ANCHOR ASSEMBLY INCLUDING EXPANDABLE ANCHOR

• US 20110270278A1
• Filed: 04/27/2011
• Published: 11/03/2011
• Est. Priority Date: 04/27/2010
• Status: Active Grant

• Current Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Inventors: Henrichsen, Kevin, Singhatat, Wamis, Talbot, James, Larsen, Scott, Vennard, Daniel, Manos, Jamie, Overes, Tom
• Granted Patent: US 9,173,645 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/842 Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 2017/00623 Introducing or retrieving devices therefor
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06176 with protrusions, e.g. barbs

Abstract

An anchor assembly can include at least one anchor member, such as a pair of anchor members that are configured to be implanted in a target anatomical location in a first configuration, and can subsequently be actuated to an expanded configuration that secures the anchor members in the target anatomy. The anchor assembly can further include a connector member that attaches the pair of anchor members together across a gap so as to approximate the anatomical defect.

Claims

1. An anchor assembly configured to be anchored to an anatomical location, the anchor assembly comprising:

an anchor including an anchor body that defines an expandable portion, the expandable portion defining a direction of elongation, the anchor body defining a plurality of openings that extend through the expandable portion and are spaced substantially along the direction of elongation; and

the anchor further including an actuation member that extends through at least two of the openings, the actuation member configured to receive an actuation force and, in response to the actuation force, actuate the expandable portion from a first configuration, wherein the expandable portion defines a first maximum thickness along a second direction that is angularly offset from the direction of elongation, to an expanded configuration, wherein the expandable portion defines a second maximum thickness along the second direction that is greater than the first maximum thickness.

2. The anchor assembly as recited in claim 1, wherein the anchor body comprises a substrate that is initially devoid of at least some of the openings, and the substrate is at least one of braided, knitted and woven so as to define the openings.

3. The anchor assembly as recited in claim 2, wherein the substrate comprises an anchor body strand.

4. The anchor assembly as recited in claim 3, wherein the anchor body strand comprises a strand of suture.

5. The anchor assembly as recited in claim 3, wherein the anchor comprises a plurality of similarly constructed loops that are spaced along the direction of elongation.

6. The anchor assembly as recited in claim 1, wherein the expandable portion collapses along the direction of elongation as the expandable portion is actuated from the first configuration to the expanded configuration.

7. The anchor assembly as recited in claim 1, wherein the actuation member comprises an actuation strand.

8. The anchor assembly as recited in claim 1, wherein the actuation force is a tensile force.

9. The anchor assembly as recited in claim 3, wherein the actuation member comprises an actuation strand.

10. The anchor assembly as recited in claim 9, wherein the actuation strand is defined by an auxiliary strand that is separate from substrate and attached to the substrate.

11. The anchor assembly as recited in claim 10, wherein the actuation force is a proximally directed force, and the actuation strand comprises a first end that receives the actuation force.

12. The anchor assembly as recited in claim 11, wherein the actuation strand extends distally from the first end and is woven distally through at least first and second select ones of the openings along the direction of elongation.

13. The anchor assembly as recited in claim 12, wherein the actuation strand is looped through the second select opening so as to define a proximally extending second end.

14. The anchor assembly as recited in claim 13, wherein the second end is woven proximally through at least one of the openings.

15. The anchor assembly as recited in claim 13, wherein the second end extends proximally out the anchor body so as to be attached to another anchor.

16. The anchor assembly as recited in claim 13, wherein the second end is further woven proximally through a plurality of the openings.

17. The anchor assembly as recited in claim 12, wherein the actuation strand is woven distally through a plurality of the openings along the direction of elongation.

18. The anchor assembly as recited in claim 17, wherein the actuation strand is looped through one of the openings so as to define a proximally extending second end.

19. The anchor assembly as recited in claim 17, wherein the second end is further woven proximally through at least one of the openings.

20. The anchor assembly as recited in claim 19, wherein the second end is woven through one of the plurality openings that the actuation strand is woven distally through.

21. The anchor assembly as recited in claim 20, wherein the second end is woven through a proximal-most one of the openings.

22. The anchor assembly as recited in claim 9, wherein the actuation strand is barbed.

23. The anchor assembly as recited in claim 22, wherein the actuation strand comprises a first at least one barb that allows movement of the actuation strand through the openings along an actuation direction so as to actuate the expandable portion from the first configuration to the expanded configuration.

24. The anchor assembly as recited in claim 23, wherein the actuation strand further comprises a second at least one barb that is oriented opposite the first at least one barb, wherein the second at least one barb is configured to mate with the anchor body strand as the actuation strand moves along the actuation direction.

25. The anchor assembly as recited in claim 18, wherein the second end and the first end define a loop having a size.

26. The anchor assembly as recited in claim 25, wherein the actuation strand defines a sliding member disposed proximally with respect to the anchor body, and the second end is slidably coupled to the sliding member so as to decrease the size of the loop.

27. The anchor assembly as recited in claim 26, wherein the sliding member comprises an opening that extends through the actuation strand, such that the second end extends through the opening.

28. The anchor assembly as recited in claim 25, wherein the actuation strand defines a sliding member disposed proximally with respect to the expandable portion, and the first end is slidably coupled to the sliding member so as to decrease the size of the loop.

29. The anchor assembly as recited in claim 26, wherein the sliding member comprises an opening that extends through the second end, such that the first end extends through the opening.

30. The anchor assembly as recited in claim 10, wherein the actuation strand defines a post end and a free end, wherein the free end is knotted about the post end such that the post end is initially translatable with respect to the free end.

31. The anchor assembly as recited in claim 30, wherein the post end defines the actuation strand.

32. The anchor assembly as recited in claim 30, wherein the free end can be tightened to lock the post end with respect to translation relative to the free end.

33. The anchor assembly as recited in claim 30, wherein the free end provides an actuation strand of a second anchor.

34. The knot anchor as recited in claim 30, wherein the free end is further formed into an eyelet.

35. The anchor assembly as recited in claim 30, wherein the free end is fed through an eyelet of a second anchor body.

36. The anchor assembly as recited in claim 35, wherein the eyelet is configured to receive an actuation strand that is coupled to a second anchor.

37. The knot anchor assembly as recited in claim 10, wherein the anchor further comprises a looped strand.

38. The anchor assembly as recited in claim 37, wherein each of opposed ends of the loop extends through at least one respective opening of the anchor body so as to define respective first and second eyelets.

39. The anchor assembly as recited in claim 38, wherein the actuation strand extends through the first and second eyelets.

40. The anchor assembly as recited in claim 39, wherein the actuation strand defines first and second ends that extend from the a fold that extends through the second eyelet, and the first and second ends of the actuation strand extend through the first loop.

41. The anchor assembly as recited in claim 40, wherein application of the actuation force to at least one of the first and second ends causes the second eyelet to move through the first eyelet.

42. The anchor assembly as recited in claim 41, wherein the second eyelet defines a connector member configured to attach to another connector member so as to attach the anchor body to a second anchor body.

43. The anchor assembly as recited in claim 5, wherein the actuation strand is integral with the substrate.

44. The anchor assembly as recited in claim 43, wherein the anchor body defines a proximal end and an opposed distal end, the actuation strand is fed distally through a select one of the openings and woven proximally through at least one other of the openings that is disposed proximally with respect to the select one of the openings.

45. The anchor assembly as recited in claim 44, wherein the select opening is a distal-most opening.

46. The anchor assembly as recited in claim 44, wherein the actuation strand is woven proximally from the select opening through a plurality of openings.

47. The anchor assembly as recited in claim 43, wherein the actuation strand extends proximally from the anchor body.

48. The anchor assembly as recited in claim 43, wherein the anchor body strand defines a first end portion that extends proximally out the anchor body, and the first end portion defines the actuation strand.

49. The anchor assembly as recited in claim 48, wherein the anchor body strand further comprises a second end portion that extends distally out the anchor body.

50. The anchor assembly as recited in claim 49, wherein the second end portion is terminated at a location proximate to the anchor body.

51. The anchor assembly as recited in claim 47, wherein the second end portion is configured to attach the anchor body to a second anchor body.

52. The anchor assembly as recited in claim 9, wherein the anchor defines an eyelet and a plurality of loops that define respective openings, the loops spaced distally from the eyelet substantially along the direction of elongation.

53. The anchor assembly as recited in claim 52, wherein the eyelet is defined by a knot at one end of the anchor body.

54. The anchor assembly as recited in claim 52, wherein the anchor body is stitched through itself so as to define the eyelet.

55. The anchor assembly as recited in claim 52, wherein the anchor body is welded to itself so as to define the eyelet.

56. The anchor assembly as recited in claim 52, wherein the actuation strand defines first and second ends, and a fold disposed between the first and second ends, wherein the fold extends through the eyelet.

57. The anchor assembly as recited in claim 56, wherein the first and second ends extend through a plurality of select ones of the openings.

58. The anchor assembly as recited in claim 57, wherein the first and second ends extend through the same openings.

59. The anchor assembly as recited in claim 58, wherein each of at least a plurality of the openings is divided so as to define a first portion and a second portion disposed adjacent the first portion and separated from the first portion by a strand, and the first and second ends extend alternatingly through respective ones of the first and second portions of the select openings.

60. The actuation strand as recited in claim 58, wherein the actuation force comprises a tensile force applied to at least one of the first and second ends of the actuation strand that causes the eyelet to be pulled through the anchor body along a path defined by the actuation strand, and extend out the anchor body.

61. The anchor assembly as recited in claim 60, wherein the eyelet is configured to be attached to another strand that connects the anchor body to a second anchor body.

62. The anchor assembly as recited in claim 9, wherein the anchor body strand is elongate along a central axis that extends substantially along the direction of elongation when the expandable portion is in the first configuration.

63. The anchor assembly as recited in claim 62, wherein the anchor body strand defines a first cross-sectional dimension and the actuation strand defines a second cross-sectional dimension that is less than the first cross-sectional dimension.

64. The anchor assembly as recited in claim 63, wherein the expandable portion folds into an accordion structure when actuated to the expanded configuration.

65. The anchor assembly as recited in claim 3, wherein the anchor body strand is folded so as to define a double-segmented strand pair of strand segments that are braided so as to define the openings.

66. The anchor assembly as recited in claim 3, wherein the anchor body strand defines a pair of separate anchor body strand segments that are braided so as to define the openings.

67. The anchor assembly as recited in claim 1, wherein the openings are pre-existing in the substrate as-manufactured.

68. The anchor assembly as recited in claim 67, wherein the substrate includes a plurality of fibers that define at least one of a braid, weave, knit, and a mesh.

69. The anchor assembly as recited in claim 68, wherein the braid comprises a braided strand.

70. The knot anchor assembly as recited in claim 69, wherein the braid comprises a plurality of strands that are braided together.

71. The anchor assembly as recited in claim 1, wherein the openings are cut through the substrate.

72. The anchor assembly as recited in claim 71, wherein the openings are laser-cut through the substrate.

73. The anchor assembly as recited in claim 1, wherein the expandable portion defines opposed proximal and distal ends, and the direction of elongation extends linearly between the proximal and distal ends.

74. The anchor assembly as recited in claim 73, wherein the expandable portion is elongate along a central axis.

75. The anchor assembly as recited in claim 74, wherein at least a portion of the central axis is offset with respect to the direction of elongation.

81. The anchor assembly as recited in claim 1, wherein the anchor is a first anchor, the actuation strand of the first anchor is a first actuation strand, the anchor body of the first anchor is a first anchor body, and the knot anchor assembly further comprises a second anchor including 1) a second anchor body that extends substantially along a second direction of elongation, the second anchor defining a second plurality of openings that extend through the second anchor body, the openings spaced along the second direction of elongation, and 2) a second actuation strand that is woven through at least two of the openings,

wherein a tensile force applied to the second actuation strand along a direction substantially along the second direction of elongation causes the second anchor body to collapse along the second direction of elongation and expand along a direction angularly offset with respect to the second direction of elongation, so as to expand the second anchor from a first configuration to an expanded configuration.

82. The anchor assembly as recited in claim 81, wherein the first actuation strand is attached to the second actuation strand.

83. The anchor assembly as recited in claim 82, wherein the first actuation strand is integral with second actuation strand.

84. The anchor assembly as recited in claim 82, wherein the first actuation strand is separate from and attached to the second actuation strand.

85. The anchor assembly as recited in claim 81, further comprising a connector member that attaches the first anchor to the second anchor.

86. The anchor assembly as recited in claim 85, wherein the connector member defines a sliding member that allows one of the first and second actuation strands to translate relative to the other of the first and second actuation strands through the connector member.

87. The anchor assembly as recited in claim 85, wherein the connector member defines a locking member that prevents the first and second actuation strand translating relative to the other of the first and second actuation strands through the connector member.

88. The anchor assembly as recited in claim 85, wherein the connector member is defined by the first and second actuation strands.

89. The anchor assembly as recited in claim 88, wherein the connector member comprises a knot defined by the first and second actuation strands.

90. The anchor assembly as recited in claim 89, wherein the first actuation strand and the second actuation strand are tied so as to define the knot.

91. The anchor assembly as recited in claim 90, wherein the knot has 1) an unlocked configuration wherein one of the first and second actuation strands is translatable with respect to the other of the first and second actuation strands through the knot, and 2) a locked configuration wherein the first and second actuation strands are locked together with respect to relative translation through the knot.

92. The anchor assembly as recited in claim 88, wherein the connector member comprises a weldment between the first and second actuation strands.

93. The anchor assembly as recited in claim 92, wherein the first actuation strand is welded to the second actuation strand.

94. The anchor assembly as recited in claim 88, wherein the connector member comprises a twist tie.

95. The anchor assembly as recited in claim 94, wherein the twist tie is defined by the first and second actuation strands.

96. The anchor assembly as recited in claim 95, wherein at least one of the first and second actuation strands comprises a pliable deformable material so as to at least partially define the twist tie.

97. The anchor assembly as recited in claim 81, wherein the first actuation strand is integral with the first anchor body, and the second actuation strand is integral with the second anchor body.

98. The anchor assembly as recited in claim 97, wherein the second actuation strand is spliced through the first actuation strand so as to define a first splice.

99. The anchor assembly as recited in claim 98, wherein the first actuation strand is spliced through the second actuation strand so as to define a second splice.

100. The anchor assembly as recited in claim 99, wherein the first splice is disposed closer to the first anchor than the second splice.

101. The anchor assembly as recited in claim 81, wherein the first actuation strand is integral with the second actuation strand.

102. The anchor assembly as recited in claim 88, wherein the connector member is an auxiliary connector member configured to attach the first actuation strand to the second actuation strand.

103. The anchor assembly as recited in claim 102, wherein the auxiliary connector member comprises a strand that is stitched through the first and second actuation strands.

104. The anchor assembly as recited in claim 102, wherein the auxiliary connector member comprises a staple that attaches the first actuation strand to the second actuation strand.

105. The anchor assembly as recited in claim 102, wherein at least one of the first and second actuation strands is stitched through the auxiliary connector member.

106. The anchor assembly as recited in claim 105, wherein at least one of the first and second actuation strands is tied about the auxiliary connector.

107. The anchor assembly as recited in claim 102, wherein the first and second actuation strands are woven into the auxiliary connector member.

108. The anchor assembly as recited in claim 107, wherein the auxiliary connector member comprises a braided tube.

109. The anchor assembly as recited in claim 108, wherein the braided tube comprises at least one of a suture that defines a core and a tubular mesh.

110. The anchor assembly as recited in claim 102, wherein the auxiliary connector member comprises a shrink wrap material that is configured to be activated so as to tighten about the first and second actuation strands.

111. The anchor assembly as recited in claim 102, wherein the auxiliary connector comprises at least one tooth that is configured to engage at least one of the first and second actuation strands so as to prevent movement of the actuation strand through the auxiliary connector along a direction toward the respective anchor body.

112. The anchor assembly as recited in claim 111, wherein the auxiliary connector member comprises a collar having at least one ratchet tooth, and the first and second actuation strands have respective complementary ratchet teeth that engage the at least one ratchet tooth of the collar.

113. The anchor assembly as recited in claim 112, wherein at least one ratchet tooth of the collar mates with the ratchet teeth of the first and second actuation strands so as to allow the first and second actuation strands to slide through the collar along a direction away from the first and second anchors, respectively, while preventing the first and second actuation strands from sliding in the collar along a direction toward the first and second anchors, respectively.

114. The anchor assembly as recited in claim 112, wherein the first and second actuation strands are inserted into the collar along opposite directions.

115. The anchor assembly as recited in claim 111, wherein the auxiliary connector member comprises a ratchet housing having at least one ratchet tooth that mates with complementary ratchet teeth of the first and second actuation strands as the ratchet housing slides along the first and second actuation strands toward the anatomical location.

116. The anchor assembly as recited in claim 115, wherein the first and second actuation strands are inserted into the collar along substantially same direction.

117. The anchor assembly as recited in claim 111, wherein the auxiliary connector member comprises a zip tie housing that defines first and second channels configured to receive the first and second actuation strands.

118. The anchor assembly as recited in claim 117, wherein the zip tie housing defines a plurality of teeth configured to mate with the first and second actuation strands such that the zip tie housing is movable toward the first and second anchors but is prevented from moving away from the first and second anchors.

119. The anchor assembly as recited in claim 118, wherein each of the first and second actuation strands define a rack of teeth configured to mate with the teeth of the zip tie housing such that the zip tie housing is movable toward the first and second anchors but is prevented from moving away from the first and second anchors.

120. The anchor assembly as recited in claim 81, wherein at least the first anchor further comprises a first looped strand that extends through at least one respective opening of the first anchor body so as to define respective first and second eyelets that define respective first and second openings.

121. The anchor assembly as recited in claim 120, wherein the first actuation strand comprises an auxiliary strand that extends through the openings of the first and second eyelets.

122. The anchor assembly as recited in claim 121, wherein the second anchor further comprises a second looped strand that extends through at least one respective opening of the second anchor body so as to define respective first and second eyelets that define respective first and second openings.

123. The anchor assembly as recited in claim 122, wherein the second actuation strand is an auxiliary strand that extends through the openings of the first and second eyelets of the second looped strand.

124. The anchor assembly as recited in claim 123, wherein the first actuation strand is integral with the second actuation strand.

125. The anchor assembly as recited in claim 123, further comprising a connector member that attaches the first actuation strand to the second actuation strand.

126. The anchor assembly as recited in claim 125, wherein the connector member comprises a knot that can be actuated between an unlocked configuration whereby the at least one of the first and second actuation strands is translatable through the knot with respect to the other of the first and second actuation strands, and a locked configuration whereby the first and second actuation strands are translatably fixed to each other through the knot.

127. The anchor assembly as recited in claim 81, wherein the first actuation strand is separate from and attached to the first anchor body and defines first and second portions that extend from the first anchor body.

128. The anchor assembly as recited in claim 127, further comprising a connector member that couples the first portion of the first actuation strand to the second portion of the first actuation strand.

129. The anchor assembly as recited in claim 128, wherein the connector member is a knot that is operable between an unlocked configuration whereby the first portion of the first actuation strand is translatable through the knot so as to actuate the first anchor from the first configuration to the expanded configuration, and a locked configuration so as to prevent translation of the first portion of the first actuation strand through the knot.

130. The anchor assembly as recited in claim 128, wherein the second actuation strand is separate from and attached to the second anchor body and defines first and second portions that extend from the second anchor body.

131. The anchor assembly as recited in claim 130, wherein the connector member is a first connector member, the anchor assembly further comprising a second connector member that couples the first portion of the second actuation strand to the second portion of the second actuation strand.

132. The anchor assembly as recited in claim 131, wherein the connector member is a second knot that is operable between an unlocked configuration whereby the first portion of the second actuation strand is translatable through the second knot so as to actuate the second anchor from the first configuration to the expanded configuration, and a locked configuration so as to prevent translation of the first portion of the second actuation strand through the second knot.

133. The anchor assembly as recited in claim 130, wherein the first actuation strand defines first and second portions that extend out from the first anchor body, and the second actuation strand defines first and second portions that extend out from the second anchor body.

134. The anchor assembly as recited in claim 133, wherein the second portion of the firs actuation strand is integral with the second portion of the first actuation strand.

135. The anchor assembly as recited in claim 134, wherein the first and second actuation strands are defined by a common strand, the anchor assembly further comprising a first connector member that attaches the first portion of the first actuation strand to a location of the common strand and a second connector that attaches the second portion of the second actuation strand to another location of the common strand.

136. The anchor assembly as recited in claim 81, wherein the first actuation strand is spliced through the second actuation strand.

137. The anchor assembly as recited in claim 136, wherein the second actuation strand is spliced through the first actuation strand.

138. The anchor assembly as recited in claim 136, wherein the first actuation strand is spliced through the second actuation strand along a direction from the second anchor body toward the first anchor body.

139. The anchor assembly as recited in claim 138, wherein the second actuation strand is spliced through the first actuation strand along a direction from the first anchor body toward the second anchor body.

140. The anchor assembly as recited in claim 137, wherein the second actuation strand is spliced through the first actuation strand at a first location, the first actuation strand is spliced through the second actuation strand at a second location, and the first location is spaced closer to the first anchor body than the second location.

141. The anchor assembly as recited in claim 81, wherein the second anchor comprises an eyelet, and the first actuation strand is attached to the eyelet.

142. The anchor assembly as recited in claim 141, wherein the first actuation strand extends through the eyelet so as to define a first end and a second end.

143. The anchor assembly as recited in claim 142, further comprising a connector member that attaches the first end to the second end.

144. The anchor assembly as recited in claim 143, wherein the connector member is integral with the first and second ends.

145. The anchor assembly as recited in claim 144, wherein the connector member is a knot.

146. The anchor assembly as recited in claim 145, wherein the knot is configured to be actuated between an unlocked configuration whereby the first end is translatable through the knot with respect to the second end, and a locked configuration whereby the first end is fixed to the second end with respect to translation through the knot.

147. The anchor assembly as recited in claim 141, wherein the second actuation strand is auxiliary with respect to the second anchor body and defines the eyelet.

148. The anchor assembly as recited in claim 147, wherein the second actuation strand includes first and second portions that extend from the second anchor body, wherein the second portion defines the eyelet and the first portion is attached to the second portion.

149. The anchor assembly as recited in claim 148, wherein the first portion and the second portion define a knot that is configured to be actuated between an unlocked configuration whereby the first portion is translatable through the knot with respect to the second portion, and a locked configuration whereby the first portion is fixed to the second portion with respect to translation through the knot.

150. The anchor assembly as recited in claim 81, further comprising a connector member attached between the first and second anchors.

151. The anchor assembly as recited in claim 150, wherein the connector member is attached between the first and second actuation strands.

152. The anchor assembly as recited in claim 150, wherein the connector member comprises a connector strand.

153. The anchor assembly as recited in claim 152, further comprising a second connector member that attaches a first portion of the connector strand to a second portion of the connector strand so as to secure the first and second actuation strands to each other.

154. The anchor assembly as recited in claim 153, wherein the second connector member is integral with the first and second portions of the connector strand.

155. The anchor assembly as recited in claim 154, wherein the second connector member comprises a knot that is defined by the first and second connector strands.

156. The anchor assembly as recited in claim 155, wherein the knot is configured to be actuated between an unlocked configuration whereby the first portion is translatable through the knot with respect to the second portion, and a locked configuration whereby the first portion is fixed to the second portion with respect to translation through the knot.

157. The anchor assembly as recited in claim 152, wherein the first anchor comprises a first eyelet, the second anchor comprises a second eyelet, and the connector strand is attached to the first and second eyelets.

158. The anchor assembly as recited in claim 157, wherein the connector strand extends through the first and second eyelets, and the connector strand defines first and second portions that extend from the first and second eyelets, respectively.

159. The anchor assembly as recited in claim 158, further comprising a second connector member that attaches the first and second portions of the connector strand.

160. The anchor assembly as recited in claim 159, wherein the second connector is integral with the first and second portions of the connector strand.

161. The anchor assembly as recited in claim 160, wherein the second connector is a knot defined by the first and second portions of the connector strand.

162. The anchor assembly as recited in claim 161, wherein the knot is configured to be actuated between an unlocked configuration whereby the first portion is translatable through the knot with respect to the second portion, and a locked configuration whereby the first portion is fixed to the second portion with respect to translation through the knot.

163. The anchor assembly as recited in claim 81, further comprising first and second connector strands attached between the first and second actuation strands.

164. The anchor assembly as recited in claim 163, wherein the first connector strand is spliced through the second connector strand.

165. The anchor assembly as recited in claim 164, wherein the first connector strand is spliced through the second connector strand and first and second locations that are spaced from each other.

166. The anchor assembly as recited in claim 163, wherein the second connector strand is spliced through the first connector strand.

167. The anchor assembly as recited in claim 166, wherein the second connector strand is spliced through the first connector strand and first and second locations that are spaced from each other.

168. The anchor assembly as recited in claim 167, wherein the first connector strand is spliced through the second connector strand.

169. The anchor assembly as recited in claim 168, wherein the first connector strand extends from the first actuation strand so as to define corresponding first and second portions, and the second connector strand extends from the second actuation strand so as to define corresponding first and second portions.

170. The anchor assembly as recited in claim 169, wherein the first portion of the first connector strand is spliced through the first portion of the second connector strand.

171. The anchor assembly as recited in claim 170, wherein the first portion of the first connector strand is spliced through the first portion of the second connector strand along a direction from the second anchor body toward the first anchor body.

172. The anchor assembly as recited in claim 170, wherein the first portion of the second connector strand is spliced through the first portion of the first connector strand.

173. The anchor assembly as recited in claim 172, wherein the first portion of the first connector strand is spliced through the first portion of the second connector strand at a first location, the first portion of the second connector strand is spliced through the first portion of the first connector strand at a second location, and the first location is disposed closer to the second anchor body than the second location.

174. The anchor assembly as recited in claim 172, wherein the second portion of the first connector strand is spliced through the second portion of the second connector strand.

175. The anchor assembly as recited in claim 174, wherein the second portion of the second connector strand is spliced through the first portion of the second connector strand.

176. The anchor assembly as recited in claim 170, wherein the second portion of the first connector strand is spliced through the second portion of the second connector strand.

177. The anchor assembly as recited in claim 176, wherein the first and second portions of the first connector strand exit the respective first and second portions of the second connector strand so as to define respective first and second terminal portions.

178. The anchor assembly as recited in claim 177, further comprising a connector member that attaches the first terminal portion to the second terminal portion.

179. The anchor assembly as recited in claim 178, wherein the connector member is integral with the first and second terminal portions.

180. The anchor assembly as recited in claim 179, wherein the connector member comprises a knot defined by the first and second terminal portions.

181. The anchor assembly as recited in claim 180, wherein the knot is configured to be actuated between an unlocked configuration whereby the first terminal portion is translatable through the knot with respect to the second terminal portion, and a locked configuration whereby the first terminal portion is fixed to the second terminal portion with respect to translation through the knot.

182. The anchor assembly as recited in claim 102, wherein at least one of the first and second anchors includes an eyelet, and the auxiliary connector member is attached to the eyelet.

183. The anchor assembly as recited in claim 151, wherein the connector member is an auxiliary connector attached between the first and second actuation strands.

184. The anchor assembly as recited in claim 183, wherein at least one of the first and second anchors includes an eyelet, and the auxiliary connector member is attached to the eyelet.

185. The anchor assembly as recited in claim 184, wherein the auxiliary connector member comprises at least one hook attached to the eyelet.

186. The anchor assembly as recited in claim 185, wherein the other of the first and second anchors includes a second eyelet, and the auxiliary connector comprises a second hook attached to the second eyelet and configured to mate with the first hook so as to attach the first and second anchors.

187. The anchor assembly as recited in claim 186, wherein the first and second hooks are made from a shape memory material and define a first shape when mated to each other and a second shape after mating with each other, wherein the first shape is different than the second shape.

188. The anchor assembly as recited in claim 152, wherein the connector strand comprises a first end, and defines and a second end that is configured to mate with the first end.

189. The anchor assembly as recited in claim 188, wherein the connector strand defines a loop having a size when the first end mates with second end, and the first end mates with the second end such that the first end is movable with respect to the second end only in a directly that decreases the size of the loop.

190. The anchor assembly as recited in claim 189, wherein the first end is barbed, and the second end defines an aperture configured to receive the barbed first end.

191. The anchor assembly as recited in claim 188, wherein the first and second anchors comprise eyelets, and the connector strand extends through the eyelets.

192. The anchor assembly as recited in claim 85, wherein the connector member comprises a spring having a spring constant that biases the first anchor toward the second anchor.

193. The anchor assembly as recited in claim 192, wherein the spring member is attached to at least one of the first and second actuation strands.

194. The anchor assembly as recited in claim 192, wherein the at least one of the first and second anchors defines an eyelet, and the spring member is attached to the eyelet.

195. The anchor assembly as recited in claim 81, wherein the first and second actuation strands define a sliding member that allows one of the actuation strands to translate relative to the second actuation strand so as to apply a force to at least one of the anchors that biases the anchor toward the other anchor.

196. The anchor assembly as recited in claim 195, further comprising a locking member that prevents the actuation strands from translating relative to each other through the locking member.

197. The anchor assembly as recited in claim 196, further comprising a connector member that defines both the sliding member and the locking member.

198. The anchor assembly as recited in claim 81, further comprising a locking member that prevents the actuation strands from translating relative to each other through the locking member.

199. The anchor assembly as recited in claim 81, further comprising a connector strand attached between the first and second anchors.

200. The anchor assembly as recited in claim 199, wherein the connector strand defines a first portion and a second portion spaced from the first portion, the anchor assembly comprising a sliding member that allows one of the first and second portions to translate relative to the other of the first and second portions so as to apply a force to at least one of the anchors that biases the anchor toward the other anchor.

201. The anchor assembly as recited in claim 200, further comprising a locking member that prevents the first and second portions from translating relative to each other through the locking member.

202. The anchor assembly as recited in claim 201, further comprising a connector member that defines both the sliding member and the locking member.

203. The anchor assembly as recited in claim 199, wherein the connector strand defines a first portion and a second portion spaced from the first portion, the anchor assembly further comprising a locking member that prevents the first and second portions from translating relative to each other through the locking member.

204. The anchor assembly as recited in claim 199, wherein the connector strand is attached to at least one of the first and second actuation strands.

205. The anchor assembly as recited in claim 204, further comprising a sliding member that allows one of the connector strand and the at least one of the first and second actuation strands to translate relative to the other so as to apply a force to at least one of the anchors that biases the anchor toward the other anchor.

206. The anchor assembly as recited in claim 205, further comprising a locking member that prevents the connector strand and the at least one of the first and second actuation strands from sliding relative to each other through the locking member.

207. The anchor assembly as recited in claim 206, further comprising a connector member that defines both the sliding member and the locking member.

208. The anchor assembly as recited in claim 204, further comprising a locking member that prevents the connector strand and the at least one of the first and second actuation strands from translating relative to each other through the locking member.

209. The anchor assembly as recited in claim 81, wherein the first actuation strand is auxiliary with respect to the first anchor body and the second actuation strand is integral with the second anchor body.

210. The anchor assembly as recited in claim 82, wherein the first actuation strand defines a first portion and a second portion that extend from the anchor body.

211. The anchor assembly as recited in claim 210, wherein the second portion is integral with the second actuation strand.

212. The anchor assembly as recited in claim 211, further comprising a connector that attaches the first portion of the first actuation strand to at least one of the second portion of the actuation strand and the second actuation strand.

213. The anchor assembly as recited in claim 212, wherein the connector allows the first portion of the first actuation strand to translate with respect to the at least one of the second portion of the actuation strand and the second actuation strand.

214. The anchor assembly as recited in claim 213, wherein the connector is further configured to prevent the first portion of the first actuation strand from translating with respect to the at least one of second first portion of the first actuation strand and the second actuation strand.

215. The anchor assembly as recited in claim 212, wherein the connector comprises a knot defined by the first portion of the first actuation strand and at least one of the first portion of the actuation strand and the second actuation strand.

216. The anchor assembly as recited in claim 85, wherein the first and second anchor bodies comprise respective first and second eyelets and the first and second actuation strands are woven through the respective first and second anchor bodies and attached to the first and second eyelets.

217. The anchor assembly as recited in claim 216, wherein the first actuation strand is integral with the second actuation strand.

218. The anchor assembly as recited in claim 216, further comprising a connector member that attaches the first actuation strand to the second actuation strand.

219. The anchor assembly as recited in claim 216, wherein the first actuation strand comprises a first actuation portion and a first attachment portion that each extend out from the first anchor body, and the second actuation strand comprises a second actuation portion and a second attachment portion that each extend out from the second anchor body.

220. The anchor assembly as recited in claim 219, wherein the first attachment portion is integral with the second attachment portion.

221. The anchor assembly as recited in claim 219, wherein the connector member that attaches the first actuation portion and the second actuation portion.

222. The anchor assembly as recited in claim 221, wherein the connector member is defined by the first actuation portion and the second actuation portion.

223. The anchor assembly as recited in claim 222, wherein the connector member comprises a knot that is defined by the first actuation portion and the second actuation portion.

224. The anchor assembly as recited in claim 223, wherein the knot that can be actuated between an unlocked configuration whereby the at least one of the first and second actuation portions is translatable through the knot with respect to the other of the first and second actuation portions, and a locked configuration whereby the first and second actuation portions are translatably fixed to each other through the knot.

225. The anchor assembly as recited in claim 221, wherein the first and second actuation portions are each configured to receive respective actuation forces that causes the respective first and second anchors to actuate from the respective first configuration to the expanded configuration.

226. The anchor assembly as recited in claim 85, wherein the first and second anchor bodies comprise respective first and second eyelets and the first and second actuation strands are woven through the respective first and second anchor bodies and attached to the first and second eyelets.

227. The anchor assembly as recited in claim 226, wherein the first actuation strand defines first and second portions that extend from the first anchor body.

228. The anchor assembly as recited in claim 227, wherein the connector member attaches the first portion of the first actuation strand to the second portion of the first actuation strand.

229. The anchor assembly as recited in claim 228, wherein the connector member is a knot that is operable between an unlocked configuration whereby the first portion of the first actuation strand is translatable through the knot so as to actuate the first anchor from the first configuration to the expanded configuration, and a locked configuration so as to prevent translation of the first portion of the first actuation strand through the knot.

230. The anchor assembly as recited in claim 228, wherein the second actuation strand first and second portions that extend from the second anchor body.

231. The anchor assembly as recited in claim 230, wherein the connector member is a first connector member, the anchor assembly further comprising a second connector member that couples the first portion of the second actuation strand to the second portion of the second actuation strand.

232. The anchor assembly as recited in claim 231, wherein the second connector member is a second knot that is operable between an unlocked configuration whereby the first portion of the second actuation strand is translatable through the second knot so as to actuate the second anchor from the first configuration to the expanded configuration, and a locked configuration so as to prevent translation of the first portion of the second actuation strand through the second knot.

233. The anchor assembly as recited in claim 230, wherein the first actuation strand defines first and second portions that extend out from the first anchor body, and the second actuation strand defines first and second portions that extend out from the second anchor body.

234. The anchor assembly as recited in claim 233, wherein the second portion of the firs actuation strand is integral with the second portion of the first actuation strand.

235. The anchor assembly as recited in claim 234, wherein the first and second actuation strands are defined by a common strand, the anchor assembly further comprising a first connector member that attaches the first portion of the first actuation strand to a location of the common strand and a second connector that attaches the second portion of the second actuation strand to another location of the common strand.

236. The anchor assembly as recited in claim 85, wherein the first and second anchor bodies comprise respective first and second eyelets and the first and second actuation strands are woven through the respective first and second anchor bodies and attached to the first and second eyelets.

237. The anchor assembly as recited in claim 236, wherein the first actuation strand is integral with the second actuation strand so as to define a common auxiliary strand

238. The anchor assembly as recited in claim 236, wherein the second actuation strand is spliced through the first actuation strand so as to define a first splice.

239. The anchor assembly as recited in claim 238, wherein the first actuation strand is spliced through the second actuation strand so as to define a second splice.

240. The anchor assembly as recited in claim 239, wherein the first splice is disposed closer to the first anchor than the second splice.

241. The anchor assembly as recited in claim 239, wherein the first actuation strand defines first and second spaced portions that extend out from the first anchor body, the second actuation strand defines first and second spaced portions that extend out from the first anchor body, and the second portion of the first actuation strand is attached to the second portion of the second actuation strand.

242. The anchor assembly as recited in claim 241, wherein the second portion of the first actuation strand is integral with the second portion of the second actuation strand.

243. The anchor assembly as recited in claim 241, wherein the first portion of the first actuation strand is spliced through the second portion of the second actuation strand, and the first portion of the second actuation strand is spliced through the second portion of the first actuation strand.

244. The anchor assembly as recited in claim 236, wherein the first actuation strand defines first and second spaced portions that extend out from the first anchor body, and the second actuation strand defines first and second spaced portions that extend out from the second anchor body, the anchor assembly further comprising a compression member that is attached to the second portions of the first and second actuation strands.

245. The anchor assembly as recited in claim 244, wherein the second portions of the first and second actuation strands are integral with the compression member.

246. The anchor assembly as recited in claim 244, wherein the first portions of the first and second actuation strands extend through the compression member.

247. The anchor assembly as recited in claim 246, wherein a tensile force applied to the first portions of the first and second actuation strands induces tension in the first and second actuation strands that causes the compression member to compress against the first portions of the first and second actuation strands.

248. The anchor assembly as recited in claim 85, wherein the first and second anchor bodies comprise respective first and second eyelets and the first and second actuation strands are woven through the respective first and second anchor bodies and attached to the first and second eyelets.

249. The anchor assembly as recited in claim 248, wherein the first and second actuation strands each extend through both the first anchor body and the second anchor body.

250. The anchor assembly as recited in claim 249, wherein the first and second actuation strands each extend through both the first eyelet and the second eyelet.

251. The anchor assembly as recited in claim 248, further comprising a compression member attached between the first and second actuation strands.

252. The anchor assembly as recited in claim 251, wherein the compression member is integral with the first and second actuation strands.

253. The anchor assembly as recited in claim 251, wherein the first actuation strand is attached to the compression member at one end, extends through the first and second eyelets, and defines a first terminal portion at another end, wherein the first terminal portion extends through the compression member.

254. The anchor assembly as recited in claim 253, wherein the second actuation strand is attached to the compression member at one end, extends through the first and second eyelets, and defines a second terminal portion at another end, wherein the second terminal portion extends through the compression member.

255. The anchor assembly as recited in claim 254, wherein a tensile force applied to the terminal portions of the first and second actuation strands induces tension in the first and second actuation strands that causes the compression member to apply a compression force against the first and second actuation strands.

256. The anchor assembly as recited in claim 81, wherein the first anchor body includes a first eyelet and the second anchor includes a connector strand integral with the second anchor body, wherein the connector strand of the second anchor defines an actuation strand of the first anchor.

257. The anchor assembly as recited in claim 256, wherein the actuation strand of the first anchor comprises an attachment portion and an actuation portion, wherein the attachment portion extends to the second anchor body and the actuation portion is slidably attached to the attachment portion.

258. The anchor assembly as recited in claim 257, wherein the actuation portion is spliced through the attachment portion.

259. The anchor assembly as recited in claim 258, wherein the second anchor body defines a second eyelet, and the first anchor includes a connector strand integral with the first anchor body, wherein the connector strand of the first anchor defines an actuation strand of the second anchor.

260. The anchor assembly as recited in claim 259, wherein the actuation strand of the second anchor comprises a second attachment portion and a second actuation portion, wherein the second attachment portion extends to the first anchor body and the second actuation portion is slidably attached to the second attachment portion.

261. The anchor assembly as recited in claim 260, wherein the second actuation portion is spliced through the second attachment portion.

262. The anchor assembly as recited in claim 256, wherein the actuation member extends through the eyelet.

263. The anchor assembly as recited in claim 258, wherein the actuation strand of the second anchor extends through the second eyelet.

264. The anchor assembly as recited in claim 85, wherein the first anchor body comprises an eyelet and the first actuation strand is woven through the first anchor body and attached to the eyelet.

265. The anchor assembly as recited in claim 264, wherein the first actuation strand is auxiliary with respect to the first anchor body and the second actuation strand is integral with the second anchor body.

266. The anchor assembly as recited in claim 265, wherein the first actuation strand defines a first portion and a second portion that extend from the anchor body.

267. The anchor assembly as recited in claim 266, wherein the second portion is integral with the second actuation strand.

268. The anchor assembly as recited in claim 267, wherein the connector member attaches the first portion of the first actuation strand to at least one of the second portion of the actuation strand and the second actuation strand.

269. The anchor assembly as recited in claim 268, wherein the connector member allows the first portion of the first actuation strand to translate with respect to the at least one of the second portion of the actuation strand and the second actuation strand.

270. The anchor assembly as recited in claim 269, wherein the connector member is further configured to prevent the first portion of the first actuation strand from translating with respect to the at least one of the second portion of the actuation strand and the second actuation strand.

271. The anchor assembly as recited in claim 268, wherein the connector member comprises a knot defined by the second portion of the first actuation strand to at least one of the first portion of the actuation strand and the second actuation strand.

272. The anchor assembly as recited in claim 266, wherein the first actuation strand is spliced through the second actuation strand such that the connector member defines a splice.

273. The anchor assembly as recited in claim 81, wherein at least one of the first and second anchor bodies comprises an eyelet, and a plurality of actuation strands are woven through the eyelet.

274. The anchor assembly as recited in claim 102, wherein the auxiliary connector member comprises a connector strand that attaches the first anchor body to the second anchor body.

275. The anchor assembly as recited in claim 274, wherein the connector strand extends through a first opening of the first anchor body along a direction away from the second anchor body, is folded through a second opening of the first anchor body along a direction toward the second anchor body, extends through a first opening of the second anchor body, and is folded through a second opening of the second anchor body along a direction toward the first anchor body.

276. The anchor assembly as recited in claim 275, wherein the connector strand defines first and second portions that extend from the first and second anchor bodies, respectively.

277. The anchor assembly as recited in claim 276, further comprising a connector member that attaches the first portion of the connector strand to the second portion of the connector strand.

76. An anchor configured to be inserted to an anatomical location, the anchor comprising:

a plurality of knots slidably coupled to a common actuation strand, the common actuation strand defining a variable sized loop, wherein each of the plurality of knots is configured to be inserted to a target anatomical location, and the variable sized loop is configured to be reduced in size so as to bring each of the plurality of knots together to define a cluster that is dimensioned greater than each of the plurality of knots individually.

77. The anchor as recited in claim 76, wherein each of the knots is slidably mounted on the common actuation strand.

78. The anchor assembly as recited in claim 77, wherein each of the knots defines an eyelet that receives the common actuation strand and is slidable along the common actuation strand.

79. The anchor assembly as recited in claim 76, wherein the common actuation strand defines a pair of free ends at the actuation portion that are slidably attached to each other.

80. The anchor assembly as recited in claim 78, wherein the free ends are tied in a sliding knot such that one of the free ends slides along the other so as to decrease the size of the loop.

278. A method of constructing an anchor body from an anchor body strand, the anchor body configured to be implanted at a target anatomical location and subsequently expanded, the method comprising the steps of:

tying the anchor body strand so as to define a first stopper knot having a post end and a free end, the free end defined by a first end portion of the anchor body strand and the post end defined by a second end portion of the anchor body strand;

looping the first end portion so as to form a first proximal loop;

passing the first proximal loop through the stopper knot such that the second end portion extends from the first proximal loop through the stopper knot;

braiding the second end portion distally from the stopper knot so as to define a plurality of similarly constructed loops that are spaced substantially along a direction of elongation, wherein each of the loops defines a respective opening;

weaving an actuation strand through at least one of the openings, such that the actuation strand is configured to receive an actuation force that causes the anchor body to expand along a second direction that is offset with respect to the direction of elongation.

279. The method as recited in claim 278, wherein the passing step further comprises drawing the first end portion through the first proximal loop and tightening the first end portion so as to define a proximal-most knot;

280. The method as recited in claim 278, further comprising the step of creating additional distal loops and passing each of the additional distal loops through an immediately proximal loop relative to each of the additional distal loops.

281. A method of constructing an anchor from at least one anchor body strand, the anchor including an expandable portion that is configured to be implanted at a target anatomical location and subsequently expanded, the method comprising the steps of:

(A) creating a first prior loop, such that the anchor body strand defines an end portion that extends from the prior loop;

(B) creating the expandable portion from the anchor body strand, including the steps of;

(i) looping the end portion through the first prior loop so as to define a first new loop, the first new loop defining an opening, wherein the first new loop is disposed on one side of the first prior loop, and the end portion extends from the first new loop on an opposite side of the first prior loop;

(ii) looping the end portion through a second prior loop, which is defined by the first new loop, so as to define a second new loop, the second new loop defining an opening;

(iii) tightening the second new loop about the second prior loop; and

(iv) creating additional new loops that extend through respective prior loops so as to define a plurality of loops each having a respective opening; and

(C) weaving an actuation strand through at least one of the openings, such that the actuation strand is configured to receive an actuation force that causes the anchor body to expand along a second direction that is offset with respect to the direction of elongation.

282. The method as recited in claim 281, wherein the first prior loop defines an eyelet.

283. The method as recited in claim 282, further comprising the step of forming the eyelet integrally with the anchor body strand.

284. The method as recited in claim 283, wherein the actuation strand is stitched through itself so as to define the eyelet.

285. The method as recited in claim 284, wherein the actuation strand is further tied so as to fix the eyelet.

286. The method as recited in claim 284, wherein the actuation strand is stitched through itself a second time.

287. The method as recited in claim 284, wherein the actuation strand is knotted so as to define the eyelet.

303. The insertion instrument according to claim 287, wherein the cannula defines a first longitudinal aperture and the hollow push rod defines a second longitudinal aperture so that by rotating said push rod relative to said cannula said first and second aperture can be aligned and said insertion instrument can be released from said elongated suturing element.

288. An insertion instrument configured to deploy at least one anchor at an anatomical structure, the anchor including a substrate that extends substantially along a direction of elongation, the substrate defining a plurality of openings spaced along the direction of elongation, and an actuation member that is woven through at least two of the openings, the insertion instrument comprising:

a cannula defining a central opening sized to receive the anchor; and

a push rod insertable into the cannula and configured to be depressed in the central opening so as to eject an anchor from the cannula and into the anatomical structure, such that when a tensile force is applied to the actuation member along a direction substantially along the direction of elongation, such that the anchor expands along a second direction angularly offset with respect to the direction of elongation.

289. The insertion instrument as recited in claim 288, wherein the push rod is configured to brace against the anchor.

290. The insertion instrument according to claim 288, wherein the cannula defines a slot that receives the actuation member, such that the actuation member extends from the knot anchor out the cannula.

291. The insertion instrument according to claim 288, wherein the push rod has an outer diameter which is smaller than that of the central opening of said cannula such that the actuation member extends through said central opening of said cannula alongside the push rod.

292. The insertion instrument according to claim 288, wherein the push rod comprises a central bore so that the anchor can be inserted through the central bore and into the central opening of the cannula.

293. The insertion instrument according to claim 288, wherein the insertion instrument further comprises a handle, and the cannula is removably attached to the handle.

294. The insertion instrument according to claim 288, wherein said cannula defines a conical inlet.

295. The insertion instrument according to claim 288, wherein the depressing the push rod causes the anchor to translate out the opening.

296. The insertion instrument according to claim 295, wherein the cannula defines a distal end that defines a needle tip, and depressing the push rod causes the anchor to translate distally out the opening.

297. The insertion instrument according to claim 296, wherein the needle tip is conical.

298. The insertion instrument according to claim 295, wherein the opening terminates at a distal end, and the cannula defines a side ejection portal in communication with the distal end of the opening.

299. The insertion instrument according to claim 298, further comprising a tip that extends distally from the cannula.

300. The insertion instrument according to claim 299, wherein the tip is conical.

301. The insertion instrument according to claim 300, wherein the tip comprises a cone.

302. The insertion instrument according to claim 295, wherein the cannula defines a tapered distal end.