Surgical devices assembled using heat bondable materials

• US 6,503,267 B2
• Filed: 12/15/2000
• Issued: 01/07/2003
• Est. Priority Date: 06/28/1990
• Status: Expired due to Fees

• Current Assignee: P TECH, LLC
• Original Assignee: The Bonutti 2003 Trust A
• Inventors: Brillhart, Mark V., Bonutti, Peter M.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US09/737,380
• Publication Number:
  US 20010014814A1
• Time in Patent Office: 753 Days
• Field of Search: 606/232
• US Class Current: 606/232
• 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 17/68 Internal fixation devices , including fasteners and spinal fixators, even if a part thereof projects from the skin bone staples A61B17/0642
• CPC Class Codes: A61B 17/80 Cortical plates , i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
• CPC Class Codes: A61B 17/866 Material or manufacture
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/0408 Rivets
• 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 2017/0619 thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it
• CPC Class Codes: A61B 2017/867 with integral locking or clamping means
• CPC Class Codes: A61F 2/30734 Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
• CPC Class Codes: A61F 2/367 Proximal or metaphyseal parts of shafts trochanteric devices connected to said proximal parts A61F2/30739
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30065 thermoplastic, i.e. softening or fusing when heated, and hardening and becoming rigid again when cooled
• CPC Class Codes: A61F 2002/30736 Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
• CPC Class Codes: A61F 2210/0004 bioabsorbable
• CPC Class Codes: A61F 2210/0071 thermoplastic
• CPC Class Codes: B29C 65/602 using hollow rivets B29C65/607 takes precedence
• 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 66/721 : Fibre-reinforced materials B29C66/729 takes precedence
• CPC Class Codes: B29C 66/7212 : characterised by the composition of the fibres
• CPC Class Codes: B29C 66/73791 : biodegradable
• CPC Class Codes: B29C 66/8322 : Joining or pressing tools reciprocating along one axis
• CPC Class Codes: B29K 2023/04 : Polymers of ethylene
• CPC Class Codes: B29K 2023/06 : PE, i.e. polyethylene
• CPC Class Codes: B29K 2077/00 : Use of PA, i.e. polyamides, e.g. polyesteramides or derivatives thereof, as moulding material
• CPC Class Codes: B29K 2077/10 : Aromatic polyamides [polyaramides] or derivatives thereof
• CPC Class Codes: B29K 2277/00 : Use of PA, i.e. polyamides, e.g. polyesteramides or derivatives thereof, as reinforcement
• CPC Class Codes: B29K 2277/10 : Aromatic polyamides [Polyaramides] or derivatives thereof
• CPC Class Codes: B29K 2305/00 : Use of metals, their alloys or their compounds, as reinforcement
• CPC Class Codes: B29K 2305/12 : Iron
• CPC Class Codes: B29K 2307/04 : Carbon
• CPC Class Codes: Y10S 606/908 : Bioabsorbable material
• CPC Class Codes: Y10S 606/91 : Polymer

Abstract

Surgical devices such as implants or suture fastenings are assembled from a plurality of discrete components, one of which components includes a heat bondable plastic material for bonding the components together. At least two components are bonded to each other by the applying heat to the heat bondable plastic material of one component. The heat bondable plastic material is preferably a polymeric or composite material suitable for surgical applications and implantation in humans, and may be a biodegradable material. A laser may be used as the heat source. The present invention is advantageously embodied in heat bonded fastenings for sutures or K-wires, in which a variety of different suture anchors are usable, including expandable distal suture anchors. Other embodiments include a metal bone plate which is held to bone by a metal bone screw and a nut of bondable material bonded to the plate to secure the connection; a piece of bondable material bonded to a metal prosthesis to custom fit the prosthesis; and a surgical implant custom formed by bonding together a plurality of discrete elements one or more of which is bondable.

Claims

1. A method comprising the steps of moving an anchor through a first tissue segment with a suture connected to the anchor, moving the anchor into a second tissue segment with the suture connected to the anchor, tensioning the suture, applying force against the first tissue segment with a fastener to press the first tissue segment toward the second tissue segment, conducting energy to the fastener while the suture is being tensioned, and bonding the fastener to the suture while tensioning the suture and applying force against the first tissue segment with the fastener, wherein the second tissue segment is a bone disposed in a patient'"'"'s body, said method further includes moving a cannula into the patient'"'"'s body, said step of moving a cannula into the patient'"'"'s body includes moving the cannula through the first tissue segment into engagement with the bone, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into second body tissue includes moving the anchor through the cannula and into the cavity in the bone.

2. A method as set forth in claim 1 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

3. A method as set forth in claim 1 further including the step of moving a leading end portion of a sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

4. A method comprising the steps of moving a cannula through tissue in a patient'"'"'s body, moving a tool through the cannula into engagement with a bone in the patient'"'"'s body, forming a cavity in the bone with the tool, moving an anchor through the cannula, said step of moving an anchor through the cannula is at least partially performed with a force transmitting element connected with the anchor, moving the anchor out of an end portion of the cannula and into the cavity in the bone with the force transmitting element connected with the anchor, tensioning the force transmitting element after performing said step of moving the anchor out of the end portion of the cannula, pressing the anchor against body tissue under the influence of force transmitted through the force transmitting element during tensioning of the force transmitting element, pressing a fastener against body tissue disposed between the fastener and the anchor, engaging the force transmitting element with the fastener while pressing the fastener against the body tissue disposed between the fastener and the anchor, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and pressing the fastener against the body tissue disposed between the fastener and the anchor.

5. A method as set forth in claim 4 further including the step of expanding the anchor in the cavity in the bone.

6. A method as set forth in claim 4 wherein the anchor, force transmitting element, and fastener are formed of biodegradable material.

7. A method as set forth in claim 4 wherein said step of moving an anchor through the cannula includes moving a member along an interior of the cannula with the anchor at least partially enclosed by the member, said step of moving the anchor out of the end portion of the cannula includes moving the anchor out of the member into the body tissue.

8. A method as set forth in claim 7 further including the step of expanding the anchor as it moves out of the member.

9. A method as set forth in claim 4 wherein said step of moving an anchor through the cannula includes moving a member along an interior of the cannula with the anchor at least partially enclosed by a leading end portion of the member, moving a leading end of the member past an end of the cannula disposed in the body tissue, and disengaging the anchor from the member while the leading end of the member is disposed deeper into the body tissue than the end of the cannula.

10. A method as set forth in claim 9 further including the step of expanding the anchor in the body tissue while the anchor is disposed deeper into the body tissue than the end of the cannula.

11. A method as set forth in claim 10 wherein the anchor is at least partially formed of copolymer.

12. A method as set forth in claim 10 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

13. A method comprising the steps of moving an anchor into a patient'"'"'s body and through a tendon with a force transmitting element connected to the anchor, moving the anchor into tissue adjacent to the tendon with the force transmitting element connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the tendon, tensioning the force transmitting element expanding the anchor, transmitting force to the tendon from a fastener to urge the tendon toward the body tissue disposed adjacent to the tendon while tensioning the force transmitting element, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and transmitting force from the fastener to the tendon.

14. A method as set forth in claim 13 further including the step of moving a cannula through the tendon, said step of moving the anchor through the tendon includes moving the anchor along a passage in the cannula.

15. A method as set forth in claim 13 wherein the tissue disposed in the patient'"'"'s body adjacent to the tendon is a bone, said method further includes moving a cannula into the patient'"'"'s body, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into the patient'"'"'s body and through a tendon disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the cavity in the bone.

16. A method as set forth in claim 15 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

17. A method as set forth in claim 15 further including the step of moving a leading end portion of the sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

18. A method as set forth in claim 13 wherein the anchor and the force transmitting element are formed of a biodegradable material.

19. A method as set forth in claim 13 wherein the anchor and the force transmitting element are formed of a copolymer.

20. A method as set forth in claim 13 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

21. A method comprising the steps of moving an anchor into a patient'"'"'s body and through a ligament with a force transmitting element connected to the anchor, moving the anchor into tissue disposed adjacent to the ligament with the force transmitting element connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the ligament, tensioning the force transmitting element after expanding the anchor, transmitting force to the ligament from a fastener to urge the ligament toward the body tissue disposed adjacent to the ligament while tensioning the force transmitting element, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and transmitting force from the fastener to the ligament.

22. A method as set forth in claim 21 further including the step of moving a cannula through the ligament, said step of moving the anchor through the ligament includes moving the anchor along a passage in the cannula.

23. A method as set forth in claim 21 wherein the tissue disposed in the patient'"'"'s body adjacent to the ligament is a bone, said method further includes moving a cannula into the patient'"'"'s body, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into the patient'"'"'s body and through a ligament disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the cavity in the bone.

24. A method as set forth in claim 23 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

25. A method as set forth in claim 23 further including the step of moving a leading end portion of the sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

26. A method as set forth in claim 21 wherein the anchor and the force transmitting element are formed of a biodegradable material.

27. A method as set forth in claim 21 wherein the anchor and the force transmitting element are formed of a copolymer.

28. A method as set forth in claim 21 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

29. A method moving an anchor into a patient'"'"'s body and through a meniscus with a force transmitting element connected to the anchor, moving the anchor into tissue disposed adjacent to the meniscus with the force transmitting element connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the meniscus, tensioning the force transmitting element after expanding the anchor, transmitting force to the meniscus from a fastener to urge the meniscus toward the body tissue disposed adjacent to the meniscus while tensioning the force transmitting element, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and transmitting force from the fastener to the meniscus.

30. A method as set forth in claim 29 further including the step of moving a cannula through tissue in the patient'"'"'s body, said step of moving the anchor through the meniscus includes moving the anchor along a passage in the cannula.

31. A method as set forth in claim 29 wherein the tissue disposed in the patient'"'"'s body adjacent to the meniscus is a bone, said method further includes moving a cannula into the patient'"'"'s body, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into the patient'"'"'s body and through a meniscus disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the cavity in the bone.

32. A method as set forth in claim 31 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

33. A method as set forth in claim 31 further including the step of moving a leading end portion of the sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

34. A method as set forth in claim 29 wherein the anchor and the force transmitting element are formed of a biodegradable material.

35. A method as set forth in claim 29 wherein the anchor and the force transmitting element are formed of a copolymer.

36. A method as set forth in claim 29 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

37. A method comprising the steps of moving an anchor into a patient'"'"'s body and through a fascia with a force transmitting element connected to the anchor, moving the anchor into tissue disposed adjacent to the fascia with the force transmitting element connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the fascia, tensioning the force transmitting element after expanding the anchor, transmitting force to the fascia from a fastener to urge the fascia toward the body tissue disposed adjacent to the fascia while tensioning the force transmitting element, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and transmitting force from the fastener to the fascia.

38. A method as set forth in claim 37 further including the step of moving a cannula through the tissue in the patient'"'"'s body, said step of moving the anchor through the fascia includes moving the anchor along a passage in the cannula.

39. A method as set forth in claim 37 wherein the tissue disposed in the patient'"'"'s body adjacent to the fascia is a bone, said method further includes moving a cannula into the patient'"'"'s body, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into the patient'"'"'s body and through a fascia disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the cavity in the bone.

40. A method as set forth in claim 39 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

41. A method as set forth in claim 39 further including the step of moving a leading end portion of the sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

42. A method as set forth in claim 37 wherein the anchor and the force transmitting element are formed of a biodegradable material.

43. A method as set forth in claim 37 wherein the anchor and the force transmitting element are formed of a copolymer.

44. A method as set forth in claim 37 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

45. A method comprising the steps of moving an anchor into a patient'"'"'s body and through a rotator cuff with a force transmitting element connected to the anchor, moving the anchor into tissue disposed adjacent to the rotator cuff with the force transmitting element connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the rotator cuff, tensioning the force transmitting element after expanding the anchor, transmitting force to the rotator cuff from a fastener to urge the rotator cuff toward the body tissue disposed adjacent to the rotator cuff while tensioning the force transmitting element, and bonding the force transmitting element and fastener together while tensioning the force transmitting element and transmitting force from the fastener to the rotator cuff.

46. A method as set forth in claim 45 further including the step of moving a cannula through tissue in the patient'"'"'s body, said step of moving the anchor through the rotator cuff includes moving the anchor along a passage in the cannula.

47. A method as set forth in claim 45 wherein the tissue disposed in the patient'"'"'s body adjacent to the rotator cuff is a bone, said method further includes moving a cannula into the patient'"'"'s body, moving a tool through the cannula into engagement with the bone, forming a cavity in the bone with the tool, said step of moving the anchor into the patient'"'"'s body and through a rotator cuff disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the cavity in the bone.

48. A method as set forth in claim 47 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

49. A method as set forth in claim 47 further including the step of moving a leading end portion of the sleeve through the cannula into the cavity in the bone, moving the anchor from the leading end portion of the sleeve while the leading end portion of the sleeve is disposed in the cavity in the bone, and expanding the anchor as the anchor moves from the leading end portion of the sleeve.

50. A method as set forth in claim 45 wherein the anchor and the force transmitting element are formed of a biodegradable material.

51. A method as set forth in claim 45 wherein the anchor and the force transmitting element are formed of a copolymer.

52. A method as set forth in claim 45 wherein said step of bonding the force transmitting element and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the force transmitting element extending parallel to polymer chains of the fastener.

53. A method comprising the steps of moving an anchor connected with a suture into engagement with a first tissue segment disposed in a patient'"'"'s body, moving at least the suture through a second tissue segment in the patient'"'"'s body, tensioning the suture, pressing the first and second tissue segment together, and bonding a fastener to the suture by plastically deforming the fastener while tensioning the suture, wherein the suture is a multifilament suture and the fastener is made of a plurality of components, at least one of which includes a heat bondable material for bonding the member to the fastener.

54. A method as set forth in claim 53 further including the step of expanding the anchor while the anchor is engaged with the first tissue segment.

55. A method as set forth in claim 53 further including the steps of moving a cannula into the patient'"'"'s body and moving the anchor along the cannula into the patient'"'"'s body.

56. A method as set forth in claim 53 wherein the first tissue segment is a bone disposed in the patient'"'"'s body, said method further includes moving a cannula into the bone, said step of moving the anchor into the first tissue segment includes moving the anchor through the cannula and into the bone.

57. A method as set forth in claim 56 further including the step of expanding the anchor while the anchor is in the cavity in the bone.

58. A method as set forth in claim 53 wherein the anchor and the suture are formed of a biodegradable material.

59. A method as set forth in claim 53 wherein the anchor and the suture are formed of a copolymer.

60. A method as set forth in claim 53 wherein said step of bonding the fastener to the suture includes bonding the fastener to the suture with polymer chains of the suture extending parallel to polymer chains of the fastener.

61. A method as set forth in claim 53 wherein the fastener is made of a biodegradable material.

62. A method as set forth in claim 53 wherein the suture is made of a heat bondable material.

63. A method as set forth in claim 53 wherein the suture is made of a biodegradable material.

64. A method as set forth in claim 53 wherein the suture and fastener are made of the same material.

65. A method as set forth in claim 53 wherein the suture and fastener are made of different materials.

104. A method as set forth in claim 61 wherein the biodegradable material includes an antibiotic.

105. A method as set forth in claim 61 wherein the biodegradable material includes a tissue ingrowth promoter.

66. A method comprising the steps of moving a cannula into a patient'"'"'s body, moving an anchor through the cannula into engagement with tissue in the patient'"'"'s body, expanding the anchor in the patient'"'"'s body, tensioning a suture connected with the anchor, and bonding the suture and a fastener together by plastically deforming the fastener in the patients body.

67. A method as set forth in claim 66 wherein the anchor, suture, and fastener are formed of a biodegradable material.

68. A method as set forth in claim 66 wherein said step of bonding the suture and fastener together includes bonding the fastener to the force transmitting element with polymer chains of the suture extending parallel to polymer chains of the fastener.

69. A method comprising the steps of moving an anchor through a tendon disposed in a patient'"'"'s body, moving the anchor into tissue disposed adjacent to the tendon with suture connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the tendon, tensioning the suture, and bonding the suture and a fastener together by plastically deforming the fastener while tensioning the suture.

70. A method as set forth in claim 69 further including the step of moving a cannula through the tendon, said step of moving the anchor through the tendon includes moving the anchor along a passage in the cannula.

71. A method as set fort in claim 69 wherein the tissue disposed in the patient'"'"'s body adjacent to the tendon is a bone, said step of moving the anchor through a tendon disposed in the patients body includes moving the anchor through a cannula and into the bone.

72. A method as set forth in claim 71 further including the step of expanding the anchor while the anchor is in the bone.

73. A method as set forth in claim 69 wherein the anchor and the suture are formed of a biodegradable material.

74. A method as set forth in claim 69 wherein the anchor and the suture are formed of a copolymer.

75. A method as set forth in claim 69 wherein said step of bonding the suture and fastener together includes bonding the fastener to the suture with polymer chains of the suture extending parallel to polymer chains of the fastener.

76. A method comprising the steps of moving an anchor through a ligament disposed in a patient'"'"'s body, moving the anchor into tissue disposed adjacent to the ligament with a suture connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the ligament, tensioning the suture, and bonding the suture and a fastener together by plastically deforming the fastener while tensioning the suture.

77. A method as set in claim 76 further including the step of moving a cannula through the ligament, said step of moving the anchor through the ligament includes moving the anchor along a passage in the cannula.

78. A method as set forth in claim 76 wherein the tissue disposed in the patient'"'"'s body adjacent to the ligament is a bone, said step of moving the anchor through a ligament disposed in the patient'"'"'s body includes moving the anchor through a cannula and into the bone.

79. A method as set forth in claim 78 further including the step of expanding the anchor while the anchor is in the bone.

80. A method as set forth in claim 76 wherein the anchor and the suture are formed of a biodegradable material.

81. A method as set forth in claim 76 wherein the anchor and the suture are formed of a copolymer.

82. A method as set forth in claim 76 wherein said step of bonding the suture and fastener together includes bonding the fastener to the suture with polymer chains of the suture extending parallel to polymer chains of the fastener.

83. A method comprising the steps of moving an anchor through a meniscus disposed in a patient'"'"'s body, moving the anchor into tissue disposed adjacent to the meniscus with a suture connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the meniscus, tensioning suture, and bonding the suture and fastener together by plastically deforming the fastener while tensioning suture.

84. A method as set forth in claim 83 further including the step of moving a cannula through the meniscus, said step of moving the anchor through the meniscus includes moving the anchor along a passage in the cannula.

85. A method as set forth in claim 83 wherein the tissue disposed in the patient'"'"'s body adjacent to the meniscus is a bone, said step of moving the anchor through a meniscus disposed in the patient'"'"'s body includes moving the anchor through a cannula and into the bone.

86. A method as set forth in claim 85 further including the step of expanding the anchor while the anchor is the bone.

87. A method as set forth in claim 83 wherein the anchor and the suture are formed of a biodegradable material.

88. A method as set forth in claim 83 wherein the anchor and the suture are formed of a copolymer.

89. A method as set forth in claim 83 wherein said step of bonding the suture and fastener together includes bonding the fastener to the sum with polymer chains of the suture extending parallel to polymer chains of the fastener.

90. A method comprising the steps of moving an anchor through a fascia disposed in a patient'"'"'s body, moving the anchor into tissue disposed adjacent to the fascia with the suture connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the fascia, tensioning the suture, and bonding the suture and fastener together by plastically deforming the fastener.

91. A method as set forth in claim 90 further including the step of moving a cannula through the fascia, said step of moving the anchor through the fascia includes moving the anchor along a passage in the cannula.

92. A method as set forth in claim 90 wherein the tissue disposed in the patient'"'"'s body adjacent to the fascia is a bone, said step of moving the anchor through fascia disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the bone.

93. A method as set forth in claim 92 further including the step of expanding the anchor while the anchor is in the bone.

94. A method as set forth in claim 90 when the anchor and the suture are formed of a biodegradable material.

95. A method as set forth in claim 90 wherein the anchor and the suture are formed of a copolymer.

96. A method as set forth in claim 90 wherein said step of bonding the suture and fastener together includes bonding the fastener to the suture with polymer chains of the suture extending parallel to polymer chains of the fastener.

97. A method comprising the steps of moving an anchor through a rotator cuff disposed in a patient'"'"'s body, moving the anchor into tissue disposed adjacent to the rotator cuff with a suture connected to the anchor, expanding the anchor while the anchor is disposed in the body tissue adjacent to the rotator cuff, tensioning the suture, and bonding the suture and fastener together by plastically deforming the fastener.

98. A method as set forth in claim 97 further including the step of moving a cannula through the rotator cuff, said step of moving the anchor through the rotator cuff includes moving the anchor along a passage in the cannula.

99. A method as set forth in claim 97 wherein the tissue disposed in the patient'"'"'s body adjacent to the rotator cuff is a bone, said step of moving the anchor through a rotator cuff disposed in the patient'"'"'s body includes moving the anchor through the cannula and into the bone.

100. A method as set forth in claim 99 further including the step of expanding the anchor while the anchor is in the above.

101. A method as set forth in claim 97 wherein the anchor and the suture are formed of a biodegradable material.

102. A method as set forth in claim 97 wherein the anchor and the suture are formed of a copolymer.

103. A method as set forth in claim 97 wherein said step of bonding the suture and fastener together includes bonding the fastener to the suture with polymer chains of the suture extending parallel to polymer chains of the fastener.

106. A method of securing a suture relative to body tissue comprising the steps of providing a member having a passage that extends between opposite ends of the member, moving the member along the suture with the suture extending through the passage in the member, and bonding the member to the suture by plastically deforming the member, wherein the member is made of a plurality of components, at least one of which includes a heat bondable material for bonding the member to the suture.

107. A method as set forth in claim 106 wherein the member is made of a polymer.

108. A method as set forth in claim 106 wherein the member is made of a biodegradable material.

109. A method as set forth in claim 106 wherein the suture is made of a heat bondable material.

110. A method as set forth in claim 106 wherein the suture is made of a biodegradable material.

111. A method as set forth in claim 106 wherein the suture is a multifilament suture.

112. A method as set forth in claim 106 wherein the suture is a monofilament suture.

113. A method as set forth in claim 106 wherein the suture and member are made of the same material.

114. A method of securing a suture relative to body tissue comprising the steps of providing a member having a passage that extends between opposite ends of the member, moving the member along the suture with the suture extending through the passage in the member, forming a loop in the suture, with the loop extending at least partially around the body tissue, and bonding the member to the suture by plastically deforming the member, wherein first and second portions of the suture are bonded to the member to maintain the loop in the suture.