Knotless anchor insertion

Abstract

Various exemplary systems, devices, and methods for knotless anchor insertion are provided. Generally, an inserter tool is configured for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool is configured to insert an anchor into a patient's bone to secure the soft tissue relative to the bone. Sutures coupled to the soft tissue are secured to the bone by being trapped between an outer surface of the anchor and a bone surface defining a hole in the bone in which the anchor is positioned.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 63 / 017,009, entitled "Knotless Anchor Insertion," filed April 29, 2020, which is incorporated by reference in its entirety herein.

[0002] FIELD OF THEINVENTION The present disclosure relates generally to knotless anchor insertion. [Background technology]

[0003] A variety of injuries and conditions require repair of soft tissue damage or reattachment of soft tissue to bone and / or surrounding tissue. For example, when otherwise healthy tissue has been detached from the bone, such as when the labrum has detached from the glenoid cavity (shoulder instability), surgery is often required to reattach the tissue to the bone to allow healing and natural reattachment to occur. Numerous devices and methods have been developed to perform these surgical repairs. Some of the methods that provide better results include the use of suture fixation members, such as suture anchors, which typically have an anchor body with a suture attachment mechanism and a tissue or bone engaging mechanism for holding the suture anchor in or adjacent to the tissue or bone. Depending on the particular injury, one or more suture anchors connected to one or more segments of suture or interconnected with one or more segments of suture may be used to perform the repair.

[0004] Surgery may also be required when tears occur in large areas of a single type of tissue. Sutures may also be used with one or more suture anchors to repair such tissue tears. The sutures may be fastened to the suture anchors and tissue with a knot tied by the surgeon during the repair procedure, or with a "knotless" device and method in which one or more anchors and one or more sutures may be connected and tensioned without the surgeon having to tie a knot during surgery. Knotless fastening is particularly useful in minimally invasive surgical procedures, such as endoscopic or arthroscopic repair. In minimally invasive surgical procedures, the tying process can be difficult and time-consuming, as the surgeon remotely manipulates the sutures at the surgical site using instruments inserted percutaneously through small diameter cannulas, endoscopic tubes, or otherwise. However, while knotless anchors can be very effective at reattaching soft tissue to bone, the small size of the anchor and the patient's anatomy can make it difficult to locate and insert the anchor into the bone hole. Additionally, visualization of the hole can be difficult due to the challenging angles and the tight nature of the joint space. Summary of the Invention [Problem to be solved by the invention]

[0005] Thus, there remains a need for improved knotless anchor insertion. [Means for solving the problem]

[0006] Generally, systems and devices for knotless anchor insertion and methods of knotless anchor insertion are provided.

[0007] In one aspect, a surgical system is provided that includes, in one embodiment, a handle, an outer shaft extending distally from the handle and including an inner lumen, and an inner shaft extending distally from the handle. The inner shaft is positioned within the inner lumen of the outer shaft, a distal end of the inner shaft is positioned distal to the open distal end of the outer shaft, the distal end of the inner shaft having a notch formed therein, the notch being configured to seat a suture therein. The system also includes an anchor configured to be embedded in bone. The anchor includes an inner lumen, and the inner shaft is positioned within the inner lumen of the anchor. With the distal end of the inner shaft positioned within the bone hole, the outer shaft is configured to translate longitudinally and distally relative to the inner shaft, thereby translating the anchor longitudinally and distally into the bone hole.

[0008] This system can vary in many ways. For example, after translation of the outer shaft, the outer and inner shafts can be configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole. In another example, prior to translation of the outer shaft, the distal end of the outer shaft can abut the proximal end of the anchor with the inner shaft positioned within the inner lumen of the anchor.

[0009] In yet another example, the notch can have an open distal end and a closed proximal end. The system can also further include a compliant member extending along the open distal end of the notch to cooperate with the inner shaft to define a sealed passageway, which can be configured to seat a suture therethrough. The compliant member can be configured to bend such that the sealed passageway opens to allow the suture to be released. The compliant member can be made of a shape memory material or a superelastic material.

[0010] In yet another example, the notch can extend longitudinally along a longitudinal axis of the inner shaft. In yet another example, the notch can define a tortuous path. In yet another example, the anchor can have a plurality of bone-engaging surface features configured to engage walls of a bone hole to secure the anchor to the bone hole. In yet another example, the distal portion of the inner shaft including the notch can be made from a shape memory material or a superelastic material.

[0011] In another example, the inner shaft can include distal arms defining a notch therebetween. The notch can have an open distal end, and the arms can each be configured to bend radially outward in response to a suture passing through the open distal end. The arms can be made from a shape memory material or a superelastic material.

[0012] In yet another example, the system may include a suture seated in the notch. The suture may be seated in the notch before the distal end of the inner shaft is positioned in the bone hole, and may be seated in the notch after translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. The system may include a suture retaining member on the handle, which may be configured to releasably retain the suture therein. After translation of the outer shaft, the inner shaft may be configured to translate longitudinally and proximally relative to the anchor in the bone hole, the notch may have an open distal end, and the suture may be configured to exit the notch through the open distal end in response to longitudinal and proximal translation of the inner shaft.

[0013] In yet another example, the system may include a locking mechanism configured to move from a locked position, where the outer shaft is prevented from translating longitudinally and distally relative to the inner shaft, to an unlocked position, where the outer shaft is allowed to translate longitudinally and distally relative to the inner shaft.

[0014] In yet another example, the system may include a strike cap extending proximally from the handle and operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft. The system may include a locking mechanism configured to move from a locked position in response to a strike against the strike cap, where the outer shaft is prevented from translating longitudinally and distally relative to the inner shaft, to an unlocked position in response to a strike against the strike cap, where the outer shaft is permitted to translate longitudinally and distally relative to the inner shaft. The system may include a protective member configured to move from a closed position in which the protective member covers a striking surface of the strike cap to an open position in which the protective member does not cover the striking surface of the strike cap. The protective member may be attached to the handle via a hinge. The hinge may be a living hinge.

[0015] In another example, the system may include a suture and a loading aid that may be configured to releasably couple to the inner shaft and to guide the suture into the notch. The loading aid may include a first channel configured to guide the suture through the first channel and into the notch formed in the inner shaft with the loading aid releasably coupled to the inner shaft. The loading aid may have a second channel formed therein that communicates with the first channel, and the inner shaft may be configured to pass through the second channel during release of the loading aid from the inner shaft. The loading aid may be configured to be released from the inner shaft after the suture is seated in the notch and before a distal end of the inner shaft is positioned in the bone hole. The loading aid can include a V-shaped distal seating groove that can be in communication with the first channel such that the suture is configured to seat in the distal seating groove and pass into the first channel to automatically seat the suture in the notch.

[0016] In another embodiment, a surgical system includes an inserter tool, a suture, and an anchor. The inserter tool includes an outer shaft and an inner shaft. A distal end of the inner shaft has a suture retaining channel formed therein, the inner shaft being positioned within the outer shaft, the suture retaining channel being positioned distal to the open distal end of the outer shaft. The suture is seated within the suture retaining channel. The anchor is configured to be embedded in bone and has the inner shaft seated within a cannulated interior. The anchor is configured to be pushed distally by the outer shaft moving axially and distally along a longitudinal axis of the inserter tool relative to the inner shaft and the suture.

[0017] The system can have many variations. For example, after axial movement of the outer shaft, the outer shaft and the inner shaft can be configured to simultaneously move axially and proximally along the longitudinal axis of the inserter tool relative to the anchor and suture. In another example, prior to axial movement of the outer shaft, the distal end of the outer shaft can abut the proximal end of the anchor in which the inner shaft is positioned.

[0018] In yet another example, the suture retaining channel may have an open distal end and a closed proximal end. The system may include a compliant member extending along the open distal end of the suture retaining channel to cooperate with the inner shaft to define a sealed passageway, which may be configured to seat the suture therethrough. The compliant member may be configured to bend such that the sealed passageway opens to allow the suture to be released. The compliant member may be made of a shape memory material or a superelastic material.

[0019] In yet another example, the suture retaining channel can extend longitudinally along the longitudinal axis of the inner shaft, hi another example, the suture retaining channel can define a tortuous path.

[0020] In yet another example, the inner shaft can include a pair of distal arms defining a suture retaining channel therebetween. The suture retaining channel can have an open distal end, and the arms can each be configured to bend radially outward in response to a suture passing through the open distal end. The arms can be made of a shape memory material or a superelastic material.

[0021] In yet another example, following axial movement of the outer shaft, the inner shaft can be configured to move axially and proximally along a longitudinal axis of the inserter tool relative to the anchor and suture, and the suture retaining channel can have an open distal end and the suture can be configured to pass out of the suture retaining channel through the open distal end in response to axial and proximal translation of the inner shaft. In another example, the anchor can have a plurality of bone engaging surface features configured to engage walls of the bone hole to secure the anchor in the bone hole.

[0022] In yet another example, the inserter tool can include a handle and the outer shaft and the inner shaft can extend distally from the handle. The system can include a suture retaining member on the handle, which can be configured to releasably retain a suture therein.

[0023] In another example, the inserter tool may include a locking mechanism configured to move from a locked position, in which the outer shaft is prevented from moving axially and distally relative to the inner shaft, to an unlocked position, in which the outer shaft is allowed to move axially and distally relative to the inner shaft.

[0024] In yet another example, the inserter tool may include a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by the tool, thereby moving the outer shaft axially and distally relative to the inner shaft. The inserter tool may include a locking mechanism configured to move from a locked position in response to a strike against the strike cap, where the outer shaft is prevented from moving axially and distally relative to the inner shaft, to an unlocked position in response to a strike against the strike cap, where the outer shaft is allowed to move axially and distally relative to the inner shaft. The inserter tool may include a protective member configured to move from a closed position in which the protective member covers a striking surface of the strike cap to an open position in which the protective member does not cover the striking surface of the strike cap. The protective member may be attached to the inserter tool via a hinge. The hinge may be a living hinge.

[0025] In yet another example, the system may include a loading aid configured to be releasably coupled to the inner shaft and configured to guide a suture into the suture holding channel. The loading aid may include a first channel configured to guide a suture through the first channel and into a suture holding channel formed in the inner shaft with the loading aid releasably coupled to the inner shaft. The loading aid may be configured to be released from the inner shaft after the suture is seated in the suture holding channel. The loading aid may have a second channel formed therein in communication with the first channel, and the inner shaft may be configured to pass through the second channel during release of the loading aid from the inner shaft. The loading aid may include a V-shaped distal seating groove, which may be in communication with the first channel such that the suture is configured to seat in the distal seating groove and pass into the first channel to automatically seat the suture in the suture holding channel.

[0026] In another embodiment, a surgical system includes a handle, an outer shaft extending distally from the handle and including an inner lumen, and an inner shaft extending distally from the handle. The inner shaft is positioned within the inner lumen of the outer shaft, and a distal end of the inner shaft is positioned distal to the open distal end of the outer shaft. The system also includes a flexible member cooperating with the distal end of the inner shaft to define a sealed passage configured to seat a suture therethrough. The system also includes an anchor configured to be embedded in bone. The anchor includes an inner lumen, and the inner shaft is positioned within the inner lumen of the anchor. The outer shaft is configured to translate relative to the inner shaft, thereby translating the anchor distally into the bone hole. The flexible member is configured to bend to open the sealed passage.

[0027] The system can vary widely. For example, the flexible member can be configured to automatically expand in response to longitudinal and proximal translation of the inner shaft relative to the anchor, thereby opening up the sealed passage. In another example, movement of the outer shaft can be longitudinal and distal relative to the inner shaft, and with the distal end of the inner shaft positioned within the bone hole, translation of the anchor can be longitudinal and distal into the bone hole.

[0028] In another example, after translation of the outer shaft, the outer shaft and the inner shaft can be configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole.

[0029] In yet another example, a first end of the flexible member can be fixedly attached to the handle and a second end of the flexible member can be freely movable relative to the handle and the inner shaft. The second end of the flexible member can be configured to automatically bend relative to the inner shaft in response to longitudinal and proximal translation of the inner shaft relative to the anchor.

[0030] In another example, the proximal surface of the inner shaft can include a pair of opposing distal arms that define a proximal side of the sealed passageway, the flexible member can define a distal side of the sealed passageway, and the inner shaft can define left and right sides of the sealed passageway that each extend between the proximal and distal sides of the sealed passageway. In yet another example, the system can include a wire operably coupled to the flexible member and an actuator at the handle configured to be actuated to thereby move the wire proximally, where proximal movement of the wire can cause bending of the flexible member such that the sealed passageway is opened.

[0031] In yet another example, the compliant member may include metal wires, braided fabric, or textile strands. The compliant member may be made from a shape memory material or a superelastic material.

[0032] In another example, prior to translation of the outer shaft, the distal end of the outer shaft can abut the proximal end of the anchor with the inner shaft positioned within the inner lumen of the anchor. In yet another example, the anchor can have a plurality of bone-engaging surface features configured to engage the walls of the bone hole to secure the anchor to the bone hole. In another example, the anchor can have a plurality of independent external bone-engaging surface features that extend helically along the length of the anchor and each configured to engage bone. In yet another example, the anchor can have a plurality of bone-engaging surface features and a plurality of gussets.

[0033] In yet another example, the system may include a suture seated through the sealed passage. The suture may be seated through the sealed passage before the distal end of the inner shaft is positioned within the bone hole and may be seated through the sealed passage after translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. The system may include a suture retaining member on the handle, which may be configured to releasably retain the suture therein.

[0034] In another example, following translation of the outer shaft, the inner shaft can be configured to translate longitudinally and proximally relative to the anchor in the bone hole, where translation of the inner shaft can be configured to automatically cause bending of the flexible member, thereby allowing release of the suture from the sealed passage.

[0035] In yet another example, the system may include a locking mechanism configured to move from a locked position, where the outer shaft is prevented from translating longitudinally and distally relative to the inner shaft, to an unlocked position, where the outer shaft is allowed to translate longitudinally and distally relative to the inner shaft.

[0036] In another example, the system may include a strike cap extending proximally from the handle and operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft. The system may include a locking mechanism configured to move from a locked position in response to a strike against the strike cap, where the outer shaft is prevented from translating longitudinally and distally relative to the inner shaft, to an unlocked position in response to a strike against the strike cap, where the outer shaft is permitted to translate longitudinally and distally relative to the inner shaft. The system may include a protective member configured to move from a closed position in which the protective member covers a striking surface of the strike cap to an open position in which the protective member does not cover the striking surface of the strike cap. The protective member may be attached to the handle via a hinge. The hinge may be a living hinge.

[0037] In another example, the system can include a suture and a loading aid that can be configured to releasably couple to the inner shaft and configured to guide the suture through the sealed passage. The loading aid can include a suture threader.

[0038] In another embodiment, a surgical system is provided that includes a handle, an outer shaft extending distally from the handle and including an inner lumen, and an inner shaft extending distally from the handle. The inner shaft is positioned within the inner lumen of the outer shaft, a distal end of the inner shaft is positioned distal to the open distal end of the outer shaft, the distal end of the inner shaft includes a first interlocking component and a second interlocking component that define a sealed passage configured to receive a suture therethrough. The system also includes an anchor configured to be embedded in bone. The anchor includes an inner lumen, and the inner shaft is positioned within the inner lumen of the anchor. Movement of the outer shaft relative to the inner shaft is configured to translate the anchor longitudinally and distally into the bone hole. The first component is configured to move relative to the second component, thereby opening the sealed passage.

[0039] The system can vary in a variety of ways. For example, the system can include a suture and can be configured such that movement of the first component automatically opens the sealed passage, thereby allowing release of the suture.

[0040] In another example, movement of the outer shaft relative to the inner shaft may include longitudinal and distal translation of the outer shaft relative to the inner shaft before the first component moves relative to the second component. Movement of the outer shaft may be configured to occur with a distal end of the inner shaft positioned within the bone hole, and the suture may extend through the sealed passage after translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. The first component may be configured to move relative to the second component after movement of the outer shaft, and opening of the sealed passage may allow release of the suture.

[0041] In another embodiment, a surgical system is provided that includes a biocompatible anchor configured to be advanced distally into bone, the anchor having a plurality of independent external bone-engaging surface features extending helically along a length of the anchor and each configured to engage bone, the anchor tapering radially inwardly in a distal direction such that a diameter of the tapered helical anchor at a proximal end of the anchor is larger than a diameter of the anchor at a distal end of the anchor.

[0042] The system can have several variations. For example, each of the bone engaging surface features can extend along the entire length of the anchor. In another example, each of the bone engaging surface features can extend along a partial length of the anchor, such that the anchor has a threaded proximal portion and a non-threaded distal portion. In yet another example, the anchor can be cannulated. In yet another example, the bone engaging surface features can be threads.

[0043] In another example, the system may also include an inserter tool including an outer shaft and an inner shaft, the outer shaft may include an inner lumen, the inner shaft may be positioned within the inner lumen of the outer shaft, a distal end of the inner shaft may be positioned distal to the open distal end of the outer shaft, the distal end of the inner shaft may have a notch formed therein, the notch configured to seat a suture therein, and the inner shaft may be configured to be positioned within the inner lumen of the anchor, and with the inner shaft positioned within the inner lumen of the anchor, the outer shaft may be configured to translate longitudinally and distally relative to the inner shaft, thereby translating the anchor longitudinally and distally into the bone hole. After translation of the outer shaft, the outer shaft and the inner shaft may be configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole. Prior to translation of the outer shaft, the distal end of the outer shaft may abut a proximal end of the anchor with the inner shaft positioned within the inner lumen of the anchor. The system may include a suture, and translation of the outer shaft may be configured to cause the anchor to capture the suture between the anchor and a wall of the bone hole. The inserter tool may also include a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by the tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft and translating the anchor longitudinally and distally into the bone hole.

[0044] In another embodiment, a surgical system includes a biocompatible anchor and an inserter tool. A plurality of independent external threads each extend helically along a length of the anchor, each configured to engage bone. An inner lumen extends through the anchor. An outer diameter of the anchor decreases distally along the entire length of the anchor. The inserter tool includes an outer shaft and an inner shaft. The outer shaft includes an inner lumen. The inner shaft is positioned within the inner lumen of the outer shaft. A distal end of the inner shaft has a notch formed therein, the notch being configured to seat a suture therein. The inner shaft extends through the inner lumen of the anchor, the distal end of the inner shaft being positioned distal to the open distal end of the outer shaft. The outer shaft is configured to translate longitudinally and distally relative to the inner shaft, thereby translating the anchor longitudinally and distally relative to the inner shaft.

[0045] This system can vary in many ways. For example, after translation of the outer shaft, the outer shaft and the inner shaft can be configured to simultaneously translate longitudinally and proximally relative to the anchor. In another example, prior to translation of the outer shaft, the distal end of the outer shaft can abut the proximal end of the anchor. In yet another example, the bone-engaging surface features can be threads. In another example, the outer diameter of the anchor can continuously decrease distally along the entire length of the anchor.

[0046] In yet another example, the system may include a suture, and longitudinal and distal translation of the anchor may be configured to advance the anchor into the bone hole and translation of the outer shaft may be configured to cause the anchor to capture the suture between the anchor and a wall of the bone hole. After translation of the outer shaft, the outer shaft and inner shaft may be configured to simultaneously translate longitudinally and proximally relative to the anchor within the bone hole.

[0047] In yet another example, the inserter tool can include a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by the tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft and translating the anchor longitudinally and distally into the bone hole.

[0048] In another aspect, a surgical method is provided that, in one embodiment, includes positioning a distal end of an inner shaft of an inserter tool within a bone hole. The distal end of the inner shaft has a notch formed therein, and a suture is seated within the notch. The method also includes moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding an anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. The method also includes moving the outer shaft and the inner shaft axially and proximally relative to the anchor, such that after the axial and distal movement of the outer shaft, the inner shaft is removed from the bone hole and the anchor and suture remain in the bone hole.

[0049] This method can vary widely. For example, axial and proximal movement of the inner shaft can automatically cause the suture to exit the notch by passing through the open distal end of the notch.

[0050] In another example, prior to axial distal movement of the outer shaft, a compliant member can extend along the distal side of the notch to prevent the suture from exiting the notch distally, and axial proximal movement of the inner shaft can automatically cause the compliant member to bend to allow the suture to exit the notch. The compliant member can be made of a shape memory or superelastic material.

[0051] In yet another example, axial proximal movement of the inner shaft can automatically cause the suture to exit the notch by passing through an open distal end of the notch, which can be defined by a pair of distal arms of the inner shaft, each of which can bend radially outward in response to the suture passing through the open distal end of the notch. The arms can be made from a shape memory or superelastic material to facilitate radially inward movement of the arms after the suture has passed through the open distal end of the notch.

[0052] In another example, the method may include tensioning the suture before the outer shaft is moved axially and distally. In yet another example, the method may include retaining the suture in a suture retaining member in a handle of the inserter tool. In yet another example, the method may include moving a locking mechanism prior to axial and distal movement of the outer shaft from a locked position, where the outer shaft is prevented from translating axially and distally relative to the inner shaft, to an unlocked position, where the outer shaft can translate axially and distally relative to the inner shaft.

[0053] In another example, striking a strike cap of the inserter tool can cause axial and distal movement of the outer shaft. The method can include, prior to striking the strike cap, moving a locking mechanism from a locked position, in which the outer shaft is prevented from translating axially and distally relative to the inner shaft, to an unlocked position, in which the outer shaft can translate axially and distally relative to the inner shaft. The method can include, prior to striking the strike cap, moving a protective member from a closed position, in which the protective member covers a striking face of the strike cap, to an open position, in which the protective member does not cover the striking face of the strike cap.

[0054] In yet another example, the method may include manually loading the suture into the notch prior to positioning the distal end of the inner shaft within the bone hole.

[0055] In yet another example, the method may include loading a suture into the notch using a tool releasably coupled to the inner shaft prior to positioning a distal end of the inner shaft into the bone hole. The tool may include a loading aid, and loading the suture may include guiding the suture into the notch through a first channel of the loading aid. Loading the suture may include guiding the suture from a first channel of the loading aid in communication with the notch to a second channel such that passing the suture into the second channel automatically seats the suture in the notch. Loading the suture may include guiding the suture from a V-shaped distal seating groove of the loading channel into the first channel. The method may include releasing the tool from the inner shaft after the suture is loaded into the notch using the tool.

[0056] In another embodiment, the surgical method may include positioning a distal end of an inner shaft of an inserter tool within a bone hole with a flexible member attached to the inner shaft. The flexible member and the inner shaft cooperate to define a sealed passage through which the suture extends. The method also includes moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding the anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. The method may also include moving the outer shaft and the inner shaft axially and proximally relative to the anchor after the axial and distal movement of the outer shaft such that the flexible member spreads and the inner shaft is removed from the bone hole, leaving the anchor and the suture in the bone hole.

[0057] This method can have various variations, for example, a first end of the flexible member can be fixedly attached to the inner shaft and not movable relative to the inner shaft, a second end of the flexible member can be freely movable relative to the inner shaft, and the second end of the flexible member can automatically move relative to the inner shaft in response to axial and proximal translation of the inner shaft to expand the flexible member, and movement of the flexible member can open the sealed passageway.

[0058] In another example, a first end of the flexible member may be fixedly attached to the handle of the inserter tool and may not be movable relative to the inner shaft, and a second end of the flexible member may be freely movable relative to the inner shaft, and the second end of the flexible member may automatically move relative to the inner shaft in response to axial and proximal translation of the inner shaft to expand the flexible member, and movement of the flexible member may cause the sealed passage to open.

[0059] In another example, the method may include tensioning the suture before the outer shaft is moved axially and distally. In yet another example, the method may include retaining the suture in a suture retaining member in a handle of the inserter tool. In yet another example, the method may include moving a locking mechanism prior to axial and distal movement of the outer shaft from a locked position where the outer shaft is prevented from translating axially and distally relative to the inner shaft to an unlocked position where the outer shaft can translate axially and distally relative to the inner shaft. In another example, the compliant member may be made of a shape memory material or a superelastic material.

[0060] In yet another example, striking a strike cap of an inserter tool may cause axial and distal movement of the outer shaft. The method may include, prior to striking the strike cap, moving a locking mechanism from a locked position, where the outer shaft is prevented from translating axially and distally relative to the inner shaft, to an unlocked position, where the outer shaft may translate axially and distally relative to the inner shaft. The method may include, prior to striking the strike cap, moving a protective member from a closed position, where the protective member covers a striking face of the strike cap, to an open position, where the protective member does not cover the striking face of the strike cap.

[0061] In another example, the method may include loading a suture into the sealed passage using a suture threader prior to positioning the distal end of the inner shaft within the bone hole.

[0062] In another embodiment, a surgical method includes positioning a distal end of an inner shaft of an inserter tool within a bone hole, the distal end of the inner shaft having a notch formed therein, a suture seated within the notch, and the inner shaft extending through an anchor having a plurality of bone-engaging surface features extending helically along a length of the cannulated, tapered anchor. The method also includes moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding the anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole.

[0063] This method can vary widely. For example, the anchor can be tapered radially inward in a distal direction such that the diameter of the tapered helical anchor at the proximal end of the anchor is larger than the diameter of the anchor at the distal end of the anchor. With the anchor positioned in the bone hole, the proximal end of the anchor can engage the cortical bone and the distal end of the anchor can engage the cancellous bone.

[0064] In another example, the method can include moving the outer shaft axially and proximally relative to the anchor such that after axial and distal movement of the outer shaft, the inner shaft is removed from the bone hole and the anchor and suture remain in the bone hole. In yet another example, the bone engaging surface feature can be a thread. [Brief description of the drawings]

[0065] The present invention will now be described with reference to the accompanying drawings. [Figure 1] FIG. 13 is a perspective view of an embodiment of an inserter tool and an embodiment of a locking aid coupled to the inserter tool. [Diagram 2] 2 is a perspective view of a distal portion of the inserter tool of FIG. 1 without a loading aid coupled thereto and with one embodiment of a suture coupled to the inserter tool. [Diagram 3] 3 is a side partial cross-sectional view of the suture and a distal portion of the inserter tool of FIG. 2. [Figure 4] 3 is a perspective view of a distal portion of the inserter tool of FIG. 1 with the suture of FIG. 2 not yet coupled to the inserter tool. [Diagram 5] 5 is a perspective view of a distal portion of the inserter tool of FIG. 4 with a suture positioned in a distal seating groove of a loading aid. [Figure 6] 6 is another perspective view of the inserter tool, loading aid, and suture of FIG. 5. [Figure 7] FIG. 7 is a perspective view of a distal portion of the inserter tool of FIGS. 5 and 6 with a suture positioned within a loading channel of a loading aid. [Figure 8] 8 is another perspective view of the inserter tool, loading aid, and suture of FIG. 7. [Figure 9] 9 is a perspective view of a distal portion of the inserter tool of FIGS. 7 and 8 with a suture positioned within a release channel of the loading aid and within a suture retaining channel of the inserter tool. FIG. [Figure 10] 10 is a perspective view of a distal portion of the inserter tool of FIG. 9 with the loading aid detached from the inserter tool and suture. FIG. [Figure 11] 3 is a side partial cross-sectional view of a distal portion of another embodiment of the suture and inserter tool of FIG. 2. [Figure 12] 3 is a side partial cross-sectional view of a distal portion of yet another embodiment of the suture and inserter tool of FIG. 2. FIG. [Figure 13] 13 is a side partial cross-sectional view of the suture of FIG. 12 and the distal portion inserter tool of FIG. 12 coupled with the loading aid of FIG. 1. [Figure 14] 1. FIG. 4 is a perspective view of another embodiment of a loading aid coupled to the inserter tool of FIG. [Figure 15] FIG. 15 is a perspective view of the loading aid and inserter tool of FIG. 14 with a suture seated in a distal seating groove of the loading aid. [Figure 16] 16 is a perspective view of the loading aid and inserter tool of FIG. 15 with a suture positioned in a release channel of the loading aid and in a suture retaining channel of the inserter tool. FIG. [Figure 17]FIG. 13 is a perspective view of yet another embodiment of an inserter tool. [Figure 18] FIG. 18 is a side view of a distal portion of the inserter tool of FIG. 17. [Figure 19] 18 is a side view of a distal portion of the inserter tool of FIG. 17, another embodiment of a suture, and another embodiment of a loading aid. [Figure 20] FIG. 20 is a side view of the distal portion of the inserter tool, the loading aid, and the suture of FIG. 19, with the suture positioned within the loop of the inserter tool and within the sealed passage of the loading aid. [Figure 21] FIG. 21 is a side view of the distal portion of the inserter tool and suture of FIG. 20 with the suture positioned within the loop of the inserter tool and the loading aid removed. [Figure 22] 22 is a side view of the distal portion of the inserter tool and suture of FIG. 21 with the loop open. FIG. [Diagram 23] 13 is a side cross-sectional view of a proximal portion of another embodiment of an inserter tool. [Figure 24] FIG. 13 is a perspective partial transparent view of a distal portion of yet another embodiment of an inserter tool. [Diagram 25] 25 is a side partial cross-sectional view of a distal portion of the inserter tool of FIG. 24. [Figure 26] 26 is a side partial cross-sectional view of a distal portion of the inserter tool of FIG. 25 with an anchor advanced distally therefrom. [Figure 27] 13 is a perspective view of a distal portion of yet another embodiment of an inserter tool. FIG. [Figure 28] 28 is a perspective view of a distal portion of the inner and outer shafts of the inserter tool of FIG. 27. [Figure 29] 28 is a perspective view of a distal portion of the inserter tool of FIG. 27 having another embodiment of a suture coupled thereto. [Diagram 30] FIG. 28 is a side view of the anchor and distal cap implanted in bone using the inserter tool of FIG. 27. [Diagram 31]28 is a perspective view of a distal portion of the inserter tool of FIG. 27 coupled to another embodiment of a loading aid and another embodiment of a suture seated in a distal seating groove of the loading aid. FIG. [Diagram 32] FIG. 32 is a perspective view of the loading aid, suture, and distal portion of the inserter tool of FIG. 31, with the suture seated in a notch in the inserter tool. [Diagram 33] 33 is a perspective view of the loading aid, suture, and distal portion of the inserter tool of FIG. 32, with a distal cap coupled to the inserter tool. FIG. [Diagram 34] 13 is a perspective view of a proximal portion of another embodiment of an inserter tool. FIG. [Diagram 35] FIG. 35 is a perspective view of an intermediate portion of the inserter tool of FIG. 34. [Diagram 36] FIG. 35 is a cross-sectional view of the inserter tool of FIG. 34. [Figure 37] FIG. 35 is a perspective view of a distal portion of the inserter tool of FIG. 34 with sutures coupled thereto and extending through one embodiment of a cannula positioned in a patient. [Figure 38] 13 is a perspective view of a proximal portion of yet another embodiment of an inserter tool, the protective member being in a closed position. FIG. [Figure 39] FIG. 39 is another perspective view of the proximal portion of the inserter tool of FIG. 38. [Diagram 40] 39 is a perspective view of a proximal portion of the inserter tool of FIG. 38, with the protective member in an open position. [Diagram 41] FIG. 41 is another perspective view of one embodiment of the proximal portion and mallet of the inserter tool of FIG. 40. [Diagram 42] FIG. 13 is a perspective view of yet another embodiment of an inserter tool. [Diagram 43] FIG. 43 is a cross-sectional view of a portion of the inserter tool of FIG. 42. [Diagram 44] FIG. 43 is a perspective view of a distal portion of the inserter tool of FIG. 42. [Diagram 45] 45 is a perspective view of a distal portion of the inserter tool of FIG. 44 with the inner shaft of the inserter tool advanced more distally relative to the outer shaft of the inserter tool. [Diagram 46]FIG. 43 is a perspective view of a proximal portion of the inserter tool of FIG. 42. [Figure 47] 46 is another perspective view of the distal portion of the inserter tool of FIG. 45 with the anchor advanced distally relative to the inner and outer shafts. FIG. [Figure 48] 43 is a cross-sectional view of the anchor and the inner and outer shafts of the inserter tool of FIG. 42. [Figure 49] FIG. 13 is a perspective view of yet another embodiment of an inserter tool. [Figure 50] FIG. 50 is a perspective view of a distal portion of the inserter tool of FIG. 49. [Figure 51] 50 is another perspective view of the distal portion of the inserter tool of FIG. 49. [Figure 51A] FIG. 1 is a perspective view of one embodiment of an anchor. [Figure 52] FIG. 50 is a cross-sectional view of a distal portion of the inserter tool of FIG. 49. [Figure 53] FIG. 50 is yet another perspective view of the distal portion of the inserter tool of FIG. 49. [Figure 54] 50 is a perspective view of a proximal portion of the inserter tool of FIG. 49 with the locking mechanism of the inserter tool in an unlocked position prior to striking the strike cap of the inserter tool. [Figure 55] FIG. 50 is a perspective view of a distal portion of the inserter tool of FIG. 49, with the locking feature of the inserter tool in a locked position. [Figure 56] FIG. 51 is a perspective view of the proximal portion of the inserter tool of FIG. 50 after striking the striking cap. [Figure 57] 50 is another perspective view of the inserter tool of FIG. 49 with the locking feature of the inserter tool in the locked position and another embodiment of a loading aid coupled to the inserter tool. [Figure 58] FIG. 58 is another perspective view of the inserter tool and loading aid of FIG. 57. [Figure 59] 53 is a cross-sectional view of the inserter tool of FIG. 52 and a suture extending through the sealed passage of the inserter tool. [Figure 60] 60 is a cross-sectional view of the inserter tool of FIG. 59 showing a distal force being applied to the anchor of the inserter tool. [Figure 61] 61 is a cross-sectional view of the inserter tool of FIG. 60 showing a distal force being continued to be applied to the anchor. [Figure 62] FIG. 62 is a perspective view of the inserter tool of FIG. 61 showing the anchor fully advanced distally after striking the strike cap of the inserter tool. [Figure 63] 63 is a cross-sectional view of the inserter tool of FIG. 62 showing a proximal force being applied to the inserter tool. [Figure 64] FIG. 64 is a cross-sectional view of the inserter tool of FIG. 63 showing a proximal force being continued to be applied to the inserter tool. [Figure 65] 65 is a cross-sectional view of the inserter tool of FIG. 64 showing a proximal force being continued to be applied to the inserter tool. [Figure 66] 13 is a cross-sectional view of a distal portion of another embodiment of an inserter tool. [Figure 67] 67 is a cross-sectional view of a distal portion of the inner shaft of the inserter tool of FIG. 66. [Figure 68] FIG. 67 is a cross-sectional view of the inserter tool of FIG. 66. [Figure 69] 67 is a cross-sectional view of a proximal portion of the inserter tool of FIG. 66 after actuation of the actuator of the inserter tool. [Figure 70] FIG. 13 is a perspective view of a distal portion of yet another embodiment of an inserter tool. [Figure 71] 71 is a perspective view of a distal portion of the inserter tool of FIG. 70 after actuation of the actuator of the inserter tool. [Figure 72] FIG. 13 is a perspective view of yet another embodiment of an inserter tool. [Figure 73] 73 is another perspective view of the inserter tool of FIG. 72 with the locking feature of the inserter tool in the locked position and with the loading aid of FIG. 57 coupled to the inserter tool. [Figure 74] FIG. 74 is another perspective view of the inserter tool and loading aid of FIG. 73. [Figure 75] FIG. 73 is a perspective view of the inserter tool of FIG. 72 after striking the striking cap of the inserter tool. [Figure 76] FIG. 73 is a perspective view of an intermediate portion of the inserter tool of FIG. 72. [Figure 77] FIG. 77 is another perspective view of the intermediate portion of the inserter tool of FIG. 76. [Figure 78] 78 is a perspective view of an intermediate portion of the inserter tool of FIG. 77 with a suture held by a suture holding channel of the inserter tool. [Figure 79] FIG. 73 is another perspective view of the intermediate portion of the inserter tool of FIG. 72. [Figure 80] FIG. 1 illustrates a perspective view of one embodiment of a tapered helical anchor. [Figure 81] FIG. 81 is an end view of the anchor of FIG. 80. [Figure 82] FIG. 13 is a perspective view of another embodiment of a tapered helical anchor. [Figure 83] FIG. 83 is an end view of the anchor of FIG. 82. [Figure 84] FIG. 13 is a perspective view of yet another embodiment of a tapered helical anchor. [Figure 85] FIG. 85 is an end view of the anchor of FIG. 84. [Figure 86] FIG. 13 is a perspective view of yet another embodiment of a tapered helical anchor. [Figure 87] FIG. 87 is an end view of the anchor of FIG. 86. [Figure 88] FIG. 13 is a perspective view of another embodiment of a tapered helical anchor. [Figure 89] FIG. 89 is an end view of the anchor of FIG. [Figure 90] FIG. 13 is a side view of yet another embodiment of a tapered helical anchor. [Figure 91] FIG. 91 is an end view of the anchor of FIG. 90. [Figure 92] FIG. 13 is a side view of yet another embodiment of a tapered helical anchor. [Figure 93] 93 is a perspective view of the anchor of FIG. 92 releasably coupled to the inserter tool of FIG. 1. [Figure 94] 93 is another perspective view of the anchor of FIG. 92 releasably coupled to the inserter tool of FIG. 1. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0066] Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices, systems, and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the devices, systems, and methods detailed herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the invention is defined solely by the claims. Features illustrated or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be within the scope of the invention.

[0067] Furthermore, in this disclosure, like-named components of the embodiments generally have similar characteristics, and therefore, in a particular embodiment, each feature of each like-named component is not necessarily described in full detail. Additionally, to the extent that linear or circular dimensions are used in describing the disclosed systems, devices, and methods, such dimensions are not intended to limit the types of shapes that can be used in conjunction with such systems, devices, and methods. Those skilled in the art will recognize that the equivalent of such linear and circular dimensions can be readily determined for any geometric shape. Those skilled in the art will understand that, although the dimensions are not exact values, they are likely to be close to the values ​​due to factors such as manufacturing tolerances and sensitivity of measuring equipment. The size and shape of the systems and devices and their components may depend at least on the subject's anatomical structure within which the systems and devices are used, the size and shape of the components with which the systems and devices are used, and the method and procedure in which the systems and devices are used.

[0068] Various exemplary systems and devices for knotless anchor insertion and methods of knotless anchor insertion are provided. In general, an inserter tool is configured for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool is configured to insert an anchor into a patient's bone to secure the soft tissue relative to the bone. Sutures coupled to the soft tissue are secured to the bone by being captured between an outer surface of the anchor and a bone surface defining a hole in the bone in which the anchor is positioned. Thus, the anchor allows for the sutures to be secured in place without the need for knots, which may be time consuming and / or difficult to perform during surgery due to small suture diameters, limited working area in the joint space, wet surgical environment, and / or limited visualization at the surgical site due to the challenging angles and tight nature of the joint space.

[0069] The inserter tool is configured to releasably couple each of the suture and anchor to insert each of the suture and anchor into the bone hole. The inserter tool is configured to position the suture within the bone hole before the anchor is secured to the bone hole. Thus, the inserter tool is configured to allow the suture to be under tension relative to the bone and anchor after the suture is positioned within the bone hole and before the anchor is secured to the bone hole to attach the suture in position relative to the bone, thereby allowing the soft tissue to be desirably positioned relative to the bone before being secured in position for healing. The inserter tool is configured to advance the anchor into the bone hole by longitudinally translating the anchor distally into the bone hole, for example, by striking the inserter tool with a mallet, hammer, or other tool, thereby capturing the suture between an outer surface of the anchor and a bone surface defining the bone hole. After the anchor is inserted into the bone, the inserter tool is configured to be longitudinally translated proximally so as to be removed from the patient's body with the suture remaining in the anchor and bone. By longitudinally translating the inserter tool along its longitudinal axis, separating the inserter tool from the suture and anchor may take less time and / or require the user to apply less force than other methods of separating the tool from the implanted anchor, including rotating the tool about its longitudinal axis. Unlike longitudinally translating the inserter tool for removal, rotating the tool for removal may cause the anchor to rotate and / or experience unintended off-axis loads that may prevent the anchor from being securely positioned in the bone and / or cause damage to the suture and / or anchor.

[0070] The suture is releasably coupled to the inserter tool before the inserter tool is advanced into the patient's body. In at least some embodiments, a loading aid is configured to facilitate coupling of the suture and the inserter tool. In general, the loading aid is configured to position the suture in a suture-holding channel of the inserter tool. The suture is configured to be slid into the suture-holding channel and snap-fit ​​therein using the loading aid. Thus, the suture does not need to be fed by the user through an aperture, eyelet, or other opening of the anchor or inserter tool coupled to the inserter tool for insertion into the patient's body. Feeding a suture through an aperture, eyelet, or other opening, similar to threading a needle, is time-consuming and / or difficult to perform due to small suture diameters, small opening diameters, and / or wet surgical environments. The loading aid is configured to properly align the suture with the suture retaining channel to facilitate sliding of the suture into the suture retaining channel, which relieves the user from the need to align the suture with the suture retaining channel by direct visual visualization or by electronic visualization, which may be time consuming and / or difficult to perform due to small suture diameters, small opening diameters, and / or wet surgical environments.

[0071] The suture retaining channel is located distal to the anchor releasably coupled to the inserter tool. Thus, the suture seated in the suture retaining channel can be positioned in a bone hole distal to the anchor, thereby allowing the anchor to be advanced distally into the bone hole with the suture already positioned therein. In an exemplary embodiment, the suture has a U-shape before and after the anchor is secured to the bone hole. In the U-shape, each of the legs of the suture extends longitudinally along opposing sides of the anchor, and an intermediate portion of the suture connecting the legs extends along the distal tip of the anchor to loop around the distal tip of the anchor. The U-shape configuration of the suture relative to the anchor can maximize the length of the suture that the anchor presses against to secure the suture in place relative to the bone, which can help ensure that the soft tissue coupled to the suture remains in place relative to the bone to facilitate healing.

[0072] The systems, devices, and methods described herein are applicable in a variety of surgical procedures for soft tissue repair, for example, in tissue repair surgical procedures in joints such as the shoulder, knee, or hip.

[0073] FIG. 1 illustrates one embodiment of an inserter tool 100, also referred to herein as an "inserter," for knotless anchor insertion in a soft tissue repair surgical procedure. In general, the inserter tool 100 is configured to insert the anchor 102 into a patient's bone to secure soft tissue relative to the bone. As shown in FIG. 2, an inner lumen 102i extends through the anchor 102 such that the anchor 102 is cannulated. A plurality of bone-engaging surface features 102f are formed on an outer surface of the anchor 102. The bone-engaging surface features 102f are configured to engage bone to retain the anchor 102 within the bone, e.g., to engage a surface of the bone that defines a bone hole within which the anchor 102 is positioned. The bone-engaging surface features 102f include a plurality of ribs that each extend circumferentially around the anchor 102 at different axial positions along the longitudinal length of the anchor. However, the bone engaging surface feature 102f may have another configuration, such as a plurality of barbs or other forms of protrusions formed on the outer surface of the anchor. The bone engaging surface feature 102f is also configured to engage the suture against the bone to aid in securing the suture to the bone.

[0074] The anchor 102 can be absorbable or non-absorbable. The anchor 102 can be made from any of a variety of materials, such as, for example, Polyether ether ketone (PEEK), Polylactic acid or polylactide (PLA), BIOCRYL®, BIOCRYL®, RAPIDE®, titanium, ceramic, carbon fiber, stainless steel, etc. The anchor 102 can be formed by a variety of techniques, such as, for example, machining, molding, metal injection molding, overmolding, or post-molding processes such as post-molding machining. Exemplary embodiments of anchors include HealixAdvance™ anchors and GRYPHON® anchors available from DePuy Mitek, Inc. of Raynham, MA, and various exemplary embodiments of anchors and their features are further described in U.S. Pat. No. 8,114,128, entitled "Cannulated Suture Anchor," issued on February 14, 2012, U.S. Pat. No. 8,882,801, entitled "Dual Thread Cannulated Suture Anchor," issued on November 11, 2014, and U.S. Pat. No. 8,133,257, entitled "Bioabsorbable Suture Anchor System For Use In Small Joints," issued on March 13, 2012, which are incorporated by reference in their entireties herein.

[0075] The inserter tool 100 includes a handle 106, an outer shaft 108 extending distally from the handle 106, an inner shaft 110 extending distally from the handle 106, and a strike cap 112 extending proximally from the handle 106. The handle 106 is configured to be held by hand during use of the inserter 100. In a robotic surgical implementation, the handle 106 may be held by a mechanical member of a robotic surgical system. The handle 106 has a generally cylindrical, distally tapered shape in this illustrated embodiment, but may have any of a variety of shapes. The handle 106 has an inner lumen 106i extending therethrough. The outer shaft 108 and the inner shaft 110 are positioned within the inner lumen 106i and extend distally out of the inner lumen 106i. The proximal ends of one or both of the outer shaft 108 and the inner shaft 110 may be located within the inner lumen 106, or one or both of the outer shaft 108 and the inner shaft 110 may extend proximally beyond the handle 106 such that the proximal ends of the respective outer shaft 108 and inner shaft 110 are located proximal to the handle 106. For example, as in this illustrated embodiment, the proximal end of the inner shaft 110 may be attached to the handle 106 and the proximal end of the outer shaft 108, also referred to herein as a "push tube", may be located within the inner lumen 106i of the handle 106. In another example, the proximal end of the inner shaft 110 may be attached to the handle 106 and the proximal end of the outer shaft 108 may be located proximal to the handle 106.

[0076] The distal end of the striking cap 112 abuts the proximal end of the push tube 108 in the initial insertion configuration, which can maximize the transfer of distal forces applied to the striking cap 112 to the push tube 108, thereby helping to efficiently advance the push tube 108 distally to advance the anchor 102 distally into the bone hole. However, the distal end of the striking cap may be spaced a distance proximal to the proximal end of the push tube, or the striking cap 112 may be integrally formed with the push tube 108. The striking cap 112 is configured to have its proximal surface 112s struck with a mallet, hammer, or other tool. The proximal surface 112s is substantially flat in this illustrated embodiment, which can facilitate a uniform strike of the striking cap 112, and thus a uniform transfer of distal forces from the striking cap 112 to the push tube 108. Those skilled in the art will appreciate that the surface may not be precisely flat and yet be considered substantially flat for any one or more reasons, such as manufacturing tolerances and sensitivity of the measurement equipment, etc. However, the proximal surface 112s may have another shape, e.g., textured with ribs, raised dome protrusions, or the like, convex, etc.

[0077] The inner lumen 108i extends through the outer shaft 108 such that the outer shaft 108 is cannulated. In the initial configuration of the inserter 100 shown in Figures 1 and 2, the inner shaft 110 is seated within the inner lumen 102i of the anchor 102 and within the inner lumen 108i of the outer shaft 108. Figure 2 is shown with a portion of the outer shaft 108 removed and without the inner shaft 110 therein to clarify the tubular configuration of the outer shaft at least in this portion of the outer shaft 108. The inner shaft 110 extends distally from the outer shaft 108 and anchor 102. The distal end 108d of the outer shaft 108 is located proximal to the proximal end 102p of the anchor 102. 1 and 2, the distal end 108d of the outer shaft abuts the proximal end 102p of the anchor in the initial configuration of the inserter, which can help maximize the transfer of distal forces applied to the push tube 108 to the anchor 102, thereby efficiently advancing the anchor 102 distally into the bone hole. However, the distal end 108d of the outer shaft may be spaced a distance proximal to the proximal end 102p of the anchor in the initial configuration of the inserter.

[0078] As in this illustrated embodiment, the locking mechanism 118 can be configured to be releasably coupled to the inserter tool 100. The locking mechanism 118 is configured to lock the outer shaft 108 in place relative to the inner shaft 110 when the locking mechanism 118 is coupled to the inserter tool 100. Thus, the locking mechanism 118 can help prevent premature distal advancement of the outer shaft 108 relative to the inner shaft 110, and thus premature distal advancement of the anchor 102 relative to the inner shaft 110. The locking mechanism 118 in this illustrated embodiment includes a clip that includes a pair of resilient legs 118g. The resilient legs 118g have a size and shape that allows the legs 118g to be positioned between a proximal surface of the handle 106 and a distal surface of the strike cap 112, seating a distal extension of the strike cap 112 therebetween. Thus, the locking mechanism 118 coupled to the inserter tool 100 prevents the strike cap 112 from moving distally relative to the handle 106, and therefore further prevents a strike on the strike cap 112 from pushing the push tube 108 distally, until the locking mechanism 118 is removed from the inserter tool 100. The locking mechanism 118 is configured to be removed from the inserter 100 by grasping the handle portion 118h of the locking mechanism 118 and pulling the locking mechanism 118 away from the inserter 100, which causes the resilient legs 118g to bend radially outwardly and release the strike cap 112 therefrom.

[0079] As shown in FIG 2, when the inserter 100 is in an initial configuration, the suture 114 releasably coupled to the inserter 100 has a U-shape. As described above, the U-shape of the suture 114 before the anchor 102 is inserted into the bone hole allows the suture 114 to have two legs 114g each extending longitudinally along either side of the anchor 102 and an intermediate portion 114i of the suture 114 connecting the legs 114g extending along the distal tip 102t of the anchor so as to loop around the distal tip 102t of the anchor after the anchor 102 is inserted into the bone hole. As also shown in FIG 3, the suture 114 includes two suture strands in this illustrated embodiment, but may include another number of suture strands, e.g., one, three, four, etc.

[0080] As shown in FIGS. 2 and 3, the inner shaft 110 includes a notch formed therein that defines a suture retaining channel 116. The notch is formed in a distal end of the inner shaft 110 and is defined by opposing distal arms 120 of the inner shaft 110. A proximal portion 116p of the suture retaining channel 116 is configured to seat a suture 114 therein. The proximal portion 116p of the suture retaining channel 116 has an open distal end and a closed proximal end that defines the proximal end of the suture retaining channel. A distal portion 116d of the suture retaining channel 116 extends distally from the proximal portion 116p of the suture retaining channel 116. The distal portion 116d of the suture retaining channel 116 has an open proximal end and an open distal end that defines the distal end of the suture retaining channel. Thus, the suture retaining channel 116 has a closed proximal end and an open distal end. The suture retaining channel 116 is configured to receive the suture 114 therein through the open distal end of the suture retaining channel. The suture 114 may then be moved through the distal portion 116d of the suture retaining channel 116 to be positioned at the proximal portion 116p of the suture retaining channel 116. The proximal portion 116p of the suture retaining channel 116 has a diameter D1 that is greater than the diameter D2 of the distal portion 116d of the suture retaining channel 116, which, if not prevented, may help to retain the suture 114 within the suture retaining channel 116 by impeding, if not preventing, the suture 114 from moving distally out of the suture retaining channel 116 before it is desired for the suture 114 to separate from the inserter tool 100.

[0081] The distal arms 120 of the inner shaft 110 are configured to bounce back and forth relative to one another, similar to tweezers arms. Movement of the distal arms 120 relative to one another is configured to change the diameter D2 of the distal portion 116d of the suture retaining channel 116 to facilitate seating and removal of the suture 114 within and from the suture retaining channel 116. FIGS. 2 and 3 show the arms 120 in a rest configuration in which the diameter D2 of the distal portion 116d of the suture retaining channel 116 is at a minimum. The arms 120 are configured to move from the rest configuration to an expanded configuration in which the arms 120 move radially outward such that the suture retaining channel 116 is larger and the diameter D2 of the distal portion 116d of the suture retaining channel 116 is increased above the diameter D1 at least in the distal portion of the distal portion 116d of the suture retaining channel. The expanded diameter D2 of distal portion 116d provides more room for suture 114 to enter suture retaining channel 116. Arm 120 is biased to a resting configuration such that arm 120 is configured to dynamically move from the resting configuration to an expanded configuration in response to suture 114 advancing proximally into suture retaining channel 116 such that arm 120 is configured to dynamically move from the expanded configuration to the resting configuration in response to suture 114 advancing proximally out of distal portion 116d of suture retaining channel 116 and into proximal portion 116p such that arm 120 is configured to dynamically move from the resting configuration to an expanded configuration in response to suture 114 advancing distally out of proximal portion 116p and into distal portion 116d and then out of suture retaining channel 116.

[0082] Because the suture(s) do not have to be folded for insertion into an opening, eyelet, or other opening that is coupled to the inserter tool or anchor, the suture retaining channel 116 may allow more sutures and / or larger diameter suture(s) to be coupled to the inserter 100 than with other types of inserter tools.

[0083] 1 and 2, the suture retaining channel 116 is located distal to the anchor 102 that is releasably coupled to the inserter tool 100. Thus, the suture 114 seated in the suture retaining channel 116 can be positioned within a bone hole distal to the anchor 102, thereby allowing the anchor 102 to be advanced distally into the bone hole with the suture already positioned within the bone hole.

[0084] The suture 114 is positioned within the suture holding channel 116 by a user of the inserter tool 100, which may provide the user of the inserter 100 with flexibility in determining the size and type of suture 114 to be used that is appropriate for a particular patient and a particular surgical procedure. The suture 114 may be manually positioned within the suture holding channel 116 by the user, similar to threading a needle. As an alternative to manual positioning, the suture 114 may be positioned within the suture holding channel 116 using a tool such as an extruder tube or a loading aid. One embodiment of a loading aid 122 is shown in FIGS. 1 and 4.

[0085] The distal portion of the inner shaft 110, including the arms 120, may be made from a shape memory or superelastic material, such as Nitinol or other material, which may facilitate movement of the arms 120 between a rest configuration and an expanded configuration. The rest configuration may be the default shape of the arms 120. In some embodiments, the only portion of the inner shaft 110 made from a shape memory or superelastic material may include the arms 120. In other embodiments, only the distal portion of the inner shaft 110 that extends distally from the outer shaft 108 may be made from a shape memory or superelastic material. In other embodiments, only the distal portion of the inner shaft 110 that extends distally to the anchor 102 is made from a shape memory or superelastic material.

[0086] 1 and 4 show the loading aid 122 positioned relative to the inserter tool 100 before the suture 114 is positioned within the suture retaining channel 116. The loading aid 122 is positioned on the distal end of the inserter tool 100, and in particular on the distal end of the inner shaft 110. The loading aid 122 is directly coupled to the inner shaft 110 in this illustrated embodiment, but may be indirectly coupled to the inner shaft 110, for example, by being directly coupled to another portion of the inserter 100, such as the outer shaft 108, or by being directly coupled to the anchor 102, with the inner shaft 110 seated in the inner lumen 102i of the anchor 102. In an exemplary embodiment, the loading aid 122 is pre-loaded onto the inserter tool 100 during manufacture, which may help ensure that the loading aid 122 is correctly positioned on the inserter 100 and / or may provide a reminder to a user of the inserter 100 that the suture 114 should be coupled to the inserter 100 before the inserter 100 is advanced into a patient's body. Alternatively, the loading aid 122 may be loaded onto the inserter tool 100 by a user, which may allow the inserter 100 to be sold without the loading aid 122 and therefore at a lower cost than an inserter 100 sold with the loading aid 122.

[0087] As shown in FIG. 5, the suture 114 is positioned in the distal seating groove 124 of the loading aid 122. The distal seating groove 124 is defined by opposing distal wings 126 of the loading aid 122. The distal wings 126 each extend radially outward to define a V-shape. Thus, the distal seating groove 124 is V-shaped. The distal seating groove 124 is located distal to the suture retaining channel 116 of the inner shaft. The suture 114 is then positioned on the inner surface 126s of one of the distal wings 126, as shown in FIG. 6, and slid proximally along the inner surface 126 of the distal wing to guide the suture 114 to the apex of the distal seating groove 124, e.g., to the point of the V-shape. The suture 114 can slide along either of the inner surfaces 126 of the distal wings. The suture 114 continues to be slid proximally into the longitudinal loading channel 128 of the loading aid 122. The loading channel 128 is aligned with the suture retaining channel 116. Thus, sliding the suture 114 proximally within the loading channel 128 causes the suture 114 to enter the suture retaining channel 116 and in particular the distal portion 116d thereof. Continued proximal movement of the suture 114 within the loading channel 128 and the suture retaining channel 116 seats the suture 114 in the proximal portion 116p of the suture retaining channel 116, as shown in FIGS. 7-9. The closed proximal end of the suture retaining channel 116 serves as a stop surface for the suture 114 within the suture retaining channel 116, although in some embodiments the suture 114 may be positioned at the proximal portion 116p and not abut a stop surface. As discussed above, the distal arms 118 of the inner shaft 110 may spread radially outward as the suture 114 passes into and through the distal portion 116d, and can spread radially inward to their rest position after the suture 114 exits the distal portion 116d and enters the proximal portion 116p.

[0088] As shown in FIG. 9 , the loading aid 122 includes a longitudinal release channel 130 located opposite the longitudinal loading channel 128 of the loading aid 122. The suture 114 also enters the release channel 130 as the suture 114 is slid proximally into the loading channel 128. The suture 114 also moves proximally within the release channel 130 as the suture 114 is slid further proximally within the loading channel 128 into the proximal portion 116p of the suture holding channel 116. The release channel 130 is configured to facilitate release of the loading aid 122 from the inserter tool 100. As shown in FIG. 10 , lateral movement of the loading aid 122 relative to the inserter 100 (or vice versa) moves the inserter 100, e.g., its inner shaft 110, through the release channel 130 to release the loading aid 122 from the inserter 100. The suture 114 also moves through the release channel 130 during removal of the loading aid from the inserter 100. Figures 2 and 3 show the inserter 100 with the loading aid 122 removed from the inserter 100 and the suture 114 positioned within the suture retaining channel 116.

[0089] Sliding the suture 114 along the inner surface 126 of the distal wing toward the loading channel 128 can help ensure that the suture 114 properly enters the loading channel 128 and therefore the suture 114 properly enters the suture holding channel 116, but the suture 114 does not need to slide along any of the inner surfaces 126s of the distal wing before entering the loading channel 128.

[0090] Instead of the loading aid 122 being held in place by hand and the suture 114 sliding relative to the loading aid 122, the suture 114 can be held by hand and the loading aid 122 moved relative thereto to position the suture 114 as described above. In an exemplary embodiment, the loading aid 122 is held in place by hand and the suture 114 moves relative thereto. The loading aid 122 includes opposing finger holders 132 configured to provide a surface that is easily held by the hand during use of the loading aid 122. By including the finger holders 132 on opposing sides of the loading aid 122, the loading aid 122 can be conveniently held by the left or right hand and in an easily held position regardless of the rotational position of the loading aid relative to the user. One of both finger holders 132 can be held at a time.

[0091] With the suture 114 coupled to the inserter 100, and with the loading aid 122 removed from the inserter 100 if the loading aid 122 is coupled to the inserter 100 to facilitate coupling the suture to the inserter 100, the inserter 100 can be used to insert the suture 114 and anchor 102 into the bone hole. In an exemplary embodiment in which the inserter 100 is used to insert the suture 114 and anchor 102 into the bone hole, a drill or other bone removal tool is inserted into the patient's body to form the bone hole, as will be understood by those skilled in the art. As will be further understood by those skilled in the art, the drill or other bone removal tool can be advanced into the patient's body through an opening, e.g., a cannula positioned in an incision, formed in the patient's skin, and then removed from the patient's body. The cannula can then serve as a guide for distal advancement of the inserter toward the bone hole.

[0092] The inserter 100 is advanced distally into the patient's body and positioned with the distal end of the inner shaft 110 within the bone hole. Thus, the suture 114 is positioned within the bone hole before the anchor 102 is secured thereto. The bottom surface of the bone hole can act as a stop surface to stop the distal movement of the inserter 100 relative to the bone. With the inserter 100 positioned within the bone hole, the interior of the bone hole cannot be visualized, and therefore the bottom surface of the bone hole acting as a stop can help ensure that the inserter 100 has advanced as distally as possible within the bone hole, and can help ensure that the anchor 102 is secured thereto with the proximal end of the anchor flush or nearly flush with the proximal end of the bone hole. Alternatively, the inserter 100 can be inserted into the bone hole a certain distance before the distal end of the anchor 102 engages the open proximal end of the bone hole. Because the anchor 102 cannot be easily advanced into the bone hole without impacting the striking cap 112, the distance that the inserter 100 protrudes from the anchor 102 controls the distance that the inserter 100 will advance into the bone hole.

[0093] With the distal end of the inner shaft 110 positioned within the bone hole, the suture 114 can be tensioned as desired prior to advancing the anchor 102 distally relative to the inner shaft 110. Alternatively, the tension in the suture 114 can be approximate prior to placing the inserter 100 within the bone hole, with advancement of the inserter 100 into the bone hole applying a tension approximately equal to the length of the distance the inserter protrudes from the distal end of the anchor 102. One of ordinary skill in the art will appreciate that the values ​​may not be exactly equal, but are nevertheless considered to be approximately equal for any one or more reasons, such as manufacturing tolerances and sensitivity of the measuring equipment.

[0094] With the distal end of the inner shaft 110 positioned within the bone hole, the locking mechanism 118 is removed from the inserter 100. The outer shaft 108 is now free to move relative to the inner shaft 110 in response to a strike against the striking cap 112.

[0095] With the distal end of the inner shaft 110 positioned within the bone hole, the anchor 102 is advanced distally into the bone hole by longitudinally translating the anchor 102 distally relative to the inner shaft 110. In other words, the anchor 102 is pushed axially along the longitudinal axis 104 of the inserter 100. The striking cap 112 is struck with a mallet, hammer, or other tool to move the outer tube 108 distally relative to the inner shaft 110 and to move the anchor 102 distally relative to the inner shaft 110 and advance it distally into the bone hole. The striking cap 112 may be struck one or more times to fully advance the anchor 102 into the bone hole. The anchor 102 in the bone hole captures the suture 114, e.g., its legs 114g, between the outer surface of the anchor 102 and the bone surface that defines the bone hole.

[0096] After the anchor 102 is inserted into the bone hole, the inserter 100, including the outer shaft 108 and inner shaft 110, is longitudinally translated proximally and, for example, pulled axially along the longitudinal axis 104 of the inserter 100 to remove it from the patient's body with the anchor 102 and suture 114 remaining within the bone. The suture 114 automatically exits the suture retaining channel 116 in the inner shaft in response to pulling the inner shaft 110 proximally out of the bone hole. The tails of the suture 114 can be trimmed if necessary.

[0097] FIG. 11 illustrates another embodiment of an inner shaft 200 of an inserter tool. The inner shaft 200 is constructed and used similarly to the inner shaft 110 of the inserter tool 100 of FIG. 1, except that the inner shaft suture retaining channel 202 has a narrower distal portion 202d defined by the inner shaft distal arm 204 as compared to the distal portion 116p of the suture retaining channel 116. In general, the narrower the distal portion of the suture retaining channel, the less likely a suture positioned within the suture retaining channel will prematurely exit the suture retaining channel through the distal portion, e.g., through its open distal end. FIG. 11 illustrates a suture 114 positioned in a proximal portion 202p of the suture retaining channel 202.

[0098] 12 and 13 show another embodiment of an inner shaft 300 of an inserter tool. In this illustrated embodiment, the inner shaft 300 is constructed and used similarly to the inner shaft 110 of the inserter tool 100 of FIG. 1, except that the suture-retaining channel 302 of the inner shaft does not have a longitudinal distal portion like the distal portion 116p of the suture-retaining channel 116. Instead, the distal portion 302d of the suture-retaining channel is a serpentine channel that follows a serpentine path. The serpentine path reduces the likelihood that a suture positioned within the suture-retaining channel 302 will prematurely exit the suture-retaining channel 302 through the distal portion 302d, e.g., through its open distal end. FIG. 12 shows a suture 114 positioned in the proximal portion 302p of the suture-retaining channel 302. FIG. 13 shows a loading aid 122 coupled to the inner shaft 300 to aid in seating the suture 114 within the suture retaining channel 302.

[0099] 14-16 show another embodiment of a loading aid 400. The loading aid 400 is shown in FIGS. 14-16 in use with the outer and inner shafts 108 and 110 of FIG. 1, the suture 114 of FIG. 2, and another embodiment of an anchor 402, but may be used with other outer and inner shafts and other anchors as well. In this illustrated embodiment, the loading aid 400 is constructed and used similarly to the loading aid 122 of FIG. 1, except that the opposing finger holders 404 of the loading aid 400 extend laterally outward further than the opposing finger holders 132 of the loading aid 122. FIG. 14 shows the loading aid 400 positioned relative to the inner shaft 110 before the suture 114 is positioned within the suture retaining channel 116. FIG. 15 shows the suture 114 positioned within the V-shaped distal seating groove 404 of the loading aid 400. Arrow 406 in Figure 15 indicates the proximal movement direction for movement of suture 114 into suture retaining channel 116. Figure 16 shows suture 114 seated within suture retaining channel 116 and within longitudinal loading channel 408 of loading aid 400. Arrow 410 in Figure 16 indicates the direction in which loading aid 400 can be moved relative to inner shaft 116 to remove it therefrom.

[0100] FIG. 17 illustrates another embodiment of an inserter tool 500 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 500 is generally configured and used similarly to the inserter tool 100 of FIG. 1, for example configured to insert an anchor into a patient's bone to secure soft tissue to the bone, and includes a handle 506, an outer shaft 508 extending distally from the handle 506, an inner shaft 510 extending distally from the handle 506, and a striking cap 512 extending proximally from the handle 506. However, in this illustrated embodiment, the inner shaft 510 does not include a notch or suture retaining channel. Instead, the inserter tool 510 includes a snare configured to seat a suture therein. As shown in FIG. 18, the snare is defined by a loop 516 of a flexible member 516f. A "flexible member" is also referred to herein as a "soft member." The flexible member 516f is configured to fold or bend without destroying, disintegrating, or otherwise losing structural integrity. The flexible member 516f is a single metal filament wire in this illustrated embodiment, but may have other configurations, such as metal multifilament wire, braided fabric, textile strands, monofilament fiber, etc. In some embodiments, the flexible member 516f may be made from a shape memory or superelastic material, such as Nitinol or other materials.

[0101] The loop 516 is located distal to the inner shaft 510, and thus distal to the anchor 102, with the inner shaft 510 positioned in the inner lumen 102i. The loop 516 has a horseshoe shape, with one end fixedly attached to the inserter 500 and one end free to not be fixedly attached to the inserter 500. The end of the flexible member 516f fixedly attached to the inserter 500 is fixedly attached to the outer shaft 508 of the inserter 500 in this illustrated embodiment, but can be attached to another portion of the inserter 500. The loop 516 cooperates with the distal end of the inner shaft 510 to define an enclosed passage 532. The suture is configured to seat within the loop 516, e.g., extend through the passage 532, during use of the inserter tool 500, e.g., similar to that described above with respect to the suture retaining channel 116 and as discussed further below. The free end of the loop 516 extends through the inner shaft 510 and out the handle 506, allowing a user to apply tension to the flexible member 516f, thereby adjusting the size of the passageway 532. The handle 506 can include a suture retaining member, such as a slot formed in the handle 506 and configured to releasably retain the suture by seating the suture in a quinch or pinch, a protrusion around which the suture can be tied or wrapped, or the like, which allows tension to be maintained in the flexible member 516f, and thus the size of the loop 516. Embodiments of suture retaining members are discussed further below.

[0102] The anchor 102 shown in FIG. 17 is the same anchor 102 as shown in FIG. 1, although other anchors can be used with the inserter tool 500 as well.

[0103] For this illustrated embodiment, the locking mechanism 518 may be configured to be releasably coupled to the inserter tool 500 to lock the outer shaft 508 in place relative to the inner shaft 510 when the locking mechanism 518 is coupled to the inserter tool 500. The locking mechanism 518 is generally constructed and used similarly to the locking mechanism 118 of FIG.

[0104] The suture is positioned within the loop 516 by a user of the inserter tool 500, which may provide the user of the inserter 500 with flexibility in determining the size and type of suture to be used that is appropriate for a particular patient and a particular surgical procedure. The suture may be manually positioned by the user within the loop 516, similar to threading a needle. As an alternative to manual positioning, the suture may be positioned within the loop 516 using a loading aid 522, shown in FIG. In embodiments in which the suture is positioned within the loop 516 by a user of the inserter tool 500, the user can manually adjust the size of the loop 516 as needed to aid in positioning the suture within the loop 516, by pulling the flexible member 516f, e.g., by moving a length of the flexible member 516f out of the inner shaft 510 to increase the size of the flexible member 516f, or by pushing the flexible member 516f, e.g., by moving a length of the flexible member 516f into the inner shaft 510 to decrease the size of the loop 516.

[0105] The loading aid 522 in this illustrated embodiment includes a suture threader. The suture threader can have a variety of configurations, as will be appreciated by those skilled in the art. In this illustrated embodiment, the loading aid 522 includes a base 524 and a wire loop 526 attached to the base 524, the wire loop 526 extending distally from the base 524 and defining an enclosed passageway 528. The wire loop 526 is formed by a single metal filament wire in this illustrated embodiment, but can have other configurations similar to the loop 516 described above. The suture 514 is configured to be seated within the passageway 528 defined by the loop 526, as shown in FIG. 19. The suture 514 is generally configured and used similarly to the suture 114 of FIG. 2, and includes two strands in this illustrated embodiment, but can include another number of strands, similar to that described above with respect to the suture 114. The suture 514 may be coupled to the loading aid 522 by the user, which may provide a user of the inserter 500 with flexibility in determining the size and type of suture to be used that is appropriate for a particular patient and a particular surgical procedure, and / or may allow the inserter 500 to be sold without the loading aid 522 and therefore at a lower cost than an inserter 500 sold with the loading aid 522.

[0106] With the suture 514 extending through the loop 526 of the loading aid 522, the loading aid 522 can be pulled by the base 524 to pull the suture 514 through the snare, for example, through the loop 516 defined by the flexible member 516f, as shown in FIG. 20. The suture 514 can then be released from the loading aid 522 by removing it from the passage 528 defined by the loop 526. FIG. 21 shows the suture 514 released from the loading aid 522 and extending through the loop 516 defined by the flexible member 516f. Thus, the suture 514 extending through the loop 516 is releasably coupled to the inserter 500 and has a U-shape when the inserter 500 is in its initial configuration, similar to that described above with respect to the suture 114 and the inserter 100 of FIG. 2.

[0107] With the suture 514 coupled to the inserter 500, and with the loading aid 522 detached from the suture 514, if a loading aid 522 was used to facilitate coupling the suture to the inserter 500, the inserter 500 may be used to insert the suture 514 and anchor 102 into the bone hole. In an exemplary embodiment in which the inserter 500 is used to insert the suture 514 and anchor 102 into the bone hole, a drill or other bone removal tool is inserted into the patient's body to form the bone hole, similar to that described above with respect to the inserter 100 of FIG.

[0108] The inserter 500 is advanced distally into the patient's body and positioned with the distal end of the inner shaft 510, and therefore the loop 516, within the bone hole. Thus, the suture 514 extending through the loop 516 is positioned within the bone hole before the anchor 102 is secured to the bone hole. The bottom surface of the bone hole can act as a stop surface to stop distal movement of the inserter 500 relative to the bone, similar to that described above with respect to the inserter 100 of FIG.

[0109] With the distal end of the inner shaft 510 positioned within the bone hole, the suture 514 can be tensioned, if desired, prior to advancing the anchor 102 distally relative to the inner shaft 510.

[0110] With the distal end of the inner shaft 510 positioned within the bone hole, the locking mechanism 518 is removed from the inserter 500. The outer shaft 508 is now free to move relative to the inner shaft 510 in response to a strike against the striking cap 512.

[0111] With the distal end of the inner shaft 510 positioned within the bone hole, the anchor 102 is advanced distally into the bone hole by striking the striking cap 512 and distally advancing the push tube 508, similar to that described above with respect to the inserter 100 of Figure 1, thereby translating the anchor 102 longitudinally distally relative to the inner shaft 510. The anchor 102 in the bone hole captures the suture 514 between an outer surface of the anchor 102 and the bone surface defining the bone hole.

[0112] After the anchor 102 is inserted into the bone hole, the inserter 500 is translated longitudinally proximally, e.g., pulled axially along the longitudinal axis 504 of the inserter 500, and removed from the patient's body with the anchor 102 and suture 514 remaining in the bone. Because one of the ends of the flexible member is free and the other of the ends of the flexible member is fixedly attached to the inserter 500, proximal movement of the inserter 500 spreads the snare. The end of the flexible member 516f attached to the inserter 500 moves proximally with the inserter 500, and the free end of the flexible member 516f slides within the inserter 500 until the free end of the flexible member 516f exits the open distal end of the inner shaft 510, causing the loop 516 to open and no longer exist as a loop. Continued proximal movement of the inserter 500 causes the entire flexible member 516f to exit the patient's body along with the inserter 500. With the loop 516 open and no longer present, the suture 514 may be released from the flexible member 516f and thus remain fixed in place within the bone hole. The tails of the suture 514 may be trimmed as necessary. Although not showing the suture 514 positioned within the bone hole, FIG. 22 shows the snare in its deployed configuration and also shows the free end 516e of the flexible member 516f.

[0113] 17 is a passive snare in which the suture 514 extends through the loop 516 of the flexible member 516f and is free to slide through the loop 516 until the anchor 502 secures the suture 514 in place relative to the bone. In other embodiments, the snare may be an active snare in which the snare securely engages the suture in the loop of the flexible member such that the suture extending through the loop cannot slide freely through the loop before or after the anchor secures the suture in place relative to the bone.

[0114] 23 illustrates another embodiment of an inserter tool 600 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 600 is generally configured and used similarly to the inserter tool 500 of FIG. 17, for example, configured to insert an anchor into a patient's bone to secure soft tissue to the bone, and includes a handle 606, an outer shaft 608 extending distally from the handle 606, an inner shaft 610 extending distally from the handle 606, a striking cap 612 extending proximally from the handle 606, and a snare defined by a loop of flexible member 616f. However, in this illustrated embodiment, the snare is an active snare. The flexible member 616f is a textile strand in this illustrated embodiment, but may have other configurations, for example, a metallic multifilament wire, a braided fabric, a single metallic filament wire, etc.

[0115] The loop defined by the flexible member 616f is generally constructed and used similarly to the loop 516 defined by the flexible member 516f, e.g., located distal to the inner shaft 610 and therefore distal to the anchor. The anchor has the inner shaft 610 positioned in its inner lumen, has a horseshoe shape, has one end 616e fixedly attached to the inserter 600 and has one end that is free so as not to be fixedly attached to the inserter 600. However, in this illustrated embodiment, the end 616e of the flexible member 616f that is fixedly attached to the inserter 600 is spring loaded. The fixed end 616e of the flexible member 616f is operably coupled to a spring 620 that is fixedly attached to the handle 606. The spring 620 is a coil spring in this illustrated embodiment, but could be another type of spring or biasing member. The spring 620 is configured to bias the flexible member 616f in a proximal direction, e.g., toward the handle 606. The spring 620 is thus configured to self-tension the loop on the suture passed through the loop. The suture may thus be held in a known fixed position relative to the inner shaft 610, which may help ensure that the anchor engages the proper length of each suture leg captured between the anchor and the bone. Before the user releases the flexible member 616f to allow the spring 620 to tension the flexible member 616f on the suture extending through the loop, the user may manually increase the size of the loop, as needed, to aid in placing the suture within the loop, e.g., by pulling on the flexible member 616f to move a length of the flexible member 616f out of the inner shaft 610 to increase the size of the loop. The suture may be manually positioned by a user within the loop defined by flexible member 616f, or the suture may be positioned within the loop defined by flexible member 616f using a loading aid, such as loading aid 522 of FIG. 19.

[0116] Similar to that described above, the free end of the loop defined by the flexible member 616f extends through the inner shaft 610 and out of the handle 606, allowing a user to apply tension to the flexible member 616f and thereby adjust the size of the loop. The handle 606 can include a suture retaining member, such as a slot formed in the handle 606 configured to releasably seat the suture with a quinch or pinch, a protrusion around which the suture can be tied or wrapped, or the like, which allows tension to be maintained in the flexible member 616f, and therefore the size of the loop.

[0117] For this illustrated embodiment, the locking mechanism 618 may be configured to be releasably coupled to the inserter tool 600 to lock the outer shaft 608 in place relative to the inner shaft 610 when the locking mechanism 618 is coupled to the inserter tool 600. The locking mechanism 618 is generally constructed and used similarly to the locking mechanism 118 of FIG.

[0118] FIG. 24 illustrates another embodiment of an inserter tool 700 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 700 is generally configured and used similarly to the inserter tool 600 of FIG. 23, e.g., configured to insert an anchor 702 into a patient's bone to secure soft tissue to the bone, and includes a handle 706, an outer shaft 708 extending distally from the handle 706, an inner shaft 710 positioned inside the outer shaft 708, a striking cap extending proximally from the handle 706, and a snare that is active and defined by a loop 716 of a flexible member 716f. A locking mechanism can be used. The loop 716 defined by the flexible member 716f is generally configured and used similarly to the loop defined by the flexible member 616f, e.g., located distal to the inner shaft 710 and therefore distal to the anchor 702. The anchor 702 has a horseshoe shape and has one end 716e fixedly attached to the inserter 700 and one end 716r that is free so as not to be fixedly attached to the inserter 700. However, in this illustrated embodiment, the fixed end 716e of the flexible member 716f is fixedly attached to the inner shaft 710 and loops around a pulley 720 located proximally of the inner shaft 710. The pulley 720 in this illustrated embodiment is fixedly attached to the inner wall of the outer shaft 708, but may be located elsewhere, such as in the handle 706. The fixed end 716e of the flexible member 716f is fixedly attached to the inner shaft 710 at a proximal surface, for example, by crimping, welding, tying, etc., but may be attached to another portion of the inner shaft 710. The flexible member 716f is a single metal filament wire in this illustrated embodiment, but may have other configurations, for example, a metal multifilament wire, a braided fabric, a textile strand, etc.

[0119] When the inserter 700 is in the initial configuration shown in Figures 24 and 25, the anchor 702 is disposed within the inner lumen 708i of the outer shaft 708. The distal end 708d of the inner shaft abuts the proximal end 702p of the anchor in the initial configuration of the inserter. Thus, the inner shaft 710 in this illustrated embodiment is configured to be pushed distally relative to the outer shaft 708, for example by striking the striking cap, to advance the anchor 702 distally out of the outer shaft 708 and embed into bone. Distal advancement of the inner shaft 710 relative to the outer shaft 708 moves the flexible member 716f around the pulley 720, widening the snare until the free end 716r of the flexible member 716f exits the open distal end of the outer shaft 708, as shown in Figure 26, thereby eliminating the loop 716. A first arrow 722 in FIG. 26 indicates distal movement of the anchor 702 and inner shaft 710, and a second arrow 724 in FIG. 26 indicates simultaneous proximal movement of the flexible member 716f into the inner lumen 708i of the outer shaft as the flexible member 716f moves around the pulley 720.

[0120] Each of the embodiments of the inserter tools 100, 500, 600, 700 described above with respect to Figures 1, 11, 12, 17, 23, and 24 are configured to insert an anchor and a suture into a patient's bone that will remain in the bone after the inserter tool is removed from the patient's body. In other embodiments, the inserter tool may be configured to insert an anchor, a suture, and a distal cap into a patient's bone that will remain in the bone after the inserter tool is removed from the patient's body. In such embodiments, a flexible member does not need to be used to define a loop through which the suture passes, as the suture can instead pass through a sealed passage defined by the distal cap and the inner shaft of the inserter tool.

[0121] FIG. 27 illustrates another embodiment of an inserter tool 800 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 800 is generally constructed and used similarly to the inserter tool 100 of FIG. 1, e.g., configured to insert an anchor 802 into a patient's bone to secure soft tissue to the bone, and includes a handle, an outer shaft 808 extending distally from the handle, an inner shaft 810 extending distally from the handle, and a striking cap extending proximally from the handle. A locking mechanism may be used. The anchor 802 is generally constructed and used similarly to the anchor 102 of FIG. 1.

[0122] However, in this illustrated embodiment, the notch 804 formed in the distal end of the inner shaft 810 does not completely define a suture retaining channel. Instead, the notch 804 cooperates with the distal cap 812 to define a sealed passage 832 similar to the sealed passage 532 of the loop 516 described above with respect to the inserter tool 500 of FIG. 17. FIG. 28 shows the outer shaft 808 and inner shaft 810 without the remainder of the inserter 800. FIG. 29 shows the suture 814 extending through the sealed passage 832. The distal cap 812 is configured to prevent the suture 814 from migrating distally out of the sealed passage 832 before it is desired that the suture 814 separate from the inserter tool 800.

[0123] The anchor 802 has a distal groove 802g formed therein configured to seat the suture 814 therein prior to advancing the anchor 802 into the bone, as shown in Fig. 29. The distal groove 802g is defined by opposing arcs formed at the distal end of the anchor in this illustrated embodiment, however, the distal groove 802g can have another shape, for example, a scalloped shape defined by multiple arcs formed at the distal end of the anchor, opposing longitudinal slots, opposing rectangular notches, etc.

[0124] The distal cap 812 is located distal to the anchor 802 and is releasably coupled to the inner shaft 810. The distal cap 812 is a solid member. The distal cap 812 can be absorbent or non-absorbent. Although the distal cap 812 in this illustrated embodiment has a cylindrical body with a pointed distal tapered tip, the distal cap 812 can have another shape, for example, a cylinder without a pointed distal tapered tip, a cylindrical body with a blunt distal tapered tip, a square pyramid, etc.

[0125] The inner shaft 810 is configured to separate from the distal cap 812 in response to the outer shaft 808 being pushed distally to secure the anchor 802 and suture 814 to the bone, for example, via a strike of the strike cap, and the inner shaft 810 being moved proximally to remove the inner shaft 810 and the remainder of the inserter tool 800 from the patient's body. Thus, the distal cap 812 may remain embedded within the patient's body along with the anchor 802 and suture 814. Separation of the inner shaft 810 from the distal cap 802 also eliminates the sealed passageway 832. FIG. 30 illustrates the relative positions of the distal cap 812, anchor 802, and suture 814 after being embedded in a bone hole 818 formed in a bone 816. The distal groove 802g of the anchor 802 is also configured to seat the suture 814 therein after the anchor 802 is advanced into the bone hole 818, as shown in FIG. 30. However, depending on one or more factors, such as the size of the bone hole, the size of the suture, the size of the anchor 802, and the tension applied to the suture 814, the suture 814 may not seat in the groove 802g after implantation, and instead may be located distal to the groove 802g within the bone hole.

[0126] The suture 814 may be manually positioned by a user in the sealed passage 832, or the suture 814 may be positioned in the sealed passage 832 using a loading aid. For example, the loading aid 522 of FIG. 19 may be used to load the suture 814 into the sealed passage 832, similar to that described above with respect to the loading aid 522 used to thread the suture 514 through the loop 516. In another example, another embodiment of the loading aid 822 shown in FIG. 31 may be used to load the suture 814 into the sealed passage 832.

[0127] 31 shows the loading aid 822 positioned relative to the inserter tool 800 before the suture 814 is positioned within the sealed passageway 832. In an exemplary embodiment, the loading aid 822 is preloaded onto the inserter tool 800 during manufacture, which may help ensure that the loading aid 822 is correctly positioned relative to the inner shaft 810 and distal cap 812 and / or may provide a reminder to the user of the inserter 800 that the suture 814 should be coupled to the inserter 800 before the inserter 800 is advanced into the patient's body. Alternatively, the loading aid 822 may be loaded onto the inserter tool 800 by the user, which may allow the inserter 800 to be sold without the loading aid 822 and therefore at a lower cost than an inserter 800 sold with the loading aid 822.

[0128] As shown in FIGS. 31 and 32, the loading aid 822 includes a distal seating groove 824, a plunger 826, a slide loader 828, a plurality of guide members 830, and a cavity 834 formed therein.

[0129] The plurality of guide members 830 are configured as seating guides for the inner shaft 810 to position the inner shaft 810, and thus its notch 804, in an optimal position relative to the distal cap 812 for suture loading. The guide members 830 define a seating channel 836 therebetween configured to seat the inner shaft 810 therein. The guide members 830 are sized and shaped such that the seating channel 836 has a size and shape that allows the inner shaft 810 to be releasably snapped in and out of the seating channel 836. The guide members 830 are positioned alternately on either side of the seating channel 836 along its length. The loading aid 822 includes three guide members 820 in this illustrated embodiment, but may include another number of guide members. For example, the loading aid 822 may include two guide members 830 each extending along the entire length of the seating channel 836 defined therebetween. In another example, the loading aid may include four or more guide members 830 positioned alternately on either side of the seating channel 836 along the length of the seating channel 836. The guide members 830 each include an elongated rectangular block in this illustrated embodiment, but may have other shapes, e.g., a half dome, a square block, etc.

[0130] Distal seating groove 824 is defined by opposing distal wings 838 of loading aid 822. Distal wings 826 each extend radially outward to define a V-shape. Thus, distal seating groove 824 is V-shaped.

[0131] The cavity 834 is located at the apex of the V-shaped distal seating groove 824 and is distal to the seating channel 836. Thus, as shown in FIGURE 32, the notch 804 of the inner shaft 810 is positioned proximal to the cavity 834 with the inner shaft 810 and distal cap 812 coupled to the loading aid 822. The sealed passageway 832 is not yet present in FIGURES 31 and 32.

[0132] As shown in FIG. 31 , the suture 814 is positioned within the distal seating groove 824 of the loading aid 822. The suture 814 is then positioned on the inner surface 838s of one of the distal wings 838, as shown in FIG. 6 , and slid proximally along the inner surface 838s of the distal wing to guide the suture 814 to the apex of the distal seating groove 824, for example, to a V-shaped point. The suture 814 can slide along either of the inner surfaces 838s of the distal wings. The suture 114 continues to be slid proximally to enter the notch 804 of the inner shaft 810. The proximal surface of the notch 804 acts as a stop surface for the suture 814 within the notch 804, although in some embodiments the suture 814 may be positioned within the notch 804 but not abut a stop surface.

[0133] With the suture 814 positioned in the notch 804, the sliding loader 828 is actuated to move the distal cap 812 into the cavity 834. The sliding loader 828 is configured to be actuated by sliding the loader 828 radially inward, for example by a user pushing on a head of the loader 828, which moves the distal cap 812, previously seated in the loading aid 822, radially inward and into the cavity 834. FIG. 32 shows the loading aid 822 after actuation of the sliding loader 828. Because the distal cap 812 is not seated in the cavity 834 before the suture 814 is positioned in the notch 804, the suture 814 can slide from the distal seating cavity 824 into the notch 804.

[0134] With the distal cap 812 seated in the cavity 834, the plunger 826 is actuated to push the distal cap 812 proximally towards the inner shaft 810, thereby forming a sealed passageway 832 with the suture 814 extending through the sealed passageway 832. The plunger 826 is configured to be actuated by sliding the plunger 826 proximally, for example by a user pushing on the head of the plunger 826, which moves the distal cap 812 out of the cavity 834 and seats it on the distal end of the inner shaft 810. FIG. 33 shows the loading aid 822 after actuation of the plunger 826. The inserter tool 800 can then be removed from the loading aid 822 by releasing the inner shaft 810 from the guide member 830 (e.g., by allowing the inner shaft 810 to slip out of the seating channel 836), with the suture 814 extending through the sealed passage 834.

[0135] As described above with respect to the inserter tool 500 of FIG. 17, the inserter tool 500 may include a suture retaining member configured to releasably hold the suture to keep the suture in a desired position at a desired tension. Any of the inserter tools described herein may include a suture retaining member. Sutures are traditionally held using hemostats. An inserter tool including a suture retaining member may eliminate the need to use a hemostat for the suture.

[0136] 34 illustrates another embodiment of an inserter tool 900 for knotless anchor insertion in a soft tissue repair surgical procedure. The handle 906 of the inserter tool 900 can similarly be used as a handle for any of the inserter tool handles described herein.

[0137] As shown in FIGS. 34-37, the handle 906 includes a suture retaining member 904 configured to releasably hold the suture to keep the suture in a desired position at a desired tension. The suture retaining member 904 is located at a distal end of the handle 906, which may help to avoid interference with a user's hold on the handle 906. However, the suture retaining member 904 may be located elsewhere on the handle 906. The suture retaining member 904 in this illustrated embodiment includes a groove 904g formed in the handle 906 configured to seat the suture therein. The groove 904g may have any of a variety of shapes, e.g., U-shaped, V-shaped, half-dome shaped, W-shaped, rectangular, etc. The suture retaining member 904 also includes a rocker switch 904r configured to be selectively moved into and out of alignment with the groove 904g. In some embodiments, the rocker switch 904r may be spring biased into alignment with the groove 904g, which may help hold the suture in place within the groove 904g.

[0138] One or more surfaces of the handle 906 that define the groove 904g may include gripping features 904f thereon configured to facilitate gripping of the suture within the groove 904g. The gripping surfaces 904f are configured to provide friction with the suture to help hold the suture in place within the groove 904g when the rocker switch 904r is aligned with the groove 904g. In an exemplary embodiment, at least the surface 906s of the handle 906 that faces the rocker switch 904r includes gripping features 904f as in this illustrated embodiment because the rocker switch 904r biases the suture against its surface 906s when aligned with the groove 904g. The gripping features 904f include a ribbed textured surface in this illustrated embodiment, but may have other configurations, such as another type of textured surface, surface protrusions, etc.

[0139] 34-36 show the rocker switch 904r not aligned with the groove 904g. FIG. 37 shows the rocker switch 904r aligned with the groove 904g, with the suture 914 seated in the groove 904g and held by the suture holding member 904. FIG. 37 also shows one embodiment of a method of using the inserter tool 900 including the suture holding member 904 in a surgical procedure. In this illustrated embodiment, the surgical procedure is performed in a shoulder joint, but as mentioned above, the inserter tool 900 and other embodiments of the inserter tools described herein can be used in a variety of other surgical procedures. As shown in FIG. 37, the cannula 912 can be positioned on the skin 914 of a patient. The suture 914 can extend through an inner lumen 912i of the cannula 912 into the patient's body (e.g., secured in place relative to a bone and through the soft tissue of the bone). With the suture 914 extending into the patient's body, a drill or other bone removal tool can be advanced through the inner lumen 912i of the cannula 912 into the patient's body to form a bone hole. The drill or other bone removal tool can then be removed from the cannula 912. The inserter tool 900 can then be "zipped" along the suture 914 through the inner lumen 912i of the cannula 912 to position the distal end of the inserter tool 900 within the bone hole. The suture 914 can be released from the suture retaining mechanism 904 at any time and repositioned within the suture retaining mechanism 904 as many times as desired.

[0140] The striking surface of each of the striking caps 112, 512, 612 shown in Figures 1, 17, and 23 is exposed for striking with a mallet, hammer, or other tool. In other embodiments, the inserter tool may include a striking cap and a protective member configured to cover or conceal at least the striking surface of the striking cap. The protective member may help prevent premature striking of the striking cap and / or unintended distal movement of the striking cap and, therefore, unintended distal advancement of an anchor coupled to the inserter tool. In some embodiments, the protective member may completely cover or conceal the striking cap.

[0141] 38-41 show another embodiment of an inserter tool 1000 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 1000 in this illustrated embodiment includes a protective member 1004 configured to cover or hide a strike cap 1012 of the inserter tool 1000. The protective member 1004 may be used with any of the inserter tools described herein.

[0142] The protective member 1004 is configured to move between a closed position, shown in FIGS. 38 and 39, and an open position, shown in FIGS. 40 and 41. FIG. 41 also shows one embodiment of a mallet 1016 configured to strike the striking cap 1012. In the closed position, the protective member 1004 covers or conceals at least one striking surface 1012s of the striking cap 1012. In this illustrated embodiment, the entire striking cap 1012s is covered or concealed by the striking cap 1012 with the striking cap 1012 in the closed position. In the open position, at least the striking surface 1012s of the striking cap 1012 is exposed. In this illustrated embodiment, the entire striking cap 1012s is exposed with the striking cap 1012 in the open position.

[0143] The protective member 1004 is configured to move from a closed position to an open position and vice versa in a flip-top manner. The protective member 1004 is attached to the handle 1006 of the inserter tool 1000 using a living hinge 1014. Alternatively, the protective member 1004 may be attached to the handle 1006 of the inserter tool 1000 with another type of hinge. The hinge 1014 is configured to hold the protective member 1004 to the handle 1006 regardless of whether the protective member 1004 is in the closed or open position. The protective member 1004 can be opened and closed with one hand by flipping it open and closed, which may improve ease of use since a user can open and close the protective member 1004 without changing the hand grip of the handle 1006.

[0144] 42-48 illustrate another embodiment of an inserter tool 1100 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 1100 is generally constructed and used similarly to the inserter tool 100 of FIG. 1, e.g., configured to insert an anchor 1102 into a patient's bone to secure soft tissue to the bone, and includes a handle 1106, an outer shaft 1108 extending distally from the handle 1106, an inner shaft 1110 extending distally from the handle 1106, and a striking cap 1112 extending proximally from the handle 1106. The anchor 1102 is generally constructed and used similarly to the anchor 102 of FIG.

[0145] However, unlike the inserter tool described above, the outer shaft 1108 and the inner shaft 1110 in this illustrated embodiment are not linear. Instead, as shown in Figures 42, 44, 45, and 47, the outer shaft 1108 and the inner shaft 1110 are curved at their distal portions. In this illustrated embodiment, the outer shaft 1108 and the inner shaft 1110 are curved, but the outer shaft 1108 and the inner shaft 1110 can be linear instead. Similarly, the inserter tool described above can have curved inner and outer shafts instead of linear inner and outer shafts. Because the patient's anatomy at the joint can be constrained and therefore difficult to access the target site, the outer shaft 1008 and the inner shaft 1110 being curved at their distal portions can facilitate the distal end of the inserter tool accessing the target site to implant the anchor 1102. The curvature of the outer shaft 1008 and the inner shaft 1110 is fixed in this illustrated embodiment.

[0146] Further, in this illustrated embodiment, as shown in Figures 44, 45, 47, and 48, an opening 1104 is formed in the distal end of the inner shaft 1110 and configured to seat a suture therein. The opening 1104 defines a sealed passageway through which the suture is configured to extend, similar to the sealed passageways described above. The opening 1104 has an oval cross-sectional shape in this illustrated embodiment, but may have another cross-sectional shape, e.g., circular, rectangular, etc. The distal end of the inner shaft 1110 in this illustrated embodiment is a closed distal end. In this illustrated embodiment, the closed distal end is rounded.

[0147] 44 shows the inner shaft 1110 in a loading position with the opening 1104 located distal to the anchor 1102 and distal to the open distal end of the outer shaft 1108. Thus, the opening 1104 is accessible for loading a suture therethrough. In some embodiments, the suture is positioned within the opening 1104 during manufacture. Thus, a user of the inserter tool 1100 receives the inserter tool 1100 with the inserter tool 1100 preloaded therein. In other embodiments, the suture is positioned within the opening 1104 by the user of the inserter tool 1100, which may provide the user of the inserter tool 1100 with versatility in determining the size and type of suture to be used that is appropriate for a particular patient and a particular surgical procedure. The suture may be manually positioned by the user within the opening 1104, similar to threading a needle. Alternatively to manual positioning, the suture may be positioned within the opening 1104 using a loading aid, such as loading aid 522 of FIG.

[0148] With the suture extending through the opening 1104, the distal end of the inner shaft 1110 is advanced distally into the bone hole. The inserter 1100 includes a collar 1118 operably coupled to the inner shaft 1110, as shown in FIG. 43. Sliding the collar 1118 relative to the handle 1106 moves the inner shaft 1110 distally relative to the anchor 1102 and outer shaft 1108 such that the inner shaft 1110 extends distally a distance beyond the outer shaft 1108 and anchor 1102, as shown in FIG. 45. The opening 1104 is thereby positioned within the bone hole a distance distal to the outer shaft 1108 and anchor 1102. The distance the inner shaft 1110 advances distally beyond the outer shaft 1108 and anchor 1102 will vary based on the depth of the bone hole into which the inner shaft 1110 is advanced.

[0149] The collar 1118 includes opposing finger retaining portions 1118f that extend radially through a slot 1114 formed in the handle 1106. The finger retaining portions 1118f are configured to provide a surface that is easily held by a hand during movement of the collar 1118. By including finger retaining portions 1118f on opposing sides of the collar 1118, the collar 1118 can be conveniently held by either the left or right hand and easily in a held position regardless of the rotational position of the loading aid relative to the user. One of both finger retaining portions 1118f can be held at a time. The finger retaining portions 1118f move distally within the slots 1114 as the collar 1118 moves distally relative to the handle 1106.

[0150] The inserter tool 1100 includes a spring 1116 disposed within the handle 1106 and operably coupled to a collar 1118. The spring 1116 is a coil spring in this illustrated embodiment, but could be another type of spring or biasing member. The spring 1116 biases the collar 1118 proximally. Thus, the inner shaft 1110 is biased proximally. Distal advancement of the collar 1118 relative to the handle 1106 compresses the spring 1116. The collar 1118 can be locked in place relative to the collar 1118 in a distally advanced position to lock the inner shaft 1110 in a distally advanced position relative to the outer shaft 1108 and anchor 1102. Because the inner shaft 1110 is coupled to the collar 1118, when the collar 1118 is locked in a distal position, the collar 1118 also locks the inner shaft 1110 distally.

[0151] With the inner shaft 1110 and the opening 1104 through which the suture extends are positioned within the bone hole, the anchor 1102 is advanced distally by striking the striking cap 1112 with a mallet, hammer, or other tool. Striking the striking cap 1112, in this illustrated embodiment, does not cause the outer shaft 1108 to move distally to push the anchor 1102 distally. Instead, because the distal extension of the striking cap 1112 extends distally through the outer shaft 1108, as shown in FIG. 43 , the distal surface of the striking cap 1112 abuts the proximal surface of the anchor 1102. Thus, striking the striking cap 1112 moves the striking cap 1112 distally to push the anchor 1102 distally relative to the outer shaft 1108 and inner shaft 1110. 45, 47, and 48 show the anchor 1102 advanced partially distally out of the outer shaft 1108.

[0152] As described above, advancement of the anchor 1102 into the bone hole causes the bone-engaging surface features 1102f of the anchor 1102 to engage the walls of the bone hole to secure the anchor 1102 therein and the suture to the bone. The bone-engaging surface features 1102f in this illustrated embodiment include a plurality of ribs, each extending circumferentially around the anchor 1102 at different axial positions along the longitudinal length of the anchor. Each of the ribs has a scalloped proximal edge, which may further facilitate engagement of the anchor with the bone. As shown in FIG. 48, the ribs are narrower at the proximal portion of the anchor 1102 than at the distal portion of the anchor 1102. Narrower ribs may facilitate engagement of the anchor with the cortical bone and wider ribs may facilitate engagement of the anchor with the cancellous bone underlying the cortical bone.

[0153] Once the anchor 1102 is positioned within the bone hole and the sutures are captured therein as described above, the inserter tool 1100 can be removed from the patient's body. The collar 1118 can be moved proximally relative to the handle 1106 and the inner shaft 1110 can be moved proximally to retract relative to the anchor 1102, the outer shaft 1108, and the handle 1106. The inner shaft 1110 can then be removed from the patient's body by pulling the inserter 1100 proximally with the handle 1106, thereby moving the outer shaft 1108 and the inner shaft 1110 proximally. The suture tails can be trimmed if necessary.

[0154] 49-54 illustrate another embodiment of an inserter tool 1200 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 1200 is generally constructed and used similarly to the inserter tool 100 of FIG. 1, e.g., configured to insert an anchor 1202 into a patient's bone to secure soft tissue to the bone, and includes a handle 1206, an outer shaft 1208 extending distally from the handle 1206, an inner shaft 1210 extending distally from the handle 1206, and includes a notch formed therein defining a suture retaining channel 1204, and a strike cap 1212 extending proximally from the handle 1206.

[0155] The anchor 1202 is generally constructed and used similarly to the anchor 102 of FIG. 1. FIG. 51A shows the anchor as a stand-alone element. A plurality of bone-engaging surface features 1202f are formed on an outer surface of the anchor 1202. The bone-engaging surface features 1202f in this illustrated embodiment include a plurality of ribs that each extend circumferentially around the anchor 1202 at different axial positions along the longitudinal length of the anchor. The anchor 1202 in this illustrated embodiment includes a plurality of gussets 1202g configured to reinforce the anchor 1202. The gussets 1202g each extend longitudinally along the anchor 1202. A first set of gussets 1202g1 are aligned with one another along the length of the anchor, a second set of gussets 1202g2 are aligned with one another along the length of the anchor, a third set of gussets 1202g are aligned with one another along the length of the anchor, and a fourth set of gussets 1202g are aligned with one another along the length of the anchor. The third and fourth sets of gussets 1202g are not apparent in FIG. 51A. The first, second, third, and fourth sets of gussets 1202g are disposed equidistantly around the circumference of the anchor 1202, which may help to stiffen the anchor 1202 about its entire circumference. In other embodiments, the anchor may include a different number of gusset sets and / or the gusset sets may be disposed non-equidistantly around the circumference of the anchor.

[0156] 1, e.g., the notch is formed in a distal end of the inner shaft 1210 and is defined by opposing distal arms 1220 of the inner shaft 1210, the suture retaining channel 1204 has an open distal end and a closed proximal end, and the suture retaining channel 1204 extends longitudinally. The suture retaining channel 1204 has a substantially constant diameter in this illustrated embodiment, although different portions may have different diameters, e.g., the proximal portion of the suture retaining channel 1204 has a larger diameter than the distal portion of the suture retaining channel, the distal portion of the suture retaining channel 1204 has a larger diameter than the proximal portion of the suture retaining channel, or other different diameters. Those skilled in the art will appreciate that values ​​such as diameter values ​​may not be exactly the same, but are nevertheless considered to be substantially the same, for any one or more reasons, such as manufacturing tolerances and sensitivity of the measurement equipment.

[0157] The handle 1206 in this illustrated embodiment includes facets 1206f on opposing sides, e.g., its left and right sides, which are configured to aid in a user's grip and fine motor movements.

[0158] In this illustrated embodiment, the inserter tool 1200 includes a flexible member 1216. As mentioned above, a "flexible member" is also referred to herein as a "flexible member." The flexible member 1216 is configured to fold or bend without destroying, disintegrating, or otherwise losing structural integrity. The flexible member 1216 is a single metal filament wire in this illustrated embodiment, but may have other configurations, such as a metal multifilament wire, a braided fabric, a textile strand, a monofilament fiber, etc.

[0159] The flexible member 1216 is located distal to the anchor 1202 with the inner shaft 1210 positioned within its inner lumen. The flexible member 1216 has a first end 1216a that is fixedly attached to the inner shaft 1210 and has a second end 1216b that is free to not be fixedly attached to the inner shaft 1210.

[0160] The first end 1216a of the flexible member 1216 may be fixedly attached to the inner shaft 1210 in one or more ways, such as by being crimped to the inner shaft 1210, by being glued to the inner shaft 1210 using an adhesive, by being welded to the inner shaft 1210, or by being attached using another attachment mechanism. In this illustrated embodiment, the inner shaft 1210 includes a cavity 1218 formed therein configured to fixedly seat the first end 1216a of the flexible member 1216 therein. The first end 1216a of the flexible member 1216 is fixedly attached within the cavity 1218 of the inner shaft 1210. The cavity 1218 is formed in a sidewall of the inner shaft 1210 and extends substantially perpendicular to the longitudinal axis of the inner shaft 1210, and thus is substantially perpendicular to the longitudinal axis of the outer shaft 1208, which is coaxial with the longitudinal axis of the inner shaft 1210. One skilled in the art will appreciate that these axes may not be exactly perpendicular, but are nevertheless considered to be substantially perpendicular for any one or more reasons, such as manufacturing tolerances and sensitivities of the measurement equipment. The cavity 1218 extending substantially perpendicular to the longitudinal axis of the inner shaft 1210 may help prevent the first end 1216a of the flexible member 1216 from being pulled away from the inner shaft 1210 during movement of the flexible member 1216, as discussed further below. As shown in FIGS. 52 and 53, the cavity 1218 is formed in the inner shaft 1210 proximal to the arm 1220 and distal to the anchor 1202.

[0161] The inner shaft 1210 includes a groove 1222 configured to releasably seat the second end 1216b of the flexible member 1216 therein. The groove 1222 is formed in a first one of the distal arms 1220 of the inner shaft and extends into the distal arm 1220 through a distal tip of the distal arm 1220. The groove 1222 is formed on a side of the inner shaft 1210 opposite the cavity 1218, e.g., on the right side opposite the left side. Thus, when the second end 1216b of the flexible member 1216 is released from the groove 1222, e.g., when the second end 1216b moves distally out of the groove 1222, the flexible member 1216 is urged toward the side of the inner shaft 1210 in which the cavity 1218 is formed.

[0162] The inner shaft 1210 also includes a bore 1224 formed therein configured to seat the flexible member 1216 therein. The bore 1224 is located between the cavity 1218 and the groove 1222 such that an intermediate portion of the flexible member 1216, located between the first end 1216a and the second end 1216b of the flexible member 1216, extends through the bore 1224. The bore 1224 is formed in the one of the distal arms 1220 of the inner shaft that does not have the groove 1222 formed therein and is formed on the same side of the shaft 1210 as the cavity 1218. The holes 1224 are configured to help constrain the bending motion of the flexible member 1216 to a distal portion of the flexible member 1216 extending from the holes 1224 to the grooves 1222, which may help prevent the flexible member 1216 from becoming entangled with or otherwise interfering with any objects during surgical use.

[0163] The flexible member 1216 cooperates with the distal end of the inner shaft 1210 to define a sealed passageway 1232. The inner shaft 1210 defines three sides of the sealed passageway 1232, with the distal surface of the inner shaft 1210 defining a proximal side of the sealed passageway 1232 and the distal arm 1220 defining opposing sides (e.g., left and right sides) of the sealed passageway 1232. The flexible member 1216 defines a fourth and final side of the sealed passageway 1232. In particular, a distal portion of the flexible member 1215 extending between the hole 1224 and the groove 1222 defines the fourth and final side of the sealed passageway 1232. The suture is configured to extend through the suture retaining channel 1216 and the sealed passage 1232 during use of the inserter tool 1200, similar to that described above with respect to the suture retaining channel 116 and as discussed further below. The flexible member 1216 is configured to move to open the sealed passage 1232, thereby allowing release of the suture from the suture retaining channel 1216, as discussed further below. Generally, the flexible member 1216 is configured to bend to move out of the groove 1222 and open the sealed passage 1232 by no longer providing a fourth side of the sealed passage 1232.

[0164] In an exemplary embodiment, the flexible member 1216 is made from a superelastic material such as Nitinol or other material. The flexible member 1216 can have a default bent shape that corresponds to the shape of the flexible member 1216 that cooperates with the inner shaft 1210 to form a sealed passageway 1232 with the flexible member 1216 seated in the groove 1222, which can help ensure that the second end 1216b of the flexible member 1216 remains seated in the groove 1222 until desired.

[0165] The handle 1206 in this illustrated embodiment includes a suture retaining member 1234 configured to releasably retain a suture to keep the suture in a desired position at a desired tension. The suture retaining member 1234 is located at a distal end of the handle 1206, but can be located elsewhere, as described above. The suture retaining member 1234 in this illustrated embodiment includes a pair of grooves on opposing sides (e.g., left and right sides) of the handle 1206. Providing the suture retaining members 1234 on opposing sides of the handle 1206 may help accommodate use of the inserter tool 1200 by left-handed and right-handed users and / or may facilitate engagement of a suture with one of the suture retaining members 1234 regardless of the orientation in which the inserter tool 1200 is held and the angle of the suture's approach into the handle 1206.

[0166] A first one of the suture retaining grooves is defined between the handle 1206 and a first elastomeric cleat 1236a fixedly attached to the handle 1206. A second one of the suture retaining grooves is defined between the handle 1206 and a second elastomeric cleat 1236b fixedly attached to the handle 1206. The first elastomeric cleat 1236a and the second elastomeric cleat 1236b are each made from an elastomeric material such as rubber or other polymer. The handle 1206 is made from a rigid, non-elastomeric material such as a plastic such as polycarbonate or other plastic, a metal (e.g., stainless steel, titanium, etc.), polytetrafluoroethylene (PTFE), or other biocompatible material. Thus, each groove is located at a junction between an elastomeric material and a rigid material. The elastomeric material of the first elastomeric crete 1236a and the second elastomeric crete 1236b dynamically increases the width of the associated groove to adjust to the size and shape of the suture seated therein, allowing the suture to be securely held in the groove and gripped between the elastomeric material and the rigid material. Thus, the suture retaining member 1234 is self-adjusting. Different sutures have different sizes and shapes, and the first elastomeric crete 1236a and the second elastomeric crete 236b are each configured to dynamically adapt to the particular size and shape of the suture seated therein. Having the suture securely held in the groove can help ensure that tension in the suture is maintained, for example, without reduction, while the suture is held by the suture retaining member 1234. Once the suture is released from the grooves, the elastomeric cleat 1236a, 1236b no longer grips the suture and thus is allowed to return to its original smaller width as the elastomeric material elastically returns to its original configuration.

[0167] The suture retaining member 1234 is located in a hammerhead-shaped portion of the inserter tool 1200 defined by the handle 1206 and the elastomeric creases 1236a, 1236b. A proximal surface of the hammerhead-shaped portion defined by the proximal surface of the handle 1206 and the proximal of each of the elastomeric creases 1236a, 1236b extends radially outward and tapers distally. The taper is configured to urge the suture along the proximal surface of the handle 1206 toward one of the elastomeric creases 1236a, 1236b to seat the suture in the associated groove. Each of the elastomeric creases 1236a, 1236b has a beveled edge facing the associated groove, which may also help urge the suture into the groove.

[0168] As in this illustrated embodiment, the locking mechanism 1238 can be configured to lock the outer shaft 1208 in place relative to the inner shaft 1210 when the locking mechanism 1238 is in a locked position. FIGS. 55, 57, and 58 show the locking mechanism 1238 in a locked position. FIGS. 49 and 54 show the locking mechanism 1238 in an unlocked position where the outer shaft 1208 is not locked in place relative to the inner shaft 1210. The locking mechanism 1238 is configured to move from the locked position to the unlocked position by sliding relative to the outer shaft 1208, the inner shaft 1210, the striking cap 1212, and the handle 1206. The sliding movement of the locking mechanism 1238 is a lateral movement substantially perpendicular to the longitudinal axes of the outer shaft 1208 and the inner shaft 1210. The initial position of the locking mechanism 1238 is a locked position to help prevent premature distal translation of the outer shaft 1208 relative to the inner shaft 1210.

[0169] The locking feature 1238 includes a recess 1238d on its side. The recess 1238d is configured to communicate where to place a finger on the locking feature 1238. The recess surface is configured as a push surface on which a finger can be placed to push the locking feature 1238 from the locked position to the unlocked position. The curvature of the recess 1238 matches the curvature of the handle 1206 adjacent the locking feature 1238 in the unlocked position. The matching curvature of the recess 1238 and the handle 1206 is configured to indicate to a user that the locking feature 1238 has been fully moved to the unlocked position.

[0170] The locking mechanism 1238 includes a keyway 1240 formed therein, within which the outer shaft 1208 and the striking cap 1212 are configured to move, respectively. The keyway 1240 includes a reduced diameter portion 1240a and an enlarged diameter portion 1240b. With the locking mechanism 1238 in the locked position, the outer shaft 1208 extends through the reduced diameter portion 1240a and the striking cap 1212 is located proximal to the keyway 1240. The diameter of the reduced diameter portion 1240a is smaller than the diameter of the striking cap 1212 at least at the distal end of the end cap 1212. Thus, the striking cap 1212 cannot move distally into the keyway 1240, thereby preventing the outer shaft 1208 from moving distally by striking the proximal surface 1212s of the striking cap 1212. The proximal surface 1212s in this illustrated embodiment is convexly curved, which may provide more feedback (compared to a flat surface) to a user striking the striking cap 1212. With the locking mechanism 1238 in the unlocked position, the outer shaft 1208 extends through the enlarged diameter portion 1240b and the striking cap 1212 is located proximal to the keyway 1240. The diameter of the enlarged diameter portion 1240b is greater than the diameter of the striking cap 1212 at least at the distal end of the striking cap 1212. Thus, the striking cap 1212 can move distally into the keyway 1240, thereby allowing the outer shaft 1208 to move distally by striking the proximal surface 1212s of the striking cap 1212. The diameter of the enlarged diameter portion 1240b is smaller than the diameter of the head of the striking cap 1212, including the proximal surface 1212s, thereby preventing the striking cap 1212 from passing completely through the keyway 1240 as the distal surface of the striking cap 1212 abuts the locking feature 1238 about the keyway 1240. FIG. 56 shows the locking feature 1238 in an unlocked position with the distal surface of the striking cap 1212 abutting the locking feature 1238 about the keyway 1240 after the striking cap 1212 has been struck.

[0171] The locking mechanism 1238 in this illustrated embodiment is not releasable from the inserter tool 1200 .

[0172] The suture is positioned within the sealed passageway 1232 by a user of the inserter tool 1200, which may provide the user of the inserter tool 1200 with flexibility in determining the size and type of suture to be used that is appropriate for a particular patient and a particular surgical procedure. The suture may be manually positioned by the user within the sealed passageway 1232, similar to threading a needle. As an alternative to manual positioning, the suture may be positioned within the sealed passageway 1232 using a loading aid, such as the loading aid 1242 shown in FIGS. 57 and 58.

[0173] The loading aid 1242 in this illustrated embodiment includes a suture threader. The suture threader can have a variety of configurations, as will be appreciated by those skilled in the art. In this illustrated embodiment, the loading aid 1242 is generally constructed and used similarly to the loading aid 522, including, for example, a base 1244 and a wire loop 1246 attached to the base 1244 and defining an enclosed passageway 1248. The wire loop 1246 is formed by a single metal filament wire in this illustrated embodiment, but may have other configurations similar to the loop 516 described above. The suture is configured to seat within the passageway 1248 defined by the loop 1246. The suture may be coupled to the loading aid 1242 by the user, which may provide a user of the inserter tool 1200 with flexibility in determining the size and type of suture to be used that is appropriate for a particular patient and a particular surgical procedure, and / or may allow the inserter tool 1200 to be sold without the loading aid 1242 and therefore at a lower cost than an inserter tool 1200 sold with the loading aid 1242.

[0174] The loading aid 1242 in this illustrated embodiment is configured to be releasably attached to the inserter tool 1200. FIGS. 57 and 58 show the loading aid 1242 releasably attached to the inserter tool 1200. The base 1244 of the loading aid 1242 includes a plurality of clips 1252 configured to releasably clip to the outer shaft 1208 to releasably attach the loading aid 1242 to the inserter tool 1200. The loading aid 1242 includes three clips 1252 in this illustrated embodiment, two of the clips 1252 clipped to one side of the outer shaft 1208 and a third of the clips 1252 located between the other two clips 1252 clipped to the other side of the outer shaft 1208, although the loading aid 1242 may include another number of clips 1252.

[0175] With the suture 1250 extending through the loop 1246 of the loading aid 1242, the loading aid 1242 can be pulled by the base 1244 in the direction of the arrow 1254 on the base 1244 (e.g., printed, etched, adhered as a sticker, etc.) to release the clip 1252 from the outer shaft 1208 and pull the suture 1250 through the sealed passage 1232 defined by the inner shaft 1210 and the flexible member 1216, thereby threading the suture 1250 through the sealed passage 1232. The location of the arrow 1254 on the base 1244 indicates to a user where to hold the loading aid 1242 while removing it from the inserter tool to which it is coupled. The suture 1250 may then be released from the loading aid 1242 by being removed from the loading aid passage 1248 defined by the loop 1246. FIG. 59 shows the suture 1250 released from the loading aid 1242 and extending through the sealed passage 1232. Thus, the suture 1250 extending through the sealed passage 1232 is releasably coupled to the inserter tool 1200 and has a U-shape with the inserter tool 1200 in its initial configuration, similar to that described above with respect to the suture 114 and inserter 100 of FIG. 2. The suture 1250 is generally constructed and used similarly to the suture 114 of FIG. 2, and includes two strands in this illustrated embodiment, but may include another number of strands, similar to that described above with respect to the suture 114.

[0176] With the suture 1250 coupled to the inserter tool 1200, and with the loading aid 1242 removed if used to facilitate coupling the suture to the inserter tool 1200, the inserter tool 1200 can be used to insert the suture 1250 and anchor 1202 into the bone hole. In an exemplary embodiment in which the inserter tool 1200 is used to insert the suture 1250 and anchor 1202 into the bone hole, a drill or other bone removal tool is inserted into the patient's body to form the bone hole, similar to that described above with respect to the inserter 100 of FIG.

[0177] The inserter tool 1200 is advanced distally into the patient's body and positioned with the distal end of the inner shaft 1210, and thus the sealed passage 1232, within the bone hole. The suture 1250 extending through the sealed passage 1232 is thus positioned within the bone hole before the anchor 1202 is secured thereto. The bottom surface of the bone hole can act as a stop surface to stop distal movement of the inserter tool 1200 relative to the bone, similar to that described above with respect to the inserter 100 of FIG.

[0178] With the distal end of the inner shaft 1210 positioned within the bone hole, the suture 1250 may be tensioned as desired and held by the suture holding member 1234 prior to advancing the anchor 1250 distally relative to the inner shaft 1210.

[0179] With the distal end of the inner shaft 1210 positioned within the bone hole, the locking mechanism 1238 is moved from a locked position to an unlocked position, as described above. The outer shaft 1208 is now free to move relative to the inner shaft 1210 in response to a strike on the strike cap 1212. With the distal end of the inner shaft 1210 positioned within the bone hole, striking the strike cap 1212 to distally advance the outer shaft 1208 advances the anchor 1202 distally into the bone hole by longitudinally translating the anchor 1202 distally relative to the inner shaft 1210, in a manner similar to that described above with respect to the inserter 100 of FIG. 1. The anchor 1202 within the bone hole captures the suture 1250 between an outer surface of the anchor 1202 and the bone surface defining the bone hole. FIG. 60 illustrates a distal force (represented by arrow 1254) applied to the anchor 1202 from distal movement of the outer shaft 1208 caused by a strike against the strike cap 1212. FIG. 61 illustrates continued application of distal force to the anchor 1202 with the anchor 1202 moving distally from its position in FIG. 60. The outer shaft 1208 abuts the proximal end 1202p of the anchor 1202 in FIG. 61 (and FIG. 60), but is not shown for clarity of illustration. FIG. 62 illustrates the anchor 1202 fully advanced distally by, for example, distal axial translation of the outer shaft 1208 with the distal surface of the strike cap abutting the locking feature 1238 as described above.

[0180] After the anchor 1202 is inserted into the bone hole, the inserter tool 1200 is translated longitudinally in the proximal direction and pulled axially along the longitudinal axis 1204 of the inserter tool 1200, for example, as shown by arrow 1256 in Figures 63-65, to remove it from the patient's body with the anchor 1202 and suture 1250 remaining within the bone. Because the second end 1216b of the flexible member 1216 is free and the first end 1216a of the flexible member 1216 is fixedly attached to the inserter tool 1200, the proximal movement of the inserter tool 1200 causes the flexible member 1216 to bend. As the first end 1216a of the flexible member 1216 attached to the inserter tool 1200 moves proximally with the inserter tool 1200, the flexible member 1216 bends and the free second end 1216b of the flexible member 1216 slides out of the groove 1222, thereby opening the sealed passageway 1232 and allowing the suture 1250 to exit, as shown in FIG. 64. The cavity 1218 extending substantially perpendicular to the longitudinal axis of the inner shaft 1210 may help prevent the first end 1216a of the flexible member 1216 from being pulled away from the inner shaft 1210 during proximal movement of the inner shaft 1210, thereby causing bending of the flexible member 1216 to open the sealed passageway 1232 as the flexible member 1216 bends away from the longitudinal axis of the inner shaft 1210. Continued proximal movement of the inserter tool 1200 causes the entire flexible member 1216 to exit the patient's body along with the inserter tool 1200. With the sealed passage 1232 opening, the suture 1250 is released from the sealed passage 1232, and therefore from the suture retaining channel 1204, and thus may remain secured in place within the bone hole by the anchor 1202, as shown in FIG. 65. The tails of the suture 1250 may be trimmed as necessary. Although the suture 1250 is shown distal to the anchor 1202 in FIG. 65, the suture 1250 may be located completely or partially within the anchor 1202, for example, in embodiments where the anchor 1202 has an open distal end.

[0181] The flexible member 1216 in this illustrated embodiment is passive such that the suture 1250 extends through the sealed passage 1232 and is freely slidable through the sealed passage 1232 until the anchor 1202 secures the suture 1250 in place relative to the bone.

[0182] 66-69 illustrate another embodiment of an inserter tool 1300 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 1300 is generally constructed and used similarly to the inserter tool 1200 of Figures 49-54, e.g., configured to insert an anchor 1302 into a patient's bone to secure soft tissue to the bone, and includes a handle 1306, an outer shaft 1308 extending distally from the handle 1306, an inner shaft 1310 extending distally from the handle 1306, a notch formed therein that defines a suture retaining channel 1304, a flexible member 1316 that cooperates with the inner shaft 1310 to define an enclosed passageway 1332, and a suture retaining member defined by the handle 1306 and first and second elastomeric cleat fixedly attached to the handle 1306 (only one of the elastomeric cleat 1336a is shown in Figures 68 and 69). The anchor 1302 is generally constructed and used similarly to the anchor 102 of Figure 1. Although not shown in Figures 66-69, the inserter tool 1300, similar to the inserter tool 1200, also includes a striking cap extending proximally from the handle 1306 and a locking mechanism configured to lock the outer shaft 1308 in position relative to the inner shaft 1310 when the locking mechanism is in a locked position.

[0183] The flexible member 1316 has a first end fixedly attached to the handle 1306 and a second end that is free to not be fixedly attached to the handle 1306. The inner shaft 1310 includes a groove 1322 configured to releasably seat the second end 1216a of the flexible member 1216 therein, similar to the groove 1222 that seats the second end 1216a of the flexible member 1216 therein. The first end of the flexible member 1316 is fixedly attached to the actuator 1314 at the handle 1306. The first end of the flexible member 1316 may be attached to the actuator 1314 in any of a variety of ways, similar to those described above with respect to the first end 1216a of the flexible member 1216 being fixedly attached to the inner shaft 1210.

[0184] The flexible member 1216 extends from the actuator 1314 to a groove 1322 in the inner lumen of the outer shaft 1308 in which the inner shaft 1310 is disposed, as shown in Figures 66 and 68. The inner shaft 1310 includes a longitudinal channel 1320 extending longitudinally along the inner shaft 1310 configured to seat the flexible member 1216 therein. The flexible member 1216 bends to exit the longitudinal channel 1320 to allow a second end of the flexible member 1216 to seat in the groove 1322 of the inner shaft.

[0185] The flexible member 1216 of the inserter tool 1200 is a passive member, as described above. In this illustrated embodiment, the flexible member 1316 is an active member. The flexible member 1316 is configured to be actively moved to open the sealed passageway 1332 using an actuator 1314. Actuation of the actuator 1314 is configured to move the flexible member 1316 to open the sealed passageway 1332. The actuator 1314 is a slidable trigger in this illustrated embodiment, but may have other configurations, e.g., a rotatable knob, a retractable lever, etc.

[0186] The actuator 1314 is configured to move between an unactuated position and an actuated position. In the unactuated position, shown in FIG. 68, the flexible member 1316 is seated within the groove 1322 of the inner shaft 1310 and a sealed passage 1332 is present to receive a suture therethrough. The suture can be positioned within the sealed passage 1332 in a manner similar to that described above with respect to the suture positioned within the sealed passage 1232. In the actuated position, shown in FIG. 69, the flexible member 1316 is not seated within the groove 1322 of the inner shaft 1310 and the sealed passage 1332 is open, allowing the suture to exit the suture retaining channel of the inner shaft 1310. In some embodiments, the flexible member 1316 does not have sufficient stiffness to bend back into the groove 1322 when the actuator 1314 is actuated a second time to slide proximally. In other embodiments, the flexible member 1316 is stiff enough to bend back into the groove 1322 when the actuator 1314 is actuated a second time and slid proximally.

[0187] The handle 1306 includes a channel 1326 configured to slidably seat the actuator 1314 therein. The actuator 1314 is user-accessible outside of the channel 1326. The actuator 1314 is configured to slide proximally within the channel 1326 relative to the handle 1306, the outer shaft 1308, and the inner shaft 1310 from an unactuated position to an actuated position. Proximal movement of the actuator 1314 is configured to move the flexible member 1316 proximally relative to the handle 1306, the outer shaft 1308, and the inner shaft 1310. Proximal movement of the flexible member 1316 causes a second end of the flexible member 1316 to exit the groove 1322 in the inner shaft 1310, thereby opening the sealed passageway 1332.

[0188] With the suture coupled to the inserter tool 1300, and with the loading aid removed if used to facilitate coupling of the suture to the inserter tool 1300, the inserter tool 1300 can be used to insert the suture and anchor 1302 into the bone hole. In an exemplary embodiment in which the inserter tool 1300 is used to insert the suture and anchor 1302 into the bone hole, a drill or other bone removal tool is inserted into the patient's body to form the bone hole, similar to that described above with respect to the inserter 100 of FIG.

[0189] The inserter tool 1300 is advanced distally into the patient's body and positioned with the distal end of the inner shaft 1310, and thus the sealed passage 1332, within the bone hole. Thus, the suture extending through the sealed passage 1332 is positioned within the bone hole before the anchor 1302 is secured to the bone hole. The bottom surface of the bone hole can act as a stop surface to stop distal movement of the inserter tool 1300 relative to the bone, similar to that described above with respect to the inserter 100 of FIG.

[0190] With the distal end of the inner shaft 1310 positioned within the bone hole, the suture may be tensioned as desired and held by the suture holding member 1300 of the inserter tool 1300 prior to advancing the anchor 1302 distally relative to the inner shaft 1310.

[0191] With the distal end of the inner shaft 1310 positioned within the bone hole, the locking mechanism is moved from a locked position to an unlocked position, as described above. The outer shaft 1308 is now free to move relative to the inner shaft 1310 in response to a strike on the strike cap. With the distal end of the inner shaft 1310 positioned within the bone hole, striking the strike cap to distally advance the outer shaft 1308 advances the anchor 1302 distally into the bone hole by longitudinally translating the anchor 1302 distally relative to the inner shaft 1310, similar to that described above with respect to the inserter 100 of FIG. 1. The anchor 1302 in the bone hole captures the suture between an outer surface of the anchor 1302 and the bone surface defining the bone hole.

[0192] After the anchor 1302 is inserted into the bone hole, the actuator 1314 is actuated, e.g., slid proximally within the handle channel 1326, to move the flexible member 1316 and open the sealed passageway 1332. Because the second end of the flexible member 1316 is free and the first end of the flexible member 1316 is fixedly attached to the actuator 1314, proximal movement of the actuator 1314 moves the flexible member 1316 proximally. The first end of the flexible member 1316, which is attached to the actuator 1314, moves proximally with the actuator 1314, and the free second end of the flexible member 1316 slides out of the groove 1322, opening the sealed passageway 1332 to allow the suture to exit therefrom. The opening of the sealed passageway 1332 allows the suture to exit the sealed passageway 1332 and, therefore, the suture retaining channel 1304.

[0193] With the sealed passage 1332 open, e.g., after actuation of the actuator 1314, the inserter tool 1300 is longitudinally translated proximally and, e.g., pulled axially along the longitudinal axis of the inserter tool 1300 to remove it from the patient's body with the anchor 1302 and suture remaining within the bone. The proximal movement of the inserter tool 1300 causes the entire flexible member 1316 to exit the patient's body with the inserter tool 1300. The suture tails can be trimmed if necessary.

[0194] 70 and 71 show another embodiment of an inserter tool 1400 for knotless anchor insertion in a soft tissue repair surgical procedure. The inserter tool 1400 is generally constructed and used similarly to the inserter tool 100 of FIG. 1, e.g., configured to insert an anchor 1402 into a patient's bone to secure soft tissue to the bone, and includes a handle (not shown), an outer shaft (not shown) extending distally from the handle, an inner shaft 1410 (not shown) extending distally from the handle, a striking cap (not shown) extending proximally from the handle, a locking mechanism (not shown) configured to lock the outer shaft in place relative to the inner shaft 1410 when the locking mechanism is in a locked position, and a suture retaining member (not shown). The anchor 1402 is generally constructed and used similarly to the anchor 102 of FIG. 1.

[0195] In this illustrated embodiment, the inner shaft 1410 includes a first component 1410a and a second component 1410b that cooperate to define a sealed passageway 1432 configured to receive a suture therethrough similar to the sealed passageway described above. FIG. 70 shows the first component 1410a and the second component 1410b in an engaged position that cooperates to define the sealed passageway 1432. The engaged position is an initial position of the first component 1410a and the second component 1410b. The distal tips of the first component 1410a and the second component 1410b are interlocked in the engaged position, which allows the sealed passageway 1432 to exist. The first component 1410a and the second component 1410b are dovetailed to interlock in this illustrated embodiment, but may interlock in other manners. 71 shows the first component 1410a and the second component 1410b in a disengaged position with the sealed passageway 1432 open. The second component 1410b is configured to move relative to the first component 1410a to move from an engaged position to a disengaged position.

[0196] The inserter tool 1400 includes an actuator (not shown) configured to be actuated to move the second component 1410b relative to the first component 1410a. The actuator is generally configured and used similarly to the actuator 1214 of the inserter tool 1200, for example by being a slidable trigger or other actuator. The actuator is configured to move between an unactuated position corresponding to an engaged position of the first component 1410a and the second component 1410b, and an actuated position corresponding to a disengaged position of the first component 1410a and the second component 1410b.

[0197] With the suture coupled to the inserter tool 1400, and with the loading aid removed if a loading aid is used to facilitate coupling of the suture to the inserter tool 1400, the inserter tool 1400 can be used to insert the suture and anchor 1402 into the bone hole. In an exemplary embodiment in which the inserter tool 1400 is used to insert the suture and anchor 1402 into the bone hole, a drill or other bone removal tool is inserted into the patient's body to form the bone hole, similar to that described above with respect to the inserter 100 of FIG.

[0198] The inserter tool 1400 is advanced distally into the patient's body and positioned with the distal end of the inner shaft 1410, and thus the sealed passage 1432, within the bone hole. Thus, the suture extending through the sealed passage 1432 is positioned within the bone hole before the anchor 1402 is secured to the bone hole. The bottom surface of the bone hole can act as a stop surface to stop distal movement of the inserter tool 1400 relative to the bone, similar to that described above with respect to the inserter 100 of FIG.

[0199] With the distal end of the inner shaft 1410 positioned within the bone hole, the suture may be tensioned as desired and held by the suture holding member 1300 of the inserter tool 1400 before advancing the anchor 1402 distally relative to the inner shaft 1410.

[0200] With the distal end of the inner shaft 1410 positioned within the bone hole, the locking mechanism is moved from a locked position to an unlocked position, as described above. The outer shaft is now free to move relative to the inner shaft 1410 in response to a strike on the strike cap. With the distal end of the inner shaft 1410 positioned within the bone hole, striking the strike cap to distally advance the outer shaft advances the anchor 1402 distally longitudinally relative to the inner shaft 1410, thereby advancing the anchor 1402 distally into the bone hole, in a manner similar to that described above with respect to the inserter 100 of FIG. 1. The anchor 1402 in the bone hole captures the suture between an outer surface of the anchor 1402 and the bone surface defining the bone hole.

[0201] After the anchor 1402 is inserted into the bone hole, the actuator is actuated, for example, by sliding it distally within a channel in the handle or otherwise actuated, to move the second component 1410b distally relative to the first component 1410b, thereby opening the sealed passage 1432. Opening the sealed passage 1432 allows the suture to exit the sealed passage 1432.

[0202] The sealed passage 1432 opens, and after actuation, for example, of an actuator, the inserter tool 1400 is longitudinally translated proximally and, for example, pulled axially along the longitudinal axis of the inserter tool 1400 to remove it from the patient's body with the anchor 1402 and suture remaining in the bone. The suture tails can be trimmed if necessary.

[0203] The inserter tools 100, 500, 600, 700, 800, 900, 1000, 1200, 1300, 1400 described above have linear outer and inner shafts, but as described above may have curved outer and inner shafts. Similarly, and further as described above, the inserter tool 1100 has curved outer and inner shafts, but may have linear outer and inner shafts. Figures 72-79 show another embodiment of an inserter tool 1500 having a curved outer shaft 1508 and inner shaft 1510.

[0204] The inserter tool 1500 is for knotless anchor insertion in a soft tissue repair surgical procedure and is similar to the inserter tool 1200 of FIGS. 49-54 except for the curvature of the outer shaft 1508 and inner shaft 1510 (and associated indicators discussed below), and is configured to insert the anchor 1202 into a patient's bone, e.g., to secure soft tissue to the bone, and includes a handle 1506, an outer shaft 1508 extending distally from the handle 1506, an inner shaft 1510 extending distally from the handle 1506, and a suture retaining channel 1518. the suture retaining member 1534 defined by a handle 1506, a first elastomeric crease 1536a and a second elastomeric crease 1536b fixedly attached to the handle 1506; a strike cap 1512 extending proximally from the handle 1506; and a locking mechanism 1538 configured to lock the outer shaft 1508 in place relative to the inner shaft 1510 when the locking mechanism is in a locked position.

[0205] The curved outer shaft 1508 in this illustrated embodiment is flexible, unlike the linear outer shaft 1208 of the inserter tool 1200. The flexible outer shaft 1508 facilitates translation of the outer shaft along the curved inner shaft 1510.

[0206] Figure 72 is similar to Figure 49 and shows the locking mechanism 1538 in an unlocked position before the strike cap 1512 is struck. Figures 73 and 74 are similar to Figures 57 and 58, respectively, and show the locking mechanism 1538 in a locked position and show the loading aid 1242 releasably attached to the inserter tool 1500. Figure 75 is similar to Figure 62 and shows the locking mechanism 1538 in an unlocked position after the strike cap 1512 is struck.

[0207] 76-78 show an indicator 1540 on the handle 1506 that includes a fin that protrudes from the handle 1506 and curves in the same direction (indicated by arrow 1542) as the outer shaft 1508 and inner shaft 1510. Because the handle 1506 is located outside the patient's body during use of the inserter tool 1500, the indicator 1540 on the handle 1506 is configured to indicate the direction of the curvature of the outer and inner shafts to a user, for example, when the curvature of the outer and inner shafts is not visible within the patient's body. FIG. 78 also shows a first suture 1550a seated in a first suture retaining groove 1534a defined by the handle 1506 and a first elastomeric crease 1536a, and a second suture 1550b seated in a second suture retaining groove 1534b defined by the handle 1506 and a second elastomeric crease 1536b.

[0208] FIG. 79 shows the outer shaft 1508 abutting the anchor 1202 before the anchor 1202 is advanced distally into the bone.

[0209] As mentioned above, any of a variety of anchors can be used with the inserter tools described herein. In an exemplary embodiment, the anchor is a tapered helical anchor. Generally, the tapered helical anchor tapers radially inward in a distal direction such that the diameter of the tapered helical anchor at the proximal end of the tapered helical anchor is greater than the diameter of the tapered helical anchor at the distal end of the tapered helical anchor. Thus, the tapered helical anchor can achieve more engagement with cortical bone than with cancellous bone, with the increased diameter proximal portion of the tapered helical anchor engaging the cortical bone overlying (proximal to) the cancellous bone. Because cortical bone is harder than cancellous bone, more engagement with cortical bone than engagement with cancellous bone can better aid in securing the tapered helical anchor to bone.

[0210] The tapered helical anchor includes a plurality of bone-engaging surface features, e.g., threads or other features. Each of the bone-engaging surface features extends helically along the length of the tapered helical anchor. Each of the bone-engaging surface features is independent of other bone-engaging surface features of the tapered helical anchor. Thus, each of the bone-engaging surface features is configured to form its own path in the bone, which may help minimize undesired shearing of both the cortical and cancellous bone layers. The combination of the distal taper of the tapered helical anchor and the independent helical bone-engaging surface features allows the tapered helical anchor to gradually engage new regions of the bone as it advances distally into the bone, which may generate radial stresses with axial displacement to improve fixation of the helical anchor in the bone, especially in cancellous bone, which is softer than cortical bone.

[0211] In some embodiments, each of the bone-engaging surface features of the tapered helical anchor can extend along the entire length of the tapered helical anchor. In other embodiments, each of the bone-engaging surface features of the tapered helical anchor can extend along only a partial length of the tapered helical anchor, such that a proximal portion of the tapered helical anchor includes bone-engaging surface features (e.g., is threaded) and a distal portion of the tapered helical anchor lacks threads (e.g., is unthreaded). The distal portion of the tapered helical anchor lacking bone-engaging surface features can facilitate guiding the tapered helical anchor into a preformed bone hole.

[0212] The tapered helical anchor is configured to be advanced distally into the bone using an inserter tool as described herein that is configured to longitudinally translate the anchor into the bone, however, the tapered helical anchor may alternatively be rotationally driven into the bone.

[0213] 80 and 81 illustrate one embodiment of a tapered helical anchor 1600. The tapered helical anchor 1600 includes six helical bone-engaging surface features 1602 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 1600. The threads 1602 each extend along the entire length of the tapered helical anchor 1600. The tapered helical anchor 1600 has a riffling to cold-form the threads 1602. The tapered helical anchor 1600 tapers radially inward in a distal direction such that a diameter of the tapered helical anchor 1600 at a proximal end 1604 of the tapered helical anchor 1600 is larger than a diameter of the tapered helical anchor 1600 at a distal end 1606 of the tapered helical anchor 1600. The tapered helical anchor 1600 is cannulated.

[0214] 82 and 83 illustrate another embodiment of a tapered helical anchor 1700. The tapered helical anchor 1700 includes six helical bone-engaging surface features 1702 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 1700. The threads 1702 each extend along the entire length of the tapered helical anchor 1700. The threads 1702 have a greater depth than the threads 1602 of FIGS. 80 and 81. The tapered helical anchor 1700 has a riffling to cold-form the threads 1702. The tapered helical anchor 1700 tapers radially inward in the distal direction such that the diameter of the tapered helical anchor at a proximal end 1704 of the tapered helical anchor 1700 is larger than the diameter of the tapered helical anchor at a distal end 1706 of the tapered helical anchor 1700. The tapered helical anchor 1700 is cannulated.

[0215] 84 and 85 illustrate another embodiment of a tapered helical anchor 1800. The tapered helical anchor 1800 includes nine helical bone-engaging surface features 1802 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 1800. The threads 1802 each extend along the entire length of the tapered helical anchor 1800. The threads 1802 have a higher pitch than the threads 1602 of FIGS. 80 and 81. The threads 1802 have the same depth as the threads 1602 of FIGS. 80 and 81. The tapered helical anchor 1800 includes riffling to cold-form the threads 1802. The tapered helical anchor 1800 tapers radially inward in the distal direction such that the diameter of the tapered helical anchor at a proximal end 1804 of the tapered helical anchor 1800 is larger than the diameter of the tapered helical anchor at a distal end 1806 of the tapered helical anchor 1800. The tapered helical anchor 1800 is cannulated.

[0216] 86 and 87 illustrate another embodiment of a tapered helical anchor 1900. The tapered helical anchor 1900 includes nine helical bone-engaging surface features 1902 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 1900. The threads 1902 each extend along the entire length of the tapered helical anchor 1900. The threads 1902 have a higher pitch than the threads 1702 of FIGS. 82 and 83. The threads 1902 have the same depth as the threads 1702 of FIGS. 82 and 83. The tapered helical anchor 1900 has a riffling to cold-form the threads 1902. The tapered helical anchor 1900 tapers radially inward in the distal direction such that the diameter of the tapered helical anchor at a proximal end 1904 of the tapered helical anchor 1900 is larger than the diameter of the tapered helical anchor at a distal end 1906 of the tapered helical anchor 1900. The tapered helical anchor 1900 is cannulated.

[0217] 88 and 89 illustrate another embodiment of a tapered helical anchor 2000. The tapered helical anchor 2000 includes six helical bone-engaging surface features 2002 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 2000. The threads 2002 each extend along the entire length of the tapered helical anchor 2000. The tapered helical anchor 2000 includes omnidirectional notches along each of the threads 2002 such that the threads 2002 are discontinuous unlike the threads 1602, 1702, 1802, 1902 which are continuous. The omnidirectional notches are configured to allow each of the threads 2002 to repeatedly engage the bone, which may improve fixation of the tapered helical anchor 2002 within the bone. The tapered helical anchor 2000 tapers radially inward in a distal direction such that the diameter of the tapered helical anchor at a proximal end 2004 of the tapered helical anchor 2000 is greater than the diameter of the tapered helical anchor at a distal end 2006 of the tapered helical anchor 2000. The tapered helical anchor 2000 is cannulated.

[0218] 90 and 91 illustrate another embodiment of a tapered helical anchor 2100. The tapered helical anchor 2100 includes six helical bone-engaging surface features 2102 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 2100. The threads 2102 each extend along a partial length of the tapered helical anchor 2100 such that a proximal portion of the tapered helical anchor 2100 is threaded and a distal portion of the tapered helical anchor 2100 is unthreaded. The tapered helical anchor 2100 tapers radially inward in the distal direction such that the diameter of the tapered helical anchor at the proximal end 2104 of the tapered helical anchor 2100 is larger than the diameter of the tapered helical anchor at the distal end 2106 of the tapered helical anchor 2100. The tapered helical anchor 2100 is cannulated.

[0219] 92 illustrates another embodiment of a tapered helical anchor 2200. The tapered helical anchor 2200 includes six helical bone-engaging surface features 2202 in the form of threads that are independent of one another and each extend helically around the tapered helical anchor 2200. The threads 2202 each extend along a partial length of the tapered helical anchor 2200 such that a proximal portion of the tapered helical anchor 2200 is threaded and a distal portion of the tapered helical anchor 2200 is unthreaded. The unthreaded distal portion of the tapered helical anchor 2200 is bifurcated with a pair of distal arms 2208 that extend distally from the threaded proximal portion of the tapered helical anchor 2200. The distal arm 2208 is configured to penetrate into the bone, for example, at the distal bottom of a bone hole in which the tapered distal anchor 2200 is disposed, which may help secure the tapered helical anchor 2200 within the bone. The tapered helical anchor 2200 tapers radially inward in the distal direction, such that the diameter of the tapered helical anchor at the proximal end 2204 of the tapered helical anchor 2200 is larger than the diameter of the tapered helical anchor at the distal end 2206 of the tapered helical anchor 2200. The tapered helical anchor 2200 is cannulated.

[0220] FIG 92 illustrates the tapered helical anchor 2200 as a stand-alone element. FIG 93 illustrates the tapered helical anchor 2200 releasably coupled to the inserter tool 100 of FIG 1 in an initial position, for example, before the outer shaft 108 advances the tapered helical anchor 2200 distally. FIG 94 illustrates the tapered helical anchor 220 after the outer shaft 108 advances the tapered helical anchor 2200 distally and before the inserter tool 100 moves proximally relative to the tapered helical anchor 2200. Although FIGS 93 and 94 illustrate the tapered helical anchor 2200 used with the inserter tool 100 of FIG 1, as previously mentioned, the tapered helical anchor 2200 may be used with another inserter tool.

[0221] The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular parts, and subsequent reassembly. Specifically, the device can be disassembled and any number of particular parts or portions of the device can be selectively replaced or removed in any combination. After cleaning and / or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

[0222] The devices described herein may be processed before use. First, a new or used instrument is obtained and cleaned if necessary. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic bag or a TYVEK bag. The container and instrument are then placed in a field of radiation or toxic gases that can penetrate the container, such as ethylene oxide, gamma radiation, X-rays, or high-energy electrons. The radiation kills any bacteria on the instrument or in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

[0223] Sterilization can be accomplished by a variety of methods known to those skilled in the art, including beta or gamma radiation, ethylene oxide, steam, and liquid baths (eg, cold immersion).

[0224] Those skilled in the art will recognize that the practice of the present disclosure has application in conventional minimally invasive and open surgical instrumentation, as well as in robotic assisted surgery.

[0225] Those skilled in the art will recognize further features and advantages of the present invention based on the above-described embodiments. Accordingly, the present invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety for all purposes.

[0226] [Embodiment] (1) A surgical system, comprising: A handle and an outer shaft extending distally from the handle and including an inner lumen; an inner shaft extending distally from the handle, the inner shaft positioned within the inner lumen of the outer shaft, a distal end of the inner shaft positioned distal to an open distal end of the outer shaft, the distal end of the inner shaft having a notch formed therein, the notch configured to seat a suture therein; an anchor configured to be implanted into bone, the anchor including an inner lumen, the inner shaft being positioned within the inner lumen of the anchor; a surgical system configured to translate longitudinally and distally relative to the inner shaft with the distal end of the inner shaft positioned within a bone hole, thereby translating the anchor longitudinally and distally into the bone hole. (2) The system of embodiment 1, wherein after the translation of the outer shaft, the outer shaft and the inner shaft are configured to simultaneously translate longitudinally and proximally relative to the anchor within the bone hole. (3) The system of embodiment 1, wherein prior to the translation of the outer shaft, the distal end of the outer shaft abuts the proximal end of the anchor, the inner shaft being positioned within the inner lumen of the anchor. (4) The system of embodiment 1, wherein the notch has an open distal end and a closed proximal end. (5) The system of embodiment 4, further comprising a flexible member extending along the open distal end of the notch to cooperate with the inner shaft to define a sealed passageway, the sealed passageway configured to seat the suture therethrough.

[0227] (6) The system of embodiment 5, wherein the flexible member is configured to bend such that the sealed passage is opened to allow the suture to be released. (7) The system of embodiment 1, wherein the inner shaft includes a pair of distal arms defining the notch therebetween. (8) The system of claim 1, further comprising the suture seated in the notch. (9) The system of embodiment 8, wherein the suture is seated in the notch before the distal end of the inner shaft is positioned in the bone hole, and is seated in the notch after the translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. (10) The system of embodiment 8, further comprising a suture retaining member on the handle, the suture retaining member configured to releasably retain the suture therein.

[0228] (11) The system of embodiment 1, further comprising a locking mechanism configured to move from a locked position that prevents the outer shaft from translating longitudinally and distally relative to the inner shaft to an unlocked position that allows the outer shaft to translate longitudinally and distally relative to the inner shaft. (12) The system of embodiment 1, further comprising a strike cap extending proximally from the handle and operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft. (13) The suture and a loading aid are further provided, 2. The system of claim 1, wherein the loading aid is configured to releasably couple to the inner shaft and configured to guide the suture into the notch. (14) A surgical system comprising: 1. An inserter tool comprising: An outer shaft; an inserter tool comprising: an inner shaft, a distal end of the inner shaft having a suture retaining channel formed therein, the inner shaft positioned within the outer shaft, the suture retaining channel positioned distal to an open distal end of the outer shaft; a suture seated within the suture retaining channel; an anchor configured to be embedded in bone and seated within a cannulated inner shaft, the anchor configured to be pushed distally by the outer shaft moving axially and distally along a longitudinal axis of the inserter tool relative to the inner shaft and the suture. (15) The system of embodiment 14, wherein the outer shaft and the inner shaft are configured to simultaneously move axially and proximally along the longitudinal axis of the inserter tool relative to the anchor and the suture after the axial movement of the outer shaft.

[0229] (16) The system of embodiment 14, wherein prior to the axial movement of the outer shaft, a distal end of the outer shaft abuts a proximal end of the anchor in which the inner shaft is positioned. (17) The system of embodiment 14, wherein the suture retaining channel has an open distal end and a closed proximal end. (18) The system of embodiment 17, further comprising a flexible member extending along the open distal end of the suture retaining channel to cooperate with the inner shaft to define an enclosed passageway, the enclosed passageway configured to seat the suture therethrough. (19) The system of embodiment 18, wherein the flexible member is configured to bend such that the sealed passage is opened to allow the suture to be released. (20) The system of embodiment 14, wherein the inner shaft includes a pair of distal arms defining the suture retaining channel therebetween.

[0230] (21) The system of embodiment 14, wherein the inserter tool further comprises a handle, the outer shaft and the inner shaft extending distally from the handle. (22) The system of embodiment 21, further comprising a suture retaining member on the handle, the suture retaining member configured to releasably retain the suture therein. (23) The system of embodiment 14, further comprising a locking mechanism configured to move the inserter tool from a locked position, where the outer shaft is prevented from moving axially distally relative to the inner shaft, to an unlocked position, where the outer shaft is allowed to move axially distally relative to the inner shaft. (24) The system of embodiment 14, wherein the inserter tool further comprises a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby moving the outer shaft axially and distally relative to the inner shaft. (25) The system of embodiment 14, further comprising a loading aid configured to be releasably coupled to the inner shaft and configured to guide the suture into the suture retaining channel.

[0231] (26) A surgical method comprising: positioning a distal end of an inner shaft of an inserter tool into a bone hole, the distal end of the inner shaft having a notch formed therein, a suture being seated in the notch; moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding an anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole; and moving the outer shaft axially and proximally relative to the anchor such that after said axial and distal movement of the outer shaft, the inner shaft is removed from the bone hole and the anchor and the suture remain in the bone hole. (27) The method of embodiment 26, wherein the axial proximal movement of the inner shaft automatically causes the suture to exit the notch by passing through an open distal end of the notch. (28) a flexible member extends along a distal side of the notch to prevent the suture from distally exiting the notch prior to the axial and distal movement of the outer shaft; 27. The method of embodiment 26, wherein the axial and proximal movement of the inner shaft automatically causes the flexible member to bend so that the suture can exit the notch. (29) The method of claim 26, further comprising retaining the suture within a suture retaining member in a handle of the inserter tool. (30) The method of embodiment 26, further comprising, prior to said axial distal movement of the outer shaft, moving a locking mechanism from a locked position, where the outer shaft is prevented from translating axially and distally relative to the inner shaft, to an unlocked position, where the outer shaft can translate axially and distally relative to the inner shaft.

[0232] (31) The method of embodiment 26, wherein the axial and distal movement of the outer shaft is caused by striking a strike cap of the inserter tool. (32) A surgical system comprising: A handle and an outer shaft extending distally from the handle and including an inner lumen; an inner shaft extending distally from the handle, the inner shaft being positioned within the inner lumen of the outer shaft and a distal end of the inner shaft being positioned distal to the open distal end of the outer shaft; a flexible member cooperating with the distal end of the inner shaft to define a sealed passage configured to seat a suture therethrough; an anchor configured to be implanted into bone, the anchor including an inner lumen, the inner shaft being positioned within the inner lumen of the anchor; the outer shaft is configured to translate relative to the inner shaft to thereby translate the anchor distally into a bone hole; The surgical system, wherein the flexible member is configured to bend to open the sealed passageway. (33) The system of embodiment 32, wherein the flexible member is configured to automatically expand in response to longitudinal and proximal translation of the inner shaft relative to the anchor, thereby opening the sealed passage. (34) The system of embodiment 32, wherein a first end of the flexible member is fixedly attached to the handle and a second end of the flexible member is freely movable relative to the handle and the inner shaft. (35) The system of embodiment 34, wherein the second end of the flexible member is configured to automatically bend relative to the inner shaft in response to longitudinal proximal translation of the inner shaft relative to the anchor.

[0233] (36) A proximal surface of the inner shaft defines a proximal side of the sealed passage; the flexible member defines a distal side of the sealed passage; The system of embodiment 32, wherein the inner shaft includes a pair of opposing distal arms each extending between the proximal and distal sides of the sealed passage and defining a left and right side of the sealed passage. (37) A wire operably coupled to the flexible member; The system of embodiment 32, further comprising an actuator in the handle configured to be actuated to thereby move the wire proximally, the proximal movement of the wire causing bending of the flexible member such that the sealed passage is opened. (38) The system of embodiment 32, wherein the flexible member comprises a metal wire, a braided fabric, or a textile strand. (39) The system of embodiment 32, further comprising the suture seated through the sealed passage. (40) The system of embodiment 39, wherein the suture is seated through the sealed passage before the distal end of the inner shaft is positioned within the bone hole, and the anchor is seated through the sealed passage after the translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole.

[0234] (41) After the translation of the outer shaft, the inner shaft is configured to translate longitudinally and proximally relative to the anchor in the bone hole; The system of embodiment 39, wherein the translation of the inner shaft is configured to automatically cause the bending of the flexible member, thereby enabling release of the suture. (42) The suture and a loading aid are further provided, 33. The system of claim 32, wherein the loading aid is configured to releasably couple to the inner shaft and configured to guide the suture through the sealed passage. (43) A surgical system comprising: A handle and an outer shaft extending distally from the handle and including an inner lumen; an inner shaft extending distally from the handle, the inner shaft being positioned within the inner lumen of the outer shaft, a distal end of the inner shaft being positioned distal to the open distal end of the outer shaft, the distal end of the inner shaft including first and second interlocking components defining a sealed passage configured to receive a suture therethrough; an anchor configured to be implanted into bone, the anchor including an inner lumen, the inner shaft being positioned within the inner lumen of the anchor; movement of the outer shaft relative to the inner shaft is configured to translate the anchor longitudinally and distally into a bone hole; The first component is configured to move relative to the second component, thereby opening the sealed passageway. (44) The suture further comprises: 44. The system of embodiment 43, wherein the movement of the first component is configured to automatically open the sealed passage, thereby enabling release of the suture. (45) The system of embodiment 43, wherein the movement of the outer shaft relative to the inner shaft includes longitudinal and distal translation of the outer shaft relative to the inner shaft before the first component moves relative to the second component.

[0235] (46) The movement of the outer shaft is configured to occur with the distal end of the inner shaft positioned within a bone hole; 46. ​​The system of embodiment 45, wherein the suture extends through the sealed passage after translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. (47) The system of embodiment 46, wherein the first component is configured to move relative to the second component following the movement of the outer shaft, and the opening of the sealed passage allows for release of the suture. (48) A surgical method comprising: positioning a distal end of an inner shaft of an inserter tool within a bone hole, a flexible member attached to the inner shaft, the flexible member and the inner shaft cooperating to define an enclosed passage through which a suture extends; moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding an anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole; and after said axial and distal movement of the outer shaft, moving the outer shaft and the inner shaft axially and proximally relative to the anchor such that the flexible member spreads and the inner shaft is removed from the bone hole, leaving the anchor and the suture in the bone hole. (49) A flexible member having a first end fixedly attached to the inner shaft and not movable relative to the inner shaft, and a flexible member having a second end freely movable relative to the inner shaft; the second end of the flexible member automatically moves relative to the inner shaft in response to the axial and proximal translation of the inner shaft to expand the flexible member; 49. The method of claim 48, wherein the movement of the flexible member causes the sealed passage to open. (50) A first end of the flexible member is fixedly attached to a handle of the inserter tool and is not movable relative to the inner shaft, and a second end of the flexible member is freely movable relative to the inner shaft; the second end of the flexible member automatically moves relative to the inner shaft in response to the axial and proximal translation of the inner shaft to expand the flexible member; 49. The method of claim 48, wherein the movement of the flexible member causes the sealed passage to open.

[0236] (51) The method of embodiment 48, further comprising retaining the suture within a suture retaining member in a handle of the inserter tool. (52) A surgical system comprising: a biocompatible anchor configured to be advanced distally into a bone, the anchor having a plurality of independent external bone-engaging surface features extending helically along a length of the anchor, each configured to engage the bone; The anchor tapers radially inward in a distal direction, the diameter of the tapered helical anchor at a proximal end of the anchor being greater than the diameter of the anchor at a distal end of the anchor. (53) The system of embodiment 52, wherein each of the bone engaging surface features extends along an entire length of the anchor. (54) The system of embodiment 52, wherein each of the bone engaging surface features extends along a partial length of the anchor such that the anchor has a threaded proximal portion and a non-threaded distal portion. (55) The system of embodiment 52, wherein the anchor is cannulated.

[0237] (56) The system of embodiment 52, wherein the bone engaging surface feature is a thread. (57) An inserter tool, The inserter tool comprises: an outer shaft including an inner lumen; an inner shaft positioned within the inner lumen of the outer shaft, a distal end of the inner shaft positioned distal to the open distal end of the outer shaft, the distal end of the inner shaft having a notch formed therein, the notch configured to seat a suture therein; the inner shaft is configured to be positioned within an inner lumen of the anchor; 53. The system of embodiment 52, wherein the outer shaft is configured to translate longitudinally and distally relative to the inner shaft with the inner shaft positioned within the inner lumen of the anchor, thereby translating the anchor longitudinally and distally into the bone hole. (58) The system of embodiment 57, wherein after the translation of the outer shaft, the outer shaft and the inner shaft are configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole. (59) The system of embodiment 57, wherein prior to the translation of the outer shaft, a distal end of the outer shaft abuts the proximal end of the anchor with the inner shaft positioned within the inner lumen of the anchor. (60) The suture further comprises: 58. The system of embodiment 57, wherein the translation of the outer shaft is configured to cause the anchor to capture the suture between the anchor and the wall of the bone hole.

[0238] (61) The system of embodiment 57, wherein the inserter tool further comprises a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft and translating the anchor longitudinally and distally into the bone hole. (62) A surgical system comprising: 1. A biocompatible anchor, comprising: a plurality of independent external bone-engaging surface features each extending helically along a length of said anchor, each configured to engage bone; an inner lumen extending through the anchor; a biocompatible anchor, the outer diameter of the anchor decreasing distally along the length of the anchor; 1. An inserter tool comprising: an outer shaft including an inner lumen; an inserter tool comprising: an inner shaft positioned within the inner lumen of the outer shaft, a distal end of the inner shaft having a notch formed therein, the notch being configured to seat a suture therein; the inner shaft extends through the inner lumen of the anchor, the distal end of the inner shaft being positioned distal to the open distal end of the outer shaft; The surgical system, wherein the outer shaft is configured to translate longitudinally and distally relative to the inner shaft, thereby causing the anchor to translate longitudinally and distally relative to the inner shaft. (63) The system of embodiment 62, wherein after the translation of the outer shaft, the outer shaft and the inner shaft are configured to simultaneously translate longitudinally and proximally relative to the anchor. (64) The system of embodiment 62, wherein a distal end of the outer shaft abuts a proximal end of the anchor prior to the translation of the outer shaft. (65) The suture further comprises: the longitudinal and distal translation of the anchor is configured to advance the anchor into a bone hole; 63. The system of embodiment 62, wherein the translation of the outer shaft is configured to cause the anchor to capture the suture between the anchor and the wall of the bone hole.

[0239] (66) The system of embodiment 65, wherein after the translation of the outer shaft, the outer shaft and the inner shaft are configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole. (67) The system of embodiment 62, wherein the inserter tool further comprises a strike cap operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft and translating the anchor longitudinally and distally into a bone hole. (68) A surgical method comprising: positioning a distal end of an inner shaft of an inserter tool within a bone hole, the distal end of the inner shaft having a notch formed therein, a suture being seated within the notch, the inner shaft extending through an anchor having a plurality of bone-engaging surface features extending helically along a length of the cannulated tapered anchor; and moving an outer shaft of the inserter tool axially and distally relative to the inner shaft, thereby sliding the anchor along the inner shaft and positioning the anchor within the bone hole such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole. (69) The method of embodiment 68, wherein the anchor tapers radially inward in a distal direction, the diameter of the tapered helical anchor at a proximal end of the anchor being larger than the diameter of the anchor at a distal end of the anchor. (70) The method of embodiment 69, wherein with the anchor positioned in the bone hole, the proximal end of the anchor engages cortical bone and the distal end of the anchor engages cancellous bone.

[0240] (71) The method of embodiment 68, further comprising moving the outer shaft axially and proximally relative to the anchor such that after the axial and distal movement of the outer shaft, the inner shaft is removed from the bone hole and the anchor and the suture remain in the bone hole.

Claims

1. 1. A surgical system comprising: A handle and an outer shaft extending distally from the handle and including an inner lumen; an inner shaft extending distally from the handle, the inner shaft positioned within the inner lumen of the outer shaft, a distal end of the inner shaft positioned distal to an open distal end of the outer shaft, the distal end of the inner shaft having a notch formed therein, the notch configured to seat a suture therein; an anchor configured to be implanted into bone, the anchor including an inner lumen, the inner shaft being positioned within the inner lumen of the anchor; with the distal end of the inner shaft positioned within a bone hole, the outer shaft is configured to translate longitudinally and distally relative to the inner shaft, thereby translating the anchor longitudinally and distally into the bone hole; A surgical system, wherein prior to the translation of the outer shaft, a distal end of the outer shaft abuts a proximal end of the anchor with the inner shaft positioned within the inner lumen of the anchor.

2. The system of claim 1 , wherein the outer shaft and the inner shaft are configured to simultaneously translate longitudinally and proximally relative to the anchor in the bone hole after the translation of the outer shaft.

3. The system of claim 1 , wherein the notch has an open distal end and a closed proximal end.

4. 4. The system of claim 3, further comprising a flexible member extending along the open distal end of the notch to cooperate with the inner shaft to define a sealed passageway, the sealed passageway configured to seat the suture therethrough.

5. The system of claim 4 , wherein the flexible member is configured to bend such that the sealed passage is opened to allow the suture to be released.

6. The system of claim 1 , wherein the inner shaft includes a pair of distal arms defining the notch therebetween.

7. The system of claim 1 , further comprising the suture seated in the notch.

8. 8. The system of claim 7, wherein the suture is seated in the notch before the distal end of the inner shaft is positioned in the bone hole and is seated in the notch after the translation of the outer shaft such that the anchor captures the suture between an outer surface of the anchor and a wall of the bone hole.

9. The system of claim 7 , further comprising a suture retaining member on the handle, the suture retaining member configured to releasably retain the suture therein.

10. 10. The system of claim 1, further comprising a locking mechanism configured to move from a locked position that prevents the outer shaft from translating longitudinally and distally relative to the inner shaft to an unlocked position that allows the outer shaft to translate longitudinally and distally relative to the inner shaft.

11. 10. The system of claim 1, further comprising a strike cap extending proximally from the handle and operably coupled to the outer shaft, the strike cap configured to be struck by a tool, thereby translating the outer shaft longitudinally and distally relative to the inner shaft.

12. The suture and a loading aid are further included, The system of claim 1 , wherein the loading aid is configured to releasably couple to the inner shaft and configured to guide the suture into the notch.

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