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 bone anchor system for coupling tissue to bone with a suture, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end, a distal end, and a cavity, the cavity comprising a first opening at or near the proximal end; and   a locking assembly at least partially disposed in the cavity, the locking assembly comprising:
 a first locking element; 
 a second locking element interacting with the first locking element, the first and second locking elements movable with respect to the cavity; and 
 a suture path extending through a second opening in the first locking element in a direction toward the second locking element, through a suture gap between the first locking element and the second locking element, around the second locking element, through a third opening in the second locking element, and back through the second opening, wherein the first and second locking elements are positionable with respect to each other such that the suture is moveable along the suture path in a first direction and inhibited from moving in a second direction. 
   
     
     
         33 . The bone anchor system of  claim 32  wherein the locking assembly comprises a two bar locking assembly. 
     
     
         34 . The bone anchor system of  claim 32 , wherein the cavity extends along a longitudinal axis of the main body. 
     
     
         35 . The bone anchor system of  claim 32 , further comprising one or more coupling members disposed on a surface of the main body, wherein the one or more coupling members are configured to substantially inhibit the main body from moving out of the bone. 
     
     
         36 . The bone anchor system 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 bone anchor system of  claim 32 , wherein the first and second locking elements are axially movable with respect to each other. 
     
     
         38 . The bone anchor system of  claim 32 , wherein movement of at least one of the first and second locking elements in an axial direction with respect to another of the first and second locking elements allows or inhibits movement of the suture. 
     
     
         39 . The bone anchor system of  claim 32 , wherein each of the first and second locking elements comprises a proximal portion and a distal portion, and wherein the distal portions are disposed in the cavity. 
     
     
         40 . The bone anchor system of  claim 32 , wherein the first and second locking elements are substantially parallel to each other. 
     
     
         41 . The bone anchor system of  claim 32  wherein the first locking element comprises a first locking ring, and wherein the second locking element comprises a second locking ring. 
     
     
         42 . The bone anchor system of  claim 41 , wherein each of the first and second locking rings comprises an upper bar located along the suture path and a lower bar disposed at least partially in the cavity. 
     
     
         43 . The bone anchor system of  claim 32 , further comprising the suture, wherein the suture comprises a distal loop portion and two proximal end portions, wherein at least one of the two proximal end portions is coupled to the locking assembly such that tensioning the at least one of the two proximal end portions in the first direction moves the suture in the first direction, and tensioning the at least one of the two proximal end portions in the second direction engages the locking assembly to inhibit movement of the suture. 
     
     
         44 . The bone anchor system of  claim 32 , further comprising a suture puller, wherein the suture puller is configured to thread at least a portion of the suture through the locking assembly. 
     
     
         45 . The bone anchor system of  claim 32 , further comprising an inserter, the inserter being configured to be reversibly coupled to the main body, wherein the inserter is configured to position the main body in a fourth opening in the bone. 
     
     
         46 . The bone anchor system of  claim 32  wherein the first direction comprises a portion of the suture path extending from the second locking element, through the suture gap, and toward the first locking element. 
     
     
         47 . The bone anchor system of  claim 32  wherein movement of the suture in the first direction increases the suture gap. 
     
     
         48 . The bone anchor system of  claim 32  wherein movement of the suture in the first direction displaces the first locking element away from the proximal end of the main body to permit suture movement in the first direction. 
     
     
         49 . The bone anchor system of  claim 32  wherein movement of the second locking element toward the proximal end of the main body permits suture movement in both the first and second directions. 
     
     
         50 . The bone anchor system of  claim 32  wherein the locking assembly comprises a reversible locking assembly. 
     
     
         51 . The bone anchor system of  claim 32  wherein the second direction comprises a portion of the suture path extending from the first locking element, through the suture gap, and toward the second locking element. 
     
     
         52 . The bone anchor system of  claim 32  wherein movement of the suture in the second direction decreases the suture gap to inhibit suture movement in the second direction. 
     
     
         53 . The bone anchor system of  claim 32  wherein movement of the suture in the second direction displaces the second locking element away from the proximal end of the main body to inhibit suture movement in the second direction. 
     
     
         54 . The bone anchor system of  claim 32  wherein movement of the suture in the second direction compresses the suture between the first and second locking elements to inhibit suture movement in the second direction. 
     
     
         55 . The bone anchor system of  claim 32  wherein movement of the suture in the first direction creates tension on the suture in the second direction. 
     
     
         56 . The bone anchor system of  claim 32  wherein the first and second locking elements are axially movable with respect to each other to compress the suture in the suture gap. 
     
     
         57 . The bone anchor system of  claim 32  further comprising an insert coupled to the main body, wherein the locking assembly is part of the insert. 
     
     
         58 . A bone anchor system for coupling tissue to bone, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end and a distal end;   a locking assembly comprising at least a first locking element and a second locking element, the first and second locking elements movable with respect to the main body; and   at least one suture extending along a proximal surface of the first locking element facing the main body and toward the second locking element, through a suture gap located between the proximal surface of the first locking element and a distal surface of the second locking element facing away from the main body, around the second locking element, and along proximal surfaces of the second locking element and the first locking element, wherein the first and second locking elements are positionable with respect to each other such that the at least one suture is moveable in a first direction and inhibited from moving in a second direction.   
     
     
         59 . A bone anchor system for coupling tissue to bone, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end and a distal end;   a locking assembly comprising at least a first locking element and a second locking element, the first and second locking elements movable with respect to the main body; and   at least one suture extending between the first locking element and the proximal end of the main body toward the second locking element, through a suture gap between the first and second locking elements, around the second locking element, and between the first and second locking elements and the proximal end of the main body, wherein the first and second locking elements are positionable with respect to each other such that the at least one suture is moveable in a first direction and inhibited from moving in a second direction.   
     
     
         60 . A bone anchor system for coupling tissue to bone, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end and a distal end;   a locking assembly comprising at least a first locking element and a second locking element, the first and second locking elements movable with respect to the main body; and   at least one suture wrapped around the first locking element in a first direction and wrapped around the second locking element in a second opposite direction, such that the first locking element is substantially stationary with respect to the main body in response to a first tension force on a first end of the at least one suture, and wherein the second locking element compresses the at least one suture against the first locking element in response to a second tension force on a second end of the at least one suture, such that the at least one suture is inhibited from movement in response to the second tension force.   
     
     
         61 . A bone anchor system for coupling tissue to bone, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end and a distal end;   a locking assembly comprising at least a first locking element and a second locking element, the first and second locking elements movable with respect to the main body; and   at least one suture wrapped around the first locking element in a first direction and wrapped around the second locking element in a second opposite direction, such that a gap between the first and second locking elements permits free passage of the at least one suture through the locking assembly in response to a first tension force on a first end of the at least one suture, and the gap is reduced in response to a second tension force on a second end of the at least one suture, such that the at least one suture is inhibited from movement in response to the second tension force.   
     
     
         62 . A bone anchor system for coupling tissue to bone, the bone anchor system comprising:
 a main body configured to be placed in a bone, the main body comprising a proximal end, a distal end, and a cavity, the cavity comprising a first opening at or near the proximal end; and   a locking assembly at least partially disposed in the cavity, the locking assembly comprising:
 a first locking element; 
 a second locking element interacting with the first locking element, the first and second locking elements movable with respect to the cavity; 
 a suture path extending through a second opening in the first locking element in a direction toward the second locking element, through a suture gap between the first locking element and the second locking element, around the second locking element, through a third opening in the second locking element, and back through the second opening; and 
 a suture in the suture path, wherein the first and second locking elements are positionable with respect to each other such that the suture is moveable along the suture path in a first direction and inhibited from moving in a second direction.