Described herein are methods and apparatus for approximating targeted tissue using locking sutures. The locking sutures can be configured to receive suture ends that are interweaved through portions of the locking sutures. In a pre-deployment configuration, a locking suture can slide along suture tails and can be positioned at a target location within a target region. Once a desired position and/or tension is achieved, the locking suture can be transitioned to a post-deployment configuration where the locking suture constricts around the suture tails to inhibit relative movement between the suture tails and the locking suture.

An apparatus for laparoscopic intracorporeal knot tying includes a needle grasper including a needle holder shaft and a needle holder jaw located at a distal end of the needle holder shaft, and a knot loop grasper including a knot loop holder shaft, which is slidable on the needle holder shaft, and a knot loop holder jaw located at a distal end of the knot loop holder shaft. In an inactive state of the apparatus, the knot loop holder is located proximal to the needle holder jaw. In an active state of the apparatus at a time of a knot tying, the knot loop holder jaw slides on the needle holder shaft toward the distal end of the needle holder shaft and beyond the needle holder jaw to carry components of a knot over a standing end of a suture held by the needle holder jaw.

A method of anchoring soft tissue to a suitable bone site, using a soft suture anchor, includes steps of disposing the soft suture anchor on a shaft of an inserter, and securing a proximal end of a tensioning suture limb, extending proximally from the soft suture anchor, to structure in a handle of the inserter, so that it is maintained in place at a first level of holding tension (T.sub.hold). The inserter shaft is inserted into a hone hole at a desired procedural site, so that the soft suture anchor is positioned at a location where it is to be anchored. A further step involves actuating a control mechanism in the inserter handle to move the structure proximally to apply a second level of deployment tension (T.sub.load) to the tensioning suture limb.

A method includes passing a first flexible strand through a tissue section by a first needle coupled to a driver. The driver includes a longitudinal body defining an opening at a distal end. The first needle is positioned in the opening. A first hole is formed through a bone. The first flexible strand is passed through the first hole using a strand retriever. The strand retriever includes a body having a first longitudinal tube extending therefrom and a first snare slideably deployable from the first longitudinal tube. The first longitudinal tube is positioned from a first side of the bone in the first hole and the first snare is deployed on a second side of the bone. The first snare passes the first flexible strand through the first hole in the bone. The tissue section is secured to the bone using the first flexible strand.

Sutures with pre-tied knots for use in percutaneous surgical procedures and devices for easily and quickly tying complex suture knots are disclosed.

A laparoscopic device with suture cutter includes a tubular housing having first, second, and third channels. Each channel extends longitudinally along the housing. A first suture grasping instrument in the first channel has an end effector that can be actuated to extend outwardly from the distal end of the housing to grasp a first portion of a suture. A second suture grasping instrument in the second channel has an end effector that can be actuated to extend outwardly from the distal end to grasp a second portion of a suture. A cutting blade is recessed in the distal end at a location between the first and second channels. The first and second instruments can be retracted into the distal end of the housing while grasping the suture and to engage the suture with the blade to sever the suture. The third channel can house a laparoscope.

In one embodiment, the present invention is a system for repairing a meniscus including: a suture assembly including a first anchor, a second anchor, and a flexible suture connecting the first anchor and the second anchor, the flexible suture including a slide knot between the first anchor and the second anchor; and an inserter including a needle having a longitudinal extending bore and an open distal end, the bore being configured to receive the first anchor and the second anchor, a housing operatively connected to a proximal end of the needle, the housing having a lumen and a slot, the slot including a first portion, a second portion, a first shoulder and a second shoulder and a pusher configured to rotate and slide within the lumen of the housing and the longitudinal extending bore of the needle, the pusher having an extension extending through the slot and configured to be maneuverable through the first portion and second portion and engageable with the first shoulder and second shoulder.

A method of anchoring soft tissue to a suitable bone site, using a soft suture anchor, includes steps of disposing the soft suture anchor on a shaft of an inserter, and securing a proximal end of a tensioning suture limb, extending proximally from the soft suture anchor, to structure in a handle of the inserter, so that it is maintained in place at a first level of holding tension (T.sub.hold). The inserter shaft is inserted into a bone hole at a desired procedural site, so that the soft suture anchor is positioned at a location where it is to be anchored. A further step involves actuating a control mechanism in the inserter handle to move the structure proximally to apply a second level of deployment tension (T.sub.load) to the tensioning suture limb.

A method of anchoring soft tissue to a suitable bone site, using a soft suture anchor, includes steps of disposing the soft suture anchor on a shaft of an inserter, and securing a proximal end of a tensioning suture limb, extending proximally from the soft suture anchor, to structure in a handle of the inserter, so that it is maintained in place at a first level of holding tension (T.sub.hold). The inserter shaft is inserted into a hone hole at a desired procedural site, so that the soft suture anchor is positioned at a location where it is to be anchored. A further step involves actuating a control mechanism in the inserter handle to move the structure proximally to apply a second level of deployment tension (T.sub.load) to the tensioning suture limb.

A knot tying device including a sheath configured for placement over a surgical instrument. The sheath includes a proximal end portion and a distal end portion. The distal end portion is elastically reconfigurable between a straightened configuration and a hook shaped configuration. Position of the sheath on the surgical instrument is adjustable between an extended position in which the sheath extends beyond a distal tip of the surgical instrument and a retracted position in which the sheath is pulled back from the distal tip of the surgical instrument. The distal end portion is in the hook shaped configuration when the sheath is in the extended position and the distal end portion is in the straightened configuration when the sheath is in the retracted position.