Soft tissue tensioning and fixation system

Abstract

A surgical tensioner according to certain embodiments generally includes a barrel, a passage member, a cleat, and an adjustment device. The barrel extends along a first longitudinal axis. The passage member defines a passage that extends along a second longitudinal axis offset from the first longitudinal axis by an offset distance. The cleat is mounted for movement relative to the barrel and configured to facilitate coupling of a suture with the cleat. The adjustment device is mounted to the barrel and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture.

Description

SOFT TISSUE TENSIONING AND FIXATION SYSTEMCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] The present application claims priority to US Provisional Patent Application No.63 / 712,000, filed October 25, 2024, the contents of which are hereby incorporated by reference in their entirety.TECHNICAL FIELD

[0002] The present disclosure generally relates to surgical devices, and more particularly but not exclusively relates to devices for adjusting tension in a suture and / or other tether.BACKGROUND

[0003] Surgical tensioners are occasionally used to adjust tension in a tether, such as a suture, a cable, a wire, an adjustable fixation device, a graft, a biologic augmentation, a synthetic augmentation, or suture tape. However, certain existing surgical tensioners suffer from one or more drawbacks or limitations, including but not limited to difficulty in one or more areas such as insertion and / or attachment to the surgical site, accuracy of positioning, accuracy and / or efficiency of measurement, inspecting the surgical site, independently adjusting tension for two or more tethers, anchoring sutures to the tensioner, stabilizing the tensioner, and / or manipulating fixation devices while using the tensioner. For these reasons among others, there remains a need for further improvements in this technological field.SUMMARY

[0004] A surgical tensioner according to certain embodiments generally includes a barrel, a passage member, a cleat, and an adjustment device. The barrel extends along a first longitudinal axis. The passage member defines a passage that extends along a second longitudinal axis offset from the first longitudinal axis by an offset distance. The cleat is mounted for movement relative to the barrel and configured to facilitate coupling of a suture with the cleat. The adjustment device is mounted to the barrel and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture. Further embodiments, forms, features, and aspects of the present application shall become apparent from the description and figures provided herewith.BRIEF DESCRIPTION OF THE FIGURES

[0005] Fig. 1 is a perspective and partially exploded view of a surgical tensioner according to certain embodiments.

[0006] Fig. 2 is a perspective cutaway view of the surgical tensioner illustrated in Fig. 1.

[0007] Fig. 3 is a partially exploded assembly view of a cleat assembly according to certain embodiments, the cleat assembly including a base member, a spool member, and a clamp member.

[0008] Fig. 4 is a perspective view of the base member illustrated in Fig. 3.

[0009] Fig. 5 is a perspective view of the spool member illustrated in Fig. 3.

[0010] Fig. 6 is a perspective view of the clamp member illustrated in Fig. 3.

[0011] Fig. 7 is a rear view of an attachment device of the cleat assembly illustrated in Fig. 3.

[0012] Fig. 8 is a perspective view illustrating loading of a suture to the attachment device illustrated in Fig. 7.

[0013] Fig. 9 is a schematic flow diagram of a process according to certain embodiments.

[0014] Fig. 10 is an exploded assembly view of an adjustment device according to certain embodiments.

[0015] Fig. 11 is a rear plan cutaway view of the surgical tensioner illustrated in Fig. 1.

[0016] Fig. 12 is a perspective view of a surgical tensioner according to certain embodiments.

[0017] Fig. 13 is a perspective view of a portion of the surgical tensioner illustrated in Fig. 12, and illustrates a fixation device and a stabilization skid.

[0018] Fig. 14 is a plan view of a portion of the surgical tensioner illustrated in Fig. 12, and illustrates the stabilization skid being held in a retracted position by a detent mechanism according to certain embodiments.

[0019] Fig. 15 is a plan view of a portion of the surgical tensioner illustrated in Fig. 12, and illustrates the stabilization skid being held in an extended position by the detent mechanism.

[0020] Fig. 16 is a plan view of a portion of the surgical tensioner illustrated in Fig. 12, and illustrates the detent mechanism in a releasing state.

[0021] Fig. 17 is a perspective view of a cleat mechanism according to certain embodiments.

[0022] Fig. 18 is a cross-sectional illustration of a surgical site including a joint during a surgical procedure involving the surgical tensioner illustrated in Fig. 12.

[0023] Fig. 18A illustrates the fixation device engaging bone during the surgical procedure.

[0024] Fig. 19 is a rear plan view of a portion of the surgical tensioner illustrated in Fig. 12.

[0025] Fig. 20 is a schematic flow diagram of a process according to certain embodiments.

[0026] Fig. 21 is a perspective illustration of a fixation device according to certain embodiments, the fixation device including a cam.

[0027] Fig. 22 is a perspective illustration of a fixation device according to certain embodiments, the fixation device including a ratchet strip.

[0028] Fig. 23 is a perspective illustration of a fixation device according to certain embodiments, the fixation device including a cam and a slider.

[0029] Fig. 24 is a cross-sectional illustration of the fixation device illustrated in Fig. 23.

[0030] Fig. 25 is an exploded assembly view of a fixation device according to certain embodiments, the fixation device including a button with outward splaying arms and a relatively short threaded fastener.

[0031] Fig. 26 is a cross-sectional illustration of the surgical site of a joint repair procedure performed using the fixation device illustrated in Fig. 25.

[0032] Fig. 27 is an exploded assembly view of a fixation device according to certain embodiments, the fixation device including a button with outward splaying arms and a relatively long threaded fastener.

[0033] Fig. 28 is a cross-sectional illustration of the surgical site of a joint repair procedure performed using the fixation device illustrated in Fig. 27.

[0034] Fig. 29 is an end view of a fixation device according to certain embodiments, the fixation device including a button with lateral windows.

[0035] Fig. 30 is a cross-sectional illustration of the surgical site of a joint repair procedure performed using the fixation device illustrated in Fig. 29.

[0036] Fig. 31 is a perspective illustration of a fixation device according to certain embodiments, the fixation device including a button and an anchor plate.

[0037] Fig. 32 is a perspective illustration of the button illustrated in Fig. 31.

[0038] Fig. 33 is a perspective illustration of a fixation device according to certain embodiments.

[0039] Fig. 34 depicts the fixation device illustrated in Fig. 33 during loading of the fixation device with a suture.

[0040] Fig. 35 is a side view of a fixation device according to certain embodiments.

[0041] Fig. 36 is a plan view of the fixation device illustrated in Fig. 35.

[0042] Fig. 37 is an exploded assembly view of a fixation device according to certain embodiments, the fixation device including a button and an anchor plate.

[0043] Fig. 38 is a plan view of the fixation device illustrated in Fig. 37, and illustrates the anchor plate passing through an enlarged aperture of the button.

[0044] Fig. 39 is a cross-sectional view of a fixation device according to certain embodiments in a releasing state, the fixation device including a countersunk button and a threaded fastener.

[0045] Fig. 40 is a cross-sectional view of the fixation device illustrated in Fig. 39 while the fixation device is in a holding state and is engaged with a pair of tethers.

[0046] Fig. 41 is a side view of a fixation device according to certain embodiments about to engage an interference screw.

[0047] Fig. 42 is a side view of the fixation device illustrated in Fig. 41 after insertion of an extension of the fixation device into a cannulation of the interference screw.

[0048] Fig. 43 illustrates a kit according to certain embodiments.

[0049] Fig. 44 is a schematic flow diagram of a process according to certain embodiments.

[0050] Fig. 45 is a schematic representation of a surgical site during performance of a surgical procedure according to certain embodiments.

[0051] Fig. 46 is a schematic flow diagram of a process according to certain embodiments.

[0052] Fig. 47 is an exploded assembly view of a cleat assembly according to certain embodiments.

[0053] Fig. 48 is a perspective illustration of the cleat assembly illustrated in Fig. 47 during an example use case.

[0054] Fig. 49 is a plan view of a portion of the cleat assembly illustrated in Figs. 47 and 48.

[0055] Fig. 50 is a plan view of a surgical tensioner according to certain embodiments.

[0056] Fig. 51 is a perspective view of a pair of adjustment devices according to certain embodiments.

[0057] Fig. 52 is a perspective view of a surgical tensioner including the adjustment devices illustrated in Fig. 51.

[0058] Fig. 53 is a schematic illustration of a system in which a tensioner includes a pater that engages a mater of a fixation device to thereby stabilize the tensioner.

[0059] Fig. 54 is a schematic illustration of a system in which a tensioner includes a mater that receives a pater of a fixation device to thereby stabilize the tensioner.

[0060] Fig. 55 is a schematic illustration of a system in which each of a tensioner and a fixation device includes a corresponding mater that receives a corresponding portion of a floating pater to thereby stabilize the tensioner.

[0061] Fig. 56 is a perspective view of a cleat assembly according to certain embodiments.

[0062] Fig. 57 is a perspective view of a portion of the cleat assembly illustrated in Fig. 56.

[0063] Fig. 58 is an exploded view of a connection mechanism according to certain embodiments being used to releasably connect first and second tensioner components.

[0064] Fig. 59 is a cross-sectional view illustrating a first connection mechanism component and a second connection mechanism component in an engaged state.

[0065] Fig. 60 is a perspective view of a tensioner component including an instance of the second connection mechanism component.

[0066] Fig. 61 is a perspective view of another tensioner component including another instance of the second connection mechanism component.

[0067] Fig. 62 is a perspective view of a feedback mechanism according to certain embodiments provided to an adjustment device.

[0068] Fig. 63 illustrates a surgical tensioner according to certain embodiments during use with an adjustable loop fixation device.

[0069] Fig. 64 is a perspective view of an engagement system according to certain embodiments, the engagement system including an end piece and a fixation device.

[0070] Fig. 65 is a cross-sectional view of an end portion of the engagement system illustrated in Fig. 64.

[0071] Fig. 66 is a partially exploded view of the engagement system illustrate in Fig. 64.

[0072] Fig. 67 is a cross-sectional view of the end piece taken along the line LXVII-LXVII in Fig. 65.

[0073] Fig. 68 is a partially exploded view of a portion of an engagement system according to certain embodiments.

[0074] Fig. 69 is a longitudinal cross-sectional view of the engagement system illustrated in Fig.DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

[0075] Although the concepts of the present disclosure are susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and will be described herein in detail. It should be understood, however, that there is no intent to limit the concepts of the present disclosure to the particular forms disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives consistent with the present disclosure and the appended claims.

[0076] References in the specification to “one embodiment,” “an embodiment,” “an illustrative embodiment,” etc., indicate that the embodiment described may include a particular feature, structure, or characteristic, but every embodiment may or may not necessarily include that particular feature, structure, or characteristic. Moreover, such phrases are not necessarily referring to the same embodiment. It should further be appreciated that although reference to a “preferred” component or feature may indicate the desirability of a particular component or feature with respect to an embodiment, the disclosure is not so limiting with respect to other embodiments, which may omit such a component or feature. Further, when a particular feature, structure, or characteristic is described in connection with an embodiment, it is submitted that it is within the knowledge of one skilled in the art to implement such feature, structure, or characteristic in connection with other embodiments whether or not explicitly described.

[0077] As used herein, the terms “longitudinal,” “lateral,” and “transverse” may be used to denote motion or spacing along three mutually perpendicular axes, wherein each of the axes defines two opposite directions. These terms are used for ease and convenience of description, and are without regard to the orientation of the system with respect to the environment. For example, descriptions that reference a longitudinal direction may be equally applicable to a vertical direction, a horizontal direction, or an off-axis orientation with respect to the environment. Furthermore, motion or spacing along a direction defined by one of the axes need not preclude motion or spacing along a direction defined by another of the axes. For example, elements that are described as being “laterally offset” from one another may also be offset in the longitudinal and / or transverse directions, or may be aligned in the longitudinal and / or transverse directions. Moreover, the term “transverse” may also be used to describe motion or spacing that is non-parallel to a particular axis or direction. For example, an element that is described as being “movable in a direction transverse to the longitudinal axis” may move in a direction that isperpendicular to the longitudinal axis and / or in a direction oblique to the longitudinal axis. The terms are therefore not to be construed as limiting the scope of the subject matter described herein to any particular arrangement unless specified to the contrary.

[0078] Additionally, it should be appreciated that items included in a list in the form of “at least one of A, B, and C” can mean (A); (B); (C); (A and B); (B and C); (A and C); or (A, B, and C). Similarly, items listed in the form of “at least one of A, B, or C” can mean (A); (B); (C); (A and B); (B and C); (A and C); or (A, B, and C). Items listed in the form of “A, B, and / or C” can also mean (A); (B); (C); (A and B); (B and C); (A and C); or (A, B, and C). Further, with respect to the claims, the use of words and phrases such as “a,” “an,” “at least one,” and / or “at least one portion” should not be interpreted so as to be limiting to only one such element unless specifically stated to the contrary, and the use of phrases such as “at least a portion” and / or “a portion” should be interpreted as encompassing both embodiments including only a portion of such element and embodiments including the entirety of such element unless specifically stated to the contrary.

[0079] In the drawings, some structural or method features may be shown in certain specific arrangements and / or orderings. However, it should be appreciated that such specific arrangements and / or orderings may not necessarily be required. Rather, in some embodiments, such features may be arranged in a different manner and / or order than shown in the illustrative figures unless indicated to the contrary. Additionally, the inclusion of a structural or method feature in a particular figure is not meant to imply that such feature is required in all embodiments and, in some embodiments, may be omitted or may be combined with other features.

[0080] With reference to Fig. 1, illustrated therein is a surgical tensioner 100 according to certain embodiments. The surgical tensioner 100 generally includes a body 110, a guide member 120 mounted to the body 110, a cleat assembly 200 mounted for movement relative to the body 110, and an adjustment device 300 operable to exert an adjustable force on the cleat assembly 200. As described herein, during use of the tensioner 100, a suture may be secured to the cleat assembly 200, and the adjustment device 300 may be utilized to adjust a tension of the suture. In certain embodiments, at least a portion of the surgical tensioner 100 may be sterilized.

[0081] With additional reference to Fig. 2, the body 110 generally includes a barrel 111 that extends along a first longitudinal axis 112, and a passage member 115 that extends along asecond longitudinal axis 116. While other forms are contemplated, in the illustrated form, the passage member 115 is provided in the form of an open channel member 115. The first and second longitudinal axes 112, 116 are offset from one another by a non-zero offset distance 119. Each of the longitudinal axes 112, 116 extends in a proximal direction toward the user (generally to the right in Figs. 1 and 2) and an opposite distal direction away from the user (generally to the left in Figs. 1 and 2). In the illustrated form, the longitudinal axes 112, 116 are parallel to one another. In other embodiments, the longitudinal axes 112, 116 may be not necessarily be parallel to one another. For example, in embodiments in which the barrel 111 and the channel member 115 extend in different directions, the longitudinal axes 112, 116 may be askew or perpendicular to one another. An example tensioner 1800 including non-parallel axes 1812, 1812', 1816 is described herein with reference to Fig. 49.

[0082] The barrel 111 defines a chamber 113 in which the adjustment device 300 may be mounted, and a guide slot 114 connected with the chamber 113. The channel member 115 defines an open passage or channel 117 through which a portion of the suture may extend, and a nadir line 117' defining a bottom of the channel 117. The barrel 111 has a barrel radius rill, which in the illustrated form is defined between the first longitudinal axis 112 and a top surface 111 ' of the barrel 111. The channel member 115 has a channel radius rl 15, which in the illustrated form is defined between the second longitudinal axis and the nadir line 117'. While other forms are contemplated, in the illustrated form, the channel radius rl 15 is less than the barrel radius rl 11, and the offset distance 119 is greater than the barrel radius rill. In the illustrated embodiment, the offset distance 119 is greater than a sum of the barrel radius rl 11 and the channel radius rl 15. As a result, the nadir line 117' is offset from the top surface 111' of the barrel 111. In certain forms, such as those in which the guide member 120 is removably attached to the body 110 the distal end of the channel member 115 may include one or more apertures sized and shaped to receive posts 129 of the guide member 120 to thereby facilitate mounting of the guide member 120 to the body 110.

[0083] In the illustrated embodiment, the guide member 120 is mounted to a distal end of the channel member 115, and generally includes a base 128 and a body in the form of a tube 122 extending distally from the base 128 to a distal end portion 123. The tube 122 is hollow such that a passage 121 is defined within the tube 122. In the illustrated form, the body is provided in the form of a tube 122 that defines the passage 121 as a circumferentially closed passage. It isalso contemplated that the body may instead be provided in the form of a channel, in which case the passage 121 may be a circumferentially open passage. The distal end portion 123 includes an engagement device 124 configured to facilitate coupling of the guide member 120 with a fixation device, examples of which are described herein with reference to Figs. 21-42. In the illustrated form, the engagement device 124 is formed within the tube 122, and includes a plurality of engagement features 125. While other geometries are contemplated, each of the illustrated engagement features 125 is provided in the form of a pater, and more particularly as a spline. As described herein, embodiments including the engagement device 124 may facilitate manipulation of a fixation device and / or the performance of a trial cycling procedure.

[0084] In certain embodiments, the guide member 120 may be considered to constitute a portion of the body 110. It is also contemplated that the body 110 and the guide member 120 may together be considered to constitute a housing 110'. In either event, the guide member 120 may be detachably mounted to the body 110, may be secured to the body 110, or may be integrally formed with the body 110 to thereby define a unitary construction. However, it should be appreciated that providing the guide member 120 as a separate piece may provide certain advantages. For example, a detachable guide member 120 may be provided in a kit with another form of end piece, and the guide member 120 and the end piece may be interchangeable. An example form of a kit 1300 according to certain embodiments is described herein with reference to Fig. 43. Additionally, while the illustrated guide member 120 is mounted to the body 110 via posts 129, it is also contemplated that the guide member 120 may be mounted to the body 110 via other features, such as the connection device 2300 described herein with reference to Figs. 58 and 59.

[0085] As noted above, each of the channel member 115 and the guide member 120 defines a corresponding and respective passage therethrough. More particularly, the channel member 115 defines a circumferentially open passage in the form of a channel 117, and the illustrated guide member 120 defines a circumferentially closed passage 121. As will be appreciated by those skilled in the art, a circumferentially open passage such as a channel 117 includes an open side that permits lateral access to the channel 117, whereas a circumferentially closed passage such as the passage 121 is circumferentially surrounded by one or more walls that define the passage. Although the illustrated body 110 includes a channel member 115 defining a circumferentially open passage in the form of a channel 117, it is also contemplated that the body 110 may insteadinclude a tubular member defining a circumferentially closed passage in the form of a tube. In either event, the longitudinal axis 116 of the passage member 115 may be offset from the longitudinal axis 112 of the barrel 111.

[0086] With additional reference to Fig. 3, the cleat assembly 200 is mounted to a sleeve 310 of the adjustment device 300, and extends along a lateral axis 201 transverse to the longitudinal axes 112, 116 of the barrel 111 and the channel member 115. The cleat assembly 200 includes a first attachment mechanism 202 to which a first suture may be attached, and in the illustrated form further includes a second attachment mechanism 204 to which a second suture may be attached. The cleat assembly 200 generally includes a base member 210, a spool member 220 mounted to one side of the base member 210, and a clamp member 230 that cooperates with the spool member 220 to define a clamp 240. In certain forms, the cleat assembly 200 may include instructional indicia 250 that convey to the user information regarding an intended mode of use for the cleat assembly 200.

[0087] As described herein, the base member 210, the spool member 220, the clamp member 230, and the clamp 240 cooperate to define the first attachment mechanism 202. In the illustrated form, the cleat assembly 200 further includes a second attachment mechanism 204 opposite the first attachment mechanism 202. In certain embodiments, the second attachment mechanism 204 may be a structural mirror image of the first attachment mechanism 202 relative to a longitudinally-extending centerline 209 of the cleat assembly 200. The second attachment mechanism 204 may, for example, be defined by and / or comprise the base member 210, a second spool member 220', and a second clamp member 230' that cooperates with the second spool member 220' to define a second clamp 240'. In the illustrated form, the first and second attachment mechanisms 202, 204 are provided as a single unit that is mounted to a single adjustment device 300. It is also contemplated that the attachment mechanisms 202, 204 may be provided as separate attachment devices that are movable relative to one another. For example, individual attachment devices could be mounted to independently-operable adjustment devices in a manner analogous to that described herein with reference to the dual tensioner 500 illustrated in Figs. 12-18.

[0088] With additional reference to Fig. 4, the base member 210 defines a base for the cleat assembly 200, and in the illustrated form includes a base portion 212, a cleat 214 projecting from the base portion 212, and an engagement portion 218 through which the base member 210engages the spool member 220. The base portion 212 includes a mounting aperture 213 through which the base member 210 may be mounted to the sleeve 310, for example via an appropriate fastener 206. The cleat 214 includes a post 215 that projects from the base portion 212 and a stop 216 positioned atop the post 215. The stop 216 projects beyond the outer periphery of the post 215 such that a guide channel 217 is defined between the base portion 212 and the stop 216. The engagement portion 218 is sized and shaped to engage a corresponding engagement portion 228 of the spool member 220 (Fig. 5), and in the illustrated form generally includes a ridge 219 and a channel 219'.

[0089] With additional reference to Fig. 5, the spool member 220 generally includes a spool portion 222 including a pair of walls 224, 226, and an engagement portion 228 operable to engage the engagement portion 218 of the base member 210. In the illustrated form, the engagement portion 228 includes a ridge 229 sized and shaped for receipt in the base member channel 219', and a channel 229' sized and shaped to receive the base member ridge 219. It is also contemplated that the engagement portions 218, 228 may include other geometries that prevent relative rotation of the base member 210 and the spool member 220, or may be omitted. By way of example, the engagement portions 218, 228 may be omitted in embodiments in which the base member 210 and the spool member 220 are provided as a monolithic or single-piece construction.

[0090] The spool portion 222 includes an annular channel 223, which is defined between the first and second walls 224, 226. As described herein, during use of the tensioner 100, a portion of a suture may be wrapped about the spool portion 222, for example to take up slack in the suture. Such wrapping of the suture about the spool portion 222 can additionally reduce the amount of force needed to cleat the free end of the suture to the clamp 240. Those skilled in the art will readily recognize that this holding force will vary as a function of the winding according to the capstan equation. The first wall 224 is positioned nearer the center of the cleat assembly 200, and may accordingly be referred to herein as the medial wall 224. Conversely, the second wall 226 is positioned farther from the center of the cleat assembly 200, and may alternatively be referred to herein as the lateral wall 226. The medial wall 224 includes a first catch 225, which provides an anchor point for the suture during winding of the suture about the spool portion 222 to thereby discourage slipping of the suture during the winding process. Similarly, the lateral wall 226 includes a second catch 227, which provides an anchor point for the suture as the userengages the suture with the clamp 240 to thereby discourage slipping of the suture during the clamping process. As described herein, the lateral end face 221 of the spool member 220 may define a first clamp surface 242 of the clamp 240.

[0091] With additional reference to Fig. 6, the clamp member 230 generally includes a body portion 232 defining a through-hole 233, and a medial end face 231 that faces the lateral end face 221 of the spool member 220. As described herein, the medial end face 231 defines a second clamp surface 242 of the clamp 240.

[0092] With additional reference to Fig. 7, the clamp 240 generally includes a pair of clamp surfaces 242 that face one another, and a bias mechanism 246 biasing the clamp surfaces 242 into engagement with one another. In the illustrated form, a first clamp surface 242 is formed on the lateral end face 221 of the spool member 220, and a second clamp surface 242 is formed on the medial end face 231 of the clamp member 230. In the illustrated embodiment, each of the clamp surfaces 242 includes a series of ridges 243 that project in the lateral direction and extend radially. With the clamp surfaces 242 biased into engagement with one another, the ridges 243 mesh with one another and define an interlock region 244 (Fig. 8). In the illustrated form, the radially outer ends of the ridges 243 are tapered to thereby define a tapered inlet 245 to the interlock region 244 (Fig. 8).

[0093] The bias mechanism 246 generally includes a spring 247 and a bolt 248 on which the spring 247 is mounted. The bolt 248 extends through the through-hole 233 of the clamp member 230 and engages a stationary portion of the cleat assembly 200. For example, the bolt 248 may include a threaded portion that engages a threaded aperture formed in the base member 210. With the bolt 248 extending through the through-hole 233, the clamp member 230 is capable of at least some limited movement along the lateral axis 201. Additionally, the spring 247 is captured between the head 249 of the bolt 248 and the lateral end face 239 of the clamp member 230. As a result, the bias mechanism 246 biases the clamp member 230 in the medial direction, thereby biasing the clamp surfaces 242 into engagement with one another.

[0094] In embodiments that include the instructional indicia 250, the instructional indicia 250 may convey to the user information regarding an intended mode of use for the cleat assembly 200. In the illustrated form, the instructional indicia 250 comprise a first indicator 251, a second indicator 252, and a third indicator 253. By way of illustration, the first indicator 251 may relate to a first step to be taken, the second indicator 252 may relate to a second step to be takensubsequent to the first step, and third indicator 253 may relate to a third step to be taken subsequent to the second step. As described herein, in the illustrated embodiment, each of the indicators 251-253 includes a corresponding and respective order indicium (designated with the a suffix) and a corresponding and respective directional indicium (designated with the b suffix). It is also contemplated that one or more of the indicators 251-253 may take another form. For example, one or more of the indicators 251-253 may omit its order indicium, and / or one or more of the indicators 251-253 may omit its directional indicium. Moreover, while the illustrated order indicia are alphanumeric indicia and the directional indicia are geometric indicia, it should be appreciated that other forms of order indicia and directional indicia are contemplated.

[0095] As noted above, each of the illustrated indicators 251-253 includes a corresponding and respective order indicium 251a-253a and a corresponding and respective directional indicium 251b-253b. More particularly, the first indicator 251 includes a first order indicium 251a and a first directional indicium 251b, the second indicator 252 includes a second order indicium 252a and a second directional indicium 252b, and the third indicator 253 includes a third order indicium 253a and a third directional indicium 253b. In the illustrated form, the order indicia 251a-253a are alphanumeric characters, and more particularly numeric characters. It is also contemplated that alphabetic characters and / or other characters may be used. In the illustrated form, the directional indicia 251b-253b comprise triangles that point toward the feature to be engaged. It is also contemplated that other geometries may be utilized, such as arrows.

[0096] While other embodiments are contemplated, in the illustrated form, the cleat assembly 200 exhibits structural mirror symmetry in that the first attachment mechanism 202 and the second attachment mechanism 204 are structurally mirror images of one another relative to the longitudinally-extending centerline 209. It should be appreciated that, as used herein, “structural mirror symmetry” indicates that the structural features of the first attachment mechanism 202 are substantial mirror images of the structural features of the second attachment mechanism 204. In embodiments that include instructional indicia 250, the indicia 250 may not necessarily be mirror images of one another. For example, the directional indicia may be mirror images of one another due to the mirror-imaged structural features, while the order indicia may not necessarily be mirrored, for example in embodiments in which the order indicia comprise characters, symbols, and / or words that would be difficult for the user to identify or read when reversed.

[0097] With additional reference to Fig. 8, illustrated therein is the first attachment mechanism 202 after loading of a suture 90. As described herein, during use of the tensioner 100, a first portion of the suture 90 may be secured to the patient (e.g., to a ligament of the patient), and a second portion of the suture 90 may be engaged with the cleat assembly 200. When the suture 90 is loaded onto the attachment mechanism 202, the suture 90 includes a longitudinally- extending portion 91, a laterally-extending portion 92, a spooled portion 93, and a clamped portion 94. An example process 400 for loading the suture 90 is illustrated in Fig. 9.

[0098] With additional reference to Fig. 9, an exemplary process 400 that may be performed using the cleat assembly 200 is illustrated. Blocks illustrated for the processes in the present application are understood to be examples only, and blocks may be combined or divided, and added or removed, as well as re-ordered in whole or in part, unless explicitly stated to the contrary. Additionally, while the blocks are illustrated in a relatively serial fashion, it is to be understood that two or more of the blocks may be performed concurrently or in parallel with one another. Moreover, while the process 400 is described herein with specific reference to the tensioner 100 and cleat assembly 200 illustrated in Figs. 1-8, it is to be appreciated that the process 400 may be performed with tensioners and / or cleat assemblies having additional and / or alternative features.

[0099] In certain embodiments, the process 400 may begin with one end portion of the suture 90 anchored in a relatively fixed location. For example, the far or distal end portion of the suture 90 may be attached to soft tissue (e g., a ligament), bony tissue, or a fixation device. It is also contemplated that the process 400 may begin with both ends of the suture 90 free.

[0100] The process 400 may include block 410, which generally involves forming the longitudinally extending portion 91 of the suture 90. For example, block 410 may involve passing a portion of the suture 90 through the guide member 120 and / or extending the portion of the suture 90 along the channel 117. Block 410 can include block 414, which generally involves engaging the suture 90 with the cleat 214. For example, block 414 may involve pulling the suture 90 to render the longitudinal portion 91 taut, and engaging the suture 90 with the cleat 214 to thereby cause a portion of the suture 90 to extend laterally. With the suture 90 properly engaged with the cleat 214, the suture 90 extends along the channel 217 and is captured between the base portion 212 and the stop 216 to thereby discourage the suture 90 from sliding out of engagement with the cleat 214.

[0101] In certain embodiments, block 410 may involve block 412, which generally involves consulting the instructional indicia 250. In such forms, the engaging of block 414 may be performed based on information conveyed by the instructional indicia 250. For example, block 412 may involve consulting the first indicator 251, which generally relates to a first step to be taken in loading the suture 90. In the illustrated form, the order indicium 25 la of the first indicator 251 comprises the numeral “1” to thereby indicate that the engaging of block 414 is the first step to be taken in the attachment process 400. Additionally, the directional indicium 251b of the first indicator 251 points in the lateral direction, thereby indicating that the free portion of the suture 90 should be wrapped about the cleat 214 to thereby begin to form the laterally extending portion 92 of the suture 90.

[0102] The process 400 may include block 420, which generally involves forming the laterally extending portion 92 of the suture 90. Block 420 can include block 424, which generally involves engaging the suture 90 with the catch 225. In certain embodiments, block 424 may involve pulling the suture 90 to thereby form the laterally extending portion 92 as a taut portion of the suture 90.

[0103] In certain embodiments, block 420 may involve block 422, which generally involves consulting the instructional indicia 250. In such forms, the engaging of block 424 may be performed based on information conveyed by the instructional indicia 250. For example, block 422 may involve consulting the second indicator 252, which generally relates to a second step to be taken in loading the suture 90. In the illustrated form, the order indicium 252a of the second indicator 252 comprises the numeral “2” to thereby indicate that the engaging of block 424 is to occur after the forming of block 410, which corresponds to the numeral “1” of the first order indicium 251a. Additionally, the directional indicium 252b of the second indicator 252 points in the lateral direction and toward the catch 225, thereby indicating that the free portion of the suture 90 should be passed in the direction indicated by the triangle for engagement with the catch 225 and subsequent wrapping about the spool 222.

[0104] The process 400 may include block 430, which generally involves forming the wrapped portion 93. Block 430 can involve block 434, which generally involves winding the suture 90 about the spool 222 of the spool member 220. In certain embodiments, block 434 may involve pulling the suture 90 during the winding process to thereby ensure that the longitudinal portion 91 and the lateral portion 92 remain taut. Those skilled in the art will readily appreciate thatwinding the suture 90 tightly about the spool 222 increases the frictional forces associated with the engagement, thereby discouraging the suture 90 from unwinding in a manner that would alter the tension of the suture 90.

[0105] In certain embodiments, block 430 may involve block 432, which generally involves consulting the instructional indicia 250. In such forms, the winding of block 434 may be performed based on information conveyed by the instructional indicia 250. For example, block 432 may involve consulting a winding indicator 254. In the illustrated form, the winding indicator 254 includes directional indicia 254b indicating the direction in which the suture 90 is to be wound about the spool 222. While the illustrated winding indicator 254 does not include an order indicium, it should be appreciated that the winding indicator 254 may include an order indicium indicating that the winding should occur after block 420 and prior to block 440.

[0106] The process 400 may include block 440, which generally involves forming the clamped portion 94. Block 440 can involve block 444, which generally involves clamping the suture 90 using the clamp 240. In certain embodiments, block 444 involves pulling the suture 90 taut against the catch 227, and feeding the suture 90 into the interlock region 244 via the tapered inlet 245 such that the suture 90 becomes clamped between the ridges 243. As will be appreciated, the act of feeding the suture 90 into the interlock region 244 may urge the clamp member 230 laterally away from the spool member 220. In such a case, the bias mechanism 246 will continue urging the clamp member 230 into engagement with the spool member 220 to thereby maintain the clamp 240 in its clamped state. Those skilled in the art will recognize that, due at least in part to the frictional forces generated by wrapping the suture 90 about the spool 222, the amount of force that must be exerted by the clamp 240 to retain tension in the suture 90 may be reduced according to the capstan equation, as noted above.

[0107] In certain embodiments, block 440 may involve block 442, which generally involves consulting the instructional indicia 250. In such forms, the clamping of block 444 may be performed based on information conveyed by the instructional indicia 250. For example, block 442 may involve consulting the third indicator 253. In the illustrated form, the order indicium 253a of the third indicator 253 comprises the numeral “3” to thereby indicate that the clamping of block 444 is to occur after the forming of block 420. Additionally, a directional indicium 253b of the third indicator 253 points in the medial direction and toward the interlock region 244, thereby indicating that the free portion of the suture 90 should be passed into the interlockregion 244 via the tapered inlet 245. Tn certain forms, the instructional indicia 250 may include a further directional indicium 255b positioned on the opposite side of the clamp 240. The further directional indicium 255b may cooperate with the directional indicium 253b in indicating the intended path for the suture 90.

[0108] With additional reference to Fig. 10, the adjustment device 300 extends along a longitudinal axis 301 corresponding to the barrel longitudinal axis 112, and generally includes a sleeve 310, a stem in the form of a bolt 320 that extends through the sleeve 310, a spring 330 captured between the sleeve 310 and the bolt 320, and a knob 340 engaged with a threaded end portion 322 of the bolt 320, and in the illustrated form further includes an indicator pin 350. In certain embodiments, the adjustment device 300 further includes a bearing assembly 360 that aids in reducing friction between the sleeve 310 and the barrel 111. When the adjustment device 300 is installed to the body 110, the longitudinal axis 301 generally aligns with the barrel longitudinal axis 112.

[0109] The sleeve 310 is slidably mounted in the chamber 113 of the barrel 111, and generally includes an end wall 312 having an aperture 313, and a plateau 314 including a slot 315 and a mounting location 317. The mounting location 317 may also be referred to herein as a mount 317. As described herein, the end wall 312 defines an anchor point for the spring 330, and the bolt 320 extends through the aperture 313 for engagement with the knob 340. The plateau 314 is received in the guide slot 114 of the barrel 111 to thereby define a keyed spline connection that prevents rotation of the sleeve 310 relative to the body 110. Disposed adjacent the slot 315 is a set of adjustment indicia 316. As described herein, the indicator pin 350 is aligned with the slot 315 and cooperates with the adjustment indicia 316 to thereby define a tension gauge 104 configured to indicate tension on a loaded suture 90. In certain embodiments, the sleeve 310 may include an additional slot 315 ' opposite the indicating slot 315. The mounting location 317 facilitates mounting of the cleat assembly 200 to the sleeve 310, and in the illustrated form includes a threaded aperture operable to engage the fastener 206.

[0110] The stem or bolt 320 is seated in the sleeve 310, and generally includes a threaded end portion 322 engaged with the knob 340, and a head 324 opposite the threaded end portion 322. In the illustrated form, the head 324 includes an aperture 325 in which the indicator pin 350 is mounted, and a spline 326 that cooperates with the slot 315 to thereby prevent rotation of the bolt320 relative to the sleeve 310. This connection in turn prevents rotation of the bolt 320 relative to the body 110.[01111 The spring 330 includes a proximal first end 332 and a distal second end 334 opposite the first end 332. The first end 332 of the spring 330 is engaged with the end wall 312 of the sleeve 310, and the second end 334 of the spring 330 is engaged with the head 324 of the bolt 320 such that the spring 330 is captured within the sleeve 310. In the illustrated form, the spring 330 is provided as a compression spring. It should be appreciated, however, that other forms of springs may be utilized to provide an adjustable biasing force. By way of example, the adjustment device 300 may utilize an extension spring, a torsion spring, a leaf spring, and / or a clock spring in addition or as an alternative to the illustrated compression spring 330.

[0112] The knob 340 is rotatably mounted to the body 110, and generally includes a grip 342 and a threaded aperture 344 formed within the grip 342. The grip 342 facilitates manual grasping of the knob 340, and may include one or more indentations 343 configured to further facilitate such manual grasping. The threaded end portion 322 of the bolt 320 extends into the threaded aperture 344 such that the knob 340 and the bolt 320 are threadedly engaged with one another. In the illustrated form, the knob 340 is mounted to the end of the barrel 111 for rotation about the barrel longitudinal axis 112. It is also contemplated that the knob 340 may be mounted for rotation about another axis, for example as described with reference to Figs. 50 and 51.

[0113] The indicator pin 350 is mounted in the aperture 325 of the bolt 320 such that the indicator pin 350 is visible via the indicator slot 315. The indicator pin 350 cooperates with the tension indicia 316 to indicate a current tension on a loaded suture 90. In certain embodiments, the indicator pin 350 may include one or more features to facilitate the reading of the indicated tension. As one example, the indicator pin 350 may include a chisel edge 352 to thereby provide a more accurate indication of the tension being indicated. As another example, the indicator pin 350 may be of a color intended to attract attention and provide contrast with the sleeve 310. For example, the background of the tension gauge 104 may be white, and the indicator pin 350 may be red.

[0114] The bearing assembly 360 aids in reducing friction between the sleeve 310 and the barrel 111, and generally includes one or more roller bearings. As noted above, in the illustrated form, the longitudinal axes 112, 116 of the barrel 111 and channel member 115 are offset from one another. It has been found that in embodiments with such offset axes 112, 116, use of thetensioner 100 may result in a moment on the sleeve 310 that causes uneven friction. More particularly, it has been found that increased friction will be generated on the channel-facing side of the distal end portion 310D of the sleeve 310 and the opposite side of the proximal end portion 31 Op of the sleeve 310. In the interest of conciseness and clarity, these sides may be referred to as the “upper” and “lower” sides of the sleeve 310, making reference to an orientation in which the channel member 316 is positioned higher than the barrel 111, for example as illustrated in Figs. 1 and 2. Stated another way, the channel-facing side may be referred to herein as the upper side 310u of the sleeve 310, and the opposite side may be referred to herein as the lower side 310L of the sleeve 310.

[0115] In certain circumstances, the uneven generation of friction on the sleeve 310 may result in undesirable performance characteristics, such as jerky movement of the sleeve 310. To mitigate the risk of such characteristics, the bearing assembly 360 may be employed to reduce friction between the sleeve 310 and the barrel 111. For example, the sleeve 310 may include or more distal recesses 318 for receiving one or more distal roller bearings 368 and / or one or more proximal recesses 319 for receiving one or more proximal roller bearings 369. In the illustrated form, the sleeve 310 includes two pairs of distal recesses 318 that are formed on the lower side 310L of the distal end portion 310D of the sleeve 310, and each of the distal recesses 318 receives a corresponding distal roller bearing 368. The illustrated sleeve 310 also includes two pairs of proximal recesses 319 that are formed on the upper side 310U of the proximal end portion 31 OP of the sleeve 310, and each of the proximal recesses 319 receives a corresponding proximal roller bearing 369. In the illustrated form, each of the roller bearings 368, 369 is provided as a ball bearing. It is also contemplated that other forms of roller bearings may be utilized, such as cylindrical roller bearings.

[0116] In the illustrated form, the bolt 320 is rotationally locked to the body 110 and is threadedly engaged with the knob 340. As a result, rotation of the knob 340 in opposite directions drives the bolt 320 in the proximal and distal directions for adjustment of the tension. It is also contemplated that the bolt 320 may be rotatable relative to the body 110 and rotationally coupled with the knob 340. For example, the orientation of the bolt 320 may be reversed such that the threaded portion 322 is distal to the head 324, and the pin 350 may be mounted to a nut that is threaded onto the threaded portion 322 and rotationally locked to the body 110 with the spring 330 captured between the nut and the end wall 312 of the sleeve 310.In such forms, rotation of the knob 340 may rotate the bolt 320 to thereby advance and retreat the nut to thereby adjust tension in the suture.

[0117] With the tensioner 100 assembled, a user may adjust the amount of tension the tensioner 100 is operable to provide by rotating the knob 340 in an appropriate direction. Rotation of the knob 340 in a first rotational direction causes the threaded portion 322 to advance in the proximal direction such that the bolt head 324 moves toward the knob 340, thereby exerting a force on the spring 330. When the sleeve 310 is free to slide along the barrel 111, such proximal movement of the bolt head 320 causes the spring 330 to drive the sleeve 310 proximally.However, when the sleeve 310 is restrained from moving proximally (e.g., when a suture 90 is loaded onto the cleat assembly 200 and the opposite end of the suture 90 is anchored), the spring 330 will compress. Compression of the spring 330 is correlated with distal movement of the sleeve 310. This causes the indicator pin 350 to cooperate with the indicia 316 to indicate the force exerted by the spring 330, which corresponds to the tension in the suture 90. For example, when the tension experienced by the suture 90 is about 40 Newtons, the indicator pin 350 may align with a “40” of the adjustment indicia 316. While the illustrated indicia 316 indicate force in Newtons, it is also contemplated that other units may be utilized.

[0118] With additional reference to Fig. 11, illustrated therein is a rear cutaway view of the tensioner 100. As noted above, the longitudinal axes 112, 116 of the barrel 111 and channel member 115 are offset from one another by an offset distance 119. This is in contrast to certain existing tensioners, in which the suture passes through a tube that is generally aligned with the longitudinal axis of the adjustment device. It has been found that this offset distance 119 may provide one or more advantages during use of the tensioner 100. For example, the offset distance 119 may facilitate inspection and a clear visualization of the surgical site and / or the use of tools to be inserted via the channel member 115. Moreover, the guide passage 217 of the cleat 214 is aligned with the channel 117, which enables the suture 90 to pass from the channel member 115 to the cleat 214 without requiring a change in direction of the suture 90. It should also be noted that the cleats 214 are laterally offset from the channel longitudinal axis 116, which provides a clear path between the cleats 214 to thereby provide tool access to the channel 117. In the illustrated embodiment, the offset distance 119 is selected such that the nadir line 117' of the channel 117 is positioned above the top surface 111' of the barrel 111.

[0119] With additional reference to Fig. 12, illustrated therein is a tensioner 500 according to certain embodiments. The tensioner 500 is somewhat similar to the above-described tensioner 100, and generally includes a body 510, an anchor piece 520 mounted to a channel member 515 of the body 510, a stabilization skid 530 slidably mounted to the channel member 515, a detent mechanism 540 selectively resisting movement of the stabilization skid 530 relative to the body 510, a pair of cleat mechanisms 550 configured to facilitate anchoring of one or more sutures, and a pair of adjustment devices 300 operable to adjust the tension in the suture(s). In the interest of conciseness, the following description of the tensioner 500 focuses mainly on elements and features that are different from those described above with reference to the tensioner 100. Moreover, while certain features are described with specific reference to the tensioner 500 illustrated in Fig. 12, including the anchor piece 520, the stabilization skid 530, the detent mechanism 540, and the cleat mechanisms 550, it should be appreciated that one or more of these features may be utilized in connection with the tensioner 100 illustrated in Fig. 1.

[0120] The body 510 is somewhat similar to the body 110, and generally includes a pair of barrels 511 and a channel member 515. Each barrel 511 extends along a corresponding and respective longitudinal axis 512, and the barrel longitudinal axes 512 are laterally offset from one another. The channel member 515 includes a channel 517 that extends along a channel member longitudinal axis 516, and the channel member longitudinal axis 516 is offset from the barrel longitudinal axes 512 in the transverse direction. In certain embodiments, the offset distance 519 may be measured between the second longitudinal axis 516 and a line that extends between the longitudinal axes 512 of the barrels 511.

[0121] In the illustrated form, the longitudinal axes 512 of the barrels 511 are parallel to one another and to the longitudinal axis 516 of the channel member 515. However, it should be appreciated that the barrel longitudinal axes 512 may be non-parallel relative to one another and / or to the channel member longitudinal axis 516. An example of such a tensioner is described herein with reference to Fig. 49.

[0122] In certain embodiments, the tensioner 500 may include one or more features that facilitate the positioning and stabilization of the tensioner 500 relative to the surgical site. In the illustrated form, positioning and stabilization may be facilitated by the anchor piece 520 and / or the stabilization skid 530 as described herein. It is also contemplated that additional or alternative mechanisms may be utilized, such as delivery of a guide wire or pin, a cannulatedtube, or the like. These devices may be removably coupled to the body 510 in a manner analogous to that described herein.

[0123] In the illustrated form, the channel member 515 is fixed to and / or integrally formed with the body 510. It is also contemplated that the channel member 515 may be removably coupled to the body 510. For example, a removable end piece 501 may be provided, the removable end piece 501 including the channel member 515 and the stabilization skid 530 and optionally the anchor piece 520. As described herein, such a removable end piece 501 may be releasably coupled to the body 510 via a connection mechanism, such as the connection mechanism 2300 illustrated in Figs. 58 and 59.

[0124] With additional reference to Fig. 13, the anchor piece 520 is mounted to the distal end of the channel member 515, and generally conforms to the longitudinal cross-sectional geometry of the channel member 515. In certain embodiments, the anchor piece 520 may be detachably mounted to the channel member 515, for example via posts and recesses along the lines described above with reference to the posts 129. The anchor piece 520 includes a base portion 522 and at least one spike 524 projecting distally from the base portion 522, and in the illustrated form includes a plurality of spikes 524. The base portion 522 includes a slot 523 through which a tongue 532 of the skid 530 may project when the tongue 532 is in an extended position. The spikes 524 may facilitate anchoring of the end of the channel member 515 to bone, for example to facilitate cycling of a joint as described herein. In certain situations, the user may cause the spikes 524 to loosely engage the bone or other tissue, for example by sitting atop the bone or other tissue. In other situations, it may be advantageous for the spikes 524 to pierce or penetrate the bone or other tissue, for example as illustrated in Fig. 18A. Each spike 524 includes a corresponding and respective pointed end 525, and the spikes 524 cooperate to define a anchor device 526 of the anchor piece 520. The anchor device 526 defines an engagement plane 527 (Fig. 18A) that is occupied by the pointed ends 525.

[0125] With additional reference to Figs. 14 and 15, the stabilization skid 530 is mounted to the channel member 515 for sliding movement between a proximal retracted position (Fig. 14) and a distal extended position (Fig. 15). The stabilization skid 530 generally includes a longitudinally- extending tongue 532 and a grip portion 534 extending transversely from the tongue 532. In the illustrated embodiment, the tongue 532 is fully retracted into a distal end of the tensioner 500 when in the retracted position (Fig. 14), and projects beyond the distal end when in the extendedposition (Fig. 15). Tn the illustrated form, the grip portion 534 extends through a slot 518 formed in the bottom of the channel member 515 to facilitate grasping of the grip portion 534 by the user. As described herein, the tongue 532 is sized and shaped for receipt in a bone tunnel, and may facilitate the use of the tensioner 500 by assisting the user in stabilizing the tensioner 500. The stabilization skid 530 may also facilitate accurate positioning of the tensioner 500 to ensure reproducible positioning of the tensioner 500, whether that be in the same patient or from one patient to another. The grip portion 534 facilitates manual manipulation of the skid 530, and in the illustrated form includes one or more sets of finger indentations. In certain embodiments, the grip portion 534 may include a set of front finger indentations 535 formed on the distal side 536 of the grip portion 534 to thereby facilitate retraction of the skid 530. Additionally or alternatively, the grip portion 534 may include a set of rear finger indentations 535' formed on the proximal side 536' of the grip portion 534 to thereby facilitate extension of the skid 530.

[0126] The illustrated detent mechanism 540 is defined in part by the channel member 515 and in part by the stabilization skid 530. More particularly, the illustrated detent mechanism 540 includes an engagement surface 542 provided by the channel member 515, and a spring arm 544 provided by the stabilization skid 530. The illustrated engagement surface 542 is provided by the edge of the slot 518, and includes a series of recesses 543. The spring arm 544 is formed on the skid 530, and includes a protrusion 545 sized and shaped for receipt in the recesses 543. While the illustrated detent mechanism 540 includes two engagement surfaces 542 and two spring arms 544, it should be appreciated that the detent mechanism 540 may take another form, such as one that includes more or fewer engagement surfaces 542 and / or more or fewer spring arms 544. Moreover, while one example of a detent mechanism 540 is illustrated, it should be appreciated that other forms of detent mechanisms may be utilized to selectively prevent movement of the stabilization skid 530 along the channel member 515.

[0127] The skid 530 is movable relative to the body 510 between a plurality of discrete rest positions, each position corresponding to one of the recesses 543. The skid 530 may therefore be described as being operable in a plurality of discrete positions. As used herein, the term “operable in a plurality of discrete positions” may be used to indicate that a component (e.g., the skid 530) does not have a continuous range of positions available. Stated another way, a component that is “operable in a plurality of discrete positions” can come to rest at the discrete positions, but is discouraged or prevented from coming to rest at locations between the discretepositions. While the illustrated detent mechanism 540 renders the skid 530 operable in a plurality of discrete positions, it is also contemplated that other embodiments may provide for a continuous range of positions.

[0128] When the skid 530 is in one of its discrete rest positions, the protrusion 545 is engaged with a corresponding recess 543. When a longitudinal force is exerted on the skid 530 (e.g., via the grip portion 534), engagement between the recess 543 and protrusion 545 will urge the spring arm(s) 544 inward. Moreover, when the longitudinal force exceeds the threshold longitudinal force, the spring arm(s) 544 will deflect inward to permit movement of the skid 530. If the longitudinal force is below the threshold force, the detent mechanism 540 will prevent movement of the skid 530. As such, the illustrated detent mechanism 540 is operable to selectively prevent movement of the skid 530. More particularly, the illustrated detent mechanism 540 is configured to permit movement of the skid 530 in response to application of a threshold longitudinal force on the skid 530.

[0129] As noted above, the detent mechanism 540 is configured to selectively prevent movement of the stabilization skid 530 along the channel member 515. In the illustrated form, the detent mechanism 540 is configured to prevent movement of the skid 530 until a threshold longitudinal force is exerted on the skid 530. It is also contemplated that the detent mechanism 540 may be configured to selectively permit movement of the skid 530 in response to application of another form of force. As one example, the detent mechanism 540 may include a trigger 546 configured to facilitate manual disengagement of the recess 543 and protrusion 545. In the illustrated form, the trigger 546 is provided in the form of a tab mounted to the spring arm 544. Upon application of a sufficient lateral force on the trigger 546, the spring arm 544 flexes inward such that the protrusion 545 disengages from the recess 543. This places the detent mechanism 540 in a disengaged condition (Fig. 16), in which sliding movement of the skid 530 is permitted. While the illustrated trigger 546 is provided on the arm 544, it should be appreciated that the trigger 546 may be provided elsewhere and / or in another form.

[0130] As will be appreciated from the descriptions herein, the stabilization skid 530 facilitates accurate positioning of the tensioner 500 and aids in stabilizing the tensioner 500 during use. While the illustrated skid 530 includes a tongue 532, it should be appreciated that the skid 530 may include other forms of stabilization device, such as a pin or cannulated tube that can beinserted separately from the tensioner or advanced from the tensioner into the bone tunnel to achieve similar effects.

[0131] With additional reference to Fig. 17, each of the illustrated cleat mechanisms 550 includes a generally annular boss 552 and an anchor portion 556 on one side of the annular boss 552. A post 551 projects from a bottom of the boss 552 and facilitates mounting and / or rotational coupling of the cleat mechanism 550 to the sleeve 310. An aperture 553 extends through the boss 552 and is operable to receive a fastener by which the cleat mechanism 550 can be secured to the sleeve 310. In certain embodiments, the head of the fastener may engage an internal shelf that prevents the head of the fastener from passing fully through the aperture 553. Formed on the exterior of the boss 552 is a waist 554, which in the illustrated form has a generally V-shaped cross-section in which tapered walls meet at a waist plane 555. The anchor portion 556 generally includes an anchor base 556' projecting from the boss 552, and a channel 557 that wraps around the anchor base 556'. Teeth 558 project into the channel 557 to thereby define a tortuous passage 558' through the channel 557. The outward facing sides of the teeth 558 are tapered to thereby define a tapered inlet 559 to the tortuous passage 558'. When anchoring a suture to the cleat mechanism 550, the suture may first be wrapped around the boss 552 within the waist 554, and subsequently wrapped about the anchor base 556'. In this state, a portion of the suture is seated in the tortuous passage 558', and the teeth 558 discourage unwinding of the suture from about the anchor base 556'.

[0132] In the illustrated form, the tensioner 500 is configured such that a longitudinal projection of the channel 517 intersects the waist plane 555. As used herein, a projection of a component is an imaginary extension of that component taken along a particular line or axis. For example, a “longitudinal projection of the channel 517” can be considered an imaginary extension of the channel 517 along the longitudinal axis 516 of the channel 517. In the illustrated form, the longitudinal projection of the channel 517 intersects neither of the cleat mechanisms 550.Instead, the cleat mechanisms 550 are laterally offset from one another such that a gap 505 is formed between the cleat mechanisms 550, and the longitudinal projection of the channel 517 passes through the gap 505.

[0133] With additional reference to Fig. 18, illustrated therein is a portion of the surgical tensioner 500 during use of the surgical tensioner 500 at a surgical site 600 for repair of a joint 610 including a first bone 612 and a second bone 620. The joint repair procedure may includeone or more conventional steps, such as formation of a tunnel 630 into the joint 610. The tunnel 630 can include a distal tunnel portion 631 formed in the first bone 612 and a proximal tunnel portion 632 formed in the second bone 620. In the illustrated form, an anchor 640 has been threaded into the distal tunnel 631 to thereby anchor proximal end(s) of tethers 650 to the first bone 612. While the illustrated anchor 640 is provided in the form of a fixation screw, it should be appreciated that the anchor 640 may be provided in a different form, such as a graft or a button including a loop, screw, post, bone anchor, or another form. In certain embodiments, one or both tethers 650 may be provided in the form of a graft, augmentation, suture tape, a suture, a cable, a wire, or another form of tether operable to transmit tensile forces. Moreover, while the tethers 650 are illustrated as separate components, it should be appreciated that the proximal ends of the tethers 650 may be joined. For example, the tethers 650 may be provide by a generally Y-shaped graft including a first leg that splits to define two additional legs. The distal end of each tether 650 is secured to a corresponding suture 90. For example, the suture 90 may be passed through the tether 650. In certain forms, two tethers joined together may be configured to define a single tether 650. For example, a first tether (e.g., a graft or augmentation) and a second tether (e.g., a suture 90) attached to the first tether may be considered to define a single tether 650.

[0134] With additional reference to Fig. 18A, in certain procedures, the proximal tunnel portion 632 and the exposed surface 627 of the bone 620 in which the tunnel portion 632 is drilled may define an oblique bone angle 0627 relative to one another. In order to promote engagement between the bone 620 and the anchor device 526, the spikes 524 may be arranged to conform to the exposed surface 627. As noted above, the anchor device 526 defines an engagement plane 527 that is occupied by a plurality of the pointed ends 525, and which may be defined by three or more of the pointed ends 525. In the illustrated form, the engagement plane 527 defines an oblique fixation angle 0527 relative to the longitudinal axis 516 of the channel member 515. The oblique fixation angle 0527 may be selected to correspond to the oblique bone angle 0627, which may, for example, promote simultaneous engagement of the plurality of spikes 524 with the exposed surface 627 of the bone 620. It should be appreciated that in certain embodiments, such as those in which the bone angle 0627 approaches perpendicular, the fixation angle 0527 may not necessarily be oblique.

[0135] With additional reference to Fig. 19, once the tethers 650 have been secured to the sutures 90, each suture 90 has a body-anchored portion 98 that is indirectly secured to the first bone 612 via the anchor 640 and the corresponding tether 650. The free end of each suture 90 may then be loaded onto the corresponding cleat mechanism 550 to thereby define a tool- anchored portion 99 of the suture 90. For example, the suture 90 may first be wrapped about the boss 552 within the waist 554, and subsequently wrapped about the anchor base 556' within the tortuous passage 558'. In embodiments in which the waist plane 555 is generally aligned with the channel 517, as in the illustrated embodiment, the suture 90 may be substantially straight and without inflection points or bends along the path from the channel 517 to the boss 552.

[0136] With the sutures 90 loaded to the tensioner 500 and anchored to the tethers 650, the user may adjust the tension in the tethers 650 individually and independently. More particularly, the user may rotate the knob 340 of one adjustment device 300 to adjust tension in one tether 650, and may rotate the knob 340 of the other adjustment device 300 to adjust tension in the other tether 650. This individual and independent tension adjustment may facilitate balancing of the joint 610 to thereby improve patient outcomes.

[0137] In certain types of joint repair procedures, the surgeon may wish to perform joint trials by causing the joint 610 to undergo one or more movement cycles, for example by causing relative movement of the bones 612, 620. In certain conventional procedures, the surgeon is required to anchor the tethers 650 to the second bone 620 prior to performing the trial cycles. However, the illustrated embodiment of a surgical tensioner 500 includes one or more features that may facilitate the performance of trial cycles without requiring such anchoring of the tethers 650. As described herein, these features can include the engagement feature 124, spikes 524 and / or a stabilization skid 530.

[0138] As noted above, the illustrated surgical tensioner 500 includes an anchor piece 520 that is mounted to the end of the channel member 515 and which includes one or more spikes 524. These spikes 524 are configured to pierce or otherwise impinge upon the cortical bone 624 of the second bone 620 as illustrated in Fig. 18. Those skilled in the art will readily recognize that the engagement of the spikes 524 with the second bone 620 resists or discourages slipping or other shifting of the body 510 relative to the joint 610, and thereby aids the user in maintaining the tensioner 500 in the desired position during the trial cycles. The surgeon may thus perform the trial cycles while viewing the tension gauge 104 to ascertain how the tension changes during thecycling. Those skilled in the art will also recognize that as tension in the tethers 650 increases, the spike(s) 524 will bite into the bone 620 to a greater degree, thereby increasing the engagement and decreasing the likelihood of slippage. Should the surgeon determine that the tension of one or both tethers 650 should be changed, the surgeon may manipulate the corresponding knob 340 to thereby adjust the tension as needed. Moreover, because the proximal ends of the tethers 650 are not anchored, the surgeon can perform such adjustment without requiring removal of the fixation device 660, which can cause damage.

[0139] As will be appreciated by those skilled in the art, the spike(s) 524 aid in discouraging relative shifting of the anchor piece 520 and the bone 620, and thereby aid in maintaining the channel member 515 in a desired location relative to the tunnel 630. In certain circumstances, it may additionally or alternatively be advantageous to retain the channel member 515 in a desired orientation relative to the tunnel 630. In the illustrated form, such a function may be performed at least in part by the stabilization skid 530. While the illustrated tensioner 500 includes both an anchor piece 520 and a stabilization skid 530, it should be appreciated that these features may be employed independently of one another.

[0140] As noted above, the stabilization skid 530 includes a tongue 532 that projects from a distal end of the channel member 515 at least when the skid 530 is in its extended position. The tongue 532 is also sized and shaped for receipt in the tunnel 630 such that the tongue 532 may be extended into the proximal tunnel 632 as illustrated in Fig. 18. With the tongue 532 extending into the proximal tunnel 632, the stabilization skid 530 aids in maintaining alignment of the channel member 515 and the proximal tunnel 632, thereby reducing the likelihood of variations in tension resulting from movement of the tensioner 500 relative to the second bone 620.

[0141] While other forms are contemplated, in the illustrated embodiment, each of the illustrated tensioners is provided in an offset configuration in which the body includes first and second portions that each extend longitudinally along axes that are offset from one another by an offset distance. For example, the tensioner 100 includes a barrel 111 extending along a first longitudinal axis 112 and a channel member 115 extending along a second longitudinal axis 116, and the axes 112, 116 are offset from one another by an offset distance 119. Similarly, the tensioner 500 includes a pair of barrels 511 each extending along a corresponding first longitudinal axis 512, and a channel member 515 extending along a second longitudinal axis 516 offset from the first longitudinal axes 512 by an offset distance 519. As noted above, thisarrangement may facilitate inspection of the bone tunnel and / or the use of tools to be inserted via the channel member. For example, the view of Fig. 19 may correspond to that seen by surgeon utilizing the tensioner 500 to perform a procedure on the joint 610. As should be evident from this view, the offset distance 519 provided between the channel member 515 and the barrels 511 allows the user to view the surgery site 600 more clearly than embodiments in which the longitudinal axes 512, 516 of the barrels 511 and channel member 515 are coplanar or are offset by a degree insufficient to enable viewing of the site 600 along the second longitudinal axis 516. Moreover, the gap 505 between the cleat mechanisms 550 may aid in ensuring that the user’s view is not blocked and / or facilitate the insertion of a tool through the channel member 515 for manipulation of a fixation device 660 provided at the surgery site 600.

[0142] With additional reference to Fig. 20, an exemplary process 700 that may be performed using the surgical tensioner 500 is illustrated. Blocks illustrated for the processes in the present application are understood to be examples only, and blocks may be combined or divided, and added or removed, as well as re-ordered in whole or in part, unless explicitly stated to the contrary. Additionally, while the blocks are illustrated in a relatively serial fashion, it is to be understood that two or more of the blocks may be performed concurrently or in parallel with one another. Moreover, while the process 700 is described herein with specific reference to the tensioner 500 illustrated in Figs. 12-19, it is to be appreciated that the process 700 may be performed with tensioners having additional and / or alternative features. As one example, the process 700 may be performed with an embodiment of the tensioner 500 that includes a single adjustment device 300. For example, the process 700 may be performed with an embodiment of the tensioner 100.

[0143] The process 700 may include block 710, which generally involves attaching a first portion of a suture to a portion of a patient’s anatomy. By way of example, block 710 may involve attaching the suture 90 to a tether 650 (e.g., a graft, augmentation, surgical tape, or another suture) to thereby define a body-anchored portion 98 that is attached to the patient’s anatomy (e g., the tether or via the tether 650). In the illustrated form, block 710 can involve securing the tether 650 to the first bone 612 via an anchor 640. Once the suture is attached to the tether, the suture may be considered to define a portion of the tether.

[0144] The process 700 may include block 720, which generally involves attaching a second portion of the suture to a cleat of the tensioner. For example, block 720 may involve wrapping afirst portion of the suture 90 about the waist 554 and wrapping a second portion of the suture 90 about the anchor base 556' to thereby provide a tool-anchored portion 99 that is secured to the cleat mechanism 550.

[0145] In certain embodiments, the process 700 may include block 730, which generally involves adjusting tension in the suture. For example, block 730 may involve rotating the knob 340 in one direction to increase tension and / or rotating the knob 340 in the opposite direction to thereby decrease tension.

[0146] The process 700 may include block 740, which generally involves engaging a spike with bone. For example, block 740 may involve engaging the spikes 524 with the cortical bone 624 of the second bone 620 to thereby discourage shifting of the channel member 515 relative to the second bone 620.

[0147] The process 700 may include block 750, which generally involves extending a tongue into a tunnel. For example, block 750 may involve moving the skid 530 from a retracted position to an extended position to thereby extend the tongue 532 into the proximal tunnel 632. In certain embodiments, the extending of block 750 may be performed after the engaging of block 740, while in other embodiments, the extending of block 750 may be performed before the engaging of block 740.

[0148] The process 700 may include block 760, which generally involves selectively maintaining a position of the tongue. For example, block 760 may involve the use of a detent mechanism such as the detent mechanism 540 to selectively retain the tongue 532 in a selected position. In certain embodiments, block 760 may involve biasing a protrusion into a selected recess of a plurality of recesses to thereby discourage shifting of the skid 530. In certain embodiments, block 760 may involve exerting a threshold longitudinal force on the skid 530 (e.g., via the grip portion 534) to thereby overcome a retention force of the detent mechanism 540 and move the skid 530. In certain embodiments, block 760 may involve engaging a trigger 546 that transitions the detent mechanism 540 between a hold position and a release position to thereby release the skid 530. In certain forms, engaging the trigger 546 may involve exerting a lateral force on the trigger 546.

[0149] The process 700 may include block 770, which generally involves performing one or more trial cycles of the joint. For example, in embodiments in which the joint 610 is a knee joint, block 770 may involve flexing and extending the knee throughout its normal range ofmotion. In certain embodiments, the cycling of block 770 may be performed with the spikes 524 engaged with the second bone 620 to thereby discourage shifting of the channel member 515 from a desired position relative to the second bone 620. In certain embodiments, the cycling of block 770 may be performed with the tongue 532 extended into the second tunnel 632 to thereby aid in maintaining a desired orientation of the channel member 515 relative to the bone 620.

[0150] As will be appreciated, the process 700 may include additional or alternative steps not specifically illustrated in Fig. 20. As one example, block 770 may involve adjusting the tension in the suture 90 following one or more first trial cycles, and subsequently performing one or more second trial cycles following the adjustment. Once an appropriate tension has been achieved, the proximal end of the tether 650 may be secured to the second bone 620, for example via an additional anchor.

[0151] With additional reference to Figs. 21-42, illustrated therein are examples of fixation devices according to certain embodiments, which may be utilized in connection with the tensioner 100 and / or the tensioner 500. As described herein, each of the fixation devices is configured to be mounted at least partially in a bone tunnel generated during a surgical procedure, and to facilitate fixation of a tether to the bone. As also described herein, at least some embodiments of the fixation devices are also configured for connection with the tensioner to facilitate connection of the tensioner to bone such that the bone, tether, fixation device, and tensioner are all connected to one another. In various embodiments, the tether may, for example, be provided in the form of a graft, suture tape, a suture, a biologic augmentation, a synthetic augmentation, or another form.

[0152] With reference to Fig. 21, illustrated therein is a fixation device 800 according to certain embodiments. The fixation device 800 generally includes a button 810 sized and shaped for mounting in a bone tunnel, and a cam 820 rotatably mounted to the button 810. As described herein, the fixation device 800 is configured to facilitate fixation of a tether to bone.

[0153] The illustrated button 810 is generally circular, and includes a generally annular ridge 812 that projects to thereby define a recess 814 within the button 810. The button 810 also includes an aperture 816 that extends through the button 810 and is open on each side of the button 810 such that a portion of a tether (e.g., a suture) may be passed through the button 810 via the aperture 816. In certain embodiments, the button 810 may include one or more engagement features configured to facilitate engagement of the button 810 with the engagementdevice 124 of the guide member 120. For example, the button 810 may include one or more exterior notches 818 sized and shaped to receive the spline(s) 125 of the engagement device 124 to thereby facilitate anchoring of the guide member 120 to the button 810.

[0154] The cam 820 is seated in the recess 814, is mounted to the button 810 for rotation about a rotational axis 821, and is secured to the button 810 such that movement of the cam 820 along the rotational axis 821 is at least selectively prevented. By way of illustration, the cam 820 may include a post 822 including flexible arms that act to maintain rotatable engagement between the cam 820 and the button 810, for example as described herein with reference to Fig. 24. The cam 820 also includes an aperture 824 that facilitates rotation of the cam 820 relative to the button 810. In the illustrated form, the aperture 824 is generally hexagonal, and is configured to receive a portion of a hex key by which the cam 820 may be rotated. It should be appreciated, however, that other geometries are contemplated for the aperture 824.

[0155] The cam 820 has an outer perimeter 825 that includes a flat 826 and an eccentric cam surface 828. When the flat 826 is aligned with the aperture 816, a tether may be passed through the aperture 816. The user may then rotate the cam 820, for example by engaging a hex key with the aperture 824 and rotating the hex key to thereby rotate the cam 820. Rotation of the cam 820 in one direction causes the eccentric cam surface 828 to engage the tether and capture the tether between the eccentric cam surface 828 and the circumferential ridge 812, thereby locking or securing the tether to the fixation device 800.

[0156] With additional reference to Fig. 22, illustrated therein is a fixation device 850 according to certain embodiments. The fixation device 850 generally includes a ratchet strip 860 and a button 870 that is movably mounted to the ratchet strip 860, and which is sized and shaped for mounting in a bone tunnel. As described herein, the fixation device 850 is configured to facilitate fixation of a tether to bone.

[0157] The ratchet strip 860 extends along a longitudinal axis 861 defining a proximal direction (generally to the right and upward in Fig. 22) and an opposite distal direction (generally to the left and downward in Fig. 22). A distal end portion 862 of the ratchet strip 860 includes an aperture 863 that facilitates attachment of the tether to the distal end portion 862. For example, a portion of the tether may be passed through the aperture 863 and subsequently tied to the distal end portion 862. While not specifically illustrated, it should be appreciated that the proximal end portion 868 may include a similar aperture, for example to facilitate attachment of a suture thatcan then be anchored to the cleat of a tensioner. The ratchet strip 860 also includes a plurality of ratchet teeth 864, each of which includes a ramp 865 and a holding edge 866. As described herein, the ratchet teeth 864 engage an arm 874 of the button 870 to thereby permit the ratchet strip 860 to be pulled in the proximal direction relative to the button 870, while preventing the ratchet strip 860 from being driven in the distal direction relative to the button 870.

[0158] The button 870 generally includes a post 872 and a flange 876 extending radially from the post 872. Formed on the post 872 is a flexible arm 874 operable to engage the ratchet teeth 864. The flange 876 is generally circular, and in the illustrated form defines an oblique angle relative to the longitudinal axis 861 of the ratchet strip 860. In certain embodiments, the button 870 may include one or more engagement features configured to facilitate engagement of the button 870 with the engagement device 124 of the guide member 120. For example, the button 870 may include one or more notches along the lines discussed above.

[0159] When the ratchet strip 860 is pulled in the proximal direction, the flexible arm 874 rides along the ramps 865 and permits proximal movement of the ratchet strip 860. When the ratchet strip 860 is pulled in the distal direction, the flexible arm 874 engages one of the holding edges 866 and thereby prevents distal movement of the ratchet strip 860. As such, tension can be easily increased in predetermined increments corresponding to the longitudinal lengths of the ratchet teeth 864. Once an appropriate tension has been achieved, the proximal portion of the ratchet strip 860 may be cut off and discarded.

[0160] With additional reference to Figs. 23 and 24, illustrated therein is a fixation device 900 according to certain embodiments. The fixation device 900 generally includes a button 910 sized and shaped for mounting to a bone tunnel, a cam 920 rotatably mounted to the button 910, and a slider 930 slidably mounted to the button 910. As described herein, the fixation device 900 is configured to facilitate fixation of a tether to bone.

[0161] The button 910 is generally circular, and includes a ridge 912 that surrounds and defines a recess 914 of the button 910. Formed within the ridge 912 is a channel 913 operable to receive a ridge 933 of the slider 930. The button 910 also includes an elongated aperture 916 and an additional aperture 918 separate from the elongated aperture 916. The additional aperture 918 includes a shoulder 919 operable to at least selectively prevent movement of the cam 920 along its rotational axis 921. In certain embodiments, the button 910 may include one or more engagement features configured to facilitate engagement of the button 910 with the engagementdevice 124 of the guide member 120. For example, the button 910 may include one or more notches along the lines discussed herein.

[0162] The cam 920 is substantially similar to the cam 820 of the above-described fixation device 800. The cam 920 is seated in the recess 914, is mounted to the button 910 for rotation about a rotational axis 921, and is secured to the button 910 such that movement of the cam 920 along the rotational axis 921 is at least selectively prevented. For example, the cam 920 may include a post 922 including flexible arms 923 that act to maintain rotatable engagement between the cam 920 and the button 910. In the illustrated form, each arm 923 includes a corresponding and respective shoulder 923' operable to engage the shoulder 919 to thereby prevent separation of the cam 920 from the button 910. The cam 920 also includes an aperture 924 that facilitates rotation of the cam 920 relative to the button 910. In the illustrated form, the aperture 924 is generally hexagonal, and is configured to receive a portion of a hex key by which the cam 920 may be rotated. It should be appreciated, however, that other geometries are contemplated for the aperture 924. The cam 920 also has an outer perimeter 925 that includes a flat 926 and an eccentric cam surface 928. Rotation of the cam 920 causes the eccentric cam surface 928 to drive the slider 930 transversely between first and second positions.

[0163] The slider 930 is slidably mounted within the recess 914, and is operable to slide relative to the button 910 in one or more directions transverse to the rotational axis 921 of the cam 920. The slider 930 includes at least one aperture 932 aligned with the elongated aperture 916, and in the illustrated form includes a plurality of apertures 932 through which a portion of a tether 901 may be passed. Additionally or alternatively, a tether 902 may be passed through the aperture 916 in a manner that causes a portion of the tether 902 to be captured between the slider 930 and the ridge 912. In such forms, rotation of the cam 920 may not only lock the first tether 901 in place, but may also cause the second tether 902 to become captured within the channel 913 by the ridge 933.

[0164] With additional reference to Figs. 25 and 26, illustrated therein is a fixation device 950 according to certain embodiments. The fixation device 950 generally includes a button 960 sized and shaped for mounting in a bone tunnel, and a threaded fastener 970 operable to engage the button 960. Also illustrated in Fig. 26 is a joint 990 including a first bone 992 and a second bone 994. The bones 992, 994 have been prepared to define a tunnel 991 including a first tunnelportion 993 in the first bone 992 and a second tunnel portion 995 in the second bone 994. As described herein, the fixation device 950 is configured to facilitate fixation of a tether to bone.

[0165] The button 960 generally includes a body 962 and a flange 966. The body 962 extends along a longitudinal axis 961, and defines an internally threaded aperture 963. The body 962 also includes at least one fixation arm 964 operable to engage the wall of the bone tunnel 991 to thereby secure the button 960 to the bone. More particularly, the fixation arm 964 is configured to splay outward as the fastener 970 is threaded into the aperture 963 to thereby cause the fixation arm 964 to engage the bone and discourage removal of the button 960 from the tunnel 991. The fixation arm 964 may include one or more ridges 965 configured to promote engagement with the wall of the tunnel 991. The illustrated flange 966 defines an oblique angle relative to the longitudinal axis 961, and may include one or more interior grooves 967 through which a portion of a tether may pass. In certain embodiments, the button 960 may include one or more engagement features configured to facilitate engagement of the button 960 with the engagement device 124 of the guide member 120. For example, the button 960 may include one or more exterior notches 968 sized and shaped to receive the spline(s) 125 of the engagement device 124 to thereby facilitate anchoring of the guide member 120 to the button 960.

[0166] The threaded fastener 970 generally includes a head 972 and a threaded shank 974 extending from the head 972. The head 972 includes a shaped recess 973 configured to receive a tip of a tool to thereby facilitate rotation of the fastener 970. The threaded shank 974 is configured to mate with the internally threaded aperture 963 to thereby secure the fastener 970 to the button 960 while causing the fixation arm(s) 964 to splay outward as described above.

[0167] In the illustrated form, the fixation device 950 has been used to secure two tethers 952 to the second bone 994. More particularly, each tether 952 has been attached to a corresponding suture 954, which has in turn been secured to the bone 994 via the fixation device 950. In the illustrated form, the tethers 952 (e.g., grafts or suture tape) extend substantially to the button 960, but do not extend into the aperture 963. Instead, the sutures 954 are captured between the internal threads of the aperture 963 and the external threads of the shank 974 to thereby anchor the proximal ends of the tethers 952 to the second bone 994. Such a configuration may, for example, be useful for securing grafts such as for the knee, the hamstring, the Achilles tendon, or patellar bone-to-bone grafts.

[0168] With additional reference to Figs. 27 and 28, illustrated therein is a fixation device 1000 according to certain embodiments. The fixation device 1000 is substantially similar to the fixation device 950, and generally includes a button 1010 and a threaded fastener 1020 that respectively correspond to the button 960 and threaded fastener 970. In the interest of conciseness, the following description of the fixation device 1000 focuses primarily on elements and features different from those described above with reference to the fixation device 950.

[0169] In the illustrated form, the shank 1024 of the fastener 1020 includes a first threaded portion 1025 and a second threaded portion 1026. The first threaded portion 1025 is configured to mate with the threads of the internally threaded aperture 1013 in a manner analogous to that described above with reference to the fixation device 950. The second threaded portion 1026 is configured to extend beyond the distal end of the button 1010 and to engage the walls of the second bone tunnel portion 1005. In the illustrated form, the first threaded portion 1025 has a first thread pitch, and the second threaded portion 1026 has a second thread pitch different from the first thread pitch. It is also contemplated that the threaded portions 1025, 1026 may share a common thread pitch.

[0170] In the illustrated form, the tethers 1002 are secured to the sutures 1004, and are anchored in place by the fastener 1020. More particularly, the tethers 1002 are captured between the second threaded portion 1026 and the wall of the bone tunnel 1041. Additionally, the tethers 1002 do not extend to the button 1010, and are instead engaged with the button 1010 via the sutures 1004. The fixation device 1000 provides a hybrid suspension / interference approach to anchoring that can involve suture locking, graft locking, and / or a backup knot. The fixation device 1000 may, for example, be useful for securing grafts such as for the knee, the hamstring, the Achilles tendon, or patellar bone-to-bone grafts.

[0171] With additional reference to Figs. 29 and 30, illustrated therein is a fixation device 1050 according to certain embodiments. The fixation device 1050 is substantially similar to the fixation devices 950, 1000, and generally includes a button 1060 and a threaded fastener 1070 that respectively correspond to the buttons 960, 1010 and threaded fasteners 970, 1020. In the interest of conciseness, the following description of the fixation device 1000 focuses primarily on elements and features different from those described above with reference to the fixation device 950.

[0172] In the illustrated embodiment, the button 1060 includes one or more recesses 1068 extending radially outward from the threaded aperture 1063. Each recess 1068 is connected with a corresponding lateral window 1069 that extends axially along at least a portion of the button body 1062. These recesses 1068 and windows 1069 allow portions of the tethers 1052 to extend through the button 1060 without being engaged or impinged upon by the threads of the first threaded portion 1075. Instead, the tethers 1052 are anchored to the bone 1094 by engagement of the second threaded portion 1076 with the wall of the tunnel 1091. This arrangement may, for example, provide for graft locking, a backup knot, and lateral windows 1069. The fixation device 1050 may, for example, be useful for securing grafts such as for the knee, the hamstring, or the Achilles tendon.

[0173] With additional reference to Figs. 31 and 32, illustrated therein is a fixation device 1100 according to certain embodiments. The fixation device 1100 generally includes a button 1110 and an anchor plate 1120 seated within a recess 1112 of the button 1110. The button 1110 includes an aperture 1113 through which a tether may be passed, and may include notches 1118 that facilitate coupling of the button 1110 with the guide member 120 in a manner analogous to that described above. The anchor plate 1120 includes one or more apertures 1122 through which one or more tethers (e.g., a graft, suture tape, or a suture) may be passed to secure the tether to the anchor plate 1120.

[0174] With additional reference to Figs. 33 and 34, illustrated therein is a fixation device 1100' according to certain embodiments. The fixation device 1100' is substantially similar to the above-described fixation device 1100, and generally includes a button 1110' and the anchor plate 1120. The button 1110' is substantially similar to the above-described button 1110, but includes a radial slot 1114' extending from the aperture 1112' to the outer periphery of the button 1110', which may facilitate loading of the suture onto the fixation device 1100'.

[0175] With additional reference to Figs. 35 and 36, illustrated therein is a fixation device 1150 according to certain embodiments. The fixation device 1150 generally includes a button 1160. The button 1160 includes a body 1162 and a flange 1166 that defines an oblique angle 91166 relative to a longitudinal axis 1161 of the button 1160. The flange 1166 may include notches 1168 that facilitate coupling of the button 1160 with the guide member 120 in a manner analogous to that described above. Formed within the button 1160 are a plurality of apertures1169 through which one or more tethers (e.g., a graft, suture tape, or a suture) may be passed to secure the tether to the button 1160.

[0176] With additional reference to Figs. 37 and 38, illustrated therein is a fixation device 1170 according to certain embodiments. The fixation device 1170 generally includes a button 1180 and an anchor plate 1190 seated within a recess 1182 of the button 1180. The button 1180 may include notches 1188 that facilitate coupling of the button 1180 with the guide member 120 in a manner analogous to that described above. The anchor plate 1190 includes one or more apertures 1192 through which one or more tethers (e.g., a graft, suture tape, or a suture) may be passed to secure the tether to the anchor plate 1190. The button 1180 also includes an enlarged aperture 1183, which is sized and shaped such that the anchor plate 1190 is operable to pass through the aperture 1183. The enlarged aperture 1183 may include a tapered inlet 1184 sized and shaped to mate with a tapered protrusion 1194 of the anchor plate 1190 to aid in centering the anchor plate 1190 within the recess 1182.

[0177] With additional reference to Figs. 39 and 40, illustrated therein is a fixation device 1200 according to certain embodiments. The fixation device 1200 generally includes a button 1210 and a threaded fastener 1220. As described herein, the fixation device 1200 may facilitate the anchoring of one or more tethers (e.g., a graft, suture tape, or a suture) to bone.

[0178] The button 1210 generally includes a body 1212 and a flange 1216. The body 1212 has a threaded aperture 1213 formed therein, and a pair of radial apertures 1214 are connected with the threaded aperture 1213. Formed within the flange 1216 is a countersunk recess 1217 including a plurality of steps 1217' that converge toward the longitudinal axis 1211 of the button 1210.

[0179] The fastener 1220 includes a head 1222 and a shank 1224 extending distally from the head 1222. The head 1222 has a shoulder that may be tapered or flat to retain a cushion or pad 1223 positioned on the distal side of the head 1222. The distal portion of the shank 1224 is threaded, and is engaged with the threaded aperture 1213.

[0180] The fastener 1220 has a withdrawn position (Fig. 39) and an advanced position (Fig. 40).During use of the fixation device 1200, a tether 1202 may be passed through one or both radial apertures 1213 and through the countersunk recess 1217 while the fastener 1220 is withdrawn. Once an appropriate tension has been achieved, the fastener 1220 may be advanced, for example by rotating the fastener 1220 with an appropriate tool. Advancing the fastener 1220 causes the tether(s) 1202 to become captured between the tapered head 1222 and the steps 1217' of thecountersunk recess 1217. Tn embodiments that include the pad 1223, the pad 1223 may provide a cushion to discourage damage that may otherwise be inflicted on the tether 1202. Should further adjustment of the tension be warranted, the fastener 1220 may simply be rotated to thereby withdraw the fastener 1220 and disengage the fixation device 1200 from the tethers 1202, and subsequently returned to its advanced position to re-anchor the tethers 1202.

[0181] With additional reference to Figs. 41 and 42, illustrated therein is a fixation device 1250 according to certain embodiments. The fixation device 1250 is substantially similar to the above-described fixation device 800, and generally includes a button 1260 corresponding to the button 810 and a cam 1270 corresponding to the cam 820. In the interest of conciseness, the following description of the fixation device 1250 focuses primarily on elements and features different from those described above with reference to the fixation device 800.

[0182] In contrast to the fixation device 800, in which the distal side of the button 810 is substantially flat, the button 1260 of the fixation device 1250 includes a extension 1269 that extends from the rear or distal side of the button 1260. As described herein, the extension 1269 is configured to mate with a cannulation 1289 of an interference screw 1280 to thereby anchor the button 1260 to bone. While the extension 1269 is illustrated only in connection with the fixation device 1200 illustrated in Figs. 41 and 42, it should be appreciated that such an extension may be utilized to facilitate engagement between the screw 1280 and one or more other embodiments of fixation device, such as one or more of the fixation devices illustrated in Figs. 21-40.

[0183] During use of the fixation device 1250, a tether 1252 (e.g., a bone-to-bone tendon graft) may be tensioned (e.g., with a tensioner such as the tensioner 100 and / or the tensioner 500) and subsequently fixed in place with an interference screw 1280, and a brace suture 1254 may be shuttled through the aperture 1266. The fixation device 1250 may then be advanced (Fig. 42) such that the extension 1269 enters the cannulation 1289 of the interference screw 1280, thereby rotationally coupling the button 1260 with the interference screw 1280. In certain embodiments, the extension 1269 may be configured to snap into the cannulation 1289. The cam 1270 may be rotated to lock the suture 1254 in place, and the suture 1254 may be cut.

[0184] As described above, the fixation devices illustrated in Figs. 21-42 may include an engagement feature sized and shaped to mate with the engagement feature 124 of the guide member 120. In the illustrated form, the guide member engagement feature 124 comprises apater in the form of a spline 125, and the fixation device engagement feature comprises a mater in the form of a notch (e.g., the notch 818). It is also contemplated that a mating engagement according to other embodiments may include maters and paters of different configurations. For example, a fixation device may include a pater such as a protrusion, and the guide tube may include a mater such as a recess. As used herein, the terms “mater” and “pater” refer to two parts of a mating or sexed engagement in which the mater is operable to matingly receive the pater. For example, a mater may include a negative space feature such as a notch, recess, channel, slot, or cavity, and a pater may include a positive space feature such as a protrusion, extension, protuberance, boss, arm, or finger.

[0185] With additional reference to Fig. 43, illustrated therein is a kit 1300 according to certain embodiments. The kit 1300 generally includes a tensioner 1310 and an end piece 1320, and may further include a fixation device 1330. In certain embodiments, the kit 1300 may include a tool 1340 configured to facilitate manipulation of the fixation device 1330. As described herein, the tensioner 1310 may, for example, take the form of one of the above-described tensioners 100, 500, and the end piece 1320 may, for example, take the form of the guide member 120 or the anchor piece 520. Moreover, the fixation device 1330 may take one of the forms described herein, or may take another form. In certain forms, one or more components of the kit 1300 may be sterilized, either prior to packaging or prior to use.

[0186] The tensioner 1310 generally includes a channel member 1312 operable to receive a portion of a tether, a cleat 1314 operable to anchor an end of the tether, and at least one adjustment device 1316 operable to adjust tension in the tether. In certain embodiments, the tensioner 1310 may take the form of one of the above-described tensioners 100, 500. For example, in embodiments in which the tensioner 1310 is provided in the form of the tensioner 100, the channel member 1312 may correspond to the channel member 115, the cleat 1314 may correspond to the cleat assembly 200, and the at least one adjustment device 1316 may correspond to the adjustment device 300. As another example, in embodiments in which the tensioner 1310 is provided in the form of the tensioner 500, the channel member 1312 may correspond to the channel member 515, the cleat 1314 may correspond to the cleat mechanism 550, and the at least one adjustment device 1316 may correspond to the adjustment devices 300. The channel member 1312 may include an engagement portion 1313 that facilitates coupling ofthe end piece 1320 to the tensioner 1310. For example, one or more cavities may be formed in the distal end of the channel member 1312 to receive posts 1323 of the end piece 1320.

[0187] In the illustrated form, the end piece 1320 generally includes an engagement portion 1322 configured for coupling with the channel member engagement portion 1313. For example, the engagement portion 1322 may include one or more posts 1323 sized and shaped for insertion into the cavities of the channel member engagement portion 1313. It is also contemplated that the end piece 1320 may be formed by or otherwise fixed to the body of the tensioner 1310.Moreover, while the illustrated engagement portions 1312, 1322 include recesses and posts 1323, it should be appreciated that the engagement portions 1312, 1322 may take another form. By way of illustration, the engagement portions 1312, 1322 may include a quick connect connection mechanism, such as the connection mechanism 2300 illustrated in Figs. 58 and 59.

[0188] The end piece 1320 further includes an anchor mechanism 1324 configured to facilitate anchoring of the end piece 1320 to bone. For example, in embodiments in which the end piece 1320 is provided in the form of the anchor piece 520, the anchor mechanism 1324 may be provided in the form of one or more spikes 524 configured to directly engage bone. In embodiments in which the end piece 1320 is provided in the form of the guide member 120, the anchor mechanism 1324 may be provided in the form of an engagement feature 124 configured to engage bone via the fixation device 1330. In embodiments in which more than one form of end piece 1320 is available and the end piece 1320 are detachable, the end pieces 1320 may be interchangeable. For example, the guide member 120 may be interchangeable with the anchor piece 520. It is also contemplated that the end pieces 1320 may be permanently coupled or integrally formed with the tensioner 1310.

[0189] The fixation device 1330 is configured for mounting in a bone tunnel and for coupling to a tether (e.g., a suture, a graft, or suture tape), and generally includes an engagement feature 1332 configured to engage the engagement feature 124 of the guide member 120. For example, in embodiments in which the fixation device 1330 is provided in the form of the fixation device 800, the engagement feature 1332 may be provided in the form of notches 818. In certain embodiments, the fixation device 1330 may include a rotatable component 1334 configured to facilitate anchoring of a tether to the fixation device 1330. As one example, the rotatable component 1334 may be provided in the form of a cam, such as the cam 820. As anotherexample, the rotatable component may be provided in the form of a threaded fastener, such as the threaded fastener 970.

[0190] It should be appreciated that multiple fixation devices of the same or different configurations may be provided in a kit 1300. For example, the illustrated kit 1300 can include a first fixation device 1330 in the form of the fixation device 800 illustrated in Fig. 21, and a second fixation device 1330 in the form of the fixation device 1250 illustrated in Figs. 40 and 41. The one or more fixation devices 1330 of the kit 1300 may be provided in any number of forms, including but not limited to the form of the fixation device 850 illustrated in Fig. 22, that of the fixation device 900 illustrated in Figs. 23 and 24, that of the fixation device 950 illustrated in Figs. 25 and 26, that of the fixation device 1000 illustrated in Figs. 27 and 28, that of the fixation device 1050 illustrated in Figs. 29 and 30, that of the fixation device 1100 illustrated in Figs. 31 and 32, that of the fixation device 1100' illustrated in Figs. 33 and 34, that of the fixation device 1150 illustrated in Figs. 35 and 36, that of the fixation device 1170 illustrated in Figs. 37 and 38, that of the fixation device 1200 illustrated in Figs. 39 and 40, that of the fixation device 1250 illustrated in Figs. 41 and 42, and / or that of another configuration of fixation device not specifically illustrated herein.

[0191] As noted above, certain embodiments of the kit 1300 may include a tool 1340. For example, where the fixation device 1330 includes a rotatable component 1334 (e.g., a cam or fastener), the tool 1340 may be provided to facilitate rotation of the rotatable component 1334. The tool 1340 generally includes a proximal end portion 1342 configured to be gripped by a user, a distal end portion 1343 configured to matingly engage the rotatable component 1334, and a body portion 1344 configured to extend through the guide member 120 and / or the channel 1312. Example forms for the tool 1340 include a hex key, Allen wrench, screwdriver, drill, and others.

[0192] With additional reference to Fig. 44, an exemplary process 1400 that may be performed using the kit 1300 is illustrated. Blocks illustrated for the processes in the present application are understood to be examples only, and blocks may be combined or divided, and added or removed, as well as re-ordered in whole or in part, unless explicitly stated to the contrary. Additionally, while the blocks are illustrated in a relatively serial fashion, it is to be understood that two or more of the blocks may be performed concurrently or in parallel with one another. While the process 1400 is described herein with specific reference to the kit 1300 illustrated in Fig. 43, it isto be appreciated that the process 1400 may be performed with kits having additional and / or alternative features. Moreover, while the process 1400 is described herein with specific reference to a joint repair procedure, it should be appreciated that one or more of the concepts described in association with the process 1400 may be utilized in other forms of surgical procedures.

[0193] In certain embodiments, the process 1400 may be performed using a kit that includes a tensioner and at least one end piece, and which may further include at least one fixation device. For example, the process 1400 may be performed with the kit 1300, which includes a tensioner 1310 (e.g., the tensioner 100 and / or the tensioner 500) and at least one end piece (e.g., the guide member 120 and / or the anchor piece 520), and which may further include at least one fixation device 1330 (e.g., one or more of the fixation devices illustrated in Figs. 21-42).

[0194] The process 1400 may include block 1410, which generally includes selecting a fixation device. In certain embodiments, block 1410 may involve selecting the fixation device 1330 from a plurality of fixation devices 1330, such as the fixation device 800 and the fixation device 1250. Further example forms from which the fixation device may be selected are illustrated in Figs. 21- 42. In certain forms, one or more of the fixation devices may be configured for use in a first type of surgical procedure, and one or more other fixation devices may be configured for use in a second type of surgical procedure. Accordingly, in certain embodiments, the selecting of block 1410 may be performed based at least in part on the type of surgical procedure to be performed. In certain embodiments, the fixation device 1330 selected in block 1410 may include an engagement feature 1332.

[0195] The process 1400 may include block 1420, which generally involves selecting an end piece for a surgical tensioner. In certain embodiments, block 1420 may involve selecting the end piece 1320 from a plurality of end pieces 1320, such as the guide member 120 and the anchor piece 520. In certain embodiments, the selecting of block 1420 may be based at least in part upon the surgical procedure to be performed. In certain embodiments, the selecting of block 1420 may be based at least in part upon the fixation device selected in block 1410. For example, if the fixation device 1330 selected in block 1410 includes an engagement feature 1332, block 1420 may involve selecting the guide member 120. If the engagement feature is omitted from the fixation device 1330 selected in block 1410, block 1420 may involve selecting the anchor piece 520.

[0196] The process 1400 may include block 1430, which generally involves mounting the selected end piece to the tensioner. In the illustrated form, block 1430 involves engaging an engagement portion 1313 of the tensioner 1310 with a corresponding engagement portion 1322 of the selected end piece 1320, for example by inserting posts 1323 into correspondingly shaped cavities in the channel member 1312.

[0197] The process 1400 may include block 1440, which generally involves anchoring the end piece to bone. In certain embodiments, block 1440 may involve anchoring the end piece 1320 directly to bone. For example, when the selected end piece 1320 corresponds to the anchor piece 520, block 1440 may involve engaging the spikes 524 with bone in a manner analogous to that described above with reference to the process 400. It is also contemplated that block 1440 may involve anchoring the end piece 1320 indirectly to bone, such as via an implanted fixation device 1330. For example, once a fixation device 1330 has been mounted to the bone tunnel, the user may mate the end piece engagement feature 124 / 1324 with the corresponding engagement feature 1332 to thereby indirectly anchor the guide member 120 to bone.

[0198] The process 1400 may include block 1450, which generally involves adjusting tension in the tether. Adjustment of the tether may occur following attachment of the tether to the tensioner 1310, which may proceed along the lines described above.

[0199] The process 1400 may include block 1460, which generally involves locking the tether.In certain embodiments, the locking of block 1460 may include manipulating the fixation device 1330 via a tool 1340 that extends through the channel member 1312. For example, block 1460 may involve aligning the tool 1340 with the channel 1312 such that the tool 1340 is positioned at least partially in the channel 1312, and advancing the tool 1340 to engage the distal end portion 1343 with the rotatable component 1334. In embodiments in which the selected end piece includes a tube (such as the guide member 120), the tool 1340 may also extend through the tube. With the tool 1340 engaged with the rotatable component 1334, the user may rotate the rotatable component 1334 via the tool 1340 to thereby lock the suture in place. As will be appreciated by those skilled in the art, the offset configuration of the illustrated embodiments of tensioner may facilitate the manipulation by providing a greater amount of room for the user to maneuver while viewing the site 600 and / or manipulating the fixation device 1330.

[0200] The process 1400 may include block 1470, which generally involves performing one or more trial cycles. Block 1470 may be performed while the distal end of the tensioner 1310 isanchored to bone (e.g., directly via spikes or indirectly via a fixation device). When the tensioner 1310 is so anchored, the tension in the tether should only vary as a result of the cycling, and not as a result of movement (e.g., sliding and / or pivoting) of the tensioner. As such, the anchored end may facilitate the generation and / or evaluation of isometric tensions during the cycling process.

[0201] The process 1400 may include block 1480, which generally involves determining whether the trials were satisfactory. For example, block 1480 may involve determining that the trial cycles were satisfactory when the trial cycles result in substantial isometry for the tension throughout the trial cycles. In certain embodiments, “substantial isometry” may be considered to be present when the tension varies by less than 20%, less than 10%, or less than 5% across a particular range of motion. In response to determining that the trials were satisfactory, the process 1400 may proceed along path 1480Y, which may result in an end of the process 1400. In response to determining that the trials were not satisfactory, the process 1400 may proceed along path 1480N to block 1490. Further details regarding an example process 1600 for determining sufficient isometry are provided below with reference to Figs. 45 and 46.

[0202] In certain embodiments, such as those in which the first iteration of trial cycles was found unsatisfactory, the process 1400 may include block 1490, which generally involves unlocking the tether. Block 1490 may, for example, involve manipulating the fixation device 1330 via a tool 1340 that extends through the channel 1312 and possibly the end piece 1320. Upon unlocking the tether, the process 1400 may return to block 1450 for adjustment of the tension based upon information generated in the trial cycle.

[0203] With additional reference to Figs. 45 and 46, illustrated therein are a schematic representation of a surgical site 1500 including a joint 1510 (Fig. 45), and a schematic flow diagram of a process 1600 for determining sufficient isometry during a joint repair procedure at the surgical site 1500 (Fig. 46). It should be appreciated that the process 1600 may involve determining sufficient isometry across a full range of motion for the joint, or across only a portion of the full range of motion for the joint. The range of motion across which isometry is sought may vary according to one or more factors, such as which ligament is being repaired, the function of that ligament, and the desired location for the repair or reconstruction. For example, isometry may be sought through 30% of the full range of motion.

[0204] The joint 1510 includes a first bone 1512 and a second bone 1514. In the illustrated form, the joint 1510 is a knee joint in which the first bone 1512 is a tibia and the second bone 1514 is a femur. It is also contemplated that the process 1600 may be used to repair joints other than the knee. As described herein, the process 1600 involves determining substantial isometry at the joint 1510 using a tensioner 1530 and an anchor such as a rod 1520 having one or more tethers 1522 secured thereto. Although the illustrated anchor is provided in the form of a rod, it should be appreciated that other anchors may be utilized, such as a suture anchor that fixes to the bone and has attached thereto a tether that can be loaded to the tensioner 1530. Additionally, it should be understood that the fixation point can be at any location in or on the bone along the line of the rod, anchor, or other fixation device. Moreover, while the illustrated tensioner 1530 is provided in the form of the tensioner 100, it should be appreciated that other forms of tensioner may be utilized in the process 1600.

[0205] The process 1600 may include block 1610, which generally involves inserting the rod 1520 into the second bone 1514 at a target surgical trajectory. Examples of target trajectories 1542, 1544, 1546 are illustrated in Fig. 45. The target trajectory may be one that the surgeon believes will provide substantial isometry during a trial cycling procedure. In certain forms, the tether(s) 1522 may be secured to the rod 1520 during the insertion. It is also contemplated that the tether(s) 1522 may be secured to the rod 1520 after the insertion.

[0206] The process 1600 may include block 1620, which generally involves clamping the rod 1520 against the surface of the second bone 1514. For example, block 1620 may involve applying a clamp to secure the rod 1520 in a fixed position against the bone 1514.

[0207] The process 1600 may include block 1630, which generally involves attaching the tether(s) 1522 to the tensioner 1530. For example, block 1630 may involve attaching a suture of the tether 1522 to a cleat of the tensioner 1530 along the lines described herein.

[0208] The process 1600 may include block 1640, which generally involves adjusting the tension in the tether 1522. For example, block 1640 may involve rotating a knob of the tensioner 1540 to thereby adjust the tension in the tether 1522.

[0209] The process 1600 may include block 1650, which generally involves cycling the joint 1510. By way of illustration, block 1650 may include moving the joint 1510 through its normal range of motion and observing changes in tension during such cycling, such as by monitoring the tension gauge 104.

[0210] The process 1600 may include block 1660, which generally involves determining whether sufficient isometry has been achieved. For example, block 1660 may involve determining sufficient isometry has been achieved in response to the joint 1510 exhibiting substantial isometry as discussed above. Should sufficient isometry be observed, the process 1600 may proceed along path 1660Y, and the joint repair procedure may continue in a relatively conventional fashion.

[0211] If sufficient isometry is not observed in block 1660, the process 1600 may continue along path 1660N to block 1670, which generally involves repositioning the rod 1520 at a new surgical trajectory. With the rod 1520 repositioned, the process 1600 may loop back to block 1620 to perform additional adjustment and cycling.

[0212] With additional reference to Figs. 47 and 48, illustrated therein is a cleat assembly 1700 according to certain embodiments. The cleat assembly 1700 may, for example, be utilized in place of the cleats 550 illustrated in Fig. 17. The cleat assembly 1700 generally includes a fastener 1710 such as a screw, and the fastener 1710 is configured to facilitate mounting of the cleat assembly 1700 to the sleeve 310. The cleat assembly 1700 also includes a spool 1720, a first cleat section 1730, and a second cleat section 1740, each of which is mounted to the fastener 1710. In the illustrated form, the first cleat section 1730 and the second cleat section 1740 are separate components that are movable relative to one another, and may alternatively be referred to herein as the first cleat plate 1730 and the second cleat plate 1740, respectively. It is also contemplated that the first cleat plate 1730 and the second cleat plate 1740 may be integrated into a single body, for example as described herein with reference to Figs. 56 and 57.

[0213] The fastener 1710 includes a head 1712 and a threaded portion 1714 opposite the head 1712. The threaded portion 1714 is configured to mate with the threaded aperture of the mounting location 317 of the sleeve 310.

[0214] The spool 1720 includes an aperture 1722 through which the fastener 1710 extends, and a waist 1724 that facilitates winding of a suture about the spool 1720. The bottom of the spool 1720 may include a non-circular recess 1726 sized and shaped to matingly receive a non-circular boss 1736 of the first cleat plate 1730 to thereby prevent relative rotation of the spool 1720 and the first cleat plate 1730.

[0215] The first cleat plate 1730 includes an aperture 1732 through which the fastener 1710 extends, a non-circular boss 1736, and a plate portion 1738 extending away from the boss 1736.The non-circular boss 1736 projects from a top of the first cleat plate 1730, and is sized and shaped to matingly engage the non-circular recess 1726 of the spool 1720 to thereby prevent relative rotation of the spool 1720 and the first cleat plate 1730. The plate portion 1738 includes a first side 1734 and an opposite second side 1735, and includes a one or more slits 1739, 1739' projecting inward from the first side 1734 and / or the second side 1735. In the illustrated form, at least one first slit 1739 projects inward from the first side 1734 toward the second side 1735, and at least one second slit 1739' projects inward from the second side 1735 toward the first side 1734. In the illustrated form, the slits 1739 are tapered slits that narrow along the length of the slits 1739. It is also contemplated that the slits 1739 may not necessarily be tapered.

[0216] The second cleat plate 1740 is substantially similar to the first cleat plate 1730, and generally includes an aperture 1742 through which the fastener 1710 extends, a non-circular boss 1746, and a plate portion 1748 extending away from the boss 1746. The boss 1746 projects from a bottom of the second cleat plate 1740, and is sized and shaped for mating engagement with a corresponding recess of the mounting location 317 to thereby prevent rotation of the second cleat plate 1740 relative to the tensioner body 510. The plate portion 1748 is substantially similar to the plate portion 1738 of the first cleat plate 1730, and likewise includes a plurality of slits, such as one or more first slits 1749 and / or one or more second slits 1749'.

[0217] With additional reference to Fig. 49, the cleat assembly 1700 has a first side 1704 and an opposite second side 1705. The first slits 1739, 1749 extend from the first side 1704 in a first direction 1706 toward the second side 1705. The second slits 1739', 1749' extend from the second side 1705 in a second direction 1707 toward the first side 1704. The first slits 1739, 1749 are offset from the second slits 1739', 1749' in a direction 1708 transverse to the first direction 1706 and the second direction 1707.

[0218] The first cleat plate 1730 and the second cleat plate 1740 are arranged such that when the cleat assembly 1700 is installed to the sleeve 310, the slits 1739, 1739' of the first cleat plate 1730 and the slits 1749, 1749' of the second cleat plate 1740 partially overlap one another to thereby define one or more pinch points 1709. When a suture 1702 is loaded onto the cleat assembly 1700 (Fig. 48), this partial overlap results in the suture 1702 becoming pinched by the cleat plates 1730, 1740 at the pinch points 1709. This pinching may increase the engagement force with which the cleat assembly 1700 is operable to grip the suture 1702.

[0219] As will be appreciated, the cleat assembly 1700 may be utilized in connection with a tensioner to facilitate attachment of a tether to the tensioner. By way of example, one or more instances of the cleat assembly 1700 may be utilized in connection with the tensioner 1800 illustrated in Fig. 50. As another example, one or more instances of the cleat assembly 1700 may be utilized in the tensioner 500 in place of the cleat mechanisms 550. In certain embodiments that employ two instances of the cleat assembly 1700, the cleat assemblies 1700 may be independently movable to facilitate adjustment of the tension in the corresponding tethers individually and independently. It is also contemplated that the two cleat assemblies 1700 may be attached to a single mounting device such that the cleat assemblies 1700 move together, for example along the lines illustrated in connection with the cleat assemblies 202, 204. Moreover, it should be appreciated that the cleat assembly 1700 may be utilized in connection with a tensioner that utilizes a single instance of a cleat assembly.

[0220] With additional reference to Fig. 50, illustrated therein is a tensioner 1800 according to certain embodiments. The tensioner 1800 is substantially similar to the above-described tensioner 500, and generally includes a body 1810 corresponding to the body 510, a pair of adjustment mechanisms 300, and a pair of cleats 1850, each of which is mounted to the sleeve 310 of a corresponding one of the adjustment mechanisms 300. In the illustrated form, each cleat 1850 is provided in the form of the above-described cleat assemblies 1700. It should be appreciated, however, that other forms of cleat may be utilized.

[0221] One primary difference between the tensioner 1800 and the above-described tensioner 500 is the arrangement of the barrels 1811, 1811'. In the housing 510, the longitudinal axes 512 of the barrels 512 are parallel to one another and to the longitudinal axis 516 of the channel member 515. In the body 1810, however, the longitudinal axes 1812, 1812' of the barrels 1811, 1811' are askew to one another and to the longitudinal axis 1816 of the channel member 1815. More particularly, in the plan view of Fig. 49, the longitudinal axis 1812 of one barrel 1811 defines a first angle 91812 relative to the channel member axis 1816, and the longitudinal axis 1812' of the other barrel 1811' defines a second angle 01812' relative to the channel member axis 1816. In the illustrated form, the body 1810 exhibits mirror symmetry such that the first angle 01812 is equal to the second angle 91812'. It is also contemplated that the body 1810 may not necessarily exhibit mirror symmetry, and that the angles 91812, 01812' may be different. In the illustrated form, each angle 01812, 01812' is an oblique angle. It is also contemplated that one orboth angles 01812, 01812' may be a right angle. In various embodiments, each angle 01812, 01812' may be 90° or less, 45° or less, 20° or less, 15° or less, or 10° or less. In certain embodiments, each angle 01812, 01812' may be 3° or more, 5° or more, or 10° or more. In the illustrated form, the longitudinal axes 1812, 1812', 1816 are parallel to one another in a side view. It is also contemplated that the longitudinal axes 1812, 1812', 1816 may be askew to one another in the side view.

[0222] With additional reference to Figs. 51 and 52, illustrated therein are adjustment mechanisms 1900 according to certain embodiments and a tensioner 2000 including a pair of the adjustment mechanisms 1900. The adjustment mechanism 1900 is somewhat similar to the above-described adjustment device 300, and generally includes a sleeve 1910, a bolt 1920, a spring 1930, and a knob 1940, which respectively correspond to the sleeve 310, bolt 320, spring 330, and knob 340. Moreover, the tensioner 2000 is somewhat similar to the tensioner 500, and includes a body 2010 to which the adjustment mechanisms 1900 are mounted and a pair of cleats 2050, each of which is secured to the sleeve 1910 of a corresponding one of the adjustment mechanisms 1900. As such, those skilled in the art will readily appreciate that rotation of the knob 1940 moves the bolt 1920 to thereby adjust the tension on a suture secured to the sleeve 1910 via the cleat 2050. In the interest of conciseness, the following description of the adjustment mechanism 1900 and tensioner 2000 focuses primarily on elements and features that differ from those described above with reference to the adjustment device 300 and tensioner 500.

[0223] In contrast to the adjustment device 300, in which the bolt 320 and knob 340 are rotatable about a common rotational axis 301 (which coincides with the longitudinal axis 512 of the corresponding barrel 511), the knob 1940 of the adjustment mechanism 1900 is mounted for rotation about a lateral rotational axis 1941 that is transverse to the longitudinal rotational axis 1921 of the bolt 1920 (which may coincide with the longitudinal axis 2012 of the corresponding barrel 2011). Moreover, the adjustment mechanism 1900 further includes a bevel gear set 1950 that causes the bolt 1920 to rotate about the longitudinal axis 1921 in response to rotation of the knob 1940 about the lateral rotational axis 1941. As such, rotation of the knob 1940 results in adjustment of the tension on the suture in a manner analogous to that described above with reference to the adjustment device 300.

[0224] As noted above, in certain embodiments, a tensioner may be configured to engage a fixation device, for example to stabilize the tensioner. By way of illustration, the tensioner 100is operable to engage the fixation device 800 via mating engagement of splines 125 and notches 818. It is also contemplated that tensioners according to certain embodiments may engage fixation devices in another manner. Certain illustrative examples of such engagement will now be described with reference to Figs. 53-55.

[0225] With reference to Fig. 53, illustrated therein is a schematic representation of a system 2110 including a mating engagement device 2120 operable to form a mating engagement between a fixation device 2112 and a tensioner 2116. The tensioner 2116 includes a passage 2117 that extends along a longitudinal axis 2118. The mating engagement device 2120 generally includes a pater 2122 and a mater 2124 operable to receive the pater 2122 when the fixation device 2112 and the tensioner 2116 are moved toward one another along a longitudinally- extending insertion axis 2128. As will be appreciated, relative movement of the fixation device 2112 and the tensioner 2116 away from one another along the longitudinal insertion axis 2128 will cause the pater 2122 and the mater 2124 to disengage.

[0226] In the illustrated form, the pater 2122 is provided to the tensioner 2116, and the mater 2124 is formed in the fixation device 2112. The pater 2122 extends beyond an end of the channel 2117 of the tensioner 2116. In certain forms, the pater 2122 may be movable relative to the channel 2117. For example, the pater 2122 may take the form of the movable skid 530. It is also contemplated that the pater 2122 may be fixed in place relative to the channel 2117. When the mating engagement device 2120 is fully mated, relative movement of the fixation device 2112 and tensioner 2116 is discouraged. As such, when the fixation device 2112 is mounted to bone, the mating engagement device 2120 may aid in stabilizing the tensioner 2116.Additionally, in certain forms, the length of the pater 2122 may be sufficient to extend through the mater 2124 and beyond the rim of the fixation device 2112 such that the pater 2122 is operable to engage the walls of the bone tunnel to provide further stabilization.

[0227] With additional reference to Fig. 54, illustrated therein is a schematic representation of a system 2130 including a mating engagement device 2140 operable to form a mating engagement between a fixation device 2132 and a tensioner 2136. The tensioner 2136 includes a passage 2137 that extends along a longitudinal axis 2138. The mating engagement device 2140 generally includes a pater 2142 and a mater 2144 operable to receive the pater 2142 when the fixation device 2132 and the tensioner 2136 are moved toward one another along a longitudinally- extending insertion axis 2148. As will be appreciated, relative movement of the fixation device2132 and the tensioner 2136 away from one another along the longitudinal insertion axis 2148 will cause the pater 2142 and the mater 2144 to disengage.

[0228] In the illustrated form, the pater 2142 is provided to the fixation device 2132, and the mater 2144 is formed in the tensioner 2136. In the illustrated form, the pater 2142 extends beyond a rim 2133 of the fixation device 2130. It is also contemplated that the pater 2142 may terminate within the boundary defined by the rim 2133. When the mating engagement device 2140 is fully mated, relative movement of the fixation device 2132 and tensioner 2136 is discouraged. As such, when the fixation device 2132 is mounted to bone, the mating engagement device 2140 may aid in stabilizing the tensioner 2136.

[0229] With additional reference to Fig. 55, illustrated therein is a schematic representation of a system 2150 including a mating engagement device 2160 operable to form a mating engagement between a fixation device 2152 and a tensioner 2156. The tensioner 2156 includes a passage 2157 that extends along a longitudinal axis 2158. The mating engagement device 2160 generally includes a floating pater 2162 and a pair of maters 2164, 2166, each operable to receive a corresponding portion of the floating pater 2162 when the fixation device 2152 and the tensioner 2156 are moved toward one another along a longitudinally-extending insertion axis 2168. As will be appreciated, relative movement of the fixation device 2152 and the tensioner 2156 away from one another along the longitudinal insertion axis 2168 will cause the pater 2142 to disengage from one or both of the maters 2164, 2166.

[0230] In the illustrated form, the pater 2162 is not secured to neither the fixation device 2152 nor the tensioner 2156, but instead “floats” between the fixation device 2152 and the tensioner 2156. Moreover, the fixation device 2152 includes a first mater 2164 operable to receive a first end of the floating pater 2162, and the tensioner 2156 includes a second mater 2164 operable to receive a second end of the floating pater 2162. When the mating engagement device 2160 is fully mated, relative movement of the fixation device 2152 and tensioner 2156 is discouraged. As such, when the fixation device 2152 is mounted to bone, the mating engagement device 2160 may aid in stabilizing the tensioner 2156. In certain forms, the length of the floating pater 2162 may be sufficient to extend through the first mater 2164 and beyond the rim of the fixation device 2152 such that the pater 2162 is operable to engage the walls of the bone tunnel to provide further stabilization.

[0231] As will be appreciated from the foregoing, the maters and the paters of the illustrated mating engagement devices are configured to engage and disengage one another in response to relative movement of the fixation device and the tensioner along an insertion axis. In each of the mating engagement devices illustrated in Figs. 53-55, the insertion axis extends along the longitudinal direction defined by the longitudinal axis of the tensioner. It is also contemplated that in certain embodiments, an engagement device may be configured to engage and disengage in response to relative movement of the components along an insertion axis that is oblique to the longitudinal axis, for example as described herein with reference to Figs. 64-69.

[0232] With additional reference to Figs. 56 and 57, illustrated therein is a cleat assembly 2200 according to certain embodiments. The cleat assembly 2200 includes a first cleat mechanism 2201 and a second cleat mechanism 2202, and in the illustrated form the cleat mechanisms 2201, 2202 are mirror images of one another. Each cleat mechanism 2201, 2202 generally includes a spool 2220, a first cleat section 2230, and a second cleat section 2240, which respectively correspond to the above-described spool 1720, first cleat section / plate 1730, and second cleat section / plate 1740. In the interest of conciseness, the following description of the cleat assembly 2200 focuses primarily on elements and features different from those described above with reference to the cleat assembly 1700.

[0233] The cleat assembly 2200 also includes a base 2210 including a mounting aperture 2212 that facilitates mounting of the cleat assembly 2200 to a mount, such as the mount 317. In the illustrated form, the cleat assembly 2200 is integrally formed as a single monolithic construct. As such, the first cleat section 2230 and the second cleat section 2240 are not movable relative to one another. However, each of the cleat sections 2230, 2240 nonetheless includes a corresponding set of slits 2239, 2249 that cooperate to define pinch points 2209.

[0234] With additional reference to Fig. 58, illustrated therein is a connection mechanism 2300 according to certain embodiments, along with a surgical tensioner 2390 including the connection mechanism 2300. The surgical tensioner 2390 generally includes a first tensioner component 2391 and a second tensioner component 2392, and the connection mechanism 2300 facilitates the rapid connection and disconnection of the tensioner components 2391, 2392. In the illustrated form, the first component 2391 is a tensioner body, and the second component 2392 is an end piece. For example, the first component 2391 may be provided along the lines of one of the above-described bodies 110, 510, 1310, and the second component 2392 may be provided alongthe lines of one of the above-described end pieces 120, 520, 1320. As noted above, the connection mechanism 2300 may be utilized in the kit 1300 in place of the recesses and posts.

[0235] The illustrated connection mechanism 2300 includes a latch mechanism 2302, which generally includes a first latch mechanism component in the form of an anchor 2310, and a second latch mechanism component in the form of a flexible arm 2320 operable to engage the anchor 2310. The latch mechanism 2302 may further include one or more ramps 2330 that facilitate the coupling of the flexible arm 2320 with the anchor 2310. As described herein, the illustrated connection mechanism 2300 further includes a guide mechanism 2304 that facilitates alignment of the flexible arm 2320 with the anchor 2310 and provides additional stability to the connection provided by the connection mechanism 2300.

[0236] With additional reference to Fig. 59, the anchor 2310 includes an inner ridge 2312 and may further include an outer ridge 2314 spaced from the inner ridge 2312 by a channel 2316. As described herein, the inner ridge 2312 is operable to engage a latch 2322 of the flexible arm 2320 to thereby retain the second component 2392 in a fully seated position relative to the first component 2391. In embodiments in which the outer ridge 2314 is included, the outer ridge 2314 may serve to retain the second component 2392 in a partially seated position relative to the first component 2391.

[0237] The flexible arm 2320 depends from the second component 2392 and is joined to the remainder of the second component 2392 by a flexible section 2321 that partially defines the flexible arm 2320. The flexible arm 2320 further includes a latch 2322 and a grip 2329 operable to flex the latch 2322. The flexible arm 2320 biases the latch 2322 toward a latching position, and the grip 2329 is operable to flex the latch 2322 toward an unlatching position. The latch 2322 includes a finger 2323 that extends longitudinally from the flexible section 2321 to a pawl 2324. The pawl 2324 includes a shoulder 2325 operable to interface with each of the ridges 2312, 2314 to thereby retain the second component in the corresponding seated position.

[0238] In order to connect the components 2391, 2392 via the connection mechanism 2300, the user may align the latch 2322 with the anchor 2310 and drive the components 2391, 2392 into engagement with one another to thereby engage the latch mechanism 2302. As the latch 2322 moves into engagement with the anchor 2310, the pawl 2324 rides along the outer ridge 2314 and the channel 2316, and thereafter engages the inner ridge 2312. When the pawl 2324 passes the inner ridge 2312, the finger 2323 flexes the latch 2322 to its latching position to therebyengage the pawl 2324 with the inner ridge 2312 and retain the second component 2392 in its fully seated position relative to the first component 2391. When disconnection is desired, the user may urge the grip 2329 forward to thereby flex the latch 2322 to its unlatching position, thereby permitting disengagement of the latch mechanism 2302 and separation of the components 2391, 2392.

[0239] As noted above, the illustrated connection mechanism 2300 includes one or more ramps 2330 that facilitate the connection process and / or the disconnection process. For example, the outer ridge 2314 may include a ramp 2334 that causes flexing of the latch 2322 as the pawl 2324 passes along the outer ridge 2314, and / or the inner ridge 2312 may include a ramp 2332 that causes flexing of the latch 2322 as the pawl 2324 passes along the inner ridge 2312.Additionally or alternatively, the pawl 2324 may include a ramp 2336 that facilitates flexing of the latch 2322 as the pawl 2324 passes along the ridges 2312, 2314.

[0240] As noted above, the illustrated connection mechanism 2300 further includes a guide mechanism 2304 that facilitates alignment of the latch 2322 with the anchor 2310. The guide mechanism 2304 generally includes a first guide mechanism component 2340 and a second guide mechanism component 2350. While other forms are contemplated, in the illustrated form, the first guide mechanism component 2340 includes a pair of grooves 2352, and the second guide mechanism component 2350 includes a pair of splines 2342 operable to enter the grooves 2352. The grooves 2352 are separated from one another by a web 2353, and the splines 2342 are spaced from one another to thereby define a slot 2343 operable to receive the web 2353.

[0241] In the illustrated form, the first guide mechanism component 2340 including splines 2342 and a channel 2343 is provided to the first surgical tensioner component 2391, and the second guide mechanism component 2350 including grooves 2352 and a web 2353 is provided to the second surgical tensioner component 2392. It is also contemplated that this arrangement may be adjusted such that one or more splines are provided to the second surgical tensioner component 2392 while one or more grooves are provided to the first surgical tensioner component 2391. The guide mechanism 2304 may further include a detent mechanism 2360 that aids in retaining the second component 2392 in its fully seated position. For example, one or both of the grooves 2352 may include a detent recess 2362 that receives a projection on the corresponding spline to thereby define an engaged state of the detent mechanism 2360.

[0242] With additional reference to Fig. 60, illustrated therein is a surgical tensioner component 2400 according to certain embodiments. The tensioner component 2400 is provided as an end piece and defines a first connection mechanism component 2391 that is configured to mate with a second connection mechanism component 2392 defined by the base portion of a surgical tensioner. When so mated, the tensioner component 2400 and the base component (e.g., a base component along the lines of the body 110 or the body 510), the mated components at least partially define a surgical tensioner.

[0243] The tensioner component 2400 is substantially similar to the end piece portion 501 of the above-described surgical tensioner 500, and similar reference characters are used to indicate similar elements and features. For example, the tensioner component 2400 generally includes a channel member 2415, a fixation piece 2420, and a stabilization skid 2430, which respectively correspond to the above-described channel member 515, anchor piece 520, and stabilization skid 530. In certain forms, the fixation piece 2420 may be fixedly coupled and / or integrally formed with the channel member 2415. It is also contemplated that the fixation piece 2420 may be removable, for example as described above with reference to the tensioner 500, or even omitted.

[0244] With additional reference to Fig. 61, illustrated therein is a surgical tensioner component 2500 according to certain embodiments. The tensioner component 2500 is provided as an end piece and defines a first connection mechanism component 2391 that is configured to mate with a second connection mechanism component 2392 defined by the base portion of a surgical tensioner. When so mated, the tensioner component 2500 and the base component (e.g., a base component along the lines of the body 110 or the body 510) with which it is mated at least partially define a surgical tensioner. Like the above-described end piece 120, the tensioner component 2500 includes a tube 2520 defining a closed passage extending along a longitudinal axis 2516 of the component 2500.

[0245] With additional reference to Fig. 62, illustrated therein is a feedback mechanism 2600 according to certain embodiments. As described herein, the feedback mechanism 2600 is configured to at least selectively provide tactile and / or audible feedback during adjustment of an adjustment mechanism. While the tactile feedback mechanism 2600 is illustrated in connection with the adjustment device 300 described above, it should be appreciated that the tactile feedback mechanism 2600 may be utilized in connection with adjustment devices of another configuration.

[0246] The feedback mechanism 2600 generally includes a first engagement surface 2610 and a second engagement surface 2620 facing the first engagement surface 2610. Each of the engagement surfaces 2610, 2620 is provided to a corresponding component of the adjustment device 300. In the illustrated form, the first engagement surface 2610 is provided to the proximal end wall 312 of the sleeve 310, and the second engagement surface 2620 is provided to an inner rim 346 of the knob 340 such that the engagement surfaces 2610, 2620 face one another. Each of the engagement surfaces 2610, 2620 includes at least one projection, and at least one of the engagement surfaces 2610, 2620 includes a plurality of projections. In the illustrated form, the first engagement surface 2610 includes a single projection 2612, and the second engagement surface 2620 includes a plurality of projections 2622 that are angularly spaced about distal face 347 of the inner rim 346. It is also contemplated that the first engagement surface 2610 may include a plurality of projections in a manner similar to that illustrated in connection with the second engagement surface 2620.

[0247] As noted above, rotation of the knob 340 longitudinally drives the stem 320, thereby urging the sleeve 310 toward or away from the knob 340, depending on the direction in which the knob 340 is rotated. As will be appreciated, the sleeve 310, and thus the cleat 200, are limited to a limited travel range that is bounded by one or more stop positions. When the sleeve 310 reaches the proximal end of its travel (i.e., a proximal stop position), the proximal end wall 312 of the sleeve 310 begins to abut the inner rim 346 of the knob 340. As this occurs, the projection(s) 2612 of the first engagement surface 2610 engage the projection(s) 2622 of the second engagement surface 2620, thereby producing tactile and / or audible feedback during continued rotation of the knob 340. The tactile and / or audible feedback indicates to the user that the sleeve 310 has bottomed out or reached the proximal end of its travel. This may indicate to the user that rotation of the knob 340 should cease and / or that the scale needs to be reset.

[0248] As will be appreciated, the illustrated feedback mechanism 2600 is configured to selectively generate the feedback in response to rotation of the knob 340. More specifically, the feedback mechanism 2600 has a feedback-generating state in which the feedback mechanism 2600 generates feedback in response to rotation of the knob 340, and a feedback-withholding state in which the feedback mechanism 2600 does not generate feedback in response to rotation of the knob 340. The feedback-generating state occurs when the sleeve 310 is at a stop position(e.g., the proximal stop position), and the feedback-withholding state occurs when the sleeve 310 is at an offset position that is offset from the stop position.

[0249] From the foregoing, those skilled in the art will readily appreciate that when the sleeve 310 is at its proximal stop position and the engagement surfaces 2610, 2620 are engaged with one another, the feedback mechanism provides selective resistance to rotation of the knob 340 from each of a plurality of incrementally offset rotational positions. The feedback mechanism 2600 may therefore be considered to include a detent mechanism configured to provide tactile resistance to rotation of the knob 340 when the sleeve 310 is at the stop position.

[0250] With additional reference to Fig. 63, illustrated therein is a system 2700 according to certain embodiments during use in a surgical procedure on a bone 2790 having a tunnel 2792 formed therein. The system 2700 generally includes a tensioner 2710, an anchor 2720, and an adjustable loop fixation device 2730 connecting the tensioner 2710 with the anchor 2720.

[0251] The tensioner 2710 generally includes a body 2711 having a distal end portion 2711', one or more cleats 2712 movably mounted to the body 2711, and one or more adjustment devices 2713, each operable to exert an adjustable force on a corresponding one of the cleats 2712. The tensioner 2710 may, for example, take the form of the tensioner 500 described above. It is also contemplated that the tensioner 2710 may be provided as one of the above-described tensioners 100, 1800, 2000

[0252] The anchor 2720 is received in the tunnel 2792 and affixed to the bone 2790 within the tunnel 2792. In certain forms, the anchor 2720 may, for example, be in the form of a bone anchor, a fixation screw, or a graft.

[0253] The adjustable loop fixation device 2730 includes a button 2732, an anchor tether 2734 connected between the button 2732 and the anchor 2720, and one or more control tethers 2736 connected between the button 2732 and the tensioner 2710. The button 2732 is positioned at the distal end portion 2711' of the tensioner body 2711, and in certain embodiments may be engaged with the distal end portion 2711', for example via a mating engagement such as those described in connection with Figs. 53-55. The anchor tether 2734 has an effective length L2734 defined between the button 2732 and the anchor 2720, and the effective length L2734 can be adjusted by manipulation of the control tether(s) 2736. In the illustrated form, a first control tether 2736 is attached to a first of the cleats 2712, and a second control tether 2736 is attached to a second of the cleats 2736.

[0254] Although one embodiment of an adjustable loop fixation device 2730 is illustrated herein, it should be appreciated that other forms of adjustable loop fixation devices may be utilized. As one example, a fixation device may include an adjustable loop that attaches to a separate button. In certain embodiments, a fixation device may include an adjustable loop with a button attached. As a further example, a fixation device may include an adjustable loop with a first button attached, and the first button may be coupled to a second button that is attached to the tensioner.

[0255] In the illustrated embodiment, applying tension to one of the control tethers 2736 reduces the effective length L2734 to thereby tighten the connection between the button 2732 and the anchor 2720. Additionally or alternatively, applying tension to the other of the control tethers 2736 may increase the effective length L2734 to thereby loosen the connection between the button 2732 and the anchor 2720. As will be appreciated, the tensioner 2710 may facilitate the application of tension to the control tether(s) 2736 to thereby facilitate adjustment of the effective length L2734, and thus the tension in the anchor tethers 2734. This will in turn generate the tension reading on the scale to inform the user of the tension. The tension may be displayed at a 1 : 1 ratio or a different ratio (e.g., 1 :4), and the user may interpret the tension and base one or more decisions on the tension displayed by the tensioner 2710.

[0256] With additional reference to Figs. 64-67, illustrated therein is an engagement system 2800 for engaging a fixation device 2870 with a tensioner component 2890. As described herein, the engagement system 2800 generally includes a flange 2810 defined by a button 2880 of the fixation device 2870, and a seat 2820 defined by the tensioner component 2890.

[0257] The fixation device 2870 generally includes a threaded fastener 2872 and the button 2880, which generally includes a body 2882 and the flange 2810. The fastener 2872 is threaded into a bore of the button 2880 and extends along a longitudinal axis 2871 of the fixation device 2870. The flange 2810 defines an oblique angle relative to the longitudinal axis 2871 and includes at least one mater such as a notch 2814. While the illustrated fixation device 2870 is provided generally in the form of the fixation device 950 illustrated in Figs. 25 and 26, it should be appreciated that the fixation device 2870 may take another form.

[0258] The illustrated tensioner component 2890 is provided as an end piece and generally includes an open passage in the form of a channel 2892 extending along a longitudinal axis 2891. The tensioner component 2890 includes a distal end portion 2894 that defines the seat 2820, and an opposite proximal end portion 2896. The proximal end portion 2896 defines a firstconnection mechanism component 2391 that is configured to mate with a second connection mechanism component defined by the base portion of a surgical tensioner. When so mated, the tensioner component 2890 and the base component (e.g., a base component along the lines of the body 110 or the body 510) with which it is mated at least partially define a surgical tensioner. While the illustrated engagement system 2800 is described in connection with a removable end piece 2890, it should be appreciated that the engagement system 2800 may be utilized to releasably engage a fixation device 2870 with another form of tensioner component, such as an end piece that is fixedly coupled to the body of the tensioner.

[0259] As noted above, the seat 2820 is defined by the distal end portion 2894 of the tensioner component 2890. The seat 2820 generally includes a mater in the form of an arcuate slot 2822, which is formed at an oblique angle 92820 relative to the longitudinal axis 2891. The slot 2822 is sized and shaped to receive the flange 2810 when the flange 2810 is inserted into the slot 2822 along an oblique insertion axis 2801. The slot 2822 is interrupted at its nadir by a pater in the form of a longitudinal spline 2824, which is configured to mate with the notch 2814 of the flange 2810 to thereby define a mating engagement device. The slot 2822 is bounded and partially defined by each of a distal shoulder 2828 and a proximal shoulder 2829.

[0260] The arcuate slot 2822 has a diameter d2822 and spans a central angle 92822 of greater than 180° to thereby define a neck 2823 having a neck dimension d2823 less than the diameter d2822. As such, when the flange 2810 is inserted along the insertion axis 2801, the flange 2810 and / or the proximal end portion 2894 will deform slightly to allow further insertion of the flange 2810.

[0261] When the flange 2810 is fully seated in the slot 2822, the neck 2823 discourages but does not prevent removal of the flange 2810 from the slot 2822. Moreover, the flange 2810 is longitudinally captured between the shoulders 2828, 2829 and rotationally locked to the component 2890 via engagement of the notch 2814 and the spline 2824. As such, the user can manipulate the fixation device 2870 with control over all degrees of freedom by manipulating the tensioner component 2890. Once the user has secured the fixation device in the proper location on the patient’s anatomy, the engagement system 2800 can be disengaged by urging the tensioner component 2890 along the insertion axis 2801 to thereby cause the flange 2810 to exit the arcuate slot 2822 and disengage from the seat 2820.

[0262] With additional reference to Figs. 68 and 69, illustrated therein is an engagement system 2900 for engaging a fixation device 2980 with a tensioner component 2990. As described herein, the engagement system 2900 generally includes a flange 2910 defined by the fixation device 2980 and a seat 2920 defined by the tensioner component 2990.

[0263] The fixation device 2970 generally includes a threaded fastener 2972 and the button 2980, which generally includes a body 2982 and the flange 2910. The fastener 2972 is threaded into a bore of the button 2980 and extends along a longitudinal axis 2971 of the fixation device 2970. The flange 2910 defines an oblique angle relative to the longitudinal axis 2971 and has a distal side 2918 and an opposite proximal side 2919. The distal side 2918 includes a plurality of maters, including a bottom recess 2914 and a pair of side recesses 2916. In the illustrated form, the proximal side 2919 is substantially flat and free of recesses.

[0264] The seat 2920 generally includes a recess 2922 that extends at an oblique angle 02920 relative to the longitudinal axis 2991 of the channel 2992 of the tensioner component 2990. The recess 2922 is operable to receive the flange 2910 along an oblique insertion axis 2901 and is defined in part by a set of distal shoulders 2928 and in part by a set of proximal shoulders 2929. The distal shoulders 2928 are defined by a plurality of paters, including a bottom tab 2924 and a pair of side tabs 2926. When the button 2980 is seated in the seat 2920, the flange 2910 is captured between the distal shoulders 2928 and the proximal shoulders 2929, the bottom tab 2924 is engaged with the bottom recess 2914, and the side tabs 2926 are engaged with the side recesses 2916 to thereby define a plurality of mating engagements. As such, the user can manipulate the fixation device 2970 with control over all degrees of freedom by manipulating the tensioner component 2990 in a manner similar to that described above.

[0265] Certain embodiments of the subject application relate to a surgical tensioner, comprising:a barrel extending along a first longitudinal axis; and a passage member defining a passage that extends along a second longitudinal axis offset from the first longitudinal axis by an offset distance; a cleat mounted for movement relative to the barrel and configured to facilitate coupling of a suture with the cleat; and an adjustment device mounted to the barrel and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture.

[0266] In certain embodiments, the barrel has a barrel radius; wherein the passage has a passage radius; and wherein the offset distance is greater than a sum of the barrel radius and the passage radius.

[0267] In certain embodiments, the passage comprises a channel, and wherein a nadir line of the channel is offset from a top surface of the barrel.

[0268] In certain embodiments, the nadir line is above the top surface of the barrel.

[0269] In certain embodiments, the surgical tensioner further comprises a guide tube extending along the first longitudinal axis.

[0270] In certain embodiments, the guide tube comprises an engagement feature operable to engage a corresponding engagement feature of a fixation device.

[0271] In certain embodiments, the engagement feature comprises a pater.

[0272] In certain embodiments, the pater comprises a longitudinally extending spline.

[0273] In certain embodiments, the cleat comprises a cleat passage aligned with the passage.

[0274] In certain embodiments, the first longitudinal axis and the second longitudinal axis are parallel to one another.

[0275] In certain embodiments, the first longitudinal axis and the second longitudinal axis define an oblique angle relative to one another.

[0276] In certain embodiments, the adjustment device comprises: a sliding component mounted for sliding movement within the barrel; and a bearing assembly reducing friction between the sliding component and the barrel.

[0277] In certain embodiments, the sliding component comprises a distal end portion, a proximal end portion opposite the distal end portion, an upper side, and a lower side opposite the upper side; wherein the cleat is mounted to the upper side between the proximal end portion and the distal end portion; wherein the bearing assembly comprises one or more distal roller bearings on the lower side of the distal end portion; and wherein the bearing assembly comprises one or more proximal roller bearings on the upper side of the proximal end portion.

[0278] Certain embodiments of the present application relate to a kit comprising the surgical tensioner, wherein the kit further comprises: a first end piece configured for mounting to a distal end of the passage member; and a second end piece configured for mounting to the distal end of the passage member; wherein the first end piece and the second end piece are interchangeable and of different configurations.

[0279] In certain embodiments, the first end piece comprises a spike operable to engage bone.

[0280] In certain embodiments, the second end piece comprises a tube.

[0281] Certain embodiments of the present application relate to a kit, comprising: a surgical tensioner having a first longitudinal axis and a second longitudinal axis offset from the first longitudinal axis, the surgical tensioner comprising: a barrel extending along the first longitudinal axis; an adjustment device mounted for movement relative to the barrel; and a passage extending along the second longitudinal axis; and a fixation device operable to engage a tether, the fixation device comprising: a button sized and shaped for mounting in a bone tunnel; and a rotatable component rotatably mounted to the button; wherein rotation of the rotatable component in opposite directions causes the fixation device to engage and disengage the tether.

[0282] In certain embodiments, the surgical tensioner comprises a tube defining the passage as a circumferentially closed passage.

[0283] In certain embodiments, the tube is removably mounted to the barrel.

[0284] In certain embodiments, the kit further comprises an end piece comprising a spike;wherein the end piece and the tube are interchangeable.

[0285] In certain embodiments, the passage has a passage radius; wherein the barrel has a barrel radius; and wherein the first longitudinal axis and the second longitudinal axis are offset from one another by an offset distance no less than a sum of the passage radius and the barrel radius.

[0286] In certain embodiments, the kit further comprises a tool operable to manipulate the rotatable component while extending through the passage.

[0287] In certain embodiments, the tool comprises: a proximal end portion configured to be gripped by a user; a distal end portion configured to engage the rotatable component; and a body portion configured to extend through the passage.

[0288] In certain embodiments, the rotatable component comprises a cam.

[0289] In certain embodiments, the rotatable component comprises a threaded fastener.

[0290] In certain embodiments, the surgical tensioner further comprises a cleat configured to facilitate anchoring of the tether to the cleat; and wherein the cleat includes an additional passage aligned with the passage.

[0291] Certain embodiments of the present application relate to a method of performing a surgical procedure at a surgical site, the method comprising: securing a suture to a surgical tensioner comprising a barrel extending along a first longitudinal axis, a passage extending along a second longitudinal axis offset from the first longitudinal axis, and a cleat mounted for movement relative to the barrel, wherein securing the suture to the surgical tensioner comprises:passing a portion of the tether through the passage; and anchoring the tether to the cleat; and inspecting at least a portion of the surgical site via the passage.

[0292] In certain embodiments, the surgical tensioner further comprises a tube defining at least a portion of the passage; and wherein inspecting at least a portion of the surgical site via the passage comprises viewing the at least a portion of the surgical site via the tube.

[0293] In certain embodiments, the method further comprises manipulating the surgical site using a tool that extends through the passage.

[0294] In certain embodiments, manipulating the surgical site comprises manipulating a fixation device of the surgical site.

[0295] In certain embodiments, manipulating the fixation device comprises causing the tool to rotate a rotatable component of the fixation device.

[0296] In certain embodiments, the method further comprises adjusting tension in the tether, wherein the adjusting comprises manipulating an adjustment device of the surgical tensioner.

[0297] In certain embodiments, manipulating the adjustment device causes a component of the adjustment device to move along the first longitudinal axis.

[0298] In certain embodiments, the method further comprises anchoring a distal end of the surgical tensioner to the surgical site.

[0299] Certain embodiments of the present application relate to a surgical tensioner operable to independently adjust tension of a first tether and a second tether, the surgical tensioner comprising: a body; a first cleat mounted for movement relative to the body and configured to facilitate attachment of the first tether to the first cleat; a second cleat mounted for movement relative to the body and configured to facilitate attachment of the second tether to the second cleat; a first adjustment device operable to exert a first adjustable force on the first cleat to thereby adjust tension of the first tether; and a second adjustment device operable to exert a second adjustable force on the second cleat to thereby adjust tension of the second tether; wherein the first adjustment device and the second adjustment device are independently operable.

[0300] In certain embodiments, the body comprises a first barrel and a second barrel; wherein the first adjustment device is mounted in the first barrel; and wherein the second adjustment device is mounted in the second barrel.

[0301] In certain embodiments, the surgical tensioner further comprises: a first tension gauge configured to indicate tension of the first tether; and a second tension gauge configured to indicate tension of the second tether.

[0302] In certain embodiments, the body comprises: a first section to which the first adjustment device and the second adjustment device are mounted, the first section extending along a first longitudinal axis; and a second section including a passage that extends along a second longitudinal axis offset from the first longitudinal axis.

[0303] In certain embodiments, the first cleat comprises a first waist; wherein the second cleat comprises a second waist; and wherein a longitudinal projection of the passage intersects a line extending between the first waist and the second waist.

[0304] In certain embodiments, a longitudinal projection of the passage intersects neither the first cleat nor the second cleat.

[0305] In certain embodiments, each of the first cleat and the second cleat comprises: a boss projecting away from the body, the boss including a waist; and an anchor portion comprising a channel including a plurality of teeth that define a tortuous passage within the channel.

[0306] In certain embodiments, for each cleat, the anchor portion is formed on a laterally outward side of the boss.

[0307] In certain embodiments, the surgical tensioner further comprises a plurality of interchangeable end pieces of different configurations; wherein each of the end pieces is configured for mounting to a distal end of the body.

[0308] In certain embodiments, at least one of the end pieces comprises a spike for engaging bone.

[0309] In certain embodiments, at least one of the end pieces comprises a pater operable to engage a mater of a fixation device.

[0310] Certain embodiments of the present application relate to a surgical tensioner operable to independently adjust tension in each of a plurality of tethers, comprising: a body; a plurality of cleats mounted for independent movement relative to the body, each cleat operable to anchor a corresponding one of the tethers; and a plurality of adjustment devices, each adjustment device associated with a corresponding one of the cleats and operable to adjust tension in the corresponding tether when the tether is anchored to the cleat; wherein the adjustment devices are independently operable.

[0311] In certain embodiments, two of the cleats are offset from one another such that a gap is formed between the two of the cleats; and wherein the body includes a channel aligned with the gap-

[0312] In certain embodiments, the channel extends along a longitudinal axis, and is offset from the adjustment devices in a direction transverse to the longitudinal axis.

[0313] In certain embodiments, the surgical tensioner further comprises a plurality of strain gauges; wherein each of the strain gauges is configured to display information associated with tension in a corresponding one of the tethers.

[0314] Certain embodiments of the present application relate to a method of utilizing a surgical tensioner comprising a plurality of independently operable adjustment devices including a first adjustment device and a second adjustment device, the method comprising: anchoring a first tether to a first cleat associated with the first adjustment device; anchoring a second tether to a second cleat associated with the second adjustment device; manipulating the first adjustment device to thereby adjust tension in the first tether; and manipulating the second adjustment device to thereby adjust tension in the second tether.

[0315] In certain embodiments, manipulating the first adjustment device does not adjust tension in the second tether; and wherein manipulating the second adjustment device does not adjust tension in the first tether.

[0316] In certain embodiments, each tether comprises a corresponding and respective proximal end portion and a corresponding and respective distal end portion; wherein anchoring the first tether to the first cleat comprises anchoring the proximal end portion of the first tether to the first cleat; and wherein anchoring the second tether to the second cleat comprises anchoring the proximal end portion of the second tether to the second cleat.

[0317] In certain embodiments, the proximal end portion of each tether comprises a corresponding and respective suture; and wherein the distal end portion of each tether comprises a corresponding and respective one of a graft or suture tape.

[0318] In certain embodiments, the method further comprises anchoring the distal end portions of the first tether and the second tether to a portion of a subject’s anatomy.

[0319] Certain embodiments of the present application relate to an attachment mechanism for a surgical tensioner, the attachment mechanism comprising: a cleat operable to alter an orientation of a suture from a longitudinal direction to a lateral direction; a spool about which the suture isoperable to be wound; and a clamp operable to grip a portion of the suture; wherein the spool is positioned between the cleat and the clamp.

[0320] In certain embodiments, the attachment mechanism further comprises a first catch positioned on a first side of the spool.

[0321] In certain embodiments, the attachment mechanism further comprises a second catch positioned on a second side of the spool such that the spool is laterally between the first catch and the second catch.

[0322] In certain embodiments, each attachment mechanism further comprises a movable first clamp member that partially defines the clamp.

[0323] In certain embodiments, each attachment mechanism further comprises a corresponding second clamp member that further defines the clamp.

[0324] In certain embodiments, each first clamp member is biased toward engagement with the corresponding second clamp member.

[0325] In certain embodiments, each clamp comprises an interlock region including a plurality of ridges configured to grip the portion of the suture.

[0326] In certain embodiments, each clamp further comprises a tapered inlet leading to the interlock region.

[0327] In certain embodiments, the attachment mechanism further comprises an instructional indicia relating to an intended manner of use of the attachment mechanism.

[0328] In certain embodiments, the instructional indicia comprise order indicia relating to an intended order of operations for loading the suture to the attachment mechanism.

[0329] In certain embodiments, the instructional indicia comprise directional indicia relating to an intended direction for passing the suture.

[0330] Certain embodiments of the present application relate to a cleat assembly comprising a first of the attachment mechanisms and a second of the attachment mechanisms.

[0331] In certain embodiments, the first attachment mechanism and the second attachment mechanism exhibit structural mirror symmetry.

[0332] Certain embodiments of the present application relate to a cleat assembly, comprising: a pair of cleats, wherein the cleats are laterally offset from a center of the cleat assembly and are positioned on opposite sides of the center; a pair of spools positioned laterally outward of thepair of cleats such that the cleats are positioned between the spools; a pair of clamps positioned laterally outward of the spools such that the spools are positioned between the clamps.

[0333] In certain embodiments, each clamp comprises a corresponding stationary portion and a corresponding movable portion that is biased into engagement with the corresponding stationary portion.

[0334] In certain embodiments, the cleat assembly further comprises a base member comprising the pair of cleats.

[0335] In certain embodiments, the cleat assembly further comprises a pair of spool members, each spool member comprising a corresponding and respective one of the spools.

[0336] In certain embodiments, each spool member is detachably engaged with the base member via a corresponding set of engagement features.

[0337] In certain embodiments, the cleat assembly further comprises order indicia relating to an intended order of operations for loading a suture to the cleat assembly.

[0338] In certain embodiments, the cleat assembly further comprises directional indicia relating to an intended direction for passing a suture as the suture is loaded to the cleat assembly.

[0339] Certain embodiments of the present application relate to a method of loading a suture to an attachment mechanism including a cleat, a first catch, a spool, and a clamp, the method comprising: engaging a first portion of the suture with the cleat to thereby alter a direction of the suture from a longitudinal direction to a lateral direction; engaging a second portion of the suture with the first catch such that a lateral portion of the suture is defined between the cleat and the first catch; wrapping a third portion of the suture about the spool to thereby define a wrapped portion of the suture; and engaging a fourth portion of the suture with a clamp to thereby define a clamped portion of the suture.

[0340] In certain embodiments, the suture extends along the first portion, the second portion, the third portion, and the fourth portion in that order.

[0341] In certain embodiments, the method further comprises consulting instructional indicia of the attachment mechanism, and performing at least one act corresponding to instructions relayed by the instructional indicia.

[0342] In certain embodiments, the method further comprises biasing a movable first portion of the clamp into engagement with a second portion of the clamp to thereby capture the camped portion between the movable first portion of the clamp and the second portion of the clamp.

[0343] Certain embodiments of the present application relate to a surgical tool, comprising: a body; a cleat configured to facilitate attachment of a suture to the surgical tool; and a stabilization skid mounted to the body for movement between an extended position and a retracted position, wherein a tongue of the stabilization skid projects beyond an end of the body when the stabilization skid is in the extended position; wherein the tongue is sized and shaped for receipt in a bone tunnel.

[0344] In certain embodiments, the tongue is curved.

[0345] In certain embodiments, the body comprises a channel member; wherein the stabilization skid is mounted to the channel member; and wherein the tongue projects beyond the end of the channel member when the stabilization skid is in the extended position.

[0346] In certain embodiments, the channel member extends along a longitudinal axis; and wherein the tongue is curved about the longitudinal axis.

[0347] In certain embodiments, the channel member partially defines a channel; and wherein the tongue further defines the channel.

[0348] In certain embodiments, the surgical tool further comprises a detent mechanism operable to selectively prevent movement of the stabilization skid.

[0349] In certain embodiments, the detent mechanism has a holding state in which the detent mechanism prevents movement of the stabilization skid, and a releasing state in which the detent mechanism does not prevent movement of the stabilization skid.

[0350] In certain embodiments, the surgical tool further comprises a trigger operable to transition the detent mechanism between the holding state and the releasing state.

[0351] In certain embodiments, the detent mechanism is configured to selectively retain the stabilization skid in each of a plurality of discrete rest positions between the extended position and the retracted position.

[0352] In certain embodiments, the detent mechanism is configured to discourage the stabilization skid from adopting intermediate positions between the plurality of discrete rest positions.

[0353] In certain embodiments, the detent mechanism comprises a plurality of recesses and a flexible arm operable to engage the plurality of recesses.

[0354] In certain embodiments, the stabilization skid further comprises a grip portion configured to facilitate manual manipulation of the stabilization skid.

[0355] In certain embodiments, the grip portion comprises a proximal side and an opposite distal side; and wherein one of the proximal side or the distal side includes a first finger recess.

[0356] In certain embodiments, the other of the proximal side or the distal side includes a second finger recess.

[0357] In certain embodiments, the surgical tool further comprises a spike projecting from an end of the body and configured to engage bone.

[0358] In certain embodiments, the surgical tool further comprises an adjustment device operable to adjust tension of a suture anchored to the cleat.

[0359] Certain embodiments of the present application relate to a system comprising the surgical tool, the system further comprising a fixation device configured for mounting to bone; wherein the fixation device comprises a mater configured to receive the tongue.

[0360] Certain embodiments of the present application relate to a method of using a surgical tool including a body, a cleat, and a stabilization skid mounted to the body, the method comprising: anchoring a proximal end portion of a tether to the body, wherein a distal end portion of the tether is anchored to a portion of a subject’s anatomy at a surgical site, the surgical site including a bone having a tunnel formed therein; and inserting at least a portion of the stabilization skid into the tunnel, thereby stabilizing the surgical tool relative to the bone.

[0361] In certain embodiments, the stabilization skid is movably mounted to the body; and wherein the method further comprises moving the stabilization skid between an extended position and a retracted position.

[0362] In certain embodiments, the body comprises a channel member; and wherein moving the stabilization skid to the extended position causes the at least a portion of the stabilization skid to extend beyond a distal end of the channel member.

[0363] In certain embodiments, the method further comprises engaging a spike of the body with the bone, thereby further stabilizing the surgical tool relative to the bone.

[0364] In certain embodiments, the method further comprises manipulating an adjustment device of the surgical tool, thereby adjusting tension in the tether.

[0365] In certain embodiments, the method further comprises causing a detent mechanism of the surgical tool to selectively prevent movement of the stabilization skid.

[0366] In certain embodiments, the method further comprises operating a detent mechanism of the surgical tool to selectively retain the stabilization skid in each of a plurality of discrete rest positions.

[0367] In certain embodiments, operating the detent mechanism comprises manipulating a trigger to move the detent mechanism between a holding state and a release state.

[0368] In certain embodiments, the subject’s anatomy further includes a joint comprising the bone; and wherein the method further comprises performing one or more trial cycles of the joint while the at least a portion of the stabilization skid is inserted in the bone tunnel.

[0369] In certain embodiments, the method further comprises: securing a fixation device to the bone; and extending the stabilization skid into a mater of the fixation device, thereby stabilizing the surgical tool relative to the fixation device.

[0370] Certain embodiments of the present application relate to a surgical tensioner, comprising:a body; a cleat configured to facilitate attachment of a suture to the surgical tool; an adjustment device operable to adjust tension of the suture when the suture is anchored to the cleat; and a tongue that at least selectively projects beyond an end of the body, wherein the tongue is sized and shaped for receipt in a bone tunnel.

[0371] In certain embodiments, the surgical tensioner further comprises a stabilization skid mounted to the body for movement between an extended position and a retracted position; wherein the tongue projects beyond the end of the body when the stabilization skid is in the extended position.

[0372] In certain embodiments, the tongue has a fixed position relative to the body.

[0373] Certain embodiments of the present application relate to a surgical tensioner, comprising:a body; a cleat mounted for movement relative to the body and configured to facilitate anchoring of a suture to the cleat; and an adjustment device mounted at least partially in the body and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture; and an anchor device including a plurality of pointed ends operable to engage bone.

[0374] In certain embodiments, the pointed ends of the anchor device define an engagement plane, the engagement plane defining an oblique angle relative to a longitudinal axis of the body.

[0375] In certain embodiments, the plurality of pointed ends comprises at least three pointed ends that occupy the engagement plane.

[0376] In certain embodiments, the body comprises a channel member extending along a longitudinal axis; and wherein the pointed ends extend longitudinally.

[0377] In certain embodiments, the anchor device is removably mounted to the body.

[0378] In certain embodiments, the anchor device comprises a plurality of spikes, each spike comprising at least one of the pointed ends.

[0379] Certain embodiments of the present application relate to a method, comprising:manipulating an adjustment device of a surgical tensioner to thereby adjust tension of a tether, wherein the tether is connected between tissue of a subject and a cleat of the adjustment device; and engaging a spike of the surgical tensioner with a bone of the subject to thereby discourage shifting of the surgical tensioner relative to the bone.

[0380] In certain embodiments, the manipulating is performed after the engaging.

[0381] In certain embodiments, the bone partially defines a joint of the subject; and wherein the method further comprises performing one or more trial cycles of the joint while the spike is engaged with the bone.

[0382] In certain embodiments, the method further comprises: determining, based on the one or more trial cycles, whether the tension of the tether is appropriate; in response to determining that the tension of the tether is appropriate, securing the tether to an anchor device to thereby lock the tether with the appropriate tension; and in response to determining that the tension of the tether is not appropriate, manipulating the adjustment device to thereby readjust the tension, and subsequently performing one or more additional trial cycles.

[0383] In certain embodiments, the surgical tensioner comprises an anchor device including the spike and two additional spikes, wherein each of the spike and the two additional spikes includes a corresponding and respective pointed end; wherein the pointed ends occupy an engagement plane that defines an oblique angle relative to a longitudinal axis of the surgical tensioner; and wherein the method further comprises maintaining simultaneous engagement between the bone and the pointed ends.

[0384] In certain embodiments, the method further comprises detachably mounting a removable end piece to the body, the removable end piece comprising the spike.

[0385] In certain embodiments, the method further comprises selecting the removable end piece from a plurality of removable end pieces having different configurations.

[0386] Certain embodiments of the present application relate to a surgical tensioner, comprising: a body; a cleat mounted for movement relative to the body and configured to facilitate coupling of a suture with the cleat; and an adjustment device mounted at least partially in the body and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture; and a spike extending from an end of the body to promote engagement with bony tissue.

[0387] In certain embodiments, the body comprises a channel member; and wherein the spike extends from a distal end of the channel member.

[0388] In certain embodiments, the surgical tensioner further comprises an end piece removably mounted to the end of the body, the end piece comprising the spike.

[0389] In certain embodiments, the body comprises a channel; wherein the surgical tensioner includes a plurality of engagement features, the plurality of engagement features including the spike and at least two additional spikes; wherein the plurality of engagement features at least partially surround a longitudinal projection of the channel.

[0390] In certain embodiments, the surgical tensioner further comprises an anchor device including the spike and two additional spikes; wherein ends of the spike and the two additional spikes define an engagement plane; and wherein the engagement plane defines an oblique angle relative to a longitudinal axis of the body.

[0391] In certain embodiments, the body comprises a channel member extending along the longitudinal axis.

[0392] Certain embodiments of the present application relate to a surgical kit, comprising: a tensioner comprising: a housing comprising a first engagement feature; a cleat movably mounted to the housing and configured to facilitate anchoring of a tether; and an adjustment device operable to adjust tension in the tether when the tether is anchored to the cleat; and a fixation device configured for mounting to bone, the fixation device comprising a second engagement feature configured to mate with the first engagement feature to thereby facilitate anchoring of the housing to bone.

[0393] In certain embodiments, the tensioner has a proximal end portion and an opposite distal end portion; and wherein the distal end portion comprises the first engagement feature.

[0394] In certain embodiments, the first engagement feature comprises a pater; and wherein the second engagement feature comprises a mater operable to receive the pater.

[0395] In certain embodiments, the housing comprises: a body, wherein the adjustment device is mounted to the body; and a guide tube extending from a distal end of the body, the guide tube comprising the first engagement feature.

[0396] In certain embodiments, the guide tube is detachably mounted to the body.

[0397] In certain embodiments, at least a portion of the body extends along a first longitudinal axis; wherein the guide tube extends along a second longitudinal axis; and wherein the first longitudinal axis and the second longitudinal axis are offset from one another.

[0398] In certain embodiments, the fixation device comprises: a button comprising the second engagement feature; and a rotatable component rotatably mounted to the button.

[0399] In certain embodiments, the housing comprises a tube operable to receive at least a portion of the button.

[0400] In certain embodiments, the first engagement feature is formed within the tube.

[0401] In certain embodiments, the first engagement feature comprises a spline formed within the tube; and wherein the second engagement feature comprises a notch formed in the button.

[0402] In certain embodiments, the surgical kit further comprises a tool configured to extend through the tube to facilitate manipulation of the rotatable component.

[0403] In certain embodiments, the tool comprises: a proximal end portion configured to be gripped by a user; a distal end portion configured to engage the rotatable component; and a body portion configured to extend through the tube.

[0404] In certain embodiments, the housing extends along a longitudinal axis; and wherein the first engagement feature and the second engagement feature are configured to engage and disengage one another in response to relative movement of the fixation device and the tensioner along a longitudinal insertion axis.

[0405] In certain embodiments, the housing extends along a longitudinal axis; and wherein the first engagement feature and the second engagement feature are configured to engage and disengage one another in response to relative movement of the fixation device and the tensioner along an insertion axis that extends at an oblique angle relative to the longitudinal axis.

[0406] In certain embodiments, the fixation device comprises an adjustable loop defined by the tether.

[0407] Certain embodiments of the present application relate to a surgical method, comprising:mounting a fixation device to a bone; engaging a distal end portion of a housing of a surgicaltensioner with the fixation device; loading a tether to a cleat of the surgical tensioner; and adjusting tension in the tether by manipulating an adjustment device of the surgical tensioner.

[0408] In certain embodiments, the method further comprises securing the tether to the fixation device in response to determining an appropriate tension in the tether.

[0409] In certain embodiments, securing the tether to the fixation device comprises rotating a rotatable component of the fixation device.

[0410] In certain embodiments, the distal end portion of the housing comprises a tube; and wherein rotating the rotatable component comprises rotating a tool engaged with the rotatable component, the tool extending through the tube.

[0411] In certain embodiments, the adjustment device extends along a first longitudinal axis; wherein the tube extends along a second longitudinal axis; and wherein the first and second longitudinal axes are offset from one another.

[0412] In certain embodiments, the bone is a bone of a joint; and wherein the method further comprises performing one or more trial cycles of the joint while the distal end portion is engaged with the fixation device.

[0413] In certain embodiments, the surgical method further comprises: readjusting the tension in the tether following the one or more trial cycles; and performing one or more additional trial cycles subsequent to readjusting the tension.

[0414] In certain embodiments, the distal end portion comprises a pater; wherein the fixation device comprises a mater operable to receive the pater; and wherein engaging the distal end portion with the fixation device comprises inserting the pater into the mater.

[0415] In certain embodiments, the fixation device is an adjustable loop fixation device and comprises an adjustable loop defined by the tether.

[0416] In certain embodiments, the tether at least partially defines an adjustable loop of the fixation device.

[0417] Certain embodiments of the present application relate to a surgical system, comprising: a fixation device configured for mounting to a bone; a surgical tensioner comprising a body, a cleat mounted for movement relative to the body, and an adjustment device operable to adjust tension of a tether attached to the cleat; and a mating engagement device configured to facilitate engagement between the fixation device and the surgical tensioner, the mating engagement device comprising a pater and a mater operable to receive the pater.

[0418] In certain embodiments, the pater is movable relative to the body.

[0419] In certain embodiments, the fixation device comprises the mater; and wherein the pater is sized and shaped to extend beyond a rim of the fixation device when received in the mater.

[0420] In certain embodiments, the fixation device comprises the mater; wherein the body comprises an additional mater; and wherein the pater is a floating pater configured for simultaneous insertion in each of the mater and the additional mater.

[0421] In certain embodiments, the fixation device comprises the pater; and wherein the body comprises the mater.

[0422] In certain embodiments, the pater extends beyond a rim of the fixation device.

[0423] In certain embodiments, the body extends along a longitudinal axis; and wherein the mater and the pater are configured to engage and disengage one another in response to relative movement of the fixation device and the surgical tensioner along a longitudinal insertion axis.

[0424] In certain embodiments, the body extends along a longitudinal axis; and wherein the mater and the pater are configured to engage and disengage one another in response to relative movement of the fixation device and the surgical tensioner along an insertion axis that extends at an oblique angle relative to the longitudinal axis.

[0425] Certain embodiments of the present application relate to a surgical tensioner operable to adjust tension of a tether, the surgical tensioner comprising: a body; an adjustment device comprising a mount that is movable relative to the body; a cleat assembly coupled to the mount and configured to facilitate attachment of the tether to the mount, the cleat assembly comprising: a first cleat section comprising a first slit operable to receive the tether; and a second cleat section comprising a second slit operable to receive the tether; wherein the first slit and the second slit partially overlap one another such that a pinch point is formed between the first cleat section and the second cleat section, the pinch point configured to grip the tether; and wherein, with the tether attached to the mount via the cleat assembly, the adjustment device is operable to adjust the tension of the tether.

[0426] In certain embodiments, the surgical tensioner further comprises a threaded fastener coupling the cleat assembly to the mount such that the first cleat section and the second cleat section are clamped together.

[0427] In certain embodiments, loosening of the threaded fastener permits relative movement of the first cleat section and the second cleat section.

[0428] In certain embodiments, the cleat assembly further comprises a spool about which the tether can be wrapped.

[0429] In certain embodiments, the second cleat section is sandwiched between the first cleat section and the mount; and wherein the tensioner further comprises a non-circular boss preventing rotation of the second cleat section relative to the mount.

[0430] In certain embodiments, the cleat assembly has a first side and an opposite second side;and wherein each of the first slit and the second slit extend from the first side toward the second side.

[0431] In certain embodiments, the first cleat section further comprises a third slit extending from the second side toward the first side; wherein the second cleat section comprising a fourth slit extending from the second side toward the first side; and wherein the third slit and the fourth slit partially overlap one another such that another pinch point is formed between the first cleat section and the second cleat section.

[0432] In certain embodiments, at least one of the first slit or the second slit is tapered.

[0433] In certain embodiments, the first cleat section and the second cleat section are movable relative to one another.

[0434] In certain embodiments, the first cleat section and the second cleat section are fixed relative to one another.

[0435] In certain embodiments, the first cleat section and the second cleat section are integrally formed with one another.

[0436] Certain embodiments of the present application relate to a method of using a surgical tensioner comprising a cleat assembly and an adjustment device, the method comprising: loading a tether to the cleat assembly, wherein the cleat assembly is mounted to a mount of the adjustment device, wherein the cleat assembly includes two cleat sections, wherein each of the two cleat sections includes a corresponding first slit, wherein the first slits partially overlap one another to define a first pinch point, and wherein loading the tether comprises: extending the tether through the first slits; and engaging the tether with the first pinch point such that the first pinch point grips the tether; and after loading the tether, adjusting a tension of the tether, the adjusting comprising manipulating the adjustment device.

[0437] In certain embodiments, loading the tether further comprises engaging the tether with a spool to thereby alter a direction of the tether such that when the tether is loaded to the cleatassembly, a first portion of the tether extends in a longitudinal direction of the body and a second portion of the tether extends in a direction transverse to the longitudinal direction.

[0438] In certain embodiments, each of the two cleat sections includes a first side and a second side opposite the first side; wherein each first slit extends from the first side of the corresponding cleat section; wherein each of the two cleat sections further includes a corresponding second slit extending from the second side of the corresponding cleat section; wherein the second slits partially overlap one another to define a second pinch point; and wherein loading the tether further comprises: extending the tether through the second slits; and engaging the tether with the second pinch point such that the second pinch point grips the tether.

[0439] In certain embodiments, the first slits extend in a first direction; and wherein the second slits extend in a second direction opposite the first direction.

[0440] In certain embodiments, the method further comprises preventing rotation of at least one of the two cleat sections relative to the mount.

[0441] In certain embodiments, preventing rotation of at least one of the two cleat sections relative to the mount comprises engaging a pater with a mater.

[0442] In certain embodiments, the cleat assembly is secured to the mount by a threaded fastener that discourages relative movement of the two cleat sections.

[0443] In certain embodiments, the method further comprises: loosening the threaded fastener to permit relative movement of the two cleat sections; and adjusting a relative position of the two cleat sections, thereby moving the first pinch point.

[0444] Certain embodiments of the present application relate to a cleat assembly for a surgical tensioner, the cleat assembly comprising: a bottom plate comprising at least one bottom plate slit; a top plate comprising at least one top plate slit; a threaded fastener comprising a head and a shank, wherein the shank extends through an aperture of the top plate and an aperture of the bottom plate such that a threaded end portion of the shank extends below the bottom plate and is operable to engage a mount of the surgical tensioner; and at least one pinch point defined by the at least one bottom plate slit and the at least one top plate slit, wherein each of the at least one bottom plate slits partially overlaps a corresponding one of the at least one top plate slits to thereby define a corresponding one of the at least one pinch point.

[0445] In certain embodiments, the cleat assembly further comprises a spool positioned atop the top plate, wherein the shank further extends through an aperture of the spool.

[0446] In certain embodiments, the bottom plate comprises an engagement feature operable to engage a corresponding engagement feature of the mount to thereby prevent rotation of the bottom plate relative to the mount.

[0447] In certain embodiments, the cleat assembly has a first side and an opposite second side;wherein the at least one bottom plate slit comprises a first bottom plate slit extending from the first side and a second bottom plate slit extending from the second side; and wherein the at least one top plate slit comprises a first top plate slit extending from the first side and a second top plate slit extending from the second side.

[0448] In certain embodiments, the first bottom plate slit extends in a first direction; and wherein the second bottom plate slit is offset from the first bottom plate slit in a direction transverse to the first direction.

[0449] In certain embodiments, the bottom plate and the top plate are separate components.

[0450] Certain embodiments of the present application relate to a surgical tensioner comprising the cleat assembly, wherein the surgical tensioner further comprises: a body; and an adjustment device comprising the mount, wherein the mount is movable relative to the body; wherein the threaded end portion of the shank extends into the mount such that the top plate and the bottom plate are captured between a head of the threaded fastener and the mount; wherein the cleat assembly is configured to facilitate attachment of a tether to the mount; and wherein, with the tether attached to the mount via the cleat assembly, the adjustment device is operable to adjust a tension of the tether.

[0451] Certain embodiments of the present application relate to a surgical tensioner including a guide mechanism and a latch mechanism, the surgical tensioner comprising: a first surgical tensioner component comprising a first guide mechanism component and a first latch mechanism component; and a second surgical tensioner component comprising a second guide mechanism component and a second latch mechanism component; wherein the first guide mechanism component and the second guide mechanism component are configured to engage one another to thereby guide movement of the surgical tensioner between a decoupled configuration and a seated configuration; and wherein the first latch mechanism component and the second latch mechanism component are configured to engage one another as the surgical tensioner approaches the seated configuration to thereby retain the surgical tensioner in the seated configuration.

[0452] In certain embodiments, the surgical tensioner further comprises: a body portion comprising one of the first surgical tensioner component or the second surgical tensioner component; a passage defined by the other of the first surgical tensioner component or the second surgical tensioner component; a cleat mounted for movement relative to body portion and configured to facilitate coupling of a suture with the cleat; and an adjustment device mounted to the body portion and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture.

[0453] In certain embodiments, the surgical tensioner further comprises a grip operable to move the latch mechanism from a latching state to an unlatching state to thereby permit movement of the surgical tensioner from the seated configuration.

[0454] In certain embodiments, one of the first guide mechanism component or the second guide mechanism component comprises a spline; and wherein the other of the first guide mechanism component or the second guide mechanism component comprises a groove operable to receive the spline.

[0455] In certain embodiments, the one of the first guide mechanism component or the second guide mechanism component further comprises an additional spline spaced apart from the spline by a slot; wherein the other of the first guide mechanism component or the second guide mechanism component further comprises an additional groove separated from the groove by a web; and wherein the slot is sized and shaped to receive the web.

[0456] In certain embodiments, one of the first latch mechanism component or the second latch mechanism component comprises an anchor; and wherein the other of the first latch mechanism component or the second latch mechanism component comprises a latch operable to engage the anchor.

[0457] In certain embodiments, the other of the first latch mechanism component or the second latch mechanism component further comprises a flexible portion biasing the latch toward a latching position.

[0458] In certain embodiments, the surgical tensioner further comprises a detent mechanism configured to resist movement of the surgical tensioner from the seated configuration when the latch mechanism is disengaged.

[0459] Certain embodiments of the present application relate to a surgical tensioner component configured for coupling to a base component to thereby at least partially define a surgicaltensioner, the surgical tensioner component comprising: an elongated portion extending along a longitudinal axis and defining a longitudinally-extending passage; a base portion comprising a pair of grooves, wherein each of the grooves is operable to receive a corresponding spline formed on the base component to thereby guide movement of the surgical tensioner component relative to the base component; and a flexible arm projecting from the base portion, the flexible arm comprising: a latch having a latching position and an unlatching position, wherein the latch in the latching position is operable to engage an anchor of the base component to thereby couple the surgical tensioner component with the base component, and wherein the latch in the unlatching position is configured to disengage from the anchor to thereby permit separation of the surgical tensioner component and the base component; and a grip configured to facilitate flexing of the flexible arm to thereby move the latch between the latching position and the unlatching position.

[0460] In certain embodiments, the grooves extend longitudinally.

[0461] In certain embodiments, the flexible arm further comprises a finger including the latch;and wherein the finger extends longitudinally.

[0462] In certain embodiments, at least one of the grooves comprises a detent recess.

[0463] In certain embodiments, the grooves are separated from one another by a web sized and shaped for receipt in a slot defined between the splines.

[0464] Certain embodiments of the present application relate to a method of assembling a surgical tensioner including a guide mechanism and a latch mechanism, the method comprising: in response to engagement of a first guide mechanism component with a second guide mechanism component, engaging the guide mechanism; by the engaged guide mechanism, constraining a first surgical tensioner component and a second surgical tensioner component to relative movement along a guide path defined by the guide mechanism; in response to relative movement of the first surgical tensioner component and the second surgical tensioner component along the guide path and toward a seated configuration, engaging a first latch mechanism component with a second latch mechanism component to thereby engage the latch mechanism; and by the engaged latch mechanism, retaining the surgical tensioner in the seated configuration.

[0465] In certain embodiments, the method further comprises, in response to movement of a grip, disengaging the latch mechanism to thereby permit movement of the surgical tensioner from the seated configuration.

[0466] In certain embodiments, the first guide mechanism component comprises a spline; and wherein the second guide mechanism component comprises a groove sized and shaped to matingly receive the spline.

[0467] In certain embodiments, the first latch mechanism component comprises an anchor; and wherein the second latch mechanism component comprises a latch operable to engage the anchor and a flexible arm operable to move the latch between a latching position and an unlatching position.

[0468] In certain embodiments, the surgical tensioner comprises a body portion comprising one of the first surgical tensioner component or the second surgical tensioner component; wherein a passage is defined by the other of the first surgical tensioner component or the second surgical tensioner component; and wherein the method further comprises mounting a cleat to an adjustment device that is mounted to the body portion such that the adjustment device is operable to exert an adjustable force on the cleat.

[0469] Certain embodiments of the present application relate to a surgical tensioner, comprising:a body; a cleat mounted for movement relative to the body and configured to facilitate coupling of a suture with the cleat; an adjustment device mounted to the body and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture; a manual actuator operable to adjust the adjustable force; and a feedback mechanism operable to generate feedback in response to actuation of the manual actuator.

[0470] In certain embodiments, the feedback mechanism is configured to move between a feedback-generating state and a feedback-withholding state in response to actuation of the manual actuator.

[0471] In certain embodiments, the cleat has a limited travel range relative to the body; and wherein the feedback mechanism is configured to generate the feedback when the cleat is at an end of the limited travel range.

[0472] In certain embodiments, the feedback mechanism is configured to not generate the feedback when the cleat is at an offset position that is offset from the end of the limited travel range.

[0473] In certain embodiments, the feedback mechanism is configured to generate the feedback as audible feedback and / or tactile feedback.

[0474] In certain embodiments, the feedback mechanism comprises a first engagement surface and a second engagement surface configured to engage the first engagement surface when the cleat is at a stop position; and wherein engagement between the first engagement surface and the second engagement surface generates the feedback in response to actuation of the manual actuator when the cleat is at the stop position.

[0475] In certain embodiments, the manual actuator comprises a knob; wherein the adjustment device comprises: a stem engaged with the knob; a sleeve to which the cleat is mounted; and a spring engaged between the stem and the sleeve; wherein an end of the sleeve is configured to abut an end of the knob when the cleat is in a stop position; and wherein the feedback mechanism is defined at least in part by the end of the sleeve and the end of the knob.

[0476] In certain embodiments, the feedback mechanism is configured to resist movement of the manual actuator from each of a plurality of incrementally offset positions.

[0477] Certain embodiments of the present application relate to a surgical tensioner, comprising:a barrel extending along a longitudinal axis defining a proximal direction and a distal direction opposite the proximal direction; an adjustment device mounted to the barrel, the adjustment device comprising: a sleeve mounted in the barrel for reciprocal movement along the longitudinal axis; a spring engaged with the sleeve; and a knob rotatably mounted to an end of the barrel and defining a stop position for the sleeve, wherein rotation of the knob in a first rotational direction causes the spring to urge the sleeve toward the knob; and a feedback mechanism configured to generate tactile and / or audible feedback in response to rotation of the knob when the sleeve is at the stop position.

[0478] In certain embodiments, the feedback mechanism comprises a first engagement surface and a second engagement surface; wherein the first engagement surface comprises at least one first engagement feature, each first engagement feature comprising a projection and / or a recess; wherein the second engagement surface comprises a plurality second engagement features, each second engagement feature comprising a projection and / or a recess; and wherein, with the sleeve at the stop position, the at least one first engagement feature is configured to engage the plurality of second engagement features during the rotation of the knob to thereby generate the tactile and / or audible feedback.

[0479] In certain embodiments, the sleeve comprises one of the first engagement surface or the second engagement surface; and wherein the knob comprises the other of the first engagement surface or the second engagement surface.

[0480] In certain embodiments, the adjustment device further comprises a stem engaged between the knob and the spring; wherein the spring comprises a first end portion engaged with the stem and a second end portion engaged with the sleeve; and wherein the stem is configured to move the first end portion toward the knob in response to rotation of the knob in a first rotational direction.

[0481] In certain embodiments, the feedback mechanism comprises a detent mechanism configured to provide tactile resistance to rotation of the knob when the sleeve is at the stop position.

[0482] In certain embodiments, the feedback mechanism comprises a detent mechanism configured to resist rotation of the knob from each of a plurality of incremental rotational positions when the sleeve is at the stop position.

[0483] Certain embodiments of the present application relate to a method of operating a surgical tensioner comprising a body portion, a manual actuator, and a cleat mounted to the body portion for movement within a limited movement range, the method comprising: in response to movement of the manual actuator in a first direction, adjusting deformation of a spring engaged with the cleat, thereby adjusting tension of a suture that is secured to the cleat, wherein sufficient movement of the manual actuator in the first direction causes the cleat to reach a first end of the limited movement range; and with the cleat at the first end of the limited movement range, generating tactile and / or audible feedback in response to further movement of the manual actuator in the first direction.

[0484] In certain embodiments, the first direction is a tension-increasing direction that further deforms the spring and increases the tension of the suture.

[0485] In certain embodiments, the manual actuator comprises a knob mounted for rotation relative to the body portion; and wherein movement of the manual actuator in the first direction comprises rotation of the knob in a first rotational direction..

[0486] In certain embodiments, the cleat is engaged with the spring via a reciprocating component that moves toward the knob in response to rotation of the knob in the first rotational direction; and wherein the tactile and / or audible feedback is generated by engaging one or morefirst engagement features on the reciprocating component with one or more second engagement features on the knob.

[0487] In certain embodiments, the tactile and / or audible feedback is not generated when the cleat is at an offset position that is offset from the first end of the limited movement range.

[0488] In certain embodiments, generating tactile and / or audible feedback comprises resisting movement of the manual actuator from each of a plurality of incrementally offset positions.

[0489] While the disclosed subject matter has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the disclosed subject matter are desired to be protected.

[0490] It should be understood that while the use of words such as preferable, preferably, preferred or more preferred utilized in the description above indicate that the feature so described may be more desirable, it nonetheless may not be necessary and embodiments lacking the same may be contemplated as within the scope of the invention, the scope being defined by the claims that follow. In reading the claims, it is intended that when words such as “a,” “an,” “at least one,” or “at least one portion” are used there is no intention to limit the claim to only one item unless specifically stated to the contrary in the claim. When the language “at least a portion” and / or “a portion” is used the item can include a portion and / or the entire item unless specifically stated to the contrary.

Claims

1. WHAT TS CLAIMED IS:

1. A surgical tensioner, comprising:3.a barrel extending along a first longitudinal axis;4.a passage member defining a passage that extends along a second longitudinal axis offset from the first longitudinal axis by an offset distance;5.a cleat mounted for movement relative to the barrel and configured to facilitate coupling of a suture with the cleat; and6.an adjustment device mounted to the barrel and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture.

2. The surgical tensioner of claim 1, wherein the barrel has a barrel radius;8.wherein the passage has a passage radius; and9.wherein the offset distance is greater than a sum of the barrel radius and the passage radius.

3. The surgical tensioner of claim 1, wherein the passage comprises a channel, and wherein a nadir line of the channel is offset from a top surface of the barrel.

4. The surgical tensioner of claim 3, wherein the nadir line is above the top surface of the barrel.

5. The surgical tensioner of claim 1, further comprising a guide tube extending along the first longitudinal axis.

6. The surgical tensioner of claim 5, wherein the guide tube comprises an engagement feature operable to engage a corresponding engagement feature of a fixation device.

7. The surgical tensioner of claim 6, wherein the engagement feature comprises a pater.

8. The surgical tensioner of claim 7, wherein the pater comprises a longitudinally extending spline.

9. The surgical tensioner of claim 1, wherein the cleat comprises a cleat passage aligned with the passage.

10. The surgical tensioner of claim 1, wherein the first longitudinal axis and the second longitudinal axis are parallel to one another.

11. The surgical tensioner of claim 1, wherein the first longitudinal axis and the second longitudinal axis define an oblique angle relative to one another.

12. The surgical tensioner of claim 1, wherein the adjustment device comprises:19.a sliding component mounted for sliding movement within the barrel; and20.a bearing assembly reducing friction between the sliding component and the barrel.

13. The surgical tensioner of claim 12, wherein the sliding component comprises a distal end portion, a proximal end portion opposite the distal end portion, an upper side, and a lower side opposite the upper side;22.wherein the cleat is mounted to the upper side between the proximal end portion and the distal end portion;23.wherein the bearing assembly comprises one or more distal roller bearings on the lower side of the distal end portion; and24.wherein the bearing assembly comprises one or more proximal roller bearings on the upper side of the proximal end portion.

14. A kit comprising the surgical tensioner of claim 1, the kit further comprising:26.a first end piece configured for mounting to a distal end of the passage member; and a second end piece configured for mounting to the distal end of the passage member; wherein the first end piece and the second end piece are interchangeable and of different configurations.

15. A kit, comprising:28.a surgical tensioner having a first longitudinal axis and a second longitudinal axis offset from the first longitudinal axis, the surgical tensioner comprising:29.a barrel extending along the first longitudinal axis;30.an adjustment device mounted for movement relative to the barrel; and31.a passage extending along the second longitudinal axis; and32.a fixation device operable to engage a tether, the fixation device comprising: a button sized and shaped for mounting in a bone tunnel; and33.a rotatable component rotatably mounted to the button;34.wherein rotation of the rotatable component in opposite directions causes the fixation device to engage and disengage the tether.

16. The kit of claim 15, wherein the surgical tensioner comprises a tube defining the passage as a circumferentially closed passage.

17. The kit of claim 16, wherein the tube is removably mounted to the barrel.

18. The kit of claim 17, further comprising an end piece comprising a spike;38.wherein the end piece and the tube are interchangeable.

19. The kit of claim 15, wherein the passage has a passage radius;40.wherein the barrel has a barrel radius; and41.wherein the first longitudinal axis and the second longitudinal axis are offset from one another by an offset distance no less than a sum of the passage radius and the barrel radius.

20. The kit of claim 15, further comprising a tool operable to manipulate the rotatable component while extending through the passage.

21. The kit of claim 15, wherein the rotatable component comprises a cam.

22. The kit of claim 15, wherein the rotatable component comprises a threaded fastener.

23. The kit of claim 15, wherein the surgical tensioner further comprises a cleat configured to facilitate anchoring of the tether to the cleat; and46.wherein the cleat includes an additional passage aligned with the passage.

24. A method of performing a surgical procedure at a surgical site, the method comprising:48.securing a suture to a surgical tensioner comprising a barrel extending along a first longitudinal axis, a passage extending along a second longitudinal axis offset from the first longitudinal axis, and a cleat mounted for movement relative to the barrel, wherein securing the suture to the surgical tensioner comprises:49.passing a portion of the tether through the passage; and anchoring the tether to the cleat; and50.inspecting at least a portion of the surgical site via the passage.

25. The method of claim 24, wherein the surgical tensioner further comprises a tube defining at least a portion of the passage; and52.wherein inspecting at least a portion of the surgical site via the passage comprises viewing the at least a portion of the surgical site via the tube.

26. The method of claim 24, further comprising manipulating the surgical site using a tool that extends through the passage.

27. The method of claim 26, wherein manipulating the surgical site comprises manipulating a fixation device of the surgical site.

28. The method of claim 27, wherein manipulating the fixation device comprises causing the tool to rotate a rotatable component of the fixation device.

29. The method of claim 24, further comprising adjusting tension in the tether, wherein the adjusting comprises manipulating an adjustment device of the surgical tensioner.

30. A surgical tool, comprising:58.a body;59.a cleat configured to facilitate attachment of a suture to the surgical tool; and60.a stabilization skid mounted to the body for movement between an extended position and a retracted position, wherein a tongue of the stabilization skid projects beyond an end of the body when the stabilization skid is in the extended position;61.wherein the tongue is sized and shaped for receipt in a bone tunnel.

31. The surgical tool of claim 30, wherein the tongue is curved.

32. The surgical tool of claim 30, wherein the body comprises a channel member;64.wherein the stabilization skid is mounted to the channel member; and65.wherein the tongue projects beyond the end of the channel member when the stabilization skid is in the extended position.

33. The surgical tool of claim 32, wherein the channel member extends along a longitudinal axis; and66.wherein the tongue is curved about the longitudinal axis.

34. The surgical tool of claim 32, wherein the channel member partially defines a channel; and68.wherein the tongue further defines the channel.

35. The surgical tool of claim 30, further comprising a detent mechanism operable to selectively prevent movement of the stabilization skid.

36. The surgical tool of claim 35, wherein the detent mechanism has a holding state in which the detent mechanism prevents movement of the stabilization skid, and a releasing state in which the detent mechanism does not prevent movement of the stabilization skid.

37. The surgical tool of claim 36, further comprising a trigger operable to transition the detent mechanism between the holding state and the releasing state.

38. The surgical tool of claim 35, wherein the detent mechanism is configured to selectively retain the stabilization skid in each of a plurality of discrete rest positions between the extended position and the retracted position.

39. The surgical tool of claim 35, wherein the detent mechanism is configured to discourage the stabilization skid from adopting intermediate positions between the plurality of discrete rest positions.

40. The surgical tool of claim 35, wherein the detent mechanism comprises a plurality of recesses and a flexible arm operable to engage the plurality of recesses.

41. The surgical tool of claim 30, wherein the stabilization skid further comprises a grip portion configured to facilitate manual manipulation of the stabilization skid.

42. The surgical tool of claim 38, wherein the grip portion comprises a proximal side and an opposite distal side; and77.wherein one of the proximal side or the distal side includes a first finger recess.

43. The surgical tool of claim 42, wherein the other of the proximal side or the distal side includes a second finger recess.

44. The surgical tool of claim 30, further comprising a spike projecting from an end of the body and configured to engage bone.

45. The surgical tool of claim 30, further comprising an adjustment device operable to adjust tension of a suture anchored to the cleat.

46. A system comprising the surgical tool of claim 30, the system further comprising a fixation device configured for mounting to bone;81.wherein the fixation device comprises a mater configured to receive the tongue.

47. A method of using a surgical tool including a body, a cleat, and a stabilization skid mounted to the body, the method comprising:83.anchoring a proximal end portion of a tether to the body, wherein a distal end portion of the tether is anchored to a portion of a subject’s anatomy at a surgical site, the surgical site including a bone having a tunnel formed therein; and84.inserting at least a portion of the stabilization skid into the tunnel, thereby stabilizing the surgical tool relative to the bone.

48. The method of claim 47, wherein the stabilization skid is movably mounted to the body; and86.wherein the method further comprises moving the stabilization skid between an extended position and a retracted position.

49. The method of claim 48, wherein the body comprises a channel member; and wherein moving the stabilization skid to the extended position causes the at least a portion of the stabilization skid to extend beyond a distal end of the channel member.

50. The method of claim 47, further comprising engaging a spike of the body with the bone, thereby further stabilizing the surgical tool relative to the bone.

51. The method of claim 47, further comprising manipulating an adjustment device of the surgical tool, thereby adjusting tension in the tether.

52. The method of claim 47, further comprising causing a detent mechanism of the surgical tool to selectively prevent movement of the stabilization skid.

53. The method of claim 47, further comprising operating a detent mechanism of the surgical tool to selectively retain the stabilization skid in each of a plurality of discrete rest positions.

54. The method of claim 53, wherein operating the detent mechanism comprises manipulating a trigger to move the detent mechanism between a holding state and a release state.

55. The method of claim 47, wherein the subject’s anatomy further includes a joint comprising the bone; and93.wherein the method further comprises performing one or more trial cycles of the joint while the at least a portion of the stabilization skid is inserted in the bone tunnel.

56. The method of claim 47, further comprising:95.securing a fixation device to the bone; and96.extending the stabilization skid into a mater of the fixation device, thereby stabilizing the surgical tool relative to the fixation device.

57. A surgical tensioner, comprising:98.a body;99.a cleat configured to facilitate attachment of a suture to the surgical tool;100.an adjustment device operable to adjust tension of the suture when the suture is anchored to the cleat; and101.a tongue that at least selectively projects beyond an end of the body, wherein the tongue is sized and shaped for receipt in a bone tunnel.

58. The surgical tensioner of claim 57, further comprising a stabilization skid mounted to the body for movement between an extended position and a retracted position;103.wherein the tongue projects beyond the end of the body when the stabilization skid is in the extended position.

59. The surgical tensioner of claim 57, wherein the tongue has a fixed position relative to the body.

60. A surgical kit, comprising:105.a tensioner comprising:106.a housing comprising a first engagement feature;107.a cleat movably mounted to the housing and configured to facilitate anchoring of a tether; and108.an adjustment device operable to adjust tension in the tether when the tether is anchored to the cleat; and109.a fixation device configured for mounting to bone, the fixation device comprising a second engagement feature configured to mate with the first engagement feature to thereby facilitate anchoring of the housing to bone.

61. The surgical kit of claim 60, wherein the tensioner has a proximal end portion and an opposite distal end portion; and111.wherein the distal end portion comprises the first engagement feature.

62. The surgical kit of claim 60, wherein the first engagement feature comprises a pater; and113.wherein the second engagement feature comprises a mater operable to receive the pater.

63. The surgical kit of claim 60, wherein the housing comprises:115.a body, wherein the adjustment device is mounted to the body; and116.a guide tube extending from a distal end of the body, the guide tube comprising the first engagement feature.

64. The surgical kit of claim 63, wherein the guide tube is detachably mounted to the body.

65. The surgical kit of claim 63, wherein at least a portion of the body extends along a first longitudinal axis;119.wherein the guide tube extends along a second longitudinal axis; and120.wherein the first longitudinal axis and the second longitudinal axis are offset from one another.

66. The surgical kit of claim 60, wherein the fixation device comprises:122.a button comprising the second engagement feature; and a rotatable component rotatably mounted to the button.

67. The surgical kit of claim 60, wherein the housing extends along a longitudinal axis; and wherein the first engagement feature and the second engagement feature are configured to engage and disengage one another in response to relative movement of the fixation device and the tensioner along a longitudinal insertion axis.

68. The surgical kit of claim 60, wherein the housing extends along a longitudinal axis; and wherein the first engagement feature and the second engagement feature are configured to engage and disengage one another in response to relative movement of the fixation device and the tensioner along an insertion axis that extends at an oblique angle relative to the longitudinal axis.

69. The surgical kit of claim 60, wherein the fixation device comprises an adjustable loop defined by the tether.

70. A surgical method, comprising:127.mounting a fixation device to a bone;128.engaging a distal end portion of a housing of a surgical tensioner with the fixation device; loading a tether to a cleat of the surgical tensioner; and129.adjusting tension in the tether by manipulating an adjustment device of the surgical tensioner.

71. The surgical method of claim 70, wherein the method further comprises securing the tether to the fixation device in response to determining an appropriate tension in the tether.

72. The surgical method of claim 71, wherein securing the tether to the fixation device comprises rotating a rotatable component of the fixation device.

73. The surgical method of claim 72, wherein the distal end portion of the housing comprises a tube; and133.wherein rotating the rotatable component comprises rotating a tool engaged with the rotatable component, the tool extending through the tube.

74. The surgical method of claim 73, wherein the adjustment device extends along a first longitudinal axis;wherein the tube extends along a second longitudinal axis; and135.wherein the first and second longitudinal axes are offset from one another.

75. The surgical method of claim 70, wherein the bone is a bone of a joint; and137.wherein the method further comprises performing one or more trial cycles of the joint while the distal end portion is engaged with the fixation device.

76. The surgical method of claim 74, further comprising:139.readjusting the tension in the tether following the one or more trial cycles; and performing one or more additional trial cycles subsequent to readjusting the tension.

77. The surgical method of claim 70, wherein the distal end portion comprises a pater;141.wherein the fixation device comprises a mater operable to receive the pater; and wherein engaging the distal end portion with the fixation device comprises inserting the pater into the mater.

78. The surgical method of claim 70, wherein the fixation device is an adjustable loop fixation device and comprises an adjustable loop defined by the tether.

79. The surgical method of claim 70, wherein the tether at least partially defines an adjustable loop of the fixation device.

80. A surgical system, comprising:145.a fixation device configured for mounting to a bone;146.a surgical tensioner comprising a body, a cleat mounted for movement relative to the body, and an adjustment device operable to adjust tension of a tether attached to the cleat; and147.a mating engagement device configured to facilitate engagement between the fixation device and the surgical tensioner, the mating engagement device comprising a pater and a mater operable to receive the pater.

81. The surgical system of claim 80, wherein the pater is movable relative to the body.

82. The surgical system of claim 80, wherein the fixation device comprises the mater; and wherein the pater is sized and shaped to extend beyond a rim of the fixation device when received in the mater.

83. The surgical system of claim 80, wherein the fixation device comprises the mater; wherein the body comprises an additional mater; and150.wherein the pater is a floating pater configured for simultaneous insertion in each of the mater and the additional mater.

84. The surgical system of claim 80, wherein the fixation device comprises the pater; and wherein the body comprises the mater.

85. The surgical system of claim 84, wherein the pater extends beyond a rim of the fixation device.

86. The surgical system of claim 80, wherein the body extends along a longitudinal axis; and wherein the mater and the pater are configured to engage and disengage one another in response to relative movement of the fixation device and the surgical tensioner along a longitudinal insertion axis.

87. The surgical system of claim 80, wherein the body extends along a longitudinal axis; and wherein the mater and the pater are configured to engage and disengage one another in response to relative movement of the fixation device and the surgical tensioner along an insertion axis that extends at an oblique angle relative to the longitudinal axis.

88. A surgical tensioner including a guide mechanism and a latch mechanism, the surgical tensioner comprising:156.a first surgical tensioner component comprising a first guide mechanism component and a first latch mechanism component; and157.a second surgical tensioner component comprising a second guide mechanism component and a second latch mechanism component;158.wherein the first guide mechanism component and the second guide mechanism component are configured to engage one another to thereby guide movement of the surgical tensioner between a decoupled configuration and a seated configuration; and159.wherein the first latch mechanism component and the second latch mechanism component are configured to engage one another as the surgical tensioner approaches the seated configuration to thereby retain the surgical tensioner in the seated configuration.

89. The surgical tensioner of claim 88, further comprising:160.a body portion comprising one of the first surgical tensioner component or the second surgical tensioner component;161.a passage defined by the other of the first surgical tensioner component or the second surgical tensioner component;162.a cleat mounted for movement relative to body portion and configured to facilitate coupling of a suture with the cleat; and163.an adjustment device mounted to the body portion and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture.

90. The surgical tensioner of claim 88, further comprising a grip operable to move the latch mechanism from a latching state to an unlatching state to thereby permit movement of the surgical tensioner from the seated configuration.

91. The surgical tensioner of claim 88, wherein one of the first guide mechanism component or the second guide mechanism component comprises a spline; and166.wherein the other of the first guide mechanism component or the second guide mechanism component comprises a groove operable to receive the spline.

92. The surgical tensioner of claim 91, wherein the one of the first guide mechanism component or the second guide mechanism component further comprises an additional spline spaced apart from the spline by a slot;168.wherein the other of the first guide mechanism component or the second guide mechanism component further comprises an additional groove separated from the groove by a web; and wherein the slot is sized and shaped to receive the web.

93. The surgical tensioner of claim 88, wherein one of the first latch mechanism component or the second latch mechanism component comprises an anchor; and170.wherein the other of the first latch mechanism component or the second latch mechanism component comprises a latch operable to engage the anchor.

94. The surgical tensioner of claim 93, wherein the other of the first latch mechanism component or the second latch mechanism component further comprises a flexible portion biasing the latch toward a latching position.

95. The surgical tensioner of claim 88, further comprising a detent mechanism configured to resist movement of the surgical tensioner from the seated configuration when the latch mechanism is disengaged.

96. A surgical tensioner component configured for coupling to a base component to thereby at least partially define a surgical tensioner, the surgical tensioner component comprising:173.an elongated portion extending along a longitudinal axis and defining a longitudinally-extending passage;174.a base portion comprising a pair of grooves, wherein each of the grooves is operable to receive a corresponding spline formed on the base component to thereby guide movement of the surgical tensioner component relative to the base component; and175.a flexible arm projecting from the base portion, the flexible arm comprising:176.a latch having a latching position and an unlatching position, wherein the latch in the latching position is operable to engage an anchor of the base component to thereby couple the surgical tensioner component with the base component, and wherein the latch in the unlatching position is configured to disengage from the anchor to thereby permit separation of the surgical tensioner component and the base component; and177.a grip configured to facilitate flexing of the flexible arm to thereby move the latch between the latching position and the unlatching position.

97. The surgical tensioner component of claim 96, wherein the grooves extend longitudinally.

98. The surgical tensioner component of claim 96, wherein the flexible arm further comprises a finger including the latch; and180.wherein the finger extends longitudinally.

99. The surgical tensioner component of claim 96, wherein at least one of the grooves comprises a detent recess.

100. The surgical tensioner component of claim 96, wherein the grooves are separated from one another by a web sized and shaped for receipt in a slot defined between the splines.

101. A method of assembling a surgical tensioner including a guide mechanism and a latch mechanism, the method comprising:183.in response to engagement of a first guide mechanism component with a second guide mechanism component, engaging the guide mechanism;184.by the engaged guide mechanism, constraining a first surgical tensioner component and a second surgical tensioner component to relative movement along a guide path defined by the guide mechanism;185.in response to relative movement of the first surgical tensioner component and the second surgical tensioner component along the guide path and toward a seated configuration, engaging a first latch mechanism component with a second latch mechanism component to thereby engage the latch mechanism; and186.by the engaged latch mechanism, retaining the surgical tensioner in the seated configuration.

102. The method of claim 101, further comprising, in response to movement of a grip, disengaging the latch mechanism to thereby permit movement of the surgical tensioner from the seated configuration.

103. The method of claim 101, wherein the first guide mechanism component comprises a spline; and189.wherein the second guide mechanism component comprises a groove sized and shaped to matingly receive the spline.

104. The method of claim 101, wherein the first latch mechanism component comprises an anchor; and191.wherein the second latch mechanism component comprises a latch operable to engage the anchor and a flexible arm operable to move the latch between a latching position and an unlatching position.

105. The method of claim 101, wherein the surgical tensioner comprises a body portion comprising one of the first surgical tensioner component or the second surgical tensioner component;192.wherein a passage is defined by the other of the first surgical tensioner component or the second surgical tensioner component; and193.wherein the method further comprises mounting a cleat to an adjustment device that is mounted to the body portion such that the adjustment device is operable to exert an adjustable force on the cleat.

106. A surgical tensioner, comprising:195.a body;196.a cleat mounted for movement relative to the body and configured to facilitate coupling of a suture with the cleat;197.an adjustment device mounted to the body and operable to exert an adjustable force on the cleat to thereby adjust a tension of the suture;198.a manual actuator operable to adjust the adjustable force; and199.a feedback mechanism operable to generate feedback in response to actuation of the manual actuator.

107. The surgical tensioner of claim 106, wherein the feedback mechanism is configured to move between a feedback-generating state and a feedback-withholding state in response to actuation of the manual actuator.

108. The surgical tensioner of claim 106, wherein the cleat has a limited travel range relative to the body; and202.wherein the feedback mechanism is configured to generate the feedback when the cleat is at an end of the limited travel range.

109. The surgical tensioner of claim 108, wherein the feedback mechanism is configured to not generate the feedback when the cleat is at an offset position that is offset from the end of the limited travel range.

110. The surgical tensioner of claim 106, wherein the feedback mechanism is configured to generate the feedback as audible feedback and / or tactile feedback.

111. The surgical tensioner of claim 106, wherein the feedback mechanism comprises a first engagement surface and a second engagement surface configured to engage the first engagement surface when the cleat is at a stop position; and205.wherein engagement between the first engagement surface and the second engagement surface generates the feedback in response to actuation of the manual actuator when the cleat is at the stop position.

112. The surgical tensioner of claim 106, wherein the manual actuator comprises a knob; wherein the adjustment device comprises:207.a stem engaged with the knob;208.a sleeve to which the cleat is mounted; and209.a spring engaged between the stem and the sleeve;210.wherein an end of the sleeve is configured to abut an end of the knob when the cleat is in a stop position; and211.wherein the feedback mechanism is defined at least in part by the end of the sleeve and the end of the knob.

113. The surgical tensioner of claim 106, wherein the feedback mechanism is configured to resist movement of the manual actuator from each of a plurality of incrementally offset positions.

114. A surgical tensioner, comprising:214.a barrel extending along a longitudinal axis defining a proximal direction and a distal direction opposite the proximal direction;215.an adjustment device mounted to the barrel, the adjustment device comprising:216.a sleeve mounted in the barrel for reciprocal movement along the longitudinal axis; a spring engaged with the sleeve; and217.a knob rotatably mounted to an end of the barrel and defining a stop position for the sleeve, wherein rotation of the knob in a first rotational direction causes the spring to urge the sleeve toward the knob; and a feedback mechanism configured to generate tactile and / or audible feedback in response to rotation of the knob when the sleeve is at the stop position.

115. The surgical tensioner of claim 114, wherein the feedback mechanism comprises a first engagement surface and a second engagement surface;219.wherein the first engagement surface comprises at least one first engagement feature, each first engagement feature comprising a projection and / or a recess;220.wherein the second engagement surface comprises a plurality second engagement features, each second engagement feature comprising a projection and / or a recess; and221.wherein, with the sleeve at the stop position, the at least one first engagement feature is configured to engage the plurality of second engagement features during the rotation of the knob to thereby generate the tactile and / or audible feedback.

116. The surgical tensioner of claim 115, wherein the sleeve comprises one of the first engagement surface or the second engagement surface; and223.wherein the knob comprises the other of the first engagement surface or the second engagement surface.

117. The surgical tensioner of claim 114, wherein the adjustment device further comprises a stem engaged between the knob and the spring;225.wherein the spring comprises a first end portion engaged with the stem and a second end portion engaged with the sleeve; and226.wherein the stem is configured to move the first end portion toward the knob in response to rotation of the knob in a first rotational direction.

118. The surgical tensioner of claim 114, wherein the feedback mechanism comprises a detent mechanism configured to provide tactile resistance to rotation of the knob when the sleeve is at the stop position.

119. The surgical tensioner of claim 114, wherein the feedback mechanism comprises a detent mechanism configured to resist rotation of the knob from each of a plurality of incremental rotational positions when the sleeve is at the stop position.

120. A method of operating a surgical tensioner comprising a body portion, a manual actuator, and a cleat mounted to the body portion for movement within a limited movement range, the method comprising:229.in response to movement of the manual actuator in a first direction, adjusting deformation of a spring engaged with the cleat, thereby adjusting tension of a suture that is secured to the cleat, wherein sufficient movement of the manual actuator in the first direction causes the cleat to reach a first end of the limited movement range; and230.with the cleat at the first end of the limited movement range, generating tactile and / or audible feedback in response to further movement of the manual actuator in the first direction.

121. The method of claim 120, wherein the first direction is a tension-increasing direction that further deforms the spring and increases the tension of the suture.

122. The method of claim 120, wherein the manual actuator comprises a knob mounted for rotation relative to the body portion; and233.wherein movement of the manual actuator in the first direction comprises rotation of the knob in a first rotational direction..

123. The method of claim 122, wherein the cleat is engaged with the spring via a reciprocating component that moves toward the knob in response to rotation of the knob in the first rotational direction; and235.wherein the tactile and / or audible feedback is generated by engaging one or more first engagement features on the reciprocating component with one or more second engagement features on the knob.

124. The method of claim 120, wherein the tactile and / or audible feedback is not generated when the cleat is at an offset position that is offset from the first end of the limited movement range.

125. The method of claim 120, wherein generating tactile and / or audible feedback comprises resisting movement of the manual actuator from each of a plurality of incrementally offset positions.

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