Soft anchor arrangement

Abstract

A soft anchor arrangement 2 comprising an elongate flexible member 4 having a first end 6 and a second end 8 and extending lengthwise therebetween. The elongate flexible member is wound to form a deployable closed loop 10 intermediate the first and second ends, where the deployable closed loop is deployable from an insertion configuration for insertion into an aperture in a bone to an anchor configuration where the closed loop is contracted and an external surface of the closed loop engages with a surface of the bone to anchor the elongate flexible element. Deployment is effected by application of a pulling force on one or both of the first and second ends in one or more deployment directions away from the deployable closed loop.

Description

Field of the invention The invention relates to surgical devices and more specifically to soft-anchors for tissue fixation and methods of using soft-anchors. Background / Description of the related art In various surgical procedures it can be desirable to temporarily or permanently attach soft tissue such as ligament or tendon against hard tissue such as bone. For example, when soft tissue becomes detached from the bone to which it is normally joined, reattachment of the soft tissue to the bone is achieved using a fixation device. The fixation device locates the soft tissue against the bone to support tissue integration and the healing process. Under other circumstances it can be desirable to have a fixation device that attaches between one or more regions of bone. In certain situations, it can be desirable to couple fixation devices together. Conventional fixation devices for securing soft tissue to hard tissue generally comprise a rigid anchor body which is located in the bone and a pre-attached flexible strand element extends from the anchor body to which it is engaged. The strand element is threaded into the soft tissue and used to couple and retain the soft tissue adjacent to bone. The strand element is regularly provided by a surgical suture and the style of fixation device is commonly termed suture-anchor. Alternatively, the fixation device is entirely made from soft, flexible materials, commonly termed soft anchors. Known soft anchors are constructed from at least two components; a long flexible strand which is threaded through a short sheath. The strand and sheath are provided by different diameters of surgical suture, the diameter of the strand being smaller than the diameter of the sheath. An instrument is used to locate the soft anchor in a drilled hole in a bone in a nondeployed condition. Pulling on the free ends of the strand causes the sheath to bunch around the strand, forming a shape larger than the diameter of the hole. In this deployed state, the soft anchor is retained in the hole within the bone by a friction fit. The free ends of the strand are threaded into the soft-tissue and used to couple the soft-tissue to the bone. Suture-anchors and soft-anchors provide limited fixation strength with respect to anchorage in the surrounding bone providing a reduction in the healing process time frame however limitations in strength and speed of healing remain. Statements of Invention Aspects of the present invention provide an improve arrangement or at least a useful alternative. According to the present invention there is a soft anchor arrangement comprising an elongate flexible member having a first end and a second end and extending lengthwise therebetween, wherein the elongate flexible member is wound to form a deployable closed loop intermediate the first and second ends, where the deployable closed loop is deployable from an insertion configuration for insertion into an aperture in a bone to an anchor configuration where the closed loop is contracted and an external surface of the closed loop engages with a surface of the bone to anchor the elongate flexible element, and where deployment is effected by application of a pulling force on one or both of the first and second ends in one or more deployment directions away from the deployable closed loop. The provision of a closed loop rather than simply a ‘U’ shape means that the closed loop forms the anchor instead of the provision of a sheath. This provides a significant benefit in manufacturing as the elongate flexible member itself engages with the bone and an additional sheath capturing the elongate member is not required. It will be appreciated that the shape of the closed loop changes from the insertion configuration to the deployed configuration. In the insertion configuration the closed loop can readily deform in shape and locate into a narrow bone aperture. The closed loop in the anchor configuration is bunched. In this configuration the loop cannot conform to the geometry of the aperture to release from the aperture, meaning it abuts against the surrounding bone surface and anchors in position. The closed loop cannot be undone through application of force to either or both of the first and second ends. It will be appreciated that the deployment direction may be the same if a pulling force is applied to the first and second ends, or alternatively force may be applied in two different deployment directions to effect deployment of the closed loop. The elongate flexible member is beneficially a unitary member. Through the provision of a unitary member the arrangement is simplified, and manufacturing costs are minimised. The elongate flexible member is preferably wound to form the deployable closed loop and comprises at least: - a first portion projecting away from the first end; - a second portion extending from the first portion and projecting towards the first end; a third portion extending from the second portion and projecting away from the first end; and - a fourth portion extending from the third portion and projecting toward the first end. It will be appreciated that the first and third portions also project away from the second end, and the second and fourth portions project towards the second end. The first portion beneficially projects away from the first end in a first general direction; the second portion beneficially extends from the first portion at least partially in a second direction opposite to the first direction; the third portion beneficially extends from the second portion at least partially in the first direction; and the fourth portion beneficially extends from the third portion at least partially in the second direction towards the second end. At least a portion of the first and third portions are preferably generally contiguous and at least a portion of the second and fourth portions are generally contiguous. A majority of the first and third portions are preferably contiguous and a majority of the second and fourth portions are preferably contiguous. A bridge portion is preferably provided intermediate the second and third portions. The bridge portion is beneficially substantially diametrically opposite to a distal end of the deployable closed loop. The deployable closed loop (of the elongate flexible member) beneficially comprises an eyelet region and a deployment region, the deployment region extending to the first and / or second ends, and where the deployment region interacts with the eyelet region such that application of the pulling force causes the eyelet region to fold at a plurality of locations. When deployed the length of the eyelet region does not change, however the eyelet region changes shape by bunching meaning the closed loop forms an anchor. The eyelet region beneficially comprises a circumference of substantially fixed length. The elongate member is beneficially looped and secured to itself at spaced apart locations to define the eyelet region. The spaced apart locations may be secured by a knot, weld or splice. This means that the circumferential length of the eyelet region does not change significantly whether in the insertion or deployed configuration. It will be understood that a knot, weld, or splice can be utilized as examples. A knot is beneficial as is secure and simple to manufacture. It does, however, have a relatively large thickness meaning insertion into particularly tight bone apertures can be difficult. A splice is beneficial as does not have a significant thickness meaning it can be inserted into small bone apertures, however, is more involved in manufacture meaning higher cost. A weld is beneficial as again can have a relatively small depth but again adds manufacturing complexity and therefore cost. The deployment region preferably comprises first and second tails extending to first and second tail ends respectively, the first and second tails secured relative to and extending from the eyelet region. The first and second tails beneficially extend from the spaced apart locations of the elongate flexible member at the location of the knot, weld or splice. The first and second tails preferably extend from a common fixed location on the eyelet region. The eyelet region preferably comprises a plurality of apertures through which the deployment region passes. This allows the eyelet region to be folded upon pulling on the deployment region. The first tail preferably passes through at least first and second apertures in the eyelet region and the second tail preferably passes through at least third and fourth apertures in the eyelet region. The apertures are beneficially longitudinally spaced apart in the elongate member. The first and second apertures are preferably in the first portion of the deployable closed loop extending away from the first end, and the third and fourth apertures are preferably in the second portion of the deployable closed loop projecting towards the first end. A first length of the eyelet may comprise a conduit therethrough where a first aperture provides an opening into the conduit and a second aperture provides an exit to the conduit, and the deployment region enters the first aperture, extends through the conduit and exits the second aperture. There may be one or more additional conduits (or the conduit may be extended) between third and fourth apertures with the deployment region entering and exiting from the third and fourth apertures respectively. The first and second apertures may be in the first portion of the deploy able closed loop, and the third and fourth apertures in the second portion of the deployable closed loop. It will be appreciated that during assembly one of the first or second ends of the elongate flexible member is therefore beneficially woven through a first aperture and second aperture respectively. Beneficially there are more than two apertures, and the first or second end is passed sequentially through the plurality of apertures. Preferably there are at least four apertures. The first or second end preferably weaves through the plurality of apertures. The closed loop region may comprise a first length of the closed loop region comprising a conduit therethrough where the first aperture provides an opening into the conduit and the second aperture provides an exit to the conduit, and a second length of the closed loop region enters the first aperture, extends through the conduit and exits the second aperture. The conduit preferably extends longitudinally for at least the distance between the apertures. The conduit may extend substantially the entire longitudinal length of the closed loop region and may extend the entire longitudinal length of the flexible elongate member. It will be appreciated that there may be a plurality of first and second lengths of the elongate flexible element. The second length of the closed loop region may extend longitudinally through the conduit or may extend across the width of the conduit meaning multiple apertures may be disposed at overlapping longitudinal positions of the closed loop region. The soft anchor arrangement may further comprise a second elongate flexible member having a respective first end and a second end and extending lengthwise therebetween, wherein the second elongate flexible member comprises a deployment portion wound to cooperate with the deployable closed loop, where the deployment portion is deployable from an insertion configuration for insertion into the aperture in the bone to an anchor configuration where the deployable portion is contracted, and where deployment of the second elongate flexible member is effected by application of a pulling force on one or both of the first and second ends in a deployment direction away from the deployable closed loop. The deployment portion of the second elongate member preferably comprises an external surface that engages with a surface defining the aperture in a bone to anchor the soft anchor arrangement in position in the bone. It will be appreciated that the second elongate member is preferably a unitary elongate flexible member. The pulling force on the first and second ends of the first flexible elongate member is beneficially in the same direction as the pulling force on the first and second ends of the second elongate member. It will be appreciated that the deployment portion of the second flexible elongate member preferably comprises a second deployable closed loop. The deployment portion of the second flexible elongate member beneficially passes through the first and second aperture in the closed loop region of the first elongate flexible member. It will also be appreciated that the second elongate flexible member preferably comprises a plurality of longitudinally spaced apertures in the deployment portion. In the same manner as the apertures in first flexible elongate member one of the respect ends may pass through the apertures to define a closed loop. Alternatively or in addition the flexible elongate member of the first flexible elongate member may pass through apertures in the deployment portion of the second flexible elongate member. Any reference to apertures may comprise through apertures extending through the longitudinal length of the deployable closed loop region, preferably the eyelet region. The deployable closed is beneficially arranged to contract by application of a force to the first and / or second ends in a direction away from the closed loop. In use, the closed loop is held in position by a suitable element as the force is applied thereby effecting deployment and contraction of the closed loop to form the anchor. The element is preferably a tool. Alternatively, the element is a bone surface. The deployable closed loop of the elongate flexible member, and preferably the entire elongate flexible member preferably comprises a fabric, where the fabric preferably comprises an open weave structure. An open weave structure provides benefits in encouraging tissue growth. At least the closed loop portion of the elongate flexible member comprises multiple strands. The multiple strands are beneficially braided. The deployable closed loop portion preferably comprises an undulated surface profile. The cross sectional profile of the elongate flexible member (and if present second elongate flexible member) preferably comprises a first length in a first axis and a second length in a second axis parallel to the first axis, where the first length is greater than the second length. Preferably the first length is more than four times greater the second length. A typical first and second length are 1.5-3mm and 1.2-1.5mm respectively. By providing the first length greater than the second length soft tissue incorporation is encouraged and also load sharing between soft tissue and the soft anchor arrangement can be effectively achieved. Illustrative Embodiments Aspects of the present invention will now be described by way of example only with reference to the accompanying figures where: Figure lisa schematic representation of a first illustrative embodiment according to the present invention, with Figure la in a ready to use configuration, and Figures lb and 1c showing forming of the soft anchor arrangement, and Figures Id and e showing production of an alternate embodiment. Figure 2 is a schematic representation of a second illustrative embodiment according to the present invention. Figure 3 is a schematic representation of a third illustrative embodiment according to the present invention. Figure 4 is a schematic representation of a fourth illustrative embodiment according to the present invention. Figure 5 is a schematic representation of a fifth illustrative embodiment according to the present invention. Figure 6 is a schematic representation of a sixth illustrative embodiment according to the present invention. Figure 7 is a schematic representation of a seventh illustrative embodiment according to the present invention. Figure 8 is a schematic representation of an eighth illustrative embodiment according to the present invention. Figure 9 is a schematic representation of a ninth illustrative embodiment according to the present invention. Figure 10 is a schematic representation of a tenth illustrative embodiment according to the present invention. Figure 11 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 12 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 13 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 14 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 15 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 16 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 17 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 18 is a schematic representation of an eleventh illustrative embodiment according to the present invention. Figure 19 is a schematic illustration of the steps of fixing of a soft anchor arrangement as shown in any of the illustrative embodiments into a bone aperture where the arrangement is anchored by abutting against a bone wall. Figure 20 is a schematic illustration of the steps of fixing a soft anchor arrangement as shown in any of the illustrative embodiments into a bone aperture where the arrangement is fixed in the aperture by a friction fit. Referring to Figure 1 there is a soft anchor arrangement 2 comprising a unitary elongate flexible member 4 typically made of an open weave structure which promotes bone growth through the weave having a first end 6 and a second end 8 and extending lengthwise therebetween. The elongate flexible member 4 is wound to form a deployable closed loop 10 intermediate the first and second ends, where the deployable closed loop 10 is deployable from an insertion configuration and an anchor configuration by application of a pulling force on one or both first and second ends 6,8 in a deployment direction indicated by arrows 11 away from the deployable closed loop 10. The elongate flexible member comprises a first tail portion 12 extending towards the first end 6 and a second tail portion 13 extending towards the second end 8. The elongate flexible member 4 is wound to form the deployable closed loop 10 and comprises a first portion 14 projecting away from the first end 6, a second portion 16 extending from the first portion 14 and projecting towards the first end 6, a third portion 18 extending from the second portion 16 and projecting away from the first end 6, and a fourth portion 20 extending from the third portion 18 and projecting toward the first end 6. The first and third portions 14, 18 are generally contiguous and the second and fourth portions 16, 20 are also generally contiguous. Intermediate the second and third portions 16, 18 is a bridge portion 22. The bridge portion 22 is substantially diametrically opposite to a distal end 24 of the deployable closed loop 10. The distal end 24 is the portion of the soft anchor arrangement 2 that enters the bone aperture first. It will be appreciated that the deployable closed loop defines an eyelet region 26. The deployable closed loop 10 comprises the eyelet region 26 which is a first region of the elongate flexible member and a deployment region comprising the first portion 14 and fourth portion 20. In the embodiment of Figure la, the eyelet region 26 can either be of fixed length being secured by virtue of a knot, weld or splice 23 (as represented by manufacturing steps of Figures lb and 1c), or can be free moving at location 23 (as represented by manufacturing steps of Figures Id and le). The eyelet region is arranged so as to maintain the deployable closed loop during insertion into a bone aperture while at the same time being capable of contracting during deployment. As best shown in Figure lb and 1c, during formation of the deployable closed loop 10 the eyelet region 26 is formed and is of a fixed length. The first end 6 is then passed through a first aperture 28a in the eyelet region 26 and passes through a conduit defined in the third portion 18 and out of a second aperture 28b. The second end passes through a third aperture 28c in the eyelet region 26, passes through a conduit in the second portion 16 and passes out through fourth aperture 28d. A deployment region is thereby formed, meaning that pulling on the ends 6,8 causes bunching of the eyelet region 26 and effecting anchoring in position. In this illustration however it will be appreciated that the apertures 28 may be positioned at alternative locations in the second and third portions 16,18 meaning more or less of the first and fourth portion 14,20 is exposed. The length of elongate flexible member 4 defining the conduit between the first and second aperture may be termed a first length, and the elongate flexible member extending between the first and second aperture through the conduit may be termed a second length. Referring to Figures Id and le, an alternative embodiment does not require the fixed length being secured by virtue of a knot, weld or splice 23. Instead, as shown in Figure Id the first end 6 is fed into aperture 28a, and as shown in Figure 28b passes through the conduit of the third portion 18 and passes out through aperture 28b. As also represented in Figure le, the second end 8 is passed into aperture 28c and then passes through the conduit defined in the second portion 16. It then extends out of the aperture 28d as shown in Figure la. It will be understood that all embodiments can comprise a fixed length being secured at location represented by numeral 23, or alternatively there may be no fixing at such locations. Figure 2 is a schematic representation on an illustrative embodiment similar to that described with respect to Figure 1, however in use the deployable closed loop 10 is inserted into the bone aperture in an opposite direction with the bridge portion 22 entering the bone aperture first and the first and / or second tail portions 12, 13 being tensioned in the opposite direction. Figure 3 is a schematic representation of a further illustrative embodiment where the difference between the embodiment described with respect to Figure 2 is that the first and second tail portions 12, 13 project from apertures 28d and 28b respectively meaning that there is a crossover of the elongate flexible element 4 portion within the bridge portion 22. Referring to Figure 4 there is an illustrative embodiment of the present invention where there are an increased number of apertures provided in the closed loop region 27. The closed loop region comprises a conduit through the elongate flexible element and the elongate flexible element 4 is wound to pass through a first aperture into the conduit, and out of a second aperture to external of the conduit. This is repeated four times in the illustrative embodiment of Figure 4, meaning that upon deployment the external surface configuration of the anchor forms more undulations and therefore modifies the bunching effect and may increase the resistance to unintentional release from the anchored configuration. In this embodiment there are protruding sections 32 of the region of the elongate flexible element 4 comprising the deployment region extend from an aperture 28e and then returning through another aperture 28e are arranged to project outwardly from the eyelet region 26. Referring to Figure 5, a further embodiment is presented whereby protruding sections of elongate flexible element are arranged to also project inwardly into a zone defined by the eyelet region 26, meaning they extend through the thickness of the elongate flexible member 4. The apertures 28e are therefore positioned at spaced apart transverse locations around the eyelet region 26 of the element 4 (and in this illustrative embodiment in the third and second portions 18, 16 respectively) meaning that some parts of the flexible elongate element project inwardly and some project outwardly. In the embodiment of Figure 4 there are protruding sections 32 protruding from both the third portion 18 and second portion 16. Reference numeral 33 identifies the protrusion distance that a protruding section 32 projects from the second portion 16. In a further embodiment, the number of protruding sections 32 may be unequally spaced around the eyelet region. In a further embodiment, the number of protruding sections 32 may be equally spaced around the eyelet region. It will be appreciated that the basic forming of the anchor arrangements of Figures 2-5 is the same as for the embodiment described with respect to Figure 1. Figures 6 and 7 show a further illustrative embodiment similar to Figures 4 and 5 where the protruding sections 32 are elongated compared to the embodiments of Figures 4 and 5. Again the methodology for forming these anchor arrangements is fundamentally the same as for previous embodiments. Figure 8 is a further illustrative embodiment where the first and second tail portions 12,13 project from a single aperture 28b. In this embodiment therefore, both the first and second ends 6, 8 are fed through a aperture 28b. Accordingly, this embodiment is effectively the same as the first embodiment but with a single exit aperture 28b. Figure 9 is a further illustrative embodiment the elongate flexible member 4 is wound to form the deployable closed loop 10 and again is similar to the embodiment described with respect to Figure 1. However, during manufacture instead of the first portion 14 and fourth portion 20 exiting through apertures 28b and d respectively, the element 4 further extends through and around the eyelet region 26 and exits apertures adjacent to the knot, weld or splice 23. Figure 10 is an embodiment designed such that a pulling force should be applied to the first end 6 only as indicated by arrow 11 with the second end 8 being held. In this embodiment, the same form is initially made as shown in Figure lb with the member 4 secured via a knot or similar at reference numeral 23. The first end is then passed through aperture and passed clockwise as shown in the Figure around the conduit defined in the member 4 defining the eyelet region 26. The first end then passes out of aperture. The second end extends via loop portion 46 through a through hole 48 in the member 4 forming the eyelet region and extends to the second end 8. Accordingly, deployment is achieved by pulling on the first end 6 only. Figure 11 is a further illustrative embodiment whereby first and second flexible elongate members 4, 40 are utilised, each presenting respective first and second deployable closed loops 10a, b that are arranged to cooperate to form the anchor in the bone aperture. The first and second deployable closed loops 10a, b cooperate by intersection at positions 47 and 48. It will be appreciated that deployment of the second elongate flexible member is achieved by application of a pulling force on one or both of the first and second ends 6, 8 and also ends 50,52 in a deployment direction away from both the deployable closed loops 10 a,b. In further embodiments, it will be appreciated that various different deployable closed loop configurations can be utilized as described herein, such as those having protruding sections 32 in an equally or an unequally spaced arrangement around the circumference of one or both of the eyelet regions of each deployable closed loops 10a, b. A benefit associated with utilising a second elongate flexible member that cooperates with the first elongate flexible member is that the respective ends of each of the flexible members may be deployed in different directions and can therefore couple to different locations such as different soft tissue structures. The first and second elongate members cooperate by the provision of at least one aperture (two apertures in this embodiment) in one of the elongate members through which the other of the elongate members is fed. Figure 12 is an illustration of a further embodiment like that described with respect to Figure 11 with cooperation at intersection 47 however the distal ends of each deployable closed loop 10a,bwhich are inserted into a bone aperture first are arranged so that one does not project through an aperture in the other. This means that the deployable closed loops 10a, b are disconnected from one another at the distal end. In a further embodiment, protruding sections 32 are utilised in an equally or an unequally spaced arrangement around the circumference of one or both deployable closed loops 10 a, b. Figure 13 is an illustration of a further embodiment of the present invention whereby the elongate flexible member 4 is wound to form a deployable closed loop 10 and comprises a first portion 14 projecting away from the first end 6 that repeatedly changes direction to extend in opposing directions and passes through other portions (described later) of the elongate member 4. A second portion 16 extends from the first portion 14 and projecting towards the first end 6, a third portion 18 extending from the second portion 16 and projecting away from the first end 6, and a fourth portion 20 extending from the third portion 18 and projecting toward the first end 6. In this embodiment a fifth portion 40 extends from the fourth portion 20 and projects towards the away from the first end 6 and a sixth portion 42 extends from the fifth portion 40 towards the first end 6 passing through the second portion 16 at multiple locations until it exits the second portion 16 and extends to the second end 8. An embodiment whereby the elongate member 4 passes through itself in opposing directions multiple times ensures the anchor has a large size when force is applied meaning it is capable of anchoring into larger bone apertures. Figure 14 is an illustrative embodiment where the first and second tail portions 12,13 are not truncated as in previous Figures, and where for illustration only the deployable closed loop 10 is that of the embodiment described with respect to Figure 4. Figure 15 is an illustrative embodiment similar to Figure 13 where the second tail portion 13 enters an aperture 51 in the first tail portion 12 and extends through a conduit defined inside the first tail portion. The second tail portion 13 extends through this conduit and exits the first end 6 allowing force to be applied to both ends 6,8 thereby enabling deployment. Figure 16 is a schematic illustration of the anchor arrangement according to one illustrative embodiment (although equally applicable to other illustrative embodiments) located into a bone aperture before deployment. It will be appreciated that the deployable closed loop 10 can readily enter the aperture 80 defined in a bone 82 due to the ability of the closed loop to deform to the geometry of the aperture. Upon deployment, the closed loop contracts to form the anchor with an irregular outer surface which engages with the internal bone wall 84 defining the aperture and thereby engages with a friction fit. An illustration of the deployable closed loop 10 in the anchored / deployed configuration can be readily seen in Figures 19 and 20. Figure 17 is a schematic illustration of a soft anchor according to an illustrative embodiment, together with a guide strand 100 in the form of an additional elongate member that can provide a functionality as required for a specific application. The guide strand 100 which is passed through the closed loop 10 may be used for deployment of the deployable closed loop into a bone aperture, and the action of this functionality is best shown in Figure 19. Furthermore, the guide strand can also be used as a suture for providing an additional fixing to another bone or other soft tissue. Figure 18 is like Figure 17, however in this illustration a second guide strand is utilised which again can be fixed to another bone or other soft tissue. Figure 19 is a schematic illustration of the process of utilising a soft anchor arrangement according to any of the illustrative embodiments for securing bone to soft tissue. In the illustration of Figure 19a a guide strand 100 is passed through the closed loop 10 and the ends thereof are pulled through an opening 101 to a channel 102 in a bone 82. The distal ends 103 of the strand 100 are then pulled through the channel 102 thereby drawing the closed loop 10 through the channel 102 indicated by arrow 104 in Figure 19b. Figure 19c shows the entirety of the closed loop 10 having been drawn through the channel 102 and a force is applied to the tail portions 12,13 in the opposite direction as indicated by arrow 106 following which the closed loop 10 is compressed against a rearward wall 110 of the bone 82 forming an anchor against the rearward wall 110. The strand 100 can then be discarded. Figure 20 is a similar representation to Figure 19 and functionality is the same, however in this illustration the closed loop 10 forms an anchor via a friction fit within the confines of the aperture in the bone 82. In both Figures 19 and 20 the soft anchor arrangement is drawn into the aperture via a guide strand 100 extending through the bone thickness and being used to draw the deployable closed loop 10 into the aperture. It will also be appreciated however that a suitable tool can push the soft anchor arrangement 2 into the aperture 80, and the provision of the guide strand 100 is not essential, nor is a complete channel through the bone 82. Aspects of the present invention have been described by way of example only and it will be appreciated to the skilled addressee that variations and modifications may be made without departing from the scope of protection afforded by the appended claims. It will further be appreciated that in Figures 14-20 single illustrative soft anchor configurations have been presented however in each of these Figures other soft anchor configurations according to other illustrative embodiments may be utilised.

Claims

1. A soft anchor arrangement comprising an elongate flexible member having a first end and a second end and extending lengthwise therebetween, wherein the elongate flexible member is wound to form a deployable closed loop intermediate the first and second ends, where the deployable closed loop is deployable from an insertion configuration for insertion into an aperture in a bone to an anchor configuration where the closed loop is contracted and an external surface of the closed loop engages with a surface of the bone to anchor the elongate flexible element, and where deployment is effected by application of a pulling force on one or both of the first and second ends in one or more deployment directions away from the deployable closed loop.

2. A soft anchor arrangement wherein the elongate flexible member is a unitary member.

3. A soft anchor arrangement according to any preceding claim where the elongateflexible member is wound to form the deployable closed loop and comprises:a first portion projecting away from the first end;a second portion extending from the first portion and projecting towards the first end;a third portion extending from the second portion and projecting away from the first end; anda fourth portion extending from the third portion and projecting toward the first end.

4. A soft anchor arrangement according to claim 3 where at least a portion of the first and third portions are generally contiguous and at least a portion of the second and fourth portions are generally contiguous.

5. A soft anchor arrangement according to any preceding claim wherein the deployable closed loop comprises an eyelet region and a deployment region, the deployment region extending to the first and / or second ends, and where the deployment region interacts with the eyelet region such that application of the pulling force causes the eyelet region to fold at a plurality of locations.

6. A soft anchor arrangement according to claim 5 wherein the eyelet region comprises a circumference of substantially fixed length, and the elongate member is looped and secured to itself at spaced apart locations to define the eyelet region.

7. A soft anchor arrangement according to any of claims 5-6 wherein the deployment region comprises first and second tails extending to first and second tail ends respectively, the first and second tails secured relative to and extending from the eyelet region.

8. A soft anchor arrangement according to claim 7 wherein the first and second tails extend from a common fixed location on the eyelet region.

9. A soft anchor arrangement according to any of claims 5-8 where the eyelet region comprises a plurality of apertures through which the deployment region passes.

10. A soft anchor arrangement according to claim 9 when dependent on claim 7 wherein the first tail passes through at least first and second apertures in the eyelet region and the second tail passes through at least third and fourth apertures in the eyelet region.

11. A soft anchor arrangement according to claim 9 wherein the apertures are longitudinally spaced apart in the elongate member.

12. A soft anchor arrangement according to claim 9 wherein a first length of the eyelet region comprises a conduit therethrough where a first aperture provides an opening into the conduit and a second aperture provides an exit to the conduit, and the deployment region enters the first aperture, extends through the conduit and exits the second aperture.

13. A soft anchor arrangement according to any preceding claim further comprising a second elongate flexible member having a first end and a second end and extending lengthwise therebetween, wherein the second elongate flexible member comprises a deployment portion wound to cooperate with the deployable closed loop, where the deployment portion is deployable from an insertion configuration for insertion into the aperture in the bone to an anchor configuration where the deployable portion is contracted, and where deployment of the second elongate flexible member is effected by application of a pulling force on one or both of the first and second ends of the second elongate flexible member in a deployment direction away from the deployable closed loop.

14. A soft anchor arrangement according to claim 13 wherein the deployment portion comprises a second deployable closed loop.

15. A soft anchor arrangement according to claim 9 and any of claims 13-14 wherein the deployment portion of the second flexible elongate member passes through the first and second aperture in the closed loop region of the first elongate flexible member.

16. A soft anchor arrangement according to any preceding claim wherein the deployable closed loop is arranged to contract by application of a force to the first and / or second ends in a direction away from the closed loop.

17. A soft anchor arrangement according to any preceding claim wherein the deployable closed loop of the elongate flexible member comprises a fabric, where the fabric comprises an open weave structure.

18. A soft anchor arrangement according to any preceding claim where the cross-sectional profile of the elongate flexible member comprises a first length in a first axis and a second length in a second axis parallel to the first axis, where the first length is greater than the second length.

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