Method of securing body tissue

US 20010041916A1
Filed: 02/21/2001
Published: 11/15/2001
Est. Priority Date: 05/03/2000
Status: Active Grant

First Claim

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1. A method of securing first body tissue with second body tissue, said method comprising the steps of providing a plurality of anchors with a suture extending between the anchors, moving a first anchor of the plurality of anchors along a first path into the second body tissue, moving a second anchor of the plurality of anchors along a second path into the second body tissue, tensioning at least a portion of the suture extending between the first and second anchors by moving the second anchor along at least a portion of the second path which extends transverse to the first path, and transmitting force through the suture to the first body tissue.

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Abstract

To secure a first body tissue with a second body tissue, a first anchor is moved along a first path through the first body tissue into the second body tissue. A second anchor is moved along a second path through the first body tissue into the second body tissue. A suture extending between the anchors may be tightened by moving the second anchor along a path which extends transverse to the path of the first anchor. The suture which extends between the anchors may have free ends which are connected with a suture retainer. The free ends of the suture may be interconnected either before or after the anchors are moved along the first and second paths. Alternatively, the suture may be a continuous loop which extends between the two anchors. A guide assembly may be provided to guide movement of the anchors along the two paths. The paths along which the anchors move may intersect so that the anchors may be interconnected at the intersection between the two paths.

367 Citations

206 Claims

1. A method of securing first body tissue with second body tissue, said method comprising the steps of providing a plurality of anchors with a suture extending between the anchors, moving a first anchor of the plurality of anchors along a first path into the second body tissue, moving a second anchor of the plurality of anchors along a second path into the second body tissue, tensioning at least a portion of the suture extending between the first and second anchors by moving the second anchor along at least a portion of the second path which extends transverse to the first path, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
- - 2. A method as set forth in claim 1 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 3. A method as set forth in claim 2 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 4. A method as set forth in claim 3 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 5. A method as set forth in claim 4 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 6. A method as set forth in claim 1 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 7. A method as set forth in claim 6 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 8. A method as set forth in claim 1 further including the steps of sliding a suture retainer along a first portion of the suture which extends from the first anchor, sliding the suture retainer along a second portion of the suture which extends from the second anchor, and gripping the first and second portions of the suture with the suture retainer.
  - 9. A method as set forth in claim 1 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, said step of tensioning at least a portion of the suture by moving the second anchor along at least a portion of the second path is performed after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 10. A method as set forth in claim 1 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 11. A method as set forth in claim 1 wherein said step of moving the first anchor along the first path includes moving the first anchor along a first path having a nonlinear central axis, said step of moving the second anchor along the second path includes moving the second anchor along a second path having a nonlinear central axis.
  - 12. A method as set forth in claim 1 wherein said steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 13. A method as set forth in claim 12 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 14. A method as set forth in claim 12 wherein said step of interconnecting the first an d second anchors includes moving one of the first and second anchors into an opening in the other of the first and second anchors .
  - 15. A method as set forth in claim 1 wherein said step of moving the first anchor of the plurality of anchors along a first path into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 16. A method as set forth in claim 15 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 17. A method as set forth in claim 1 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, moving the first anchor along the first guide surface during movement of the first anchor along the first path, and moving the second anchor along the second guide surface during movement of the second anchor along the second path.
  - 18. A method as set forth in claim 1 further including moving a thin elongated member along the first path into the second body tissue, said step of moving a first anchor along a first path into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path into the second body tissue, said step of moving a second anchor along a second path into the second body tissue is at least partially performed with the thin elongated member extending through the second anchor.
  - 19. A method as set forth in claim 1 further including the steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path through the first body tissue into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the-second tubular guide along the second path through the first body tissue into engagement with the second body tissue, said step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.
  - 20. A method as set forth in claim 1 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.

21. A method of securing first body tissue with second body tissue, said method comprising the steps of moving a first anchor along a first path through the first body tissue into the second body tissue with a first suture portion extending from the first anchor, moving a second anchor along a second path through the first body tissue into the second body tissue with a second suture portion extending from the second anchor, tensioning the first and second suture portions with a predetermined force, and gripping the first and second suture portions with the suture retainer while tensioning the first and second suture portions with the predetermined force.
- View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45)
- - 22. A method as set forth in claim 21 wherein said step of gripping the first and second suture portions with the suture retainer includes pressing force transmitting members against the suture retainer, and transmitting ultrasonic vibratory energy to a location where one of the force transmitting members presses against the suture retainer.
  - 23. A method as set forth in claim 21 further including the steps of wrapping the first suture portion around the suture retainer, wrapping the second suture portion around the suture retainer, and moving the suture retainer along the first and second suture portions toward the first body tissue while the first and second suture portions are wrapped around the suture retainer.
  - 24. A method as set forth in claim 23 further including the step of gripping the first and second suture portions with the suture retainer while the first and second suture portions are wrapped around the suture retainer by plastically deforming material of the suture retainer.
  - 25. A method as set forth in claim 21 further including the step of selecting first and second suture portions of a known size and strength, said step of tensioning the first and second suture portions with a predetermined force includes tensioning the first and second suture portions with a force which is a known function of the known size and strength of the first and second suture portions.
  - 26. A method as set forth in claim 21 wherein the first body tissue is a first layer of soft tissue and the second body tissue is a second layer of soft tissue, said method further includes approximating the first and second layers of body tissue, and pressing the first layer of body tissue against the second layer of body tissue.
  - 27. A method as set forth in claim 21 wherein said step of moving the second anchor along the second path through the first body tissue into the second body tissue includes moving the second anchor along a portion of the second path which extends transverse to the first path.
  - 28. A method as set forth in claim 21 wherein a third suture portion extends between the first and second anchors, said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path to tension the third suture portion.
  - 29. A method as set forth in claim 21 wherein said step of moving a first anchor along a first path through the first body tissue into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 30. A method as set forth in claim 29 wherein said step of moving a first anchor along a first path through the first body tissue into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 31. A method as set forth in claim 30 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 32. A method as set forth in claim 31 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 33. A method as set forth in claim 21 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 34. A method as set forth in claim 33 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 35. A method as set forth in claim 21 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 36. A method as set forth in claim 21 wherein said step of moving the first anchor along the first path includes moving the first anchor along a first path having a nonlinear central axis, said step of moving the second anchor along the second path includes moving the second anchor along a second path having a nonlinear central axis.
  - 37. A method as set forth in claim 21 wherein said steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 38. A method as set forth in claim 37 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 39. A method as set forth in claim 37 wherein said step of interconnecting the first and second anchors includes moving of the first and second anchors into an opening in the other of the first and second anchors.
  - 40. A method as set forth in claim 21 wherein said step of moving the first anchor along a first path through the first body tissue into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue, said step of moving the second anchor along a second path through the first body tissue into the second body tissue includes moving the second anchor through a predetermined distance into the second body tissue.
  - 41. A method as set forth in claim 40 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue, said step of moving the second anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the second anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the second anchor has been moved through a predetermined distance relative to the second body tissue.
  - 42. A method as set forth in claim 21 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, engaging the first anchor with the first guide surface during movement of the first anchor along the first path, and engaging the second anchor with the second guide surface during movement of the second anchor along the second path.
  - 43. A method as set forth in claim 21 further including the steps of moving a thin elongated member along the first path through the first body tissue into the second body tissue, said step of moving a first anchor along the first path through the first body tissue into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path through the first body tissue into the second body tissue, said step of moving a second anchor along the second path through the first body tissue into the second body tissue is at least partially performed with the thin elongated member extending through the second anchor.
  - 44. A method as set forth in claim 21 wherein said steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path through the first body tissue into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the second tubular guide along the second path through the first body tissue into engagement with the second body tissue, said step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.
  - 45. A method as set forth in claim 21 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.

46. A method of securing first body tissue with second body tissue, said method comprising the steps of moving a first anchor along a first path into the second body tissue, moving a second anchor along a second path into the second body tissue, said steps of moving the first and second anchors along first and second paths include moving the first and second anchors along first and second paths which intersect in the second body tissue, connecting the first and second anchors together at the intersection between the first and second paths in the second body tissue, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (47, 48, 49, 50, 51, 52, 53, 54)
- - 47. A method as set forth in claim 46 wherein said step of connecting the first and second anchors together includes engaging a surface on the first anchor with a surface on the second anchor.
  - 48. A method as set forth in claim 46 wherein said step of connecting the first and second anchors together includes moving one of the anchors into an opening in the other anchor.
  - 49. A method as set forth in claim 46 wherein said step of connecting the first and second anchors together includes tensioning a suture portion connected with the second anchor and pressing a surface on the second anchor against a surface on the first anchor under the influence of force transmitted through the suture portion to the second anchor.
  - 50. A method as set forth in claim 46 wherein the first path enters the second body tissue at a first location and the second path enters the second body tissue at a second location, said step of moving the first anchor along the first path into the second body tissue includes moving the first anchor along a portion of the first path which extends at an acute angle to a straight line between the first location where the first path enters the second body tissue and the second location where the second path enters the second body tissue, said step of moving the second anchor along the second path into the second body tissue includes moving the second anchor along a portion of the second path which extends at an acute angle to the straight line between the first location where the first path enters the second body tissue and the second location where the second path enters the second body tissue.
  - 51. A method as set forth in claim 46 wherein said steps of moving the first and second anchors along the first and second paths includes tensioning a suture which extends between the first and second anchors.
  - 52. A method as set forth in claim 46 further including the steps of tensioning a first suture portion extending from the first anchor, tensioning a second suture portion extending from the second anchor, transmitting force from a suture retainer to the first body tissue to urge the first body tissue toward the second body tissue, and gripping the first and second suture portions with the suture retainer while tensioning the first and second suture portions and while transmitting force from the suture retainer to the first body tissue.
  - 53. A method as set forth in claim 46 further including the step of positioning a guide assembly having first and second guide surfaces relative to the second body tissue with the first guide surface aligned with the first path and with the second guide surface aligned with the second path, said step of moving the first anchor along the first path includes moving the first anchor along the first guide surface, said step of moving the second anchor along the second path includes moving the second anchor along the second guide surface.
  - 54. A method as set forth in claim 53 wherein said step of moving the first anchor along the first path includes applying force against a trailing end portion of the first anchor with a pusher member and determining when the first anchor has moved to a desired position relative to the intersection of the first and second paths by detecting when the pusher member has moved to a predetermined position relative to the guide assembly, said step of moving the second anchor along the second path includes applying force against a trailing end portion of the second anchor with a pusher member and determining when the second anchor has moved to a desired position relative to the intersection of the first and second paths by detecting when the pusher member has moved to a predetermined position relative to the guide assembly.

55. A method of securing first body tissue with second body tissue, said method comprising the steps of moving a first anchor along a first path into the second body tissue with a suture extending between the first anchor and a second anchor, moving the second anchor along a second path into the second body tissue with the suture extending between the first anchor and the second anchors, determining when a predetermined tension is present in the suture, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79)
- - 56. A method as set forth in claim 55 further including the step of tensioning by moving at least one of the first and second anchors along at least one of the first and second paths.
  - 57. A method as set forth in claim 55 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path.
  - 58. A method as set forth in claim 55 further including the step of increasing tension in the suture, said method further includes interrupting said step of increasing the tension in the suture in response to determining that the predetermined tension is present in the suture.
  - 59. A method as set forth in claim 55 further including the steps of selecting a suture of a known size and strength, increasing the tension in the suture, and interrupting said step of increasing the tension in the suture in response to determining that a predetermined tension which is a function of the known size and strength of the suture is present in the suture.
  - 60. A method as set forth in claim 55 further including the step of gripping a portion of the suture extending from the first anchor and a portion of the suture extending from the second anchor with a suture retainer while the suture is tensioned with the predetermined tension.
  - 61. A method as set forth in claim 55 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 62. A method as set forth in claim 61 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 63. A method as set forth in claim 62 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 64. A method as set forth in claim 63 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 65. A method as set forth in claim 55 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 66. A method as set forth in claim 65 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 67. A method as set forth in claim 55 wherein said step of determining when a predetermined tension is present in the suture is at least partially performed while moving at least one of the first and second anchors along at least one of the first and second paths.
  - 68. A method as set forth in claim 55 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, said step of tensioning the suture includes moving the second anchor along at least a portion of the second path after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 69. A method as set forth in claim 55 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 70. A method as set forth in claim 55 wherein said step of moving the first anchor along the first path includes moving the first anchor along a first path having a nonlinear central axis, said step of moving the second anchor along the second path includes moving the second anchor along a second path having a nonlinear central axis.
  - 71. A method as set forth in claim 55 wherein said steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 72. A method as set forth in claim 71 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 73. A method as set forth in claim 71 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into an opening in the other of the first and second anchors.
  - 74. A method as set forth in claim 55 wherein said step of moving the first anchor of the plurality of anchors along a first path into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 75. A method as set forth in claim 74 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 76. A method as set forth in claim 55 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, moving the first anchor along the first guide surface during movement of the first anchor along the first path, and moving the second anchor along the second guide surface during movement of the second anchor along the second path.
  - 77. A method as set forth in claim 55 further including the steps of moving a thin elongated member along the first path into the second body tissue, said step of moving a first anchor along a first path into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path into the second body tissue, said step of moving a second anchor along a second path into the second body tissue is at least partially performed with the thin elongated member extending through the second anchor.
  - 78. A method as set forth in claim 55 further including the steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the second tubular guide along the second path into engagement with the second body tissue, said step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.
  - 79. A method as set forth in claim 55 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.

80. A method of securing first body tissue with second body tissue, said method comprising the steps of moving a first anchor along a first path into the second body tissue with a first suture portion extending from the first anchor, moving a second anchor along the second path into the second body tissue with a second suture portion extending from the second anchor, tensioning the first and second suture portions, determining when a predetermined tension is present in the first and second suture portions during performance of said step of tensioning the first and second suture portions, interconnecting the first and second suture portions after determining that the predetermined tension is present in the first and second suture portions, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (81, 82, 83, 84, 85, 86, 87, 88, 89)
- - 81. A method as set forth in claim 80 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path.
  - 82. A method as set forth in claim 80 wherein said step of tensioning the first and second suture portions includes increasing tension in the first and second suture portions, said method further includes interrupting said step of increasing the tension in the first and second suture portions in response to determining that the predetermined tension is present in the first and second suture portions.
  - 83. A method as set forth in claim 80 further including the steps of selecting a first and second suture portions of a known size and strength, said step of tensioning the first and second suture portions includes increasing the tension in the first and second suture portions, and interrupting said step of increasing the tension in the first and second suture portions in response to determining that a predetermined tension which is a function of the known size and strength of the first and second suture portions is present in the first and second suture portions.
  - 84. A method as set forth in claim 80 wherein said step of interconnecting the first and second suture portions includes gripping the first and second suture portions with a suture retainer.
  - 85. A method as set forth in claim 80 wherein said step of gripping the first and second suture portions with a suture retainer includes heating the suture retainer by transmitting ultrasonic vibratory energy to the suture retainer.
  - 86. A method as set forth in claim 80 wherein said step of interconnecting the first and second suture portions includes heating the first and second suture portions by transmitting ultrasonic vibratory energy to the first and second suture portions.
  - 87. A method as set forth in claim 80 wherein said step of interconnecting the first and second suture portions includes wrapping the first suture portion around a suture retainer, wrapping the second suture portion around the suture retainer, and moving the suture retainer along the first and second suture portions toward the first body tissue while the first and second suture portions are wrapped around the suture retainer.
  - 88. A method as set forth in claim 80 wherein a third suture portion extends between the first and second anchors, said method further includes the steps of tensioning the third suture portion and determining when a predetermined tension is present in the third suture portion.
  - 89. A method as set forth in claim 80 wherein said steps of moving the first and second anchors along first and second paths includes moving the first and second anchors along first and second paths which intersect in the body tissue, said method further includes connecting the first and second anchors together at the intersection between the first and second paths in the second body tissue.

90. A method of securing first body tissue with second body tissue, said method comprises the steps of moving a first anchor into first body tissue at a first location, moving the first anchor into the second body tissue, moving a second anchor into the first body tissue at a second location, moving the second anchor into the second body tissue, moving the first anchor in the second body tissue in a direction away from the first location where the first anchor moved into the first body tissue and in a direction toward the second location where the second anchor moved into the first body tissue, pulling a first suture portion into the second body tissue under the influence of force transmitted from the first anchor to the first suture portion as the first anchor moves in the second body tissue in a direction away from the first location where the first anchor moved into the first body tissue and toward the second location where the second anchor moved into the first body tissue, moving the second anchor in the second body tissue in a direction away from the second location where the second anchor moved into the first body tissue and in a direction toward the first location where the first anchor moved into the first body tissue, and pulling a second suture portion into the second body tissue under the influence of force transmitted from the second anchor to the second suture portion as the second anchor moves in the second body tissue in a direction away from the second location where the second anchor moved into the first body tissue and toward the first location where the first anchor moved into the first body tissue.
- View Dependent Claims (91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114)
- - 91. A method as set forth in claim 90 wherein said step of moving the first anchor into the second body tissue in a direction away from the first location where the first anchor moved into the first body tissue and toward the second location where the second anchor moved into the first body tissue includes moving the first anchor along a linear path which extends through the first location where the first anchor moved into the first body tissue, and said step of moving the second anchor in the second body tissue in a direction away from the second location where the second anchor moved into the first body tissue and toward the first location where the first anchor moved into the first body tissue includes moving the second anchor along a linear path which extends through the second location where the second anchor moved into the first body tissue.
  - 92. A method as set forth in claim 90 wherein said step of moving the first anchor in the second body tissue in a direction away from the first location where the first anchor moved into the first body tissue and toward the second location where the second anchor moved into the first body tissue includes moving the first anchor along a nonlinear path which extends through the first location where the first anchor moved into the first body tissue and said step of moving the second anchor in the second body tissue in a direction away from the second location where the second anchor moved into the first body tissue and toward the first location where the first anchor moved into the first body tissue includes moving the second anchor along a nonlinear path which extends through the second location where the second anchor moved into the first body tissue.
  - 93. A method as set forth in claim 90 further including the step of tensioning the first and second suture portions during movement of at least one of said first and second anchors in the second body tissue.
  - 94. A method as set forth in claim 93 wherein said step of tensioning the first and second suture portions includes increasing the tension in the first and second suture portions, said method further includes interrupting said step of increasing the tension in the first and second suture portions when a predetermined tension is present in the first and second suture portions.
  - 95. A method as set forth in claim 90 further including the step of interconnecting the first and second suture portions after performing said steps of moving the first anchor into the second body tissue and moving the second anchor into the second body tissue.
  - 96. A method as set forth in claim 90 wherein said step of moving a first anchor into the first body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 97. A method as set forth in claim 96 wherein said step of moving a first anchor into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 98. A method as set forth in claim 97 wherein said step of moving a second anchor into the first body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 99. A method as set forth in claim 98 wherein said step of moving a second anchor into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 100. A method as set forth in claim 90 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 101. A method as set forth in claim 100 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while tensioning the first suture portion by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while tensioning the second suture portion by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 102. A method as set forth in claim 90 further including the steps of sliding a suture retainer along the first suture portion, sliding the suture retainer along the second suture portion, and gripping the first and second suture portions with the suture retainer.
  - 103. A method as set forth in claim 90 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to a straight line between the first and second locations, said method further includes the step of tensioning at least one of the first and second suture portions by moving a portion of the second anchor in the second body tissue after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 104. A method as set forth in claim 90 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to a straight line between the first and second locations, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the straight line between the first and second locations.
  - 105. A method as set forth in claim 104 further including the step of tensioning the first and second suture portions after performance of said step of changing the orientation of the first anchor relative to the second body tissue.
  - 106. A method as set forth in claim 90 further including the step of interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 107. A method as set forth in claim 106 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 108. A method as set forth in claim 106 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into an opening in the other of the first and second anchors.
  - 109. A method as set forth in claim 90 wherein said step of moving the first anchor into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 110. A method as set forth in claim 109 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 111. A method as set forth in claim 90 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, engaging the first anchor with the first guide surface during movement of the first anchor relative to the first and second body tissues, and engaging the second anchor with the second guide surface during movement of the second anchor relative to the first and second body tissues.
  - 112. A method as set forth in claim 90 further including moving a first thin elongated member into the second body tissue, said step of moving a first anchor into the second body tissue is at least partially performed with the first thin elongated member extending through the first anchor, and moving a second thin elongated member into the second body tissue, said step of moving a second anchor into the second body tissue is at least partially performed with the second thin elongated member extending through the second anchor.
  - 113. A method as set forth in claim 90 wherein said steps of providing a guide assembly having a base and first and second tubular guides, moving the first tubular guide through the first body tissue into engagement with the second body tissue, moving the second tubular guide through the first body tissue into engagement with the second body tissue, said step of moving the first anchor into the second body tissue includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor into the second body tissue includes moving the second anchor through the second tubular guide into the second body tissue.
  - 114. A method as set forth in claim 90 wherein said step of moving a first anchor into the second body tissue includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor into the second body tissue includes transmitting force from the robotic assembly to the second anchor.

115. A method of securing first body tissue with bone, said method comprising the steps of moving a first anchor along a first path with a first suture portion extending from the first anchor, said step of moving the first anchor along the first path includes engaging a trailing end portion of the first anchor with a pusher, piercing the first body tissue with a leading end portion of the first anchor at a location ahead of the pusher which engages the trailing end portion of the first anchor as the first anchor moves along the first path with the first suture portion extending from the first anchor, piercing a hard outer layer of the bone with the leading end portion of the first anchor at a location ahead of the pusher which engages the trailing end portion of the first anchor as the first anchor moves along the first path with the first suture portion extending from the first anchor, piercing cancellous bone enclosed by the hard outer layer of the bone with the leading end portion of the first anchor at a location ahead of the pusher which engages the trailing end portion of the first anchor as the first anchor moves along the first path with the first suture portion extending from the first anchor, moving a second anchor along a second path with a second suture portion extending from the second anchor, said step of moving the second anchor along the second path includes engaging a trailing end portion of the second anchor with a pusher, piercing the first body tissue with a leading end portion of the first anchor at a location ahead of the pusher which engages the trailing end portion of the second anchor as the second anchor moves along the second path with the second suture portion extending from the second anchor, piercing the hard outer layer of the bone with the leading end portion of the second anchor at a location ahead of the pusher which engages the trailing end portion of the second anchor as the second anchor moves along the second path with the second suture portion extending from the second anchor, piercing the cancellous bone enclosed by the hard outer layer of the bone with the leading end portion of the second anchor at a location ahead of the pusher which engages the trailing end portion of the second anchor as the second anchor moves along the second path with the second suture portion extending from the second anchor, tensioning the first and second suture portions with the first and second suture portions extending across at least a portion of the first body tissue disposed between the first and second paths, and transmitting force from the first and second suture portions to at least a portion of the first body tissue disposed between the first and second paths, said step of transmitting force from the first and second suture portions to at least a portion of the first body tissue between the first and second paths includes transmitting force between the first and second anchors through the first and second suture portions.
- View Dependent Claims (124)
- - 124. A method as set forth in claim 115 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the first and second suture portions by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the first and second suture portions by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.

116. A method as set forth in 115 further including the step of interconnecting the first and second suture portions at a location between the first and second paths to enable force to be transmitted between the first and second suture portions.

117. A method as set forth in 115 wherein the first and second suture portions are interconnected during performance of said step of moving the second anchor along the second path, said step of tensioning the first and second suture portions includes moving at least one of the first and second anchors along at least one of the first and second paths.

118. A method as set forth in 115 wherein the first and second suture portions are interconnected to form a continuous loop which extends between the first and second anchors.

119. A method as set forth in 115 wherein at least a portion of the second path extends transverse to the first path, said step of tensioning the first and second suture portions includes moving the second anchor along at least the portion of the second path which extends transverse to the first path.

120. A method as set forth in 115 wherein said step of tensioning the first and second suture portions includes transmitting force from a suture retainer to the first body tissue to urge the first body tissue toward the bone, and gripping the first and second suture portions with the suture retainer while tensioning the first and second suture portions and transmitting force from the suture retainer to the first body tissue.

121. A method as set forth in 115 further including the step of connecting the first and second anchors together while the first and second anchors are disposed in the cancellous bone enclosed by the hard outer layer of bone.

122. A method as set forth in 115 further including the step of determining when a predetermined tension is present in the first and second suture portions during performance of said step of tensioning the first and second suture portions.

123. A method as set forth in 115 wherein said step of moving the first anchor along the first path includes moving the first anchor in the cancellous bone toward a location where the second anchor pierces the cancellous bone, said step of moving the second anchor along the second path includes moving the second anchor in the cancellous bone toward a location where the first anchor pierces the cancellous bone.

125. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture extending between the first and second anchors, moving the first anchor along a first path into the second body tissue, moving the second anchor along a second path into the second body tissue, detecting when a predetermined tension is present in the suture during movement of at least one of the first and second anchors along at least one of the first and second paths, and interrupting movement of at least the one of the first and second anchors along the one of the first and second paths upon detection of the predetermined tension in the suture.
- View Dependent Claims (126, 127, 128, 129, 130)
- - 126. A method as set forth in claim 125 wherein said step of moving the first anchor along the first path is performed prior to performance of said step of moving the second anchor along the second path, and said step of detecting when a predetermined tension is present in the suture is performed during movement of the second anchor along the second path.
  - 127. A method as set forth in claim 125 wherein said steps of moving the first and second anchors along the first and second paths are at least partially performed simultaneously, and said step of detecting when a predetermined tension is present in the suture is performed during movement of the first and second anchors along the first and second paths.
  - 128. A method as set forth in claim 125 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path, said step of detecting when a predetermined tension is present in the suture is performed during movement of the second anchor along the portion of the second path which extends transverse to the first path.
  - 129. A method as set forth in claim 125 wherein said step of moving the first anchor along the first path includes initiating formation of a first opening in the second body tissue at a first location with a leading end portion of the first anchor, said step of moving the second anchor along the second path includes initiating formation of a second opening in the second body tissue at a second location with a leading end portion of the second anchor, said step of detecting when a predetermined tension is present in the suture is performed with a portion of the suture extending between the first and second locations.
  - 130. A method as set forth in claim 125 wherein said step of moving the first anchor along the first path includes moving the first anchor along the first path in a direction toward the second path, said step of moving the second anchor along the second path includes moving the second anchor along the second path in a direction toward the first path.

131. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture extending between the first and second anchors, moving the first anchor along a first path through the first body tissue into the second body tissue, moving the second anchor along a second path through the first body tissue into the second body tissue, and pressing the first body tissue against the second body tissue under the influence of force transmitted to the first body tissue from a portion of the suture extending between a location where the first path enters the first body tissue and a location where the second path enters the first body tissue.
- View Dependent Claims (132, 133, 134, 135, 136, 137, 138, 139)
- - 132. A method as set forth in claim 131 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path.
  - 133. A method as set forth in claim 131 wherein said step of moving the second anchor along the second path includes moving the second anchor in the second body tissue while first anchor is stationary in the second body tissue.
  - 134. A method as set forth in claim 131 further including the step of engaging the first body tissue with the portion of the suture extending between the location where the first path enters the first body tissue and the location where the second path enters the first body tissue.
  - 135. A method as set forth in claim 131 wherein said step of moving the first anchor along the first path includes moving the first anchor along a nonlinear portion of the first path, said step of moving the second anchor along the second path includes moving the second anchor along a nonlinear portion of the second path.
  - 136. A method as set forth in claim 131 wherein said steps of moving the first and second anchors along the first and second paths are at least partially performed simultaneously, and said step of pressing the first body tissue against the second body tissue under the influence of force transmitted to the first body tissue from a portion of the suture extending between the location where the first path enters the first body tissue and the location where the second path enters the first body tissue is initiated during movement of the first and second anchors along the first and second paths.
  - 137. A method as set forth in claim 131 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path, said step of pressing the first body tissue against the second body tissue under the influence of force transmitted to the first body tissue from a portion of the suture extending between the location where the first path enters the first body tissue and the location where the second path enters the first body tissue is initiated during movement of the second anchor along the portion of the second path which extends transverse to the first path.
  - 138. A method as set forth in claim 131 further including the steps of detecting when a predetermined tension is present in the portion of the suture extending between the location where the first path enters the first body tissue and the location where the second path enters the first body tissue, and interrupting movement of at least one of the first and second anchors along at least one of the first and second paths upon detection of the predetermined tension in the portion of the suture extending between the location where the first path enters the first body tissue and the location where the second path enters the first body tissue.
  - 139. A method as set forth in claim 131 wherein said step of moving the first anchor along the first path includes initiating formation of the first opening in the second body tissue with a leading end portion of the first anchor, said step of moving the second anchor along the second path includes initiating formation of a second opening in the second body tissue with a leading end portion of the second anchor.

140. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture extending between the first and second anchors, moving the first anchor along a first path through the first body tissue into the second body tissue, said step of moving the first anchor along the first path includes initiating formation of an opening in the first body tissue with a leading end portion of the first anchor and initiating the formation of an opening in the second body tissue with the leading end portion of the first anchor, moving the second anchor along a second path through the first body tissue into the second body tissue, said step of moving the second anchor along the second path includes initiating formation of an opening in the first body tissue with a leading end portion of the second anchor and initiating formation of an opening in the second body tissue with the leading end portion of the second anchor, and tensioning at least a portion of the suture extending between the first and second paths when the first and second anchors are disposed in engagement with the second body tissue.
- View Dependent Claims (141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156, 157)
- - 141. A method as set forth in claim 140 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor along the first path into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor along the second path into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 142. A method as set forth in claim 141 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 143. A method as set forth in claim 140 further including the steps of sliding a suture retainer along a first portion of the suture which extends between the first and second anchors, sliding the suture retainer along a second portion of the suture which extends between the first and second anchors, and gripping the first and second portions of the suture with the suture retainer.
  - 144. A method as set forth in claim 140 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, said step of moving the second anchor along the second path is performed after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 145. A method as set forth in claim 140 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 146. A method as set forth in claim 140 wherein the first and second body tissues are soft body tissues, said method further includes the step of placing the first and second body tissues in a side-by-side relationship.
  - 147. A method as set forth in claim 140 wherein said steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 148. A method as set forth in claim 147 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 149. A method as set forth in claim 147 wherein said step of interconnecting the first and second anchors includes moving of the first and second anchors into an opening in the other of the first and second anchors.
  - 150. A method as set forth in claim 140 wherein said step of moving the first anchor along a first path through the first body tissue into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 151. A method as set forth in claim 150 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 152. A method as set forth in claim 140 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, moving the first anchor along the first guide surface during movement of the first anchor along the first path, and moving the second anchor along the second guide surface during movement of the second anchor along the second path.
  - 153. A method as set forth in claim 140 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.
  - 154. A method as set forth in claim 140 further including the step of detecting when there is a predetermined tension in the suture and interrupting movement of the second anchor along the second path upon detecting the predetermined tension in the suture.
  - 155. A method as set forth in claim 140 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends toward the first path.
  - 156. A method as set forth in claim 140 wherein said step of moving the second anchor along the second path includes moving the second anchor in the second body tissue while the first anchor is stationary in the first body tissue.
  - 157. A method as set forth in claim 140 wherein said steps of moving the first and second anchors along the first and second paths are at least partially performed simultaneously.

158. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture disposed in a continuous loop extending between the first and second anchors, moving the first anchor along a first path into the second body tissue with the continuous loop extending through a passage in the first anchor, moving the second anchor along a second path into the second body tissue with the continuous loop extending through a passage in the second anchor, and moving a portion of the suture in the continuous loop along the passage in the second anchor, and tensioning suture in the continuous loop as the second anchor moves in to the second body tissue.
- View Dependent Claims (159, 160, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176, 177, 178, 179)
- - 159. A method as set forth in claim 158 wherein said step of moving a portion of the suture along the passage in the second anchor is at least partially performed during movement of the second anchor into the second body tissue.
  - 160. A method as set forth in claim 158 wherein first and second lengths of the suture extend between the passages in the first and second anchors and form portions of the continuous loop, said step of moving a portion of the suture in the continuous loop along the passage in the second anchor includes increasing an extent of one of the first and second lengths of the suture and decreasing an extent of another of the first and second lengths of the suture.
  - 161. A method as set forth in claim 158 further including the step of connecting a first portion of the suture with a second portion of the suture to form the continuous loop, said step of connecting a first portion of the suture with a second portion of the suture includes tying a knot between the first and second portions of the suture.
  - 162. A method as set forth in claim 158 further including the step of gripping first and second portions of the suture with a suture retainer to form the continuous loop.
  - 163. A method as set forth in claim 158 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path while the second anchor is disposed in the second body tissue.
  - 164. A method as set forth in claim 158 further including the step of determining when a predetermined tension is present in the continuous loop.
  - 165. A method as set forth in claim 158 further including the step of interrupting movement of the second anchor along the second path in response to determining that a predetermined tension is present in the continuous loop.
  - 166. A method as set forth in claim 158 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 167. A method as set forth in claim 166 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 168. A method as set forth in claim 167 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 169. A method as set forth in claim 168 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 170. A method as set forth in claim 158 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 171. A method as set forth in claim 170 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the continuous loop by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the continuous loop by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 172. A method as set forth in claim 158 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, said step of tensioning at least a portion of the suture by moving the second anchor along at least a portion of the second path is performed after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 173. A method as set forth in claim 158 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 174. A method as set forth in claim 158 wherein said step of moving the first anchor along a first path into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 175. A method as set forth in claim 174 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 176. A method as set forth in claim 158 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, engaging the first anchor with the first guide surface during movement of the first anchor along the first path, and engaging the second anchor with the second guide surface during movement of the second anchor along the second path.
  - 177. A method as set forth in claim 158 further including moving a thin elongated member along the first path into the second body tissue, said step of moving a first anchor along a first path into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path into the second body tissue, said step of moving a second anchor along a second path into the second body tissue is at least partially performed with the thin elongated member extending through the second anchor.
  - 178. A method as set forth in claim 158 wherein said steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the second tubular guide along the second path into engagement with the second body tissue, said step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.
  - 179. A method as set forth in claim 158 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.

180. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture extending through passages in the first and second anchors, moving the first anchor along a first path into the second body tissue with the suture extending through the passages in the first and second anchors, moving the second anchor along a second path into the second body tissue with the suture extending through the passages in the first and second anchors, moving a portion of the suture along the passage in the second anchor during movement of the second anchor into the second body tissue, said step of moving a portion of the suture along the passage in the second anchor includes increasing the extent of a portion of the suture extending between the first and second anchors during movement of the second anchor into the second body tissue, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (181, 182, 183, 184, 185)
- - 181. A method as set forth in claim 180 wherein the suture extends in a continuous loop between the first and second anchors, said step of moving the second anchor into the second body tissue includes tensioning the continuous loop.
  - 182. A method as set forth in claim 180 further including the step of connecting a first portion of the suture with a second portion of the suture by tying a knot between the first and second portions of the suture after performing said step of moving the second anchor into the second body tissue.
  - 183. A method as set forth in claim 180 further including the step of gripping first and second portions of the suture with a suture retainer after performing said step of moving the second anchor into the second body tissue.
  - 184. A method as set forth in claim 180 wherein said step of moving the second anchor along the second path includes moving the second anchor along a portion of the second path which extends transverse to the first path while the second anchor is disposed in the second body tissue.
  - 185. A method as set forth in claim 180 further including the step of connecting a first portion of the suture with a second portion of the suture at a location disposed between the first and second paths after performing said steps of moving the first anchor along the first path into the second body tissue and moving the second anchor along the second path into the second body tissue.

186. A method of securing first body tissue with second body tissue, said method comprising the steps of providing first and second anchors with a suture extending between the first and second anchors, moving the first anchor along a first path into the second body tissue with the suture extending between the first and second anchors, moving the second anchor along a second path into the second body tissue with the suture extending between the first and second anchors, said step of moving the first anchor along the first path into the second body tissue includes decreasing a distance between the first anchor and the second path, said step of moving the second anchor along the second path into the second body tissue includes decreasing a distance between the second anchor and the second path, and transmitting force through the suture to the first body tissue.
- View Dependent Claims (187, 188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 205, 206)
- - 187. A method as set forth in claim 186 wherein said step of moving the second anchor along the second path into the second body tissue includes moving the second anchor along a portion of the second path which extends transverse to the first path.
  - 188. A method as set forth in claim 186 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.
  - 189. A method as set forth in claim 188 wherein said step of moving a first anchor along a first path into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.
  - 190. A method as set forth in claim 189 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.
  - 191. A method as set forth in claim 190 wherein said step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.
  - 192. A method as set forth in claim 186 wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, said step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, said step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.
  - 193. A method as set forth in claim 192 further including the steps of retaining the first anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the first anchor and the cancellous bone while the first anchor is spaced from the hard outer layer of the bone and retaining the second anchor against movement relative to the hard outer layer of the bone while maintaining tension in the suture by transmitting force between the second anchor and the cancellous bone while the second anchor is spaced from the hard outer layer of the bone.
  - 194. A method as set forth in claim 186 further including the steps of sliding a suture retainer along a first portion of the suture which extends from the first anchor, sliding the suture retainer along a second portion of the suture which extends from the second anchor, and gripping the first and second portions of the suture with the suture retainer.
  - 195. A method as set forth in claim 186 further including the step of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, said step of tensioning at least a portion of the suture by moving the second anchor along at least a portion of the second path is performed after performing said step of changing the orientation of the first anchor relative to the second body tissue.
  - 196. A method as set forth in claim 186 further including the steps of changing the orientation of the first anchor relative to the second body tissue, said step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, said step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.
  - 197. A method as set forth in claim 196 further including the step of tensioning the suture after performance of said step of changing the orientation of the first anchor relative to the second body tissue.
  - 198. A method as set forth in claim 186 wherein said steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.
  - 199. A method as set forth in claim 198 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into engagement with the other of the first and second anchors.
  - 200. A method as set forth in claim 198 wherein said step of interconnecting the first and second anchors includes moving one of the first and second anchors into an opening in the other of the first and second anchors.
  - 201. A method as set forth in claim 186 wherein said step of moving the first anchor of the plurality of anchors along a first path into the second body tissue includes moving the first anchor through a predetermined distance into the second body tissue.
  - 202. A method as set forth in claim 201 wherein said step of moving the first anchor through a predetermined distance into the second body tissue includes applying force against a trailing end portion of the first anchor with a pusher member having indicia thereon, and detecting when the indicia on the pusher member indicates that the first anchor has been moved through a predetermined distance relative to the second body tissue.
  - 203. A method as set forth in claim 186 further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, moving the first anchor along the first guide surface during movement of the first anchor along the first path, and moving the second anchor along the second guide surface during movement of the second anchor along the second path.
  - 204. A method as set forth in claim 186 further including moving a thin elongated member along the first path into the second body tissue, said step of moving a first anchor along a first path into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path into the second body tissue, said step of moving a second anchor along a second path into the second body tissue is at least partially performed with the thin elongated member extending through the anchor.
  - 205. A method as set forth in claim 186 further including the steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path through the first body tissue into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the second tubular guide along the second path through the first body tissue into engagement with the second body tissue, said step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, said step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.
  - 206. A method as set forth in claim 186 wherein said step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, said step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.

Specification

Resources

Litigation Campaign Assessment

Current Assignee
Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
Original Assignee
The Bonutti 2003 Trust A
Inventors
Bonutti, Peter M.

Granted Patent

US 6,635,073 B2
Time in Patent Office

Days
Field of Search
US Class Current

606/232
CPC Class Codes

A61B 17/0401   Suture anchors, buttons or ...

A61B 17/0469   Suturing instruments for us...

A61B 17/0487   Suture clamps, clips or loc...

A61B 17/068   Surgical staplers , e.g. co...

A61B 2017/0409   Instruments for applying su...

A61B 2017/0414   having a suture-receiving o...

A61B 2017/044   with a threaded shaft, e.g....

A61B 2017/0445   cannulated, e.g. with a lon...

A61B 2017/0454   the anchor being crimped or...

A61B 2017/0458   Longitudinal through hole, ...

A61B 2017/0459   Multiple holes in the ancho...

A61B 2017/0488   Instruments for applying su...

A61B 2017/0496   for tensioning sutures

A61B 2017/0619   thermoplastic, e.g. for bon...

Method of securing body tissue

First Claim

11 Assignments

0 Petitions

Accused Products

Abstract

367 Citations

206 Claims

Specification

Solutions

Use Cases

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Method of securing body tissue

First Claim

11 Assignments

Subscription Required

Subscription Required

0 Petitions

Subscription Required

Accused Products

Subscription Required

Abstract

367 Citations

206 Claims

Specification

Subscription Required

Solutions

Use Cases

Quick Links