Instruments and methods for surgical transosseous attachment to a bone include a guide able to guide the formation of intersecting bone tunnels and a passer able to pass a member through the bone tunnels.

A locking suture construct having suture material with a first end and a second end, each attached to a first body in a slidable manner, a constricting member formed in the second end of the suture material, and a bight in the suture material between the first end and the second end. The bight can be pulled through the constricting member around a second body to create a locking loop. The first end and the second end are passed through the locking loop. Pulling the first end increases a perimeter of the locking loop and moves the constricting member toward the second body. When the constricting member reaches the second body, pulling the first end reduces the perimeter of the locking loop and moves/rotates the constricting member around the second body toward the first body to hold the first body in relative position to the second body.

Described herein is a simplified placement system and method for a tissue graft anchor by which a surgeon may introduce one or more sutures into a hole in a boney tissue, apply a precise amount of tension to the sutures to advance a soft tissue graft to a desired location, and then advance the anchor into the bone, preferably while maintaining the requisite pre-determined suture tension and without introducing spin to the suture. Particularly preferred embodiments allow for the one-handed operation. To that end, embodiments in which relative axial movement between the inner tensioning device and outer driver device is optionally physically constrained, for example by means of cooperating and/or compressive elements disposed in the respective hub and handle portions, are described herein.

A surgical pad can comprise a flexible pad portion configured to be positioned over an opening in a target tissue. A plurality of elongate ribs can be distributed across a surface of the flexible pad portion oriented away from the target tissue and can be coupled to the flexible pad portion. A surgical pad can comprise a central opening configured to be aligned with an opening in a target tissue, and a plurality of edge openings distributed around an outer edge portion. A method can comprise positioning a spacer between a target tissue and a surgical pad to adjust the tension of surgical cords secured to surgical pad. A method can comprise positioning a spacer between a surface of a surgical pad oriented away from a target tissue and portions of surgical cords secured over the surface of the surgical pad, to adjust the tension of the surgical cords.

A medical device for approximating and securing tissue without requiring knots includes a lock-head, a strap section, distal protuberance, and a leader section. The device also includes a transition section between the leader and the strap section and a stiffening section proximal to the protuberance. The leader section is used to draw the strap section into the body through small apertures in tissue and the transition section provides a gradual transition in stiffness and size between the leader and the strap section. Tensioner and cutter and a threading tool configured to be slidably removed from a lumen of the tensioner and cutter is provided. A blade within the lumen of the tensioner and cutter is provided to cut excess leader and/or strap when the procedure is completed.

A suture construct having a soft button, defining a multiplicity of first apertures and a set of second apertures. Also, a suture loop assembly has a suture defining a lumen and forming a double loop, formed by a double trap having a first end and a second end, formed in a trap region of the suture, and in which a first portion of the suture is threaded through the trap region lumen from the first end to the second end and the first portion extends out from the second end, and a second portion of the suture is threaded through the trap region lumen from the second end to the first end, and the second portion extends out from the first end. Finally, the double loop passes through the set of second apertures of the soft button.

Knotless suture-based implant systems and related methods for joining bone and/or tissue portions is disclosed. The implant systems include a flexible anchor tube comprising an annular side wall defining an internal cavity, a first longitudinal end and a second longitudinal end. The implant systems also comprise a suture that extends through the side wall of the anchor tube a plurality of times and forms a free loop portion that extends from the side wall. The implant systems further comprise at least one suture passer extending through a portion of the loop portion of the suture configured to translate first and second end portions of the suture through the loop portion via translation of the at least one suture passer. The suture extends along a pattern that allows the suture to slide through the anchor tube when the first and second end portions of the suture are tensioned.

A suture passing device includes a jaw assembly that is moved to an open configuration after exiting a hollow needle distal tip and moved to a closed configuration when retracted into the needle tip. The jaw assembly may include a pair of jaw members biased to a default diverging configuration. A suture capturing mechanism formed on the jaw members securely captures suture to both push and pull the captured when the jaw assembly is retracted into the hollow distal tip. The jaw members have configurations of teeth that may be staggered axially and vertically.

A suture anchor has a tubular body having an axial bore therethrough with one or more purchase enhancements on an exterior surface of the body adapted to enhance purchase of the body within a bone hole. These are preferably screw threads. A distal nose of the suture body has a smooth exterior surface. A length of suture passes down along the exterior surface over the purchase enhancements, over the distal nose, and up into the bore. The smooth exterior surface of the distal nose allows tension of the suture to be held by the engagement of the nose within the bone hole thus making it easier to obtain proper tension as the remaining portion is engaged into the bone hole to provide final fixation.