INSERTION INSTRUMENT FOR ANCHOR ASSEMBLY

• US 20120143215A1
• Filed: 10/27/2011
• Published: 06/07/2012
• 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: Corrao, Ernie, Singhatat, Wamis, Larsen, Scott, Bouduban, Nicolas, Litke, Ron George, Snyder, Stephen Joseph, Richards, Robert L.
• Granted Patent: US 9,724,080 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• 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 2017/00477 Coupling A61B2017/0046 takes 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
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• 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 2017/06042 : located close to needle tip
• CPC Class Codes: A61B 2017/06052 : Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
• CPC Class Codes: A61B 2017/06176 : with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/2917 : with flexible part
• CPC Class Codes: A61B 2017/292 : connection of actuating rod to handle, e.g. ball end in recess

Abstract

An insertion instrument is configured to eject at least one anchor body into respective target locations, and subsequently apply a predetermined tensile force at least one actuation member of the at least one anchor member so as to actuate the at least one anchor body from a first configuration to a second expanded configuration. The insertion instrument can include a tension assembly that applies the predetermined tensile force to the at least one actuation member. The predetermined tensile force can be defined by a distance of travel, a predetermined failure force of a fuse, or a combination of distance of travel and a predetermined failure force of a fuse.

Claims

1. An insertion instrument configured to eject at least one anchor at a target location, the anchor including an anchor body that extends substantially along a direction of elongation, the anchor further including an actuation member that extends from the anchor body substantially along the direction of elongation, the insertion instrument comprising:

an access member elongate along a longitudinal direction, the access member defining a distal end that is configured to be at least partially inserted into the target location;

an anchor housing that releasably carries the at least one anchor, the anchor housing configured to be aligned with the access member; and

a pusher member configured to be inserted into the anchor housing and to eject the at least one anchor from the anchor housing and out the distal end of the access member.

2. The insertion instrument of claim 1, wherein the access member defines a first cannulation extending therethrough along the longitudinal direction and sized to receive therein at least a portion of the anchor housing, and wherein the anchor housing defines a second cannulation extending therethrough along the longitudinal direction and sized to receive therein at least a portion of the pusher member.

3. The insertion instrument of claim 2, wherein the pusher member defines a third cannulation extending therethrough along the longitudinal direction and sized to receive at least a portion of the actuation member therein.

4. The insertion instrument of claim 3, wherein the access member defines a contact surface at a proximal end of the access member, the contact surface configured to abut a second contact surface defined by the anchor housing.

5. The insertion instrument of claim 4, wherein the second contact surface is intermediate with respect to opposed proximal and distal ends of the anchor housing.

6. The insertion instrument of claim 5, wherein the second contact surface abuts the contact surface when the anchor housing is fully inserted with respect to the access member.

7. The insertion instrument of claim 6, wherein when the anchor housing is fully inserted with respect to the access member, the distal end of the anchor housing substantially aligns with a distal end of the access member.

8. The insertion instrument of claim 6, wherein the anchor housing defines a third contact surface at the proximal end of the anchor housing, the third contact surface configured to abut a fourth contact surface defined by the pusher member.

9. The insertion instrument of claim 8, wherein the fourth contact surface is intermediate with respect to opposed proximal and distal ends of the pusher member.

10. The insertion instrument of claim 9, wherein when the pusher member is fully inserted with respect to the anchor housing, a distal end of the pusher member substantially aligns with the distal end of the access member.

11. The insertion instrument of claim 10, wherein the proximal end of the access member defines a first interlocking member and the anchor housing defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member, the anchor housing, and the pusher member are prevented from translating with respect to one another along the longitudinal direction.

12. The insertion instrument of claim 9, wherein when the pusher member is fully inserted with respect to the anchor housing, a distal end of the pusher member substantially aligns with respective distal ends of the access member and the anchor housing.

13. The insertion instrument of claim 12, wherein the proximal end of the access member defines a first interlocking member and the anchor housing defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the anchor housing are prevented from translating with respect to one another along the longitudinal direction.

14. The insertion instrument of claim 13, wherein the proximal end of the anchor housing defines a third interlocking member and the pusher member defines a fourth interlocking member configured to engage the third interlocking member, wherein when the third and fourth interlocking members are engaged the anchor housing and the pusher member are prevented from translating with respect to one another along the longitudinal direction.

15. The insertion instrument of claim 9, wherein the anchor is ejected out the distal end of the anchor housing when the second contact surface and the contact surface abut each other, and when the fourth contact surface and the third contact surface abut each other.

16. The insertion instrument of claim 9, further comprising an opening creating member configured to be inserted into the first cannulation, the opening creating member defining:

a tip at a distal end of the opening creating member;

a fifth contact surface configured to abut the contact surface when the opening creating member is fully inserted with respect to the access member; and

a shaft that extends between the tip and the fifth contact surface.

17. The insertion instrument of claim 16, wherein the tip is conically shaped.

18. The insertion instrument of claim 16, wherein the shaft defines at least one boring flute that extends helically from the tip along a direction toward the fifth contact surface.

19. The insertion instrument of claim 16, wherein the proximal end of the access member defines a first interlocking member and the opening creating member defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the opening creating member are prevented from translating with respect to one another along the longitudinal direction.

20. The insertion instrument of claim 3, wherein a diameter of the third cannulation is shorter than a cross sectional dimension of the anchor, such that when the pusher member is inserted into the anchor housing, a distal end of the pusher member causes the anchor to translate along the longitudinal direction.

21. The insertion instrument of claim 20, wherein the pusher member causes the anchor to eject into the opening when the pusher member is fully inserted with respect to the anchor housing.

22. The insertion instrument of claim 1, further comprising a tension assembly configured to apply a predetermined tension force characteristic to the actuation member, thereby causing the anchor body to expand along a second direction that is angularly offset relative to the direction of elongation.

23. The insertion instrument of claim 22, wherein the tension comprises a translating member configured to translate from a neutral position to an extended position with respect to the distal end of the access member.

24. The insertion instrument of claim 23, wherein the translating member abuts the proximal end of the pusher member when the translating member is in the first position.

25. The insertion instrument of claim 23, wherein the translating member applies a tensile force to the actuation member when the translating member translates between the neutral position and the extended position.

26. The insertion instrument of claim 25, further comprising a rotatable member that causes the translating member to translate from the neutral position to the extended position.

27. The insertion instrument of claim 26, wherein the translating member defines at least one projection, the at least one projection extending from the translating member along a third direction that is substantially perpendicular to the direction of elongation.

28. The insertion instrument of claim 27, wherein the pusher member defines at least one second projection, the at least one second projection extending from the pusher member along the third direction.

29. The insertion instrument of claim 28, wherein the rotatable member includes a body, the body defining an aperture configured to receive the at least one projection, and the body defining a slot configured to receive the at least one second projection, the slot having a proximal slot end and an opposed distal slot end.

30. The insertion instrument of claim 29, wherein the slot extends linearly between the proximal and distal slot ends.

31. The insertion instrument of claim 29, wherein rotation of the rotatable member about an axis that is substantially perpendicular to the direction of elongation causes the at least one second projection to translate within the slot.

32. The insertion instrument of claim 31, wherein the axis is a defined by the at least one projection.

33. The insertion instrument of claim 29, wherein the translating member is in the first position when the at least one second projection is disposed at the proximal slot end.

34. The insertion instrument of claim 33, wherein the translating member is in the second position when the at least one second projection is disposed at the distal slot end.

35. The insertion instrument of claim 33, wherein rotating the rotatable member through ninety degrees causes the at least one second projection to translate from the proximal slot end to the distal slot end.

36. The insertion instrument of claim 35, wherein the rotatable member body comprises a plate.

37. The insertion instrument of claim 34, wherein the proximal end of the access member defines a first interlocking member and the anchor housing defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the anchor housing are prevented from rotating with respect to one another around.

38. The insertion instrument of claim 37, wherein the proximal end of the anchor housing defines a third interlocking member and the pusher member defines a fourth interlocking member configured to engage the third interlocking member, wherein when the third and fourth interlocking members are engaged the anchor housing and the pusher member are prevented from translating with respect to one another along the longitudinal direction.

39. The insertion instrument of claim 34, wherein the proximal end of the access member defines a first interlocking member and the pusher member defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member, the anchor housing, and the pusher member are prevented from translating with respect to one another along the longitudinal direction.

40. The insertion instrument of claim 34, further comprising an opening shaping member configured to be inserted into the first cannulation, the opening creating member defining:

a tip at a distal end of the opening creating member;

a fifth contact surface configured to abut the contact surface when the opening creating member is fully inserted with respect to the access member; and

a shaft that extends between the tip and the fifth contact surface.

41. The insertion instrument of claim 40, wherein the tip is conically shaped.

42. The insertion instrument of claim 40, wherein the shaft defines at least one boring flutes that extend helically from the tip along a direction toward the fifth contact surface.

43. The insertion instrument of claim 40, wherein the proximal end of the access member defines a first interlocking member and the opening creating member defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the opening creating member are prevented from translating with respect to one another along the longitudinal direction.

44. The insertion instrument of claim 28, wherein rotation of the rotatable member about a longitudinal axis that is substantially parallel to the longitudinal direction causes the translating member to translate relative to the pusher member.

45. The insertion instrument of claim 44, wherein the rotatable member includes a body, the body defining a bore therethrough along the longitudinal direction, the bore defining an inner surface, the bore sized to receive the translating member and at least a portion of the pusher member therein.

46. The insertion instrument of claim 45, wherein the at least one projection comprises a first pair of projections and the at least one second projection comprises a second pair of projections.

47. The insertion instrument of claim 46, wherein the first pair of projections extend along a first common axis and the second pair of projections extend along a second common axis, the first and second common axes parallel with respect to each other.

48. The insertion instrument of claim 46, wherein the bore further defines an annular groove and a pair of opposed helical grooves, the annular groove and the helical grooves extending into the inner surface, each helical groove extending between respective opposed proximal and distal groove ends, each projection of the second pair of projections captive in a respective one of the pair of helical grooves and the first pair of projections captive in the annular groove, such that when the rotatable member is rotated about the longitudinal axis, the translating member is free to translate within the rotatable member and the pusher member is free to rotate within the rotatable member.

49. The insertion instrument of claim 48, wherein each helical grooves defines a respective variable groove pitch.

50. The insertion instrument of claim 49, wherein the respective groove pitch of each helical groove becomes shallower between the respective distal and proximal ends.

51. The insertion instrument of claim 48, wherein the pusher member further defines at least one shaft that extends proximally from the pusher member along the longitudinal direction, the translating member configured to be carried along the at least one shaft, such that the translating member is prevented from rotating with respect to the rotatable member.

52. The insertion instrument of claim 51, wherein the translating member is in the first position when the second pair of projections are disposed at the respective distal groove ends.

53. The insertion instrument of claim 52, wherein the translating member is in the second position when the second pair of projections are disposed at the respective proximal groove ends.

54. The insertion instrument of claim 44, wherein the proximal end of the access member defines a first interlocking member and the anchor housing defines a second interlocking member configured to engage with the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the anchor housing are prevented from rotating with respect to one another about the longitudinal axis.

55. The insertion instrument of claim 54, wherein when the first and second interlocking members are engaged the access member and the anchor housing are further prevented from translating with respect to one another along the longitudinal direction.

56. The insertion instrument of claim 55, wherein the proximal end of the anchor housing defines a third interlocking member and the pusher member defines a fourth interlocking member configured to engage the third interlocking member, wherein when the third and fourth interlocking members are engaged the anchor housing and the pusher member are prevented from rotating with respect to one another about the longitudinal axis.

57. The insertion instrument of claim 56, wherein when the third and fourth interlocking members are engaged the anchor housing and the pusher member are further prevented from translating with respect to one another along the longitudinal direction.

58. The insertion instrument of claim 57, wherein the access member further defines a pair of laterally opposed tabs that extend outward from the access member along the third direction.

59. The insertion instrument of claim 54, wherein the proximal end of the access member defines a first interlocking member and the pusher member defines a second interlocking member configured to engage the second interlocking member, wherein when the first and second interlocking members are engaged the access member, the anchor housing, and the pusher member are prevented from rotating with respect to one another about the longitudinal axis.

60. The insertion instrument of claim 59, wherein when the first and second interlocking members are engaged the access member and the anchor housing are further prevented from translating with respect to one another along the longitudinal direction.

61. The insertion instrument of claim 60, wherein the access member further defines a pair of laterally opposed tabs that extend outward from the access member along the third direction.

62. The insertion instrument of claim 51, further comprising an opening shaping member configured to be inserted into the first cannulation, the opening creating member defining:

a tip at a distal end of the opening creating member;

a fifth contact surface configured to abut the contact surface when the opening creating member is fully inserted with respect to the access member; and

a shaft that extends between the tip and the fifth contact surface.

63. The insertion instrument of claim 62, wherein the tip is conically shaped.

64. The insertion instrument of claim 62, wherein the shaft defines at least one boring flutes that extend helically from the tip along a direction toward the fifth contact surface.

65. The insertion instrument of claim 62, wherein the proximal end of the access member defines a first interlocking member and the opening creating member defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the opening creating member are prevented from translating with respect to one another along the longitudinal direction.

66. The insertion instrument of claim 6, further comprising:

a translating member coupled to a proximal end of the pusher member, the translating member configured to translate relative to the anchor housing along the longitudinal direction, the actuation member releasably attached to the translating member; and

a handle member configured to carry the translating member, the handle member supported by the anchor housing and translatable relative to the anchor housing between a first position and a second position.

67. The insertion instrument of claim 66, wherein when the handle member is in the first position, the at least one anchor is disposed within the anchor housing.

68. The insertion instrument of claim 67, wherein when the handle member is translated from the first position to the second position, the anchor is ejected into the opening.

69. The insertion instrument of claim 66, wherein when the handle member is in the first position, the at least one anchor is disposed at the distal end of the anchor housing.

70. The insertion instrument of claim 66, wherein when the handle member is in the second position, the second contact surface abuts the first contact surface.

71. The insertion instrument of claim 66, wherein when the handle member is in the second position, the distal end of the anchor housing is substantially aligned with a distal end of the access member.

72. The insertion instrument of claim 66, wherein when the handle member is not in the second position, the handle member is prevented from rotating relative to the anchor housing about a central axis defined by the anchor housing.

73. The insertion instrument of claim 66, wherein when the handle member is in the second position, the handle member is prevented from translating along the longitudinal direction relative to the anchor housing.

74. The insertion instrument of claim 66, wherein when the handle member is in the second position, the handle member is rotatable relative to the anchor housing about a central axis defined by the anchor housing.

75. The insertion instrument of claim 74, wherein rotating the handle member about the central axis causes the translating member to translate relative to the anchor housing.

76. The insertion instrument of claim 75, wherein the translating member comprises a proximal body member and a distal body member that is configured to releasably engage with the proximal body member, the pusher member coupled to the distal body member.

77. The insertion instrument of claim 76, wherein when the handle member is rotated the translating member translates proximally from an initial position relative to the anchor housing.

78. The insertion instrument of claim 77, wherein when the translating member is in the initial position, the actuation member is captive between the proximal and distal body members.

79. The insertion instrument of claim 78, wherein the handle member defines a bore therethrough along the longitudinal direction, the bore defining an inner surface, the bore sized to receive the translating member.

80. The insertion instrument of claim 79, wherein the translating member defines a pair of projections, the projections extending from the proximal body member along a third direction that is substantially perpendicular to the central axis.

81. The insertion member of claim 80, wherein the projections extend along a second axis that is substantially perpendicular with respect to the central axis.

82. The insertion instrument of claim 80, wherein the bore further defines a pair of opposed helical grooves extending into the inner surface, each helical groove extending between respective opposed proximal and distal groove ends, each projection of the pair of projections captive in a respective one of the pair of helical grooves, such that when the handle member is rotated about the central axis, the translating member is free to translate relative to the anchor housing.

83. The insertion instrument of claim 82, wherein the anchor housing further defines at least one shaft that extends proximally from the anchor housing along the longitudinal direction, the translating member configured to be carried along the at least one shaft, such that the translating member is prevented from rotating with respect to the anchor housing.

84. The insertion instrument of claim 82, wherein the translating member is in the initial position when the each projection is disposed at a respective distal groove end.

85. The insertion instrument of claim 82, wherein each helical grooves defines a respective variable groove pitch.

86. The insertion instrument of claim 85, wherein the respective groove pitch of each helical groove becomes shallower between the respective distal and proximal ends.

87. The insertion instrument of claim 78, wherein proximal translation of the translating member relative to the anchor housing causes the tensile force to be applied to the actuation member.

88. The insertion instrument of claim 87, wherein when magnitude of the tensile force is equal to a predetermined release value, the distal body member disengages from the proximal body member, thereby freeing the actuation member from the translating member.

89. The insertion instrument of claim 88, wherein the proximal body member defines at least one shear member configured to engage with a complementary engagement member defined by the distal body member.

90. The insertion instrument of claim 89, wherein when the tensile force is equal to the predetermined release value, the engagement member causes the shear member to be sheared from the proximal body member, thereby causing the proximal body member to disengage from the distal body member.

91. The insertion instrument of claim 75, wherein the proximal end of the access member defines a first interlocking member and the anchor housing defines a second interlocking member configured to engage with the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the anchor housing are prevented from rotating with respect to one another about the central axis.

92. The insertion instrument of claim 91, wherein when the first and second interlocking members are engaged the access member and the anchor housing are further prevented from translating with respect to one another along the longitudinal direction.

93. The insertion instrument of claim 92, wherein the access member further defines a pair of laterally opposed tabs that extend outward from the access member along the third direction.

94. The insertion instrument of claim 83, further comprising an openingl shaping member configured to be inserted into the first cannulation, the opening creating member defining:

a tip at a distal end of the opening creating member;

a fifth contact surface configured to abut the contact surface when the opening creating member is fully inserted with respect to the access member; and

a shaft that extends between the tip and the fifth contact surface.

95. The insertion instrument of claim 94, wherein the tip is conically shaped.

96. The insertion instrument of claim 94, wherein the shaft defines at least one boring flutes that extend helically from the tip along a direction toward the fifth contact surface.

97. The insertion instrument of claim 94, wherein the proximal end of the access member defines a first interlocking member and the opening creating member defines a second interlocking member configured to engage the first interlocking member, wherein when the first and second interlocking members are engaged the access member and the opening creating member are prevented from translating with respect to one another along the longitudinal direction.

98. The insertion instrument of claim 22, wherein the access member comprises a cannula having a distal end, and the insertion instrument further comprises an opening creating member that defines an opening tip that is movable from a first position that is retracted with respect to the distal end and a second position that is extended with respect to the distal end, such that the distal end of the cannula of the access member defines the pusher member.

99. The insertion instrument of claim 98, wherein the target location is a first target location, and the opening tip is configured to create a first opening at the first target location.

100. The insertion instrument of claim 99, wherein the anchor housing comprises a cartridge that defines first and second receptacles that retain first and second anchor bodies, respectively.

101. The insertion instrument of claim 100, further defining a pocket that is configured to slidably receive the cartridge such that the cartridge is movable from a first position whereby the first receptacle is aligned with the pusher member to a second position whereby the second receptacle is aligned with the pusher member.

102. The insertion instrument of claim 101, wherein the cartridge includes a cartridge housing that defines the first and second receptacles, and a stop clip removably attached to the cartridge housing, wherein the stop clip abuts the a portion of the insertion instrument so as to prevent the cartridge from moving from the first position to the second position.

103. The insertion instrument of claim 102, wherein removal of the stop clip from the cartridge housing allows the cartridge to move from the first position to the second position.

104. The insertion instrument of claim 101, wherein the pusher member is configured to translate through the first receptacle when the cartridge is in the first position so as to eject the first anchor body out the cannula and into the first opening.

105. The insertion instrument of claim 101, wherein the opening tip is configured to create a second opening at a second target location.

106. The insertion instrument of claim 105, wherein the pusher member is configured to translate through the first receptacle when the cartridge is in the second position so as to eject the second anchor body out the cannula and into the second opening.

107. The insertion instrument of claim 22, wherein the tension assembly is movable from a first position that is disengaged with the actuation member to a second position that is engaged with the actuation strand to a third position that causes the tension assembly to apply a tensile force to the actuation strand.

108. The insertion instrument of claim 22, wherein the tension assembly comprises a grip assembly that is configured to engage the actuation strand when the tension assembly is in the second position, and a motion assembly that is configured to move the grip assembly along a direction away from the anchor body so as to apply the predetermined tensile force characteristic to the actuation strand.

111. The insertion instrument of claim 108, wherein the grip assembly comprises a first engagement surface and a second engagement surface that is opposite the first engagement surface, wherein at least one of the first and second engagement surfaces is movable with respect to the other of the first engagement surfaces so as to define a variable sized gap that is configured to retain the actuation member.

112. The insertion instrument of claim 108, wherein the motion assembly includes an actuator and a latch that is pivotally coupled to the actuator, and the motion assembly further includes a grip member that at least partially receives the latch, such that movement of the actuator causes the latch to move relative to the grip member so as to capture the actuation member.

113. The insertion instrument of claim 112, wherein the movement of the actuator causes the latch and the grip member to translate away from the access member as the actuation member is captured between the latch and the grip member.

109. The insertion instrument of claim 109, wherein the motion assembly moves the grip assembly a predetermined distance so as to apply the predetermined tensile force characteristic.

110. The insertion instrument of claim 109, wherein the grip assembly is slidable along a housing of the insertion instrument along a direction away from the access member.

114. An expandable anchor configured to be inserted in an anatomical location, the expandable anchor comprising:

an anchor body including;

an expandable portion that extends along a direction of elongation, the expandable portion defining a plurality of loops that define respective openings, wherein the respective openings are substantially aligned with each other along the direction of elongation; and

an eyelet that extends from the expandable portion; and

an actuation member including first and second segments that extend through the eyelet and through the expandable portion,

wherein the actuation member is 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.

115. The expandable anchor of claim 114, wherein the eyelet extends through the expandable portion as the expandable portion is actuated from the first configuration to the expanded configuration.

116. The expandable anchor of claim 115, wherein the expandable portion defines a proximal, an opposed distal end, and a distal loop disposed at the distal end, and the eyelet extends from the distal end and defines a closure location that braces against the distal end as the eyelet is drawn through the expandable portion.

117. The expandable anchor of claim 114, wherein the loops stack against each other as the expandable portion is actuated from the first configuration to the expanded configuration.

118. The expandable anchor of claim 114, wherein each loop defines at least a pair of knots.

119. The expandable anchor of claim 118, wherein each of the pair of knots of each loop is disposed substantially opposite the other.

120. The expandable anchor of claim 119, wherein each of the pair of knots of each loop is disposed substantially 180 degrees from the other.

121. The expandable anchor of claim 118, wherein at least a plurality of the knots are configured as square knots.

122. The expandable anchor of claim 118, wherein at least a plurality of the knots are configured as overhand knots.

123. The expandable anchor of claim 114, wherein the eyelet extends at least into the expandable portion a first length when the expandable portion is in the first configuration, and the eyelet extends at least into the expandable portion a second length when the expandable portion is in the expanded configuration, wherein the second length is greater than the first length.

124. The expandable anchor of claim 114, further comprising a pair of eyelets that extend from the expandable portion.

125. The expandable anchor of claim 124, wherein the actuation strand passes through both of the pair of eyelets.