Method of using ultrasonic vibration to secure body tissue

• US 6,368,343 B1
• Filed: 03/13/2000
• Issued: 04/09/2002
• Est. Priority Date: 03/13/2000
• Status: Expired due to Term

• Current Assignee: P TECH, LLC
• Original Assignee: Peter M. Bonutti
• Inventors: Cremens, Matthew J., Bonutti, Peter M., Ruholl, Kevin
• Primary Examiner(s): Cronin, Stephen K.
• Assistant Examiner(s): NGO, LIEN M
• Application Number:
  US09/524,397
• Time in Patent Office: 757 Days
• Field of Search: 606/232, 606/233, 606/144, 606/145, 606/147, 606/139, 606/228
• US Class Current: 606/232
• 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 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0488 Instruments for applying suture clamps, clips or locks
• CPC Class Codes: A61B 2017/0619 thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it
• CPC Class Codes: B29C 65/08 using ultrasonic vibrations non-plastics element to plastics elements B29C65/645
• CPC Class Codes: B29C 65/4815 Hot melt adhesives, e.g. thermoplastic adhesives
• CPC Class Codes: B29C 65/5071 and being composed by one single element
• CPC Class Codes: B29C 65/5085 and comprising grooves, e.g. being E-shaped, H-shaped
• CPC Class Codes: B29C 66/1122 Single lap to lap joints, i.e. overlap joints B29C66/45, B29C66/472, B29C66/52272 take precedence
• CPC Class Codes: B29C 66/526 Joining bars
• CPC Class Codes: B29C 66/5261 for forming coaxial connections, i.e. the bars to be joined forming a zero angle relative to each other
• CPC Class Codes: B29C 66/69 General aspects of joining filaments bundling articles B65B13/00; interconnecting successive lengths of material B65H69/00
• CPC Class Codes: B29C 66/71 characterised by the composition of the plastics material of the parts to be joined welding bar compositions B29C65/125
• CPC Class Codes: B29C 66/7379 degradable
• CPC Class Codes: B29C 66/73791 biodegradable
• CPC Class Codes: B29C 66/81423 being concave
• CPC Class Codes: B29C 66/8322 Joining or pressing tools reciprocating along one axis
• CPC Class Codes: B29C 66/83221 : cooperating reciprocating tools, each tool reciprocating along one axis
• CPC Class Codes: B29C 66/83241 : cooperating pivoting tools
• CPC Class Codes: B29C 66/861 : Hand-held tools
• CPC Class Codes: B29C 66/8614 : Tongs, pincers or scissors
• CPC Class Codes: B29C 66/951 : by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools
• CPC Class Codes: B29C 66/9513 : characterised by specific vibration frequency values or ranges
• CPC Class Codes: B29C 66/9517 : characterised by specific vibration amplitude values or ranges
• CPC Class Codes: B29K 2059/00 : Use of polyacetals , e.g. POM, i.e. polyoxymethylene or derivatives thereof, as moulding material
• CPC Class Codes: B29K 2067/003 : PET, i.e. poylethylene terephthalate
• CPC Class Codes: B29K 2067/006 : PBT, i.e. polybutylene terephthalate
• CPC Class Codes: B29K 2067/043 : PGA, i.e. polyglycolic acid or polyglycolide
• CPC Class Codes: B29K 2077/00 : Use of PA, i.e. polyamides, e.g. polyesteramides or derivatives thereof, as moulding material

Abstract

A suture and a suture retainer are positioned relative to body tissue. Ultrasonic vibratory energy is utilized to heat the suture retainer and effect a bonding of portions of the suture retainer to each other and/or to the suture. Portions of the body tissue may be pressed into linear apposition with each other and held in place by cooperation between the suture and the suture retainer. The suture retainer may include one or more passages through which the suture extends. The suture retainer may include sections which have surface areas which are bonded together. If desired, the suture may be wrapped around one of the sections of the suture retainer. The suture retainer may be formed with a recess in which the suture is received. If desired, the suture retainer may be omitted and the sections of the suture bonded to each other.

Claims

1. A method of securing a suture relative to body tissue, said method comprising the steps of providing a suture retainer having first and second openings, providing a suture having first and second sections, positioning the suture relative to body tissue with the first and second sections of the suture extending from the body tissue, positioning the first section of the suture in the first opening in the suture retainer, positioning the second section of the suture in the second opening in the suture retainer, transmitting ultrasonic vibratory energy to the suture retainer, and gripping the first and second sections of the suture with the suture retainer by plastically deforming material of the suture retainer to close the first opening and to close the second opening.

2. A method as set forth in claim 1 wherein said step of gripping the first and second sections of the suture with the suture retainer includes bonding material of the suture retainer to the first and second sections of the suture.

3. A method as set forth in claim 1 further including the steps of tensioning the first and second sections of the suture with a predetermined force and transmitting a predetermined force from the suture retainer to the body tissue during at least a portion of said step of transmitting ultrasonic vibratory energy to the suture retainer.

4. A method as set forth in claim 1 further including the steps of forming a first bend in the first section of the suture, forming a second bend in the second section of the suture, moving the suture retainer along the first and second sections of the suture toward the body tissue, and moving the first and second bends along the first and second sections of the suture toward the body tissue as the suture retainer moves along the first and second sections of the suture toward the body tissue.

5. A method as set forth in claim 1 further including the step of wrapping the first section of the suture around a first portion of the suture retainer and wrapping the second section of the suture around a second portion of the suture retainer.

6. A method as set forth in claim 1 further wherein said step of positioning the first section of the suture in the first opening in the suture retainer includes moving the first section of the suture into a first groove in the suture retainer, said step of positioning the second section of the suture in the second opening in the suture retainer includes moving the second section of the suture into a second groove in the suture retainer.

7. A method as set forth in claim 1 further including the step of inserting the first and second sections of the suture through a passage in a suture retainer, said step of gripping the first and second sections of the suture by plastically deforming material of the suture retainer includes closing the passage in the suture retainer.

8. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture having first and second sections relative to body tissue, providing a suture retainer which has first and second recesses, positioning the first section of the suture in the first recess and outside of the second recess, positioning the second section of the suture in the second recess and outside of the first recess, transmitting ultrasonic vibratory energy to the suture retainer while the first section of the suture is in the first recess and is outside of the second recess and the second section of the suture is in the second recess and is outside of the first recess, bonding the first section of the suture and the suture retainer together while the first section of the suture is in the first recess and is outside of the second recess, and bonding the second section of the suture and the suture retainer together while the second section of the suture is in the second recess and is outside of the first recess.

9. A method as set forth in claim 8 further including the steps of tensioning the suture, moving the suture retainer along the suture toward the body tissue with the first section of the suture in the first recess and outside of the second recess and with the second section of the suture in the second recess and outside of the first recess, and transmitting force from the suture retainer to the body tissue.

10. A method as set forth in claim 8 further including the steps of tensioning the first section of the suture with at least a first predetermined force, tensioning the second section of the suture with at least a second predetermined force, and transmitting a predetermined force from the suture retainer to the body tissue while the first section of the suture is in the first recess and is tensioned with at least the first predetermined force and while the second section of the suture is in the second recess and is tensioned with at least the second predetermined force.

11. A method as set forth in claim 8 wherein a first portion of the suture retainer and a base portion of the suture retainer cooperate to at least partially define an entrance to the first recess, a second portion of the suture retainer and the base portion of the suture retainer cooperate to at least partially define an entrance to the second recess, said step of positioning the first section of the suture in the first recess includes moving the suture retainer relative to the first section of the suture to move the first section of the suture through the entrance to the first recess, said step of positioning the second section of the suture in the second recess includes moving the suture retainer relative to the second section of the suture to move the second section of the suture through the entrance to the second recess, said method further includes blocking the entrance to the first recess by bonding the first portion of the suture retainer to the base portion of the suture retainer with the first section of the suture in the first recess and outside of the second recess and blocking the entrance to the second recess by bonding the second portion of the suture retainer to the base portion of the suture retainer with the second section of the suture in the second recess and outside of the first recess.

12. A method as set forth in claim 8 wherein a first portion of the suture retainer and a base portion of the suture retainer cooperate to at least partially define an entrance to the first recess, the first portion of the suture retainer has an end portion which at least partially blocks the entrance to the first recess, a second portion of the suture retainer and the base portion of the suture retainer cooperate to at least partially define an entrance to the second recess, the second portion of the suture retainer has an end portion which at least partially blocks the entrance to the second recess, said step of positioning the first section of the suture in the first recess includes moving the suture retainer relative to the suture and applying force against the end portion of the first portion of the suture retainer with the first section of the suture to deflect the end portion of the first portion of the suture retainer away from the base portion of the suture retainer and enable the first section of the suture to move into the first recess, said step of positioning the second section of the suture in the second recess includes moving the suture retainer relative to the suture and applying force against the end portion of the second portion of the suture retainer with the second section of the suture to deflect the end portion of the second portion of the suture retainer away from the base portion of the suture retainer and enable the second section of the suture retainer to move into the second recess.

13. A method as set forth in claim 12 further including the steps of bonding the end portion of the first portion of the suture retainer to the base portion of the suture retainer with the first section of the suture in the first recess, and bonding the end portion of the second portion of the suture retainer to the base portion of the suture retainer with the second section of the suture in the second recess.

14. A method as set forth in claim 8 wherein said step of transmitting ultrasonic vibratory energy to the suture retainer includes engaging the suture retainer with a vibration applicator member and vibrating the vibration applicator member at a rate of between 20 kilohertz and 70 kilohertz.

15. A method as set forth in claim 8 wherein said step of transmitting ultrasonic vibratory energy to the suture retainer includes engaging the opposite sides of the suture retainer with first and second members, pressing the first and second members against the suture retainer and vibrating at least one of the first and second members at a rate in excess of 20 kilohertz.

16. A method as set forth in claim 8 further including the step of transmitting heat to the suture retainer during performance of at least a portion of said step of transmitting ultrasonic vibratory energy to the suture retainer.

17. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, inserting the suture through a passage which extends through a suture retainer and completely encloses a portion of the suture disposed in the passage, and collapsing the passage while the suture extends through the passage by transmitting ultrasonic vibratory energy to the suture retainer.

18. A method as set forth in claim 17 further including the steps of positioning the suture retainer relative to body tissue by sliding the suture retainer along the suture with the suture extending through the passage in the suture retainer.

19. A method as set forth in claim 17 further including the step of wrapping the suture around at least a portion of the suture retainer, said step of transmitting ultrasonic vibratory energy to the suture retainer includes pressing a portion of the suture which is wrapped around the suture retainer against material of the suture retainer.

20. A method as set forth in claim 19 wherein said step of wrapping a portion of the suture around the suture retainer includes forming a bend in the suture, said method further includes moving the suture retainer and the bend in the suture along the suture in a direction toward the body tissue.

21. A method as set forth in claim 17 further including the step of positioning a portion of the suture in a groove in the suture retainer, said step of transmitting ultrasonic vibratory energy to the suture retainer includes collapsing the groove in the suture retainer.

22. A method as set forth in claim 17 further including the step of transmitting at least a predetermined force from the suture retainer to the body tissue and tensioning the suture with at least predetermined tension.

23. A method as set forth in claim 18 wherein said step of transmitting ultrasonic vibratory energy to the suture retainer includes positioning a vibration applicator member in an opening in the suture retainer and transmitting vibrational energy from the vibration application member to the suture retainer while the suture is in the passage in the suture retainer and while the vibration applicator member is in the opening in the suture retainer.

24. A method as set forth in claim 17 wherein said step of transmitting ultrasonic vibratory energy to the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

25. A method of securing a suture relative to body tissue, said method comprising the steps of forming a first loop in the suture with the first loop extending around a portion of a suture retainer, forming a second loop in the suture with the second loop extending around a portion of the suture retainer, and gripping the first and second loops with the suture retainer by deforming material of the suture retainer, said step of deforming material of the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer.

26. A method as set forth in claim 25 wherein the suture retainer includes a plurality of separate members, said step of forming a first loop in the suture includes forming a first loop around a first one of the members, said step of forming a second loop in the suture includes forming a second loop around the first member, said step of gripping the first and second loops includes pressing a second one of the members against the first and second loops and forming a bond between the first and second members at a location where the first and second members are disposed in engagement with each other.

27. A method as set forth in claim 25 further including the step of positioning the suture retainer relative to body tissue by moving the suture retainer and the first and second loops along the suture.

28. A method as set forth in claim 25 wherein said steps of forming first and second loops includes the step of wrapping the suture around the suture retainer.

29. A method as set forth in claim 28 wherein said step of wrapping the suture around the suture retainer includes forming bends in the suture, said method further includes moving the suture retainer toward the body tissue and moving the bends in the suture along the suture in a direction toward the body tissue.

30. A method as set forth in claim 25 wherein the step of forming a first loop in the suture includes positioning a first portion of the suture in a first groove in the suture retainer, said step of forming a second loop in the suture includes positioning a second portion of the suture in a second groove in the suture retainer, said first portion of the suture and said first groove being spaced from said second portion of the suture and said second groove.

31. A method as set forth in claim 25 wherein said step of forming a first loop in the suture includes positioning a first portion of the suture in a first groove in the suture retainer, said step of forming a second loop in the suture includes positioning a second portion of the suture in a second groove in the suture retainer, said step of deforming material of the suture retainer includes pressing material of the suture retainer against the first portion of the suture disposed in the first groove and pressing material of the suture retainer against the second portion of the suture disposed in the second groove.

32. A method as set forth in claim 25 further including the steps of transmitting at least a predetermined force from the suture retainer to the body tissue and tensioning the suture with at least a predetermined tension.

33. A method as set forth in claim 25 wherein said step of forming a first loop in the suture includes positioning a portion of the suture in a first opening in the suture retainer, said step of forming a second loop in the suture includes positioning a portion of the suture in a second opening in the suture retainer, said step of transmitting ultrasonic vibratory energy to the suture retainer includes positioning a vibration applicator member in a third opening in the suture retainer and transmitting vibrational energy from the vibration application member to the suture retainer while the first loop in the suture is in the first opening in the suture retainer, while the second loop in the suture is in the second opening in the suture retainer, and while the vibration applicator member is in the third opening in the suture retainer.

34. A method as set forth in claim 25 wherein said step of transmitting ultrasonic vibratory energy to the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

35. A method as set forth in claim 25 wherein said steps of forming first and second loops in the suture include positioning the suture in engagement with a first retainer member, said method further includes moving the first retainer member and the first and second loops along the suture toward the body tissue, and positioning a second retainer member in engagement with the first retainer member, said step of deforming material of the suture retainer includes bonding the first and second retainer members together under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

36. A method as set forth in claim 25 wherein said steps of forming first and second loops in the suture include inserting first and second sections of the suture through a retainer member, said step of deforming material of the suture retainer includes heating the retainer member by transmitting ultrasonic vibratory energy to the retainer member while the first and second sections of the suture extend through the retainer member.

37. A method as set forth in claim 25 further including the step of positioning a second suture retainer in engagement with the first and second loops in the suture, said step of gripping the first and second loops includes heating at least one of the suture retainers under the influence of ultrasonic vibratory energy.

38. A method as set forth in claim 25 wherein said steps of forming first and second loops in the suture includes wrapping the suture around a first retainer member, said method further includes positioning second and third retainer members relative to opposite sides of the first retainer member, said step of gripping the first and second loops includes bonding the first, second and third retainer members together under the influence of ultrasonic vibratory energy.

39. A method of securing a suture to layers of body tissue, said method comprising the steps of positioning a suture relative to the layers of body tissue with the layers of body tissue disposed in engagement with each other, positioning a suture retainer relative to the suture with the suture extending through the suture retainer, tensioning the suture with a first predetermined force which is a function of the strength of the suture while the suture extends through the suture retainer, transmitting a second predetermined force from the suture retainer to the body tissue while the suture extends through the suture retainer, the second predetermined force being transmitted to the suture retainer without being transmitted as tension in the suture, pressing the first and second layers of body tissue together under the influence of the first and second predetermined forces, and applying ultrasonic vibratory energy to the suture retainer to grip the suture with the suture retainer while the suture is tensioned with the first predetermined force and the second predetermined force is transmitted from the suture retainer to the body tissue.

40. A method as set forth in claim 39 wherein said step of applying ultrasonic vibratory energy to the suture retainer includes heating material of the suture retainer under the influence of the ultrasonic vibratory energy.

41. A method as set forth in claim 39 further including the step of bonding material forming the suture retainer to material forming the suture.

42. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of wrapping the suture around the portion of the suture retainer includes forming a loop in the suture without including body tissue within the loop, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer.

43. A method as set forth in claim 42 wherein said step of wrapping the suture around the portion of the suture retainer is performed while a portion of the suture which is wrapped around the portion of the suture retainer is spaced from the body tissue.

44. A method as set forth in claim 42 wherein the suture retainer includes a plurality of separate members, said step of wrapping the suture around a portion of the suture retainer includes wrapping the suture around a portion of one of the members, said step of heating the suture retainer includes pressing the members together and forming a bond between the members at the location where the members are pressed together.

45. A method as set forth in claim 42 wherein the suture retainer is formed as one piece, said step of positioning the suture retainer relative to body tissue includes sliding the suture retainer along the suture with the suture wrapped around the portion of the suture retainer.

46. A method as set forth in claim 42 wherein said step of heating the suture retainer includes at least partially heating the portion of the suture retainer around which the suture is wrapped and pressing a portion of the suture which is wrapped around the portion of the suture retainer against material of the suture retainer.

47. A method as set forth in claim 42 wherein said step of wrapping a portion of the suture around the suture retainer includes forming a bend in the suture, said method further includes moving the bend in the suture along the suture in a direction toward the body tissue.

48. A method as set forth in claim 42 wherein the suture retainer includes first and second sections, said step of wrapping the suture around the portion of the suture retainer includes positioning a portion of the suture between the first and second sections of the suture retainer, said step of heating the suture retainer includes urging the first and second sections of the suture retainer toward each other with a portion of the suture disposed between the first and second sections of the suture retainer.

49. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in a groove in the suture retainer, said step of heating the suture retainer includes collapsing the groove with the portion of the suture disposed in the groove.

50. A method as set forth in claim 42 further including the steps of transmitting at least a predetermined force from the suture retainer to the body tissue and tensioning the suture with at least a predetermined tension.

51. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in an opening which extends through the suture retainer, said step of heating the suture retainer includes collapsing the opening which extends through the suture retainer with the portion of the suture in the opening.

52. A method as set forth in claim 42 wherein said step of heating the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

53. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes wrapping the suture around a first retainer member, said method further includes positioning a second retainer member in engagement with the first retainer member, said step of heating the suture retainer includes bonding the first and second retainer members together under the influence of heat resulting from transmitting ultrasonic vibratory energy to the suture retainer.

54. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes inserting first and second sections of the suture through a retainer member, said method further includes moving the retainer member and at least one of the sections of the suture relative to each other, said step of heating the suture retainer includes heating the retainer member by transmitting ultrasonic vibratory energy to the retainer member while the first and second sections of the suture extend through the retainer member.

55. A method as set forth in claim 42 wherein said step of heating the suture retainer includes heating at least one retainer member of a plurality of retainer members under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

56. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes wrapping the suture around a first retainer member and positioning second and third retainer members relative to opposite sides of the first retainer member, said step of heating the suture retainer includes bonding the first, second and third retainer members together under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

57. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a groove in the suture retainer and positioning a second portion of the suture in a passage which extends through the suture retainer, said step of heating the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the groove against the first portion of the suture and to press a side surface of the passage against the second portion of the suture.

58. A method as set forth in claim 42 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a first groove in the suture retainer and positioning a second portion of the suture in a second groove in the suture retainer, said step of heating the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the first groove against the first portion of the suture and to press a side surface of the second groove against the second portion of the suture.

59. A method as set forth in claim 42 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

60. A method as set forth in claim 42 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

61. A method as set forth in claim 42 wherein the suture includes first and second sections, said step of wrapping the suture around a portion of the suture retainer includes wrapping the first section of the suture around a first portion of the suture retainer, said method further includes wrapping the second section of the suture around a second portion of the suture retainer.

62. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, the suture retainer includes first and second sections, said step of wrapping the suture around the portion of the suture retainer includes positioning a portion of the suture between the first and second sections of the suture retainer, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of heating the suture retainer includes urging the first and second sections of the suture retainer toward each other with a portion of the suture disposed between the first and second sections of the suture retainer.

63. A method as set forth in claim 62 wherein said step of wrapping the suture around the portion of the suture retainer includes forming a loop in the suture with the portion of the suture retainer disposed within the loop.

64. A method as set forth in claim 62 wherein said step of wrapping the suture around the portion of the suture retainer is performed while a portion of the suture which is wrapped around the portion of the suture retainer is spaced from the body tissue.

65. A method as set forth in claim 62 wherein the suture retainer includes a plurality of separate members, said step of wrapping the suture around a portion of the suture retainer includes wrapping the suture around a portion of one of the members.

66. A method as set forth in claim 62 wherein the suture retainer is formed as one piece, said step of positioning the suture retainer relative to body tissue includes sliding the suture retainer along the suture with the suture wrapped around the portion of the suture retainer.

67. A method as set forth in claim 62 wherein said step of heating the suture retainer includes at least partially heating the first and second sections of the suture retainer, said step of urging the first and second sections of the suture retainer toward each other includes pressing the first and second sections of the suture retainer against the suture.

68. A method as set forth in claim 62 wherein said step of wrapping a portion of the suture around the suture retainer includes forming a bend in the suture, said method further includes moving the bend in the suture along the suture in a direction toward the body tissue.

69. A method as set forth in claim 62 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in a groove in the suture retainer, said step of urging the first and second sections of the suture retainer toward each other includes collapsing the groove with the portion of the suture disposed in the groove.

70. A method as set forth in claim 62 further including the steps of transmitting at least a predetermined force from the suture retainer to the body tissue and tensioning the suture with at least a predetermined tension.

71. A method as set forth in claim 62 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in an opening which extends through the suture retainer, said step of urging the first and second sections of the suture retainer toward each other includes collapsing the opening which extends through the suture retainer with the portion of the suture in the opening.

72. A method as set forth in claim 62 wherein said step of heating the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

73. A method as set forth in claim 62 wherein said step of wrapping the suture around a portion of the suture retainer includes inserting first and second sections of the suture through a retainer member.

74. A method as set forth in claim 62 wherein said step of heating the suture retainer includes heating at least one retainer member of a plurality of retainer members under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

75. A method as set forth in claim 62 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a groove in the suture retainer and positioning a second portion of the suture in a passage which extends through the suture retainer, said step of urging the first and second sections of the suture retainer toward each other includes plastically deforming material of the suture retainer to press a side surface of the groove against the first portion of the suture and to press a side surface of the passage against the second portion of the suture.

76. A method as set forth in claim 62 wherein said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a first groove in the suture retainer and positioning a second portion of the suture in a second groove in the suture retainer, said step of urging the first and second sections of the suture retainer toward each other includes plastically deforming material of the suture retainer to press a side surface of the first groove against the first portion of the suture and to press a side surface of the second groove against the second portion of the suture.

77. A method as set forth in claim 62 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

78. A method as set forth in claim 62 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

79. A method as set forth in claim 62 wherein the suture includes first and second sections, said step of wrapping the suture around a portion of the suture retainer includes wrapping the first section of the suture around a first portion of the suture retainer, said method further includes wrapping the second section of the suture around a second portion of the suture retainer.

80. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a groove in the suture retainer and positioning a second portion of the suture in a passage which extends through the suture retainer, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of heating the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the groove against the first portion of the suture and to press a side surface of the passage against the second portion of the suture.

81. A method as set forth in claim 80 wherein said step of wrapping the suture around the portion of the suture retainer includes forming a loop in the suture with the first portion of the suture and the second portion of the suture being portions of the loop.

82. A method as set forth in claim 80 wherein said step of wrapping the suture around the portion of the suture retainer is performed while the suture which is wrapped around the portion of the suture retainer is spaced from the body tissue.

83. A method as set forth in claim 80 wherein the suture retainer is formed as one piece, said step of positioning the suture retainer relative to body tissue includes sliding the suture retainer along the suture with the suture wrapped around the portion of the suture retainer.

84. A method as set forth in claim 80 wherein said step of heating the suture retainer includes at least partially heating the portion of the suture retainer around which the suture is wrapped and pressing a portion of the suture which is wrapped around the portion of the suture retainer against material of the suture retainer.

85. A method as set forth in claim 80 wherein said step of wrapping a portion of the suture around the suture retainer includes forming a bend in the suture, said method further includes moving the bend in the suture along the suture in a direction toward the body tissue.

86. A method as set forth in claim 80 further including the steps of transmitting at least a predetermined force from the suture retainer to the body tissue and tensioning the suture with at least a predetermined tension.

87. A method as set forth in claim 80 wherein said step of heating the suture retainer includes collapsing the passage which extends through the suture retainer with the second portion of the suture in the passage.

88. A method as set forth in claim 80 wherein said step of heating the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

89. A method as set forth in claim 80 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

90. A method as set forth in claim 80 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

91. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning a first portion of the suture in a first groove in the suture retainer and positioning a second portion of the suture in a second groove in the suture retainer, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of heating the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the first groove against the first portion of the suture and to press a side surface of the second groove against the second portion of the suture.

92. A method as set forth in claim 91 wherein said step of wrapping the suture around the portion of the suture retainer includes forming a loop in the suture without including body tissue within the loop.

93. A method as set forth in claim 91 wherein said step of wrapping the suture around the portion of the suture retainer is performed while a portion of the suture which is wrapped around the portion of the suture retainer is spaced from the body tissue.

94. A method as set forth in claim 91 wherein the suture retainer is formed as one piece, said step of positioning the suture retainer relative to body tissue includes sliding the suture retainer along the suture with the suture wrapped around the portion of the suture retainer.

95. A method as set forth in claim 91 wherein said step of wrapping a portion of the suture around the suture retainer includes forming a bend in the suture, said method further includes moving the bend in the suture along the suture in a direction toward the body tissue.

96. A method as set forth in claim 91 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

97. A method as set forth in claim 91 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

98. A method of securing a suture relative to body tissue, said method comprising the steps of providing a suture retainer having first and second openings, providing a suture having first and second sections, positioning the suture relative to body tissue with the first and second sections of the suture extending from the body tissue, positioning the first section of the suture in the first opening in the suture retainer, positioning the second section of the suture in the second opening in the suture retainer, transmitting ultrasonic vibratory energy to the suture retainer, and gripping the first and second sections of the suture with the suture retainer by plastically deforming material of the suture retainer to close the first opening and to close the second opening, said step of plastically deforming material of the suture retainer includes applying force against an outer side surface area on the suture retainer during the transmission of ultrasonic vibratory energy to the suture retainer.

99. A method as set forth in claim 98 further including the steps of tensioning the first and second sections of the suture with a predetermined force and transmitting a predetermined force from the suture retainer to the body tissue during at least a portion of said step of transmitting ultrasonic vibratory energy to the suture retainer.

100. A method as set forth in claim 98 further including the step of transmitting heat to the suture retainer from a source of heat contemporaneously with performance of said step of transmitting ultrasonic vibratory energy to the suture retainer.

101. A method as set forth in claim 98 further including the steps of forming a first bend in the first section of the suture, forming a second bend in the second section of the suture, moving the suture retainer along the first and second sections of the suture toward the body tissue, and moving the first and second bends along the first and second sections of the suture toward the body tissue as the suture retainer moves along the first and second sections of the suture toward the body tissue.

102. A method as set forth in claim 98 further including the step of wrapping the first section of the suture around a first portion of the suture retainer and wrapping the second section of the suture around a second portion of the suture retainer.

103. A method as set forth in claim 98 further wherein said step of positioning the first section of the suture in the first opening in the suture retainer includes moving the first section of the suture into a first groove in the suture retainer, said step of positioning the second section of the suture in the second opening in the suture retainer includes moving the second section of the suture into a second groove in the suture retainer.

104. A method as set forth in claim 98 further including the step of inserting the first and second sections of the suture through a passage in a suture retainer, said step of gripping the first and second sections of the suture by plastically deforming material of the suture retainer includes closing the passage in the suture retainer.

105. A method as set forth in claim 98 wherein said step of gripping the first and second sections of the suture with the suture retainer includes bonding material of the suture retainer to the first and second sections of the suture.

106. A method as set forth in claim 98 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

107. A method as set forth in claim 98 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

108. A method of securing a suture relative to body tissue, said method comprising the steps of providing a suture retainer having first and second openings, providing a suture having first and second sections, positioning the suture relative to body tissue with the first and second sections of the suture extending from the body tissue, positioning the first section of the suture in the first opening in the suture retainer, positioning the second section of the suture in the second opening in the suture retainer, transmitting ultrasonic vibratory energy to the suture retainer, transmitting heat to the suture retainer from a source of heat contemporaneously with performance of said step of transmitting ultrasonic vibratory energy to the suture retainer, and gripping the first and second sections of the suture with the suture retainer by plastically deforming material of the suture retainer to close the first opening and to close the second opening.

109. A method as set forth in claim 108 wherein said step of gripping the first and second sections of the suture with the suture retainer includes bonding material of the suture retainer to the first and second sections of the suture.

110. A method as set forth in claim 108 wherein said step of plastically deforming material of the suture retainer includes applying force against an outer side surface area on the suture retainer during the transmission of ultrasonic vibratory energy to the suture retainer and during the transmission of heat to the suture retainer.

111. A method as set forth in claim 108 further including the steps of tensioning the first and second sections of the suture with a predetermined force and transmitting a predetermined force from the suture retainer to the body tissue during at least a portion of said step of transmitting ultrasonic vibratory energy to the suture retainer.

112. A method as set forth in claim 108 further including the steps of forming a first bend in the first section of the suture, forming a second bend in the second section of the suture, moving the suture retainer along the first and second sections of the suture toward the body tissue, and moving the first and second bends along the first and second sections of the suture toward the body tissue as the suture retainer moves along the first and second sections of the suture toward the body tissue.

113. A method as set forth in claim 108 further including the step of wrapping the first section of the suture around a first portion of the suture retainer and wrapping the second section of the suture around a second portion of the suture retainer.

114. A method as set forth in claim 108 further wherein said step of positioning the first section of the suture in the first opening in the suture retainer includes moving the first section of the suture into a first groove in the suture retainer, said step of positioning the second section of the suture in the second opening in the suture retainer includes moving the second section of the suture into a second groove in the suture retainer.

115. A method as set forth in claim 108 further including the step of inserting the first and second sections of the suture through a passage in a suture retainer, said step of gripping the first and second sections of the suture by plastically deforming material of the suture retainer includes closing the passage in the suture retainer.

116. A method as set forth in claim 108 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

117. A method as set forth in claim 108 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of positioning the suture relative to body tissue includes positioning the suture in engagement with body tissue to promote degradation of the suture, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

118. A method of securing a suture to layers of body tissue, said method comprising the steps of positioning a suture relative to the layers of body tissue with the layers of body tissue disposed in engagement with each other, positioning a suture retainer relative to the suture with the suture extending through the suture retainer, forming a loop around a portion of the suture retainer with the suture, moving the suture retainer along the suture toward the body tissue, moving the loop along the suture toward the body tissue with the suture retainer, tensioning the suture with a first predetermined force which is a function of the strength of the suture while the suture extends through the suture retainer, transmitting a second predetermined force from the suture retainer to the body tissue while the suture extends through the suture retainer, the second predetermined force being transmitted to the suture retainer without being transmitted as tension in the suture, pressing the first and second layers of body tissue together under the influence of the first and second predetermined forces, and applying ultrasonic vibratory energy to the suture retainer to grip the suture with the suture retainer while the suture is tensioned with the first predetermined force and the second predetermined force is transmitted from the suture retainer to the body tissue.

119. A method as set forth in claim 118 wherein the suture retainer includes a plurality of separate members, said step of forming a loop around a portion of the suture retainer includes looping the suture around a portion of at least one of the members, said step of applying ultrasonic vibrating energy to the suture retainer includes pressing the members together and forming a bond between the members at the location where the members are pressed together.

120. A method as set forth in claim 118 wherein the suture retainer is formed as one piece, said step of moving the loop along the suture toward the body tissue includes sliding the suture retainer along the suture with the suture looped around the portion of the suture retainer.

121. A method as set forth in claim 118 wherein said step of applying ultrasonic vibrating energy to the suture retainer includes heating a portion of the suture retainer and pressing a portion of the suture against material of the suture retainer to form a bond between the suture and the suture retainer.

122. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes forming a bend in the suture, said step of moving the loop along the suture includes moving the bend in the suture along the suture in a direction toward the body tissue.

123. A method as set forth in claim 118 wherein the suture retainer includes first and second sections, said step of forming a loop around a portion of the suture retainer includes positioning a portion of the suture between the first and second sections of the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes urging the first and second sections of the suture retainer toward each other with a portion of the suture disposed between the first and second sections of the suture retainer.

124. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes positioning a portion of the suture in a groove in the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes collapsing the groove with the portion of the suture disposed in the groove.

125. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes positioning the suture in an opening which extends through the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes collapsing the opening which extends through the suture retainer with the suture in the opening.

126. A method as set forth in claim 118 wherein said step of heating the suture retainer include engaging the suture retainer with a vibration applicator member and vibrating the vibration application member at a rate of between 20 kilohertz and 70 kilohertz.

127. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes looping the suture around a first retainer member, said method further includes positioning a second retainer member in engagement with the first retainer member, said step of applying ultrasonic vibratory energy to the suture retainer includes bonding the first and second retainer members together under the influence of heat resulting from transmitting ultrasonic vibratory energy to the suture retainer.

128. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes inserting first and second sections of the suture through a retainer member, said method further includes moving the retainer member and at least one of the sections of the suture relative to each other, said step of applying ultrasonic vibratory energy to the suture retainer includes heating the retainer member by transmitting ultrasonic vibratory energy to the retainer member while the first and second sections of the suture extend through the retainer member.

129. A method as set forth in claim 118 wherein said step of applying ultrasonic vibratory energy to the suture retainer includes heating at least one retainer member of a plurality of retainer members under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

130. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes looping the suture around a first retainer member and positioning second and third retainer members relative to opposite sides of the first retainer member, said step of applying ultrasonic vibratory energy to the suture retainer includes bonding the first, second and third retainer members together under the influence of ultrasonic vibratory energy transmitted to the suture retainer.

131. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes positioning a first portion of the suture in a groove in the suture retainer and positioning a second portion of the suture in a passage which extends through the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the groove against the first portion of the suture and to press a side surface of the passage against the second portion of the suture.

132. A method as set forth in claim 118 wherein said step of forming a loop around a portion of the suture retainer includes positioning a first portion of the suture in a first groove in the suture retainer and positioning a second portion of the suture in a second groove in the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes plastically deforming material of the suture retainer to press a side surface of the first groove against the first portion of the suture and to press a side surface of the second groove against the second portion of the suture.

133. A method as set forth in claim 118 wherein the suture retainer is formed of a biodegradable material, said step of pressing the first and second layers of body tissue together under the influence of the first and second predetermined forces includes providing engagement between body tissue and the suture retainer to promote degradation of the suture retainer.

134. A method as set forth in claim 118 wherein both the suture and suture retainer are formed of a material which is biodegradable, said step of pressing the first and second layers of body tissue together under the influence of the first and second predetermined forces includes providing engagement between body tissue and the suture and the suture retainer to promote degradation of the suture and the suture retainer.

135. A method of securing a suture to layers of body tissue, said method comprising the steps of positioning a suture relative to the layers of body tissue with the layers of body tissue disposed in engagement with each other, positioning a suture retainer relative to the suture with the suture extending through the suture retainer, forming first and second loops around the suture retainer with the suture, moving the suture retainer along the suture toward the body tissue, moving the first and second loops along the suture toward the body tissue with the suture retainer, tensioning the suture with a first predetermined force which is a function of the strength of the suture while the suture extends through the suture retainer, transmitting a second predetermined force from the suture retainer to the body tissue while the suture extends through the suture retainer, the second predetermined force being transmitted to the suture retainer without being transmitted as tension in the suture, pressing the first and second layers of body tissue together under the influence of the first and second predetermined forces, and applying ultrasonic vibratory energy to the suture retainer to grip the suture with the suture retainer while the suture is tensioned with the first predetermined force and the second predetermined force is transmitted from the suture retainer to the body tissue.

136. A method as set forth in claim 135 wherein the suture retainer includes a plurality of separate members, said step of forming first and second loops around the suture retainer includes looping the suture around a portion of at least one of the members, said step of applying ultrasonic vibratory energy to the suture retainer includes pressing the members together and forming a bond between the members at the location where the members are pressed together.

137. A method as set forth in claim 135 wherein the suture retainer is formed as one piece, said step of moving the first and second loops along the suture toward the body tissue includes sliding the suture retainer along the suture with the suture looped around the suture retainer.

138. A method as set forth in claim 135 wherein said step of forming first and second loops around the suture retainer includes forming first and second spaced apart bends in the suture, said step of moving the first and second loops along the suture includes moving the first and second bends in the suture along the suture in a direction toward the body tissue with the first and second loops in the suture spaced apart from each other.

139. A method as set forth in claim 135 wherein the suture retainer includes first and second sections, said step of forming first and second loops around the suture retainer includes positioning a portion of the suture between the first and second sections of the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes urging the first and second sections of the suture retainer toward each other with at least portions of the first and second loops disposed between the first and second sections of the suture retainer.

140. A method as set forth in claim 135 wherein said step of forming first and second loops around the suture retainer includes positioning a portion of the suture in a groove in the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes collapsing the groove with the portion of the suture disposed in the groove.

141. A method as set forth in claim 135 wherein said first loop is formed around a first portion of the suture retainer and said second loop is formed around a second portion of the suture retainer which is spaced from the first portion of the suture retainer, said step of applying ultrasonic vibratory energy to the suture retainer includes heating the suture retainer and pressing the suture retainer against the first and second loops.

142. A method as set forth in claim 135 wherein the suture retainer includes first and second sections, said step of forming first and second loops around the suture retainer includes forming the first loop around a first portion of the suture retainer and forming the second loop around a second portion of the suture retainer which is spaced from the first portion of the suture retainer, said step of heating the suture retainer includes urging the first and second sections of the suture retainer toward each other with at least portions of the first and second loops disposed between the first and second sections of the suture retainer.

143. A method as set forth in claim 135 wherein said step of forming first and second loops around the suture retainer includes forming the first loop around a first portion of the suture retainer with a first axis extending through the first loop, forming the second loop around a second portion of the suture retainer with a second axis extending through the second loop.

144. A method as set forth in claim 135 wherein said step of forming first and second loops around the suture retainer includes forming the first and second loops in a coaxial relationship.

145. A method as set forth in claim 135 wherein said step of forming first and second loops around the suture retainer includes forming the first and second loops in a spaced apart relationship.

146. A method as set forth in claim 135 wherein said step of forming first and second loop around the suture retainer includes forming the first and second loops with at least a portion of the second loop in engagement with the first loop.

147. A method as set forth in claim 135 wherein the suture retainer is formed of a biodegradable material, said method further includes positioning the suture retainer in engagement with body tissue to promote degradation of the suture retainer.

148. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in a groove in the suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of heating the suture retainer includes collapsing the groove with the portion of the suture disposed in the groove.

149. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, transmitting at least a predetermined force from the suture retainer to the body tissue, tensioning the suture with at least a predetermined tension, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer.

150. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a suture relative to body tissue, wrapping the suture around a portion of a suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning the suture in engagement with surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of wrapping the suture around a portion of the suture retainer includes positioning a portion of the suture in an opening which extends through the suture retainer, and heating the suture retainer, said step of heating the suture retainer includes transmitting ultrasonic vibratory energy to the suture retainer while the suture is disposed in engagement with the surface areas which are disposed on opposite sides of the portion of the suture retainer, said step of heating the suture retainer includes collapsing the opening which extends through the suture retainer with the portion of the suture in the opening.