Multi-state anchor delivery systems, devices, kits and methods of use thereof

Abstract

A method of operating a multi-state anchor delivery system includes: (a) pushing an anchor pusher within a sheath over a specified axial overlap region between a first anchor pusher and the second pusher using the second pusher; (b) during the first state, using an anchor pusher to push the first anchor out of the sheath; (c) retracting the second pusher from the anchor pusher to reduce a specified axial overlap area between the anchor pusher and the second pusher; (d) deforming one or both of the anchor pusher and the second pusher; (e) pushing the anchor pusher using a second pusher, one or both of the anchor pusher and the second pusher having a deformation that causes mechanical interference against the specified axial overlap region, where the pushing occurs on a contact region between the anchor pusher and the second pusher that is outside the specified axial overlap region; and (f) during the second state, using the anchor pusher to push the second anchor out of the sheath.

Description

[0001] Related Applications

[0002] This application claims priority to U.S. Provisional Patent Application No. 63 / 426,024, filed on November 16, 2022, U.S. Provisional Patent Application No. 63 / 443,748, filed on February 7, 2023, and U.S. Provisional Patent Application No. 63 / 532,394, filed on August 13, 2023, the contents of which are incorporated herein by reference in their entirety.

[0003] Reference is also made herein to PCT Patent Application Serial No. PCT / IL2018 / 051298, titled "Multi-Anchor Delivery Systems and Methods", filed on November 27, 2018, the disclosure of which is incorporated herein by reference in its entirety. Technical Field

[0004] The present disclosure generally relates to medical systems, devices, kits, and methods for delivering implants, such as for delivering multiple soft tissue anchors. In some embodiments of the present invention, the present invention relates to anchors for soft tissue repair, and more particularly, but not exclusively, to anchors delivered by a multi-anchor delivery system. Background Art

[0005] It is known that in order to repair deformed or torn soft tissue, such as the meniscus, by suturing, a variety of different surgical procedures are required. There is a particular need for anchors that can be delivered to the repair site in a single surgical procedure. US8,888,798 and US 9,357,994 of Smith&Nephew, Inc. each disclose a tissue repair device, "wherein advancement of the knob allows the actuator to engage and subsequently advance a first anchor". US 9,498,203 and US 9,549,725 of Smith&Nephew each disclose a tissue repair device that includes a "spring-loaded pusher" configured to "deliver a flexible member to secure tissue".

[0006] US 9,622,736 discloses a tissue repair device that "includes first and second tubular anchors having respective longitudinal channels. The tissue repair device includes respective first and second inserters. Each inserter has a shaft, the distal portion of which is received in the longitudinal channel of the respective tubular anchor. A flexible cord couples the first anchor to the second anchor" (abstract).

[0007] Additional anchor repair systems and devices are disclosed in the following documents: US5,954,747; US6,306,156; US5,980,558; US5,993,459; US6,146,407; US6,595,911; US2003 / 0167072; US2008 / 0167660; US9,249,266; US9,173,645; 5,236,445; US4,899,743; US4,946,468; US4,968,315; US5,002,550; US5,041,129; US5,123,914; US5,258,016; US5,372,604; US5,403,348; US5,417,712; US5,417,691; US5,626,614; US5,718,717; US5,954,747; US6,554,852; US6,511,498; US5,403,348; US7,857,830; US7,905,903; US7,601,165; US8,128,658; US7,959,650; US8,771,314; US8,298,262; US8,221,454; US2014 / 0039552; US8,652,172; US8,828,053; US9,463,011; US9,622,738; and WO2019 / 102484. Summary of the Invention

[0008] The present invention seeks to provide improved anchors; and devices, kits, systems, and methods for anchor deployment, such as for delivery through soft tissue or bone tissue.

[0009] According to one aspect of some embodiments of the present invention, a method of operating a multi-state anchor delivery system is provided, comprising:

[0010] (a) Using a second pusher to push a first anchor pusher within a sheath over a specified axially overlapping region between the anchor pusher and the second pusher;

[0011] (b) During a first state, using the anchor pusher to push a first anchor out of the sheath;

[0012] (c) Retracting the second pusher from the anchor pusher, thereby reducing the specified axially overlapping region between the anchor pusher and the second pusher;

[0013] (d) Deforming one or both of the anchor pusher and the second pusher;

[0014] (e) Using a second pusher to push an anchor pusher, wherein one or both of the anchor pusher and the second pusher have a deformation portion that causes mechanical interference for a specified axially overlapping region, and wherein the pushing occurs on a contact region between the anchor pusher and the second pusher, which contact region is outside the specified axially overlapping region; and

[0015] (f) During the second state, using the anchor pusher to push a second anchor out of the sheath.

[0016] According to some embodiments of the present invention, the method further includes using an anchor switching mechanism to switch between a first state and a second state to push the anchors.

[0017] According to some embodiments of the present invention, the method further includes positioning the second anchor a certain distance outside the sheath, the distance corresponding to a reduced specified axially overlapping region.

[0018] According to some embodiments of the present invention, the method further includes positioning the second anchor a certain distance distally outside the sheath, the distance being greater than the distance at which the first anchor is positioned outside the sheath.

[0019] According to some embodiments of the present invention, the method further includes, after retracting the second pusher in a proximal direction, stopping reducing the specified axially overlapping region between the anchor pusher and the second pusher during the second state.

[0020] According to some embodiments of the present invention, the anchor is an implant.

[0021] According to some embodiments of the present invention, the anchor includes a suture.

[0022] According to one aspect of some embodiments of the present invention, there is provided a multi-state anchor delivery system, comprising:

[0023] A sheath having a proximal end and a distal end and having a channel extending therethrough;

[0024] At least two anchors disposed at the distal end of the channel;

[0025] An anchor pusher sized and shaped to push the at least two anchors out of the distal end of the channel;

[0026] A second pusher sized and shaped to push the anchor pusher distally in the channel;

[0027] A first axially overlapping region defined on the anchor pusher;

[0028] A second axial overlap region defined on the second pusher, wherein the specified potential axial overlap region is defined as the first axial overlap region and the second axial overlap region; and

[0029] An overlap switching mechanism in one or both of the first and second axial overlap regions, the overlap switching mechanism having two states, namely a first state and a second state, the first state allowing overlap at the specified axial overlap region, and the second state reducing the allowed overlap at the potential axial overlap region by mechanically interfering with the axial movement of one pusher relative to the other pusher.

[0030] According to some embodiments of the present invention, the second pusher includes a rack or other pusher assembly, and the specified axial overlap region includes a recess in the rack or other pusher assembly, the recess being operable to receive the proximal end of the anchor pusher.

[0031] According to some embodiments of the present invention, the overlap switching mechanism includes a movable panel connected to the rack, wherein the movable panel covers the recess during the second state, thereby reducing the specified axial overlap region.

[0032] According to some embodiments of the present invention, the overlap switching mechanism includes a curved protrusion extending from the sheath, the curved protrusion being positioned to deform and laterally bend the proximal end of the anchor pusher during the second state, thereby preventing the recess from receiving the anchor pusher and reducing the specified axial overlap region.

[0033] According to some embodiments of the present invention, the overlap switching mechanism includes a plate coupled between the sheath and the rack, the plate having a hole that is not centered, the plate being configured to deform the proximal end of the anchor pusher or prevent the rod from being received in the recess during the second state, thereby reducing the specified axial overlap region.

[0034] According to some embodiments of the present invention, the overlap switching mechanism includes a predetermined bend in the anchor pusher, the predetermined bend being selectively releasable from the rack and laterally bending once released to misalign with the recess in the rack.

[0035] According to some embodiments of the present invention, the overlap switching mechanism includes a rod extending from the second pusher.

[0036] According to some embodiments of the present invention, the specified axial overlap region is the second axial overlap region on the distal end of the rod and the first axial overlap region on the proximal end of the anchor pusher.

[0037] According to some embodiments of the present invention, the specified axial overlap region is a lapped overlap joint / bevel overlap joint.

[0038] According to some embodiments of the present invention, the lapped overlapping joint is configured to elastically deform at one or both of the anchor pusher and the second pusher during the second state by retracting the second pusher in the proximal direction.

[0039] According to some embodiments of the present invention, the anchor is a soft tissue anchor.

[0040] According to some embodiments of the present invention, the anchor includes at least one suture.

[0041] According to some embodiments of the present invention, the overlapping switching mechanism is configured to elastically deform between the first state and the second state.

[0042] According to some embodiments of the present invention, the deformable portion is configured to be released by retraction of the second pusher relative to the anchor pusher.

[0043] According to some embodiments of the present invention, the sheath is sized for arthroscopic use, including a diameter of less than 5 mm and a length of at least 40 mm.

[0044] According to some embodiments of the present invention, at least one of the sheath, the anchor pusher, and the second pusher is disposable.

[0045] According to some embodiments of the present invention, at least one of the sheath, the anchor pusher, and the second pusher is reusable.

[0046] According to some embodiments of the present invention, the sheath is bendable.

[0047] According to one aspect of some embodiments of the present invention, a method for reducing an axial overlap and extending an anchor pusher is provided, the method comprising:

[0048] Designating an axial overlap region between the anchor pusher and the second pusher;

[0049] Retracting the second pusher from the anchor pusher, thereby reducing the designated axial overlap region between the anchor pusher and the second pusher;

[0050] Deforming one or both of the anchor pusher and the second pusher;

[0051] Performing mechanical interference on the designated axial overlap region / forming mechanical interference on the designated axial overlap region;

[0052] Using a contact region outside the designated axial overlap region to combine the lengths of the anchor pusher and the second pusher;

[0053] Extending the lengths of the anchor pusher and the second pusher by using the new combined length; and

[0054] During the second state, the second anchor is pushed out of the sheath using the extended length of the anchor pusher.

[0055] According to one aspect of some embodiments of the present invention, a method for deploying a dual anchor is provided, including:

[0056] Advancing a first anchor out of a sheath using an anchor pushing mechanism including an anchor pusher having a first effective axial length;

[0057] Modifying the effective axial length of the anchor pusher; and

[0058] Advancing a second anchor out of the sheath using the modified effective length.

[0059] According to some embodiments of the present invention, modifying includes increasing the effective length of the anchor pusher by reducing the overlap between the anchor pusher and the pusher component that pushes the anchor pusher.

[0060] According to some embodiments of the present invention, modifying includes retracting the pusher component used to push the anchor, thereby allowing a portion of the anchor component and / or the anchor pusher to elastically deform or otherwise geometrically move so as to interfere with the axial overlap between the anchor component and a portion of the anchor pusher.

[0061] According to some embodiments of the present invention, both advancements use the same manual movement amount applied by an operator to a mechanical control connected to the anchor pushing mechanism.

[0062] According to one aspect of some embodiments of the present invention, a method for deploying an anchor is provided, including:

[0063] Displacing a pusher distally along a channel extending through the sheath;

[0064] Causing the pusher to contact a first anchor disposed within the channel and deploying the first anchor;

[0065] Retracting the pusher to a position proximal to a second anchor disposed within the channel, the retraction including temporarily deforming the pusher such that the length of the pusher changes during retraction; and

[0066] Displacing the pusher distally along the channel to deploy the second anchor.

[0067] According to one aspect of some embodiments of the present invention, a kit for dual anchor delivery is provided, including:

[0068] (a) A sheath;

[0069] (b) An anchor pusher at least partially disposed within the sheath;

[0070] (c) At least two anchors lying flat within the sheath distal to the anchor pusher;

[0071] (d) A length-variable anchor pushing mechanism including the anchor pusher, wherein the mechanism is configured to support different fixed axial overlaps between the anchor pusher and the mechanism during distal movement of the anchor pusher.

[0072] According to some embodiments of the present invention, the kit includes a suture configured to slidably thread through each of the two anchors, the suture including a slip knot configured to be released by pulling a first end of the suture and not configured to be released by pulling a second end of the suture, wherein the suture is configured to be tightened between the two anchors by pulling the first end of the suture.

[0073] According to some embodiments of the present invention, at least one of the sheath, the anchor pusher, and the second pusher is disposable.

[0074] According to some embodiments of the present invention, at least one of the sheath, the anchor pusher, and the second pusher is reusable.

[0075] According to some embodiments of the present invention, the sheath is bendable.

[0076] According to some embodiments of the present invention, the length-variable anchor pushing mechanism includes at least one of a plurality of racks and a plurality of pushers for variable anchor deployment.

[0077] According to one aspect of some embodiments of the present invention, there is provided a multi-anchor delivery system including:

[0078] A sheath having a proximal end and a distal end and having a channel extending therethrough;

[0079] A pusher having at least a distal end located within the channel, the distal end of the pusher sized and shaped to be displaceable through the channel;

[0080] A first anchor disposed within the sheath distal to the pusher; and

[0081] A second anchor disposed within the sheath at a position proximal to the first anchor, the second anchor disposed within the channel, the second anchor proximal to the distal end of the pusher, and the second anchor sized and shaped to be displaceable along the channel;

[0082] wherein the pusher is configured to retract proximally to a position proximal to the second anchor, and wherein at least a distal tip portion of the pusher is configured to deform under the action of the second anchor during proximal retraction; and

[0083] wherein the pusher is configured to deploy the second anchor.

[0084] According to some embodiments of the present invention, the pusher has sufficient flexibility to deform under the action of the second anchor during proximal retraction of the pusher.

[0085] According to some embodiments of the present invention, the distal end of the pusher has two configurations:

[0086] a relaxed state, in which the pusher can be used to deploy the anchor; and

[0087] a deformed state, in which the pusher can be fitted between the second anchor and the side wall of the sheath.

[0088] According to some embodiments of the present invention, the distal tip portion of the pusher includes at least one bend.

[0089] According to some embodiments of the present invention, the first anchor includes a proximally facing end face, and wherein the pusher includes a distally facing surface configured to contact the proximally facing end face of the first anchor during deployment.

[0090] According to some embodiments of the present invention, the second anchor includes a proximally facing end face, and wherein the pusher includes a distally facing surface configured to contact the proximally facing end face of the second anchor during deployment.

[0091] According to some embodiments of the present invention, the pusher has a non-uniform thickness along its length.

[0092] According to one aspect of some embodiments of the present invention, there is provided a multi-anchor delivery system comprising a first anchor and a second anchor connected by a suture having a slip knot.

[0093] According to some embodiments of the present invention, the suture comprises:

[0094] a first portion extending through the first of the two anchors and extending from the first anchor to the second of the two anchors;

[0095] a second portion extending between the first and second of the two anchors and threading through the second anchor; and

[0096] a third portion extending from the second anchor, the third portion including the slip knot;

[0097] wherein a first end portion of the pull suture is configured to release the slip knot.

[0098] In one aspect of some embodiments of the present invention, there is provided an anchor delivery system comprising:

[0099] a sheath having a proximal end and a distal end and having a channel extending therethrough;

[0100] a pusher element having at least a distal end located within the channel, the distal end of the pusher element being sized and shaped to be displaceable through the channel;

[0101] at least one anchor disposed within the channel and sized and shaped to be displaceable along the channel, at least a portion of the at least one anchor being located distal relative to the pusher element, the at least one anchor having a distal end and a proximal end;

[0102] at least one suture configured to thread through the distal end of the at least one anchor at least once and further configured to thread through the proximal end of the at least one anchor at least once; the at least one suture is further configured to be disposed at least partially within the channel;

[0103] the pusher element is sized and shaped to be displaceable through the channel and thereby deploy the at least one anchor.

[0104] In some embodiments of the present invention, the pusher element has a lumen and the at least one suture is configured to pass through the lumen.

[0105] In some embodiments of the present invention, the at least one suture is configured to be disposed at least partially within the channel between the inner diameter of the sheath and the outer diameter of the pusher element.

[0106] In some embodiments of the present invention, the at least one anchor is tubular.

[0107] In one aspect of some embodiments of the present invention, there is provided a flexible anchor for deployment through soft tissue, the anchor comprising:

[0108] an elongate flexible body sized and shaped to be deployable from a deployment device, the elongate body having a first end and a second end and an outer surface, the body extending along a longitudinal axis in a first orientation, the flexible body being configured to be bendable into a second orientation in which the first and second ends are closer to each other compared to the first orientation; and

[0109] a channel extending along the anchor body, wherein at least a portion of the channel is located along the outer surface of the anchor body, the channel being sized and shaped to receive a first segment of suture therethrough.

[0110] In some embodiments of the present invention, when the body is in the first orientation, one end of the suture is configured to be pulled proximally and slide through the channel, thereby shortening the first section of the suture extending through the channel, and the shortened section of the suture extending through the channel is configured to pull the body along the channel, thereby bending the body into the second orientation.

[0111] In some embodiments of the present invention, in the second orientation, the anchor body has a U-shaped configuration, with the channel located within the U-shape.

[0112] In some embodiments of the present invention, in the second orientation, the first and second ends of the body face each other at an angle.

[0113] In some embodiments of the present invention, the channel is defined by a plurality of loops positioned between the first and second ends along the outer surface of the anchor, wherein at least a first loop of the plurality of loops is positioned closer to the first end of the body than to the second end of the body, and at least a second loop of the plurality of loops is positioned closer to the second end of the body than to the first end of the body.

[0114] In some embodiments of the present invention, the loops are formed by a portion of the suture.

[0115] In some embodiments of the present invention, the anchor is tubular and has an internal lumen, and the plurality of loops extend through the outer surface of the anchor into the internal lumen.

[0116] In some embodiments of the present invention, each loop has a first and a second end, and the first and second ends pass through the material of the outer surface of the anchor from the outside of the outer surface of the anchor to the inside of the outer surface of the anchor.

[0117] In some embodiments of the present invention, the plurality of loops are formed from a single piece of material, and the second end of a loop is connected to the first end of an adjacent loop.

[0118] In some embodiments of the present invention, the channel is defined by a plurality of loops positioned between the first and second ends along the outer surface of the anchor, wherein the plurality of loops include:

[0119] A first loop, including a first loop portion having a first and a second end, the first portion extending radially outward through the outer surface from the inside of the outer surface and then extending radially inward through the outer surface; and

[0120] A second loop, including a second loop portion having a first and a second end, the second portion extending radially outward through the outer surface from the inside of the outer surface and then extending radially inward through the outer surface;

[0121] Wherein the second end portion of the first part and the first end portion of the second part are adjacent portions of a single piece of material.

[0122] According to some embodiments of the present invention, the first and second rings are part of a suture.

[0123] According to some embodiments of the present invention, the piece of material has first and second end portions that are adjacent to the first end of the first ring portion and the second end of the second ring portion, respectively; and

[0124] Wherein the first end of the first ring portion is prevented from being pulled out of the anchor by at least one of the following:

[0125] A knot in the first end portion of the piece of material;

[0126] An interweaving of the first end portion of the piece of material with a portion of the anchor; and

[0127] A portion of the first end portion of the piece of material that is welded or heat-sealed to the anchor; and

[0128] Wherein the second end of the second ring portion is prevented from being pulled out of the anchor by at least one of the following:

[0129] A knot in the second end portion of the piece of material;

[0130] An interweaving of the second end portion of the piece of material with a portion of the anchor; and

[0131] A portion of the second end portion of the piece of material that is welded or heat-sealed to the anchor.

[0132] According to some embodiments of the present invention, the plurality of rings are attached at a plurality of attachment points along the outer surface of the anchor.

[0133] According to some embodiments of the present invention, the plurality of rings includes a pair of rings.

[0134] According to some embodiments of the present invention, the plurality of rings includes a set of four rings.

[0135] According to some embodiments of the present invention, first and second anchors are provided, wherein a portion of the suture is configured to thread through a channel in each of the first and second anchors when the first and second anchors are in a first orientation, and one end of the suture is configured to be pulled proximally and slide through the channel in each of the first and second anchors, thereby shortening the first section of the suture that extends through the channel in each of the first and second anchors, and the shortened section of the suture that extends through the channel in each of the first and second anchors is configured to pull a body along the channels of the first and second anchors, thereby bending the body of each of the first and second anchors into a second orientation.

[0136] According to some embodiments of the present invention, the first suture line includes:

[0137] A first suture portion that extends from a position proximal to the first and second anchors to the first anchor;

[0138] A second suture portion that extends from the first suture portion through a channel of the first anchor;

[0139] A third suture portion that extends from the second suture portion to the second anchor;

[0140] A fourth suture portion that extends from the third suture portion through a channel of the second anchor;

[0141] A fifth suture portion that extends from the fourth suture portion to the first anchor; and

[0142] A sixth suture portion that extends from the fifth suture portion through a channel of the first anchor, the sixth suture portion having an end portion provided with a knot;

[0143] Wherein, after the first and second anchors are deployed, the first suture portion is configured to be pulled proximally, thereby shortening the segment of the suture line extending through the channels of the first and second anchors. Thus, the shortened segment of the suture line is configured to pull the body along the channels of both the first and second anchors, thereby bending both the first and second anchors such that the first and second ends of the first anchor are closer to each other than they were before the first anchor was deployed, and the first and second ends of the second anchor are closer to each other than they were before the second anchor was deployed.

[0144] According to some embodiments of the present invention, the first suture line includes:

[0145] A first suture portion that extends from a position proximal to the first and second anchors to the first anchor;

[0146] A second suture portion that extends from the first suture portion through a channel of the first anchor;

[0147] A third suture portion that extends from the second suture portion to the second anchor;

[0148] A fourth suture portion that extends from the third suture portion through a channel of the second anchor;

[0149] A fifth suture portion that extends from the fourth suture portion to the first anchor, the fifth suture portion having an end portion knotted on the first suture portion near the first anchor;

[0150] Wherein, after deploying the first and second anchor fasteners, the first suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through the channels of the first and second anchor fasteners. As a result, the shortened section of suture is configured to pull the body along the channels of both the first and second anchor fasteners, thereby bending both the first and second anchor fasteners such that the first and second ends of the first anchor fastener are closer to each other than they were before the first anchor fastener was deployed, and the first and second ends of the second anchor fastener are closer to each other than they were before the second anchor fastener was deployed.

[0151] According to some embodiments of the present invention, each of the first and second anchor fasteners has its own channel, and the first section of suture includes:

[0152] A first suture portion that forms a plurality of loops defining the channel of the second anchor fastener;

[0153] A second suture portion that extends from the first suture portion to the first anchor fastener;

[0154] A third suture portion that extends from the second suture portion through the channel of the first anchor fastener;

[0155] A fourth suture portion that extends from the third suture portion to the second anchor fastener;

[0156] A fifth suture portion that extends from the fourth suture portion away from the first anchor fastener through the channel of the second anchor fastener; and

[0157] A sixth suture portion that extends proximally from the fifth suture portion away from the second anchor fastener;

[0158] Wherein, after the first and second anchor fasteners are deployed, the sixth suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through the channels of each of the first and second anchor fasteners. As a result, the shortened section of suture is configured to pull the body along the channels of both the first and second anchor fasteners, thereby bending each of the bodies of the first and second anchor fasteners into a second orientation.

[0159] According to some embodiments of the present invention, each of the first and second anchor fasteners has its own channel, and the first section of suture includes:

[0160] A first suture portion that forms a plurality of loops defining the channel of the second anchor fastener;

[0161] A second suture portion that extends from the first suture portion to the first anchor fastener;

[0162] A third suture portion that extends from the second suture portion through the channel of the first anchor fastener;

[0163] A fourth suture portion extending from the third suture portion to the second anchor;

[0164] A fifth suture portion extending from said other suture portion through a passage of the second anchor toward the first anchor; and

[0165] A sixth suture portion extending proximally from the fifth suture portion around the first anchor;

[0166] Wherein, after deployment of the first and second anchors, the sixth suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through each of the passages in the first and second anchors, whereby the shortened section of suture is configured to pull the body along the passages of both the first and second anchors, thereby bending each of the bodies of the first and second anchors into a second orientation.

[0167] According to some embodiments of the present invention, the anchor includes an additional loop on the proximal portion of the anchor, the additional loop being configured to be grasped by a pusher of a deployment mechanism, the additional loop being configured to be released by the pusher during deployment of the anchor.

[0168] According to some embodiments of the present invention, the anchor is formed of a material, and at least a portion of the passage is defined by a portion of the material.

[0169] According to one aspect of some embodiments of the present invention, there is provided a method for securing a flexible anchor relative to soft tissue, the method comprising:

[0170] Deploying an anchor in a first orientation through soft tissue, wherein a section of suture extending through a passage along the anchor is also deployed through the soft tissue, wherein the section of suture is not coaxial with the anchor;

[0171] Pulling a portion of the suture proximally to shorten the section of suture extending through the passage, whereby the shortened section of suture bends the anchor into a second orientation, wherein in the second orientation, the first and second ends of the anchor are closer to each other than in the first orientation.

[0172] According to some embodiments of the present invention, a second anchor in a first orientation is deployed through soft tissue, wherein the section of suture also extends through a passage along the second anchor, wherein the section of suture is not coaxial with the second anchor;

[0173] Wherein pulling includes shortening the section of suture extending through the passage along the second anchor, whereby the shortened section of suture bends the second anchor into a second orientation, wherein in the second orientation, the first and second ends of the second anchor are closer to each other than in the first orientation.

[0174] In accordance with one aspect of some embodiments of the present invention, there is provided a flexible anchor for deployment through soft tissue, the anchor comprising:

[0175] An elongate flexible body sized and shaped for deployment from a deployment device, the elongate body having first and second ends and an outer surface, the body extending along a longitudinal axis in a first orientation and configured to be bendable into a second orientation in which the first and second ends are closer to each other than in the first orientation; and

[0176] A channel extending along or through the anchor body, the channel sized and shaped to receive a first segment of suture therethrough, at least a portion of the channel being non - coaxial with the longitudinal axis of the anchor body.

[0177] In accordance with some embodiments of the present invention, when the body is in the first orientation, one end of the suture is configured to be pulled proximally and slid through the channel, thereby shortening the segment of suture extending through the channel, and the shortened segment of suture extending through the channel is configured to pull the body along the channel, thereby bending the body into the second orientation.

[0178] In accordance with some embodiments of the present invention, at least a portion of the channel extends at least partially radially inwardly relative to the outer surface of the anchor body, and this portion of the channel is positioned transverse to the longitudinal axis of the anchor.

[0179] In accordance with some embodiments of the present invention, the channel extends at least partially through a portion of the anchor body at least once.

[0180] In accordance with some embodiments of the present invention, the channel extends at least partially through a portion of the anchor body at least twice.

[0181] In accordance with some embodiments of the present invention, the channel includes a first channel portion oriented perpendicular to the longitudinal axis of the anchor body.

[0182] In accordance with some embodiments of the present invention, the channel includes a second channel portion oriented at an angle other than 90° relative to the longitudinal axis of the anchor body.

[0183] In accordance with some embodiments of the present invention, the channel includes a second channel portion oriented perpendicular to the longitudinal axis of the anchor body.

[0184] In accordance with some embodiments of the present invention, the channel includes a third channel portion oriented parallel to the longitudinal axis of the anchor body.

[0185] In accordance with some embodiments of the present invention, the channel includes a third channel portion oriented at an angle other than 90° relative to the longitudinal axis of the anchor body.

[0186] According to some embodiments of the present invention, the channel includes first and second channel portions, each channel portion being oriented at an angle other than 90° relative to the longitudinal axis of the anchor body.

[0187] Unless otherwise defined, all technical and / or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the systems, devices, kits, and methods belong. Exemplary methods and / or materials are described below, but methods and materials similar or equivalent to those described herein may be used in the practice or testing of embodiments of the systems, devices, kits, and methods. In case of conflict, the patent specification (including definitions) shall prevail. In addition, the materials, methods, and examples are illustrative only and are not meant to be limiting. BRIEF DESCRIPTION OF THE DRAWINGS

[0188] With reference to the accompanying drawings, some embodiments of the systems, kits, devices, and methods are described herein only by way of example. Now specifically referring to the detailed drawings, it should be emphasized that the details shown are by way of example and for the purpose of illustrative discussion of embodiments of the systems, kits, devices, and methods. In this regard, the description in conjunction with the drawings enables those skilled in the art to understand how to practice embodiments of the systems, devices, kits, and methods. In addition, references to any features or aspects of any system, device, kit, and method according to the present invention or any combination thereof can be understood to also refer to any system, device, kit, and method discussed herein.

[0189] In the drawings:

[0190] Figure 1A is an exemplary abstract block diagram according to some embodiments of the present invention, showing a specified axial overlap region that is located in a sheath for a multi-state anchor delivery system during a first state and during a first anchor deployment;

[0191] Figure 1B is an exemplary abstract block diagram according to some embodiments of the present invention, showing a reduced specified axial overlap region that is located in a sheath for a multi-state anchor delivery system during a second state and during a second anchor deployment;

[0192] Figure 2A is an exemplary abstract block diagram showing according to some embodiments of the present invention, which shows a specified axial overlap region and an axial switching mechanism that is optionally at least partially outside of a sheath of a multi-state anchor delivery system during a first state and during a first anchor deployment operation;

[0193] Figure 2BAn exemplary abstract block diagram according to some embodiments of the present invention, showing a reduced specified axial overlap region and an axial switching mechanism, which is optionally outside the sheath for a multi-state anchor delivery system in a second state during a second anchor deployment operation;

[0194] Figure 3 An exemplary illustration of a multi-state anchor delivery system according to some embodiments of the present invention, showing an outer housing;

[0195] Figure 4 An exploded perspective view of a multi-state anchor delivery system according to some embodiments of the present invention, showing internal components inside the housing;

[0196] Figure 5 A view showing a specified axial overlap region of a mechanism with an overlapping joint during the deployment of a first anchor according to some embodiments of the present invention;

[0197] Figure 6 A side cross-sectional view of a part of a device of a system according to some embodiments of the present invention, showing a reduction in a specified axial overlap region of a mechanism with an overlapping joint during retraction of a second pusher after deployment of a first anchor;

[0198] Figure 7 A side cross-sectional view of a part of a device of a system according to some embodiments of the present invention, showing a specified axial overlap region of an overlapping joint of a deformed second pusher before deployment of a second anchor;

[0199] Figure 8 A perspective view of a part of an anchor delivery device of a system according to some embodiments of the present invention, showing a specified axial overlap region of a mechanism with a movable panel in an open position during deployment of a first anchor;

[0200] Fig. 9 A side cross-sectional view of a part of a device of a system according to some embodiments of the present invention, showing the pushing of an anchor pusher in a first state and a movable panel in an open position during deployment of a first anchor;

[0201] Fig.10 A side cross-sectional view of a part of a device of a system according to some embodiments of the present invention, including a specified axial overlap region of a mechanism with a movable panel in an open position after deployment of a first anchor;

[0202] Fig.11A side cross-sectional view of an apparatus of a system according to some embodiments of the present invention, including a designated axially overlapping region having a movable panel in a closed position covering the inner bore (or other recess) after a first anchor deployment and rack retraction, showing a reduction in the overlapping region;

[0203] Fig.12 A side cross-sectional view of a portion of an apparatus of a system according to some embodiments, showing a second pusher in a second state, where a designated axially overlapping region having a movable panel is in a closed position covering the inner bore;

[0204] Fig.13A A perspective view of a portion of a system according to some embodiments of the present invention, showing a sheath as an embodiment of reducing the axially overlapping region, the sheath having a protrusion for bending the anchor pusher after a first anchor deployment and rack retraction;

[0205] Fig. 13B A perspective view showing a sheath of a system according to some embodiments of the present invention, the sheath having a protrusion at the proximal end for bending the anchor pusher, the sheath being operable to deform the anchor pusher;

[0206] Fig.14A A perspective view showing an overlapping switching plate according to some embodiments of the present invention, the overlapping switching plate being operable to deform the anchor pusher;

[0207] Fig. 14B A perspective view showing the assembled position of an overlapping switching plate according to some embodiments of the present invention;

[0208] Fig.15A -B is a corresponding side view and end view of an anchor according to some embodiments of the present invention;

[0209] Fig.16A -C is a cross-sectional view of an anchor according to some embodiments of the present invention, each anchor including four rings;

[0210] Fig.16D is according to an embodiment of the present invention Fig.16A A plan view of a pair of anchors, the anchors shown after deployment and fixation against soft tissue;

[0211] Fig.17A -B is a cross-sectional view of an anchor according to some embodiments of the present invention, each anchor including two rings;

[0212] Fig. 17C is according to an embodiment of the present invention Fig.17A A plan view of a pair of anchors, the anchors shown after deployment and fixation against soft tissue;

[0213] Fig.17D -G is a side view of an additional anchor according to some embodiments of the present invention;

[0214] Fig.18A -B shows an alternative configuration for threading a suture through a pair of anchors according to an embodiment of the present invention, and the anchors after being fixed against soft tissue;

[0215] Fig.19A -B shows another alternative configuration for threading a suture through a pair of anchors according to an embodiment of the present invention, and the anchors after being fixed against soft tissue;

[0216] Fig.19C is a simplified schematic view of an exemplary anchor with a suture threaded therethrough in a first orientation according to an embodiment of the present invention;

[0217] Fig.19D is in a second orientation according to some embodiments of the present invention Fig.19C a simplified cross-sectional view of an anchor with a suture threaded therethrough;

[0218] Fig.19E is a simplified cross-sectional view of a part of an anchor delivery system constructed and operated according to an embodiment of the present invention, and it is shown in an initial operating orientation;

[0219] Fig.19F is a simplified cross-sectional view of a part of an anchor delivery system constructed and operated according to another embodiment of the present invention, and it is shown in an initial operating orientation;

[0220] Figure 19G is shown in an initial operating orientation Fig.19F a simplified cross-sectional view of an anchor delivery system and an enlarged view of its distal end;

[0221] Fig.19H is shown in an anchor deployment operating orientation Fig.19F a simplified cross-sectional view of an anchor delivery system and an enlarged view of its distal end;

[0222] Fig.19I is shown in an initial operating orientation Fig.19E a simplified cross-sectional view of an anchor delivery system and an enlarged view of its distal end;

[0223] Fig.19J is shown in an anchor deployment operating orientation Fig.19E a simplified cross-sectional view of an anchor delivery system and an enlarged view of its distal end;

[0224] Figure 19K -M is constructed and operated according to an embodiment of the present invention Fig.19C Simplified cross-sectional views of multiple alternative embodiments of a portion of the anchor delivery system shown therein, each shown in an initial operating orientation;

[0225] Fig. 20 is a flowchart according to some embodiments of the present invention, showing a method of operating a multi-state anchor delivery system;

[0226] Fig.21 is a flowchart according to some embodiments of the present invention, showing a method for reducing axial overlap and extending an anchor pusher;

[0227] Fig. 22 is an exploded view of an anchor delivery system including a pusher element having a curved tip according to some embodiments of the present invention;

[0228] Fig.23 is Fig. 22 a perspective view of the assembled anchor delivery system;

[0229] Fig.24 is according to some embodiments of the present invention for Fig. 22 a perspective view of a pusher element of an anchor delivery system, including an enlarged view of a portion of the pusher element;

[0230] Fig.25 is according to some embodiments of the present invention, before deploying the anchor, Figure 22-23 a side cross-sectional view of the anchor delivery system;

[0231] Fig.26 is according to some embodiments of the present invention, after deploying the first anchor, Figure 22-23 a side cross-sectional view of the anchor delivery system, wherein the pusher element is in an extended / extended position;

[0232] Fig.27A is according to some embodiments of the present invention, during retraction of the pusher element, Figure 22-23 a side cross-sectional view of the anchor delivery system;

[0233] Fig.27B is according to some embodiments of the present invention, after retraction of the pusher element, Figure 22-23 a side cross-sectional view of the anchor delivery system;

[0234] Fig.28 is according to some embodiments of the present invention, after deploying the second anchor, Figure 22-23 a side cross-sectional view of the anchor delivery system;

[0235] Fig.29Exploded view of an anchor delivery system including a pusher element having an S-shaped distal portion, according to some embodiments of the present invention;

[0236] Fig.30 According to some embodiments of the present invention Fig.29 Perspective view of the pusher element, including an enlarged view of a portion of the pusher element;

[0237] Fig.31 According to some embodiments of the present invention, prior to anchor deployment Fig.29 Side cross-sectional view of the anchor delivery system;

[0238] Fig.32 According to some embodiments of the present invention, after the first anchor is deployed Fig.29 Side cross-sectional view of the anchor delivery system, wherein the pusher element is in an extended position;

[0239] Fig.33A According to some embodiments of the present invention, during retraction of the pusher element Fig.29 Side cross-sectional view of the anchor delivery system;

[0240] Fig.33B According to some embodiments of the present invention, after the pusher element is retracted Fig.29 Side cross-sectional view of the anchor delivery system;

[0241] Fig.34 According to some embodiments of the present invention, after the second anchor is deployed Fig.29 Side cross-sectional view of the anchor delivery system;

[0242] Fig.35 Flowchart showing a method of deploying and securing a pair of anchors according to some embodiments of the present invention;

[0243] Fig.36A -J shows the deployment and fixation of a pair of anchors on soft tissue according to some embodiments of the present invention, the anchors having a segment of suture passing therethrough in a first routing configuration;

[0244] Fig.37A -J shows the deployment and fixation of a pair of anchors on soft tissue according to additional embodiments of the present invention, the anchors having a segment of suture routed therethrough in a first routing configuration;

[0245] Fig.38A -J shows the deployment and fixation of a pair of anchors on soft tissue according to yet other embodiments of the present invention, the anchors having a segment of suture routed therethrough in a second routing configuration;

[0246] Fig.39A-J shows the deployment and fixation of a pair of anchor devices on soft tissue according to further embodiments of the present invention, the anchor devices having a segment of suture threaded therethrough in a second threading configuration;

[0247] Fig.40A -B shows an alternative configuration for threading a segment of suture through a pair of anchor devices according to an embodiment of the present invention;

[0248] Fig.41A -B shows another alternative configuration for threading a segment of suture through a pair of anchor devices according to an embodiment of the present invention;

[0249] Fig.42 is a side cross-sectional view of a portion of an anchor device delivery system according to some embodiments of the present invention, including an anchor device having a suture threaded therethrough;

[0250] Fig.43A -H is a side view of the suture of the anchor device delivery system shown after deployment of the first and second anchor devices;

[0251] Fig.44 is a flow chart according to an embodiment of the present invention, showing actions performed during deployment and fixation of an anchor device to tissue;

[0252] Fig.45 is a flow chart according to an embodiment of the present invention, showing how an anchor device is deployed and fixed to tissue;

[0253] Fig.46 is according to an embodiment of the present invention Fig.23 a perspective view of a portion of an anchor device delivery system;

[0254] Fig.47 is a perspective view of a portion of an alternative delivery system according to an embodiment of the present invention; and

[0255] Fig.48A -E is a side view of a portion of an anchor device delivery system according to some embodiments of the present invention Fig.23 of. DETAILED DESCRIPTION

[0256] The present disclosure generally relates to medical systems, devices, kits, and methods for delivering implants, such as for delivering multiple soft tissue anchor devices. As discussed herein, the systems, devices, kits, and methods of the present disclosure may alternatively be used to deploy multiple anchor devices through bone.

[0257] Alternatively or additionally, in some embodiments of the present invention, the present invention relates to anchor devices for soft tissue repair, and more particularly, but not exclusively, to bendable anchor devices delivered through a multiple anchor device delivery system, and methods of deploying such anchor devices.

[0258] The present disclosure relates to an anchor delivery system and method that are particularly suitable for repairing soft tissue, such as the meniscus, or for performing temporomandibular joint disc repositioning surgery, although the anchor delivery system is not limited to these specific surgical procedures. One aspect of some embodiments of the present invention relates to deploying an anchor using a sheath and tensioning the anchor.

[0259] It should be understood that, according to embodiments of the present invention, an improved anchor with a suture partially passing therethrough is provided, and the anchor is used as part of an anchor delivery system that may be in all respects similar to the anchor delivery system 100 described and shown in PCT patent application serial number PCT / IL2018 / 051298, which is incorporated herein by reference in its entirety. Hereinafter, similar elements are denoted by similar reference numerals.

[0260] According to some embodiments, a channel may be defined along the anchor body, wherein at least a portion of the channel is located along the outer surface of the anchor body. A portion of the channel may be located through the anchor body, optionally at least partially radially inwardly of the outer surface of the anchor body. Optionally, the channel at least partially extends through a portion of the anchor body at least once. One or more portions of the channel may be oriented perpendicular to the longitudinal axis of the anchor body. Alternatively, one or more portions of the channel may be oriented at an angle other than 90° with respect to the longitudinal axis of the anchor body.

[0261] According to some aspects of some embodiments of the present invention, a system, device, kit, and method for deploying first and second anchors are provided, wherein, prior to deploying the anchors, the position of the first anchor within the device is distal to the position of the second anchor within the device. According to some embodiments, the system, device, kit, and method discussed herein include a pusher element that extends distally to deploy the first anchor and then retracts to a position proximal to the second anchor and then extends distally to deploy the second anchor.

[0262] In some embodiments of the present invention, a multi-state overlapping switching mechanism is provided for controlling the deployment of an anchor using an anchor pusher and a second pusher within an anchor delivery system. In some embodiments, the anchor delivery system is a tissue repair system, which is, for example, used for repairing soft tissue, such as the meniscus, although the anchor delivery system is not limited to only meniscus surgery. Alternatively, in some embodiments, the anchor delivery system is a tissue repair system, for example, for repairing bone tissue. Although this application may discuss various different anchors and deployment systems / methods for repairing soft tissue, it should be understood that, alternatively, such anchors and deployment systems / methods may alternatively be applicable to repairing bone tissue.

[0263] One aspect of some embodiments of the present invention relates to a mechanism for modifying the axial travel distance of an anchor pusher. Optionally, this allows the same pusher to deliver anchors to different depths. Alternatively or additionally, this allows the same anchor pusher to push a more proximal anchor to the same position as a more distal anchor, or to a position further than the more distal anchor. Such a mechanism is useful in an anchor delivery system in which an anchor pusher is used to push an anchor out of the delivery system and into tissue. If a more proximal anchor is used as an extension of the anchor pusher for pushing a more distal anchor, the proximal anchor may not extend significantly beyond the distal end of the delivery system during pushing of the more distal anchor. However, deployment of the proximal anchor does require such extension, and thus the anchor pusher may need more axial movement. The proposed mechanism provides variable length movement of the anchor pusher for different anchors. In some embodiments of the present invention, a mechanism for moving the anchor pusher is provided, and the mechanism retracts after deployment of the distal anchor. This potentially allows for a simpler mechanical design for various different mechanism features such as the degree of movement of a user-manipulated knob and / or the position of a safety mechanism. As an alternative, one could simply advance the anchor pusher for each deployed anchor without retracting the anchor. However, this may also require a longer handle or other mechanism to advance the anchor pusher, and / or may provide a different feel or different manipulation geometry for the user for each anchor deployment, which may be undesirable.

[0264] In some embodiments of the present invention, an overlapping switching mechanism is provided, in which the anchor pusher and a second pusher assembly (also referred to herein as the "second pusher") have variable axial overlap. This variable axial overlap allows the total axial length and / or travel distance of the anchor pusher to effectively differ in different overlap states. Thus, for example, when deploying a first anchor and a second anchor, the total axial length and / or travel distance of the anchor pusher can effectively differ. Such different travel amounts can differ by, for example, the length of the proximal anchor, which is part of the entire pusher structure for deploying the distal anchor, but not part of the entire structure for deploying the proximal anchor. Although two different lengths (and thus two different overlap states) may be desirable for two anchors, additional overlap states and lengths can be provided if more anchors are deployed.

[0265] In some embodiments of the present invention, an overlap switching mechanism is used to extend the length of travel distally by the anchor pusher during a second state in order to deploy a second anchor. Reducing a specified axial overlap region between the proximal end of the anchor pusher and a second pusher extends the length of travel distally by the anchor pusher, as explained below. The reduced specified axial overlap region is effectively opposite the combined length of the anchor pusher and the second pusher. This mechanism extends the length of travel distally by the anchor pusher during the second state.

[0266] In some aspects, the penetration depth for deploying a first anchor and a second anchor into tissue is equal. In some aspects, the penetration depth for deploying the second anchor into tissue is deeper, longer, or greater than the penetration depth for deploying the first anchor into tissue.

[0267] In some embodiments of the present invention, the overlap switching mechanism is activated by retracting the pusher assembly relative to the pusher, thereby allowing the pusher assembly and / or the anchor pusher to deform such that the overlap between the pusher assembly and the anchor pusher is reduced when the pusher assembly is about to advance distally next. Optionally, these states are elastically coupled such that this deformation is elastically pre-set to occur when the pusher assembly is fully retracted from the anchor pusher.

[0268] In some embodiments of the present invention, the anchor pusher deforms such that it cannot axially overlap (or has less axial overlap) with the pusher assembly. Alternatively or additionally, the pusher assembly deforms to prevent axial overlap with the anchor pusher and / or to prevent the proximal portion of the anchor pusher from inserting into a bore or recess in the pusher assembly. In some embodiments of the present invention, a door or plate of the pusher assembly closes to cover the bore or recess, thereby preventing the proximal portion of the anchor pusher from inserting into the bore or recess of the pusher assembly. Optionally or additionally, the anchor pusher deforms such that it cannot fit into the pusher assembly.

[0269] Multiple embodiments have different physical structures for the anchor pusher and the second pusher to allow for variably deploying these anchors by changing the combined length of the anchor pusher, the second pusher, or both. This can be achieved by using an overlap switching mechanism that has a specified axial overlap region inside or outside a sheath for the pusher. The lengths of the anchor pusher, the second pusher, and the axial overlap region can vary. In some embodiments of the present invention, both the anchor and the anchor pusher are wrapped by a sheath for delivering the anchor to a target tissue.

[0270] The specified axial overlap region optionally includes a first axial overlap region defined on the anchor pusher and a second axial overlap region defined on the second pusher. According to some embodiments, the overlapping engagement between the two pushers includes the specified axial overlap region. In another embodiment discussed herein, a movable panel is used to cover the inner bore (or other recess) of the rack (so that the anchor pusher cannot be assembled therein) and extend the movement of the anchor pusher during the deployment of the second anchor. In some embodiments of the present invention, after the first anchor is deployed, the protrusion on the proximal end of the sheath deforms the anchor pusher. As will be described below, the sheath protrusion can extend the movement of the anchor pusher during the deployment of the second anchor. Another option is a cam or eccentric plate to deform the anchor pusher so as to prevent it from re-entering the inner bore after retracting in the first state and thus extend the effective length of the anchor pusher as described below. After the first anchor has been deployed a first distance, when the effective length of the anchor pusher is extended, the second anchor can be deployed a second distance greater than the first distance. According to some embodiments, the anchor pusher deforms after the first state and mechanically interferes to prevent returning to a position within the inner bore of the rack as in the case of the first state.

[0271] The overlap switching mechanism can control the specified axial overlap region in one or both of the first and second axial overlap regions. In some embodiments of the present invention, the overlap switching mechanism has two states. In the first state, the overlap switching mechanism allows or maintains the specified axial overlap region such that there is no interference with the connection between the anchor pusher and the second pusher. This first state is the minimum combined distal length of the two pushers. In the second state, the overlap switching mechanism reduces the axial overlap region by mechanically interfering with the axial movement of one pusher relative to the other pusher. The reduced axial overlap region extends the combined length of the anchor pusher and the second pusher to an extent sufficient to deploy the second anchor outside the sheath. The second anchor is used to push the first anchor out of the channel. In the second state, some compensation is required to deploy the second anchor fully through the sheath and out of the channel. As described above, additional (e.g., intermediate) states can be provided.

[0272] The anchor pusher, the second pusher, or both can be made of a material that is elastically deformable and exhibits a memory effect. Nitinol alloy metal is an example of a material that can exhibit such properties. For example, in the lapped joint, when the second pusher retracts in the proximal direction, one or both pushers deform, twist, or rotate, resulting in misalignment / misregistration between the pushers during the second state.

[0273] Two or more anchors can be disposed within the sheath, where the anchor pusher is adjacent to the proximal end of the second or third anchor. To deploy the first anchor, the anchor pusher pushes the second or third anchor, which in turn moves the first anchor out of the sheath for a last-in, first-out (LIFO) assembly. During a first state for deploying the first anchor, a designated axial overlap region does not change or decrease, and the first anchor is deployed outside the sheath. The anchor pusher is located in a distal position of the sheath.

[0274] The sheath can be inserted through tissue, such as a torn meniscus. In some options, a needle for penetrating the tissue is provided through the sheath. Alternatively or additionally, the sheath itself can be sharpened and used as a needle.

[0275] According to some embodiments, the device is placed at a location on the subject's body. The device is then actuated by moving an actuator in a proximal direction. In a first state, the anchor pusher and a second pusher can be displaced distally through the sheath to deploy the first anchor, and the displacement of the anchor pusher is sufficient to deploy the first anchor from the sheath. Pushing the anchor pusher is the second pusher coupled to a designated axial overlap region between the anchor pusher and the second pusher, e.g., using the anchor pusher to push the anchor out of the sheath during the first state.

[0276] Next, retracting the second pusher from the anchor pusher causes the axial overlap region between the anchor pusher and the second pusher to decrease. During retraction, the anchor pusher can become disengaged from the axial overlap region of the second pusher.

[0277] A misalignment occurs due to deformation of one or both of the anchor pusher and the second pusher, which interferes with the overlap between the designated overlapping portions of the two pushers and causes the combined length of the anchor pusher and the second pusher to become longer during a second state than they were in the first state. This elongation of the combined length can compensate for the length of the second anchor when the second anchor pushes the first anchor out of the sheath, the length of which is no longer available as part of the deployment length after the first state. Now, after deformation and reduction of the axial overlap, the elongation of the combined length allows the second anchor to be deployed outside the sheath.

[0278] The second state begins by using the second pusher to push the anchor pusher, where one or both of the anchor pusher and the second pusher have a deformation that causes mechanical interference with the designated axial overlap region, where the pushing occurs on a contact region between the anchor pusher and the second pusher, which is optionally outside the designated axial overlap region.

[0279] In some embodiments of the present invention, the anchor pusher has a proximal end mounted in a rack, the rack having an inner bore (or recess) for providing some or all of the axially overlapping regions. The depth of the inner bore of the rack can be non-uniform to allow the anchor pusher to vary its effective length during the second state of anchor deployment. In some aspects, the kit provides different numbers of rack and anchor pusher components to allow for flexible inner bore depths for anchor deployment through optional assembly of the components in the system.

[0280] In one aspect of some embodiments of the present invention, there is provided a multi-anchor delivery system comprising: a sheath having a proximal end and a distal end and having a channel extending therethrough; an anchor pusher and a second pusher disposed within the sheath, each pusher element having at least a distal end located within the channel, the distal end of each pusher element being sized and shaped to be displaceable through the channel; a first anchor disposed within the sheath, at least a portion of the first anchor being located distally relative to the first pusher element; a second anchor disposed within the sheath proximally relative to the first anchor; the anchor pusher element being displaceable in a distal direction to contact the second anchor, the displacement having a displacement length sufficient to deploy the first anchor; wherein the second pusher element is displaceable in a distal direction to contact the anchor pusher, the displacement having a displacement length sufficient to deploy the second anchor.

[0281] One aspect of some embodiments of the present invention relates to an anchor deployment system having a plurality of anchors disposed in a sheath and a length-variable pusher system configured to push out the anchors, optionally with the same amount of axial actuation of the pusher system to push out the anchors. Optionally, the pusher system includes a pusher assembly and an anchor pusher, and when pushing out the anchors, the pusher assembly and the anchor pusher may have a varying amount of axial overlap. Optionally, the anchor includes a channel passing through and / or attached to the outside of the anchor, and optionally, when the suture in the channel retracts, folding or bending of the anchor is provided.

[0282] One aspect of some embodiments of the present invention relates to modifying the effective length of an anchor pusher. In some embodiments of the present invention, the effective length is controlled by using a pusher assembly that has a variable amount of axial overlap with the anchor pusher. One or both of the pusher assembly and the anchor pusher are optionally deformed, such as elastically deformed, for example deformed when the pusher assembly retracts from the anchor pusher to interfere with the start of axial overlap between the anchor pusher and the pusher assembly. In some embodiments, the amount of axial overlap increases after retraction, for example by using a reverse deformation mechanism that allows for greater axial overlap (e.g., by allowing the anchor pusher to fit into a recess defined in the pusher assembly).

[0283] One aspect of some embodiments of the present invention relates to a multi-anchor delivery system that includes a pusher element having a deformable distal tip portion. After deploying a first anchor, the pusher element can retract from a first position, where the distal tip portion is distal to a second anchor, to a second position, where the distal tip portion is proximal to the second anchor. During retraction of the pusher element, the second anchor can deform the distal tip portion, thereby allowing the distal tip portion to slide past the second anchor as the pusher element retracts. Optionally, the pusher element includes at least one portion that is wider and / or thicker than the distal tip portion such that during retraction of the pusher element, the second anchor is prevented from moving proximally due to the at least one wider and / or thicker portion.

[0284] The distal tip portion can have a configuration in which the distal tip portion curves upward or away from the inner wall of the sheath. Alternatively, the distal tip portion can have an S-shaped configuration. According to some embodiments, providing an S-shaped distal tip portion for the pusher element can allow the pusher distal tip to be more resilient or flexible, thereby potentially allowing the pusher element to be more easily deformed, for example, as discussed herein. Additionally, according to some embodiments, although the S-shaped portion can allow the pusher element to be more flexible, the upwardly and downwardly curved portions of the S shape can limit lateral movement of the pusher element within the sheath, as discussed herein.

[0285] One aspect of some embodiments of the present invention relates to an anchor, each anchor having a channel extending along the body of the anchor that is at least partially non-coaxial with the anchor, and an attached suture extending along the channel. For example, the channel can be at least partially located outside the anchor. Pulling on the suture allows the anchor to be more easily bent because as the suture shortens, a greater moment is applied to the anchor.

[0286] Each anchor can be provided with a plurality of loops. These loops can be defined by the suture, by a portion of the anchor itself, or by another element. As discussed herein, the loops allow the suture to be at least partially attached to the outside of the anchor.

[0287] The proximal end of the anchor can be provided with an additional loop for attaching the anchor to a component of the deployment device to prevent accidental / premature deployment of the anchor.

[0288] When multiple anchors are deployed, the suture can be routed through the channels of the anchors in a variety of different routing configurations and routed between the anchors. Generally, the anchors and their deployment methods, and in particular the anchors and their deployment methods disclosed herein, can be particularly useful for repairing soft tissue, such as the meniscus, but are not limited to this particular type of surgical procedure. One aspect of some embodiments of the present invention relates to flexible anchors, each flexible anchor having an elongated flexible body that will be deployed from a deployment device, the elongated body having first and second ends and an outer surface, the body extending along a longitudinal axis in a first orientation, the body being configured to be bendable into a second orientation, wherein in the second orientation, the first and second ends are closer to each other than in the first orientation.

[0289] When the anchor body is in the first orientation such that it extends along the longitudinal axis, a segment of suture can be routed through the channel such that after the anchor is deployed, the segment of suture can be shortened by pulling it proximally. This causes the segment of suture to slide through the channel such that the shortened portion of the suture extends through the channel. When the segment of suture extending through the channel is shortened, it pulls on the anchor body and bends the anchor into the second orientation.

[0290] In some embodiments, the channel can be formed in the material of the anchor itself such that before deployment, the segment of suture can be threaded into and out of a portion of the material of the outer surface of the anchor. In some embodiments, the anchor can have an internal lumen and the channel can extend partially through the internal lumen of the anchor. In this way, the material of the anchor itself forms the channel such that the material of the anchor itself attaches the suture to the anchor body.

[0291] In some embodiments, the channel can be defined by a plurality of rings that radially extend out from the outer surface of the anchor. For example, there can be two or four rings that are located on the outer surface of the anchor body between the first and second ends, with at least one ring positioned closer to the first end of the anchor and at least one ring positioned closer to the second end of the anchor. In this way, the rings define the channel such that the rings allow the suture to attach to the anchor body. Optionally, the rings can be formed by a portion of the segment of suture, as discussed herein with respect to Fig. 9 A and 10A.

[0292] Another advantage of an anchor body in which the channel is defined by rings is that the segment of suture can slide more easily through the rings, thereby facilitating bending of the anchor body from the first orientation to the second orientation. Additionally, since the rings can extend radially outward from the outer surface of the anchor body, this can allow a greater moment to be applied to the anchor body by the segment of suture as the segment of suture is shortened, thereby more easily bending the anchor body to the second orientation as the segment of suture is shortened.

[0293] Although multiple portions of the present application describe features of the invention with respect to embodiments having a channel defined by a loop, it should be understood that these features may also be relevant to embodiments where the channel is formed by the material of the anchor body, as discussed herein.

[0294] In some embodiments, an anchor and method can be used for the repair of torn meniscus tissue by deploying first and second anchors through the torn tissue portion and then tensioning the anchors against the tissue portion, thereby potentially holding the separated tissue portions together such that they can be repaired together. Optionally, depending on various factors, including for example the extent of tissue damage, the location of the repair, and the size of the anchor, any suitable number of anchors can be deployed. For example, a single anchor or more than two anchors can be used.

[0295] According to some embodiments, for example, when the first and second anchors are to be deployed, the second anchor can be provided with an additional loop at the proximal end of the second anchor. Before deploying the second anchor, the additional loop can be held by a selectively openable portion of the deployment device to prevent the second anchor from being inadvertently prematurely ejected from the deployment device. Optionally, the deployment device does not include a selectively openable portion, and the first and second anchors are deployed by successively ejecting them from the deployment device.

[0296] A section of suture material can extend through the channel. It is described that in some embodiments, the suture can extend through multiple loops of the first and second anchors. However, it should be understood that alternatively, the suture can extend through a channel defined by the material of the anchor itself, as discussed herein.

[0297] According to some embodiments, once the first and second anchors are deployed, the suture material includes multiple suture portions that extend through soft tissue and are located between the first and second anchors. A loop of one of the suture portions can be pulled to position and hold the anchor distally in the soft tissue. Pulling the loop tensions the suture running through the channel and pulls on multiple anchor loops (or the material of the anchor itself that defines the channel), optionally causing the anchor body to bend slightly. Once the anchor has been held against the distal side of the soft tissue, the proximal end of the suture can be pulled to further tension the suture extending through the channel defined by the multiple anchor loops (or defined by the material of the anchor itself).

[0298] One aspect of some embodiments of the present invention relates to deploying first and second anchor fasteners from a deployment device, each anchor fastener including a channel as discussed herein. A segment of suture that has been threaded through the channels of each of the first and second anchor fasteners may be deployed through soft tissue together with the deployment of the first and second anchor fasteners. A particular threading configuration of the segment of suture through the channels results in: after the first and second anchor fasteners are deployed, some portions of the segment of suture may be pulled to position the anchor fasteners distally on the soft tissue and then to tension the anchor fasteners against the distal side of the soft tissue. These portions of the segment of suture include the proximal end of the segment of suture and the portion of the segment of suture that extends between the first and second anchor fasteners, which portions are proximal to the soft tissue after the first and second anchor fasteners are deployed. This will be discussed further herein, for example, with reference to Figure 5 G-J for further discussion.

[0299] According to some embodiments, the anchor fastener body itself may define a loop through which the suture may extend along a channel defined through a portion of the anchor fastener body. For example, the channel may be laterally oriented relative to the longitudinal axis of the anchor fastener. Alternatively, the channel may be axially oriented or oriented at an angle relative to the longitudinal axis of the anchor fastener.

[0300] One aspect of some embodiments of the present invention relates to a multi-anchor fastener delivery system that includes a suture configured to slidably thread through each of two anchor fasteners, the suture including a slip knot configured to be released by pulling a first end of the suture and configured not to be released by pulling a second end of the suture, wherein the suture is configured to be tensioned between the two anchor fasteners by pulling the first end of the suture.

[0301] The suture may include: a first portion that threads through and extends through a first one of the two anchor fasteners and extends from the first anchor fastener to a second one of the two anchor fasteners; a second portion that extends between the first and second anchor fasteners of the two anchor fasteners and threads through the second anchor fastener; and a third portion that extends from the second anchor fastener, the third portion including the slip knot. Pulling the first end of the suture may release the slip knot.

[0302] Now referring to Figure 1A , which is an exemplary abstract block diagram showing a designated axial overlap region for a multi-state anchor fastener delivery system according to some embodiments of the present invention. The axial overlap region, designated by reference numeral 6, which may also be referred to as the axial switching mechanism 6, is shown in dashed lines in the figure. In Figure 1AIn accordance with some embodiments of the present invention, prior to deploying the first anchor 170, the axially overlapping region in the first state is shown positioned within the sheath 250 for a multi-state anchor delivery system. The first anchor 170 and the second anchor 180 are assembled in the sheath in a last-in-first-out (LIFO) configuration, where the first anchor exits the sheath first, followed by the second anchor. The anchor pusher 3 has a distal end proximate the second anchor and a proximal end proximate the pusher assembly or the second pusher 4. The position of the axial switching mechanism is located at a portion of the anchor pusher 3 adjacent to or coupled to the second pusher 4. Note that in some embodiments, a portion or all of the second pusher 4 may be located outside of the sheath 250.

[0303] According to some embodiments, as shown below, the second pusher 4 optionally includes a rack 220 ( Figure 4 ), however, the second pusher 4 may also have a different mechanical arrangement and is not limited to a rack. Optionally, the designated axially overlapping region is located within the sheath between the proximal end of the anchor pusher and the distal end / extension of the second pusher. The designated axially overlapping region is a combination of a first axial region on the proximal end of the anchor pusher and a second axial region on the distal end of the second pusher 4. Note that the axial switching mechanism can be a part of the anchor pusher and / or a part of the second pusher (pusher assembly).

[0304] Optionally, the first and second axial regions have lengths that can vary through manufacturing and installation. In some embodiments, a kit provides multiple pushers and multiple racks for installation inside the housing and for variable anchor deployment. The second pusher is operable to move the anchor pusher using the axial switching mechanism to deploy the anchor. In some embodiments, there are three or more anchors.

[0305] Figure 1B is an exemplary abstract block diagram showing a reduced designated axially overlapping region for a multi-state anchor delivery system in accordance with some embodiments of the present invention. The axially overlapping region 6 shown in dashed lines is shown in the first state in the first anchor 170 ( Figure 1A)The second state after deployment. According to some embodiments, before and during the deployment of the second anchor, the axially overlapping region 6 is located within the sheath of the delivery device of the system. The reduced axially overlapping region results in a combined length of the anchor pusher and the second pusher sufficient to deploy the second anchor outside the sheath. In some embodiments of the present invention, deformation of one or both of the anchor pusher and the second pusher causes misalignment and causes the combined length of the anchor pusher and the second pusher to become longer during the second state than during the first state. This extension of the combined length can compensate for the length of the second anchor, which is no longer part of the deployment length after the first state, as discussed herein. The second anchor in the first state pushes the first anchor as it moves through the sheath. Now, after deformation and reduction of the axial overlap, the extended combined length allows the second anchor to be deployed outside the sheath.

[0306] In some embodiments of the present invention, the length, perimeter / circumference of the anchor pusher is sized and shaped such that deformation or friction does not prevent the at least two anchors from moving distally out of the distal end of the sheath channel. The length, perimeter / circumference of the portion of the rod or second pusher that can overlap the anchor pusher is sized and shaped such that deformation or friction does not prevent movement distally and proximally within the sheath to push the at least two anchors out of the distal end of the sheath channel. The second pusher is sized and shaped to push the anchor pusher distally in the channel. Optionally, the anchor is an implant, optionally attached with one or more sutures as discussed herein.

[0307] Figure 2A is an exemplary abstract block diagram showing the designated axially overlapping region 6 (also referred to as the axial switching mechanism 6) according to some embodiments of the present invention, which is optionally partially or entirely outside the sheath 250 in the multi-state anchor delivery system. According to some embodiments of the present invention, the axially overlapping region 6 is shown in a first operating state before and during the deployment of the first anchor 170. As Figure 2A and 2B shown, the anchor assembly in the sheath is optionally a last-in, first-out (LIFO) configuration. Here, the designated axially overlapping region 6 is at least partially outside the sheath 250, between the proximal end of the anchor pusher and the distal end of the second pusher 4. In some aspects, there are three or more anchors. Figure 2A Shows the first state of the overlap switching mechanism before the designated axially overlapping region is reduced. A potential advantage of the axial switching mechanism being at least partially outside the sheath is that it allows lateral space for the switching mechanism to deflect and actuate. A potential advantage of the axial switching mechanism 6 being located inside the sheath 250 is that the sheath can be used to reinforce the overlap and / or prevent deformation during the first state.

[0308] Figure 2B This shows, according to some embodiments of the present invention, in a second operating state after a specified axial overlap region 6 has been reduced (relative to that shown), and before and during the deployment of the second anchor 180, an exemplary abstract block diagram of the specified axial overlap region 6 and the axial switching mechanism that is partially outside the sheath of the multi-state anchor delivery system. Figure 2A The overlap switching mechanism that is at least partially outside the sheath extends the length of the anchor pusher traveling in the distally directed direction during the second state by deflecting or bending the proximal end of the anchor pusher after it exits the inner bore in the rack, as further discussed herein. Since during the first state (refer to

[0309] -B for further discussion), some length of the anchor pusher is within the inner bore (or recess), when the anchor pusher exits the inner bore after the rack retracts and is deflected and prevented from returning to its position within the inner bore, the total available length of the anchor pusher for deploying the second anchor in the second state increases. Fig.13A -B for further discussion), some length of the anchor pusher is within the inner bore (or recess), when the anchor pusher exits the inner bore after the rack retracts and is deflected and prevented from returning to its position within the inner bore, the total available length of the anchor pusher for deploying the second anchor in the second state increases.

[0310] The above overview relates to embodiments having an anchor pusher and a second pusher with different physical structures, which allow for variable deployment of the anchor by shortening the length of the anchor pusher, the second pusher, or a combination of both. These will be described in the following figures. For example, this can be achieved by using an overlap switching mechanism having a specified axial overlap region located inside or outside the sheath. According to some embodiments, the lengths of the anchor pusher, the second pusher, and the axial overlap region can vary depending on the components and mechanisms employed.

[0311] Figure 3 This is an exemplary illustration of a multi-state anchor delivery system according to some embodiments, showing the sheath 250 and the outer housing 210 including rollers 212 (e.g., for actuating the distally directed movement and deployment of the anchor and / or retracting the anchor pusher mechanism). Descriptions of the various components are provided below.

[0312] Figure 4 This is an exploded perspective view of an exemplary multi-state anchor delivery system according to some embodiments of the present invention. The system includes a handle having a right housing portion 210R and a left housing portion 210L, which are located on the right and left sides of the device, respectively, when viewed from the distal end of the device. Components at least partially housed within the housing include a manual controller such as rollers 212 for pushing the rack 220 (or other pusher assembly), and an optional spool 300 (discussed herein with reference to the free end 288a of the suture). Also shown are a sheath 250, an extended anchor pusher element 230, a first anchor 170, and a second anchor 180 according to some embodiments of the present invention, all of which are optionally at least partially disposed within the sheath.

[0313] In some embodiments of the present invention, the elongate anchor pusher element 230 may be linearly displaced in the distal direction via a second pusher acting as a drive mechanism. The second pusher may be a rack 220 that is displaced by linear displacement of an actuator in the form of a trigger button. Alternatively, in some embodiments, the second pusher may be displaced by rotation of a roller 212 or a pinion. The actuator may be moved in the distal direction and the proximal direction, and the actuator coupled to the drive mechanism is in turn coupled to the anchor pusher element. The coupler has an arrangement such that movement of the actuator in the distal direction causes displacement of the drive mechanism in the proximal direction, and movement of the actuator in the proximal direction causes displacement of the drive mechanism in the distal direction.

[0314] Figure 5 is a view of an interior portion of an anchor delivery system according to some embodiments of the present invention, showing a designated axial overlap region 6 within a sheath. The axial switching mechanism moves the anchor pusher 3 distally (to the left) within the sheath, where the axial switching mechanism is a rod that is optionally combined with a rack to form a second pusher 4 according to this embodiment. The anchor pusher has a first axial region 3B between 3A and 3C. The rod has a second axial region 4B located between 4A and 4C. The designated potential axial overlap region 6 is the first axial region 3B and the second axial region 4B. The anchor pusher and the rod are at least partially disposed within the sheath, where the sheath is assembled within a housing.

[0315] Figure 6 is a side cross-sectional view of a portion of an apparatus of a system according to some embodiments of the present invention, showing a reduction in the designated axial overlap region 6 between 4A and 3C within the sheath 250 during retraction of the second pusher 4 after deployment of the first anchor 170 ( Figure 1A ) In some aspects, the rod may be fixedly attached to the rack 220 via a screw at the proximal end, where the rack and the rod are combined to form the second pusher.

[0316] Figure 7A side cross-sectional view of a part of the device of the system, showing a further reduction of the specified axial overlap region 6 in the sheath 250, where region 4B has been deformed to be misaligned with the anchor pusher 3. The region from 3C to 4A shows a complete reduction and misalignment of the specified axial overlap region 6. In some aspects, the anchor pusher and / or the rod is a nitinol metal alloy, which is bent to mechanically interfere and reduce the specified axial overlap region. According to some aspects, during the second state, the rod, or the anchor pusher, or both the rod and the anchor pusher are deformed and interfere with each other and with the axial overlap region; the anchor pusher is pushed on the contact region outside the specified axial overlap region. A variety of different deformation means of interference / mechanical interference overlap can be used. For example, when pushed in the second state, the deformation or relative rotation of the anchor pusher and / or the rod after retracting the second pusher mechanically interferes with the engagement, and the length or depth of the second anchor deployment can be extended.

[0317] In some embodiments of the present invention, the specified axial overlap region 6 is a lapped overlap joint. In some embodiments, the specified axial overlap region 6 is a tongue and groove joint.

[0318] Referring to Figure 8 , a perspective view of a part of the anchor delivery device of the system is shown, showing the specified axial overlap region 6 (as Figure 2A shown) located outside the sheath 250. The axial overlap region is also referred to as an axial switching mechanism. According to some embodiments of the present invention, the axial switching mechanism 6 optionally includes a movable / foldable panel / cover 845, which is shown in Figure 6 to be in the open position during the deployment of the first anchor. In the position shown in Figure 6 , the panel / cover 845 allows access to the perforation (or inner hole or recess) 227 in the rack 220, into which the anchor pusher 3 is assembled. As discussed herein, for example, with reference to Fig.11 , according to some embodiments, the panel / cover 845 can be moved or pivoted or folded so that it blocks access to the perforation 227.

[0319] The movable panel 845 component may include optional features. In some cases, the bottom base 844 has mounting holes 843 for mounting to the rack 220 using screws. In some cases, there is a foldable cover 845. In some options, there is a plane 842 and a bottom base 844. In some cases, the foldable cover 845 is hinged (e.g., a living hinge) to cover the perforation 227 in the rack 220. The anchor pusher is installed inside the perforation 227 and axially overlaps with the rack 220 and the panel 845 in the open position. Fig. 13B shown below shows the perforation 227 on the rack 220.

[0320] Reference Fig. 9 , showing a side cross-sectional view of a portion of the device of the system according to some embodiments of the present invention during the deployment of the first anchor, which includes an anchor pusher in a first state and being pushed distally simultaneously, wherein the specified axial overlap region 6 is outside the sheath 250, and the movable panel 845 is in the open position. The movable panel 845 is in the open position as long as at least a portion of the proximal end of the anchor pusher is located within the inner bore 227. In the illustrated embodiment, the proximal end of the anchor pusher is located above the collapsible panel 845. Alternatively, in some embodiments, the proximal end of the anchor pusher may be located below the collapsible panel 845. Optionally, the anchor pusher 3 will prevent the collapsible cover 845 from elastically folding (or otherwise moving) and covering the perforation (or inner bore or recess) 227 or prevent access to the perforation (or inner bore or recess). When inside the inner bore 227, the proximal end of the anchor pusher is the specified axial overlap region.

[0321] Fig.10 is a side cross-sectional view of a portion of the device of the system, including the specified axial overlap region 6 outside the sheath 250 before and during the deployment of the anchor 170( Figure 2A ). According to some embodiments of the present invention, the movable panel 845 is in the open position, and the rack 220 moves distally to push the anchor pusher 3, thereby deploying the anchor 170( Figure 2A ) to the distal outside of the sheath 250.

[0322] Fig.11 is a side cross-sectional view of a portion of the device of the system according to some embodiments of the present invention, showing the reduced specified axial overlap region 6 outside the sheath 250 and the movable panel 845 in the closed position covering the inner bore 227 of the rack 220. In some embodiments, this is after the deployment of the first anchor and before and during the deployment of the second anchor. After the rack 220 retracts in the proximal direction, the anchor pusher 3 is left outside the inner bore 227. Note that in this closed position, the panel 845 covers the inner bore 227 and reduces the specified axial overlap region to zero. Thus, the specified axial overlap region 6 is reduced because the anchor pusher cannot re-enter the inner bore 227 when the rack 220 moves distally.

[0323] Fig.12 is a side cross-sectional view of a portion of the device of the system according to some embodiments, showing the second pusher in a second state, which abuts against the panel 845, and the panel 845 prevents the anchor pusher 3 from entering the perforation (or inner bore or recess) 227 in the rack 220. As described above with respect to Fig.11As described, by covering the inner bore 227, the specified axial overlap region 6 is reduced to zero outside the sheath 250 because when the movable panel 845 is in the closed position and covers the perforation 227, it pushes the anchor pusher 3 to deploy the second anchor. In some embodiments of the present invention, this illustration is after the deployment of the second anchor.

[0324] Fig.13A is a perspective view of a part of a system according to some embodiments of the present invention, showing a deformation of a part of the device, where the specified axial overlap region 6 is outside the sheath 250. As will be Fig.13A shown, depending on whether the anchor pusher is straight or bent, the anchor pusher 3 selectively enters the rack 220. In one embodiment, a component, optionally an elastic member, causes the anchor pusher 3 to bend laterally. As long as the anchor pusher 3 is inside the rack 220, it cannot move laterally. However, once the rack 220 retracts, the anchor pusher 3 can deflect laterally. As shown, an optional curved projection 4D (e.g., a part of the sheath 250) and / or the end face 4E can be elastically pre-set to be able to deflect the anchor pusher 3 laterally. Alternatively or additionally, the anchor pusher 3 is pre-bent into a curved shape but is kept straight by the rack 220 on one side and the sheath 250 on the other side. Alternatively or additionally, the anchor pusher 3 is double-bent or kinked so that it is straight overall. However, when the first bent part enters the sheath 250, this bent part becomes straight, leaving another bent part or portion that is kinked, so that the anchor pusher 3 deflects laterally in the part where it is outside the sheath. In any case, once the anchor pusher 3 bends laterally, this bending causes the anchor pusher 3 to bend after the first anchor 170 is deployed and after the rack 220 retracts.

[0325] According to some embodiments of the present invention, in Fig.13A , the reduced specified axial overlap region outside the sheath can be seen. In the first state, the anchor pusher 3 is located in the recess 227 having a first axial depth ( Fig. 13B ). When the anchor pusher 3 bends or otherwise deflects laterally, the anchor pusher is not aligned with the recess 227 but can be aligned with a different point on the rack 220 or the recess 227G, and the axial depth of the recess 227G is less than the axial depth of the inner bore 227.

[0326] Fig.14AIs a perspective view of the interior of the sheath, showing the overlapping switching plate 229 according to some embodiments of the present invention. The overlapping switching plate 229 can deform the anchor pusher 3 (e.g., having a pre-formed double bend that changes by axial movement to cause lateral bending of the anchor pusher 3) to prevent the anchor pusher 3 from re-entering the inner bore 227 of the rack 220 or otherwise pushing the assembly. Fig. 14B Shows an external perspective view of a system according to some embodiments of the present invention, which has an overlapping switching plate 229 proximal to the sheath 250. Reference numeral 233 indicates the possible approximate location of the overlapping switching plate 229, rather than the plate itself. According to some aspects, the overlapping switching plate 229 is an eccentric-type plate with an off-center hole 228 through which the anchor pusher passes to create a deformation portion 1430. According to some aspects, the overlapping switching plate is a cam.

[0327] Exemplary anchor

[0328] Exemplary anchors are described herein that can be deployed using the anchor deployment systems described herein. Other designs may also be used. In some embodiments of the present invention, each anchor has a channel extending along the body of the anchor that is at least partially non-coaxial / non-concentric with the anchor, and an attached suture extends along the channel. For example, the channel may be at least partially external to the anchor. Pulling the suture allows the anchor to bend more easily because as the portion of the suture extending through the channel shortens, a greater moment is applied to the anchor.

[0329] Each anchor may be provided with a plurality of loops. These loops may be defined by a suture, a portion of the anchor itself, or another element. As discussed herein, the loops allow the suture to be at least partially attached to the outer side of the anchor.

[0330] The proximal end of the anchor may be provided with additional loops for attaching the anchor to a component of the deployment device to prevent accidental / premature deployment of the anchor.

[0331] When multiple anchors are deployed, the suture can be routed through the channels of the anchors in a variety of different routing configurations and between the anchors. Generally, the anchors and their deployment methods, and in particular the anchors and their deployment methods disclosed herein, can be particularly useful for repairing soft tissue, such as the meniscus, but are not limited to this particular type of surgery. For example, such anchors and their deployment methods may be particularly useful for repairing bone tissue. One aspect of some embodiments of the present invention relates to a plurality of flexible anchors, each flexible anchor having an elongate flexible body to be deployed from a deployment device. In a first orientation, the elongate body has a first end and a second end and an outer surface, and the body extends along a longitudinal axis. The body is configured to be bendable into a second orientation in which the first end and the second end are closer to each other compared to the first orientation.

[0332] When the anchor body is in the first orientation such that it extends along the longitudinal axis, a segment of suture can be routed through the channel. After the anchor is deployed, by pulling on a portion of the suture, the segment of suture slides through the channel such that the portion of the suture extending through the channel is shortened. As the suture segment extending through the channel shortens, it pulls on the anchor body and bends the anchor into the second orientation. Optionally, the loop can be formed by a portion of the segment of suture, as described herein with respect to Fig.18A and 19A described.

[0333] In some embodiments, the channel can be formed through the material of the anchor itself such that, prior to deployment, the segment of suture can be routed into and out of a portion of the material of the outer surface of the anchor. In some embodiments, the anchor can have an internal lumen and the channel can extend partially through the internal lumen of the anchor. In this manner, the material of the anchor itself forms the channel such that the material of the anchor itself attaches the suture to the anchor body.

[0334] In some embodiments, the channel can be defined by a plurality of loops that radially extend out from the outer surface of the anchor. For example, there can be two or four loops located on the outer surface of the anchor body between the first and second ends, with at least one loop positioned closer to the first end of the anchor and at least one loop positioned closer to the second end of the anchor. In this manner, the loops define the channel such that the loops allow the suture to attach to the anchor body.

[0335] An anchor body having a channel defined by a plurality of loops can be advantageous because the segment of suture can more easily slide through the loops, which helps the anchor body bend from the first orientation to the second orientation. Additionally, since the loops can radially extend outward from the outer surface of the anchor body, as the segment of suture extending through the channel shortens, this can allow the segment of suture to apply a greater moment to the anchor body, making it easier to bend the anchor body to the second orientation.

[0336] Although features of the present invention are described in connection with embodiments having a channel defined by a loop, it should be understood that these features may also be associated with embodiments in which the channel is formed from the material of the anchor body as discussed herein.

[0337] In some embodiments, the systems, devices, kits, and methods may be utilized to repair a torn meniscus tissue by deploying first and second anchors through the torn tissue portion and then tensioning the anchors against the tissue portion, thereby potentially holding the separated tissue portions together such that they may heal together. Optionally, depending on various factors, including for example the degree of tissue damage, the location of the repair, and the size of the anchors, any suitable number of anchors may be deployed. For example, a single anchor or more than two anchors may be used.

[0338] According to some embodiments, for example, when the first and second anchors are to be deployed, the second anchor may be provided with an additional loop at the proximal end of the second anchor. Before deploying the second anchor, the additional loop may be held by a selectively openable portion of the deployment device to prevent the second anchor from being inadvertently released from the deployment device prematurely. Optionally, the deployment device does not include a selectively openable portion, and the two anchors are deployed by successively ejecting the first and second anchors from the deployment device.

[0339] A length of suture material may extend through the channel. It is described that in some embodiments, the suture may extend through multiple loops of the first and second anchors. However, it should be understood that alternatively, the suture may extend through a channel defined by the material of the anchor itself, as discussed herein.

[0340] According to some embodiments, after the first and second anchors have been deployed, a certain number of portions of the suture extend through the soft tissue and between the first and second anchors. A loop of one of the suture portions may be pulled to position and hold the anchors on the distal side of the soft tissue, pulling the loop tightens the suture that runs through the channel, and pulling on the multiple anchor loops (or pulling on the material of the anchor itself that defines the channel) optionally causes the anchor body to bend slightly. After the anchors have been held against the distal side of the soft tissue, the proximal end of the suture may be pulled, thereby further tightening the suture that extends through the channel defined by the multiple anchor loops (or defined by the material of the anchor itself).

[0341] One aspect of some embodiments of the present invention relates to deploying first and second anchors from a deployment device, each anchor including a channel as discussed herein. The segment of suture that has been routed through the channels in each of the first and second anchors can be deployed through soft tissue (or bone tissue) along with the deployment of the first and second anchors. The particular routing configuration of the segment of suture through the channels results in: after the first and second anchors are deployed, some portions of the segment of suture can be pulled to position the anchors distally on the soft tissue (or bone tissue), and then the anchors can be tightened against the distal side of the soft tissue (or bone tissue). These portions of the segment of suture include the proximal end of the segment of suture and the portion of the segment of suture that extends between the first and second anchors, which are proximal to the soft tissue after the first and second anchors are deployed.

[0342] In addition, providing a channel defined by a plurality of loops extending radially outward from the outer surface of the anchor body can allow the suture to be easily routed through the plurality of loops. Additionally, this can avoid the need for the suture to pass through the interior of the anchor, such that after the anchor is deployed, when the suture is pulled and tightened, the friction of the suture moving through the channel can be reduced. This can allow the suture routed through the loops to be easily pulled and tightened because the suture can easily slide through the loops of the anchor. This can potentially allow the user to more easily position the anchor distally on the soft tissue after deployment and more easily tighten the suture extending through the plurality of loops of the anchor. This can be more preferable than routing a portion of the suture through the interior of the anchor, in which case the suture may not slide as easily through the interior of the anchor.

[0343] In addition, according to some embodiments, a channel that is non - coaxial with the longitudinal axis of the anchor can be provided, and this channel extends along the anchor over the entire exterior of the anchor outer surface. This can allow a greater moment to be applied to the anchor body, thereby assisting in bending the anchor into a second orientation.

[0344] In addition, as discussed herein, for example, with reference to Figures 15A-19D As discussed, according to some embodiments, providing a channel at least partially along the outer surface of the anchor facilitates routing a single segment of suture material through two anchors. Thus, after the first and second anchors are deployed, pulling a single loop of the suture material can position both the first and second anchors against the distal side of the soft tissue. Thereafter, pulling a single proximal end of the suture material can tighten both the first and second anchors against the distal side of the soft tissue.

[0345] In addition, as discussed herein, providing a second anchor having an additional loop at the proximal end of the anchor body can prevent the second anchor from accidentally falling out of the deployment device prior to its intended deployment.

[0346] Now refer to Fig.15A-B shows an anchor 10 for deployment through soft tissue according to some embodiments of the present invention. The anchor 10 has an elongated flexible body 12 having a length of, for example, 1-5 cm and a diameter of, for example, 1-2 cm, and the flexible body is formed of any suitable material, such as polyester or polyethylene. It should be understood that, if desired, in some embodiments, an anchor body having another suitable length, another suitable diameter, and formed of another suitable material may be employed. The body 12 has a first end 14 and a second end 16, and an outer surface 18. According to some embodiments, the anchor 10 is shown in a first orientation, with the body 12 extending along a longitudinal axis 20. According to some embodiments, the body 12 of the anchor 10 can be bent into a second orientation such that, after deployment through soft tissue, the anchor 10 can be fixed against the soft tissue, as further described herein. According to some embodiments, the cross-section of the body 12 can be circular, optionally having an opening 22 extending from the first end 14 to the second end 16 of the body 12, as Fig.15A shown in -B, the anchor has an inner surface 19. However, those skilled in the art will understand that alternatively, according to some embodiments, the body can have another cross-sectional profile, such as rectangular / square or oval (not shown), and / or the body can not have an opening extending therethrough, or can have a blind hole that only partially extends through the body 12 along the axis 20.

[0347] Referring to Fig.16A , an anchor 30 according to some embodiments of the present invention is shown. The anchor 30 has an elongated flexible body 32, which can be similar to Fig.15A the body 12 shown in -B. However, in some embodiments, the anchor 30 can be provided with a channel 35 defined by a plurality of loops 40 that are attached to the body 32 and extend out from the outer surface 38 of the body 32. Similarly, according to some embodiments, and referring to Fig. 16B -C, the corresponding anchors 50 and 70 have corresponding elongated flexible bodies 52 and 72, each flexible body being provided with a plurality of loops 60a-d and 80a-d, respectively, that define corresponding channels 65 and 85. In the Fig.16A embodiment shown in -C, each of the anchors 30, 50, and 70 has a channel defined by four loops. However, those skilled in the art will understand that, if desired, a channel defined by any suitable number of loops can be provided, where the loops are attached to the anchor in any suitable manner.

[0348] Further referring to Fig.16A-C. In some embodiments, the loops 40a-d of the anchor 30 and the loops 60a-d of the anchor 50 are each formed of any material suitable for, for example, a surgical suture, such as those discussed herein. It should be noted that each loop 40 of the anchor 30 can be formed of a separate piece of material 34, and the ends 36 of the loop 40 can be attached to the outer surface 38 of the anchor body 32 by any known means, such as by gluing, welding / fusing, or by attachment through heating. Alternatively, in embodiments where the anchor 30 is hollow, it has an opening similar to the opening 22 of the anchor 10 ( Fig. 15B ), and thus at least one end 36 of at least one loop 40 can pass through the material of the anchor 30, where it can be attached to the inner surface of the opening. Alternatively, the at least one end can pass through the material of the anchor 30 and be retained therein by any known means, such as by tying a knot.

[0349] With particular reference to Fig. 16B , the loops 60 (such as 60a-d) of the anchor 50 can be formed of a single piece of material 54, such as a suture material as discussed herein, where the ends 56 (such as 56a-h) of each loop 60 extend through the material 57 inside the outer surface 58 of the anchor 50. For example, in some embodiments, the loops 60 are woven in and out of the material 57 on the outer surface 58 of the anchor 50 such that the end 56b of loop 60a and the end 56c of the adjacent loop 60b are connected to each other within the material 57 of the outer surface or within the material 57 midway within the outer surface of the anchor 50. In one embodiment where the anchor 50 is hollow, it has an opening in the anchor body that can be similar to the opening 22 in the anchor body 12 ( Fig. 15B ), and the end 56b of loop 60a and the end 56c of the adjacent loop 60b can be continuous and / or connected to each other within the opening through the anchor body. Additionally, in some embodiments, the ends 54 of the loops 60a and 60d closest to the respective ends 51 and 53 of the body 52 can each be provided with a knot 55 located within the opening for retaining the ends (56a, 56h) of the respective loops 60a, 60d within the anchor body 52. Alternatively, in some embodiments, the ends 56a, 56h can be attached to the anchor body 52 by any other suitable means, including those discussed with respect to the anchor 30 ( Fig.16A ).

[0350] Referring to Fig. 16C , there is shown an anchor that can be similar to the anchor 50 ( Fig. 16B) the anchor 70. However, in the anchor 70, the ends 76a and 76h of the material 74 at the ends of the respective rings 80a and 80d closest to the body 72, i.e., the ends 71 and 73, may extend out again through the outer surface 78 of the anchor body 72. According to some embodiments, the knot 79 may be disposed at or near the ends 76a and 76h outside the anchor 70 for holding the ends 76a and 76h outside the anchor body 72. Alternatively, according to some embodiments, the ends 76a and 76h may be provided with any other suitable mechanism, including the mechanisms discussed with respect to the anchors 30 and 50.

[0351] It will be noted that in some embodiments, the rings of the anchors 30, 50, and 70 are shown as being evenly spaced along the lengths of the respective anchors 30, 50, and 70. However, it should be noted that according to some embodiments, if desired, the rings may be distributed unevenly along the length of the anchor, with at least one ring positioned closer to the first end of the anchor and at least a second ring positioned closer to the second end of the anchor. For example, in some embodiments, the spacing between the two inner rings of the anchor may be greater than the spacing between the two outer rings, thereby helping to pull the ends of the anchor closer to each other.

[0352] In addition, for example, in some embodiments, there may be more space at the ends of the anchor, i.e., adjacent the outer rings. This may potentially allow the ends of the anchor to overlap when pulling the suture through the rings, thereby pulling the ends of the anchor closer together.

[0353] It will be noted that, as is known in the art, at least one end of any of the rings of any of the embodiments described herein may be provided with a reinforcement for holding the at least one end in place relative to the anchor body. Such a reinforcement may be formed by heating a portion of one end of the ring material or by heating another piece of material to form a ball that holds the end of the ring in place. Although this may be advantageous and provides the potential advantage of strengthening the end of the ring and the anchor body, in some embodiments, the reinforcement portion may cause increased stress when the anchor is deployed from the delivery device and / or through soft tissue.

[0354] Also referring to Fig.16D , a pair of anchors 30 according to some embodiments is shown, the pair of anchors being shown in a deployed and fixed position against the soft tissue 42. Although Fig.16D shows that each anchor may be structurally and functionally similar to the anchor 30 ( Fig.16A ) of two anchors 30, those skilled in the art will understand that according to some embodiments, alternatively, any combination of the anchors 30, 50, and / or 70 from Figure 2A -B or any other anchor described herein may be depicted.

[0355] Each anchor 30 may include a channel defined by four rings 40, as discussed herein with reference to Fig.16A those described. According to some embodiments, the two anchors 30 may each be held in a second orientation, in which, after deployment through the soft tissue 42, the bodies 32 have each been bent into a U-shape by suture portions 44 / 46 that have been routed through the rings 40 in the anchors 30. Various configurations for routing the suture portions through the channels of the anchors before deployment of the anchors will be discussed further herein. It should be noted that, according to some embodiments, in the second orientation, the ends 31 and 33 of the anchor body 32 are closer to each other than in the first orientation (e.g., Fig.16A ). According to some embodiments, optionally, in the second orientation, the ends 31 and 33 of the anchor body 32 face each other at an angle. The suture may be formed of any suitable material, such as those discussed herein.

[0356] With further reference to Fig.17A -B, additional embodiments of the present invention are shown, particularly corresponding anchors 80 and 90. Each of the anchors 80 and 90 may include a channel defined by a plurality of respective rings 82 and 92. Each of the rings 82 and 92 may be structurally and functionally similar to the rings 40, 60a-d, and 80a-d ( Fig.16A -C). However, according to some embodiments and as Fig.17A shown in -B, it should be noted that, unlike the four-ring anchors 30, 50, and 70 ( Fig.16A -C), each of the anchors 80 and 90 may include only two rings 82 and 92, respectively.

[0357] With further reference to Fig. 17C , a pair of anchors 80 according to some embodiments of the present invention is shown in a position after being deployed and fixed against the soft tissue 42. Although Fig. 17C shows two anchors 80 each of which is structurally and functionally similar to the anchor 80 ( Fig.17A ), those skilled in the art will understand that, alternatively, any combination of the anchors 80 and / or 90 from Fig.17A -B may be depicted separately.

[0358] Each anchor 80 may include two rings 82, as discussed herein with reference to Fig.17A those. According to some embodiments, the two anchors 80 are each held in a second orientation, in which, after deployment through the soft tissue 42, the bodies 84 have each been bent into a U-shape by suture portions 44 / 46 that have been routed through the rings 82 in the anchors 80. It should be noted that, in the second orientation, the ends 81 and 83 of the anchor body 84 are closer to each other than in the first orientation (e.g., Fig.17A) are closer to each other. According to some embodiments, optionally, in the second orientation, the ends 81 and 83 of each anchor body 84 face each other at an angle. The suture can be formed of any suitable material, for example, the materials discussed herein with respect to Fig.16D the suture materials in

[0359] Referring to Fig.17D -G, an additional anchor having a channel defined by a plurality of loops is shown according to an embodiment of the present invention. For example, according to some embodiments, the anchor 91( Fig.17D ) may include a channel 75 defined by a plurality of loops 93, the loops 93 being formed from a single portion of the material 77 of the suture 94 that weaves into and out of the anchor, such that the loops 93 are connected to each other. It can be noted that the suture portions 95 at the two ends of the anchor 91 extend away from the anchor.

[0360] As Fig.17E shown, according to some embodiments, the anchor 99 may also include a channel 75 defined by a plurality of loops 93, the loops 93 being formed from a single portion of the material 77 of the suture 96 that weaves into and out of the anchor, such that the loops 93 are connected to each other. It can be noted that the suture portions 97 at the two ends of the anchor 99 may each be provided with a knot 98. According to some embodiments, the knot 98 may prevent the suture portion from detaching from the anchor 99.

[0361] Referring to Fig.17F -G, an anchor is shown according to some embodiments of the present invention. The anchor 70a may be similar to the anchor 70( Fig. 16C ), except that the ends of the loops may return and point towards the interior of the anchor 70a, which may strengthen the ends of the suture material such that the suture material does not detach from the anchor. As for the anchor 70b, it may be similar to the anchor 70a, except that according to some embodiments the ends of the loops are embedded in the anchor material, thereby potentially providing a stronger connection between the loops and the anchor body 72b.

[0362] Those skilled in the art will understand that according to some embodiments of the present invention, an anchor having four loops can provide better anchor stability to soft tissue and can be more difficult to remove after being fixed against soft tissue. However, an anchor having only two loops can pass through soft tissue, such as the meniscus, with less stress and can rest more flatly against the soft tissue.

[0363] Referring to Fig.18A-B shows an alternative configuration for threading a length of suture through a pair of anchors and the anchors after fixation against soft tissue. Specifically, as shown, according to some embodiments, the first and second anchors 401 and 402 have respective bodies 431 and 432, each body having a channel defined by a pair of loops. For example, anchor 401 may have a channel 405 defined by loops 404a and 404b, which are formed by short suture portions 406 of material 407 that are woven into and out of anchor 401, where the ends 410 and 412 of short suture portion 406 may be attached to body 431 by any known means, e.g., by the manner discussed herein with respect to any of rings 40( Fig.16A )、60( Fig. 17B )、82( Fig.17A )、92( Fig. 17B ) and 80( Fig. 16C ) to the body. According to some embodiments, anchor 402 may have a channel 405 defined by loops 408a and 408b, which are formed by portions of long suture portion 416 that are woven into or out of material 407 of anchor 402. According to some embodiments, anchors 401 and 402 may be attached via long suture portion 416 in the following threading configuration:

[0364] a. The first end 420 of long suture portion 416 may be formed as the end of loop 408b, and as described herein, long suture portion forms loop 408a and then extends away from body 432 of anchor 402.

[0365] b. Long suture portion 416 then extends toward anchor 401 and passes through channel 405 defined by loops 404b and 404a of anchor 401.

[0366] c. Long suture portion 416 then extends away from anchor 401 toward anchor 402, where long suture portion 416 passes through channel 405 defined by loops 408a and 408b.

[0367] d. The second end 422 of long suture portion 416 extends proximally away from anchor 402.

[0368] As discussed herein, according to some embodiments, the anchors 401 and 402 may be deployed through soft tissue. According to some embodiments, after release from the deployment device, the anchors 401 and 402 may be fixed against and tightened against the soft tissue by pulling on the second end 422 of the long suture portion 416. As discussed herein, according to some embodiments, as the long suture portion 416 slides through the channels 405 of each of the anchors 401 and 402, this may cause the bodies 431 and 432 of the respective anchors 401 and 402 to bend into U-shaped anchors. One such anchor 402 is shown in Fig.19B in a bent configuration.

[0369] Now referring to Fig.19A -B, another alternative configuration for routing a segment of suture through a pair of anchors and the anchors after being fixed against soft tissue is shown, according to some embodiments. Fig.19A Embodiments of Fig.18A may be similar to

[0370]

[0371] Fig.18A

[0372]

[0373] Fig.18B

[0374] Fig.18A 19A ​​​​​​​​In the embodiments, the anchor members 401 and 402 and the anchor members 501 and 502 are shown as each having a channel 405 defined by a pair of loops, but those skilled in the art will understand that any one of the anchor members 401, 402, 501, and 502 may alternatively have a channel defined by more than two loops, such as four loops, if desired.

[0375] Now refer to Fig.19C and Fig.19D , Fig.19C FIG. 9 is a simplified schematic view of an exemplary anchor member 700 with a suture 710 threaded therethrough in a first orientation according to an embodiment of the present invention. Fig.19D FIG. 10 is a simplified cross-sectional view of the Fig.19C anchor member in a second orientation and with a suture threaded therethrough.

[0376] When in the first operating orientation ( Fig.19C ), the anchor member 700 is disposed generally along a longitudinal axis 701 and defines a proximal portion 702 and a distal portion 704. Alternatively, the anchor member 700 may have any other shape in the first operating orientation.

[0377] A specific feature of an embodiment of the present invention is that at least one suture 710 is configured to thread through the distal portion 704 of the anchor member 700 at least once and is also configured to thread through the proximal portion 702 of the anchor member 700 at least once. The at least one suture 710 is further configured to be disposed at least partially radially outside the anchor member 700.

[0378] Specifically visible, the suture 710 can be schematically divided into a plurality of different portions, namely a proximal outer portion 712, a proximal inner portion 714, an intermediate outer portion 716, a distal inner portion 718, and a distal outer portion 720. In Fig.19C it is specifically visible that the proximal outer portion 712, the intermediate outer portion 716, and the distal outer portion 720 of the suture 710 are disposed radially outside the outer surface 706 of the anchor member 700, while the proximal inner portion 714 can thread through the proximal portion 702 of the anchor member 700, and the distal inner portion 718 can thread through the distal portion 704 of the anchor member 700. The proximal outer portion 712, the intermediate outer portion 716, and the distal outer portion 720 of the suture 710 can all be disposed outside relative to the outer surface 706 of the anchor member 700.

[0379] According to some embodiments, the locations / points along the anchor member 700 where the suture proximal inner portion 714 and the suture distal inner portion 718 thread through the anchor member proximal portion 702 and the anchor member distal inner portion 718, respectively, can be preselected and can depend on the desired final configuration of the anchor member 700 after tensioning. For example, as Fig.19D The desired final configuration shown. For example, for an anchor having a length L, the locations / points along the anchor 700 where the suture proximal inner portion 714 and the suture distal inner portion 718 respectively run through the anchor proximal portion 702 and the anchor distal inner portion 718 can be, for example, at 5%-45% of the length L from the proximal most end of the anchor and from the distal most end of the anchor, respectively. For example, according to some embodiments, they are respectively at 25% of the length L from the proximal most end of the anchor and from the distal most end of the anchor.

[0380] Additionally or alternatively, for example, for an anchor having a length L, according to some embodiments, the locations / points along the anchor 700 where the suture proximal inner portion 714 and the suture distal inner portion 718 respectively run through the anchor proximal portion 702 and the anchor distal inner portion 718 can each be, for example, at 5-45% of the length L from the center point of the anchor, such as at 10% of the length L from the center point of the anchor.

[0381] Furthermore, it can be noted that in Fig.19C the embodiment shown, the suture proximal inner portion 714 is shown running through the anchor proximal portion 702 at a specific distance from the proximal end of the anchor; and the suture distal inner portion 718 is shown running through the anchor distal portion 704 at the same specific distance from the distal end of the anchor. When tensioned, as Fig.19D shown, the anchor can have a configuration in which the proximal end of the anchor and the distal end of the anchor are adjacent to each other. However, it should be noted that this is just an exemplary embodiment. Alternatively, if desired, the suture proximal inner portion 714 can run through the anchor proximal portion 702 at a first distance from the proximal end of the anchor, and the suture distal inner portion 718 can run through the anchor distal portion 704 at a second distance from the distal end of the anchor, where the first distance and the second distance are not equal. After deploying and tensioning an anchor having such a configuration, this can allow different tensioned configurations, for example, a tensioned configuration in which the proximal end of the anchor extends beyond the distal end of the anchor, or vice versa.

[0382] As can be seen from Fig.19D the anchor 700 is in its second operating orientation in tension. After at least one of the proximal outer portion 712 and the distal outer portion 720 of the suture 710 has been pulled, the length of the suture running along the anchor has been shortened, causing the anchor 700 to bend, where the proximal portion 702 and the distal portion 704 of the anchor generally become closer to each other.

[0383] Although the suture 710 is in Fig.19Cis shown as having a suture proximal inner portion 714 and a suture distal inner portion 718 that respectively thread through the proximal portion 702 and the distal portion 704 of the anchor, optionally each in a direction perpendicular to the longitudinal axis 701 of the anchor, but those skilled in the art will understand that this is merely an exemplary embodiment. Alternatively, if desired, the suture 710 may thread through the proximal portion 702 and / or the distal portion 704 of the anchor in a direction not perpendicular to the longitudinal axis 701 of the anchor. Alternatively, one or both of the suture proximal inner portion 714 and the suture distal inner portion 718 may thread through a portion of the anchor 700 in different directions, one or both of them not threading perpendicular to the longitudinal axis 701 of the anchor.

[0384] For example, referring to Figure 19K , an alternative embodiment is shown in which the suture 710 has a proximal outer portion 712, a proximal inner portion 714a not perpendicular to the longitudinal axis 701 of the anchor, an intermediate outer portion 716, a distal inner portion 718a not perpendicular to the longitudinal axis, and a distal outer portion 720. Similar to the embodiment shown in Fig.19C , the suture proximal outer portion 712, the suture intermediate outer portion 716, and the suture distal outer portion 720 are each disposed radially outside the outer surface 706 of the anchor, while the suture proximal inner portion 714a may thread through the proximal portion 702 of the anchor at least once, and the suture distal inner portion 718a may thread through the distal portion 704 of the anchor 700 at least once.

[0385] Figure 19L Another alternative embodiment is shown in which the suture 710 includes a proximal outer portion 712, a proximal inner portion 714, a diagonally oriented intermediate outer portion 716b, a distal inner portion 718, and a distal outer portion 720b. The suture proximal outer portion 712, the suture intermediate outer portion 716b, and the suture distal outer portion 720b are shown disposed radially outside the outer surface 706 of the anchor 700, while the suture proximal inner portion 714 threads through the proximal portion 702 of the anchor at least once, and the suture distal inner portion 718 threads through the distal portion 704 of the anchor at least once.

[0386] Fig.19MAnother alternative embodiment is shown, where suture 710 includes a proximal outer portion 712, a proximal inner portion 714, a diagonally oriented intermediate outer portion 716c, a distal inner portion 718c, and a distal outer portion 720. The suture proximal outer portion 712, the suture intermediate outer portion 716c, and the suture distal outer portion 720 are shown as being disposed radially outside relative to the outer surface 706 of the anchor, while the suture proximal inner portion 714 runs through the proximal portion 702 of the anchor at least once, and the suture distal inner portion 718c runs through the distal portion 704 of the anchor at least once.

[0387] Although in the embodiments discussed herein with reference to Fig.19C and 19K -M the suture 710 appears to be disposed in a single plane, alternatively, the suture can alternatively be disposed relative to the anchor 700 such that these portions of the suture are in more than one plane. For example, with respect to Fig.19C the embodiment, suture portions 712 and 714 can be disposed in a first plane, while suture portions 718 and 720 are disposed in a second plane, and suture portion 716 can extend between the first and second planes. According to some embodiments, additional alternative embodiments of routing the suture 710 through multiple portions of the anchor 700 will be apparent to those skilled in the art.

[0388] A particular feature of one embodiment of the present invention is that, due to the minimization of the frictional force between the anchor 700 and the suture 710, the force that needs to be applied by the user to tighten the anchor 700 so that it transitions from its Fig.19C first operative orientation to its Fig.19D tightened second operative orientation is relatively low. The minimization of the frictional force can be achieved by minimizing the surface area where the anchor 700 engages the suture 710. This minimization of the surface area is in turn achieved by the fact that only a portion of the suture 710 runs through the anchor 700, while the remaining length of the suture 710 is disposed outside the anchor 700.

[0389] A particular feature of one embodiment of the present invention is that the force that needs to be applied by the user to tighten the anchor 700 so that it transitions from its Fig.19C first operative orientation to its Fig.19D tightened second operative orientation is relatively low compared to the force required in the case where the suture runs through the entire length of the anchor.

[0390] It should be noted that the systems and / or their components discussed herein with respect to FIGS. 1-19D and 19K-M can be used in a kit that includes the embodiments discussed with respect to Fig.19E -J, and / or with respect to Figure 20-34The embodiments discussed, and / or with respect to Figure 35-41B The embodiments discussed, and / or with respect to Figure 42-43H The embodiments discussed, and / or with respect to Figure 44-45 The embodiments discussed, and / or with respect to Figure 46-48E any one of the embodiments discussed.

[0391] Now refer to Fig.19E , which is a simplified cross-sectional view of a portion of an anchor delivery system 1100 constructed and operated in accordance with an embodiment of the present invention and shown in an initial redeployment operation orientation.

[0392] Fig.19E This portion of the anchor delivery system 1100 shown in includes a sheath 1150 having a channel 1158 therethrough, a pusher element 1130 displaceable within the channel 1158, and an anchor 1700 displaceable along the channel 1158 under the action of the pusher element 1130 and deployable from the channel 1158. Note that the sheath 1150 may be the same as or similar in structure and function to the hollow needle 1150 described and shown in PCT patent application serial number PCT / IL2018 / 051298, which is incorporated herein by reference in its entirety. Alternatively, the sheath 1150 may be different in structure and / or function from the hollow needle 1150 of PCT / IL2018 / 051298. The pusher element 1130 may also be the same as or similar to the pusher element 1130 described and shown in PCT patent application serial number PCT / IL2018 / 051298. Alternatively, the pusher element 1130 may be different in structure and / or function from the pusher element 1130 of PCT / IL2018 / 051298. Optionally, the pusher element 1130 may be similar in structure and / or function to the anchor pusher 3( Figure 1A ).

[0393] Optionally, according to various embodiments of the present invention, the pusher element 1130 may include a through lumen 1730. Optionally, the pusher element 1130 may include a distally facing surface configured to contact the anchor prior to anchor deployment.

[0394] According to some embodiments, as specifically visible in Fig.19E , the suture 1710 is partially routed through the anchor 1700 in the manner described with reference to Fig.19C -D. Alternatively, the suture 1710 may be partially routed through the anchor 1700 in the manner discussed with reference to Figure 19K -M or any other suitable manner.

[0395] Another particular feature of an embodiment of the present invention is that, as Fig.19EAs shown, the pusher element 1130 has a through lumen 1730, and one or both of the proximal outer portion 1712 and the distal outer portion 1720 of the suture 1710 can extend along the interior of the through lumen 1730 of the pusher element 1130. Optionally, the proximal outer portion 1712 and / or the distal outer portion 1720 of the suture 1710 can extend through an opening in the distally facing surface of the pusher element 1130, or through an opening in another surface of the pusher element, and at least partially extend along the interior of the through lumen 1730 of the pusher element 1130.

[0396] It can be noted that the length of each of the proximal outer portion 1712 of the suture and the distal outer portion 1720 of the suture can be preselected. The proximal outer portion 1712 of the suture and / or the distal outer portion 1720 of the suture can extend proximally from the anchor 1700 through the through lumen 1730 into a more proximal portion of the deployment device and / or protrude from an opening in the deployment device. This can allow manipulation of the suture 1710 prior to deployment of the anchor 1700. Optionally, the proximal outer portion 1712 of the suture and / or the distal outer portion 1720 of the suture can extend proximally from the anchor 1700 and terminate within the interior of the through lumen 1730.

[0397] Note that the intermediate outer portion 1716 of the suture 1710 is disposed within the channel 1158 of the sheath 1150 between the outer surface of the anchor 1700 and the inner surface of the sheath 1150.

[0398] Now refer to Fig.19F , which is a simplified cross-sectional view of a portion of an anchor delivery system 1100 constructed and operated in accordance with another embodiment of the present invention and shown in an initial redeployment operation orientation.

[0399] Except for the structure of the pusher element 1130, Fig.19F the portion of the anchor delivery system 1100 shown in Fig.19E can be substantially similar in all respects to the anchor delivery system 1100 shown in Fig.19F . As can be seen from Figure 1A , the pusher element 1130 is solid and has no lumen formed therethrough. Optionally, the pusher element 1130 can be functionally similar to the anchor pusher 3 (

[0400] In Fig.19F it can be specifically seen that the suture 1710 is routed through the anchor 1700 in a manner described with reference to Fig.19C -D.

[0401] Another particular feature of an embodiment of the present invention is that both the proximal outer portion 1712 and the distal outer portion 1720 of the suture 1710 are configured to be disposed within the channel 1158 of the sheath 1150 between the outer surface of the pusher element 1130 and the inner surface of the sheath 1150.

[0402] It will be noted that the length of each of the proximal outer portion 1712 of the suture and the distal outer portion 1720 of the suture may be preselected. The proximal outer portion 1712 of the suture and / or the distal outer portion 1720 of the suture may extend proximally from the anchor 1700 between the outer surface of the pusher element 1130 and the inner surface of the sheath 1150 into a more proximal portion of the deployment device and / or out of an opening in the deployment device. This may allow manipulation of the suture 1710 prior to deployment of the anchor 1700. Optionally, the proximal outer portion 1712 of the suture and / or the distal outer portion 1720 of the suture may extend proximally from the anchor 1700 and terminate within the sheath 1150 alongside / beside a portion of the pusher element 1130.

[0403] Now referring Figure 19G and Fig.19H , Figure 19G is Fig.19F a simplified cross-sectional view of the anchor delivery system 1100 and an enlarged view of its distal end, showing an initial pre-deployment operative orientation, Fig.19H is Fig.19F a simplified cross-sectional view of the anchor delivery system 1100 and an enlarged view of its distal end, showing an operative orientation after deployment of the anchor.

[0404] In Figure 19G it can be seen that the shaft / sheath 1150 may be fixedly attached to the handle assembly 1102, which may be the same as or similar to the handle assembly 1102 described and shown in PCT patent application serial number PCT / IL2018 / 051298, which is incorporated herein by reference in its entirety, and optionally having the same or similar delivery assembly within the handle assembly 1102. Alternatively, the handle assembly 1102 and / or the delivery assembly may be different in structure and / or function from the handle assembly and / or the delivery assembly of PCT / IL2018 / 051298. It will also be noted that Figure 19G the pusher element 1130 shown in Fig.19H -J (and the pusher element shown in Fig.19E -F) may be similar in structure and / or function to any of the pusher elements discussed herein with respect to

[0405] From Figure 19GAs can be seen in -H, the pusher element 1130 is operably coupled to a delivery assembly within the handle assembly 1102, and the pusher element is configured to be axially displaced along the channel 1158 defined by the sheath 1150.

[0406] As Figure 19G shown in -H, the anchor delivery system 1100 can correspond to Fig.19F an embodiment of the present invention shown in, where the proximal outer portion 1712 and the distal outer portion 1720 of the suture 1710 are disposed within the channel 1158 of the sheath 1150 radially outside the pusher element 1130.

[0407] In Figure 19G is shown the anchor 1700 in an initial pre-deployment operative orientation, where the pusher element 1130 is located proximal to and spaced from or adjacent to the anchor 1700, and the anchor 1700 is fully contained within the channel 1158 of the sheath 1150.

[0408] In Fig.19H is shown the anchor 1700 in a post-deployment operative orientation, subsequent to which the pusher element 1130 is displaced distally within the channel 1158 of the sheath 1150 to thereby push the anchor 1700 distally out of the sheath 1150. It will be noted that depending on the length of each of the suture proximal outer portion 1712 and the suture distal outer portion 1720, the suture proximal outer portion 1712 and / or the suture distal outer portion 1720 may have been deployed together with the anchor 1700, or alternatively, may at least partially remain within the shaft / sheath 1150 or another part of the system 1100 after the anchor 1700 is deployed. In the latter case, the suture proximal outer portion 1712 and / or the suture distal outer portion 1720 can be manipulated by the surgeon / system operator and then released from the system 1100. Similar actions can be performed in the embodiment shown in -J. Fig.19I -J.

[0409] At this stage, the anchor 1700 can be tightened by pulling proximally at least one of the proximal outer portion 1712 and the distal outer portion 1720 of the suture 1710 disposed between the inner diameter of the sheath 1150 and the outer diameter of the pusher element 1130.

[0410] After the anchor 1700 is deployed, the pusher element 1130 can be retracted into the sheath 1150.

[0411] Now referring to Fig.19I and Fig.19J , Fig.19I is Fig.19E a simplified cross-sectional view of the anchor delivery system 1100 and an enlarged view of its distal end, showing an initial redeployment operative orientation, Fig.19J Yes Fig.19E Simplified cross-sectional view of the anchor delivery system 1100 and an enlarged view of its distal end, showing the anchor deployment operation orientation.

[0412] As Fig.19I can be seen, the shaft / sheath 1150 is fixedly attached to the handle assembly 1102, which can be the same as or similar to the handle assembly 1102 described and shown in PCT patent application serial number PCT / IL2018 / 051298, which is incorporated herein by reference in its entirety, and optionally has the same or similar delivery components within the handle assembly 1102. Alternatively, the handle assembly 1102 and / or the delivery components can be different in structure and / or function from the handle assembly and / or the delivery components of PCT / IL2018 / 051298.

[0413] From Fig.19I -J, it can be seen that the pusher element 1130 is operatively coupled to the delivery components within the handle assembly 1102 and is configured to axially displace along the channel 1158 defined by the sheath 1150.

[0414] As Fig.19I shown in -J, the anchor delivery system 1100 can correspond to an embodiment of the present invention shown in Fig.19E , where the proximal outer portion 1712 and the distal outer portion 1720 of the suture 1710 can be disposed within the lumen 1730 formed through the pusher element 1130.

[0415] In Fig.19I , the anchor 1700 is shown in an initial redeployment operation orientation, where the pusher element 1130 is located proximal to the anchor and is spaced apart from or adjacent to the anchor, and the anchor 1700 is fully contained within the channel 1158 of the sheath 1150.

[0416] In Fig.19J , the anchor 1700 is shown in a deployed operation orientation, and subsequently the pusher element 1130 is displaced distally within the channel 1158 of the sheath 1150, thereby pushing the anchor 1700 distally out of the sheath 1150. When the anchor 1700 is deployed from the sheath 1150, at least a portion of each of the suture proximal outer portion 1712 and the suture distal outer portion 1720 exits the sheath 1150, and the anchor 1700 can be tightened by pulling proximally at least one of the suture proximal outer portion 1712 and the suture distal outer portion 1720 that was disposed within the lumen 1730 of the pusher element 1130 prior to the deployment of the anchor 1700.

[0417] After the anchor 1700 is deployed, the pusher element 1130 can be retracted into the sheath 1150.

[0418] Note that the anchor 1700 can be solid or tubular. When tensioned, the anchor 1700 can assume a generally U-shape as shown Fig.19D Alternatively, the anchor 1700 can remain straight or can be slightly bent into a C-shape when tensioned, depending, for example, on the stiffness of the anchor and the tightness with which the anchor is pulled by the suture material. Alternatively, when tensioned, the anchor 1700 can assume other forms, such as spherical.

[0419] It should be noted that the systems and / or their components discussed herein with respect to Fig.19E -J can be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or with respect to Figure 20-34 the embodiments discussed, and / or with respect to Figure 35-41B the embodiments discussed, and / or with respect to Figure 42-43H the embodiments discussed, and / or with respect to Figure 44-45 the embodiments discussed, and / or with respect to Figure 46-48E any one of the embodiments discussed.

[0420] Exemplary Method

[0421] In an exemplary anchor delivery method, the anchor pair is deployed as follows. The first anchor is deployed by advancing the anchor pusher a first amount, and then the anchor pushing mechanism (which includes the anchor pusher and the pushing assembly) is modified such that there is less axial overlap between the anchor pusher and the pushing assembly. Then, the anchor pusher is advanced again and the second anchor is deployed. Optionally, the same movement, such as type and amount (e.g., sliding or rotation of a button / knob), is used for both deployments. Optionally, between the two movements, the pushing assembly retracts. Optionally, the state of the mechanism automatically moves from a first state of potential overlap to a second state of potential overlap, e.g., such automatic movement is caused by elastic movement of one or more components allowed by the retraction of the pushing assembly. Then, when the pushing assembly is advanced, the anchor pusher will contact the anchor and deploy it from the sheath.

[0422] Fig. 20A method of operating a multi-state anchor delivery device in accordance with some embodiments of the present invention. At 850, the method includes using a second pusher to push an anchor pusher over a specified axially overlapping region between the anchor pusher and the second pusher. At 852, the method includes using the anchor pusher to eject an anchor from a sheath during a first state. At 854, the method includes retracting the second pusher from the anchor pusher, which results in a reduction of the specified axially overlapping region between the anchor pusher and the second pusher. At 856, one or both of the anchor pusher and the second pusher are deformed. At 858, the anchor pusher is pushed by the second pusher, with one or both of the anchor pusher and the second pusher having a deformation that causes mechanical interference for the specified axially overlapping region, where the pushing occurs over a contact region between the anchor pusher and the second pusher, the contact region being outside / beyond the specified axially overlapping region. At 860, during a second state, the next anchor is ejected from the sheath using the anchor pusher.

[0423] Fig.21 A method for reducing axial overlap and extending an anchor pusher in accordance with some embodiments of the present invention. At 862, an axially overlapping region is specified between the anchor pusher and the second pusher. At 864, the second pusher is retracted from the anchor pusher to reduce the specified axially overlapping region between the anchor pusher and the second pusher. At 866, one or both of the anchor pusher and the second pusher are deformed. At 868, mechanical interference is created for the specified axially overlapping region. At 870, the lengths of the anchor pusher and the second pusher are combined using a contact region outside the specified axially overlapping region. At 872, the lengths of the anchor pusher and the second pusher are extended by using the new combined length. At 874, during a second state, the next anchor is ejected from the sheath using the extended length of the anchor pusher.

[0424] Fig. 22 An exploded perspective view of an anchor delivery system 100 including a pusher element having a curved tip in accordance with some embodiments of the present invention. The components of the system may be structurally and functionally similar to the components of the anchor delivery system shown in the reference Figure 3-4 and are not described herein again.

[0425] System 100 includes a sheath 250 having a tip 253 and an axially extending slot 255 extending along a distal portion 250a of the sheath. A section of suture 288 can be threaded through anchors 270 and 280, the section of suture including: suture portions 288a and 288b, each portion extending between anchors 270 and 280; and a suture free end 288c that can extend proximally from either anchor 280 or anchor 270 beside the sheath 250. Reference will be made to Fig.35Further discussion of suture 288 and its function in tensioning the deployed anchors.

[0426] Additionally referring to Fig.23 , suture portions 288a and 288b may extend out through needle slot 255. It can be noted that the arrangement of slot 255 allows suture portions 288a - b to be located outside of sheath 250, thereby potentially preventing these portions of suture 288 from interfering with the movement of anchors 270 and 280 through the sheath. It can also be noted that suture free end 288c is not shown in Fig.23 as it may extend proximally through the device from either the first anchor 270 or the second anchor 280 such that it can be pulled by the user after the first and second anchors are deployed. Optionally, suture free end 288c may be wound around spool 300 ( Fig. 22 ). Further discussion of suture 288 will be made with reference to Fig.29 and 35 . It can be noted that for simplicity, suture 288 is omitted in Figure 25-28 and 31 - 34.

[0427] Fig.24 is a perspective view of pusher element 230 for an anchor delivery system according to some embodiments of the present invention. Pusher element 230 includes elongate shaft 320 that has tip 322 at the distal portion 232 of the pusher element, and the tip has a slightly upward curvature. At least the distal portion 232 of the pusher element is formed of a flexible / bendable material, which allows the distal portion to deform, which will be further discussed herein.

[0428] Pusher element 230 includes portion 321 having a relatively thin profile that extends between pusher tip 322 and portion 323 having a relatively thick profile. According to some embodiments, an inclined surface 324 may be present between portions 321 and 323. Pusher element 230 may also include portion 325 having a relatively thin profile that extends between portion 323 and relatively thick portion 327. Optionally, portion 325 may have the same thickness as portion 323. An inclined surface 326 may be present between portions 323 and 325. A recess 328 may be present adjacent portion 327. Optionally, a screw may be inserted into device 100 ( Figure 22 ) to attach pusher element 230 to rack 220 ( Figure 22 ) or another part of the deployment device.

[0429] It can be noted that some portions of the pusher element 230 (e.g., the pusher tip 322, the distal portion 232, and the portion 321) are shown to have a relatively thin profile compared to at least the portion 323 having a relatively thick profile. According to some embodiments, the relatively thin portions of the pusher element 230 allow these portions of the pusher element to be more flexible, while the relatively thick portions restrict the lateral movement of the pusher element within the sheath 250. According to some embodiments, the above-described structure of the pusher 230 can facilitate the deployment of the anchor 270.

[0430] Figure 25 FIG. 4 is a side cross-sectional view of an anchor delivery system 100 according to some embodiments of the present invention before deploying the anchors 270 and 280. In Figure 25 In the enlarged view of FIG. 5, the anchors 270 and 280 are shown located within the sheath 250, with the anchor 270 located distally of the anchor 280. The pusher element 230 extends beneath the anchor 280, where the pusher tip 322 is located distally of the anchor 280 but proximally of the anchor 270. It can be noted that, according to some embodiments, the anchor 280 can be positioned near the relatively thin portion 321 of the pusher element 230.

[0431] Although the pusher element 230 is shown extending beneath the anchor 280, those skilled in the art will understand that alternatively, the pusher element 230 can extend above or beside the anchor 280, as long as the pusher tip 322 is located distally of the anchor 280 and proximally of the anchor 270.

[0432] The distal movement of the pusher element 230 causes the pusher tip 322 to abut the proximal end 272 of the anchor 270 and moves the anchor 270 toward the sheath tip 253. According to some embodiments, as the pusher element 230 moves distally to deploy the anchor 270, the anchor 280 can move distally due to the contact of the inclined surface 324 with the proximal end 282 of the anchor 280, thus moving closer to the sheath tip 253. The pusher element 230 can extend toward the sheath tip 253 at least until the distance required for the deployment of the anchor 270.

[0433] Figure 26 FIG. 6 is a side cross-sectional view of the anchor delivery system after the deployment of the anchor 270, where the pusher element 230 is in the extended position / out position. Also referring to Figure 27A -B, the pusher element 230 can be retracted, i.e., moved proximally (to the right relative to Figure 26 the position of the pusher element in FIG. 5). As the pusher element 230 retracts, the previously upwardly curved pusher tip 322 is at the anchor 280 ( Figure 27A) is deformed under the action of such that the pusher tip is coaxial with part 321 of the pusher element, and the pusher tip (not shown in Figure 27A ) passes under the anchor 280 until it is fully disposed proximal to the proximal end of the anchor ( Figure 27B ), at which point the pusher tip 322 will return to its bent configuration.

[0434] Optionally, the second anchor 280 may be deformable such that when the pusher element 230 retracts, the pusher tip 322 causes the second anchor to undergo temporary deformation as the pusher element slides past the second anchor towards the position in Figure 27B .

[0435] It can be noted that, according to some embodiments, the provision of suture loops ( Figure 22 and 23 ) extending through slots 255 in the sheath 250 and / or anchor loops ( Figures 16A - 19B ) can prevent the anchor 280 from moving backward (distally) when the pusher element 230 retracts.

[0436] The distal movement of the pusher element 230 from its position in Figure 27B to its position in Figure 28 causes the pusher tip 322 to contact the proximal end 282 of the anchor 280, such that the anchor 280 moves distally within the sheath 250. As shown in Figure 28 , the pusher element 230 may extend towards the sheath tip 253 at least the distance required to deploy the anchor 280 ( Figure 28 ).

[0437] Figure 29 is an exploded perspective view of an anchor delivery system 200 including a pusher element 330 having a distal end 332 including an S-shaped tip or tip portion 342. The components of the system may be structurally and functionally similar to the components of the anchor delivery system shown in reference Figures 3 - 4 and / or Figures 22 - 23 and will not be described herein again.

[0438] It can be noted that, similar to what is shown in Figure 23 , the system 200 may also include a sheath 250 having an axially extending slot 255 extending along the distal portion 250a of the sheath. A section of suture 288 may be routed through the anchors 270 and 280 in a manner similar to that discussed herein (e.g., with respect to Figures 22 - 23 and Figure 35 ). The suture 288 and its function in tensioning the deployed anchors will be discussed in further detail with reference to Figure 35 .

[0439] Although the pusher elements (230 or 330) within the system may vary, when assembled, system 200 ( Figure 29 ) may have an appearance similar to system 100 ( Figure 23 ).

[0440] Figure 30 is a perspective view of a pusher element 330 for an anchor delivery system according to some embodiments of the present invention. The pusher element 330 includes an elongate shaft 332 that has an S-shaped distal end portion 342 at the distal end of the pusher element. The S-shape of the distal end portion 342 includes an upper curved portion 334, a lower curved portion 336, and a most distal tip 333. At least the S-shaped distal end portion 342 of the pusher element 330 is formed of a flexible / bendable material, which allows the S-shaped portion to deform, which will be discussed further herein.

[0441] Although the pusher element 330 ( Figure 30 ) may be functionally similar to the pusher element 320 ( Figure 24 ), it should be noted that, according to some embodiments, the particular configuration of the S-shaped distal end portion 342 of the pusher element 330 may allow the pusher element 330 to be more flexible and may allow the pusher element 330 to deform more easily, e.g., as discussed herein with respect to Figures 32 - 33B .

[0442] It may be noted that, according to some embodiments, the S-shaped portion 342 of the pusher element 330 may allow the S-shaped portion to be more flexible, while the upper curved portion 334 and the lower curved portion 336 may restrict lateral movement of the pusher element within the sheath 250.

[0443] Figure 31 is a side cross-sectional view of an anchor delivery system 200 prior to deployment of the anchors 270 and 280, according to some embodiments of the present invention. In the Figure 31 enlarged view, the anchors 270 and 280 are shown located within the sheath 250, with the anchor 270 located distally of the anchor 280. The pusher element 330 extends beneath the anchor 280, and the S-shaped pusher distal end portion 342 is located distally of the anchor 280 but proximally of the anchor 270. It may be noted that the anchor 280 is positioned adjacent to a portion of the shaft 332 of the pusher element 330.

[0444] Although the pusher element 330 is shown extending beneath the anchor 280, those skilled in the art will understand that, alternatively, the pusher element 330 may extend above or beside the anchor 280, so long as the S-shaped pusher distal end portion 342 is located distally of the anchor 280 and proximally of the anchor 270.

[0445] Distal movement of the pusher element 330 causes the tip 333 of the pusher element 330 to abut against the proximal end 272 of the anchor 270 and moves the anchor 270 toward the sheath tip 253. As the pusher element 330 moves distally to deploy the anchor 270, the anchor 280 may move distally due to contact of the rod 332 with the anchor 280, thereby moving closer to the sheath tip 253. Alternatively, as the pusher element 330 moves distally, the anchor 280 may slide relative to the rod 332. The pusher element 330 may extend toward the sheath tip 253 at least the distance required to deploy the anchor 270.

[0446] Figure 32 is a side cross-sectional view of the anchor delivery system after deployment of the anchor 270, where the pusher element 330 is in the extended / extended position. Also refer to Figure 33A -B, the pusher element 330 can be retracted, i.e., moved proximally (to the right relative to Figure 32 the position of the pusher element in). As the pusher element 330 retracts, the S-shaped tip portion 342, which previously included an upper curved portion 334 and a lower curved portion 336, is deformed under the action of the anchor 280 ( Figure 33A ), such that the tip portion 342 (previously having an S-shape) is coaxial with the rod 332 of the pusher element, and the portion of the pusher element 330 that previously formed the S-shaped tip portion 342 ( Figure 33A not shown in) passes under the anchor 280 until it is fully disposed proximal to the proximal end of the anchor ( Figure 33A ), at which point the tip portion 342 will return to its S-shaped configuration.

[0447] Optionally, the second anchor 280 may be deformable such that when the pusher element 330 retracts, the pusher tip portion 342 causes the second anchor to undergo temporary deformation as the pusher element slides past the second anchor toward the position in Figure 33B .

[0448] It may be noted that, according to some embodiments, the provision of suture loops ( Figure 30 and 23 ) and / or anchor loops ( Figures 16A - 19B ) extending through the slots 255 in the sheath 250 may prevent the anchor 280 from moving backward (distally) when the pusher element 330 retracts.

[0449] Once the pusher element 330 has been retracted such that it is fully proximal to the anchor 280, the S-shaped pusher tip portion 342 returns to its S-shaped configuration ( Figure 33B ).

[0450] The pusher element 330 from its position in Figure 33B to its position inFigure 34 Distal movement of the position in Figure 34 causes the tip 333 of the pusher element to contact the proximal end 282 of the anchor 280, such that the anchor 280 moves distally within the sheath 250. As Figure 34 shown, the pusher element 330 can extend toward the sheath tip 253 at least the distance required to deploy the anchor (

[0451] It should be noted that the systems and / or their components discussed herein can be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or with respect to Figures 20 - 34 the embodiments discussed with respect to Figure 19E -J, and / or with respect to Figures 35 - 41B the embodiments discussed with respect to Figures 42 - 43H the embodiments discussed with respect to Figures 44 - 45 the embodiments discussed with respect to Figures 46 - 48E any of the embodiments discussed with respect to Figure 35 . Referring to

[0452] , a flowchart of a method 2100 for describing the deployment of a pair of anchors through soft tissue and securing the pair of anchors against the soft tissue is shown. According to some embodiments of the present invention, according to this method, at 2102, the end of a deployment device containing a pair of anchors can be inserted through the soft tissue, and at 2104, the first anchor can be deployed through the soft tissue. At 2106, the deployment device can be withdrawn from the soft tissue. Then, at 2108, the end of the deployment device can be inserted through the soft tissue again, and at 2110, the second anchor can be deployed through the soft tissue. According to some embodiments, at 2112, the deployment device can be withdrawn from the soft tissue again. At 2114, the loop of the suture between the anchors can be pulled to tighten the anchors against the soft tissue. According to some embodiments of the present invention, at 2116, the proximal end of the suture can be pulled proximally to secure the anchors against the soft tissue, after which the suture can be knotted / tied at the location of the anchors. Figure 36A -J, the deployment of a pair of anchors 2201 and 2202 through soft tissue 242 and the securing of the pair of anchors against the soft tissue are shown according to an embodiment of the present invention. Although Figure 36A -J shows a pair of anchors 2201 and 2202, each anchor having a circular cross-sectional profile and each anchor having a channel 2205 defined by four loops 2206 (most clearly shown in Figure 36J ), it will be understood by those skilled in the art that alternatively, any other suitable anchor, such as any of the anchors discussed herein, can be used in such deployment and securing methods. Figure 36F and 36J ), but those skilled in the art will understand that alternatively, any other suitable anchor, such as any of the anchors discussed herein, can be used in such deployment and fixation methods.

[0453] In accordance with some embodiments of the present invention, prior to loading the anchors 2201 and 2202 into the deployment device 2200, a length of suture 2204 may be threaded through a passageway 2205 defined by the loops 2206 of the anchors 2201 and 2202, thereby preparing the length of suture 2204 for securing the anchors 2201 and 2202 against soft tissue 2042 after deployment of the anchors 2201 and 2202. Optionally, as discussed herein, in accordance with some embodiments (e.g., see Figure 40A and 41A ), the length of suture 2204 may be continuous with the loop 2206 of at least one of the anchors 2201 and 2202.

[0454] In accordance with embodiments of the present invention, as discussed herein, there are a number of configurations through which the length of suture 2204 may be threaded through the loops 2206 of the anchors 2201 and 2202 in order to prepare the length of suture 2204 for securing the anchors 2201 and 2301 against soft tissue 2042 after deployment of the anchors 2201 and 2301. In particular, as discussed in detail below, in accordance with some embodiments, Figure 36A -J and 37A-J, the configuration through which the length of suture may be threaded through the first and second anchors may be different from Figure 38A -J and 39A-J, the configuration through which the length of suture may be threaded through the first and second anchors. For clarity, Figure 36A -J and 37A-J, the threading configuration will be referred to as the first threading configuration, and Figure 38A -J and 39A-J, the threading configuration will be referred to as the second threading configuration. Those skilled in the art will understand that, in accordance with some embodiments, if desired, any other suitable threading configuration may be used with the anchors in accordance with the present invention, depending on the desired final fixation of the anchors (e.g., see Figure 36I -J, 37I-J, 38I-J, and 39I-J).

[0455] It may be noted that, in some embodiments, prior to deployment of the first anchor 2201 (e.g., as shown in Figure 36A -B) or the first anchor 2301 (e.g., as shown in Figure 37A -B), the knot 2216 (more clearly visible in Figure 36G and 37G ) may be larger than the loop 2206 ( Figure 36G ) or 2306 ( Figure 36G ) to prevent the knot from passing through any loop. The embodiment shown in Figure 36A -J will now be discussed in detail. Specifically, in accordance with some embodiments of the present invention, in Figure 36AIn which, the pair of anchor fasteners 2201 and 2202, and the passage 2205 through which the section of suture 2204 has been threaded have been loaded into the deployment device 2200, and the deployment device 2200 can be pushed distally, thereby forcing the end 2208 of the deployment device through the soft tissue 2042( Figure 36B ). As Figure 36C shown in -D, according to some embodiments, the first anchor fastener 2201 can be deployed through the soft tissue 2042, and the deployment device 2200 can be pulled proximally to withdraw the end 2208 of the deployment device from the soft tissue. According to some embodiments, this can cause the first anchor fastener 2201 to be on the distal side of the soft tissue 2042 (i.e., on the right side in the sense of Figure 36C -D), but remain attached to the second anchor fastener 2202 still loaded in the deployment device 2200 through the section of suture 2204, and the second anchor fastener is on the proximal side of the soft tissue (i.e., on the left side in the sense of Figure 36C -D).

[0456] Then, as Figure 36E shown in -F, according to some embodiments, the deployment device 2208 can be pushed distally again, such that the end 2208 of the deployment device 2200 can be forced through the soft tissue 2042, and the second anchor fastener 2202 can be deployed through the soft tissue. The anchor fasteners can remain adjacent to the soft tissue on the distal side of the soft tissue (i.e., on the right side of the soft tissue in the sense of Figure 36F ), and the anchor fasteners can be loosely attached to each other through the portion of the section of suture 2204 that is threaded through the loops 2206 of each of the anchor fasteners 2201 and 2202. According to some embodiments, the deployment device 2200 can be withdrawn (moved proximally) from the soft tissue 2042( Figure 36G ), and the proximal portion 2210 of the section of suture 2204 can be held in place, thus extending proximally through the deployment device 2200.

[0457] As can be seen most clearly in Figure 36G , the section of suture 2204 can include multiple portions, some of which can be threaded through the passage 2205 defined by the loops 2206 of the anchor fasteners 2201 and 2202. Specifically, as can be seen most clearly in Figure 36G -I (after the deployment of the anchor fasteners 2201 and 2202 and the withdrawal of the deployment device 2200), according to some embodiments, the proximal portion 2210 of the section of suture 2204 can extend proximally through the deployment device 2200 in the following manner, while according to some embodiments, the other end of the section of suture 2204 can extend distally out of the deployment device in the following manner:

[0458] a. Advance distally toward the first anchor 2201 through the first opening 2250 (hereinafter referred to as the "first opening 2250") through which the first anchor 2201 is deployed in the soft tissue 2042, and then through the four loops 2206 of the first anchor 2201.

[0459] b. Advance proximally through the first opening 2250 to the proximal side of the soft tissue 2042, and then advance toward the second anchor 2202 in the soft tissue 2042 through the opening 2252 (hereinafter referred to as the "second opening 2252") through which it is deployed, where the suture segment 2204 can form a first suture loop 2212 between the first opening 2250 and the second opening 2252, and then advance distally toward the second anchor 2202 through the second opening 2252, and then through the four loops 2206 of the second anchor 2202.

[0460] c. Advance proximally through the second opening 2252, and then toward the first opening 2250 (on the proximal side of the soft tissue), where the suture segment 2204 can form a second suture loop 2213 between the second opening 2252 and the first opening 2250, and then advance distally toward the first anchor 2201 through the first opening 2250.

[0461] d. Pass through the channel 2205 defined by the four loops 2206 of the first anchor, where the end 2214 of the suture segment 2204 is knotted 2216 near the proximal loop 2206 (the loop closest to the distal end of the anchor 2201 when deployed), and the knot 2216 is prevented from passing through the loop 2206 of the anchor 2201, as discussed herein.

[0462] As Figure 36G -H shows, according to some embodiments, the first suture loop 2212 between the anchors 2201 and 2202 can be pulled, thereby bending the flexible bodies 2232 of the anchors 2201 and 2202 and positioning the anchors 2201 and 2202 to lie flat against the soft tissue 2042 ( Figure 36H ). According to some embodiments, by pulling the proximal portion 2210 of the suture segment 2204 in the proximal direction, the suture segment 2204 slides through the loops 2206 of the anchors 2201 and 2202, and the first suture loop 2212 and the anchors 2201 and 2202 can be tightened against the soft tissue 2042 ( Figure 36I ), after which the suture segment 2204 can be tied at or near the location of the anchors.

[0463] According to some embodiments, a flowchart will be referred to herein Figures 44 - 45 which illustrates what happens to the anchors and the suture segment during deployment and fixation to tissue.

[0464] Figure 37A-J shows the deployment of a pair of anchors 2301 and 2302 through soft tissue 2042 and the fixation of the pair of anchors against the soft tissue.

[0465] Figure 37A Some of the components shown in -J are structurally and functionally similar to Figure 36A the corresponding components shown in -J and will not be described herein with respect to Figure 37A -J. However, in some embodiments, in Figure 37A -J, the second anchor 2302 may be provided with an additional loop 2330 at the proximal end 2314 of the second anchor 2302. According to some embodiments, the additional loop 2330 may be used to control the deployment of the second anchor 2302 by allowing the slidable portion 2320 of the deployment device 2300 to selectively hold the additional loop 2330 (see Figure 37A -E), thereby holding the second anchor 2302 while the second anchor 2302 is still within the deployment device 2300. According to some embodiments, during or after the deployment of the second anchor 2302, the actuatable portion 2322 of the slidable portion 2320 may be actuated to release the additional loop 2330 of the second anchor 2302 (see Figure 37F ), such that the second anchor 2302 can be released from the deployment device 2300.

[0466] According to some embodiments of the present invention, before loading the anchors 2301 and 2302 into the deployment device 2300, a length of suture 2204 may be routed, for example, according to a first routing configuration, through the channels defined by the loops 2306 of the anchors 2301 and 2302, thereby preparing a length of suture 2204 for fixing the anchors 2301 and 2302 against the soft tissue 242 after the deployment of the anchors 2301 and 2302. Optionally, as discussed herein, according to some embodiments (e.g., see Figure 40A and 41A ), the length of suture 2204 may be continuous with the loop 2306 of at least one of the anchors 2301 and 2302.

[0467] In addition, according to some embodiments, after the deployment of the first anchor 2301, the additional loop 2330 on the proximal end 2314 of the second anchor 2302 may prevent the second anchor 2302 from falling out of the deployment device due to pulling on the suture 2204 between the first anchor 2301 and the second anchor 2302.

[0468] Referring to Figure 38A -J, shows the deployment of a pair of anchors 2201 and 2202 through soft tissue 2042 and the fixation of the pair of anchors against the soft tissue.

[0469] Figure 38ASome of the components shown in -J may be structurally and functionally similar to Figure 36A the corresponding components shown in -J, and will not be described again with respect to Figure 38A -J. However, Figure 38A the routing configuration of suture 2204 in -J is slightly different from Figure 36A the routing configuration in -J. Specifically, as most clearly seen in Figure 38G -I (after deploying anchors 2201 and 2202 and retracting deployment device 2200), according to some embodiments, the proximal portion 2210 of this segment of suture 2204 can be extended proximally through deployment device 2200 in the following manner, and the other end of this segment of suture 2204 can be extended distally out of the deployment device:

[0470] a. Pass distally through the opening 2250 through which the first anchor 2201 in soft tissue 2042 is deployed, and then through the channel defined by the four loops 2206 of the first anchor 2201, towards the first anchor 2201;

[0471] b. Pass proximally through the first opening 2250 to the proximal side of the soft tissue 2042, and then towards the second opening 2252, where this segment of suture 2204 can form a first suture loop 2212 between the first opening 2250 and the second opening 2252, and then pass distally through the second opening 2252 towards the second anchor 2202, and then through the channel defined by the four loops 2206 of the second anchor;

[0472] c. Pass proximally through the second opening 2252, and then towards the first opening 2250 (on the proximal side of the soft tissue), where this segment of suture 2204 can form a second suture loop 2213 between the second opening 2252 and the first opening 2250, and then pass distally through the first opening 2250 towards the first anchor 2201;

[0473] d. Attach to the suture portion in (a) near the loop that is furthest distal in the sense of Figure 38G the knot 2217 of the anchor 2201 (i.e., the loop that last passed through the soft tissue 2042).

[0474] As Figure 37G shown in -H, according to some embodiments, the first suture loop 2212 between the anchors 2201 and 2202 can be pulled, thereby bending the flexible bodies 2232 of the anchors 2201 and 2202 and positioning the anchors 2201 and 2202 to lie flat against the soft tissue 2042 ( Figure 38I ). According to some embodiments, by pulling the proximal portion 2210 of this segment of suture 2204 in the proximal direction, the first suture loop 2212 and the anchors 2201 and 2202 can be tightened against the soft tissue 2042 (Figure 38I ) Thereafter, the suture segment 2204 can be tied at or near the location of the anchor.

[0475] According to some embodiments, when performing meniscus repair surgery using any of the embodiments discussed herein, attaching the knot to the suture portion (section d above) has the potential advantage that the knot can be located on the side of the meniscus away from the bone, thus avoiding the knot rubbing against the bone.

[0476] Figure 39A -J shows the deployment of a pair of anchors 2301 and 2302 through soft tissue 2042 and the fixation of the pair of anchors against the soft tissue according to some embodiments.

[0477] Figure 39A -J, some of the components shown are structurally and functionally similar to Figure 38A the corresponding components shown in -J and will not be described again with respect to Figure 39A -J. However, according to some embodiments, in Figure 39A -J, the second anchor 2302 can be provided with an additional loop 2330 at the proximal end 2314 of the second anchor 2302. According to some embodiments, the additional loop 2330 can be used to control the deployment of the second anchor 2302 by allowing the slidable portion 2320 of the deployment device 2300 to selectively hold the additional loop 2330 (see FIG. 37-E), thereby holding the second anchor 2302 while the second anchor 2302 is still within the deployment device 2300. According to some embodiments, during or after the deployment of the second anchor 2302, the actuatable portion 2322 of the slidable portion 2320 can be actuated to release the additional loop 2330 of the second anchor 2302 (see Figure 39F ), such that the second anchor 2302 can be released from the deployment device 2300.

[0478] It may be noted that, according to some embodiments, when an anchor having a loop is deployed from a deployment device such as any of those shown and / or described herein, the loop can be disposed within a groove of the deployment needle. According to some embodiments, this can prevent friction between the loop and the inner surface of the deployment device during deployment. Alternatively, according to some embodiments, the loop can be flexible and thus does not have to have a groove in the deployment needle. However, it should be noted that, according to some embodiments, if there is no groove in the deployment needle, there may be additional friction caused by the loop when the anchor passes through the deployment device.

[0479] A potential advantage of some embodiments of the anchors shown and discussed herein is that securing both the first and second anchors requires only a single suture. Specifically, after the two anchors are deployed, only one suture needs to be pulled to tighten the two anchors and fix them against the soft tissue.

[0480] According to some embodiments, another potential advantage of some of the embodiments shown and discussed herein is that, after the second anchor has been deployed (e.g., as shown in Figure 36F , 37F , 38F, 39F), when the deployment needle is still in the second insertion position, the suture extending through the channel defined by the loops on the two anchors can be pulled. According to some embodiments, this can allow the second anchor to have less friction when passing through soft tissue.

[0481] Furthermore, according to some embodiments, as discussed with respect to the embodiments of the present invention, using a single suture that can secure and tension two anchors can allow for less suture material to be required. Additionally, according to some embodiments, using a single suture that also forms the loop of at least one anchor can allow for an even shorter length of suture to be required.

[0482] Referring to Figure 40A -B, an alternative configuration for routing a section of suture through a pair of anchors is shown according to some embodiments. Specifically, as shown, in some embodiments, the first and second anchors 2401 and 2402 have respective bodies 2431 and 2432, each body having a channel defined by a pair of loops. For example, according to some embodiments, the anchor 2401 can have a channel 2405 defined by loops 2404a and 2404b, the loops 2404a and 2404b being formed by short suture portions 2406 of material 2407 that are woven into and out of the anchor 2401, wherein the ends 2410 and 2412 of the short suture portions 2406 can be attached to the body 2431 by any known means, e.g., by the means discussed herein with respect to loops 40( Figure 16A ), 60( Figure 16B ), 82( Figure 17A ), 92( Figure 17B ) and 80( Figure 16C ). According to some embodiments, the anchor 2402 can have a channel 2405 defined by loops 2408a and 2408b, the loops 2408a and 2408b being formed by portions of a long suture portion 2416 that are woven into and out of the material 2407 of the anchor 2402. According to some embodiments, the anchors 2401 and 2402 can be attached via the following routing configuration of the long suture portion 2416:

[0483] a. The first end 2420 of the long suture portion 2416 can be formed as the end of the loop 2408b, and as described herein, the long suture portion forms the loop 2408a and then extends away from the body 2432 of the anchor 2402.

[0484] b. The long suture portion 2416 then extends toward the anchor 2401 and passes through the channel 2405 defined by the loops 2404b and 2404a of the anchor 2401.

[0485] c. The long suture portion 2416 then extends away from the anchor 2401 towards the anchor 2402, where the long suture portion 2416 passes through the channel 2405 defined by the loops 2408a and 2408b.

[0486] d. The second end 2422 of the long suture portion 2416 extends proximally away from the anchor 2402.

[0487] As discussed herein, according to some embodiments, the anchors 2401 and 2402 can be deployed through soft tissue. According to some embodiments, after being released from the deployment device, by pulling the second end 2422 of the long suture portion 2416, the anchors 2401 and 2402 can be fixed against the soft tissue and tightened. As discussed herein, according to some embodiments, as the long suture portion 2416 slides through the channels 2405 of each of the anchors 2401 and 2402, this can cause the bodies 2431 and 2432 of the corresponding anchors 2401 and 2402 to bend into U-shaped anchors. One such anchor 2402 is shown in Figure 40B in a bent configuration.

[0488] Now referring to Figure 41A -B, another alternative configuration is shown for routing a section of suture through a pair of anchors according to some embodiments. Figure 41A The embodiments of Figure 40A may be similar to the embodiments of

[0489] a. The long suture portion 2416 extends from the anchor 2402 towards the anchor 2401 and passes through the channel 2405 defined by the loops 2404b and 2404a.

[0490] b. The long suture portion 2416 extends from the anchor 2401 towards the anchor 2402, passes through the loop 2408b of the channel 2405 and then through the loop 2408a. (This is different from the routing configuration of Figure 40A )

[0491] c. The long suture portion 2416 extends proximally from the anchor 2402 and bypasses the anchor 2401.

[0492] As discussed herein, according to some embodiments, the anchors 2401 and 2402 may be deployed through soft tissue. According to some embodiments, after being released from the deployment device, the anchors 2401 and 2402 may be fixed against the soft tissue and tightened by pulling on the second end 2422 of the long suture portion 2416. As discussed herein, according to some embodiments, as the long suture portion 2416 slides through the channels 2405 of each of the anchors 2401 and 2402, this may cause the bodies 2431 and 2432 of the respective anchors 2401 and 2402 to bend into U-shaped anchors. One such anchor 2402 is shown in Figure 41B in a bent configuration.

[0493] Although in the embodiments of Figure 40A and 41A the anchors 2401 and 2402 and the anchors 2501 and 2502 are shown as each having a channel 2405 defined by a pair of loops, those skilled in the art will understand that if desired, any one of the anchors 2401, 2402, 2501, and 2502 may alternatively each have a channel defined by more than two loops, such as four loops.

[0494] It should be noted that the systems and / or their components discussed herein with respect to Figures 35 - 41B may be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or the embodiments discussed with respect to Figure 19E -J, and / or the embodiments discussed with respect to Figures 20 - 34 , and / or the embodiments discussed with respect to Figures 42 - 43H , and / or the embodiments discussed with respect to Figures 44 - 45 , and / or the embodiments discussed with respect to Figures 46 - 48E any one of the embodiments discussed herein.

[0495] Figure 42 is a side cross-sectional view of a portion of an anchor delivery system according to some embodiments of the present invention, including anchors 270 and 280 having a suture 288 threaded therethrough. The anchor delivery system shown may be structurally and functionally similar to any of the anchor delivery systems discussed herein, such as system 100 ( Figure 22 ) or system 200 ( Figure 29 ). The anchors 270 and 280 are shown located within a sheath 250, with the anchor 270 located distal to the anchor 280. The system may be provided with any suitable suture, such as such as #2-0. The length of the suture may be, for example, approximately 720 mm ± 30 mm.

[0496] As discussed herein, suture 288 may thread through anchors 270 and 280, or through loop 88 as shown. Although in the illustrated embodiment, each of anchors 270 and 280 is provided with a pair of loops 88, according to some embodiments, the anchors may alternatively each be provided with more than two loops, e.g., four loops as discussed herein.

[0497] As discussed herein, a length of suture 288 is threaded loosely through loops 88 of anchors 270 and 280. In particular, suture 288 includes a suture portion 288a (inner loop) that extends between proximal end 272 of anchor 270 and distal end 284 of anchor 280, where suture portion 288a is attached to anchor 280 by a manner known in the art. According to some embodiments, suture portion 288a may have a length of, e.g., about 50 mm ± 5 mm. According to some embodiments, suture 288 may further include a suture portion 288b (outer loop) that extends between distal end 274 of anchor 270 and proximal end 282 of anchor 280. Suture portion 288b may have a length of, e.g., about 260 mm ± 5 mm. Suture 288 may further include a suture free end 288c that wraps around portion 288b twice as shown at wrap portion 298, and may extend proximally within sheath 250 (although this is not shown in the figures for clarity). According to some embodiments, a portion 290 of suture 288 may extend between portions 288a and 288b and may thread through loop 88 of anchor 270, and a portion 292 of suture 288 may extend between portions 288a and 288c and may thread through loop 88 of anchor 280.

[0498] According to some embodiments, a portion 294 of suture portion 288c that is located between portion 292 and wrap portion 298 may be provided with a slip knot 299, also known as a "stop knot" or "sliding knot" as known in the art. Slip knot 299 may be positioned along suture portion 294, e.g., at a location 35 mm from anchor 280. Slip knot 299 has an adjacent loop, as known in the art, that has a diameter of, e.g., from 0.5 - 2.5 cm, e.g., a diameter of 22 mm. Slip knot 299 may be formed such that it can be released by pulling on suture segment 287, but the slip knot may be designed such that it will not be released if suture segment 286 is pulled, as known in the art. Slip knot 299 may be easily untied by pulling on suture free end 288c, which will release the slip knot. Suture segments 286 and 287 extend from slip knot 299 to portion 292 and wrap portion 298, respectively.

[0499] Slip knot 299 may have an adjacent loop 295, as known in the art. Additionally, the relative sizes of slip knot 299 and the most distal loop 88 of anchor 280 are selected such that the slip knot cannot pass through loop 88.

[0500] As discussed herein, for example with reference to Figure 23 the suture portions 288a and 288b may extend through the slot 255 of the needle. However, for clarity, in the Figure 42 embodiment of, the slot is not shown in the needle / sheath 250. The relative positions of these portions of the suture 288 with respect to the anchors 270 and 280 are shown.

[0501] When the anchors 270 and 280 are contained within the sheath 250, or after the anchor 270 has been deployed, the suture 288 slides freely through the loop 88 in the anchors 270 and 280. However, if the section 286 slides through the loop 88 of the anchor 280 in the direction of arrow 301, this sliding will be restricted by the knot 299 when it reaches the loop 88 of the anchor 280 due to the relative sizes of the slipknot 299 and the loop 88 as described above.

[0502] After the anchors 270 and 280 have been deployed, the suture portion 288b can be pulled, as discussed in more detail with reference to Figure 43A -H. In particular, the left side of the suture portion 288b (as Figure 42 and 36A shown) can be pulled proximally, which will cause the portion 288a to shorten as the suture slides through the loop 88 of the anchor 270. Pulling the suture portion 288b proximally will also cause the anchors 270 and 280 to move closer to the tissue as the portion 288a is shortened and moves to be closer to the tissue through which the anchors were deployed.

[0503] Then, the free end 288c of the suture can be pulled proximally, for example, in the direction of arrow 302 ( Figure 42 ). This will cause the suture loop portion 298 to slide around the loop 288b, and due to the proximal pull on the suture portion 287, the slipknot 299 is released. As the free end 288c is pulled further, the portion 292 will slide through the loop 88 of the anchor 280, and the suture portion 288b will shorten until it is positioned against the tissue ( Figure 42 not shown in). Due to the loop portion 298 configured before deploying the anchors 270 and 280, a knot will be formed in the suture 288, as discussed herein with reference to Figure 43H and thereafter the free end 288c of the suture can be cut near the tissue.

[0504] Also with reference to Figure 43A -H, the suture segment 288 is shown, which is configured to be in the anchors 270 and 280 ( Figure 42)Appears schematically after being deployed through tissue 296, and this segment of suture is schematically viewed from the proximal side of the tissue. It should be noted that, for clarity, the anchors 270 and 280 that have been deployed distally to the tissue 296 are omitted in Figure 43A -H. Portions of the loops 288a and 288b pass through the opening 271 in the tissue, and the anchor 270 ( Figure 42 ) is inserted through this opening. Similarly, portions of the loops 288a and 288b pass through the opening 281 in the tissue, and the anchor 280 ( Figure 42 ) is inserted through this opening.

[0505] For example, the surgeon can pull proximally on the left side of the loop 288b, causing the suture to slide through the loop 88 in the anchor 270 ( Figure 42 ), thereby extending the loop 288b from the corresponding length shown in Figure 43A to the corresponding length shown in Figure 43B , and shortening the loop 288a. At Figure 43B , the loop 288a has less slack relative to the tissue 296. Further pulling proximally on the left side of the loop 288b causes the loop 288b to extend further and the loop 288a to shorten further, thereby shortening from the corresponding length shown in Figure 43B to the corresponding length shown in Figure 43C , at which time the loop 288a can be substantially flat against the tissue 296.

[0506] It should be noted that if the right side of the loop 288b is pulled proximally, since the suture 288 runs through the loop 88 in the anchor 280, the suture portion 286 can slide a short distance through the loop 88 in the anchor 280 until the knot 299 reaches the more distal loop 88 in the anchor 280. Then, due to the relative sizes of the slip knot 299 and the loop 88, the slip knot will prevent the suture from sliding further through the loop 88, as discussed herein.

[0507] Then, the surgeon can pull proximally on the suture end 288c, from its position in Figure 43C to its position in Figure 43D , at which time the suture loop portion 298 is slightly tightened around the loop 288b. In addition, since the suture end 288c is pulled proximally, the suture portion 287 is pulled proximally, causing the slip knot 299 to begin to loosen, and as the loop 295 near the slip knot 299 slides through the slip knot, the loop 295 becomes smaller, as is known in the art.

[0508] Referring to Figure 43E , further pulling on the suture end 288c will cause the loop portion 298 to tighten further around the loop 288b and will cause the slip knot 299 to fully untie as the loop 295 slides through the slip knot ( Figure 43E)。After untying the slip knot, further pulling on the suture end 288c will cause the suture 288 to slide through the loop 88 on the anchor 280( Figure 42 ), causing the loop 288b to shorten, e.g., from its length in Figure 43E to its length in Figure 43F .

[0509] Further pulling on the suture end 288c will cause the loop 288b to shorten further, from the length shown in Figure 43F to the length shown in Figure 43G , and then to the length shown in Figure 43H , at which point both loops 288a and 288b can rest substantially flat against the tissue 296. As the loop 288b shortens from the length shown in Figure 43G to the length shown in Figure 43H , the loop portion 298( Figure 43E ) will form a knot 297, thereby securing the suture against the tissue 296. Then, the excess length of the suture 288c can be cut or otherwise removed near the knot 297, as is known in the art.

[0510] It should be noted that the systems and / or their components discussed herein with respect to Figures 42 - 43H can be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or the embodiments discussed with respect to Figure 19E -J, and / or the embodiments discussed with respect to Figures 20 - 34 , and / or the embodiments discussed with respect to Figures 35 - 41B , and / or the embodiments discussed with respect to Figures 44 - 45 , and / or the embodiments discussed with respect to Figures 46 - 48E , and / or any one of the embodiments discussed with respect to

[0511] Referring to Figure 44 , a flowchart 600 is shown in accordance with some embodiments of the present invention, which illustrates actions performed during the placement and fixation of an anchor to tissue.

[0512] At 2602, a length of suture is threaded through the channels of the first and second anchors, as discussed herein, e.g., with reference to any one of Figure 36A -J, 37A-J, 38A-J, and 39A-J. At 2604, the anchor and the suture threaded therethrough are loaded into a deployment device, as is known in the art of anchor deployment. At 2606 and 2608, the first and second anchors are successively deployed through soft tissue, as discussed herein, e.g., with reference to Figure 36A -G.

[0513] As indicated at 2610, once the first and second anchors have been deployed and positioned distally in the soft tissue (e.g., on the right side of the soft tissue in the sense of Figure 36G , 37G , 38G, and 39G), the deployment device may be withdrawn. As shown, for example, in Figure 36G , the proximal portion 2210 of the suture, the first suture loop 2212, and the second suture loop 2213 are located proximal to the soft tissue 2042. Figure 36G , 37G , 38G, and 39G), the deployment device may be withdrawn. As shown, for example, in Figure 36G , the proximal portion 2210 of the suture, the first suture loop 2212, and the second suture loop 2213 are located proximal to the soft tissue 2042.

[0514] According to some embodiments, the proximal portion 2210 of the suture extends distally through the soft tissue to the first anchor, for example, as shown in Figure 36G . Additionally, the first suture loop 2212 and the second suture loop 2213 each extend between the first and second anchors 2201 and 2202 proximal to the soft tissue 2042 (e.g., see Figure 36G ). Figure 36G According to some embodiments, the proximal portion 2210 of the suture extends distally through the soft tissue to the first anchor, for example, as shown in Figure 36G . Additionally, the first suture loop 2212 and the second suture loop 2213 each extend between the first and second anchors 2201 and 2202 proximal to the soft tissue 2042 (e.g., see Figure 36G ). Figure 36G )

[0515] Although in the illustrated embodiments, the first and second anchors are shown (e.g., in Figure 36G ) as straight or nearly straight, optionally, they may be slightly C-shaped or U-shaped, depending on, for example, the rigidity of the anchors and the strength of the force applied to the anchors by the suture material passing through the loops 2206 ( Figure 36A -J and 38A-J) and 2306 ( Figure 37A -J and 39A-J). Figure 36G Although in the illustrated embodiments, the first and second anchors are shown (e.g., in Figure 36G ) as straight or nearly straight, optionally, they may be slightly C-shaped or U-shaped, depending on, for example, the rigidity of the anchors and the strength of the force applied to the anchors by the suture material passing through the loops 2206 ( Figure 36A -J and 38A-J) and 2306 ( Figure 37A -J and 39A-J). Figure 36A -J and 38A-J) and 2306 ( Figure 37A Figure 37A -J and 39A-J).

[0516] To firmly tighten the first and second anchors against the soft tissue 2042, the suture loop 2212 may be pulled, as indicated at action 2612. This pulls the suture portion passing through the loops 2206 in the two anchors 2201 and 2202 (or the loops 2306 in the two anchors 2301 and 2302), such that when the two anchors are pulled against the distal side of the soft tissue, the suture slides through the channels of the two anchors 2201 and 2202. In some embodiments, depending on the tightness of the suture and the rigidity of the anchors 2201 and 2202, the anchors may assume a U-shape, for example, as shown in Figure 36H . Figure 36H as shown.

[0517] According to some embodiments, once the anchors 2201 and 2202 (or 2301 and 2302) are positioned against the distal side of the soft tissue 2042, the proximal portion 2210 of the suture may be pulled proximally by the user, as indicated at action 2614. This causes the suture to further slide through the channels of the two anchors 2201 and 2202 and shortens the suture loop 2212, as Figure 36IAs shown, and further pulling the loops 2206 (or 2306) of the fasteners 2201 and 2202 (or 2301 and 2302), thereby further bending each of the fasteners 2201 and 2202 (or 2301 and 2302) into a U shape or an approximate O shape. As indicated at operation 2616, in some embodiments, the excess suture segments may then be trimmed, optionally using a cutting device such as the cutting device described in US 6,866,673.

[0518] The resulting fasteners (e.g., fasteners 2201 and 2202 ( Figure 36J and 38J )) or fasteners 2301 and 2302 ( Figure 37J and 39J )) are then secured as shown firmly against the soft tissue 2042, where the fasteners are bent as shown and held in a second orientation by suture material that is threaded through a channel 2205 defined by the loops 2206 ( Figure 36J and 38J ) or loops 2306 ( Figure 37J and 39J ) and tightened.

[0519] Figure 45 FIG. is a flow chart of a method 2800 showing how fasteners according to some embodiments of the present invention are deployed and secured to tissue.

[0520] At 2802, a segment of suture is threaded through a channel extending along the fastener, the segment of suture being non-coaxial with the fastener body. The fastener may have an elongated body in a first orientation, and the channel is optionally defined by a loop, e.g., as shown in either Figure 16A -C and 17A-B.

[0521] At 2804, the fastener is deployed through the tissue in the first orientation. This may be performed using a deployment device, e.g., as shown in any one of Figure 36A -D, 37A-D, 38A-D or 39A-D.

[0522] At 2806, the suture is pulled proximally, which causes the segment of suture to slide through the channel. This shortens the length of the suture extending through the channel, causing the fastener to bend into a second orientation, e.g., as shown in any one of Figure 36H -J, 37H-J, 38H-J or 39H-J.

[0523] It should be noted that the systems and / or their components discussed herein with respect to Figures 44 - 45 may be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or the embodiments discussed with respect to Figure 19E -J, and / or the embodiments discussed with respect toFigures 20 - 34 The embodiments discussed, and / or with respect to Figures 35 - 41B The embodiments discussed, and / or with respect to Figures 42 - 43H The embodiments discussed, and / or with respect to Figures 46 - 48E any one of the embodiments discussed.

[0524] Referring to Figure 46 , there is shown a portion of an anchor delivery system 100 according to some embodiments. The structure and function of the system 100 that have been described with reference to Figure 23 will not be described again with reference to Figure 23 . According to some embodiments, the system 100 may include an optional suture shield 251 that can prevent these portions of the suture 288 from tangling before deploying the anchor from the sheath 250 ( Figure 46 not shown). Optionally, the suture shield 251 can be used as a depth limiter to limit the depth of insertion of the sheath 250 into tissue, e.g., as discussed herein with respect to Figure 46 . The structure of the system 100 can be particularly useful for inserting an anchor into the knee, although the system 100 is not limited thereto. Figure 36A The structure of the system 100 can be particularly useful for inserting an anchor into the knee, although the system 100 is not limited thereto.

[0525] Optionally, the sheath 250 can be provided with at least one marker 254 for indicating the depth of insertion of the sheath 250 into tissue, such insertion being, for example, as shown in Figure 36A .

[0526] Referring to Figure 47 , there is shown an alternative delivery system 100a, where most components can be similar to those of the system 100. However, the sheath 256 of the system 100a includes a distal portion 257a having a first cross-sectional diameter and a proximal portion 257b having a second cross-sectional diameter, where the first cross-sectional diameter is less than the second cross-sectional diameter. Optionally, according to some embodiments, a slot 259 can extend from the distal portion 257a to the proximal portion 257b, which allows some portions of the suture, e.g., portions 288a and 288b, to extend out of the sheath 256. The portion where the proximal portion 257b of the sheath 256 meets the distal portion 257a defines a step 258. The step 258 can be used as a depth limiter to limit the depth of insertion of the sheath 256 into tissue, such insertion being, for example, as discussed herein with respect to Figure 36A . The structure of the sheath 256 including the step 258 can be particularly useful when inserting an anchor into the shoulder, where it may be preferred to limit the penetration of the sheath and thus the depth of insertion of the anchor into the shoulder, although the system 100a is not limited thereto.

[0527] Now referring to Figure 48A -E, there is shown a portion of an anchor delivery system according to some embodiments of the present invention. According to some embodiments, Figure 23 ​Figure 48A A sheath is shown having a downwardly curved or bent profile 262 of approximately 15 degrees. Figure 48B A sheath having a straight profile 263 is shown according to some embodiments. Figure 48C A sheath is shown having an upwardly curved or bent profile 264 of approximately 30 degrees, and the sheath optionally has at least one marker 254. Figure 48D A sheath 265 is shown having an upwardly curved or bent profile 265 of approximately 10 degrees, and optionally has at least one marker 254. Figure 48E A sheath 266 is shown having a downwardly curved or bent profile of approximately 10 degrees, and optionally has at least one marker 254. Those skilled in the art will understand that Figure 48A and 48C -E, the curvature / bend of the sheath is exemplary, and the sheath can be designed to have any desired curvature / bend. Those skilled in the art will also understand that, according to embodiments of the present invention, optionally, any system shown and described herein may include a sheath, and optionally also include a suture shield 251( Figures 46 - 47 ), the suture shield includes a straight profile, or an upwardly curved / bent profile having a preselected angle bend / kink, or a downwardly curved / bent profile having a preselected angle bend / kink.

[0528] It can be noted that, depending on the specific type of procedure, the specific patient (animal in pediatric / adult / veterinary procedures, fat / thin or other relevant characteristics), the distance of the bend / kink from the distal end of the sheath and the size of the sheath, including length and diameter, can be preselected.

[0529] It should be noted that, as discussed herein with respect to Figures 46 - 48E the system and / or its components can be used in a kit that includes the embodiments discussed with respect to FIGS. 1-19D and 19K-M, and / or with respect to Figure 19E -J, and / or with respect to Figures 20 - 34 the embodiments discussed with respect to Figures 35 - 41B the embodiments discussed with respect to Figures 42 - 43H the embodiments discussed with respect to Figures 44 - 45 any one of the embodiments discussed with respect to

[0530] It is expected that during the patent term from this application, many related anchoring systems will be developed, and the scope of the term "anchor" is intended to include all such prior new technologies.

[0531] As used herein, the term "about" means ±10%.

[0532] The terms "comprising", "including", "containing", "having", and variations thereof mean "including but not limited to".

[0533] The term "consisting of" means "including and limited to".

[0534] The term "consisting essentially of" means that a composition, method, or structure may include additional ingredients, steps, and / or parts, provided that the additional ingredients, steps, and / or parts do not materially alter the basic and novel characteristics of the claimed composition, method, or structure.

[0535] As used herein, the singular forms "a", "an", and "the" include the plural unless the context clearly dictates otherwise. For example, the term "compound" or "at least one compound" may include multiple compounds, including mixtures thereof.

[0536] Throughout the application, various different embodiments of systems, kits, devices, and methods may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an immutable limitation on the scope of the invention. Thus, the description of a range should be considered to have specifically disclosed all possible sub-ranges as well as the individual numerical values within that range. For example, a description of a range such as from 1 to 6 should be considered to have specifically disclosed sub-ranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6, etc., as well as the individual numbers within that range, e.g., 1, 2, 3, 4, 5, and 6. This applies to any width of the range.

[0537] Whenever a numerical range is indicated herein, it means that any recited number (fractional or integral) within the indicated range is included. The phrases "a range between a first indicated number and a second indicated number" and "a range from a first indicated number to a second indicated number" are used interchangeably herein and mean including the first and second indicated numbers and all fractional and integral numbers therebetween.

[0538] It should be understood that, for clarity, certain features of the invention described in the context of separate embodiments may also be provided in combination in a single embodiment. Conversely, for brevity, the various different features described in the context of a single embodiment may also be provided separately, or in any suitable sub-combination, or in a suitable manner, in any other described embodiment of the invention. Certain features described in the context of various different embodiments should not be considered essential features of those embodiments unless the embodiment would not function without those elements.

[0539] Although the systems, kits, devices, and methods have been described in connection with their specific embodiments, it will be apparent that many alternatives, modifications, and variations will be apparent to those skilled in the art. Accordingly, all such alternatives, modifications, and variations are intended to be included within the spirit and broad scope of the appended claims.

[0540] It is the applicant's intention that all publications, patents, and patent applications mentioned in this specification be incorporated by reference in their entirety into this specification as if each individual publication, patent, or patent application was specifically and individually noted at the time of its incorporation by reference herein. In addition, the citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. As to the section headings used, they should not be construed as necessarily limiting. In addition, any priority documents of this application are hereby incorporated by reference in their entirety.

Claims

1. A method of operating a multi-state anchor delivery system, the method comprising: (a) using a second pusher to push the anchor pusher within a sheath over a specified axially overlapping region between the first anchor pusher and the second pusher; (b) during a first state, using the anchor pusher to eject a first anchor from the sheath; (c) retracting the second pusher from the anchor pusher, thereby reducing the specified axially overlapping region between the anchor pusher and the second pusher; (d) deforming one or both of the anchor pusher and the second pusher; (e) using the second pusher to push the anchor pusher, one or both of the anchor pusher and the second pusher having a deformed portion that causes mechanical interference for the specified axially overlapping region, wherein the pushing occurs over a contact region between the anchor pusher and the second pusher, the contact region being outside the specified axially overlapping region; and (f) during a second state, using the anchor pusher to eject a second anchor from the sheath.

2. The method according to claim 1, further comprising using an anchor switching mechanism to switch between the first state and the second state to push the anchors.

3. The method according to claim 1 or 2, further comprising extending the position of the second anchor a certain distance outside the sheath, the distance corresponding to the reduced specified axially overlapping region.

4. The method according to any one of claims 1-2, further comprising positioning the second anchor a certain distance distally outside the sheath, the distance being greater than the distance at which the first anchor is positioned outside the sheath.

5. The method according to any one of claims 1-4, further comprising stopping reducing the specified axially overlapping region between the anchor pusher and the second pusher during the second state after retracting the second pusher in a proximal direction.

6. The method according to any one of claims 1-5, wherein, The anchor is an implant.

7. The method according to claim 1, wherein, The anchor includes a suture.

8. A multi-state anchor delivery system, comprising: a sheath having a proximal end and a distal end and having a channel extending therethrough; at least two anchors disposed at the distal end of the channel; an anchor pusher sized and shaped to eject the at least two anchors from the distal end of the channel; a second pusher sized and shaped to push the anchor pusher distally in the channel; a first axially overlapping region defined on the anchor pusher; a second axially overlapping region defined on the second pusher, wherein a potential specified axially overlapping region is defined as the first axially overlapping region and the second axially overlapping region; and An overlap switching mechanism in one or both of the first axially overlapping region and the second axially overlapping region, the overlap switching mechanism having two states, namely a first state and a second state, the first state allowing overlap at the specified axially overlapping region, and the second state reducing the allowable overlap at the potential axially overlapping region by mechanically interfering with the axial movement of one pusher relative to the other pusher.

9. The system according to claim 8, wherein, The second pusher includes a rack or other pusher assembly, and the specified axially overlapping region includes a recess in the rack or other pusher assembly, the recess being operable to receive the proximal end of the anchor pusher.

10. The system according to claim 9, wherein, The overlap switching mechanism includes a movable panel connected to the rack, wherein the movable panel covers the recess during the second state, thereby reducing the specified axially overlapping region.

11. The system according to claim 9, wherein, The overlap switching mechanism includes a curved protrusion extending from the sheath, the curved protrusion being positioned to deform and laterally bend the proximal end of the anchor pusher during the second state, thereby preventing the recess from receiving the anchor pusher and thus reducing the specified axially overlapping region.

12. The system according to claim 9, wherein, The overlap switching mechanism includes a plate coupled between the sheath and the rack, the plate having a hole not located at its center, the plate being configured to deform the proximal end of the anchor pusher or prevent the rod from being received in the recess during the second state, and thus reducing the specified axially overlapping region.

13. The system according to claim 9, wherein, The overlap switching mechanism includes a predetermined bend in the anchor pusher, the predetermined bend being selectively releasable from the rack and laterally bending once released to be misaligned with the recess in the rack.

14. The system according to claim 8, wherein, The overlap switching mechanism includes a rod extending from the second pusher.

15. The system according to claim 14, wherein, The specified axially overlapping region is a second axially overlapping region on the distal end of the rod and a first axially overlapping region on the proximal end of the anchor pusher.

16. The system according to claim 15, wherein, The specified axially overlapping region is a lapped overlap joint.

17. The system according to claim 16, wherein, The lapped overlap joint is configured to elastically deform at one or both of the anchor pusher and the second pusher during the second state by retracting the second pusher in the proximal direction.

18. The system according to any one of claims 8-17, wherein, The anchor is a soft tissue anchor.

19. The system according to any one of claims 8-18, wherein, The anchor includes at least one suture.

20. The system according to any one of claims 8-19, wherein, The overlap switching mechanism is configured to be elastically deformable between the first state and the second state.

21. The system according to claim 20, wherein, The deformation is configured to be released by retraction of the second pusher relative to the anchor pusher.

22. The system according to any one of claims 8-21, wherein The sheath is sized for orthopedic use, including a diameter less than 5 mm and a length of at least 40 mm.

23. The system according to any one of claims 8-22, wherein, At least one of the sheath, the anchor pusher, and the second pusher is disposable.

24. The system according to any one of claims 8-23, wherein, At least one of the sheath, the anchor pusher, and the second pusher is reusable.

25. The system according to any one of claims 8-24, wherein, The sheath is bendable.

26. A method for reducing axial overlap and extending an anchor pusher, the method comprising: Specifying an axially overlapping region between an anchor pusher and a second pusher; Retract the second pusher from the anchor pusher to reduce a specified axial overlap region between the anchor pusher and the second pusher; Deform one or both of the anchor pusher and the second pusher; Perform mechanical interference on the specified axial overlap region; Use a contact region outside the specified axial overlap region to combine the lengths of the anchor pusher and the second pusher; Extend the lengths of the anchor pusher and the second pusher by using a new combined length; and During a second state, use the extended length of the anchor pusher to push a second anchor out of the sheath.

27. A method of deploying a dual anchor, the method comprising: Advance a first anchor out of a sheath using an anchor pushing mechanism including an anchor pusher having a first effective axial length; Modify the effective axial length of the anchor pusher; and Advance a second anchor out of the sheath using the modified effective length.

28. The method according to claim 27, wherein The modification includes increasing the effective length of the anchor pusher by reducing an overlap between the anchor pusher and a pusher assembly that pushes the anchor pusher.

29. The method according to claim 27 or 28, wherein The modification includes retracting a pusher assembly used to push the anchor, thereby allowing a portion of the anchor assembly and / or the anchor pusher to elastically deform or otherwise geometrically move to interfere with an axial overlap of the anchor assembly and a portion of the anchor pusher.

30. The method according to any one of claims 27 - 29, wherein, Both of the advancements use the same manual movement amount applied by an operator to a mechanical control coupled to the anchor pushing mechanism.

31. A method of deploying an anchor, the method comprising: Displace a pusher distally along a channel extending through a sheath; Cause the pusher to contact a first anchor disposed within the channel and deploy the first anchor; Retract the pusher to a position proximal to a second anchor disposed within the channel, the retraction including temporarily deforming the pusher such that a length of the pusher changes during the retraction; and Displace the pusher distally along the channel to deploy the second anchor.

32. A kit for dual anchor delivery, the kit comprising: (a) A sheath; (b) An anchor pusher disposed at least partially within the sheath; (c) At least two anchors lying flat within the sheath distal to the anchor pusher; (d) A length-variable anchor pushing mechanism including the anchor pusher, wherein the mechanism is configured to support different fixed axial overlap degrees between the anchor pusher and the mechanism during distal movement of the anchor pusher.

33. The kit according to claim 32, comprising a suture configured to slidably thread through each of the two anchors, the suture including a slip knot configured to be released by pulling a first end of the suture and not configured to be released by pulling a second end of the suture, wherein the suture is configured to be tightened between the two anchors by pulling the first end of the suture.

34. The kit according to any one of claims 32 - 33, further comprising a second pusher, wherein at least one of the sheath, the anchor pusher, and the second pusher is disposable.

35. The kit according to any one of claims 32 - 33, further comprising a second pusher, wherein at least one of the sheath, the anchor pusher, and the second pusher is reusable.

36. The kit according to any one of claims 32 - 35, wherein, The sheath is bendable.

37. The kit according to any one of claims 32-36, wherein, The length - variable anchor pusher mechanism includes at least one of a plurality of racks and a plurality of pushers for variable anchor deployment.

38. A multi - anchor delivery system, comprising: a sheath having a proximal end and a distal end and having a channel extending therethrough; a pusher having at least a distal end located within the channel, the distal end of the pusher sized and shaped to be displaceable through the channel; a first anchor disposed within the sheath and positioned distally relative to the pusher; and a second anchor disposed within the sheath at a position proximal to the first anchor, the second anchor disposed within the channel, the second anchor positioned proximally relative to the distal end of the pusher, and the second anchor sized and shaped to be displaceable along the channel; wherein the pusher is configured to retract proximally to a position proximal to the second anchor, and at least a distal tip portion of the pusher is configured to be deformed under the action of the second anchor during proximal retraction; and wherein the pusher is configured to deploy the second anchor.

39. The multi-anchor delivery system according to claim 38, wherein, The pusher has sufficient flexibility to be deformed under the action of the second anchor during proximal retraction of the pusher.

40. The multi-anchor delivery system according to claim 38, wherein, The distal end of the pusher has two configurations: a relaxed state, wherein the pusher can be used to deploy the anchor; and a deformed state, wherein the pusher can fit between the second anchor and the sidewall of the sheath.

41. The system according to claim 38, wherein, The distal tip portion of the pusher includes at least one bend.

42. The system according to claim 38, wherein The first anchor includes a proximally - facing end face, and the pusher includes a distally - facing surface configured to contact the proximally - facing end face of the first anchor during the deployment.

43. The system according to claim 38, wherein, The second anchor includes a proximally - facing end face, and the pusher includes a distally - facing surface configured to contact the proximally - facing end face of the second anchor during the deployment.

44. The system according to claim 38, wherein, The pusher has a non - uniform thickness along its length.

45. A multi-anchor delivery system comprising a first anchor and a second anchor connected by a suture having a slip knot.

46. The system according to claim 45, wherein, The suture comprises: a first portion extending through the first of the two anchors and extending from the first anchor to the second of the two anchors; a second portion extending between the first and the second of the two anchors and threading through the second anchor; and a third portion extending from the second anchor, the third portion including the slip knot; wherein pulling a first end of the suture releases the slip knot.

47. An anchor delivery system comprising: a sheath having a proximal end and a distal end and having a channel extending therethrough; a pusher element having at least a distal end located within the channel, the distal end of the pusher element sized and shaped to be displaceable through the channel; at least one anchor disposed within the channel and sized and shaped to be displaceable along the channel, at least a portion of the at least one anchor being located distally relative to the pusher element, the at least one anchor having a distal end and a proximal end; at least one suture configured to thread through the distal end of the at least one anchor at least once and also configured to thread through the proximal end of the at least one anchor at least once; the at least one suture further configured to be at least partially disposed within the channel; the pusher element sized and shaped to be displaceable through the channel and thereby deploy the at least one anchor.

48. The system according to claim 47, wherein The pusher element has a lumen and the at least one suture is configured to pass through the lumen.

49. The system according to claim 47, wherein The at least one suture is configured to be at least partially disposed within the channel between the inner diameter of the sheath and the outer diameter of the pusher element.

50. The system according to claim 47, wherein The at least one anchor is tubular.

51. A flexible anchor for deployment through soft tissue, the anchor comprising: an elongate flexible body sized and shaped to be deployable from a deployment device, the elongate body having a first end and a second end and an outer surface, the body extending along a longitudinal axis in a first orientation, the flexible body configured to be bendable into a second orientation in which the first end and the second end are closer to each other than in the first orientation; and a channel extending along the body of the anchor, wherein at least a portion of the channel is located along the outer surface of the body of the anchor, the channel sized and shaped to receive a first segment of suture therethrough.

52. The anchor according to claim 51, wherein, When the body is in the first orientation, one end of the suture is configured to be pulled proximally and slide through the channel, thereby shortening the first segment of suture extending through the channel, the shortened segment of suture extending through the channel configured to pull the body along the channel, thereby bending the body into the second orientation.

53. The anchor according to claim 51, wherein, In the second orientation, the body of the anchor has a U-shaped configuration, wherein the channel is located within the U-shape.

54. The anchor according to claim 51, wherein, In the second orientation, the first end and the second end of the body face each other at an angle.

55. The anchor according to claim 51, wherein, The channel is defined by a plurality of loops positioned between the first end and the second end along the outer surface of the anchor, wherein at least a first loop of the plurality of loops is positioned closer to the first end of the body than to the second end of the body, and at least a second loop of the plurality of loops is positioned closer to the second end of the body than to the first end of the body.

56. The anchor according to claim 55, wherein, The plurality of loops are formed by a portion of the suture.

57. The anchor according to claim 55, wherein, The anchor is tubular and has an internal lumen, and the plurality of loops extend through the outer surface of the anchor into the internal lumen.

58. The anchor according to claim 55, wherein, Each loop has a first end and a second end, and the first end and the second end of the loop pass through the material of the outer surface of the anchor from the outside of the outer surface of the anchor to the inside of the outer surface of the anchor.

59. The anchor according to claim 55, wherein, The plurality of loops are formed from a single piece of material, and the second end of the loop is connected to the first end of an adjacent loop.

60. The anchor according to claim 51, wherein, The channel is defined by a plurality of loops positioned between the first end and the second end along the outer surface of the anchor, wherein the plurality of loops include: A first loop including a first loop portion having a first end and a second end, the first portion extending radially outward from the inside of the outer surface through the outer surface and then radially inward through the outer surface; and A second loop including a second loop portion having a first end and a second end, the second portion extending radially outward from the inside of the outer surface through the outer surface and then radially inward through the outer surface; Wherein the second end of the first portion and the first end of the second portion are adjacent portions of a single piece of material.

61. The anchor according to claim 60, wherein, The first loop and the second loop are part of a section of suture.

62. The anchor according to claim 60, wherein, The piece of material has a first end portion and a second end portion, the first end portion and the second end portion being adjacent to the first end of the first loop portion and the second end of the second loop portion, respectively; and Wherein at least one of the following is used to prevent the first end of the first loop portion from being pulled out of the anchor: A knot in the first end portion of the piece of material; An interweaving of the first end portion of the piece of material with a portion of the anchor; and A portion of the first end portion of the piece of material that is welded or heat-sealed to the anchor; and Wherein at least one of the following is used to prevent the second end of the second loop portion from being pulled out of the anchor: A knot in the second end portion of the piece of material; An interweaving of the second end portion of the piece of material with a portion of the anchor; and A portion of the second end portion of the piece of material that is welded or heat-sealed to the anchor.

63. The anchor according to claim 55, wherein, The plurality of loops are attached at a plurality of attachment points along the outer surface of the anchor.

64. The anchor according to claim 55, wherein, The plurality of loops include a pair of loops.

65. The anchor according to claim 55, wherein, The plurality of loops include a set of four loops.

66. A first anchor and a second anchor, each anchor being the anchor according to claim 51; A portion of the suture is configured to thread through the channels of each of the first anchor and the second anchor when the first anchor and the second anchor are in the first orientation. One end of the suture is configured to be pulled proximally and slide through the channels of each of the first anchor and the second anchor, thereby shortening the first segment of the suture extending through the channels of each of the first anchor and the second anchor. The shortened first segment of the suture extending through the channels of each of the first anchor and the second anchor is configured to pull the body along the channels of the first anchor and the second anchor, thereby bending the body of each of the first anchor and the second anchor into the second orientation.

67. The first and second fasteners according to claim 66, wherein, The first segment of the suture comprises: A first suture portion extending from a position proximal to the first anchor and the second anchor to the first anchor; A second suture portion extending from the first suture portion through the channel of the first anchor; A third suture portion extending from the second suture portion to the second anchor; A fourth suture portion extending from the third suture portion through the channel of the second anchor; A fifth suture portion extending from the fourth suture portion to the first anchor; and A sixth suture portion extending from the fifth suture portion through the channel of the first anchor, the sixth suture portion having an end portion with a knot disposed thereon; Wherein, after the first anchor and the second anchor are deployed, the first suture portion is configured to be pulled proximally, thereby shortening the first segment of the suture extending through the channels of the first anchor and the second anchor. Thereby, the shortened first segment of the suture is configured to pull the body along the channels of both the first anchor and the second anchor, thereby bending both the first anchor and the second anchor such that the first end and the second end of the first anchor are closer to each other than they were before the first anchor was deployed, and the first end and the second end of the second anchor are closer to each other than they were before the second anchor was deployed.

68. A first anchor and a second anchor, each anchor being the anchor according to claim 66, wherein the first segment of the suture comprises: A first suture portion extending from a position proximal to the first anchor and the second anchor to the first anchor; A second suture portion extending from the first suture portion through the channel of the first anchor; A third suture portion extending from the second suture portion to the second anchor; A fourth suture portion extending from the third suture portion through the channel of the second anchor; A fifth suture portion extending from the fourth suture portion to the first anchor, the fifth suture portion having an end portion knotted on the first suture portion near the first anchor; Wherein, after the first anchor and the second anchor are deployed, the first suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through the channels of the first anchor and the second anchor. Thus, the shortened section of suture is configured to pull the body along the channels of both the first anchor and the second anchor, thereby bending both the first anchor and the second anchor such that the first end and the second end of the first anchor are closer to each other than they were before the first anchor was deployed, and the first end and the second end of the second anchor are closer to each other than they were before the second anchor was deployed.

69. A first anchor and a second anchor, each anchor being the anchor according to claim 51, each of the first anchor and the second anchor having its own channel, wherein the first section of suture comprises: A first suture portion that forms a plurality of loops defining the channel of the second anchor; A second suture portion that extends from the first suture portion to the first anchor; A third suture portion that extends from the second suture portion through the channel of the first anchor; A fourth suture portion that extends from the third suture portion to the second anchor; A fifth suture portion that extends from the fourth suture portion away from the first anchor through the channel of the second anchor; And A sixth suture portion that extends proximally from the fifth suture portion away from the second anchor; Wherein, after the first anchor and the second anchor are deployed, the sixth suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through the channels of each of the first anchor and the second anchor. Thus, the shortened section of suture is configured to pull the body along the channels of both the first anchor and the second anchor, thereby bending each of the first anchor and the second anchor in the body into the second orientation.

70. A first anchor and a second anchor, each anchor being the anchor according to claim 51, each of the first anchor and the second anchor having its own channel, wherein the first section of suture comprises: A first suture portion that forms a plurality of loops defining the channel of the second anchor; A second suture portion that extends from the first suture portion to the first anchor; A third suture portion that extends from the second suture portion through the channel of the first anchor; A fourth suture portion that extends from the third suture portion to the second anchor; A fifth suture portion that extends from the fourth suture portion towards the first anchor through the channel of the second anchor; And A sixth suture portion that extends proximally from the fifth suture portion around the first anchor; Wherein, after the first anchor and the second anchor are deployed, the sixth suture portion is configured to be pulled proximally, thereby shortening the section of suture extending through each of the first anchor and the second anchor, whereby the shortened section of suture is configured to pull the body along the channels of both the first anchor and the second anchor, thereby bending each of the bodies of the first anchor and the second anchor into the second orientation.

71. The anchor according to claim 51, wherein, The anchor includes an additional loop on the proximal portion of the anchor, the additional loop being configured to be grasped by a pusher of a deployment mechanism and the additional loop being configured to be released by the pusher during deployment of the anchor.

72. The anchor according to claim 51, wherein, The anchor is formed of a material, wherein at least a portion of the channel is defined by a portion of the material.

73. A method for securing a flexible anchor relative to soft tissue, the method comprising: Deploying an anchor in a first orientation through soft tissue, wherein a section of suture extending through a channel along the anchor is also deployed through the soft tissue, wherein the section of suture is non-coaxial with the anchor; Pulling a portion of the suture proximally to shorten the section of suture extending through the channel, whereby the shortened section of suture bends the anchor into a second orientation, wherein in the second orientation, a first end and a second end of the anchor are closer to each other than in the first orientation.

74. The method for fastening a first anchor and a second anchor according to claim 73, wherein, A second anchor in a first orientation is deployed through soft tissue, wherein the section of suture also extends through a channel along the second anchor, wherein the section of suture is non-coaxial with the second anchor; Wherein the pulling includes shortening the section of suture extending through the channel along the second anchor, whereby the shortened section of suture bends the second anchor into a second orientation, wherein in the second orientation, a first end and a second end of the second anchor are closer to each other than in the first orientation.

75. A flexible anchor for deployment through soft tissue, the anchor comprising: An elongate flexible body sized and shaped to be deployable from a deployment device, the elongate body having a first end and a second end and an outer surface, the body extending along a longitudinal axis in a first orientation, the body being configured to bend into a second orientation, wherein in the second orientation, the first end and the second end are closer to each other than in the first orientation; and A channel extending along or through the body of the anchor, the channel sized and shaped to receive a first section of suture therethrough, at least a portion of the channel being non-coaxial with the longitudinal axis of the body of the anchor.

76. The anchor according to claim 75, wherein, When the body is in the first orientation, one end of the suture is configured to be pulled proximally and slide through the channel, thereby shortening the first segment of the suture extending through the channel, and the shortened segment of the suture extending through the channel is configured to pull the body along the channel, thereby bending the body into the second orientation.

77. The anchor according to claim 75, wherein, At least a portion of the channel extends at least partially radially inwardly relative to an outer surface of the body of the anchor, and the portion of the channel is positioned transverse to the longitudinal axis of the anchor.

78. The anchor according to claim 75, wherein, The channel extends at least partially through a portion of the body of the anchor at least once.

79. The anchor according to claim 75, wherein, The channel extends at least partially through a portion of the body of the anchor at least twice.

80. The anchor according to claim 75, wherein, The channel includes a first channel portion that is oriented perpendicular to the longitudinal axis of the body of the anchor.

81. The anchor according to claim 80, wherein, The channel includes a second channel portion that is oriented at an angle other than 90° relative to the longitudinal axis of the body of the anchor.

82. The anchor according to claim 80, wherein, The channel includes a second channel portion that is oriented perpendicular to the longitudinal axis of the body of the anchor.

83. The anchor according to claim 82, wherein, The channel includes a third channel portion that is oriented parallel to the longitudinal axis of the body of the anchor.

84. The anchor according to claim 82, wherein, The channel includes a third channel portion that is oriented at an angle other than 90° relative to the longitudinal axis of the body of the anchor.

85. The anchor according to claim 75, wherein, The channel includes a first channel portion and a second channel portion, each of the first channel portion and the second channel portion being oriented at an angle other than 90° relative to the longitudinal axis of the body of the anchor.

Images