Apparatus And Method For Securing Tissue

Abstract

An apparatus and method is disclosed for securing tissue to a bone comprising a novel screw anchor for insertion into a bone by a novel rotational driver. The screw anchor and rotation driver enables the screw to be completely embedded into the bone while permitting a suture to be threaded through a transverse aperture in the screw. The rotation driver facilitates insertion and engagement of a capture with one of a series of protuberance formed along a length of a suture. In addition, the method is disclosed of forming the series of protuberance.

Claims

1. An improved hand tool for rotationally inserting a screw within a bone, comprising: a rotational driver having a handle supporting a shaft extending from a proximal end to a distal end; a socket defined in said distal end of said shaft for receiving a head of the screw for rotationally inserting the screw within the bone; and a first and a second slot is located in said socket defining a first and a second cutting edge for cutting the bone upon rotation of said rotational driver to simultaneously insert the screw and countersink the head of the screw within the bone.

2. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a suture retainer located on said handle for removeably retaining at least one suture.

3. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a suture retainer located on said handle for removeably retaining a suture; and said first and a second slot cooperating with said suture retainer for enabling a suture to extend from suture retainer through said first and second slots and a transverse aperture in said screw.

4. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, wherein the screw head has a cross-section of a hexagon with a first and a second channel recessed in opposed sides of the screw head and communicating with a transverse aperture extending through the screw; said first and second slots of said distal end of said shaft being aligned with the first and second channels of the screw head; and said socket comprising a hexagon for engaging an outer periphery of the screw head enabling a suture to extend through the first and second channels between the screw head and said socket of said shaft and through the transverse aperture of the screw.

5. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, wherein the screw has a first and a second channel defined in a head of the screw communicating with a transverse aperture extending through the screw; and said first and second slots of said distal end of said shaft being aligned with the first and second channels defined in the head of the screw for permitting a suture to extend through the first and second channels and the transverse aperture of the screw when said first and second cutting edges countersink the head of the screw within the bone.

6. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a capture magazine located on said handle for removably retaining a capture.

7. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a capture magazine comprising a resilient wire loop for removably retaining a capture; and said resilient wire loop permitting a suture to be inserted into said resilient wire loop for threading into said capture.

8. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a capture magazine comprising a resilient wire loop extending from said handle; said resilient wire loop extending through a capture aperture in said capture for removably retaining said capture on the improved hand tool; and said resilient wire loop permitting a suture to be inserted into said resilient wire loop for threading said suture into said capture aperture of said capture.

9. An improved hand tool for rotationally inserting a screw within a bone as set forth in claim 1, including a central orifice extending axially through said shaft and communicating with an outer surface of said shaft for positioning a suture centrally in said distal end of said shaft; said suture extending through a central aperture of a capture; and said distal end of said shaft configured for pushing said capture along said suture at said distal end of said shaft.

10. An improved hand tool for rotationally inserting a screw within a bone, the screw having a first and a second channel defined in a head of the screw communicating with a transverse aperture extending through the screw, comprising: a rotational driver having a handle supporting a shaft extending from a proximal end to a distal end; a socket defined in said distal end of said shaft for receiving a head of the screw for engaging with an outer periphery of said screw head for rotationally inserting the screw within the bone; and a first and a second slot defined in said socket of said distal end of said shaft; a first and a second cutting edge defined by an edge of said first and second slots for cutting the bone upon rotation of said rotational driver; and said first and a second slot extending from said distal end of said shaft being aligned with the first and second channels defined in the head of the screw for permitting a suture to extend from said first and second slots through the first and second channels and the transverse aperture of said screw while said first and second cutting edges cut the bone to countersink the head of the screw within the bone.

11. An improved fastener for insertion into a living tissue by a rotational driver, comprising a screw body extending between a screw tip and a screw head; a helical screw thread extending from said screw tip toward said screw head; said screw head defining a socket shape in an outer periphery of said screw head for enabling the rotational driver to rotationally insert said screw body into the living tissue; a transverse aperture extending through said screw body below said screw head; a first and a second channel defined in opposed sides of said screw head and communicating with said transverse aperture for enabling a suture to extend through said first and second channels and said transverse aperture while the screw body is inserted into the living tissue by said rotational driver; and said first and second channels and said transverse aperture being dimensioned for enabling the suture to be moved through said first and second channels and said transverse aperture when said screw body is totally embedded into the living tissue.

12. An improved fastener for insertion into a living tissue as set forth in claim 1, wherein said screw head has a cross-section of a polygon.

13. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein said screw head has a cross-section of a regular polygon; and said first and second channels being recessed into opposed sides of said regular polygon.

14. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein said screw head has a cross-section of a regular hexagon; and said first and second channels being recessed into opposed sides of said regular hexagon.

15. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein said screw head has a cross-section of a regular hexagon; said first and second channels being recessed into opposed sides of said regular hexagon; and each of said first and second channels having a recess depth greater than one-third the distance between opposed sides of the regular hexagon.

16. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein said screw head has a screw head has a cross-section of a regular hexagon; said first and second channels being recessed into opposed sides of said regular hexagon; each of said first and second channels having a recess depth greater than one-third the distance between opposed sides of the regular hexagon; and each of said first and second channels having a length three times greater than said recess depth of each of said first and second channels.

17. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein said screw head has a cross-section of a regular hexagon; said first and second channels being recessed into opposed sides of said regular hexagon; and each of said first and second channels having a recess depth greater than one-third the distance between opposed sides of the regular hexagon for enabling the suture to be threaded through said first and second channels and said transverse aperture when said screw body is totally embedded into the living tissue.

18. An improved fastener for insertion into a living tissue as set forth in claim 11, wherein the rotational driver comprises a hexagonal socket; said screw head defining a hexagon outer periphery of said screw head for enabling the hexagonal socket of the rotational driver to rotationally insert said screw body into the living tissue; and said first and second channels enabling a suture to pass through said first and second channels between said screw head and the hexagonal socket of the rotational driver.

19. An improved fastener for insertion into a living tissue by a rotational driver, comprising a screw body extending between a screw tip and a screw head; a helical screw thread extending from said screw tip toward said screw head; said screw head having an outer periphery of said screw head defining a regular hexagon cross-section for enabling the hexagon rotational driver to rotationally insert said screw body into the living tissue; a transverse aperture extending through said screw body below said screw head; a first and a second channel being recessed into opposed sides of said regular hexagon screw head and communicating with said transverse aperture for enabling a suture to be threaded through said first and second channels and said transverse aperture by a flexible loop while the screw body is totally embedded into the living tissue by said rotational driver;

20. An improved fastener for insertion into a living tissue as set forth in claim 17, wherein each of said first and second channels having a recess depth greater than one-third the distance between opposed sides of the regular hexagon.

21. A method of securing a tissue to a bone with a suture, the suture having a series of protuberances spaced apart along a length thereof, comprising the steps of: rotating a driver for driving a screw into the bone with the suture extending through the transverse aperture in the screw; passing the first end of the suture through a central aperture in the driver; threading the first end of the suture through a central aperture in a capture; pushing the capture with the driver along the suture to lockingly engage the capture with one of the series of protuberances for securing the first end of the suture; and securing a second end of said suture for securing the tissue to the bone.

22. A method of securing a tissue to a bone with a suture as set forth in claim 21, including the step of passing the suture through the tissue;

23. A method of securing a tissue to a bone with a suture as set forth in claim 21, wherein the step of rotating a driver for driving a screw into the bone includes cutting the bone with the driver to countersink the screw within the bone to completely embed the screw into the bone.

24. A method of securing a tissue to a bone with a suture as set forth in claim 21, wherein the step of securing the second end of said suture includes the step of; rotating a driver for driving a second screw into the bone with the suture loop through the transverse aperture in the second screw; threading the second end of the suture through suture loop; pulling the suture loop for threading the second end of the suture through the transverse aperture in the second screw; threading the second end of the suture through a central aperture in a second capture; pushing the second capture with the driver along the suture to lockingly engage the second capture with one of the series of protuberances for securing the second end of the suture for securing the tissue to the bone.

25. A method for forming a protuberance on a suture, comprising the steps of; placing a suture to extend through a mold cavity; inserting an adhesive into the mold cavity at an ambient temperature; permitting the adhesive to cure in the mold at an ambient temperature; removing the suture with the adhered protuberance from the mold.

26. A method for forming a protuberance on a suture, as set forth in claim 25, wherein the step of placing a suture to extend through a mold cavity includes placing a braided suture to extend through a mold cavity.

27. A method for forming a protuberance on a suture, as set forth in claim 25, including the step of creating a loop in the suture; and placing the suture to extend through a mold cavity with the loop located within the mold cavity.

28. A method for forming a protuberance on a suture, as set forth in claim 25, including the step of tying a knot in the suture; and placing the suture to extend through a mold cavity with the knot located within the mold cavity.

29. A method for forming a protuberance on a suture for engaging with a capture having a capture aperture defining an entrance aperture contour and a reverse aperture contour, comprising the steps of; providing a mold having a series of mold cavities with each of the mold cavities having: a leading edge shape defined for cooperation with the entrance aperture contour of the capture; and a trailing edge shape defined for cooperation with the reverse aperture contour of the capture; placing a suture to extend through the series of mold cavities; inserting an adhesive into the mold; permitting the adhesive to cure in the mold cavities; removing the suture with the adhered protuberance from the mold cavities

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0057] For a fuller understanding of the nature and objects of the invention, reference should be made to the following detailed description taken in connection with the accompanying drawings in which:

[0058] FIG. 1 is a top isometric view of a rotational driver and a screw incorporating the present invention;

[0059] FIG. 2 is a bottom isometric view of FIG. 1;

[0060] FIG. 3 is a top view of the rotational driver and screw of FIGS. 1 and 2;

[0061] FIG. 4 is a side view of FIG. 3;

[0062] FIG. 5 is an enlarged view along line 5-5 in FIG. 4;

[0063] FIG. 6 is an enlarged view of a portion of FIG. 4;

[0064] FIG. 7 is an enlarged sectional view along line 7-7 in FIG. 4;

[0065] FIG. 8 is a top view similar to FIG. 3 illustrating the rotational driver;

[0066] FIG. 9 is an enlarged view along line 9-9 in FIG. 8;

[0067] FIG. 10 is a sectional view along line 10-10 in FIG. 8;

[0068] FIG. 11 is a sectional view along line 11-11 in FIG. 9;

[0069] FIG. 12 is an enlarged side view of the improved fastener of the present invention shown in FIGS. 1-7;

[0070] FIG. 13 is a top view of the screw of FIG. 12;

[0071] FIG. 14 is a left end view of the screw of FIG. 12 illustrating the tip of the screw;

[0072] FIG. 15 is a right end view of the screw of FIG. 12 illustrating the head of the screw;

[0073] FIG. 16 illustrates a first step in securing a tissue to a bone including rotating the rotational driver with a suture for inserting a first screw with a suture into the bone and for cutting the bone to countersink the head of the screw;

[0074] FIG. 17 is an enlarged view of the distal end of the rotational driver of FIG. 16 illustrating the cutting the bone to countersink the head of the first screw and then application of the capture so that the capture sits flush with the bone surface;

[0075] FIG. 18 is a view similar to FIG. 17 illustrating the free movement of the suture through a transverse aperture when the first screw is completely embedded into the bone;

[0076] FIG. 19 is a top view of FIG. 18;

[0077] FIG. 20 illustrates the step of passing a first end of the suture through a resilient loop of a capture magazine for threading the first end of the suture through a capture aperture of a first capture;

[0078] FIG. 21 illustrates the capture aperture of the first capture being moved along the suture;

[0079] FIG. 22 illustrates the step of passing the first end of the suture through a central aperture in the driver;

[0080] FIG. 23 illustrates the step of pushing the capture with the driver along the suture to lockingly engage the capture with one of the series of protuberances for securing the first end of the suture;

[0081] FIG. 24 is an enlarged view of a portion of FIG. 23;

[0082] FIG. 25 illustrates the step of inserting a second screw and a suture shuttle into the bone and for cutting the bone to countersink the head of the second screw;

[0083] FIG. 26 illustrates the step of inserting a second end of the suture into the loop of the suture shuttle;

[0084] FIG. 27 is an enlarged view of FIG. 26 illustrating the free movement of the suture shuttle through a transverse aperture when the second screw is completely embedded into the bone;

[0085] FIG. 28 illustrates the step of threading the second end of the suture through a transverse aperture of the second screw;

[0086] FIG. 29 illustrates the second end of the suture threaded through the transverse aperture of the second screw;

[0087] FIG. 30 is an enlarged view of a portion of FIG. 29;

[0088] FIG. 31 illustrates the step of passing the second end of the suture through the resilient loop of the capture magazine for threading the second end of the suture through a capture aperture of a second capture;

[0089] FIG. 32 illustrates the step of passing the second end of the suture through a central aperture in the driver;

[0090] FIG. 33 illustrates the step of pushing the second capture with the driver along the suture to lockingly engage the second capture with one of the series of protuberances for securing the second end of the suture;

[0091] FIG. 34 illustrates the second capture lockingly engaged with one of the series of protuberances the suture;

[0092] FIG. 35 is an enlarged view of a portion of FIG. 34 showing the capture flush in the bone;

[0093] FIG. 36 is an isometric view of a first example of a suture having a series of protuberances engaging with a capture aperture of a capture;

[0094] FIG. 37 is an isometric view of a first step in a method for forming a protuberance on a suture illustrating placing a suture to extend through a mold cavity;

[0095] FIG. 38 is an isometric view of a second step in the method for forming the protuberance on the suture illustrating inserting an adhesive into the mold cavity;

[0096] FIG. 39 is an isometric view of a third step in the method for forming the protuberance on the suture illustrating removing the suture with the adhered protuberance from the mold;

[0097] FIG. 40 is an isometric view of a second example of a suture having a series of protuberances engaging with a capture aperture of a capture;

[0098] FIG. 41 is an isometric view of a first step in a method for forming a protuberance on a suture illustrating placing a suture into a mold having a series of mold cavities with each of the mold cavities having a leading edge and a trailing edge contoured for a specific capture;

[0099] FIG. 42 is an isometric view of the step of inserting an adhesive into the mold;

[0100] FIG. 43 is an isometric view of the step of removing the suture with the adhered protuberance from the mold;

[0101] FIGS. 44-51 illustrate variations within the longitudinal suture or suture redundancies which allow the adhesive to hold more securely to the suture and prevent the protuberances from sliding along the length of the suture during a tensile load

[0102] FIG. 44 is a sectional view of a third example of a protuberance formed on a suture;

[0103] FIG. 45 is a sectional view of a fourth example of a protuberance formed on a suture;

[0104] FIG. 46 is a sectional view of a fifth example of a protuberance formed on a suture;

[0105] FIG. 47 is a sectional view of a sixth example of a protuberance formed on a suture;

[0106] FIG. 48 is a sectional view of a seventh example of a protuberance formed on a suture;

[0107] FIG. 49 is a sectional view of a eighth third example of a protuberance formed on a suture;

[0108] FIG. 50 is a sectional view of a ninth example of a protuberance formed on a suture;

[0109] FIG. 51 is a sectional view of a tenth example of a protuberance formed on a suture;

[0110] Similar reference characters refer to similar parts throughout the several Figures of the drawings.

DETAILED DISCUSSION

[0111] FIGS. 1-7 are various views of an apparatus 5 for securing a suture 10 to living tissue 20 shown in FIGS. 21-35. In this example, the suture 10 has a flexible component 13 and a series of protuberances 14 spaced apart and along a length of the flexible component 13. The flexible component 13 may be a monofilament or may be a braded flexible component 13. The protuberances 14 may be formed or molded along the length of the flexible component 13 or may be knots tied along the length of the flexible component 13.

[0112] The apparatus 5 comprises an improved hand tool shown as a rotational driver 35 having a handle 40 supporting a shaft 60. The handle 40 includes a first and a second suture retainer 41 and 42 located on opposed sides of the handle 40. A first and a second jam cleat 43 and 44 cooperate with the first and second suture retainers 41 and 42 for temporarily retaining at least one suture 10. In this embodiment, the first retainer 41 and first jam cleat 43 retains a first end 11 of the suture 10 whereas the second retainer 42 and the second jam cleat 44 temporarily retains a second end 12 of the suture 10. A first and second pass through 46 and 47 are defined in the first and second suture retainers 41 and 42 for passing a suture between opposed sides of the handle 10. As will be described in greater detail hereinafter, the suture 10 extends through a screw 100 for enabling the rotational driver 35 to rotationally insert a screw 100 into the living tissue 20 while the suture extends through the screw 100.

[0113] As best shown in FIG. 4, a capture magazine 50 is located on the handle 40 in proximity to the juncture of the handle 40 and the shaft 60. In this embodiment, the capture magazine 50 is shown storing captures 51-54 threaded onto a resilient wire loop 55. The resilient wire loop 55 extends through capture orifices within each of the captures 51-54. As will be described in greater detail here and after, the resilient wire loop 55 facilitates threading of the suture 10 through the capture orifice in the capture 51.

[0114] The shaft 60 extends from a proximal end 61 adjacent to the handle 42 a distal end 62. A socket 64 is defined in the distal end 62 of the shaft 60 for receiving the screw 100. Preferably, the screw 100 is retained in the socket 64 by a frictional fit between the socket 64 and the screw 100. As will be illustrated hereinafter, the socket 64 of the shaft 60 is configured for engaging with a capture 51 for pushing a capture with the rotational driver 35.

[0115] A first and a second slot 71 and 72 are located in the socket 64 at the distal end 62 of the shaft 60. The suture 10 extends from the screw 100 through the first and second slots 71 and 72 to the first and second suture retainers 41 and 42 for temporarily retaining the suture 10 with the socket 64.

[0116] FIGS. 8-11 are further views illustrating the rotational driver 35 of FIGS. 1-7. In this example of the invention, the socket is shown as a hexagonal socket for engaging with screw 100. The first and second slots 71 and 72 are located on opposed sides of the hexagonal socket 64. The edges of the first and second slots 71 and 72 are sharpened to form a first and a second cutting edge 81 and 82. The first and second cutting edges 81 and 82 are able to cut through bone tissue upon rotation of the rotational driver 35 while simultaneously insert the screw 100.

[0117] As best shown in FIGS. 10 and 11 a central orifice 90 is defined in the distal end 62 of the shaft 60. The central orifice 90 extends from a socket end 91 to a shaft end 92 located at an outer surface of the shaft 60 defining a tunnel 93 there between. The tunnel 93 positions a suture 10 centrally in the distal end 62 of the shaft 60. The tunnel 93 enables the suture 10 to be past through a capture 51 and through the tunnel 93 for enabling the rotational driver 35 to push the capture 51 along the suture 10.

[0118] FIGS. 12-15 are enlarged view illustrating the screw 100 of the present invention. The screw 100 comprises a screw body 102 having a helical screw thread shown as a cancellous screw thread 104. The screw body 102 extends between a screw tip 106 and a screw head 110. The screw head 110 defines a socket shape in an outer periphery of the screw head 110 for enabling the socket 64 of the rotational driver 35 to rotationally insert the screw 100 into the living tissue 20. In this example, the screw head 110 is shown as having a cross-section of a regular polygon and in particular a regular hexagon.

[0119] A transverse aperture 115 extends through the screw body 102 of the screw 100. The transverse aperture 115 is perpendicular to an axis of rotation (not shown) extending from the screw tip 106 to the screw head 110.

[0120] A first and a second channel 121 and 122 are recessed into the outer periphery of the screw head 110 and allow for the insertion of the screw without a suture and by using a suture shuttle allow for a suture to be threaded through the embedded screw after implantation. In this example, the first and second channels 121 and 122 are recessed into opposed sides of the regular hexagon. The first and second channels 121 and 122 communicate with the transverse aperture 115 to form a screw pathway 125 for the suture 10. The first and second channels 121 and 122 and the transverse aperture 115 of the screw pathway 125 are dimensioned for enabling the suture 10 to be easily moved and or threaded through the screw pathway 125 while the screw body 102 including the screw head 110 is totally embedded into living tissue 20.

[0121] It should be appreciated by those skilled in the art that the screw 100 may take various forms and shapes and still obtain the benefit of the present invention. For example the length, size and shape of the screw body screw 102, the screw threads 104, the screw tip 106 as well as the screw head 110 may be varied depending upon the desired medical treatment. Furthermore, the screw pathway 125 comprising the first and second channels 121 and 122 and the transverse aperture 115 may take several shapes and sizes for enabling the suture 10 to be easily moved and or threaded through the screw pathway 125.

[0122] A specific example of the dimensions of the screw pathway 125 is shown in FIGS. 13 and 15 but should not be construed as being a limitation on the present invention. The distance [D] between opposed sides of the regular hexagon of the screw head 110 is shown in FIG. 15. Each of the first and second channels 121 and 122 has a recess depth [D/3] greater than one-third the distance [D] between opposed sides of the regular hexagon of the screw head 110. Each of the first and second channels 121 and 122 having a length greater than the distance [D] between opposed sides of the regular hexagon of the screw head 110.

[0123] Referring back to FIGS. 1-7, the first and second slots 71 and 72 of the distal end 62 of the shaft 60 are aligned with the first and second channels 121 and 12 of the screw head 110. The suture 10 extends through the screw pathway 125 comprising transverse aperture 115 and the first and second channels 121 and 122 of the screw 110 and into the first and second slots 71 and 72 of the shaft 60. The socket 64 is able to engage the outer periphery 112 of the screw head 110 when the suture 10 extends through the first and second channels 121 and 122 of the screw 110. Furthermore, the first and second channels 121 and 122 in the screw 100 permit the suture 10 to extend from the first and second slots 71 and 72 of the shaft through the first and second channels 121 and 122 and the transverse aperture 115 of the screw 100 whiles the first and second cutting edges 81 and 82 cut the bone 21 to countersink the head 110 of the screw 110 within the bone 21.

[0124] FIG. 16 illustrates a first step in securing soft tissue 22 to a bone 21 including rotating the rotational driver 35 with the suture 10 for inserting the first screw 100A with the attached suture 10 into the bone 21 and for cutting the bone 21 to countersink the head 110 of the screw 100A.

[0125] FIG. 17 is an enlarged view of the distal end of the rotational driver 35 of FIG. 16 illustrating the cutting the bone 21 to countersink the head 110 of the first screw 100A.

[0126] FIG. 18 is a view similar to FIG. 17 illustrating the free movement of the suture 10 through the transverse aperture 115 when the first screw 100A is completely embedded into the bone 21.

[0127] FIG. 19 is a top view of FIG. 18 further illustrating the free movement of the suture 10 through the transverse aperture 115.

[0128] FIG. 20 illustrates the step of passing the first end 11 of the suture 10 through the resilient loop 55 of a capture magazine 50 for threading the first end 11 of the suture 10 through a capture aperture 51X of a first capture 51. The suture 10 bends approximately one hundred and eighty degrees as the first capture 51 is removed from the resilient loop 55 to thread a loop of the suture 10 through the capture aperture SIX of a first capture 51.

[0129] FIG. 21 illustrates the capture aperture 51X of the first capture 51 being moved along the suture 10.

[0130] FIG. 22 illustrates the step of passing the first end 11 of the suture 10 through the central aperture 90 in the rotational driver 35.

[0131] FIG. 23 illustrates the step of pushing the capture 51 with the rotational driver 35 along the suture 10 to lockingly engage the capture 51 with one of the series of protuberances 14 for securing the first end 11 of the suture 10.

[0132] FIG. 24 is an enlarged view of a portion of FIG. 23 further illustrating the locking engagement of the capture 51 with one of the protuberances 14 of the suture 10.

[0133] FIG. 25 illustrates the step of inserting a second screw 100B and a suture shuttle 30 into the bone 21 and for cutting the bone 21 to countersink the head 110 of the second screw 100B. The suture shuttle 30 extends between a first end 31 and a second end 32 and has a loop 33 located at the first end 31. Preferably, the suture shuttle 30 is treaded through the transverse aperture 115 of the second screw 100B before the second screw 100B is inserted into the socket 64 of the rotational driver 35.

[0134] FIG. 26 illustrates the step of inserting a second end 12 of the suture 10 into the loop 33 of the suture shuttle 30.

[0135] FIG. 27 is an enlarged view of FIG. 26 illustrating the free movement of the suture shuttle 30 through a transverse aperture 115 when the second screw 100B is completely embedded into the bone 21.

[0136] FIG. 28 illustrates the step of threading the second end 12 of the suture 10 through the transverse aperture 115 of the second screw 100B. As the suture shuttle 30 is pulled through the transverse aperture 115 of the second screw 100B, the loop 33 bends the suture 10 approximately one hundred and eighty degrees to form a doubled up suture loop that is threaded through the transverse aperture 115 of the second screw 100B. The second channels 121 and 122 and the transverse aperture 115 are dimensioned for enabling the doubled up suture loop of the suture 10 to be easily threaded through the second screw 100B while the second screw 100B is totally embedded into the bone 21.

[0137] FIGS. 29 and 30 illustrates the second end 12 of the suture 10 threaded through the transverse aperture 115 of the second screw 100B. The suture 10 is free to move through the second screw 100B while the second screw 100 is totally embedded into the bone 21 in order to tighten the suture 10 to bring the soft tissue 22 into engagement with the bone 21.

[0138] FIG. 31 illustrates the step of passing the second end 12 of the suture 10 through the resilient loop 55 of the capture magazine 50 for threading the second end 12 of the suture 10 through the capture aperture 52X of a second capture 52.

[0139] FIG. 32 illustrates the step of passing the second end 12 of the suture 10 through a central aperture 90 in the rotational driver 35 after the capture aperture 52X of the second capture 52 has been moved along the suture 10.

[0140] FIG. 33 illustrates the step of pushing the second capture 52 with the rotational driver 35 along the suture 10 to lockingly engage the second capture 51 with one of the series of protuberances 14 for securing the second end 12 of the suture 10.

[0141] FIGS. 34 and 35 illustrate the second capture 52 lockingly engaged with one of the series of protuberances 14 of the suture 10. The suture 10 was free to move through the second screw 100B while the second screw 100B was totally embedded into the bone 21 in order to tighten the suture 10 to bring the soft tissue 22 into engagement with the bone 21.

[0142] FIG. 36 is an isometric view of a first example of a suture 10A having a series of protuberances 14A engaging with a capture aperture 56X of a capture 56. A full explanation of the operation and benefit of this capture may be found in PCT patent application PCT/U82013/063277 which is incorporated by reference as if fully set forth herein.

[0143] FIG. 37 is an isometric view of a first step in a method for forming a protuberance 14A on a suture 10A. The mold 130A comprises a first mold and a second mold 131A and 132A defining a first and a second mold cavity 133A and 134A. Feeder tubes 135A communicate with the mold cavity 135A for introducing an adhesive 137A one into the mold cavity 135A. A flexible suture component 13A is placed into the mold cavities 133A and 134A to extend through the mold cavity 130A.

[0144] FIG. 38 is an isometric view of a second step in the method for forming the protuberance 14A on the suture 10A illustrating inserting an adhesive 137A into the mold cavities 133A and 134A through the feeder tubes 135A.

[0145] FIG. 39 is an isometric view of a third step in the method for forming the protuberance 14A on the suture 10A illustrating removing the suture 10A with the adhered protuberance 14A from the mold 130A. The protuberances 14A are formed entirely of the adhesive 137A.

[0146] FIG. 40 is an isometric view of a second example of a suture 10B having a series of protuberances 14B engaging with a capture aperture 57X of a capture 57. In this example, each of the protuberances 14B has a leading edge 141B and a trailing edge 142B. In contrast to the protuberances 14A shown in FIGS. 36-39, the leading edge 141B is not symmetrical with the trailing edge 142B. The non-symmetrical design of the protuberances 14B are specifically designed to engage with the specific capture at aperture 57X of a capture 57.

[0147] FIG. 41 is an isometric view of a first step in a method for forming a protuberance 14B on a suture 10B. The mold 130B comprises a first mold and a second mold 131B and 132B defining a first and a second mold cavity 133B and 134B.

[0148] The first and second mold cavity 133B and 134B define a leading mold portion 151B and a trailing mold portion 152B. The leading mold portion and trailing mold portion 151B and 152B correspond to the leading edge 141B and the trailing edge 142B of the protuberances 14B. Feeder tubes 135B communicate with the mold cavity 130B for introducing an adhesive 137B into the mold cavity 130B. A flexible suture component 13B is placed into the mold cavities 133B and 134B to extend through the mold cavity 130B.

[0149] FIG. 42 is an isometric view of a second step in the method for forming the protuberance 14B on the suture 10B illustrating inserting an adhesive 137B into the mold cavities 133B and 134B through the feeder tubes 135B.

[0150] FIG. 43 is an isometric view of a third step in the method for forming the protuberance 14B on the suture 10B illustrating removing the suture 10B with the adhered protuberance 14B from the mold 130B. The protuberances 14B are formed entirely of the adhesive 137B.

[0151] FIGS. 44-51 are sectional views of example of protuberances 14C-14J formed on a suture 10C-10J. Similar parts are labeled with similar reference numerals and added alphabetical character. Each of the suture 10C-10J include a flexible suture component 13C-13J which is the bent, shaped or tied to stabilize the protuberances 14C-14J formed solely from an adhesive 137. The bend shape or knot of the flexible suture component 13C-13J provides mechanical strength and prevent slippage of the protuberances 14C-14J.

[0152] FIGS. 36-43 illustrate a specific molding process for forming the protuberances 14 on a flexible suture component 13 for providing the suture 10. It should be understood that various other molding processes and or techniques may be utilized for forming the protuberances 14 on a flexible suture component 13. For example, various adhesives may be used as well as various types of molding techniques such as waffle style and clam shell molds made of metal PTFE, or TEFLON as well as 3-D printing and the like.

[0153] The present disclosure includes that contained in the appended claims as well as that of the foregoing description. Although this invention has been described in its preferred form with a certain degree of particularity, it is understood that the present disclosure of the preferred form has been made only by way of example and that numerous changes in the details of construction and the combination and arrangement of parts may be resorted to without departing from the spirit and scope of the invention.