Dave's PCF WIP: Paragraphs

Paragraphs

Actions	Matter	Content	Para #	Notes	Modified
View Edit Delete	IPP-0051-US14 cross roads	After the suture anchor system 800 is assembled, a user may insert the interference member 770 through the longitudinal opening 938 at the proximal end 930 of the collar 908 and pass the interference member 770 through the inserter longitudinal passageway 941 until the interference member 770 reaches the longitudinal passageway 714 of the suture anchor 700. In this manner, the interference member 770 can be inserted when needed during a surgical procedure to secure suture within the suture anchor 700.	177	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	In certain embodiments, the driver 910 can be used to move the interference member 770 through the inserter longitudinal passageway 941 and into the longitudinal passageway 714. Alternatively, or in addition, the driver 910 can be used to urge the interference member 770 into the anchor body 702.	178	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIGS. 93-96 are a sequence of perspective views illustrating use of the system of FIG. 66 and the implant of FIG. 52 according to one embodiment. Initially, a user, such as a surgeon, may thread one or more sutures 1034 through a suture anchor 700 having an anchor body 702 and proximal member 704 connected by a frangible connection 706. (See FIG. 93) Next, a user may connect an inserter 900 or tensioner 1000 or combination inserter/tensioner 900/1000 to the proximal member 704 by screwing the external helical threads 760 of the proximal member 704 into the internal threads 912 of the shaft 902. (See FIG. 94) At this stage, the one or more sutures 1034 may be loose and portions or ends of the one or more sutures 1034 may extend proximally towards the suture grip member 1010.	179	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	Next, a user may loosen the fastener 1040 such that the superior grip plate 1036 and inferior grip plate 1038 can be readily separated. In certain embodiments, the fastener 1040 can be removed and/or the superior grip plate 1036 removed. Referring now to FIG. 95, next a user inserts the one or more sutures 1034 or portions of the one or more sutures 1034 between the superior grip plate 1036 and inferior grip plate 1038. In certain embodiments, the user may wrap or wind the one or more sutures 1034 around the boss 1046. At this stage, a user may then re-connect or tighten the fastener 1040 to close and/or compress the superior grip plate 1036 against the inferior grip plate 1038 and thereby secure and/or tension the one or more sutures 1034 between the anchor body 702 and the suture grip member 1010. In one embodiment, a user may tighten the one or more sutures 1034 manually between the suture grip member 1010 and the anchor body 702 as the fastener 1040 compresses the superior grip plate 1036 against the inferior grip plate 1038. Next, a user may rotate the puller 1004 in a direction 1070.	180	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	Rotation of the puller 1004 in direction 1070 moves the external threads 1032 into the carriage 1002 by engagement with the internal threads 1018 of the carriage 1002. As the threads 1032, 1018 engage, this translates and moves the carriage 1002 proximally towards the puller 1004 in direction 1072. The translation of the carriage 1002 creates a translation force in direction 1072 which applies tension to the one or more sutures 1034.	181	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	The threads 1032, 1018 of the puller 1004 and carriage 1002 provide a significant mechanical advantage that increases tension in the one or more sutures 1034 secured between the anchor body 702 and the suture grip member 1010. Advantageously, reversing the rotation of the puller 1004 in a direction opposite direction 1070 loosens the one or more sutures 1034 such that a user can remove the one or more sutures 1034 or adjust the position or tension of the one or more sutures 1034.	182	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIG. 96 illustrates the position of the carriage 1002 relative to the puller 1004 after a desired level of tension is placed into the one or more sutures 1034. Note that the carriage 1002 is closer to the proximal end 904 of the shaft 902 than before the one or more sutures 1034 were tightened. This causes more of the planar surface 924 of the second section 920 to be exposed. Next, a user can insert the interference member 770 distally within the inserter longitudinal passageway 941 in the direction indicated by arrow 1074. In one embodiment, the interference member 770 is inserted with the point 780 entering the inserter longitudinal passageway 941 first. The user can then urge the interference member 770 through the inserter longitudinal passageway 941 until the interference member 770 reaches the distal end 906 of the shaft 902 and enters the bore 756 of the proximal member 704. A user can move the interference member 770 through the inserter longitudinal passageway 941 and/or bore 756 using gravity or a tool such as a driver.	183	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIG. 97 illustrates one example of a driver 1080 that can be used to move the interference member 770 through the inserter longitudinal passageway 941 and/or bore 756. The driver 1080 may be cylindrical and elongated and may include a drive shaft 1082 having a proximal end 1084 and a distal end 1086. The driver 1080 also includes a drive coupler 1088, external drive threads 1090, and a drive feature 1092.	184	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	The drive coupler 1088 is connected to the drive shaft 1082 at the proximal end 1084. The drive coupler 1088 can be any of a variety of existing couplers suitable for connecting a tool that can rotate the driver 1080 about its longitudinal axis, move the driver 1080 axially, or transmit an axial force through the driver 1080. In one embodiment, the drive coupler 1088 is a conventional Association for Osteosynthesis (AO) quick connect having a D-shaped cross section and a groove for engaging a driving mechanism. The drive mechanism (not shown) may be a manual mechanism such as a handle adapted to engage the drive coupler 1088 or a powered mechanism, such as a drill.	185	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	In certain embodiments, the driver 1080 may include external drive threads 1090 in other embodiments, the driver 1080 may not include external drive threads 1090. In one embodiment, the external drive threads 1090 can be configured to engage internal threads 942 within the longitudinal opening 938 of the collar 908 (i.e., within the inserter 900). The external drive threads 1090 may be positioned along the drive shaft 1082 between the proximal end 1084 and distal end 1086 such that the external drive threads 1090 engage the internal threads 942 when the drive shaft 1082 is inserted within the inserter longitudinal passageway 941 far enough that the external helical threads 782 of interference member 770 can engage the internal helical threads 717 of the anchor body 702 as the external drive threads 1090 engage more of the internal threads 942. In this manner, the external drive threads 1090 may provide a mechanical advantage to assist in driving the interference member 770 into the anchor body 702.	186	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	In embodiments without external drive threads 1090, the drive shaft 1082 can still be used to urge the interference member 770 into the anchor body 702 (note FIGS. 97-104 are not necessarily drawn to scale). In such an embodiment, the drive shaft 1082 may press the interference member 770 towards the suture anchor 700 as the drive shaft 1082 is moved into the inserter longitudinal passageway 941. The drive shaft 1082 is long enough that the drive shaft 1082 can press the interference member 770 into and through the bore 756 such that the point 780 extends into the longitudinal passageway 714.	187	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	The drive feature 1092 is connected to the drive shaft 1082 at the distal end 1086. The drive feature 1092 can be configured to engage a drive recess 790 of an interference member 770. In one embodiment, the drive feature 1092 is a torx shape sized and configured to engage a drive recess 790 that is a torx recess.	188	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIG. 98 illustrates a stage in a sequence of using the suture anchor system 800 in another stage of the sequence illustrated in FIGS. 93-96. At this stage, the inserter 900 is connected to the suture anchor 700 and the tensioner 1000 is positioned to apply a desired level of tension to the one or more sutures 1034. A user has inserted the drive shaft 1082 into the inserter longitudinal passageway 941 and moved the interference member 770 until the point 780 extends into the longitudinal passageway 714 and the drive feature 1092 engages the drive recess 790 of the interference member 770. Next a user may attach a drive mechanism to the drive coupler 1088 and begin rotating the drive shaft 1082. This rotation causes at least one of the external helical threads 782 to engage with an internal helical thread 717 of the anchor body 702. Because the one or more sutures 1034 extend from the proximal opening 716 of the anchor body 702 from within the longitudinal passageway 714, engagement of at least one external helical thread 782 with an internal helical thread 717 of the anchor body 702 secures and compresses at least a portion of the one or more sutures 1034 between the interference member 770 and the anchor body 702. This engagement secures the one or more sutures 1034 with the same tension, or a slightly greater tension, in the one or more sutures 1034 that was present in the one or more sutures 1034 before the interference member 770 is screwed into the proximal opening 716 of the anchor body 702.	189	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIG. 99 is a perspective view of a driver 1080 for use within the system of FIG. 66 and the implant of FIG. 52 according to one embodiment. Specifically, FIG. 99 illustrates that the drive shaft 1082 can engage the interference member 770 as the interference member 770 is moved through the shaft 902 and into the suture anchor 700. FIG. 99 is not necessarily drawn to scale. The driver 1080 applies a torque to the interference member 770 and the least one or more external helical threads 782 of the interference member 770 to engage and/or mesh with at least one or more internal helical threads 717 of the anchor body 702.	190	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	The drive shaft 1082 is long enough to drive the interference member 770 by way of rotation to move completely into the longitudinal passageway 714. Rotation of the driver 1080 in a first direction causes at least one or more external helical threads 782 of the interference member 770 to engage and/or mesh with at least one or more internal helical threads 717 of the anchor body 702. Rotation of the driver 1080 in a second direction opposite the first direction causes external helical threads 782 of the interference member 770 to disengage from one or more internal helical threads 717 of the anchor body 702.	191	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	Advantageously, the drive feature 1092 of the driver 1080 and the drive recess 790 of the interference member 770 can be used both to insert, or drive, the interference member 770 axially into the anchor body 702 and to extract, remove, or back-out the interference member 770 from the anchor body 702. The ability to back the interference member 770 out of the anchor body 702 may be useful to a surgeon who desires to adjust tension in the one or more sutures 1034, remove the suture anchor 700, reposition the suture anchor 700, reconfigure or remove the one or more sutures 1034, or the like. This added flexibility can increase the options to a surgeon using the suture anchor 700 and can lead to move favorable surgical outcomes.	192	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	In certain embodiments, the drive feature 1092 and drive recess 790 may have a configuration different from the one illustrated. For example, the drive recess 790 may be a recess that includes a lip or hook and the drive feature 1092 may include a corresponding hook or lip that engages the one on the interference member 770. In this manner the drive feature 1092 may couple to the interference member 770 and permit one or both of axial force transmission and torque transmission from the driver 1080 to the interference member 770. Such alternative embodiments are within the scope of the present disclosure and enable the driver 1080 to move the interference member 770 into and retract the interference member 770 out of the anchor body 702.	193	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	FIGS. 100-101 are a sequence of perspective views illustrating use of the system of FIG. 66 and the implant of FIG. 52 according to one embodiment after the stage shown in FIG. 98. FIG. 100 shows that after the interference member 770 is secured within the longitudinal passageway 714, the driver 1080 can be removed.	194	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	At this stage, the suture anchor system 800 is prepared for disengagement/separation of the anchor body 702 from the proximal member 704. Also at this stage, the suture anchor 700 may already be inserted/placed/deployed within a patient. Alternatively, or in addition, a user may now, at this stage, deploy or insert the suture anchor 700 into a prepare location in a patient. In such an embodiment, the user may use the inserter 900 to position and press the suture anchor 700 into the desired location. The elongated inserter 900 and securely connected suture anchor 700 facilitate positioning and placement. In certain embodiments, the inserter 900 may be used for cannulated deployment.	195	Added by DJM 9 2021	9/2/21, 12:00 AM
View Edit Delete	IPP-0051-US14 cross roads	Referring to FIG. 101, to separate the proximal member 704 from the anchor body 702, a user may insert a pushrod 1100 into the longitudinal opening 938 of the collar 908 at a proximal end of the suture anchor system 800/ inserter 900. This mounts the pushrod 1100 for axial translation within the inserter 900. The pushrod 1100 may include many similar features and aspects as the driver 1080. In certain embodiments, a driver 1080 can be used to serve the dual purposes of a driver 1080 and/or of a pushrod 1100.	196	Added by DJM 9 2021	9/2/21, 12:00 AM

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