System and method for anchor deployment in tissue

Abstract

An anchor inserter having at least one elongate shaft wherein the elongate shaft is configured for being pushed into a bone tunnel; a distal end of the shaft comprising an anchor carrying portion at the distal end of the shaft with a proximal end of the shaft being fixedly attached to an attachment portion of the inserter body at an attachment location; wherein the attachment portion of the inserter body further comprises at least one opening that is positioned adjacent the attachment location, the opening being structured to receive a guidewire therein.

Description

SYSTEM AND METHOD FOR ANCHOR DEPLOYMENT IN TISSUETECHNICAL FIELD

[0001] The present invention relates to an anchor insertion system and method for deployment of anchors in animal or human tissue, preferably bone tissue.BACKGROUND

[0002] Any references to methods, apparatus or documents of the prior art are not to be taken as constituting any evidence or admission that they formed, or form part of the common general knowledge.

[0003] Anchors are commonly employed during surgical procedures to provide a reliable attachment location for sutures in or against a substrate, those attached sutures then being used to capture and retain other objects, such as soft tissue or bone. The substrate may be bony tissue or soft tissue such as ligaments, tendons, etc. In the case of bony tissue, suture anchors are generally inserted into and retained in a pre-formed hole in the bone, so that suture extends from the anchor out of the hole. In the case of soft tissue, suture anchors generally are placed on a side of the soft tissue such that suture extends through a hole in the tissue to extend beyond the soft tissue on a side opposite the anchor.

[0004] Soft suture anchors have recently been developed from filaments of suture material which are retained within pre-formed bone holes by being deformable to increase their diameter to a size greater than that of the bone hole, to thereby residewithin the cancellous bone and under the bone cortex. Since soft anchors are commonly made entirely of suture materials, they are sometimes called “all-suture” anchors.

[0005] The pre-formed pilot holes are typically formed by initially drilling a first pilot hole along a near-side or proximal portion of the tissue and then drilling through the matrix of the bone so that the drill can exit the bone on a far side by forming a second pilot hole along the far-side or distal portion of the tissue. There may be a hollow region or bone marrow filled matrix within the bone tissue especially between the proximal and distal holes and in such instances, it can be difficult to push through the shaft of any anchor insertion device especially when viewing of the distal or far-side hole is restricted. In such instances, locating the distal hole can be difficult during surgery. This problem can be compared to drilling through a hollow body with holes drilled on a near side and a far side of the pipe surface. Locating the hole on the far-side of the hollow body after insertion of the anchor inserter into the near side of the hollow body is challenging. Therefore, it is desirable to provide an improved method and system for deployment of an anchor in tissue.SUMMARY OF INVENTION

[0006] In an aspect, the invention provides an anchor inserter having at least one elongate shaft configured for being pushed into a bone tunnel; a distal end of the shaft comprising an anchor carrying portion at the distal end of the shaft with a proximal end of the shaft being fixedly attached to an attachment portion of the inserter body at an attachment location; wherein the inserter body further comprises at least one openingthat is positioned adjacent the attachment location, the opening being structured to receive a guidewire therein.

[0007] In an embodiment, the proximal end of the elongate shaft is received and fixedly attached within a first bore extending through the attachment portion of the inserter body and wherein the opening forms a second hollow bore that is spaced away from the first bore, the second hollow bore being structured to receive the guidewire.

[0008] In an embodiment, the first bore extends in a direction along a longitudinal axis of the inserter body wherein the inserter body is substantially elongate and wherein the second bore is substantially parallel to the first bore.

[0009] In an embodiment, the first bore extends along a central longitudinal axis of the inserter body and wherein the second bore is substantially parallel to the first bore and offset from the central longitudinal axis.

[0010] In an embodiment, the first bore extends along the central longitudinal axis of the attachment portion of the inserter body.

[0011] In an embodiment, a central longitudinal of the second bore is offset from the central longitudinal axis of the first bore by a spacing in the range of 3mm and 10mm and more preferably in the range of 4mm and 8mm and even more preferably by 5mm.

[0012] In an embodiment, the inserter body comprises a housing configured for winding and housing suture extending from the anchor seated in the anchor carrying portion at the distal end of shaft.

[0013] In an embodiment, the inserter body comprises a plurality of suture receiving channels to wind and store sutures passing through the anchor loaded on the loaded portion therein.

[0014] In an embodiment, the inserter body is shaped to form a handle adapted to be held by a user’s hand.

[0015] In an embodiment, the anchor inserter comprises two of said elongate shafts wherein respective proximal portions of each shaft is attached to corresponding first and second attachment portions at respective first and second attachment locations on the inserter body.

[0016] In an embodiment, a first of said at least one opening is adjacent the first attachment location and a second of said at least one opening is adjacent the second attachment location.

[0017] In an embodiment, inserter body comprises first and second housing portions with respective suture receiving channels to wind and store sutures passing through first and second anchors loaded on the anchor carrying portions of the two said elongate shafts.

[0018] In another aspect, there is provided an anchor insertion system comprising the anchor inserter as described herein and a guiding device comprising a guide body having first and second spaced apart guidance tunnels, each guidance tunnel having a proximal entry end for receiving a respective guidewire and a distal exit end for allowing the respective guidewire to exit said guidance tunnel.

[0019] In an embodiment, the spaced apart guidance tunnels are substantially parallel to each other.

[0020] In an embodiment, the guiding device further comprises a removably disposed reducer being adapted to be coupled to the proximal end of the first guidance tunnel, the reducer having a passage with a reduced diameter relative to a diameter at the proximal end of the first guidance tunnel.

[0021] In another aspect, the invention provides a surgical method of bone repair, the method comprising the steps of: inserting a first guidewire into a first location in tissue where an anchor is to be deployed, the inserting step requiring the guidewire to be inserted into a first portion of the tissue and allow the first guidewire to exit out of the tissue from a second portion of the tissue, the second portion being at or adjacent an intended anchor deployment location such that a proximal end portion of the first guidewire extends out from the first portion of the tissue and a distal end portion of the first guidewire extends out from the second portion of the tissue; inserting a second guide wire through the tissue in a spaced apart configuration relative to the first inserted guidewire to effect fixation of the second guidewire in apre-determined orientation relative to the first guidewire such that a proximal portion of the second guidewire extends out from the tissue; and; removing the first guidewire from the tissue after the thorough tbore has been drilled in accordance with the drilling step; providing an anchor inserter as described herein and receiving the proximal portion of the second guidewire into the opening located adjacent the attachment location of the anchor inserter to thereby align the elongate shaft to pass through the thorough bore and deploy the anchor at or adjacent the second portion of the tissue.

[0022] In one embodiment, the step of drilling the thorough bore between the first and second portions of the tissue is carried out by guiding a cannulated drill over the first guidewire. In an alternative embodiment, the step of the step of drilling the thorough bore between the first and second portions of the tissue is carried out by after withdrawing the first guidewire from the first location.

[0023] In an embodiment, the method further comprises the step of providing a guiding device comprising a guide body having first and second spaced apart guidance tunnels, each guidance tunnel having a proximal entry end for receiving a respective guidewire and a distal exit end for allowing the respective guidewire to exit said guidance tunnel; wherein the step of inserting the second guidewire is preceded by the step of locating the proximal portion of the first guidewire into the first guidance tunnel of the guiding device; and wherein the step of inserting the second guidewire further comprises inserting said second guidewire through the second guidance tunnel to effect fixation of the second guidewire in a pre-determined orientation relative to the first guidewire.

[0024] In an embodiment, the step of drilling comprises passing the cannulated drill through the first guidance tunnel of the guiding device.

[0025] In an embodiment, the method further comprises the step of removing the first guidewire from the tissue after the thorough bore has been drilled and uncoupling the guidance device from the second inserted guidewire to leave the second guidewire in the predetermined inserted orientation followed by the receiving of the proximal portion of the second guidewire into the second guidance tunnel of the guidance device.

[0026] In another aspect, the invention provides a surgical method of bone repair, the method comprising the steps of: drilling a thorough bore into tissue by inserting a drill into a first location in tissue where an anchor is to be deployed, the inserting step requiring the drill to be inserted into a first portion of the tissue and allow the first drill to exit out of the tissue from a second portion of the tissue, the second portion being at or adjacent an intended anchor deployment location such that a proximal end portion of the drill bit extends out from the first portion of the tissue and a distal end portion of the drill bit extends out from the second portion of the tissue; inserting a guide wire through the tissue in a spaced apart configuration relative to the drill to effect fixation of the guidewire in a pre-determined orientation relative to the drill bit such that a proximal portion of the guidewire extends out from the tissue; and; removing the drill bit from the tissue after the thorough bore has been drilled in accordance with the drilling step;providing an anchor inserter as described herein and receiving the proximal portion of the second guidewire into the opening located adjacent the attachment location of the anchor inserter to thereby align the elongate shaft to pass through the thorough bore and deploy the anchor at or adjacent the second portion of the tissue.BRIEF DESCRIPTION OF THE DRAWINGSPreferred features, embodiments and variations of the invention may be discerned from the following Detailed Description which provides sufficient information for those skilled in the art to perform the invention. The Detailed Description is not to be regarded as limiting the scope of the preceding Summary of the Invention in any way. The Detailed Description will make reference to a number of drawings as follows:Figure 1 is an exploded top perspective view of an anchor inserter 100.Figure 2 is a sectional side view of the anchor inserter 100.Figure 3 is side view of the anchor inserter 100.Figures 4A and 4B are exemplary embodiments of known anchor assemblies generally denoted by 500.Figures 5 to 10 illustrate several method steps of a method for deploying an anchor by using an anchor inserter 100.Figure 11 illustrates the use of an alternative anchor inserter 300.Figures 12 and 13 illustrate top perspective views of the anchor inserter 300.Figure 14 is an enlarged end view of the anchor inserter 300.Figure 15 is a sectional view of the anchor inserter 300.Figure 16 is a side sectional view of the anchor inserter 300.DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

[0027] Figures 1 to 3 and 5 to 10 illustrate a first embodiment of an anchor insertion and deployment system 1000. The anchor insertion system comprises an anchor inserter 100 (isolated views shown in Figures 1 to 3). It would be understood from the description provided in the foregoing sections that the invention is in no way limited for use with any specific types of anchors. The presently described embodiment refers to the use of soft and flexible or deformable anchor bodies (shown in Figure 4 and 5). However, the anchor inserter 100 and the associated system 1000 is in no way limited in scope for use with these specific types of anchor bodies. For example, in alternative embodiments, rigid anchors may also be deployed using the anchor insertion system 1000described herein.

[0028] The anchor inserter 100 generally comprises an elongate shaft 110 and an inserter body 120 that is shaped to be grasped by a user’s hand. A proximal end portion 112 of the elongate shaft 110 is fixedly attached at to an inserter body 120 at a shaft attachment location 122 of the inserter body 120. A distal end portion 114 of the shaft 110 comprises two spaced apart tines which define a slot therebetween to form an anchor carrying portion. Any anchor such as soft anchor 510 with sutures 520 passing through the anchor 510 such as but not limited to the anchor assembly 500 shown in Figures 4A and 4B may be used in conjunction with the anchor inserter 100. The elongate shaft 110 comprises shaft body which extends between the distal end and proximal end of the shaft 110 and engages with a bone tunnel drilled into a bone. The inserter body 120 at one end forms an attachment portion 121 to provide the shaft attachment location 122. The attachment portion 121 of the inserter body 120 alsocomprises an opening 126 that forms a guidewire receiving bore 127 extending through the attachment portion 121. The opening 126 for the guidewire receiving bore 127 is located adjacent to the shaft attachment location 122. The proximal end portion 112 of the elongate shaft 110 is fixedly received and attached within a shaft receiving bore 129 provided in the attachment portion 121 of the inserter body 120. The shaft 110 is attached within an internal part of the inserter body 120.

[0029] Referring particularly to Figures 1 to 3, the shaft receiving bore 129 is generally aligned with a central longitudinal axis of the inserter body 120. The guidewire receiving bore 127 whilst being generally parallel to the shaft receiving bore 129 is radially offset from the more centrally positioned shaft receiving bore 129 by 3mm to 5mm. The elongate shaft 110 may be fixedly engaged and locked with the walls defining the shaft receiving bore 129 by way of a variety of already known locking mechanisms. In the preferred embodiment shown in Figures 1 to 3, the overall diameter of the shaft receiving bore 129 is slightly greater than the diameter of the guidewire receiving bore 127. However, this variation in bore size between the bores 127 and 129 is not limiting in any manner.

[0030] As evident from Figures 1 to 3, the inserter body 120 is generally hollow and forms a housing that is configured for winding and housing suture extending from an anchor seated in the anchor carrying portion at the distal end portion 114 of the elongate shaft 110. One or more sutures may typically extend from the anchor carrying portion at distal end portion 114 along the elongate shaft and then be wound within the housing of the inserter body 120 along a plurality of suture winding channels to store suture and allow users to unwind the suture once the anchor has been loaded.

[0031] The working of the anchor inserter 100 by way of a novel method of surgery will now be explained in the following passages. The exemplary embodiment described herein is a method of deploying the anchor 510 on the far cortex for a metacarpal bone. In many instances, the bone quality at the base of the metacarpal (near cortex) is poor (due to bone degeneration) and deployment of the anchor 510 in the near cortex region may not provide a more longer-term surgical solution or a strong anchor fixation. The first step, as shown in Figure 5, involves inserting a trajectory wire T (typically around 1 ,2mm) through the base of the index metacarpal bone such that the trajectory wire extends out from the far cortex region of the index metacarpal bone best shown in Figure 4. The trajectory wire is inserted in a manner such that it extends out of the far cortex region at a location where the anchor is intended to be fixed.

[0032] Referring to Figure 6, the next step involves the use of a guidance device 200 which may form part of the anchor insertion system 1000. The guidance device 200 comprises a guide body 210 defining two spaced apart and parallel guidance tunnels 212 and 214. Each of these guidance tunnels 212 and 214 comprises a proximal entry end, for receiving a respective guidewires or trajectory wires and a distal exit end for allowing the inserted guidewires to exit the respective guidance tunnels 212 and 214. As shown in Figure 6, the guidance tunnel 212 includes a removable guidewire sleeve 216 and the proximal portion of the inserted trajectory wire T is received into the first guidewire tunnel 212 through the guidewire sleeve 216. Thereafter, as shown in Figure 7a guidewire G is passed through the second guidewire tunnel 214 in the guidance device 200 by inserting the guidewire G into the proximal entry end and out of the distal exit of the second guidewire tunnel 214 to position the guide wire G within theindex metacarpal bone in a generally parallel orientation relative to the trajectory wire T at a set distance from the guidewire T. This distance corresponds to the distance between the anchor inserter 100 and the guiding bore,

[0033] Referring to Figure 8, the trajectory wire T is used as a drill guide to guide a cannulated drill bit D in a drilling operation to form a bone tunnel through the index metacarpal bone. The guidance device 200 comprises a removably disposed reducer 216 that is coupled to the proximal entry end of the first guidance tunnel 212. The reducer reduces the overall entry diameter of the first tunnel 212 and in the engaged position does not allow the relatively thicker drill bit D to be inserted into the proximal entry of the first guidance tunnel 212 until the reducer is uncoupled from the guide body 210. Alternatively, the trajectory wire T may be removed, and a solid drill may also be used in conjunction with the guidance device 200 to drill the first tunnel 212 without departing from the broader scope and spirit of the described embodiment. In a further alternative, the drilling step may be omitted and a slightly thicker guidewire may be used to replace the trajectory wire T which in effect can be notionally considered as a drilling step that can be carried out without an additional drilling step.

[0034] Referring to Figure 9, once the trajectory wire T is removed whilst the guidewire G is retained in the base of the index metacarpal bone. Thereafter, the proximal end of the guide wire G extending out from the near cortex region of the index metacarpal bone is received into the guidewire receiving bore 127 of the inserter body 120 for the anchor inserter 100.

[0035] The provision of the guidewire G in combination with the guidance device 200 and the novel configuration of the anchor inserter 100 (which has a provision for receiving the guidewire G) allows surgeons to easily align the elongate shaft within the bone tunnel and locate the distal end 114 of the shaft 110 easily at the intended anchor deployment location. Provision of the guidewire receiving opening 126 in the inserter body 120 in the aforementioned configuration and engagement with the guidewire G restricts the orientation of the elongate shaft 110 for the anchor inserter 100 during anchor deployment by reducing degree of freedom of the inserter shaft 110 to only one thereby helping the surgeon to aim at far cortex even when they cannot see the hole on the far side. The provision of the second guidewire G that can engage with the inserter 100 implies that the surgeon while performing surgery can impart axial movement and rotation about the longitudinal axis. Once the near cortex is engaged, rotation is no longer possible, and the only allowable movement is axial movement which assists with the deployment of the anchor correctly. Once the anchor has been deployed. Once deployment is complete, the anchor inserter 100 housing can be opened to release the suture inside the housing of the anchor inserter 100.

[0036] Figure 11 to 16 illustrate a second embodiment of the anchor inserter 300 which is particularly well suited for the deployment of an anchor implant assembly comprising two flexible anchors (not shown) that are suitably connected by plurality of sutures. For example, two of the previously described anchor assemblies 500A or 500B may be deployed using the anchor inserter 300 described in the foregoing passages. The scope of the anchor inserter 300 is in no way limited to any specific configuration of the dual anchor-implant assembly.

[0037] The inserter 300 comprises a first and second elongate shafts 31 OA and 31 OB that are mutually perpendicular to each other. Each of the shafts 31 OA and 31 OB are identical in the preferred embodiment and similar in structure and function to the shaft 110 for anchor inserter 100 described in the previous sections. Each shaft (310A and 31 OB) comprises a pair of spaced apart tines positioned at a distal end of the shaft te define a bone tunnel engaging portion for being pushed into the metacarpal bones to therein once respective bone tunnels have been created by using the method described In the previous sections and Illustrated in Figures 5 to 9, The tines for each of the shafts (310A and 310B) are spaced apart to define a slot therebetween that forms an anchor carrying portion that is immediately proximal to the bone tunnel engaging portion. The anchor inserter 300 comprises two respective Inserter body portions 320A and 320B which are also generally mutually perpendicular to each other. The Inserter body portions 320A and 320B are generally identical and for the sake of brevity and conciseness, we shall refer to these as the mutually perpendicular inserter body portions 320. In other embodiments the inserter body partions 320A and 320B may have slightly differing configurations.

[0038] A proximal end portion 312 of the elongate shaft 310 is fixedly attached at to the inserter body portion 120 at a shaft attachment location 322 of the inserter body portion 320. A distal end portion 314 of the shaft 310 comprises two spaced apart tines which define a slot therebetween to form an anchor carrying portion.

[0039] Each inserter body portion 320 at one end forms an attachment portion 321 to provide the shaft attachment location 322. The attachment portion 321 of the inserter body 320 also comprises an opening 326 that forms a guidewire receiving bore 327extending through the attachment portion 321. The opening 326 for the guidewire receiving bore 327 is located adjacent to the shaft attachment location 322. The proximal end portion 312 of the elongate is fixedly received and attached within a shaft receiving bore 329 provided in the attachment portion 321 of the inserter body 320. The shaft receiving bore 329 is generally aligned with a central longitudinal axis of the respective inserter body portion 320. The guidewire receiving bore 327 whilst being generally parallel to the shaft receiving bore 329 is radially offset from the more centrally positioned shaft receiving bore 329 by 3mm to 5mm. The elongate shaft 310 may be fixedly engaged and locked with the walls defining the shaft receiving bore 329 by way of a variety of already known locking mechanisms. In the preferred embodiment shown in Figures 1 to 3, the overall diameter of the shaft receiving bore 329 is slightly greater than the diameter of the guidewire receiving bore 327. However, this variation in bore size between the bores 327 and 329 is not limiting in any manner.

[0040] Each of the mutually perpendicular inserter body portions 320A and 320B are generally hollow and forms a housing that is configured for winding and housing suture extending from an anchor seated in the anchor carrying portion at the distal end portion 314 of the elongate shaft 310. One or more sutures may typically extend from the anchor carrying portion at the distal end portion 314 along the elongate shaft and then be wound within the housing of the inserter body portion 320 along a plurality of suture winding channels to store suture and allow users to unwind the suture once the anchor has been loaded.

[0041] In compliance with the statute, the invention has been described in language more or less specific to structural or methodical features. The term “comprises” andits variations, such as “comprising” and “comprised of’ is used throughout in an inclusive sense and not to the exclusion of any additional features.

[0042] It is to be understood that the invention is not limited to specific features shown or described since the means herein described comprises preferred forms of putting the invention into effect.

[0043] The invention is, therefore, claimed in any of its forms or modifications within the proper scope of the appended claims appropriately interpreted by those skilled in the art.

Claims

CLAIMS1. An anchor inserter having at least one elongate shaft wherein the elongate shaft configured for being pushed into a bone tunnel; a distal end of the shaft comprising anchor carrying portion at the distal end of the shaft with a proximal end of the shaft being fixedly attached to an attachment portion of the inserter body at an attachment location; wherein the inserter body further comprises at least one opening that is positioned adjacent the attachment location, the opening being structured to receive a guidewire therein.

2. An anchor inserter in accordance with claim 1 wherein the proximal end of the elongate shaft is received and fixedly attached within a first bore extending through the attachment portion of the inserter body and wherein the opening forms a second hollow bore that is spaced away from the first bore, the second hollow bore being structured to receive the guidewire.

3. An anchor inserter in accordance with 2 wherein the first bore extends in a direction along a longitudinal axis of the inserter body wherein the inserter body is substantially elongate and wherein the second bore is substantially parallel to the first bore.

4. An anchor inserter in accordance with claim 2 or claim 3 wherein the first bore extends along a central longitudinal axis of the inserter body and wherein the secondbore is substantially parallel to the first bore and offset from the central longitudinal axis.

5. An anchor inserter in accordance with claim 4 wherein the first bore extends along the central longitudinal axis of the attachment portion of the inserter body.

6. An anchor inserter in accordance with claim 4 or claim 5 wherein a central longitudinal of the second bore is offset from the central longitudinal axis of the first bore by a spacing in the range of 3mm and 10mm and more preferably in the range of 4mm and 8mm and even more preferably by 5mm.

7. An anchor inserter in accordance with any one of the preceding claims wherein the inserter body comprises a housing configured for winding and housing suture extending from the anchor seated in the anchor carrying portion at the distal end of shaft.

8. An anchor inserter in accordance with claim 7 wherein the inserter body comprises a plurality of suture receiving channels to wind and store sutures passing through the anchor loaded on the loaded portion therein.

9. An anchor inserter in accordance with any one of the preceding claims wherein the inserter body is shaped to form a handle adapted to be held by a user’s hand.

10. An anchor inserter in accordance with any one of the preceding claims comprising two of said elongate shafts wherein respective proximal portions of each shaft is attached to corresponding first and second attachment portions at respective first and second attachment locations on the inserter body.

11. An anchor inserter in accordance with claim 10 wherein a first of said at least one opening is adjacent the first attachment location and a second of said at least one opening is adjacent the second attachment location.

12. An anchor inserter in accordance with claim 10 or 11 wherein the inserter body comprises first and second housing portions with respective suture receiving channels to wind and store sutures passing through first and second anchors loaded on the anchor carrying portions of the two said elongate shafts.

13. An anchor inserter in accordance with any one of the preceding claims wherein the distal end of the shaft comprises spaced apart tines for form the anchor carrying portion.

14. An anchor insertion system comprising the anchor inserter in accordance with any one of the preceding claims and further comprising a guiding device comprising a guide body having first and second spaced apart guidance tunnels, each guidancetunnel having a proximal entry end for receiving a respective guidewire and a distal exit end for allowing the respective guidewire to exit said guidance tunnel.

15. An anchor insertion system in accordance with claim 14 wherein the spaced apart guidance tunnels are substantially parallel to each other.

16. An anchor insertion system in accordance with any one of claims 13 or 14 wherein the guiding device further comprises a removably disposed reducer being adapted to be coupled to the proximal end of the first guidance tunnel, the reducer having a passage with a reduced diameter relative to a diameter at the proximal end of the first guidance tunnel.

17. A surgical method of bone repair, the method comprising the steps of: inserting a first guidewire into a first location in tissue where an anchor is to be deployed, the inserting step requiring the guidewire to be inserted into a first portion of the tissue and allow the first guidewire to exit out of the tissue from a second portion of the tissue, the second portion being at or adjacent an intended anchor deployment location such that a proximal end portion of the first guidewire extends out from the first portion of the tissue and a distal end portion of the first guidewire extends out from the second portion of the tissue; inserting a second guide wire through the tissue in a spaced apart configuration relative to the first inserted guidewire to effect fixation of the second guidewire in a pre-determined orientation relative to the first guidewiresuch that a proximal portion of the second guidewire extends out from the tissue; and ; removing the first guidewire from the tissue after the thorough bore has been drilled in accordance with the drilling step; providing an anchor inserter in accordance with any one of the preceding claims 1 to 11 and receiving the proximal portion of the second guidewire into the opening located adjacent the attachment location of the anchor inserter to thereby align the elongate shaft to pass through the thorough bore and deploy the anchor at or adjacent the second portion of the tissue.

18. A method in accordance with claim 17 further comprising the step of drilling a thorough bore between the first and second portions of the tissue is carried out by guiding a cannulated drill over the first guidewire.

19. A method in accordance with claim 18 wherein the step of the step of drilling the thorough bore between the first and second portions of the tissue is carried out by after withdrawing the first guidewire from the first location.

20. A method in accordance with claim any one of claims 17 to 19 further comprising the step of providing a guiding device comprising a guide body having first and second spaced apart guidance tunnels, each guidance tunnel having a proximal entry end for receiving a respective guidewire and a distal exit end for allowing the respective guidewire to exit said guidance tunnel; wherein the step of inserting the second guidewire is preceded by the step of locating the proximal portion of the first guidewire into the first guidance tunnel of the guiding device; and wherein the step of inserting the second guidewire further comprises inserting said second guidewirethrough the second guidance tunnel to effect fixation of the second guidewire in a predetermined orientation relative to the first guidewire.21 . A method in accordance with claim 20 wherein the step of drilling comprises passing the cannulated drill through the first guidance tunnel of the guiding device.

22. A method in accordance with claim 18 further comprising the step of removing the first guidewire from the tissue after the thorough bore has been drilled and uncoupling the guidance device from the second inserted guidewire to leave the second guidewire in the predetermined inserted orientation followed by the receiving of the proximal portion of the second guidewire into the second guidance tunnel of the guidance device.

23. A surgical method of bone repair, the method comprising the steps of: drilling a thorough bore into tissue by inserting a drill into a first location in tissue where an anchor is to be deployed, the inserting step requiring the drill to be inserted into a first portion of the tissue and allow the first drill to exit out of the tissue from a second portion of the tissue, the second portion being at or adjacent an intended anchor deployment location such that a proximal end portion of the drill bit extends out from the first portion of the tissue and a distal end portion of the drill bit extends out from the second portion of the tissue; inserting a guide wire through the tissue in a spaced apart configuration relative to the first inserted guidewire to effect fixation of the guidewire in a pre-determinedorientation relative to the drill bit such that a proximal portion of the guidewire extends out from the tissue; and drilling a thorough bore extending between the first and second portions of the tissue; removing the drill bit from the tissue after the thorough bore has been drilled in accordance with the drilling step; providing an anchor inserter in accordance with any one of claims 1 to 11 and receiving the proximal portion of the guidewire into the opening located adjacent the attachment location of the anchor inserter to thereby align the elongate shaft to pass through the thorough bore and deploy the anchor at or adjacent the second portion of the tissue.

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