, the first and second ends  24  and  26  can be passed through the longitudinal passage  30  multiple times. It is envisioned that either a single or multiple apertures can be formed at the ends of the longitudinally formed passage. 
         [0041]    As best seen in  FIGS. 4A and 4B , a portion of the braided body  28  of the suture defining the longitudinal passage  30  can be braided so as to have a diameter larger than the diameter of the first and second ends  24  and  26 . Additionally shown are first through fourth apertures  32 ,  34 ,  42 , and  44 . These apertures can be formed in the braiding process or can be formed during the construction process. In this regard, the apertures  32 ,  34 ,  42 , and  44  are defined between adjacent fibers in the braided body  28 . As shown in  FIG. 4B , and described below, it is envisioned the sutures can be passed through other biomedically compatible structures. 
         [0042]      FIGS. 5-7  represent alternate constructions wherein a plurality of loops  46   a - d  are formed by passing the first and second ends  24  and  26  through the longitudinal passage  30  multiple times. The first and second ends  24  and  26  can be passed through multiple or single apertures defined at the ends of the longitudinal passage  30 . The tensioning of the ends  24  and  26  cause relative translation of the sides of the suture with respect to each other. 
         [0043]    Upon applying tension to the first and second ends  24  and  26  of the suture  22 , the size of the loops  46   a - d  is reduced to a desired size or load. 
         [0044]    At this point, additional tension causes the body of the suture defining the longitudinal passage  30  to constrict about the parallel portions of the suture within the longitudinal passage  30 . This constriction reduces the diameter of the longitudinal passage  30 , thus forming a mechanical interface between the exterior surfaces of the first and second parallel portions as well as the interior surface of the longitudinal passage  30 . 
         [0045]    As seen in  FIGS. 8-11 , the suture construction can be coupled to various biocompatible hardware. In this regard, the suture construction  20  can be coupled to an aperture  52  of the bone engaging fastener  54 . Additionally, it is envisioned that soft tissue or bone engaging members  56  can be fastened to one or two loops  46 . After fixing the bone engaging fastener  54 , the members  56  can be used to repair, for instance, a meniscal tear. The first and second ends  24 ,  26  are then pulled, setting the tension on the loops  46 , thus pulling the meniscus into place. Additionally, upon application of tension, the longitudinal passage  30  is constricted, thus preventing the relaxation of the tension caused by relative movement of the first and second parallel portions  38 ,  40 , within the longitudinal passage  30 . 
         [0046]    As seen in  FIGS. 9-11B , the loops  46  can be used to fasten the suture construction  20  to multiple types of prosthetic devices. As described further below, the suture  22  can further be used to repair and couple soft tissues in an anatomically desired position. Further, retraction of the first and second ends allows a physician to adjust the tension on the loops between the prosthetic devices. 
         [0047]      FIG. 11   b  represents the coupling of the suture construction according to  FIG. 2B  with a bone fastening member. Coupled to a pair of loops  46  and  46 ′ are tissue fastening members  56 . The application of tension to either the first or second end  24  or  26  will tighten the loops  46  or  46 ′ separately. 
         [0048]      FIGS. 12A-12E  represent potential uses of the suture constructions  20  in  FIGS. 2A-7  in an ACL repair. As can be seen in  FIG. 12A , the longitudinal passage portion  30  of suture construction  20  can be first coupled to a fixation member or fastener  60 . The fixation member  60  can have a first profile which allows insertion of the fixation member  60  through the tunnel and a second profile which allows engagement with a positive locking surface upon rotation. The longitudinal passage portion  30  of the suture construction  20 , fixation member  60 , loops  46  and ends  24 ,  26  can then be passed through a femoral and tibial tunnel  62 . The fixation member  60  is positioned or coupled to the femur. At this point, a natural or artificial ACL  64  can be passed through a loop or loops  46  formed in the suture construction  20 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46 , thus pulling the ACL  64  into the tunnel. In this regard, the first and second ends are pulled through the femoral and tibial tunnel, thus constricting the loops  46  about the ACL  64  (see  FIG. 12B ). 
         [0049]    As shown, the suture construction  20  allows for the application of force along an axis  61  defining the femoral tunnel. Specifically, the orientation of the suture construction  20  and, more specifically, the orientation of the longitudinal passage portion  30 , the loops  46 , and ends  24 ,  26  allow for tension to be applied to the construction  20  without applying non-seating forces to the fixation member  60 . As an example, should the loops  24 ,  26  be positioned at the fixation member  60 , application of forces to the ends  24 ,  26  may reduce the seating force applied by the fixation member  60  onto the bone. 
         [0050]    As best seen in  FIG. 12C , the body portion  28  and parallel portions  38 ,  40  of the suture construction  20  remain disposed within to the fixation member  60 . Further tension of the first ends draws the ACL  64  up through the tibial component into the femoral component. In this way, suture ends can be used to apply appropriate tension onto the ACL  64  component. The ACL  64  would be fixed to the tibial component using a plug or screw as is known. 
         [0051]    After feeding the ACL  64  through the loops  46 , tensioning of the ends allows engagement of the ACL with bearing surfaces defined on the loops. The tensioning pulls the ACL  64  through a femoral and tibial tunnel. The ACL  64  could be further coupled to the femur using a transverse pin or plug. As shown in  FIG. 12E , once the ACL is fastened to the tibia, further tensioning can be applied to the first and second ends  24 ,  26  placing a desired predetermined load on the ACL. This tension can be measured using a force gauge. This load is maintained by the suture configuration. It is equally envisioned that the fixation member  60  can be placed on the tibial component  66  and the ACL pulled into the tunnel through the femur. Further, it is envisioned that bone cement or biological materials may be inserted into the tunnel  62 . 
         [0052]      FIGS. 13A-13D  represent a close-up of a portion of the suture  20 . As can be seen, the portion of the suture defining the longitudinal passage  30  has a diameter d 1  which is larger than the diameter d 2  of the ends  24  and  26 . The first aperture  32  is formed between a pair of fiber members. As can be seen, the apertures  32 ,  34  can be formed between two adjacent fiber pairs  68 ,  70 . Further, various shapes can be braided onto a surface of the longitudinal passage  30 . 
         [0053]    The sutures are typically braided of from 8 to 16 fibers. These fibers are made of nylon or other biocompatible material. It is envisioned that the suture  22  can be formed of multiple type of biocompatible fibers having multiple coefficients of friction or size. Further, the braiding can be accomplished so that different portions of the exterior surface of the suture can have different coefficients of friction or mechanical properties. The placement of a carrier fiber having a particular surface property can be modified along the length of the suture so as to place it at varying locations within the braided constructions. 
         [0054]      FIGS. 14A and 14B  represent the coupling of suture construction  22  of  FIG. 2A  and  FIG. 4  to a bone. The longitudinal passage  30  is coupled to a fixation member  60  which can be disposed within an aperture formed in the bone. The fixation member  60  can be, for example, a staple or a bone engaging screw. After coupling the suture construction  22  to the bone, loops  46  and  47  and ends  24  and  26  are readily accessible by the physician. The application of tension to the ends  24  and/or  26  causes the loops  46  and  47  to constrict. The loops  46  and  47  can be used to couple two or more portions of the anatomy. In this regard, the loops can be used to couple bone to bone or soft tissue to bone. 
         [0055]      FIGS. 15A-15G  represent the coupling of soft tissue  80  to bone. As shown in  FIGS. 15A and 15B , the suture construction  22  is disposed about a portion of the soft tissue  80 . Alternatively, an aperture or hole  84  can be formed in the soft tissue  80 . A portion of the suture construction  22 , for example, a loop  46  or loops  46 ,  47  or ends  24  and  26  can be threaded or pulled through the aperture  84 . As seen in  FIG. 15B , a single loop  46  of suture can be coupled to the fastener  60 . This single loop  46  can be disposed over or around the soft tissue  80 . 
         [0056]    As shown in  FIG. 15C , one loop  46  can have a fastening element  70  coupled thereto. This fastener element  70  can take the form of a loop of suture having a knot  72 . This fastening element  70  along with the loop  46  and one or more strands  24  can be passed through the aperture  84  formed in the soft tissue  80 . 
         [0057]      FIG. 15D  shows the second loop  47  can be passed around the soft tissue and coupled to the fastening element  70 . The first and second loops  46  and  47  are coupled together about the soft tissue  80 , and optionally can be positioned about the knot  72 . 
         [0058]    As shown in  FIG. 15E , the first loop  46  and first end  24  can be passed through an aperture  84  of the soft tissue  80 . Coupled to the first loop  46  is a fastener  70  in the form of a suture having a knot  72 . The second loop  47  can be passed through the suture  70  and the knot  72  so as to form a pair of locking loops  73  (see  FIG. 15F ).  FIG. 15G  shows that tension can be applied to the first and second ends  24  and  26  of the suture  22  to constrict the suture  22  about the soft tissue  80 . In this regard, the first and second loops  46  and  47  are tightened to constrict about and fix the soft tissue  80  to the bone. 
         [0059]    As seen in  FIG. 16A , the construction of  FIGS. 14A and 14B  can be modified so as to place a pair of collapsible fabric tubes  74  and  76  about a portion of the suture  22 . In this regard, collapsible tubes  74  and  76  can be coupled to the first and second suture loops  46  and  47 . It is also envisioned several collapsible tubes can be coupled to a single loop  46  or the suture ends  26 ,  27 . 
         [0060]    The collapsible tubes  74  and  76  can be either threaded onto ( 76 ) or disposed about a loop  75  formed in the suture loop  46 . As seen in  FIG. 16B , the first collapsible tube  76  can be fed through the loop  75 . When tension is applied to the second end  26  of the sutures  47 , the first loop  46  constricts about the second loop causing the collapse of the first collapsible tube  74 . As shown in  FIG. 16D , tension can be applied to the first suture end  24  causing the second loop  47  to constrict causing the collapse of the second collapsible tube  76  and the subsequent locking of the soft tissue  80  to the bone. 
         [0061]      FIGS. 17A-17E  represent an alternate method for coupling soft tissue  80  to a bone using the construction of  FIGS. 14A and 14B . As shown in  FIG. 17A , the first loop  46  and first suture end  24  are passed through an aperture  84  formed in the soft tissue  80 . The second loop  47  is passed through the first loop  46 . 
         [0062]    The second loop  47  is then doubled back over the first loop  46  causing a pair of intermediate loops  77 . As shown in  FIG. 17D , a locking member  70 , soft or hard, can then be passed through the pair of intermediate loops  77  or a portion of the first loop  75  to lock the first and second loops  46  and  47  together. As shown in  FIG. 17E , tension applied to the suture ends  26 ,  27  tighten the loops  46  and  47  about the locking member  70 . The soft tissue  80  is also fixed to the bone. 
         [0063]      FIGS. 18A-18C  represent alternate suture constructions  22  which are used to couple soft tissue  80  and  81  to bone. Disposed about the first and second loops  46  and  47  are collapsible tubes  74  and  76 . The tubes  74  and  76  which can be, for example, fabric or polymer, can either be directly disposed about the suture  22  of the first and second loops  46  and  47 , or can be coupled to the suture loops  46  and  47  using a separate loop member  81 . 
         [0064]    As shown in  FIG. 18C , the suture construction  22  shown in  FIGS. 18A  or  18 B, the collapsible tubes  74  and  76  are passed through the apertures  84  formed in the soft tissue  80 . The application of tension to the ends  26  and  27  causes the soft tissue  80  to be drawn against the bone and cause compressive forces to be applied to the collapsible tubes  74  and  76 . By tightening the suture which passes through the passage  30 , the soft tissue  80  is coupled to the bone without the use of knots. 
         [0065]    As can be seen in  FIGS. 19A-19C , several fixation members  60  and  60 ′ can be coupled to the suture construction  22  to fasten soft tissue  80  to bone. As seen in  FIG. 19A , the collapsible tube  74  can be coupled to a first loop  46  while the second loop  47  can be used to couple the first suture  22  to the second fastener  60 ′. In this regard, they are coupled using a collapsible tube  76  of the second suture  22 ′, thus allowing downward force along the entire length between the fasteners, thus providing bridge fixation as well as point fixation. 
         [0066]    As seen in  FIG. 19B , tension of the ends  24  and  26  of the first suture  22  draws the second loop  47  into the fixation member  60 ′. The second loop  47  of the first suture  22  is then coupled to the collapsed tube  76 . This couples the first and second fasteners together and applies the downward force. 
         [0067]    As seen in  FIG. 19C , the second loop  47  of the first suture  22  can be passed through a second aperture  86  in the soft tissue  80 . A second loop  47  is then coupled to the collapsible tube  76  associated with the second suture  22 ′. The collapsed tube  76  of the second suture  22 ′ functions to fix the suture  22 ′ to the fixation member  60 ′. It is envisioned the collapsed tube  76  can be found within a bore defined in the bone or the fastener  60 . 
         [0068]      FIGS. 20A and 20B  represent the use of a suture construction  22  to repair a meniscus. Fasteners  82  are coupled to first and second loops  46  and  47 . After the fixation member  60  is coupled to bone or soft tissue, the first loop  46  is passed through a first aperture  84  in a first portion of the meniscus. The first loop and collapsible tube  74  is then passed through a second aperture  86  and a second portion of the meniscus. The second loop  47  and second collapsible tube  76  are similarly passed through the meniscus. Tension is applied to the first and second ends  24  and  26  of the suture  22  to pull the meniscus together. As seen in  FIG. 20B , a first and second collapsible tube  74  and  76  are constricted so as to couple the suture to the meniscus. 
         [0069]      FIG. 21  represents a tool  100  with associated fastener  102  and soft tissue anchor  104 . The tool  100  has a handle portion  106  which releasably engages the fastener  102 . Associated with the handle portion  106  is a hollow longitudinal suture  103  which accepts a soft tissue anchor  104 . Disposed at a distal end  110  of the hollow longitudinal portion  108  is a slot having a portion of the soft tissue anchor  104  disposed therethrough. The distal end  110  is further configured to support the fastener  102  for insertion into a bore defined within bone  112 . 
         [0070]      FIG. 22  represents an insertion guide  115  having a handle portion  114  and a curved longitudinal guide tube  116 . The longitudinal guide tube  116  and handle portion  114  slidably accept the fastener  102  and soft tissue anchor  104 . The curved longitudinal tube  116  and handle portion  112  define a slot  118  which also slidably accepts the suture  103  of soft tissue anchor  104 . 
         [0071]      FIGS. 23-38  generally depict the repair of labral tissue of a glenoid. While the repair shown generally relates to a specific anatomical injury, it is envisioned the teachings herein can be applied to other anatomical regions which require the coupling of soft tissue to bone. For example, a meniscal repair in a knee may be performed using similar techniques. As shown in  FIG. 23 , access to the region of the injury is made through a tube  120 . At this point, a collapsible tube  122  having an extended portion  124  is threaded through tube  120  into close proximity of the soft tissue  126  to be coupled to bone. A suture grabber  128  such as a speed pass by Biomet Sports Medicine is used to pierce the soft tissue  126  and to grab the extended portion  124  of the collapsible tube  122 . This extended portion  124  is then pulled through the soft tissue  126 . 
         [0072]    As shown in  FIG. 24 , the extended portion  124  of the collapsible tube  122  is fed back out the access tube  120  and clamped with clamp  129  so as to prevent inadvertent translation with respect to the tube. As shown in  FIG. 25 , the insertion sleeve  115  is placed through the access tube  120 . The collapsible tube  122  is placed through the slot  118  defined in the handle portion  114  and longitudinal guide tube  116 . 
         [0073]      FIG. 26  shows a drill  130  having a flexible drive shaft  132  and a bone cutting drill bit  134 . The drill bit  134  is placed through the guide tube  116  to form a bore  136  in bone at a location adjacent to a soft tissue repair. It is envisioned the bore  136  can be placed under or adjacent the soft tissue repair. 
         [0074]    After the bore  136  has been formed in the bone, the tool  100 , fastener  102 , and associated soft tissue anchor  104  are placed through the insertion guide  115 . As shown in  FIG. 28 , the fastener is inserted into the bore  136 . It is envisioned the fastener  102  can be a two-part fastener having a first insertion portion  140  and a locking portion  142 . The locking portion  142  can have a plurality of expandable bone engaging members  144 . 
         [0075]    As seen in  FIG. 30 , the pair of sutures  146  can be pulled through the soft tissue  126 . The sutures  146  can be coupled together using a suture construction shown in  FIGS. 1A  or  1 B. In this regard, the suture  146  can be looped through an integrally formed collapsible member or tube  148  which can be used to fix the suture construction with respect to either the insert or locking portion  140 ,  142  of the fastener. 
         [0076]    As shown in  FIG. 31 , when tension is applied to the suture  146  through the tool  100 , a collapsible portion  150  of the collapsible tube engages the soft tissue  126 . As seen in  FIGS. 32-33B , once the collapsible portion  150  of the collapsible tube is set, the tool  100  can be removed from the insertion guide  115 . At this point, the end of the longitudinal tube can be removed, or can be tied to the suture  146 . 
         [0077]      FIGS. 34-36  represent an alternate method for coupling a suture construction  104  to the fastener  102 . Shown is a fastener  102  being passed through the loop of the suture. In this regard, the fastener  102  is passed through the loop of the suture prior to insertion of the fastener  102  within the bore  136  in the bone. After removal of the tool  100 , tension is applied to the ends of the suture to constrict the collapsible portion  150  of the collapsible tube. This tensioning pulls the soft tissue  146  into a position with respect to the fastener  102 . 
         [0078]    As shown in  FIGS. 37 and 38 , the fastener  102  can have an associated integral loop  120 . The integral loop  120  can be a suture or can be an integral polymer construction. The compressible tube  122  can be threaded through the integral loop  120 . Application of tension onto the suture causes the collapsible portion  150  of the collapsible tube to bear against the integral loop  120  and the soft tissue. It is envisioned the integral loop can be elastically deformable or can be fixed with respect to the fastener. 
         [0079]      FIG. 39  represents a suture construction coupled to a two-piece fastener  102 . The suture construction  104  can be threaded through the aperture formed within the first or second portions of the fastener  102 . As shown, an integrally formed collapsible tube portion  148  can be disclosed within the aperture of the fastener. Upon application of tension onto the suture, the tension will cause the collapse of this second collapsible tube portion  148 , thus locking the suture to the fastener body  102 . 
         [0080]      FIGS. 40-44  represent an alternative system and method of coupling soft tissue to bone. By way of non-limiting example, a fastener  102  can be coupled to the bone as described above and shown in  FIGS. 23-30 . Subsequent to this, the collapsible portion  150  of the tube  104  can be passed through the soft tissue  126 . 
         [0081]    As best seen in  FIGS. 40-42 , a drive tool  160  is used to form a soft tissue engagement site  162  in a bone structure. The tool  160  has a drive (not shown) which rotates a bone cutting bit  164 . The bone cutting bit  164  has a first portion  166  configured to drill a hole  167  through cortical bone and a threaded second portion  168 . The threaded second portion  168  is configured to cut threads in the cortical  169  and cancellous bone  171  structures. This is accomplished by advancing the cutting bit  164  into the bone at a predetermined rate while rotating the bit at a predetermined speed. As shown in  FIG. 41 , after the second portion  168  has entered the cancellous bone  171 , the bit is rotated while keeping the rotating tool  160  in a substantially stationary position. The thread cutting threads of the second portion  168  then displace cancellous bone  171 , forming the cavity  162 . The bit is removed by rotating the thread cutting threads through the threads formed in the cortical bone  169 . 
         [0082]    As shown in  FIG. 43 , the collapsible tube  104  of suture anchor is passed through passage  167  and into the cavity  162 . In this regard, an insertion tool  173  can be used to insert the collapsible tube  104  into the cavity  162 . As shown in  FIG. 44 , tension is applied to the end  172  of the suture anchor, thus causing the collapsible portion  104  of the anchor. 
         [0083]    The description of the invention is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. For example, any of the above mentioned surgical procedures is applicable to repair of other body portions. For example, the procedures can be equally applied to the repair of wrists, elbows, ankles, and meniscal repair. The suture loops can be passed through bores formed in soft or hard tissue. It is equally envisioned that the loops can be passed through or formed around an aperture or apertures formed in prosthetic devices e.g. humeral, femoral or tibial stems. Further, the suture material and collapsible tubes can be formed of resorbable material. Such variations are not to be regarded as a departure from the spirit and scope of the invention.

Technology Category: 1