Method of securing body tissue

Abstract

To secure a first body tissue with a second body tissue, a first anchor is moved along a first path through the first body tissue into the second body tissue. A second anchor is moved along a second path through the first body tissue into the second body tissue. A suture extending between the anchors may be tightened by moving the second anchor along a path which extends transverse to the path of the first anchor. The suture which extends between the anchors may have free ends which are connected with a suture retainer. The free ends of the suture may be interconnected either before or after the anchors are moved along the first and second paths. Alternatively, the suture may be a continuous loop which extends between the two anchors. A guide assembly may be provided to guide movement of the anchors along the two paths. The paths along which the anchors move may intersect so that the anchors may be interconnected at the intersection between the two paths.

1 . A method of securing first body tissue with second body tissue, said method comprising the steps of moving a first anchor along a first path into the second body tissue, tensioning a first suture portion extending from the first anchor, and gripping the first suture portion with a suture retainer, wherein the step of tensioning the first suture portion includes applying heat to the first suture portion to thereby shrink material of the first suture portion.  
     
     
         2 . The method of  claim 1  further comprising the steps of moving a second anchor along a second path into the second body tissue, tensioning a second suture portion extending from the second anchor, and gripping the second suture portion with the suture retainer, wherein the step of tensioning the second suture portion includes applying heat to the second suture portion to thereby shrink material of the second suture portion.  
     
     
         3 . The method of  claim 2  wherein the steps of moving the first and second anchors along first and second paths include moving the first and second anchors along first and second paths which intersect in the second body tissue.  
     
     
         4 . The method of  claim 3  wherein the first and second suture portions are part of the same suture.  
     
     
         5 . The method of  claim 3  further comprising the step of connecting the first and second anchors together at the intersection between the first and second paths in the second body tissue.  
     
     
         6 . The method of  claim 5  wherein the step of connecting the first and second anchors together includes engaging a surface on the first anchor with a surface on the second anchor.  
     
     
         7 . The method of  claim 5  wherein the step of connecting the first and second anchors together includes moving one of the anchors into an opening in the other anchor.  
     
     
         8 . The method of  claim 5  wherein each of the first and second anchors has projections and the step of connecting the first and second anchors together includes engaging projections on the first anchor with projections on the second anchor.  
     
     
         9 . The method of  claim 8  wherein the projections on the first anchor intermesh with the projections on the second anchor to prevent the first anchor from being moved relative to the second anchor under the influence of tension in the first and second suture portions.  
     
     
         10 . The method of  claim 8  wherein the first and second suture portions are part of the same suture.  
     
     
         11 . The method of  claim 2  wherein the first path enters the second body tissue at a first location and the second path enters the second body tissue at a second location, the step of moving the first anchor along the first path into the second body tissue includes moving the first anchor along a portion of the first path which extends at an acute angle to a straight line between the first location where the first path enters the second body tissue and the second location where the second path enters the second body tissue, the step of moving the second anchor along the second path into the second body tissue includes moving the second anchor along a portion of the second path which extends at an acute angle to the straight line between the first location where the first path enters the second body tissue and the second location where the second path enters the second body tissue.  
     
     
         12 . The method of  claim 2  further including the step of positioning a guide assembly having first and second guide surfaces relative to the second body tissue with the first guide surface aligned with the first path and with the second guide surface aligned with the second path, the step of moving the first anchor along the first path includes moving the first anchor along the first guide surface, the step of moving the second anchor along the second path includes moving the second anchor along the second guide surface.  
     
     
         13 . The method of  claim 12  wherein the step of moving the first anchor along the first path includes applying force against a trailing end portion of the first anchor with a pusher member and determining when the first anchor has moved to a desired position relative to the intersection of the first and second paths by detecting when the pusher member has moved to a predetermined position relative to the guide assembly, the step of moving the second anchor along the second path includes applying force against a trailing end portion of the second anchor with a pusher member and determining when the second anchor has moved to a desired position relative to the intersection of the first and second paths by detecting when the pusher member has moved to a predetermined position relative to the guide assembly.  
     
     
         14 . The method of  claim 2  wherein the step of gripping the first and second suture portions with the suture retainer includes heating the suture retainer by transmitting ultrasonic vibratory energy to the suture retainer.  
     
     
         15 . A method of securing first body tissue with second body tissue, the method comprising the steps of moving a first anchor along a first path into the second body tissue with a suture extending between the first anchor and a second anchor, moving the second anchor along a second path into the second body tissue with the suture extending between the first anchor and the second anchors, tensioning the suture, transmitting force through the suture to the first body tissue, and gripping a portion of the suture extending from the first anchor and a portion of the suture extending from the second anchor with a suture retainer while the suture is tensioned, wherein the step of tensioning the suture includes applying heat to the suture to thereby shrink material of the suture.  
     
     
         16 . The method of  claim 15  wherein the step of moving a first anchor along a first path into the second body tissue includes piercing the first body tissue with a leading end portion of the first anchor.  
     
     
         17 . The method of  claim 16  wherein the step of moving a first anchor along a first path into the second body tissue includes piercing the second body tissue with the leading end portion of the first anchor.  
     
     
         18 . The method of  claim 17  wherein the step of moving a second anchor along a second path into the second body tissue includes piercing the first body tissue with a leading end portion of the second anchor.  
     
     
         19 . The method of  claim 18  wherein the step of moving a second anchor along a second path into the second body tissue includes piercing the second body tissue with the leading end portion of the second anchor.  
     
     
         20 . The method of  claim 19  wherein the second body tissue is bone having a hard outer layer disposed over cancellous bone, the step of moving the first anchor into the second body tissue includes moving the first anchor through the hard outer layer of the bone into the cancellous bone, the step of moving the second anchor into the second body tissue includes moving the second anchor through the hard outer layer of bone into the cancellous bone.  
     
     
         21 . The method of  claim 15  further including the step of changing the orientation of the first anchor relative to the second body tissue, the step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, the step of tensioning the suture includes moving the second anchor along at least a portion of the second path after performing the step of changing the orientation of the first anchor relative to the second body tissue.  
     
     
         22 . The method of  claim 15  further including the steps of changing the orientation of the first anchor relative to the second body tissue, the step of changing the orientation of the first anchor relative to the second body tissue includes rotating the first anchor about an axis which extends transverse to the first path, and changing the orientation of the second anchor relative to the second body tissue, the step of changing the orientation of the second anchor relative to the second body tissue includes rotating the second anchor about an axis which extends transverse to the second path.  
     
     
         23 . The method of  claim 15  wherein the step of moving the first anchor along the first path includes moving the first anchor along a first path having a nonlinear central axis, the step of moving the second anchor along the second path includes moving the second anchor along a second path having a nonlinear central axis.  
     
     
         24 . The method of  claim 15  wherein the steps of moving the first anchor along a first path and moving the second anchor along a second path include interconnecting the first and second anchors while the first and second anchors are disposed in the second body tissue.  
     
     
         25 . The method of  claim 15  further including the step of positioning a guide assembly having first and second guide surfaces relative to at least one of the first and second body tissues, moving the first anchor along the first guide surface during movement of the first anchor along the first path, and moving the second anchor along the second guide surface during movement of the second anchor along the second path.  
     
     
         26 . The method of  claim 15  further including the steps of moving a thin elongated member along the first path into the second body tissue, the step of moving a first anchor along a first path into the second body tissue is at least partially performed with the thin elongated member extending through the first anchor, and moving a thin elongated member along the second path into the second body tissue, the step of moving a second anchor along a second path into the second body tissue is at least partially performed with the thin elongated member extending through the second anchor.  
     
     
         27 . The method of  claim 15  further including the steps of providing a guide assembly having a base and first and second tubular guides, positioning the first tubular guide in alignment with the first path, moving the first tubular guide along the first path into engagement with the second body tissue, positioning the second tubular guide in alignment with the second path, moving the second tubular guide along the second path into engagement with the second body tissue, the step of moving the first anchor along the first path includes moving the first anchor through the first tubular guide into the second body tissue, the step of moving the second anchor along the second path includes moving the second anchor through the second tubular guide into the second body tissue.  
     
     
         28 . The method of  claim 15  wherein the step of moving a first anchor along a first path includes transmitting force from a robotic assembly to the first anchor, the step of moving a second anchor along a second path includes transmitting force from the robotic assembly to the second anchor.