A method of coupling a first portion of an anatomy to a second portion of the anatomy includes coupling first and second bones of the anatomy with a bone-tendon-bone implant. The bone-tendon-bone implant has a first bone end, a second bone end and a replacement tendon between the first and second bone ends. The first and second bone ends are positioned in corresponding first and second bores of the first and second bones. The first bone end is secured to the first bone with a first bone anchor. A second anchor coupled to the bone-tendon-bone implant is passed through and outside the second bore. The second anchor is coupled to an adjustable suture construct having two adjustable suture loops. Tensioning at least one of first and second ends of the adjustable suture construct tensions the replacement tendon and positions the first bone relative to the second bone.

An anchor construct having an anchor having a length of suture material passing therethrough, the suture material having a loop strand terminating at a first end and a post strand terminating at a second end, a splice loop formed by first end, a sliding construct formed by the first end and the second end, wherein the sliding construct is configured to adjust the relative position of the splice loop and the anchor. The anchor construct can be deployed by passing the first end through a first body and through the splice, creating a locking loop of a first size around the first body, implanting the anchor into a bone hole, pulling the post strand to decrease the perimeter of the positioning loop to a second size smaller than the first size, and pulling the loop strand to decrease the perimeter of the locking loop to a smaller second size.

Tensionable, knotless, self-locking surgical constructs and methods for surgical repairs are disclosed. A soft suture anchor and a flexible strand (flexible coupler) are provided integrally, as a one-piece machine taper construct. The repair system can include one or more shuttle/pull devices. The suture comes out of the cannulated sheath and braids to a smaller diameter round suture which is then passed back through the sheath. The braided suture may be furcated or branched to provide a plurality of passing sutures.

A suture assembly, including a button having two apertures and a suture defining a lumen and forming a double loop, formed by a double trap formed in the suture, opposed to the button, and in which a first portion of the suture is threaded through the lumen of the double trap and a second portion of the suture is also threaded through the lumen of the double trap, so that two portions of suture are positioned together in the double trap. The first portion of the suture, after emerging from the double trap, is threaded through the lumen again, thereby forming a second trap, increasing resistance of the double loop to expansion, the double loop being threaded through the apertures of the button, the suture having two suture ends that are threaded through the button apertures and accessible on a side of the button opposed to the double loop.

Suture constructs and methods for soft tissue to bone repairs. The suture construct is a soft, suture-based anchor which is self-cinching and has a specific, accordian-type configuration (i.e., with the ability to fold from a first, extended position to a second, folded or compressed position). The suture-based anchor may be formed essentially of a flexible material such as a high strength surgical suture, suture chain, or suture.

A cord comprises a braided sheath of strands having an outer surface, an inner surface, and a central hollow portion defined by the inner surface and having a volume and a core within the central hollow portion of the tubular braided sheath, such that when the cord is in a relaxed state the tubular braided sheath has a cylindrical shape and a relaxed volume of the central hollow portion wherein the core does not fill the relaxed volume of the central hollow portion of the tubular braided sheath; when the cord is in a longitudinal tensioned state, the tubular braided sheath elongates under the longitudinal tension such that a tensioned volume of at least a part of the central hollow portion of the tubular braided sheath is less than the relaxed volume; and the inner surface of the tubular braided sheath of tensioned volume contacts and cinches a surface of the core.

Reinforced surgical constructs and methods of tissue repairs. A surgical construct can offer both repair and shuttling capabilities to allow for a single pass to load multiple sutures at once. A surgical construct includes one or more repair sutures provided with one or more junctions (one or more releasable stitches), to allow the repair sutures to be joined and subsequently released. At least one of the one or more junctions (releasable stitches) can be formed by weaving back and forth another flexible strand (releasing suture) through the one or more repair sutures. When the flexible strand is pulled, it pulls out the one or more junctions (releasable stitches) from the repair sutures, freeing the repair sutures. The surgical construct may be part of a knotless or knotted construct.

A method of suturing includes: (1) wrapping a first segment of a suture through a traction loop; (2) pulling the traction loop and the first segment through an opening in a suture lock; (3) continuing to pull the traction loop such that a second segment of the suture extends through the opening, wherein the second segment has a greater denier than the first segment such that the second segment more nearly fills an entire dimension of the opening than the first segment; and (4) locking the suture in place with the second segment in the opening.

A method of suturing includes: (1) wrapping a first segment of a suture through a traction loop; (2) pulling the traction loop and the first segment through an opening in a suture lock; (3) continuing to pull the traction loop such that a second segment of the suture extends through the opening, wherein the second segment has a greater denier than the first segment such that the second segment more nearly fills an entire dimension of the opening than the first segment; and (4) locking the suture in place with the second segment in the opening.

A knotless tissue repair assembly for attachment of tissue to bone includes an anchoring implant with a length of suture threaded therethrough. The implant is preferably a soft flexible three-dimensional structure. The implant may be actuated from a first elongate low profile shape into a second short radially expanded shape having a larger diameter than the hole through which it was placed. The suture extends through the anchor, through a tissue to be secured, and back through a designated suture-binding region or passageway within the anchor enabling the suture to be secured therein and without the need for a physician to tie a knot. Further tension applied to a suture leg approximates the tissue to the anchor until a desired tension or distance between the tissue and anchor is achieved.