Ring cinch assembly to attach bone to tissue

Abstract

Systems, apparatuses and methods for securing tissue to bone using a bone anchoring system are described. Methods and apparatuses may allow transformation between locked and unlocked states, thereby allowing adjustment of the tension in the suture. The apparatus and/or methods may allow unidirectional movement of a suture, while preventing slippage or movement of the suture and tissue in the opposite direction. Ends of a suture may be individually tensioned to adjust positioning of a tissue with respect to a bone.

1 - 31 . (canceled) 
   
   
       32 . A method of coupling a tissue structure to bone comprising:
 coupling a suture to a tissue;   coupling at least one end portion of the suture to the locking assembly;   positioning a bone anchor in an opening in a bone, the bone anchor comprising:
 a main body configured to be placed in an opening in a bone, the main body comprising a proximal end, a distal end, and a cavity, the cavity comprising an opening at or near the proximal end; and 
 a two bar locking assembly at least partially disposed in the cavity of the bone anchor main body, the two bar locking assembly comprising at least two interacting locking elements, wherein at least two of the interacting locking elements comprises at least one bar; and 
   positioning the locking elements, with respect to each other, such that the bars of the locking elements allow movement of the suture in a first direction and inhibit movement of the suture in a direction opposite to the first direction.   
   
   
       33 . The method of  claim 32 , wherein at least one of the locking elements is moveable in the cavity. 
   
   
       34 . The method of  claim 32 , wherein the cavity extends along a longitudinal axis of the bone anchor main body. 
   
   
       35 . The method of  claim 32 , further comprising one or more coupling members disposed on the surface of the main body, wherein the coupling members are configured to substantially inhibit the bone anchor from moving out of the opening in the bone. 
   
   
       36 . The method of  claim 32 , further comprising an insert coupled to the main body, wherein the cavity is at least partially defined by at least a portion of the main body and at least a portion of the insert. 
   
   
       37 . The method of  claim 32 , wherein the locking assembly comprises two ring shaped members. 
   
   
       38 . The method of  claim 32 , wherein the locking assembly comprises two ring-shaped members, wherein the ring shaped members are axially movable with respect to each other. 
   
   
       39 . The method of  claim 32 , wherein movement of at least one locking element in an axial direction with respect to the other locking element allows or inhibits movement of the suture. 
   
   
       40 . The method stem of  claim 32 , wherein the locking elements comprise a proximal portion and a distal portion, wherein the distal portions are disposed in the cavity and wherein the proximal portion comprises a bar configured to interact with a suture. 
   
   
       41 . The method of  claim 32 , wherein the locking elements are substantially parallel to each other. 
   
   
       42 . The method of  claim 32 , further comprising coupling at least one end of the suture to the locking assembly. 
   
   
       43 . The method of  claim 32 , wherein positioning the bone anchor in a bone comprises reversibly coupling the bone anchor to an inserter, and using the inserter to insert at least a portion of the bone anchor in the bone. 
   
   
       44 . The method of  claim 32 , wherein coupling the suture to the locking assembly comprises coupling the suture to a suture puller, and threading at least a portion of the suture through the locking assembly using the suture puller. 
   
   
       45 . The method of  claim 32 , wherein the suture is coupled to the locking assembly prior to inserting the bone anchor in the bone. 
   
   
       46 . The method of  claim 32 , further comprising moving the suture through the locking assembly to reposition the tissue with respect to the bone.