All-suture bridge anchors

Abstract

One aspect provided herein is a suturing system for securing a suture between two holes. The system includes an anchor assembly. The anchor assembly includes a suture. The anchor assembly includes a first anchor coupled to a distal portion of the suture. The anchor assembly includes a second anchor coupled to the suture proximal to the first anchor. The suturing system includes a first inserter device coupled to the first anchor. The suturing system includes a second suture inserter device coupled to the second anchor. The first anchor is inserted into a first bone or hole therein in and the second anchor is inserted into a second bone or hole therein. The suture forms a link between the first bone or hole therein and the second bone or hole therein.

Description

ALL-SUTURE BRIDGE ANCHORSCross-Reference to Related Applications

[0001] This application claims priority to, and the benefit of, U.S. Prov. App. No. 63 / 662,156, filed June 20, 2024, the entirety of which is incorporated herein by reference.SUMMARY

[0002] One aspect provided herein is a suturing system for securing a suture between two holes. The system includes an anchor assembly. The anchor assembly includes a suture. The anchor assembly includes a first anchor coupled to a distal portion of the suture. The first anchor includes a first plurality of anchor inserts. The first anchor is configured to transition from a first insertion configuration that is substantially linear to a first deployed configuration that is at least partially nonlinear. The anchor assembly includes a second anchor coupled to the suture proximal to the first anchor. The second anchor includes a second plurality of anchor inserts. The second anchor is configured to transition from a second insertion configuration that is substantially linear to a second deployed configuration that is at least partially nonlinear. The suturing system includes a first inserter device coupled to the first anchor in the first insertion configuration. The first suture inserter device includes a first inserter operable to axially translate the first anchor with respect to the first suture inserter device from the first insertion configuration to the first deployed configuration. The suturing system includes a second suture inserter device coupled to the second anchor in the second insertion configuration. The second suture inserter device includes a second inserter operable to axially translate the second anchor with respect to the second suture inserter device from the second insertion configuration to the second deployed configuration. The first anchor is inserted into a first bone or hole therein in the first insertion configuration using the first inserter device and the second anchor is inserted into a second bone or hole therein in the second insertion configuration using the second suture inserter device. The suture forms a link between the first bone or hole therein and the second bone or hole therein.

[0003] One aspect provided herein is a method of securing a suture between two holes. The method includes inserting a first anchor secured to a first distal end of a suture through a first suture inserter device into a first bone or hole therein. The method includes deploying the first anchor by translating a first portion of the first anchor while immobilizing a second portion of the first anchor causing a first plurality of anchor inserts between the first portion and the second portion of the first anchor totransition from an insertion configuration that is substantially linear to a deployed configuration that is at least partially non-linear. The method includes inserting a second anchor secured to a second distal end of the suture through a second suture inserter device into a second bone or hole therein. The method includes deploying the second anchor by translating a first portion of the second anchor while immobilizing a second portion of the second anchor causing a second plurality of anchor inserts between the first portion and the second portion of the second anchor to transition from an insertion configuration that is substantially linear to a deployed configuration that is at least partially non-linear.

[0004] One aspect provided herein is a suture assembly. The suture assembly includes a first anchor, the first anchor including a plurality of first anchor inserts. The suture assembly includes a second anchor, the second anchor comprising a plurality of second anchor inserts. The suture assembly include a first connection line, the first anchor coupled to a first end of the first connection line at a first portion of the first anchor, and the second anchor coupled to a second end of the first connection line at a first portion of the second anchor, the first and second end opposite each other. The suture assembly includes a second connection line, the first anchor coupled to a first end of the second connection line at a second portion of the first anchor, and the second anchor coupled to a second end of the second connection line at a second portion of the second anchor, the first and second end opposite each other.BRIEF DESCRIPTION OF THE DRAWINGS

[0005] The novel features of the disclosure are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized, and the accompanying drawings of which:

[0006] FIG. 1 shows a front cross-sectional view illustration of an exemplary first suturing system, per one or more embodiments herein;

[0007] FIG. 2 shows a front-top-right perspective view illustration of an exemplary first suturing system, per one or more embodiments herein;

[0008] FIG. 3 A shows a front view illustration of an exemplary first suturing system, wherein the inserter is in a distal position, per one or more embodiments herein;

[0009] FIG. 3B shows a front view illustration of an exemplary first suturing system, wherein the inserter is in a proximal position, per one or more embodiments herein;

[0010] FIG. 4A shows a right cross-sectioned view illustration of an exemplary first suturing system, wherein the anchor is in an insertion configuration, per one or more embodiments herein;

[0011] FIG. 4B shows a right cross-sectioned illustration of an exemplary first suturing system, wherein the anchor is in deployed configuration, per one or more embodiments herein;

[0012] FIG. 4C shows a right view illustration of an exemplary anchor, per one or more embodiments herein;

[0013] FIG. 5A shows a front view illustration of an exemplary first suturing system, wherein the inserter is in the distal position, per one or more embodiments herein;

[0014] FIG. 5B shows a top view illustration of an exemplary first suturing system, wherein the inserter is in the distal position, per one or more embodiments herein;

[0015] FIG. 5C shows a front cross-sectioned view illustration of the inserter of an exemplary first suturing system per one or more embodiments herein;

[0016] FIG. 6A shows a top view illustration of an exemplary second suturing system, wherein the second needle is in a primary configuration, per one or more embodiments herein;

[0017] FIG. 6B shows a top view illustration of an exemplary second suturing system, wherein the second needle is in a secondary configuration, per one or more embodiments herein;

[0018] FIG. 6C shows a front view illustration of an exemplary second suturing system, per one or more embodiments herein;

[0019] FIG. 7A shows a front-top perspective view illustration of an exemplary second suturing system, wherein the second needle is in the primary configuration, per one or more embodiments herein;

[0020] FIG. 7B shows a front-top perspective view illustration of an exemplary second suturing system, wherein the second needle is in the secondary configuration, per one or more embodiments herein;

[0021] FIG. 7C a front-top perspective view illustration of an exemplary second suturing system, per one or more embodiments herein;

[0022] FIG. 8 shows an illustration of an exemplary anchor of the second and third suturing systems, per one or more embodiments herein;

[0023] FIG. 9A shows a top view illustration of an exemplary third suturing system, wherein the first needle is in a first primary configuration, and wherein the second needle is in a second primary configuration, per one or more embodiments herein;

[0024] FIG. 9B shows a top view illustration of an exemplary third suturing system, wherein the first needle is in a first secondary configuration, and wherein the second needle is in a second secondary configuration, per one or more embodiments herein;

[0025] FIG. 9C shows a top view illustration of an exemplary third suturing system, per one or more embodiments herein;

[0026] FIG. 10A shows a front-top perspective view illustration of an exemplary third suturing system, wherein the first needle is in a first primary configuration, and wherein the second needle is in a second primary configuration, per one or more embodiments herein;

[0027] FIG. 10B shows a front- top perspective view illustration of an exemplary third suturing system, wherein the first needle is in a first secondary configuration, and wherein the second needle is in a second secondary configuration, per one or more embodiments herein;

[0028] FIG. 10C shows a front- top perspective view illustration of an exemplary third suturing system, per one or more embodiments herein;

[0029] FIG. 11 A shows a perspective view of a first step in a second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0030] FIG. 1 IB shows a detailed perspective view of a first step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0031] FIG. 12A shows a perspective view of a second step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0032] FIG. 12B shows a detailed perspective view of a second step in the second method of two portions of a soft tissue together, per one or more embodiments herein;

[0033] FIG. 13 A shows a perspective view of a third step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0034] FIG. 13B shows a detailed perspective view of a third step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0035] FIG. 14A shows a perspective view of a fourth step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0036] FIG. 14B shows a detailed perspective view of a fourth step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0037] FIG. 15 shows a perspective view of a fifth step in the second method of anchoring two portions of a soft tissue together, per one or more embodiments herein;

[0038] FIG. 16 shows a perspective view of a sixth step in the second method of two portions of a soft tissue together, per one or more embodiments herein;

[0039] FIG. 17A shows a front-top perspective view illustration of an exemplary second suturing system without the suture, per one or more embodiments herein;

[0040] FIG. 17B shows a top view illustration of an exemplary second suturing system the suture, per one or more embodiments herein;

[0041] FIG. 18A shows an illustration of a first anchor, per one or more embodiments herein; and

[0042] FIG. 18B shows an illustration of a second anchor, per one or more embodiments herein.

[0043] FIG. 19A shows an illustration of a knotless suture anchor in an insertion configuration and comprising a repair suture and a plurality of anchor inserts, per one or more embodiments herein;

[0044] FIG. 19B shows an illustration of the knotless suture anchor from FIG. 19A in a deployed configuration, per one or more embodiments herein;

[0045] FIG. 20A shows an illustration of a knotless suture anchor in an insertion configuration and comprising a repair suture, a passing suture, and a plurality of anchor inserts, per one or more embodiments herein;

[0046] FIG. 20B shows an illustration of the knotless suture anchor from FIG. 20A in a deployed configuration, per one or more embodiments herein;

[0047] FIG. 21 shows an illustration of the knotless suture anchor from FIG. 20B, wherein the second end of the repair suture has been pull through and out of the hollow interior of the repair suture, such that a portion of the repair suture is secured within the hollow interior.

[0048] FIG. 22 shows an illustration of another anchor in an insertion configuration comprising a plurality of sutures, a plurality of anchor inserts, and a plurality of loops between the anchor inserts.

[0049] FIG. 23 A shows an illustration of an exemplary anchor with a plurality of anchor inserts in an insertion configuration, per one or more embodiments herein.

[0050] FIG. 23B shows an illustration of a repair suture weaved through the exemplary anchor from FIG. 23A while in the insertion configuration, per one or more embodiments herein.

[0051] FIG.23 C shows an illustration of the repair suture weaved through the exemplary anchor from FIG. 23 A while in the deployed configuration, per one or more embodiments herein.

[0052] FIG. 24 shows an illustration of a suturing system for securing a suture between two bone holes.

[0053] FIG. 25 shows an illustration of an embodiment of a suture assembly.

[0054] FIG. 26 shows an illustration of another embodiment of a suture assembly.

[0055] FIG. 27 illustrates a delivery device that may be used with suture assemblies described herein.

[0056] FIG. 28 illustrates an example deployment of a suture assembly within a tissue.DETAILED DESCRIPTIONFirst Suturing System

[0057] One aspect provided herein, per FIGS. 1-6C, is a first suturing system. In some embodiments, the first suturing system is configured for operating on a shoulder, a hip, a foot, an ankle, an elbow, a hand, a wrist, or any combination thereof. In some embodiments, the first suturing system is configured for rotator cuff repair, bankart repair, slap lesion repair, biceps tenodesis, acromio-clavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction, or any combination thereof of the shoulder. In some embodiments, the first suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the foot. In some embodiments, the first suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the ankle. In some embodiments, the first suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the hand. In some embodiments, the first suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the wrist. In some embodiments, the first suturing system is configured for biceps tendon reattachment, tennis elbow repair, ulnar or radial collateral ligament reconstruction, lateral epicondylitis repair, or any combination thereof of the elbow.

[0058] In some embodiments, the first suturing system comprises an anchor 400 and a suture inserter device 1000. In some embodiments, the anchor 400 comprises a suture 420 having a first end 421 and a second end 422, and an anchor insert 410. In some embodiments, the suture inserter device 1000 comprises a housing 100 and an inserter 200.

[0059] In some embodiments, the anchor insert 410 is coupled to the suture 420 between the first end 421 and the second end 422 of the suture 420. In some embodiments, the anchor insert 410 iscoupled to a mesial portion of the suture 420. In some embodiments, the anchor 400 has an insertion configuration, per FIG. 4A, and a deployed configuration, per FIG. 4B. In some embodiments, the anchor 400 comprises one or more anchor inserts 410. In some embodiments, per FIG. 4C, the anchor 400 comprises a first anchor insert 410 a second anchor insert 410 and a link therebetween. In some embodiments, the link comprises the suture 420. In some embodiments, the anchor inserts comprise one or more knots formed with a different suture from suture 420 (e.g., an anchor insert suture), wherein the anchor inserts may additionally or alternatively be linked via the anchor suture itself. In some embodiments, the anchor 400 changes from a substantially linear configuration (e.g., FIG. 4A) in the insertion configuration to a substantially nonlinear configuration (e.g., FIG. 4B) in the deployed configuration of the anchor 400. In some embodiments, the first anchor insert 410 is coupled to the second anchor insert 410 and is disposed serially between the first end 421 and the second end 422 of the suture 420 when the anchor 400 is in the insertion configuration. In some embodiments, at least two anchor inserts 410 are coupled to each other. In some embodiments, at least one anchor insert 410 is individually coupled to the suture 420. In some embodiments the plurality of anchor inserts 410 are substantially linear when the anchor 400 is in the insertion configuration to enable insertion within a bone hole or other tissue aperture. For example, as shown in some embodiments, the anchor inserts 410 are provided in a row when the anchor 400 is in the insertion configuration. In some embodiments, per FIG. 4B, the plurality of anchor inserts 410 are substantially non-linear when the anchor 400 is in the deployed configuration such that the anchor inserts 410 interlock within a bone hole (e.g., 402) or other tissue aperture. For example, as shown in FIG. 4B, in some embodiments, the anchor inserts 410 are provided in two or more rows when the anchor 400 is in the deployed configuration. In some embodiments, the anchor inserts 410, when in the deployed configuration, are arranged in any orientation and sequence with respect to each other. For example, FIG. 3B depicts the deployed configuration of the anchor inserts in two rows and two columns, with each anchor insert aligned with another anchor insert in the corresponding row or column. FIG. 4B depicts the deployed configuration with two rows of the anchor inserts, wherein the anchor inserts are not aligned in a column. In some embodiments, the anchor inserts, when in a deployed configuration, are arranged in a manner that resembles a diamond shape. Further, in some embodiments, the first end of the suture 421 is proximal to at least a portion of the anchor insert 410 when the anchor 400 is in the insertion configuration. In some embodiments, the suture 420 is referred to as a repair suture herein.

[0060] In some embodiments, per FIG. 4C, the width 430C of any one anchor insert 410 is from about 0.1 mm to about 10 mm. In some embodiments, the width 430C of each individual anchor insert 410 is at most about 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 mm, including increments therein. In some embodiments, the width 430C of each individual anchor insert 410 is at least about 0.1, 1, 2, 3, 4, 5, 6, 7, 8, or 9 mm, including increments therein. In some embodiments, the outer width 430C of the anchor insert 410 is from about 0.1 mm to about 10 mm, or is at most about 10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 mm, including increments therein. In some embodiments, the outer width 430C of the anchor insert 410 is from about 0.1 mm to about 10 mm, or is about 0.1, 1, 2, 3, 4, 5, 6, 7, 8, or 9 mm, including increments therein. Accordingly, in some embodiments, the outer width 430C of the anchor 400 in the insertion configuration (e.g., when the anchor is in a linear or substantially linear configuration) enables the anchor 400 to be inserted within the bone hole (e.g., 402) or other tissue aperture. As discussed herein, in some embodiments, the outer width 430A of the anchor inserts 410 (together) in the insertion configuration is configured to be approximately the outer width 430C, thickness, or diameter 430C of an individual anchor insert 410. In some embodiments, the outer width 430 A of the anchor inserts 410 (together) in the insertion configuration corresponds to a lateral dimension relative to a longitudinal length of the anchor insert 410. In some embodiments, the outer width 430A of the anchor inserts 410 (together) in the insertion configuration is greater than, the same, or substantially the same diameter or width as a bone hole. Accordingly, in some embodiments, the anchor in the insertion configuration contacts the inner walls of a bone hole (as depicted in FIG. 4A). In some embodiments, the anchor in the insertion configuration provides a tight-fit or snug-fit interaction with the inner wall of the bone hole.

[0061] In some embodiments, the anchor 400 is configured to transition from the insertion configuration to a deployed configuration. In some embodiments, the deployed configuration comprises displacing the anchor inserts 410 such that the outer width 430B of the anchor inserts 410 (together) in the deployed configuration, along a lateral dimension compared to a longitudinal direction of a bone hole (e.g., FIG. 4B), is greater than the outer width 430A of the anchor inserts 410 (together) when the anchor 400 is in the insertion configuration. For example, in some embodiments, the plurality of anchor inserts 410 are aligned in two or more rows when the anchor 400 is in the deployed configuration (e.g., FIG. 4B). Accordingly, the outer width 430B of the anchor inserts 410 (together) in the deployed configuration with two rows (FIG. 4B) is greater than the outer width 430A of the anchor inserts 410 (together) arranged in one row (FIG. 4A). In some embodiments, the outer width 430C of the anchor 400 is measured as an outer diameter or an outerthickness. As described herein, in some embodiments, the anchor inserts is configured to push at least a portion of the inner wall defining a bone hole when transitioning from the insertion configuration to the deployed configuration (see FIG. 4B for example).

[0062] In some embodiments, the outer width 430A of the anchor inserts 410 (together) in the insertion configuration is greater than, the same, or substantially the same diameter or width as a bone hole. Accordingly, in some embodiments, in some embodiments, the anchor inserts 410 in the insertion configuration contacts the inner walls of a bone hole. In some embodiments, the anchor inserts 410 in the insertion configuration provide a tight- fit or snug-fit interaction with the inner wall of the bone hole. Accordingly, in some embodiments, transitioning the anchor from an insertion configuration to a deployed configuration results in the anchor inserts pushing against the inner walls of the bone hole (for example, see FIG. 4B). In some embodiments, the anchor inserts in the deployed configuration push the bone hole walls to accommodate having a substantially non-linear configuration. For example, in some cases, the anchor inserts contact an inner wall of the bone hole that can be articulated to allow the anchor inserts extend at least partially beyond a bone hole width (e.g., see FIG. 3B, 4B). In some cases, the inner wall includes a thickness (e.g., 404) that is at least partially malleable, as opposed to a portion of the bone beyond said thickness, which may be more dense and thus more difficult to for the anchor inserts to push when transitioning to a deployed configuration (e.g., cortical region of bone).

[0063] Accordingly, in some embodiments, when the one or more anchor inserts 410 are arranged in a substantial linear configuration in the insertion position, the outer width 430 A of the anchor inserts 410 (together), along a lateral dimension compared to a longitudinal direction of a bone hole (e.g., FIG. 4A), is from about 0.1 mm to about 10 mm. In some embodiments, the outer width 430C of the one or more anchor inserts 410 is greater than an inner diameter of an inserter lumen (e.g., see 210 in FIG. 4A / 4B). Accordingly, in some embodiments, the one or more anchor inserts will abut the walls of the inserter 200 (e.g., when the inserter fork 230 is retracted into inserter lumen 210).

[0064] In some embodiments, the outer diameter 430B of the anchor inserts 410 (together) in the deployed configuration is greater than a diameter of a bone hole, an opening to the bone hole, and / or an opening to a tissue as described herein (where a surgical procedure is being performed). Accordingly, in some embodiments, the anchor inserts 410 when the anchor 400 is in the deployed configuration are pressed against an inner wall of a bone wall, thereby providing tension of the suture 420. Accordingly, in some embodiments, after the anchor 400 has been inserted within a bone hole opening or tissue opening in the insertion configuration, the pull out strength of the anchor 400(i.e. a force required to pull the anchor 400 out through the bone hole opening or tissue opening) significantly increases in the deployed configuration as compared to the insertion configuration. In some embodiments, the pull out strength of the anchor 400 in the deployed configuration within a bone hole is from about 5 psi to about 40 psi. In some embodiments, the pull out strength of the anchor 400 within a bone hole is from about 15 psi to about 25 psi.

[0065] In some embodiments, one or more anchor inserts 410 have a shape comprising a circle, sphere, a cylinder, a pyramid, a torus, a cone, a prism, or any combination thereof. In some embodiments, one or more anchor inserts 410 is a suture 420 knot. In some embodiments, one or more anchor inserts 410 comprise knots in a suture different from suture 420 (as described herein, for e.g., see anchor suture). In some embodiments, one or more of the anchor inserts 410 comprise a hollow structure. In some embodiments, the suture 420 passes through each of the hollow structures of such anchor inserts 410 (e.g., FIGS. 4A-4C). In some embodiments, one or more of the anchor inserts 410 comprise a solid structure (e.g., FIGS. 4A-4C). In some embodiments, the suture 420 is affixed to each of the solid structures of such anchor inserts 410. In some embodiments, each of the solid structures of the anchor inserts 410 are tethered to a common loop that is also coupled to the suture 420, thereby operatively coupling the suture 420 to said anchor inserts 410. In some embodiments, the one or anchor inserts 410 comprise one or more knots of the suture 420 or another suture (as described herein). In some embodiments, the one or more anchor inserts 410 comprise suture 420 balls, or other balls. In some embodiments, the one or more anchor inserts 410 comprise cylindrical, oval and / or disk shapes. In some embodiments, for any anchor herein, the anchor inserts 410 comprise any shape, such as spherical, cylindrical, oval, disk, triangular, square, or any non- uniform shape.

[0066] In some embodiments, the depth of a bone hole required to be drilled is at least partially dependent on the number of anchor inserts 410 on the anchor 400. In some embodiments, increasing the number of anchor inserts 410 provides an increased pull out strength of the anchor 400 when in the deployed configuration. In some embodiments, reducing the number of anchor inserts 410 in the anchor 400 reduces or limits the depth of the bone hole needed to contain the anchor inserts 410. In some embodiments, the number of anchor inserts 410 in the anchor 400 is optimized depending on the anatomical portion being targeted, so as to balance the required bone drill depth and pull out strength. In some embodiments, the plurality of anchor inserts 410 comprises 3, 4, 5, 6, 7, 8 or more anchor inserts 410. In some embodiments, the depth of the bone hole using a suturing system described herein is from about 10 mm to about 30 mm. For example, in some embodiments, thedepth of the bone hole using a suturing system comprising four anchor inserts 410 for a shoulder / hip labral repair is about 15 mm to about 20 mm, or less. In another example, in some embodiments, the depth of the bone hole using a suturing system comprising four anchor inserts 410 for a rotator cuff repair is about 22 mm to about 28 mm, or less. In some embodiments, the outer width of the anchor insert 410 is greater than the drill diameter of the bone hole, which may be at most about 2-4 mm for a shoulder / hip labral repair. In another example, the outer width of the anchor insert 410 is greater than the drill diameter of the bone hole, which may be at most about 3-5 mm for a shoulder / hip labral repair.

[0067] FIG. 22 depicts another exemplary embodiment of an anchor 2200 having been configured for any suturing system described herein. In some embodiments, the anchor comprises a plurality of anchor inserts 2210. In some embodiments, the anchor 2200 comprises two sutures 2220, 2222, that form the one or more anchor inserts 2210. In some embodiments, the two sutures 2220, 2222 are configured to form a loop 2202 or chain between the anchor inserts 2210. In some embodiments, the anchor 2200 is arranged in a braided configuration. In some embodiments, one or both distal ends 2224, 2226 of each suture 2220, 2222 is configured to be weaved back through (not shown) one or more loops 2202 between each anchor insert 2210. In some embodiments, pulling on one or both of the distal ends 2224, 2226 after being weaved through the one or more loops 2202 allows the anchor to transition from an insertion configuration to a deployed configuration. In some embodiments, the anchor 2200 comprises a single suture.

[0068] FIGS. 23A-23C depict another exemplary embodiment of an anchor 2300 having been configured for any suturing system described herein. In some embodiments, the anchor 2300 does not include an anchor insert having an fixed central opening. In some embodiments, the anchor 2300 may include one or more anchor inserts 2310 that can allow a repair suture 2320 (for example) to weave through, as shown in FIG. 23B. In some embodiments, the repair suture 2320 weaves through the anchor inserts (which may comprises “suture knots” on a separate suture). In some embodiments, the repair suture 2320 passes through the anchor inserts (e.g., through the actual inserts or knots). In some embodiments, the repair suture 2320 weaves past at least some of the anchor inserts, but is passed through the most distal anchor insert (e.g., anchor insert located furthest from a bone hole opening). In some embodiments, the repair suture 2320 is disposed within an inserter, such that when the repair suture 2320 has been inserted through one or more inserts (e.g., knots) 2310, the repair suture 2320 can be pulled so as to transition the anchor 2300 from an insertion configuration to the deployed configuration, as shown in FIG. 23C.

[0069] For any embodiment herein, the anchor insert (e.g., 410, 1910, 2210, 2310, etc.) may be of any shape. For example, the anchor insert for any embodiment of an anchor described herein may be spherical, round, oval, ellipsoidal, rectangular, square, triangular, polygonal, or any combination thereof.

[0070] For any embodiment of an anchor (e.g., 400, 1900, 2200, 2300) described herein, the anchor may be manufactured according to any automated process known in the art. For example, the anchor may be manufactured using a braiding machine. In some embodiments, for any embodiment of anchor described herein, the anchor may be at least partially manufactured by hand.

[0071] With reference to FIG. 1, FIGS. 3A-3B, and FIGS. 5A-5C, in some embodiments, the suture inserter device 1000 comprises a housing 100, an inserter 200, and / or an inserter fork 230. As used herein, the term “inserter” (for e.g., ref. char. 200) and the term “driver” may be used interchangeably. In some embodiments, the housing comprises a housing shaft axially translatable within a housing lumen 110. In some embodiments, the inserter 200 is coupled to the housing shaft 250. In some embodiments, the inserter 200 is axially translatable within the housing lumen 110. In some embodiments, the inserter 200 is axially translatable within the housing lumen 110 via translation of the housing shaft 250. In some embodiments, the inserter 200 is axially translatable within the housing lumen 110 between a distal position and a proximal position. In some embodiments, a distal portion of the inserter 200 is configured to extend from the housing lumen 110. In some embodiments, the inserter 200 comprises an inserter lumen 210 extending at least partially therethrough. In some embodiments, the inserter fork 230 (see FIG. 5C) is disposed within the inserter lumen and configured to extend from the inserter lumen. In some embodiments, the inserter fork 230 is coupled to the housing shaft 250, and is disposed within an inserter lumen. In some embodiments, the insert fork 230 is axially translatable within the inserter lumen 210 and the housing lumen 110. In some embodiments, the inserter fork 230 is axially translatable via the housing shaft 250 and within the inserter lumen 210 inserter 200, wherein the inserter 200 and the inserter lumen 210 are not axially translatable.

[0072] In some embodiments, the first end 421 and / or the second end 422 of the suture 420 is coupled to the inserter 200. In some embodiments, an outer surface of the housing shaft 250 comprises a threaded portion 240 configured to engage with a complimentary inner surface of the housing lumen. In some embodiments, the suture inserter device 1000 comprises a handle 300 a proximal end thereof. In some embodiments, the handle 300 comprises a knurl, a knob, a textured surface, or any combination thereof. In some embodiments, the handle 300 is configured to rotate,thereby axially translating the housing shaft 250 and therefore inserter 200. In other embodiments, the handle 300 is configured to rotate, thereby axially translating the housing shaft 250 and therefore the inserter fork 230 within the inserter lumen 210. In some embodiments, the handle 300 and / or the housing 100 rotate relative to the inserter 200. In some embodiments, the housing shaft 250 rotates relative to the handle 300 and the housing 100.

[0073] In other embodiments, the handle 300 is configured to rotate and tighten the suture 420 (e.g., tension the suture). In some embodiments, the inserter fork 230 is configured to be retracted and axially translated within the inserter lumen 210 via the housing shaft 250 being pulled back (e.g., manually pulling back the housing shaft 250).

[0074] In some embodiments, the housing 100 shaft has a housing 100 threaded portion, wherein the inserter 200 has an inserter 200 threaded portion, and wherein the inserter 200 is axially translatable with respect to the housing lumen 110 by rotating the housing’s 100 threaded portion with respect to the inserter’s 200 threaded portion.

[0075] In some embodiments, per FIGS. 4A, 4B, and 5C, the inserter 200 comprises a suture channel opening 220 accepting the first end 421 and the second end 422 of the suture 420. In some embodiments, as shown, the first end 421 and the second end 422 of the suture 420 enter and / or exit the inserter lumen 210 via suture channel opening 220, such that a practitioner can apply a tensile force to the first end 421 of the suture 420, the second end 422 of the suture 420, or both. In some embodiments, a distal tip of the inserter 200 comprises an inserter fork 230 receiving an anchor insert 410 (e.g., the distal anchor inserts 410). Accordingly, in some embodiments, the anchor inserts 410 are placed within a bone hole using the inserter fork. Alternatively, in some embodiments, a distal tip of the inserter 200 comprises a channel sized to hold the suture 420 and the anchor inserts 410.

[0076] In some embodiments, the suture 420, the anchor 400, the housing 100, the housing shaft 250, the inserter 200, or any combination thereof are formed of metal, plastic, glass, wood, ceramic, or any combination thereof.

[0077] With reference to FIGS. 5A-5C, in some embodiments, the first suturing system further comprises a deployment suture 423. In some embodiments, the deployment suture 423 is configured to be linked with a leading anchor insert 410 (for example the anchor insert 410 entering through a bone hole or suture 420 opening first (see e.g., FIG. 4A). In some embodiments, the deployment suture 423 is disposed within the inserter 200, such that when the anchor insert 410 has been inserted through the bone hole or tissue opening, the deployment suture 423 can be pulled so as to transitionthe anchor 400 from an insertion configuration to the deployed configuration. In some embodiments, continued pulling on the deployment suture 423 separates it from the leading anchor insert 410, and optionally, the deployment suture 423 may then be removed.First Suturing System - Knotless Version

[0078] In some embodiments, the first suturing system is provided as a knotless embodiment, such that two ends of a suture need not be knotted together to secure a suture between two bone segments, a bone segment and a tissue segment, and / or two tissue segments. FIGS. 19A-B depict an exemplary configuration of a suture anchor 1900, comprising a repair suture 1920 and one or more anchor inserts 1910. In some embodiments, the anchor inserts 1910 are coupled to the repair suture 1920. In some embodiments, the anchor inserts 1910 are formed of the repair suture 1920 (e.g., the repair suture is knotted along its length to form an anchor insert, wherein a plurality of “knots” (as described herein) correlates to a plurality of anchor inserts). In some embodiments, the anchor inserts 1910 are a separate component from the repair suture 1920, and configured to be attached or otherwise coupled to a first end or about a first end of the repair suture 1920. For example, in some embodiments, the anchor inserts comprise one or more knots formed with a different suture from repair suture 1920 (e.g., an anchor insert suture), wherein the anchor inserts may additionally or alternatively be linked via the anchor suture itself. As used herein, about a first end refers to either located at the first end, or a distance from the first end that is about 0.1% to 50% of the total length of the repair suture 1920. Accordingly, where the anchor inserts are located a distance from the first end of the repair suture, this refers to all the anchor inserts being located between the first end and a second of the repair suture 1920. In some embodiments, the suture anchor 1900 is inserted within a bone hole, similar to as depicted in FIGS. 4A-C.

[0079] In some embodiments, a terminal anchor insert (e.g., 1910a) is located at a first end of the repair suture 1920 or about a first end of the repair suture 1920 (as described herein). In some embodiments, similar to as depicted in FIGS. 4A-C, as described herein, the anchor 1900 is inserted within the bone hole in an insertion configuration, as seen in FIGS. 19A-B. In some embodiments, the anchor 1900 is inserted within the bone hole similar to as described in FIGS. 4A-5C. In some embodiments, the terminal anchor insert (e.g., 1910a) is located closest to the bone hole opening when the anchor 1900 is inserted in the insertion configuration.

[0080] In some embodiments, a second end 1921 of the repair suture (e.g., opposite from the first anchor insert 1910a) is weaved through anchor inserts 1910 (as depicted in FIG. 19B). Accordingly, in some embodiments, the second end 1921 of the repair suture 1920 is configured to be pulled awayfrom the bone hole, thereby enabling the second end 1921 of the repair suture to be inserted through another bone segment and / or a tissue segment. In some embodiments, where the repair suture 1920 is coupled to the anchor inserts and / or forms one or more of the anchor inserts (e.g., via “knots” along the length of the repair suture), pulling the second end 1921 away from the bone hole transitions the anchor 1900 from an insertion configuration to a deployed configuration, thereby securing a portion of the repair suture 1920 within the bone hole (as described herein, which may be for a first bone segment).

[0081] In some embodiments, the repair suture 1920 is inserted into a bone hole with a passing suture. For example, FIGS. 20A-B depict an anchor comprising a repair suture 1920, as described herein, with a passing suture 1930. In some embodiments, the repair suture 1920 comprises a hollow interior at least along a portion therein, wherein the passing suture 1930 is configured to be inserted through a portion of the hollow interior of the repair suture 1920. In some embodiments, the repair suture 1920 comprises two openings 1922, 1923 along its length, such that the passing suture 1930 is inserted through one opening (e.g., 1922) and comes out another opening (e.g., 1923). In some embodiments, the distance between the two openings 1922, 1923 is from about 0.2 mm to about 45 mm, from about 0.5 mm to about 30 mm, from about 0.7 mm to about 25 mm, from about 1.0 mm to about 20 mm, from about 1.5 mm to about 15 mm, or from about 2 mm to about 10 mm. In some embodiments, the repair suture 1920 comprises a #2 suture. In some embodiments, the passing suture 1930 comprises a #2-0 suture. In some embodiments, the passing suture 1930 comprises a suture loop 1932 at a primary end of the passing suture 1930, which is opposite a secondary end 1931 of the passing suture 1930. In some embodiments, as described herein, the passing loop is at least partially located within the hollow interior, wherein the primary end 1932 extends from a first opening (e.g., 1922), while the secondary end 1931 extends from the second opening (e.g., 1923). In some embodiments, the passing loop 1932 is configured to receive and couple with the second end 1921 of the repair suture 1920, such that pulling on the secondary end 1931 of the passing suture 1930 also pulls the second end 1921 of the repair suture 1920 (e.g., via its coupling with the passing loop 1932), and thereby allows the second end 1921 of the repair suture 1920 to be pulled through a first opening (e.g., 1922) of said repair suture 1920 to the hollow interior (as described herein), through the hollow interior of the repair suture 1920, and then out a second opening (e.g., 1923), such that a portion of the repair suture 1920 is inserted within itself within the hollow interior. FIG. 21 depicts an exemplary anchor (in the deployed configuration) wherein the second end 1921 of the repair suture passed through the hollow interior of the repair suture 1920 (between the two openings1922, 1923), such that a portion of the repair suture 1920 remains within the hollow interior portion 1924. In some embodiments, the portion of the repair suture within the hollow interior portion 1924 is held in place due to the friction therein (e.g., outer wall of portion of repair suture contacting inner wall of hollow interior of the repair suture), that helps prevent the portion of the repair suture from sliding out of the hollow interior portion 1924 (e.g., helps prevent the second end 1921 of the repair suture moving back towards the opening 1923). In some embodiments, such configuration of securing the repair suture within itself (in the hollow interior) allows the repair suture 1920 to secure a bone segment (via the anchor inserts 1910 in the bone hole) with a tissue and / or other bone segments (via the repair suture being inserted through said tissue and / or other bone segments, and back to the bone hole and through the hollow interior).Second Suturing System

[0082] Another aspect provided herein, per FIGS. 6A-8 and 17A-17B, is a second suturing system. In some embodiments, the second suturing system is configured for operating on a knee, shoulder, a hip, a foot, an ankle, an elbow, a hand, a wrist, or any combination thereof. In some embodiments, the second suturing system is configured for meniscal repair, extra-capsular repair: medial collateral ligament (MCL), lateral collateral ligament (LCL) and posterior oblique ligament; Iliotibial band tenodesis (IBT); patellar tendon repair; vastus medialis obliquus advancement (VMO); joint capsule closure, or any combination thereof of the knee. In some embodiments, the second suturing system is configured for rotator cuff repair, bankart repair, slap lesion repair, biceps tenodesis, acromioclavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction, or any combination thereof of the shoulder. In some embodiments, the second suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the foot. In some embodiments, the second suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the ankle. In some embodiments, the second suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the hand. In some embodiments, the second suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the wrist. Insome embodiments, the second suturing system is configured for biceps tendon reattachment, tennis elbow repair, ulnar or radial collateral ligament reconstruction, lateral epicondylitis repair, or any combination thereof of the elbow.

[0083] In some embodiments, the second suturing system comprises an anchor 700 and a suture inserter device 2000. In some embodiments, the anchor 700 comprises a suture 720, a first anchor 700 A, and a second anchor 700B. In some embodiments, the first anchor 700A is coupled to a distal portion of the suture 720 and the second anchor 700B is coupled to the suture 720 proximal to the first anchor 700 A. In some embodiments, the suture inserter device 2000 comprises a housing 500 and a second needle 620 and a second housing lumen 520. In some embodiments, the housing 500 comprises a first needle 610. In some embodiments, the first anchor 700A couples to the second needle 620. In some embodiments, the first needle 610 receives a portion of the suture 720 proximal to the first anchor 700A and distal to the second anchor 700B. In some embodiments, the second needle 620 is axially translatable within the second housing lumen 520 between a primary configuration and a secondary configuration. With reference to FIG. 7C, in some embodiments the second housing lumen is disposed within the housing 500. As shown in FIG. 17A, in some embodiments a needle described herein comprises a distal end with a step 622, wherein the anchor inserts are placed at the distal end.

[0084] In some embodiments, per FIG. 8, the first anchor 700A comprises a plurality of first anchor inserts 710A, and the second anchor 700B comprises a plurality of second anchor inserts 710B. In some embodiments, each of the plurality of first anchor inserts 710A is coupled to a preceding first anchor insert 710A, a subsequent first anchor insert 710A, or both. In some embodiments, each of the plurality of first anchor inserts 710A is coupled to a preceding first anchor insert 710A, a subsequent first anchor insert 710A, or both by a first link 731. In some embodiments, each of the plurality of second anchor inserts 710B is coupled to a preceding second anchor insert 710B, a subsequent second anchor insert 710B, or both. In some embodiments, each of the plurality of second anchor inserts 710B is coupled to a preceding second anchor insert 710B, a subsequent second anchor insert 710B, or both by a second link 732. In some embodiments, the first link 731, the second link 732, or both are formed of the same materials as the suture 720. In some embodiments, one or more of the first anchor inserts 710A, one or more of the second anchor inserts 710B, or both have a cavity therein. In some embodiments, the first link 731, the suture 720, or both pass through the cavity of one or more of the plurality of first anchor inserts 710A. In some embodiments, the first link 731, the suture 720, or both freely pass through the cavity of one or moreof the plurality of first anchor inserts 71 OA. In some embodiments, the second link 732, the suture 720, or both pass through the cavity of one or more of the plurality of second anchor inserts 71 OB. In some embodiments, the second link 732, the suture 720, or both freely pass through the cavity of one or more of the plurality of second anchor inserts 71 OB. Further, as shown, in some embodiments, at least a portion of the suture 720 passes through a loop formed by the first link 731 , the second link 732, or both. In some embodiments, at least two of the plurality of first anchor inserts 710A are coupled, wherein at least two of the plurality of first anchor inserts 710A inserts are coupled, or both. In some embodiments, at least two of the plurality of first anchor inserts 71 OA inserts are separate, wherein at least two of the plurality of first anchor inserts 71 OA are decoupled, or both. In some embodiments, per FIG. 6C, the plurality of first anchor inserts 71 OA couple to the second needle 620, wherein the plurality of second anchor inserts 71 OB couple to the first needle 610. Alternatively, in some embodiments, the plurality of first anchor inserts 710A couple to the first needle 610, wherein the plurality of second anchor inserts 710B couple to the second needle 620.

[0085] In some embodiments, at least a portion of the plurality of first anchor inserts 710A, plurality of second anchor inserts 710B, or both, have a shape comprising a sphere, a cylinder, a pyramid, a torus, a cone, a prism, or any combination thereof. For example, per FIG. 7C the suture 720 may run through the first anchor inserts 710A and / or the second anchor inserts 710B twice to create a suture one way lock. In some embodiments, at least a portion (e.g., a first anchor insert per FIG. 7C) of the plurality of first anchor inserts 710A and / or the plurality of second anchor inserts 710B may attach to the end of the suture while the remaining portions of the first anchor inserts 710A or second anchor inserts 710B moving freely. In some embodiments, at least a portion of the plurality of first anchor inserts 710A, plurality of second anchor inserts 710B, or both, comprise 3, 4, 5, 6, 7, 8 or more anchor inserts 710A 710B. In some embodiments, the anchor inserts comprise one or more knots formed with a suture separate from the suture 720 (e.g., anchor suture, as described herein), wherein the link between the anchor inserts is the anchor suture itself.

[0086] In some embodiments, the second needle 620 is axially translatable within the second housing lumen 520 between a primary configuration, per FIGS. 6A and 7A, and a secondary configuration, per FIGS. 6B and 7B. In some embodiments, in the primary configuration, a distal point of the second needle 620 is proximal to a distal point of the first needle 610. In some embodiments, in the primary configuration, a distal point of the second needle 620 is distal to a distal point of the first needle 610. In some embodiments, a distal point of the second needle 620 iscloser to a distal point of the housing 500 in the primary configuration than in the secondary configuration.

[0087] In some embodiments, the housing 500, the second needle 620 or both, comprise an indicator of the distance between the distal point of the housing 500 and the distal point of the second needle 620. In some embodiments, per FIG. 7C, the first needle 610, the second needle 620 or both, comprise an indicator (e.g., a laser mark) for indicating the depth of relating to depth of soft tissue in applications (e.g., meniscus plus anchor insert length). In some embodiments, per FIGS. 7A and 7B, the suture inserter device 2000 further comprises a second needle slider 621 coupled to the second needle 620. In some embodiments, the second needle slider 621 translates the second needle 620 within the second housing lumen 520 between the primary configuration and the secondary configuration. In some embodiments, the first anchor insert 710A, the second anchor insert 710B, or both, have a diameter of less than about 5 mm.Third Suturing System

[0088] Another aspect provided herein, per FIGS. 9A-10B, is a third suturing system. In some embodiments, the third suturing system is configured for operating on a shoulder, a hip, a foot, an ankle, an elbow, or any combination thereof. In some embodiments, the third suturing system is configured for rotator cuff repair, bankart repair, slap lesion repair, biceps tenodesis, acromioclavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction, or any combination thereof of the shoulder. In some embodiments, the third suturing system is configured for meniscal repair, extra- capsular repair: medial collateral ligament (MCL), lateral collateral ligament (LCL) and posterior oblique ligament; Iliotibial band tenodesis (IBT); patellar tendon repair; vastus medialis obliquus advancement (VMO); joint capsule closure, or any combination thereof of the knee. In some embodiments, the second suturing system is configured for rotator cuff repair, bankart repair, slap lesion repair, biceps tenodesis, acromio- clavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction, or any combination thereof of the shoulder. In some embodiments, the third suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the foot. In some embodiments, the third suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the ankle. In someembodiments, the third suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the hand. In some embodiments, the third suturing system is configured for scapholunate ligament reconstruction, ulnar collateral ligament reconstruction, radial collateral ligament reconstruction, or any combination thereof of the wrist. In some embodiments, the third suturing system is configured for biceps tendon reattachment, tennis elbow repair, ulnar or radial collateral ligament reconstruction, lateral epicondylitis repair, or any combination thereof of the elbow.

[0089] In some embodiments, the third suturing system comprises an anchor 700 and a suture inserter device 3000. In some embodiments, the anchor 700 comprises a suture 720, a first anchor 700 A, and a second anchor 700B. In some embodiments, the first anchor 700A is coupled to a distal portion of the suture 720 and the second anchor 700B is coupled to the suture 720 proximal to the first anchor 700A. In some embodiments, the suture inserter device 3000 comprises a housing 500, a first needle 610, and a second needle 620. In some embodiments, the housing 500 comprises a first housing lumen 510 and a second housing lumen 520. In some embodiments, the first anchor 700A couples to the second needle 620. In some embodiments, the first needle 610 receives a portion of the suture 720 proximal to the first anchor 700A and distal to the second anchor 700B. In some embodiments, the first needle 610 is axially translatable within the first housing lumen 510 between a first primary configuration and a first secondary configuration. In some embodiments, the second needle 620 is axially translatable within the second housing lumen 520 between a second primary configuration and a second secondary configuration. With reference to FIG. 10C, depicting other embodiments of the third suture systems from FIGS. 10A-B, wherein in some embodiments, the first housing lumen and the second housing lumen are disposed within the housing 500. In some embodiments, for any suture inserter device described herein (e.g., 2000 or 3000), the suture system may further comprise a gripping feature 502. As shown in FIG. 17A, in some embodiments a needle described herein comprises a distal end with a step 622, wherein the anchor inserts are placed at the distal end. In some embodiments, for a suture system described herein, one needle (e.g., 610) is curved or angled relative to another needle (e.g., 620).

[0090] In some embodiments, per FIG. 8, the first anchor 700A comprises a plurality of first anchor 710A inserts, and the second anchor 700B comprises a plurality of second anchor inserts 710B. In some embodiments, each of the plurality of first anchor inserts 710A is coupled to a preceding first anchor insert 710A, a subsequent first anchor insert 710A, or both. In some embodiments, each of the plurality of first anchor inserts 710A is coupled to a preceding first anchor insert 710A, asubsequent first anchor insert 710A, or both by a first link 731. In some embodiments, each of the plurality of second anchor inserts 710B is coupled to a preceding second anchor insert 710B, a subsequent second anchor insert 71 OB, or both. In some embodiments, each of the plurality of second anchor inserts 71 OB is coupled to a preceding second anchor insert 71 OB, a subsequent second anchor insert 71 OB, or both by a second link 732. In some embodiments, the first link 731, the second link 732, or both are formed of the same materials as the suture 720. In some embodiments, one or more of the first anchor inserts 710A, one or more of the second anchor inserts 71 OB, or both have a cavity therein. In some embodiments, the first link 731, the suture 720, or both to pass through the cavity of one or more of the plurality of first anchor inserts 710A. In some embodiments, the first link 731, the suture 720, or both freely pass through the cavity of one or more of the plurality of first anchor inserts 710A. In some embodiments, the second link 732, the suture 720, or both to pass through the cavity of one or more of the plurality of second anchor inserts 71 OB. In some embodiments, the second link 732, the suture 720, or both to freely pass through the cavity of one or more of the plurality of second anchor inserts 710B. Further, as shown, in some embodiments, at least a portion of the suture 720 passes through a loop formed by the first link 731, the second link 732, or both. In some embodiments, at least two of the plurality of first anchor inserts 710A are coupled, wherein at least two of the plurality of first anchor inserts 710A are coupled, or both. In some embodiments, at least two of the plurality of first anchor inserts 710A are separate, wherein at least two of the plurality of first anchor inserts 710A are decoupled, or both. In some embodiments, the first anchor 700A is coupled to a first end of the suture 720 (e.g., see reference character 721), while a second end of the suture 720 (e.g., see reference character 722) extends from the second anchor 700B. In some embodiments, as described herein, tensioning a second or third suture inserter device described herein (e.g., 2000 or 3000) comprises pulling on the second end 722 of the suture 720.

[0091] In some embodiments, per FIG. 9C, the plurality of first anchor inserts 710A couple to the second needle 620, wherein the plurality of second anchor inserts 710B couple to the first needle 610. Alternatively, in some embodiments, the plurality of first anchor inserts 710A couple to the first needle 610, wherein the plurality of second anchor inserts 710B couple to the second needle 620.

[0092] In some embodiments, at least a portion of the plurality of first anchor inserts 710A, plurality of second anchor inserts 710B, or both, have a shape comprising a sphere, a cylinder, a pyramid, a torus, a cone, a prism, or any combination thereof. In some embodiments, at least a portion of the plurality of first anchor inserts 710A, plurality of second anchor inserts 710B, or both, comprise 3, 4,5, 6, 7, 8 or more anchor inserts 710A 710B. In some embodiments, the anchor inserts comprise one or more knots formed with a suture separate from the suture 720 (e.g., anchor suture, as described herein), wherein the link between the anchor inserts is the anchor suture itself.

[0093] In some embodiments, the second needle 620 is axially translatable within the second housing lumen 520 between a primary configuration, per FIGS. 9A and 10 A, and a secondary configuration, per FIGS. 9B and 10B. In some embodiments, in the primary configuration, a distal point of the second needle 620 is proximal to a distal point of the first needle 610. In some embodiments, in the primary configuration, a distal point of the second needle 620 is distal to a distal point of the first needle 610. In some embodiments, a distal point of the second needle 620 is closer to a distal point of the housing 500 in the primary configuration than in the secondary configuration.

[0094] In some embodiments, the housing 500, the second needle 620 or both, comprise an indicator of the distance between the distal point of the housing 500 and the distal point of the second needle 620. In some embodiments, per FIGS. 10A and 10B, the suture inserter device 3000 further comprises a first needle slider 611 coupled to the first needle 610, second needle slider 621 coupled to the second needle 620, or both. In some embodiments, the first needle slider 611 translates the first needle 610 within the first housing lumen 510 between the first primary configuration and the first secondary configuration. In some embodiments, the second needle slider 621 translates the second needle 620 within the second housing lumen 520 between the second primary configuration and the second secondary configuration. In some embodiments, the first anchor insert 710A, the second anchor insert 710B, or both, have a diameter of less than about 5 mm.Suture Anchors

[0095] Provided herein, per FIGS. 8, 18A, and 18B, are suture anchors having a solid configuration. In some embodiments, each anchor (e.g., 700A, 700B) comprises a plurality of anchor inserts (e.g., 710A 710B). In some embodiments, each plurality of anchors inserts (e.g., 710A 710B) comprises 3, 4, 5, 6, 7, 8 or more anchor inserts. In some embodiments, for each plurality of anchor inserts, at least two of the anchor inserts are coupled. In one embodiment, any one anchor (e.g., 700A / 700B) comprises 2, 3, 4, 5, 6, 7, 8, or more suture anchor inserts, wherein the anchor inserts are coupled to each other and the suture 720. In some embodiments, one or more anchors (e.g., 700A, 700B) have an insertion configuration, as described herein and a deployed configuration, as described herein. In some embodiments, the anchor inserts comprise one or more knots formed with a suture separate 1from the suture 720 (e.g., anchor suture, as described herein), wherein the link between the anchor inserts is the anchor suture itself. In some embodiments, a suture anchor system described herein comprises 1, 2, 3, 4, 5, or more anchors.

[0096] In some embodiments, the suture 720 comprises a repair suture and a separate deployment suture is used to transition the anchor 700 from an insertion configuration to a deployed configuration.Method of Anchoring to a Bone

[0097] Another aspect provided herein is a method of anchoring to a bone, the method comprising: providing the first suturing system; inserting the inserter and the anchor into a hole in the bone; applying tension to the second end of the suture to alter the anchor from the insertion configuration to the deployed configuration; and axially translating the inserter with respect to the housing shaft from the distal position to the proximal position. In some embodiments, instead of applying tension to the second end of the suture, a deployment suture is provided and pulled to transition the anchor from an insertion configuration to a deployed configuration.

[0098] In some embodiments, the method further comprises trimming the suture, tightening the suture, locking the suture, or any combination thereof. In some embodiments, the hole in the bone has a depth of less than about 35 mm. In some embodiments, the hole in the bone has an inner diameter of less than about 5 mm. In some embodiments, an outer diameter of the housing is greater than the inner diameter of the hole. In some embodiments, the inserter is configured to enter at least partially within the bone hole.

[0099] In some embodiments, a method for inserting a suture for anchoring a soft tissue to a bone comprises providing a suture inserter device (e.g., first suturing system as described herein) having an anchor comprising a suture and one or more anchor inserts coupled to an inserter (as used herein, the term “inserter” and “driver’ may be used interchangeably). In some embodiments, the inserter is in the distal position (e.g., FIG. 3A), such that the distal portion of the inserter extends from the housing shaft. In some embodiments, the anchor inserts are placed within the bone hole via an inserter fork 230 (as described herein). In some embodiments, the anchor inserts are placed within the bone hole in the insertion configuration. In some embodiments, the inserter is placed against the bone, wherein the inserter with the suture and anchor insert are inserted within the bone hole, wherein the anchor insert is in the insertion configuration (see FIG. 3A). In some embodiments, a deployment suture is provided, coupled to a leading anchor insert (e.g., anchor insert located deepestwithin the bone hole in FIG. 4A), wherein the deployment suture is configured to be pulled, and further configured to pull on the leading anchor insert, thereby transitioning the anchor from an insertion configuration to a deployed configuration. In some embodiments, one end of a suture is tensioned, or both ends of a suture are tensioned, so as to pull on the anchor inserts and transition the anchor from an insertion configuration to a deployed configuration. In some embodiments, the inserter fork is axially translatable, and configured to be retracted, for example into the inserter lumen 210, wherein the anchor inserts are configured to abut inserter 200 walls and thereby transition from an insertion configuration into a deployed configuration. In some embodiments, any one of the aforementioned methods for transitioning the anchor from an insertion configuration to a deployed configuration, either alone or in combination with another method, is used to transition the anchor from an insertion configuration to a deployed configuration.

[0100] In some embodiments, the inserter is axially translated proximally (i.e. out of the bone hole), as described herein). In some embodiments, the suture may be tensioned prior to and / or after the inserter has been axially translated.

[0101] In some embodiments, as the inserter is being axially translated out of the bone hole, it pulls on an end of the suture, such that the leading anchor insert (e.g., the anchor insert located deepest within the bone hole in FIG. 4A) is then pulled by the end of the suture being pulled, thereby transitioning the anchor insert from an insertion configuration to a deployed configuration (e.g., FIG. 4B). In some embodiments, the inserter continues to pull on the suture so as to tension the suture, and thereby further enabling the anchor insert to be in the deployed configuration.

[0102] In some embodiments, such a method provides an example of a suture secured by tying the two ends of the suture in a knot once passed through a respective tissue or other bone. In some embodiments, as described herein (see e.g., FIG. 19 as described herein), a knotless suture anchor insert may be used. In some embodiments, the inserter is initially in the proximal portion (e.g., FIG.4B), and is translated into the distal position once the inserter is placed against the bone.Method of Anchoring to a Bone using a Knotless Suture Anchor System

[0103] Another aspect provided herein is a method of anchoring to a bone using a knotless suture system as described herein. With reference to FIGS. 19-21, the method comprises: providing a suture anchor 1900 with a passing suture 1930; inserting the inserter and the anchor 1900 into a hole in the bone; applying tension to the second end 1921 of the repair suture 1920 to alter the anchor 1900 from the insertion configuration to the deployed configuration; and axially translatingthe inserter with respect to the housing shaft from the distal position to the proximal position (as described herein). In some embodiments, applying tension to the second end 1921 of the repair suture comprises pulling the second end of the repair suture away from the bone hole. In some embodiments, instead of applying tension to the second end 1921 of the suture, a deployment suture is provided and pulled to transition the anchor from an insertion configuration to a deployed configuration.

[0104] In some embodiments, the method further comprises inserting the second end 1921 of the repair suture through a target tissue or a target bone; returning the second end 1921 of the repair suture towards the bone hole; coupling the second end 1921 with the suture loop 1932 of the passing suture 1930; tensioning (e.g., pulling) the secondary end 1931 of the passing suture 1930, such that the passing loop 1932 and second end 1921 of the repair suture are pulled within and then out of the repair suture 1920 (via the openings 1922, 1923); separating the second end 1921 of the repair suture from the suture loop 1932 (optionally outside the bone hole); and pulling to desired tension on the second end 1921. Accordingly, the repair suture 1920 is now secured within the bone hole, itself, and with a target tissue segment or target bone segment (due to the tension / friction of the repair suture within a hollow interior of itself, as described and depicted in FIGS. 20-21 herein).

[0105] In some embodiments, the method further comprises trimming the repair suture, tightening the repair suture, locking the repair suture, or any combination thereof. In some embodiments, the hole in the bone has a depth of less than about 35 mm. In some embodiments, the hole in the bone has an inner diameter of less than about 5 mm. In some embodiments, an outer diameter of the housing is greater than the inner diameter of the hole. In some embodiments, the inserter is configured to enter at least partially within the bone hole.

[0106] In some embodiments, a method for inserting a suture for anchoring a soft tissue to a bone comprises providing a suture inserter device (for e.g., first suturing system as described herein) having an anchor comprising a suture and one or more anchor inserts coupled to an inserter (as used herein, the term “inserter” and “driver’ may be used interchangeably). In some embodiments, the inserter is in the distal position (e.g., FIG. 3A), such that the distal portion of the inserter extends from the housing shaft. In some embodiments, the anchor inserts are placed within the bone hole via an inserter fork 230 (as described herein). In some embodiments, the anchor inserts are placed within the bone hole in the insertion configuration. In some embodiments, the inserter is placed against the bone, wherein the inserter with the suture and anchor insert are inserted within the bone hole, wherein the anchor insert is in the insertion configuration (see FIG. 3A). In some embodiments, adeployment suture is provided, coupled to a leading anchor insert (e.g., anchor insert located deepest within the bone hole in FIG. 4A), wherein the deployment suture is configured to be pulled, and further configured to pull on the leading anchor insert, thereby transitioning the anchor from an insertion configuration to a deployed configuration. In some embodiments, one end of a suture is tensioned, or both ends of a suture are tensioned, so as to pull on the anchor inserts and transition the anchor from an insertion configuration to a deployed configuration. In some embodiments, the inserter fork is axially translatable, and configured to be retracted, for example into the inserter lumen 210, wherein the anchor inserts are configured to abut inserter 200 walls and thereby transition from an insertion configuration into a deployed configuration. In some embodiments, any one of the aforementioned methods for transitioning the anchor from an insertion configuration to a deployed configuration, either alone or in combination with another method, is used to transition the anchor from an insertion configuration to a deployed configuration.

[0107] In some embodiments, the inserter is axially translated proximally (i.e. out of the bone hole), as described herein). In some embodiments, the suture may be tensioned prior to and / or after the inserter has been axially translated.

[0108] In some embodiments, as the inserter is being axially translated out of the bone hole, it pulls on an end of the suture, such that the leading anchor insert (e.g., the anchor insert located deepest within the bone hole in FIG. 4A) is then pulled by the end of the suture being pulled, thereby transitioning the anchor insert from an insertion configuration to a deployed configuration (e.g., FIG. 4B). In some embodiments, the inserter continues to pull on the suture so as to tension the suture, and thereby further enabling the anchor insert to be in the deployed configuration.

[0109] In some embodiments, a knotless suture anchor insert may be used as described herein for any inserter described herein (see e.g., FIGS. 19-21 as described herein). In some embodiments, the inserter is initially in the proximal portion (e.g., FIG.4B), and is translated into the distal position once the inserter is placed against the bone.System and Method of Securing a Suture to Between Two Bone Holes

[0110] Referring now to FIG. 24, another aspect provided herein is a system 2400 for securing a suture between two bone holes. System 2400 may include first suture inserter device 2404A and second suture inserter device 2404B. First suture inserter device 2404A and second suture inserter device 2404B may be as described above with reference to FIGs. 1-5C. First suture inserter device 2404A may have first inserter 2404A and second inserter device 2404B may havesecond inserter 2408B. Inserters 2408A,B may be as described above with reference to FIGs. 1-5C. First inserter 2408 A may be coupled to first anchor 2412A and second inserter 2408B may be coupled to second anchor 2412B. First and second anchors 2412A,B may be as described above with reference to FIGs. 1-5C. In some embodiments, first anchor 2412A is coupled to a distal portion of suture 2416 and second anchor 2412B is coupled to suture 2416 proximally to first anchor 2412A.

[0111] First anchor 2412A may comprise a first plurality of anchor inserts. Anchor inserts may be as described above with reference to FIGs. 1-5C. First anchor 2412A may be configured to transition from a first insertion configuration that is substantially linear to a first deployed configuration that is at least partially nonlinear. Second anchor 2412B may comprise a second plurality of anchor inserts. Second anchor 2412B may be configured to transition from a second insertion configuration that is substantially linear to a second deployed configuration that is at least partially nonlinear.

[0112] First suture inserter device 2404A may comprise a first inserter fork. An inserter fork may be as described above with reference to FIGs. 1-5C. A first inserter fork of first suture inserter device 2404A may be operable to axially translate first anchor 2412A with respect to itself. Second suture inserter device 2404B may comprise a second inserter fork. An inserter fork may be as escribed above with reference to FIG.s 1-5C. A second inserter fork of second inserter device 2404B may be operable to axially translate second anchor 2412B with respect to itself.

[0113] In some embodiments, the inserters 2404A,B, may be in a distal position, such that a distal portion of each of the inserters 2404A,B, extends from a respective housing shaft of first inserter device 2404A and second inserter device 2404B. In some embodiments, the anchor inserts 2412A,B, are placed within a first bone hole and a second bone hole, respectively, via an inserter fork of first and second suture inserter devices, 2404A,B. In some embodiments, the anchor inserts 2412A,B, are placed within the first bone hole and the second bone hole, respectively, in an insertion configuration. In some embodiments, the inserters 2408A,B, are placed against bone of a first bone hole and a second bone hole, respectively, wherein the inserters 2408A,B with the suture 2416 and anchor inserts 2412A,B, are inserted within the bone hole, wherein the anchor inserts 2412A,B are in the insertion configuration (see FIG. 3A). In some embodiments, for each of suture inserter devices 2404A,B, a deployment suture is provided, coupled to a leading anchor insert (e.g., anchor insert located deepest within the bone hole in FIG. 4A), wherein the deployment suture is configured to be pulled, and further configured to pull on the leading anchor insert, thereby transitioning the anchors 2412A,B, from an insertion configuration to a deployed configuration. In some embodiments, oneends of suture 2416 are tensioned, or both ends of suture 2416 are tensioned, so as to pull on the anchor inserts 2412A,B, and transition the anchor inserts 2412A,B, from an insertion configuration to a deployed configuration. In some embodiments, an inserter fork of each of first and second suture inserter devices 2404A,B, is axially translatable, and configured to be retracted, for example into an inserter lumen, wherein the anchor inserts 2412A,B, are configured to abut walls of their respective inserters 2408A,B, and thereby transition from an insertion configuration into a deployed configuration. In some embodiments, any one of the aforementioned methods for transitioning the anchor from an insertion configuration to a deployed configuration, either alone or in combination with another method, is used to transition the anchors 2412A,B, from an insertion configuration to a deployed configuration.

[0114] In some embodiments, the inserters 2408 A, B, are axially translated proximally (i.e. out of the bone hole), as described herein). In some embodiments, suture 2416 may be tensioned prior to and / or after either one of or both of the inserters 2408A,B, have been axially translated.

[0115] In some embodiments, as the inserters 2408A,B, are being axially translated out of their respective bone holes, they pull on an end of suture 2416, such that a leading anchor insert (e.g., the anchor insert located deepest within the bone hole in FIG. 4A) is then pulled by the end of suture 2416 being pulled, thereby transitioning the first or second anchor inserts 2412A,B, from an insertion configuration to a deployed configuration (e.g., FIG. 4B). In some embodiments, the inserters 2408A,B, continue to pull on suture 2416 so as to tension suture 2416, and thereby further enabling the anchor inserts 2412A.B, to be in the deployed configuration.

[0116] Another aspect provided herein is a method of securing a suture between two holes, the method comprising: inserting a first anchor secured to a first distal end of a suture through a first suture inserter device into a first bone or hole therein. The method comprises deploying the first anchor by translating a first portion of the first anchor while immobilizing a second portion of the first anchor causing a first plurality of anchor inserts between the first portion and the second portion of the first anchor to transition from an insertion configuration that is substantially linear to a deployed configuration that is at least partially non-linear. The method comprises inserting a second anchor secured to a second distal end of the suture through a second suture inserter device into a second bone or hole therein. The method comprises deploying the second anchor by translating a first portion of the second anchor while immobilizing a second portion of the second anchor causing a second plurality of anchor inserts between the first portion and the second portion of the second anchor to transition from an insertion configuration that is substantially linear to a deployedconfiguration that is at least partially non-linear. In some embodiments, the method comprises tensioning the suture by pulling on a tensioning tail of the suture to remove slack.

[0117] In some embodiments, the method comprises trimming the suture. In some embodiments, the first anchor contacts a first inner wall of the first bone and the second anchor contacts a second inner wall of the second bone. In some embodiments, the first plurality of inserts, in the deployed configuration, presses against the first inner wall and the second plurality of inserts, in the deployed configuration, presses against the second inner wall, thereby providing tension on the suture. In some embodiments, the first plurality of anchor inserts, when in the deployed configuration, prevent the first anchor from being removed from the first bone hole by having a width greater than a width of the first bone hole. In some embodiments, the second plurality of anchor inserts, when in the deployed configuration, prevent the second anchor from being removed from the second bone hole by having a width greater than a width of the second bone hole. In some embodiments, when in the deployed configuration, the first plurality of anchor inserts is wider than the first anchor and the second plurality of anchor inserts is wider than the second anchor. In some embodiments, the method comprises changing the suture shape from a first shape in a substantially linear configuration to a second shape in a substantially non-linear configuration. In some embodiments, the first plurality of anchor inserts are aligned in two or more rows when in the deployed configuration and the second plurality of anchor inserts are aligned in two or more rows when in the deployed configuration.

[0118] In some embodiments, a first end of the suture is proximal to at least a portion of the first plurality of anchor inserts and is proximal to at least a portion of the second plurality of anchor inserts when the first anchor and the second anchor is in the insertion configuration. In some embodiments, the first plurality of anchor inserts, the second plurality of anchor inserts, or both, have a shape comprising a sphere, cylinder, pyramid, torus, cone, prism, or any combination thereof. In some embodiments, the first plurality of anchor inserts, the second plurality of anchor inserts, or both, comprise 3, 4, 5, 6, 7, 8, or more anchor inserts. In some embodiments, the first or second plurality of anchor inserts, or both, when together in the insertion configuration or the deployed configuration, span an outer width of less than about 5 mm. In some embodiments, each anchor insert comprises a braided configuration. In some embodiments, the first anchor insert, the second anchor insert, or both, have a pull out strength in a deployed configuration in a range of about 5 psi to about 05 psi or in a range of about 15 psi to about 25 psi.

[0119] In some embodiments, a hole in the first or second bone, or both, has a depth of less than about 35 mm. In some embodiments, a hole in the first or second bone, or both, has an inner diameter of less than about 5 mm. In some embodiments, an outer diameter of an inserter housing of an inserter of the first or second anchor is greater than the inner diameter of the hole. In some embodiments, an inserter is configured to enter at least partially within the bone hole.Suture Assembly

[0120] Referring now to FIG. 25, a suture assembly 2500 is presented. Suture assembly 2500 may comprise first anchor 2504A and second anchor 2504B. First and second anchors 2504A,B, may be as described above with reference to FIGs. 1-5C. First anchor 2504A may comprise a plurality of first anchor inserts and second anchor 2504B may comprise a plurality of second anchor inserts. Anchor inserts may be as described above with reference to FIGs. 1-5C. A first plurality of anchor inserts may be configured to transition from an insertion configuration that is substantially linear to a deployed configuration that is substantially non-linear. A second plurality of anchor inserts may be configured to transition from an insertion configuration that is substantially linear to a deployed configuration that is substantially non-linear. First anchor 2504A may be coupled to distal anchor ends 2520 A. Distal anchor ends 2520A may assist in transitioning first anchor 2504A from an insertion configuration to a deployed configuration. For instance, pulling on one or more distal anchor ends 2520A may cause first anchor 2504A to transition from an insertion configuration to a deployed configuration. Second anchor 2504B may be coupled to distal anchor ends 2520B. Distal anchor ends 2520B may assist in transitioning second anchor 2504B from an insertion configuration to a deployed configuration. For instance, pulling on one or more distal anchor ends 2520B may cause second anchor 2504B to transition from an insertion configuration to a deployed configuration.

[0121] Suture assembly 2500 may comprise first connection line 2508A and / or second connection line 2508B. First connection line 2508A may be coupled to first anchor 2504A and second anchor 2504B. For instance, first connection line 2508A may be coupled at a first end to first anchor 2504A, such as at a first portion of first anchor 2504A. Likewise, first connection line 2508A may be coupled to second anchor 2504B at a second end of first connection line 2504A, opposite a first end of first connection line 2504A. First connection line 2504A may be coupled to a first portion of second anchor 2504B. First connection line 2504B may provide a mechanical link between first anchor 2504A and second anchor 2504B. In some embodiments, suture assembly 2500 comprises second connection line 2508B. Second connection line 2508B may be coupled to firstanchor 2504A at a second portion of first anchor 2504A and a first end of second connection line 2508B. Second connection line 2508B may be coupled to second anchor 2504B at a second end of second connection line 2508B, opposite a first end of second connection line 2508B. Second connection line 2508B may be coupled to a second portion of second anchor 2504B. Second connection line 2508B may provide a mechanical link between first anchor 2504A and second anchor 2504B. Second connection line 2508B may be an extension of first connection line 2508A. For instance, first connection line 2508A may be fixed to one or more anchor inserts of first anchor 2504A and may be woven between one or more anchor inserts of second anchor 2504B. First connection line 2508A may be looped back and fed through itself at a specific distance, which may create loop 2512.

[0122] Suture assembly 2500 may comprise loop 2512. Loop 2512 may be formed from at an end of second connection line 2508B. Loop 2512 may be formed as described above as an extension of first connection line 2508A. Suture assembly 2500 may be made of a loose weave pattern, which may allow for a tensioning between first connection line 2508A and second connection line 2508B. Loop 2512 may extend into tensioning tail 2516. Tensioning tail 2516 may be a long extension of an end of second connection line 2508B. In some embodiments, pulling on tensioning tail 2516 creates a tightening or tensioning between first anchor 2504A and second anchor 2504B through a shortening of second connection line 2508B. In some embodiments, suture assembly 2500 comprises a loop proximate first anchor 2504A. A loop proximate first anchor 2504A may be an extension of first connection line 2508A. A loop proximate first anchor 2504A may extend into a second tensioning tail. A second tensioning tail may be an extended end of first connection line 2508A. Pulling on a second tensioning tail may cause a tightening or tensioning of first anchor 2504A and second anchor 2508B by a shortening of first connection line 2508A. Suture assembly 2500 may be formed by any suturing system described throughout this disclosure, without limitation.

[0123] Referring now to FIG. 26, another embodiment of a suture assembly 2600 is presented. Suture assembly 2600 may include first implant 2604 A. First implant 2604A may be made of suture. First implant 2604A may have a width of about 0.1 mm to about 10 mm. First implant 2604A may have a length of about 1 mm to about 100 mm. First implant 2604A may be sized to fit within one or more holes of tissue of a patient. Tissue may include, but is not limited to, soft and hard tissue. In some embodiments, first implant 2604A is sized to fit within a portion of bone. In some embodiments, first implant 2604A is sized to fit within a portion of meniscus. In someembodiments, first implant 2604 is made of braided suture. Braided suture of first implant 2604 may include one or more braids 2624A. Braids 2624A may be made of two or more threads of suture. First implant 2604A may have, but is not limited to, about 1 to 10 braids 2624 A. In some embodiments, first implant 2604A has about four braids 2624A. In some embodiments, each braid of braids 2624A of first implant 2604A have a diameter of about, but not limited to, about 0.1 mm to about 10 mm. In some embodiments, each braid of braids 2624A have the same width. In other embodiments, one or more braids of braids 2624A may have widths and / or lengths that differ from one or more other braids of braids 2624 A. Each braid of braids 2624A may be separated by one or more other breads by a distance of about 0.1 mm to about 1 cm. In some embodiments, each braid of braids 2624A is separated by an equal space amongst all braids 2624A. In other emobodiments, a spacing between two or more braids 2624A is larger or lesser than a spacing between two or more other braids 2624A. In some embodiments, braids 2624A may be divided into two or more sets. Sets of braids 2624A may have two or more braids 2624A. A first set of braids 2624A may have two or more braids 2624A having a first width, and a second set of braids 2624A may have two or more braids 2624A having a second width. A first width may be greater than a second width, or vice versa. In some embodiments, a first set of braids 2624A has a first spacing between two or more braids and a second set of braids 2624A has a second spacing between two or more braids. A first spacing may be equal to a second spacing in a first and second set of braids 2624A. In some embodiments, a first spacing is greater or less than a second spacing in a first and second set of braids 2624A. A braiding of first implant 2604A may allow for greater tensile strength than a nonbraided configuration of first implant 2604 A. For instance and without limitation, tensile strength of first implant 2604A may be about, but not limited to, about 1 psi to about 300 psi.

[0124] Suture assembly 2600 may include second implant 2604B. Second implant 2604B may be the same as described above with reference to first implant 2604A. In some embodiments, second implant 2604B has different dimensions than first implant 2604A. For instance, second implant 2604B may have a longer or shorter length and / or greater or lesser width than that of first implant 2604A. In some embodiments, both first implant 2604A and second implant 2604B are made of braided suture. In some embodiments, first implant 2604A is made of braided suture and second implant 2604B is made of non-braided suture or vice versa. Second implant 2604B may have braids 2624B, which may be the same as braids 2624A described above. In some embodiments, second implant 2604B has greater of fewer braids than first implant 2604A. First and secondimplants 2604A,B, may have a same amount of braids 2624A,B. Suture assembly 600 may include three or more implants, in some embodiments.

[0125] First implant 2604 A may be connected to second implant 2604B through first connection line 2612A and / or second connection line 2616A. First and second connection lines 2612A and 2616A may be made of suture. In some embodiments, first and / or second connection lines 2612A and 2616A may be extensions of first implant 2604A such that first implant 2604A and first and second connection lines 2612A and 2616A are made of a single piece of suture. In some embodiments, first and second connection lines 2612A and 2616A are connected to first implant 2604A separately from a piece of suture composing first implant 2604A. First and second connection lines 2612A and 2616A may extend from a portion of first implant 2604A. In some embodiments, a portion from which both first connection line 2612A and second connection line 2616A extend from is the same portion of first implant 2604 A. First connection line 2612A and second connection line 2616A may extend from different portions of first implant 2604A. In some embodiments, first connection line 2612A and second connection line 2616A may extend from the same portion of first implant 2604A but at opposing sides. For instance, at an end of first implant 2604A, first connection line 2612A may extend and second connection line 2616A may extend from the same end mirroring first connection line 2612A across a longitudinal axis of first implant 2604A. First connection line 2612A may connect to a first end of second implant 2604B. Second connection line 2616A may connect to a second portion of second implant 2604B. A second portion of second implant 2604B may be different than a first portion of second implant 2604B. In some embodiments, both first and second connection lines 2612A and 2616A connect to second implant 2604B at the same location. First and second connection lines 2612A and 2616A may provide a tension between first implant 2604A and second implant 2604B. For instance, a pulling or tugging of first implant 2604A in a first direction may cause first connection line 2612A and / or second connection line 2616A to pull on a portion of second implant 2604B. Second implant 2604B may oppose a pulling force of first connection line 2612A and / or second connection line 2616A, which may cause a tension in first connection line 2612A and / or second connection line 2616A.

[0126] Second implant 2604B may be connected to first and / or second connection lines 2612B, 2616B. In some embodiments, first and / or second connection lines 2612B and 2616B are extensions of second implant 2604B. For instance, first connection line 2612B, second connection line 2616B, and second implant 2604B may all be made of a single piece of suture. First connection line 2612B may extend from second implant 2604B at a diffeetn portion of second implant 2604Bthan second connection line 2616B. In some embodiments, both first connection line 2612B and second connection line 2616B extend from the same location from second implant 2604B. In some embodiments, first connection line 2612B extends from a top portion of first implant 2604B and second connection line 2616B extends from a bottom portion of first implant 2604B, opposing the first implant. In some embodiments, first connection lines 2612A,B, and second connection lines 216A,B, have a same width and / or length. First connections lines 2612A,B, and second connection slines 216A,B, may have different widths and / or lengths.

[0127] In some embodiments, first implant 2604 A, first connection line 2612A, second connection line 2616A, second implant 2604B, first connection line 2612B, and / or second connection line 2616B may all be made a same suture material. In some embodiments, two or more suture materials may be used in suture assembly 2600.

[0128] Suture assembly 2600 may include locking loop 2608. Locking loop 2608 may be made of suture. Locking loop 2608 may be made of knotless suture. Locking loop 2608 may have a width of about 0.1 mm to about 10 mm. Locking loop 2608 may be connected to both first implant 2604A and second implant 2604B. First implant 2604A may be connected to locking loop 2608 via loop connection 2620. Loop connection 2620 may be made of suture. Loop connection 2620 may be positioned opposite first and / or second connection lines 2612A and 2616A. For instance, a first portion of first implant 2604 A may be connected to first connection line 2612A and second connection line 2616A and a second portion of first implant 2604 A positioned opposite the first portion may be connected to loop connection 2620. Loop connection 2620 may be shorter than either or both of the lengths of first connection line 2612A and second connection line 2616A. In some embodiments, loop connection 2620 is about 10% to about 20%, about 20% to about 30% about 30% to about 40%, about 40% to about 50%, or greater than about 50% the length of either or both of first connection line 2612A and second connection line 2616A. Loop connection 2620 may have a length of about 0.1 mm to about 1 cm. Locking loop 2608 may be connected to both first connection line 2612B and second connection line 2616B. Locking loop 2608 may provide tension between first implant 2604 A and second implant 2604B through loop connection 2620 and / or first connection line 2612B and second connection line 2616B.

[0129] In some embodiments, suture assembly includes first loop 2632A and second loop 2632B. First loop 2632A may be formed through first implant 2604A, first connection line 2612A, second connection line 2616A, and second implant 2604B. First loop 2632A may have an initial or starting diameter of about 0.1 mm to about 10 cm. First loop 2632A may increase or decrease indiameter. In some embodiments, first loop 2632A may have a constant surface area. Second loop 2632B may be formed through first connection line 2612B, second connection line 2616B, and locking loop 2608. Second loop 2632B may have an initial or starting diameter of about 0.1 mm to about 10 cm. Second loop 2632B may increase or decrease in surface area. For instance, manipulation of tail 2636 may cause second loop 2632B to decrease in surface area. Tail 2636 may be connected to locking loop 2608. Tail 2636 may be pulled away from second implant 2624B, which may cause either or both of first connection line 2612B and second connection line 2616B to decrease in length, which may cause second loop 2632B to decrease in overall circumference.Suture Assembly Delivery Device

[0130] Referring now to FIG. 27, a side profile view of suture assembly delivery device 2700 is illustrated. Suture assembly delivery device 2700 (delivery device 2700) may have housing 2704 and inserter 2708.

[0131] Housing 2704 may be rectangular, oval, cylindrical, or other shapes. Housing 2704 may be designed for one-handed use by a user. For instance, housing 2704 may have a width of about 1 cm to about 50 cm, a height of about 1 cm to about 50 cm, and a length of about 1 cm to about 50 cm, without limitation. In some embodiments, housing 2704 has an interior volume, An interior volume of housing 2704 may store one or more components of delivery device 2700, such as, but not limited to, needles, trigger mechanisms, needle loading mechanisms, anchor inserts, or other components. Delivery device 2700 may include connector 2716. Connector 2716 may provide a connection between housing 2704 and inserter 2708. In some embodiments, connector 2716 may be positioned at least partially within housing 2704. Inserter 2708 may be positioned at least partially inside an interior of connector 2716. In some embodiments, connector 2716 houses a portion of a triggering mechanism connected to trigger 2712 and / or one or more portions of inserter 2708. Housing 2704 may have an interior volume that may at least partially store connector 2716 and / or inserter 2708. Connector 2716 may be removably couplable to housing 2704.

[0132] In some embodiments, inserter 2708 may be a cylindrical or tubular structure that may extend distally from housing 2704. In some embodiments, inserter 2708 may have a length of about 1 mm to about 50 cm, less than about 1 mm, or greater than about 50 cm, without limitation. Inserter 2708 may house one or more anchor inserts and / or needles. Inserter 2708 may include at least two anchor insert, each placed on a corresponding needle. For instance, inserter 2708 may house an anchor insert positioned on a needle, while inserter 2708 itself may act as a sheath. In someembodiments, needles positioned in inserter 2708 may be positioned side-by-side. In other embodiments, needles position in inserter 2708 are positioned in a stack arrangement. Inserter 2708 may have a first housing for a first needle and a second housing for a second needle. In some embodiments, inserter 2708 houses two needles in two separate housings. Inserter 2708 may house two needles, each needle coupled to an anchor insert, and each anchor insert coupled to a locking loop. Inserter 2708 may be removably coupled to housing 2704. For instance, inserter 2708 may be at least partially insertable into an interior of housing 2704. Inserter 2708 may be secured to housing 2704 using one or more clamps, pins, or other devices.

[0133] In some embodiments, delivery device 2700 includes trigger 2712. Trigger 2712 may be rectangular, square, or other shapes. Trigger 2712 may be designed for gripping by a human hand. For instance, trigger 2712 may have first surface 2728A and second surface 2728B opposite the first surface. First surface 2728 A of trigger 2712 may have one or more textures that may increase a frictional force between first surface 2728A of trigger 2712 and a user’s hand. Second surface 2728B of trigger 27127 may have one or more indents, grooves, or other shapes that may allow for an ergonomic grasping of trigger 2712 by a user. Trigger 2712 may be rotatably connected to housing 2704. For instance, one or more pivots or other rotatable elements may connect trigger 2712 to housing 2704. Trigger 2712 may be rotatable in a clock-wise and / or counter-clockwise direction. Trigger 2712 may be rotatable in direction R or in a direction opposite to direction R. In some embodiments, a rotation of trigger 2712 may cause a movement of a needle inside inserter 2708. For instance, housing 2704 may have a trigger mechanism that may mechanically connect trigger 2712 to one or more movable elements that may be mechanical connected to inserter 2708. In some embodiments, a rotation of trigger 2712 in a clock-wise direction may cause a needle positioned within inserter 2708 to retract away from a distal end of inserter 2708. An anchor insert may be positioned on top a needle retractable into inserter 2708, which may cause the anchor insert to push against a distal end of inserter 2708, thereby leaving the anchor insert within a tissue. In some embodiments, a resistive element may be positioned proximate a connection between trigger 2712 and housing 2704. A resistive element may provide a form of resistance that opposes a movement of trigger 2712 in a clock- wise or counter clock- wise direction. A resistance element may include, but is not limited to, a spring or other element.

[0134] Housing 2704 may include slider 2720. Slider 2720 may be positioned on a top surface of housing 2704. A top surface of housing 2704 may be a portion of housing 2704 positioned opposite a portion of housing 2704 coupled to trigger 2712. In some embodiments, slider 2720 mayhave a protruding surface, which may allow for placement of one or more fingers of a user on slider 2720. For instance, slider 2720 may be operable by a thumb of a user. As a non-limiting example, a user may hold housing 2704 and grasp trigger 2712 while placing a thumb on slider 2720. Slider 2720 may be slidably positioned on housing 2704. Slider 2720 may be configured to slide in direction X or opposite direction X. For instance, slider 2720 may slide linearly in a direction towards an end of housing 2704 away from inserter 2708, or vice versa. A top portion of housing 2704 in which slider 2720 may be positioned may include a grooved surface that may aid in a linear displacement of slider 2720. For instance, a top portion of housing 2704 may be indented. Slider 2720 may be slidably position in an indentation of a top portion of housing 2704. In some embodiments, a sliding of slider 2720 in a linear direction away from inserter 2708 may cause a trigger mechanism to load a needle within inserter 2708. For instance, a user may pull trigger 2712 which may cause a retraction of a first needle within inserter 2708. Retraction of a first needle within inserter 2708 may cause a first anchor removably coupled to the first needle to remain behind in a tissue. A user may slide trigger 2720 which may cause a trigger mechanism to engage a second needle within inserter 2708. In some embodiments, slider 2720 may slide in a first direction, such as but not limited to in direction X, which may disengage a first needle housed within inserter 2708 from a trigger mechanism. Slider 2720 may slide in a second direction, such as but not limited to in a direction opposite direction X, which may engage a second needle housed within inserter 2708 with a trigger mechanism. A user may pull trigger 2712 a secondary time, which may cause retraction of a second needle within inserter 2708. A retraction of a secondary needle within inserter 2708 may leave behind a second anchor insert in a tissue.Method of Delivering A Suture Assembly Using A Delivery Device

[0135] In some aspects, a method of delivering a suture assembly using a delivery device is presented. A delivery device may be as described above with reference to delivery device 2700 illustrated in FIG. 27.

[0136] A method may include inserting a first needle with a first anchor insert through a target tissue. A target tissue may be a soft or hard tissue. In some embodiments, a target tissue may be part of knee, shoulder, a hip, a foot, an ankle, an elbow, a hand, a wrist, or any combination thereof. In some embodiments, the second suturing system is configured for meniscal repair, extra- capsular repair: medial collateral ligament (MCL), lateral collateral ligament (LCL) and posterior oblique ligament; Iliotibial band tenodesis (IBT); patellar tendon repair; vastus medialis obliquusadvancement (VMO); joint capsule closure, or any combination thereof of the knee. In some embodiments, the second suturing system is configured for rotator cuff repair, bankart repair, slap lesion repair, biceps tenodesis, acromio-clavicular separation repair, deltoid repair, capsular shift, capsulolabral reconstruction, or any combination thereof of the shoulder. In some embodiments, the second suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the foot. In some embodiments, the second suturing system is configured for lateral stabilization, medial stabilization, achilles tendon repair, hallux valgus reconstruction, mid-foot reconstruction, metatarsal ligament repair / tendon repair, bunionectomy, or any combination thereof of the ankle. In some embodiments, a target tissue may be a scapholunate ligament, ulnar collateral ligament, radial collateral ligament, or any combination thereof of the hand. In some embodiments, a target tissue may be biceps tendon, elbow tissues, ulnar or radial collateral ligament, lateral epicondylitis, or any combination thereof of the elbow.

[0137] A method may include rotating or pulling a trigger of the delivery device to cause a retraction of a first needle into a sheath. A trigger may rotate clock-wise or counter-clockwise upon pulling by a user. A trigger may be mechanically connected to a triggering mechanism in mechanical communication with first needle within an inserter of a delivery device and may axially translate the first needle within the inserter of the delivery device. In some embodiments, axial translation of a first needle within an inserter of a delivery device may cause retraction of the first needle, leaving behind a first anchor insert at a target location.

[0138] A method may include reloading a delivery device through a slider. Reloading a delivery device may include priming a secondary needle of the delivery device relative to a first deployed needle. Reloading a delivery device may include sliding a slider on the delivery device from a first position to a second position. In some embodiments, a slider slides linearly from a first position to a second position, wherein the second position is closer to a proximate end of the delivery device than the first position. A movement of a slider of a delivery device may cause a second needle to be loaded in the delivery device. A second needle may be structurally similar to a first needle.

[0139] A method may include positioning a second needle having a second anchor insert through a target tissue. A second needle may be housed in an inserter of a delivery device along with a first needle. In some embodiments, an inserter device may have a first housing with a first lumen for a first needle and a second housing with a second lumen for a second needle. A second needlemay pierce through a target area of a tissue. In some embodiments, a second needle pierces a same type of tissue as a first needle. In other embodiments, a second needle pierces a different type of tissue than a first needle.

[0140] A method may include rotating or pulling a trigger of the delivery device to cause a retraction of a second needle into an sheath. A trigger may be mechanically connected to a triggering mechanism in mechanical communication with a second needle. A retraction of a second needle into a sheath of a delivery device may cause a second anchor insert to be left behind in a tissue. In some embodiments, a first anchor insert may be positioned about 0.1 mm to about 10 cm away from a second anchor insert within a target tissue.

[0141] A method may include tensioning one or more suture loops to deploy one or more anchor inserts. For instance, a suture loop may be coupled to a first and / or second anchor insert. A suture loop may be tensioned in a direction away from a target tissue of which a first and / or second anchor insert may be positioned in. Tensioning of a suture loop may cause a first and / or second anchor insert to transition from an undeployed configuration to a deployed configuration.

[0142] A method may include pulling a free suture end of a suture assembly to tension one or more repairs sutures. A free suture end may be coupled to a suture assembly. Tensioning of a free suture end may tighten a tethering between two or more locations of a suture assembly.

[0143] A method may include trimming a free suture tail. Trimming a free suture tail may leave a single repair loop on inside a tissue while one or more suture bundles remain on an outside of the tissue.Example Illustration of Suture Assembly Implanted into Tissue

[0144] Referring now to FIG. 28, an illustration of suture assembly 2600 implanted into tissue 2628 is presented. Tissue 2628 may be, but is not limited to, bone, meniscus, or other tissues of the human body. First implant 2604A may be inserted into a position within tissue 2628. In some embodiments, first implant 2604A is inserted into a position within tissue 2628 using devices described above with reference to FIG. 27. Second implant 2604B may be inserted into a position within tissue 2628. First implant 2604A may be inserted into a first position and second implant 2604B may be inserted into a second position in a different location within tissue 2628 than the first position. In some embodiments, first implant 2604A is positioned away from second implant 2604B by about, but not limited to, about 0.1 mm to about 10 cm.

[0145] First implant 2604 A and / or second implant 2604B may be connected to locking loop 2608. Locking loop 2608 may be as described above with reference to FIG. 26A. Tail 2632 may be pulled away from either or both of first implant 2604A and second implant 2604B, which may cause a tensioning between first implant 2604A and second implant 2604B. In some embodiments, a tensioning of tail 2632 may cause one or more connection lines of locking loop 2608 to become tensioned. A tensioning of first implant 2604A and / or second implant 2604B may cause first implant 2604A and / or second implant 2604B to transition from an undeployed configuration to a deployed configuration, which may form suture assembly 2600 within tissue 2628.Terms and Definitions

[0146] Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

[0147] As used herein, the singular forms “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Any reference to “or” herein is intended to encompass “and / or” unless otherwise stated.

[0148] As used herein, the term “about” in some cases refers to an amount that is approximately the stated amount.

[0149] As used herein, the term “about” refers to an amount that is near the stated amount by 10%, 5%, or 1%, including increments therein.

[0150] As used herein, the term “about” in reference to a percentage refers to an amount that is greater or less than the stated percentage by 10%, 5%, or 1%, including increments therein.

[0151] As used herein, the phrases “at least one”, “one or more”, and “and / or” are open- ended expressions that are both conjunctive and disjunctive in operation. For example, each of the expressions “at least one of A, B and C”, “at least one of A, B, or C”, “one or more of A, B, and C”, “one or more of A, B, or C” and “A, B, and / or C” means A alone, B alone, C alone, A and B together, A and C together, B and C together, or A, B and C together.

[0152] While preferred embodiments of the present disclosure have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the disclosure. It should be understood that various alternatives to the embodiments of the disclosure described herein may be employed in practicing the disclosure.

Claims

CLAIMSWHAT IS CLAIMED IS:

1. A suturing system for securing a suture between two bone holes, comprising:(a) an anchor assembly comprising:(i) a suture;(ii) a first anchor coupled to a distal portion of the suture, the first anchor comprising a first plurality of anchor inserts, the first anchor configured to transition from a first insertion configuration that is substantially linear to a first deployed configuration that is at least partially nonlinear; and(iii) a second anchor coupled to the suture proximal to the first anchor, the second anchor comprising a second plurality of anchor inserts, the second anchor configured to transition from a second insertion configuration that is substantially linear to a second deployed configuration that is at least partially nonlinear; and(b) a first suture inserter device coupled to the first anchor in the first insertion configuration, the first suture inserter device comprising a first inserter operable to axially translate the first anchor with respect to the first suture inserter device from the first insertion configuration to the first deployed configuration;(c) a second suture inserter device coupled to the second anchor in the second insertion configuration, the second suture inserter device comprising a second inserter operable to axially translate the second anchor with respect to the second suture inserter device from the second insertion configuration to the second deployed configuration; wherein when the first anchor is inserted into a first bone or hole therein in the first insertion configuration using the first suture inserter device and the second anchor is inserted into a second bone or hole therein in the second insertion configuration using the second suture inserter device, the suture forms a link between the first bone or hole therein and the second bone or hole therein.

2. The suturing system of claim 1, wherein the first suture inserter device comprises: a first housing comprising a first housing lumen and a first housing shaft disposed therein, wherein the first housing shaft is axially translatable, wherein the first inserter is coupled to a first inserter fork of the first housing shaft, the first inserter fork being coupled to the first housing shaft, wherein the first inserter fork is axially translatable via the first housing shaft between a distal position and a proximal position.

3. The suturing system of any one of claim 2, wherein the first housing further comprises a first needle axially translatable within the housing lumen between a primary configuration and a secondary configuration and the second housing further comprises a second needle axially translatable within the housing lumen between a primary configuration and a secondary configuration.

4. The suturing system of any one of claims 1-3, wherein the second suture inserter device comprises: a second housing comprising a second housing lumen and a second housing shaft disposed therein, wherein the second housing shaft is axially translatable, wherein the second inserter fork is coupled to the second housing shaft and is axially translatable via the second housing shaft between a distal position and a proximal position.

5. The suturing system of any one of claims 4, wherein the second housing further comprises a second needle receiving a portion of the suture proximal to the first anchor and distal to the second anchor.

6. The suturing system of any one of claims 2-5, wherein the first and second housing shafts have a shaft threaded portion and a lumen threaded portion complimentary to the shaft threaded portion.

7. The suturing system of claim 6, wherein the first and second housing shafts are axially translatable with respect to their housing lumens by rotating the shaft threaded portions with respect to the threaded lumen portion.

8. The suturing system of any one of claims 2-7, wherein each of the first and second suture inserter devices further comprise a handle rotatably coupled to each of the first and second housing shafts, wherein the handle has a handle threaded portion complimentary to the shaft threaded portion, and wherein the first and second housing shafts are axially translatable with respect to the housing lumen by rotating the handle.

9. The suturing system of claim 8, wherein the handle comprises a knurl, a knob, a textured surface, or any combination thereof.

10. The suturing system of any one of claims 1-9, wherein each of the first and second plurality of anchor inserts comprise an independently defined shape and are linked together, and wherein each of the first and second plurality of inserts comprise a leading anchor insert that is configured to be displaced via the suture or a deployment suture, so as to transition therespective first or second anchor from the first or second insertion configuration to the first or second deployed configuration.

11. The suturing system of any one of claims 1-10, wherein the first and second plurality of anchor inserts, when in the deployed configuration, prevent the first and second anchor insert from being removed from the first and second bone holes, respectively, by having a width greater than a width of the first and second bone holes.

12. The suturing of any one of claims 1-11, wherein the first plurality of anchor inserts, in the deployed configuration, presses against a first inner wall of the first bone hole and wherein the second plurality of anchor inserts, in the deployed configuration, presses against a second inner wall of the second bone hole thereby providing tension on the suture.

13. The suturing system of any one of claims 1-12, wherein in the deployed configuration of the first and plurality of anchor inserts, the first plurality of anchor inserts is wider than the first anchor insert and the second plurality of anchor inserts is wider than the second anchor insert.

14. The suturing system of any one of claims 1-13, wherein the suture changes shape from the substantially linear configuration to the substantially non-linear configuration in the deployed configuration of the first and second anchors.

15. The suturing system of any one of claims 1-14, wherein the first or second plurality of anchor inserts, or both, are aligned in two or more rows when in the deployed configuration.

16. The suturing system of any one of claims 1-15, wherein a first end of the suture is proximal to at least a portion of the first plurality of anchor inserts when the first anchor is in the insertion configuration and a second end of the suture is proximal to at least a portion of the second plurality of anchor inserts when the second anchor is in the insertion configuration.

17. The suturing system of any one of claims 1-16, wherein the first plurality of anchor inserts, the second plurality of anchor inserts, or both, have a shape comprising a sphere, a cylinder, a pyramid, a torus, a cone, a prism, or any combination thereof.

18. The suturing system of any one of claims 1-17, wherein the first plurality of anchor inserts, the second plurality of anchor inserts, or both, comprise 3, 4, 5, 6, 7, 8, or more anchor inserts.

19. The suturing system of any one of claims 1-18, wherein the first plurality of anchor inserts, second plurality of anchor inserts, or both, together when in the insertion configuration or the deployed configuration, span an outer width of less than about 5 mm.

20. The suturing system of any one of claims 1-19, wherein each anchor insert of the first, second, or both plurality of anchor inserts, comprises a braided configuration.

21. The suturing system of any one of claims 1-20, wherein the first plurality of anchor inserts, second plurality of anchor inserts, or both, have a pull out strength in a deployed configuration in a range of about 5 psi to about 50 psi or in a range of about 15 psi to about 25 psi.

22. A method of securing a suture between two holes, comprising: inserting a first anchor secured to a first distal end of a suture through a first suture inserter device into a first bone or hole therein; deploying the first anchor by translating a first portion of the first anchor while immobilizing a second portion of the first anchor causing a first plurality of anchor inserts between the first portion and the second portion of the first anchor to transition from an insertion configuration that is substantially linear to a deployed configuration that is at least partially non-linear; inserting a second anchor secured to a second distal end of the suture through a second suture inserter device into a second bone or hole therein; and deploying the second anchor by translating a first portion of the second anchor while immobilizing a second portion of the second anchor causing a second plurality of anchor inserts between the first portion and the second portion of the second anchor to transition from an insertion configuration that is substantially linear to a deployed configuration that is at least partially non-linear.

23. The method of claim 22, further comprising tensioning the suture by pulling on a tensioning tail of the suture to remove slack.

24. The method of claim 22, further comprising trimming the suture.

25. The method of any one of claims 22-23, wherein the first anchor insert contacts a first inner wall of the first bone and the second anchor insert contacts a second inner wall of the second bone.

26. The method of claim 22, wherein the first plurality of anchor inserts, in the deployed configuration, presses against the first inner wall and the second plurality of anchor inserts, in the deployed configuration, presses against the second inner wall, thereby providing tension on the suture.

27. The method of any one of claims 22-25, wherein the first plurality of anchor inserts, when in the deployed configuration, prevent the first anchor from being removed from the first bone hole by having a width greater than a width of the first bone hole.

28. The method of any one of claims 22-26, wherein the second plurality of anchor inserts, when in the deployed configuration, prevent the second anchor from being removed from the second bone hole by having a width greater than a width of the second bone hole29. The method of any one of claims 22-27, wherein in the deployed configuration, the first plurality of anchor inserts is wider than the first anchor and the second plurality of anchor inserts is wider than the second anchor.

30. The method of any one of claims 22-28, further comprising changing the suture shape from a first shape in a substantially linear configuration to a second shape in a substantially non-linear configuration.

31. The method of any one of claims 22-29, wherein the first plurality of anchor inserts are aligned in two or more rows when in the deployed configuration and the second plurality of anchor inserts are aligned in two or more rows when in the deployed configuration.

32. The method of any one of claims 22-30, wherein a first end of the suture is proximal to at least a portion of the first plurality of anchor inserts when the first anchor is in the insertion configuration and is proximal to at least a portion of the second plurality of anchor inserts when the second anchor is in the insertion configuration.

33. The method of any one of claims 22-31, wherein the first plurality of anchor inserts, the second plurality of anchor inserts, or both, have a shape comprising a sphere, a cylinder, a pyramid, a torus, a cone, a prism, or any combination thereof.

34. The method of any one of claims 22-32, wherein the first plurality of anchor inserts, the second plurality of anchor inserts, or both, comprise 3, 4, 5, 6, 7, 8, or more anchor inserts.

35. The method of any one of claims 22-33, wherein the first or second plurality of anchor inserts together, or both, when in the insertion configuration or the deployed configuration, span an outer width of less than about 5 mm.

36. The method of any one of claims 22-34, wherein each anchor insert comprises a braided configuration.

37. The method of any one of claims 22-35, wherein the first anchor insert, second anchor insert, or both, have a pull out strength in a deployed configuration in a range of about 5 psi to about 50 psi or in a range of about 15 psi to about 25 psi.

38. A suture, comprising: a first anchor, the first anchor comprising a plurality of first anchor inserts; a second anchor, the second anchor comprising a plurality of second anchor inserts;a first connection line, the first anchor coupled to a first end of the first connection line at a first portion of the first anchor, and the second anchor coupled to a second end of the first connection line at a first portion of the second anchor, the first and second end opposite each other; a second connection line, the first anchor coupled to a first end of the second connection line at a second portion of the first anchor, and the second anchor coupled to a second end of the second connection line at a second portion of the second anchor, the first and second end opposite each other.

39. The suture of claim 38, further comprising a tensioning tail connected to the second portion of the second anchor.

40. The suture of claim 39, wherein the tensioning tail provides a tension between the second portion of the first anchor and the second portion of the second anchor when pulled.

41. The suture of claim 38, wherein the first connection line has a width of about 0.20 mm to about 1 mm and the second connection line has a width of about 0.20 mm to about 1 mm.

42. The suture of claim 38, wherein the first connection line comes into contact with the second connection line when the suture is deployed.

43. The suture of claim 38, wherein the first anchor is inserted into a first bone or hole therein and the second anchor is inserted into a second bone or hole therein.

44. The suture of claim 38, wherein the first plurality of anchor inserts, second plurality of anchor inserts, or both, have 2, 3, 4, 5, 6, 7, or 8 anchor inserts.

45. A method for securing a suture to bone, the method comprising: inserting a first suture anchor into a first bone, the first suture anchor comprising a first plurality of anchor inserts, the first suture anchor configured to transition from a first insertion configuration that is substantially linear to a first deployed configuration that is at least partially nonlinear; inserting a second suture anchor into a second bone spaced apart from the first bone, the second suture anchor comprising a second plurality of anchor inserts, the second suture anchor configured to transition from a second insertion configuration that is substantially linear to a second deployed configuration that is at least partially nonlinear, wherein the first and second suture anchors are linked together via a common suture; and tensioning the common suture so as to remove or reduce an amount of slack thereof between the first and second suture anchors.

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