초록 ▼

An insertion instrument is configured to eject a pair of anchor bodies across an anatomical gap so as to approximate the gap. The insertion instrument can include a single cannula that retains the pair of anchor bodies in a stacked relationship, or a pair of adjacent cannulas that each retain respec

An insertion instrument is configured to eject a pair of anchor bodies across an anatomical gap so as to approximate the gap. The insertion instrument can include a single cannula that retains the pair of anchor bodies in a stacked relationship, or a pair of adjacent cannulas that each retain respective anchor bodies. The insertion instrument can be actuated so as to eject the anchor bodies into respective target anatomical locations.

대표청구항 ▼

1. An insertion instrument assembly configured to eject a first anchor and a second anchor at respective target locations, the first and second anchors including respective first and second anchor bodies that extend substantially along a respective direction of elongation, each of the first and seco

1. An insertion instrument assembly configured to eject a first anchor and a second anchor at respective target locations, the first and second anchors including respective first and second anchor bodies that extend substantially along a respective direction of elongation, each of the first and second anchors further including a respective actuation member, the insertion instrument assembly comprising: a casing;a cannula fixed with respect to the casing, the cannula extending out relative to the casing in a distal direction along a cannula axis to a distal end of the cannula, the cannula defining an elongate opening that extends along the cannula axis;a first pusher member aligned with the elongate opening of the cannula;a second pusher member aligned with the elongate opening of the cannula so as to be movable within the cannula along the cannula axis, wherein 1) the second pusher member contains the first anchor body, 2) the elongate opening of the cannula contains the second anchor body and 3) the first pusher member is configured to be depressed in the elongate opening so as to eject the first and second anchor bodies from the cannula and into the respective target locations;a coupling assembly that releasably translatably couples the first pusher member to the second pusher member, such that, in a first mode of operation the first and second pusher members are coupled together and translate together to eject the second anchor body from the cannula, and in a second mode of operation, the first and second pusher members are decoupled from each other so that the first pusher member is translatable with respect to the second pusher member to eject the first anchor body from the second pusher member and out the cannula; anda plunger attached to the first pusher member, the plunger configured for rotational movement with respect to the casing so as to transition the coupling assembly from the first mode of operation to the second mode of operation so as to eject the first and second anchors from the cannula,wherein, when a tensile force is applied to the respective actuation member substantially along the direction of elongation, the respective first and second anchor bodies expand along a respective second direction perpendicular with respect to the respective direction of elongation. 2. The insertion instrument assembly as recited in claim 1, wherein the first pusher member is configured to brace against the first anchor body. 3. The insertion instrument assembly according to claim 1, wherein the cannula defines a slot that receives the respective actuation member, such that the respective actuation member extends out the cannula. 4. The insertion instrument assembly according to claim 1, wherein the first pusher member comprises a push rod that has an outer cross-sectional dimension which is smaller than that of the elongate opening of said cannula such that the respective actuation member extends through said elongate opening of said cannula alongside the push rod. 5. The insertion instrument assembly according to claim 1, wherein said cannula has a conical inlet. 6. The insertion instrument assembly according to claim 1, wherein the second anchor body is spaced from first anchor body along the distal direction. 7. The insertion instrument assembly according to claim 6, wherein the distal end of the cannula defines a needle tip, and depressing the first pusher member causes at least one of the first and second anchor bodies to translate distally out the elongate opening along the distal direction. 8. The insertion instrument assembly according to claim 7, wherein the needle tip is conical. 9. The insertion instrument assembly according to claim 6, wherein the elongate opening terminates at an elongate opening distal end, and the cannula defines a side ejection portal in communication with the elongate opening distal end. 10. The insertion instrument assembly according to claim 9, further comprising a tip that extends from the cannula along the distal direction. 11. The insertion instrument assembly according to claim 10, wherein the tip is conical. 12. The insertion instrument assembly according to claim 11, wherein the tip comprises a cone. 13. The insertion instrument assembly according to claim 6, wherein the cannula defines a tapered distal end. 14. The insertion instrument assembly according to claim 6, wherein the second pusher member defines a plug disposed between the first and second anchor bodies, and translation of the first and second pusher members a sufficient distance to eject the second anchor body causes the plug to translate to a location out the cannula. 15. The insertion instrument assembly according to claim 6, wherein in the first mode of operation, the first pusher member is initially coupled to the second pusher member such that the first pusher member and the second pusher member translate in the distal direction in tandem during a first stroke of the first pusher member. 16. The insertion instrument assembly according to claim 15, wherein the first stroke causes the second pusher member to eject the second anchor body out the cannula. 17. The insertion instrument assembly according to claim 16, wherein in the second mode of operation, the first pusher member is decoupled from the second pusher member after the first stroke such that the first pusher member translates with respect to the second pusher member. 18. The insertion instrument assembly according to claim 15, wherein a second stroke of the first pusher member ejects the first anchor body from the cannula. 19. The insertion instrument according to claim 18, wherein the first and second pusher members are coupled so as to translate in tandem during a first portion of the second stroke. 20. The insertion instrument assembly according to claim 18, further comprising a stop member that is translatably fixed with respect to the cannula, and a clip removably couples the first and second pusher members together. 21. The insertion instrument assembly according to claim 20, wherein the plunger is translatably fixed to the first pusher member, the plunger configured to be depressed so as to depress the first pusher member in the elongate opening. 22. The insertion instrument assembly according to claim 20, wherein the clip is removably attached to the plunger. 23. The insertion instrument assembly according to claim 22, further comprising an attachment member that is translatably fixed to the second pusher member, wherein the clip abuts the attachment member. 24. The insertion instrument assembly according to claim 23, wherein the plunger is depressed a first distance that causes the second anchor body to be ejected from the insertion instrument assembly, and the clip abuts the casing once the plunger has been depressed the first distance so as to prevent the plunger from being depressed a second distance greater than the first distance. 25. The insertion instrument assembly according to claim 24, wherein removal of the clip from the plunger translatably decouples the first and second pusher members, such that depression of the plunger the second distance causes the first pusher member to eject the first anchor body from the insertion instrument assembly. 26. The insertion instrument assembly according to claim 1, wherein the cannula defines a first longitudinal aperture and the first pusher member defines a second longitudinal aperture so that by rotating said first pusher member relative to said cannula said first and second longitudinal apertures can be aligned and said insertion instrument assembly can be released from said respective first and second anchor bodies. 27. The insertion instrument assembly according to claim 1, further comprising complementary first and second guide members that are operably coupled between the casing and the second pusher member so as to guide relative movement between the casing and the second pusher member. 28. The insertion instrument assembly according to claim 27, further comprising an attachment member that is supported by the second pusher member so as to be translatably fixed relative to the second pusher member. 29. The insertion instrument assembly according to claim 28, wherein the plunger is translatably fixed to the first pusher member. 30. The insertion instrument assembly according to claim 29, wherein the first and second guide members are operably coupled between the casing and the attachment member. 31. The insertion instrument assembly according to claim 29, wherein the first and second guide members are configured to translatably couple the first pusher member to the second pusher member. 32. The insertion instrument assembly according to claim 31, wherein the attachment member comprises a collar that extends about the plunger. 33. The insertion instrument assembly according to claim 29, wherein the attachment member is translatably coupled to the plunger. 34. The insertion instrument assembly according to claim 28, wherein the first and second guide members comprise a 1) guide track that extends into at least one of the attachment member and the casing, and 2) a guide pin that is coupled to the other of the attachment member and the casing, such that the guide pin rides in the guide track. 35. The insertion instrument assembly according to claim 34, wherein the guide track extends into the attachment member and the guide pin extends from the casing into the guide track. 36. The insertion instrument assembly according to claim 35, wherein the guide pin is translatably fixed to the casing. 37. The insertion instrument assembly according to claim 35, wherein the guide track defines a first track portion and a second track portion that is offset with respect to the first track portion. 38. The insertion instrument assembly as recited in claim 37, wherein rotation of the plunger causes the guide pin to ride from the first track portion to the second track portion. 39. The insertion instrument assembly as recited in claim 38, wherein the attachment member defines a stop member at terminal ends of the first and second track portions. 40. The insertion instrument assembly as recited in claim 34, wherein the guide pin translates proximally in the guide track as the plunger moves distally relative to the casing so as to eject the first and second anchor bodies from the insertion instrument assembly. 41. The insertion instrument assembly as recited in claim 34, wherein the guide track defines a base having an edge, wherein the guide pin translates along the edge so as to provide at least one of tactile and audio feedback. 42. The insertion instrument assembly according to claim 28, wherein the coupling assembly comprises a coupling member that is carried by the attachment member, the coupling member configured to translatably couple the attachment member relative to the first pusher member. 43. The insertion instrument assembly according to claim 42, wherein the first pusher member defines a first recess, and the coupling member is configured to extend into the first recess so as to translatably couple the first and second pusher members during the first mode of operation. 44. The insertion instrument assembly according to claim 43, wherein the complimentary first and second guide members define a first portion, a second portion that is offset from the first portion, and a stop at one end of the first portion. 45. The insertion instrument assembly according to claim 44, wherein the coupling member is a latch, and the stop of the first portion prevents translation of the second pusher member relative to the first pusher member in the distal direction before the latch is aligned with the second recess. 46. The insertion instrument assembly according to claim 45, wherein the first portion has a length sufficient such that movement of the second guide member along the first portion causes the second pusher member to eject the second anchor body from the insertion instrument. 47. The insertion instrument assembly according to claim 46, wherein the casing carries a second recess that is spaced from the first recess, and wherein movement of the second guide member along the second portion causes the latch to move in alignment with the second recess. 48. The insertion instrument assembly according to claim 47, wherein the latch moves into the second recess so as to translatably decouple the first and second pusher members in the second mode of operation, such that the first pusher member is translatable independently of the second pusher member so as to eject the first anchor body from the insertion instrument assembly. 49. The insertion instrument assembly as recited in claim 48, wherein the cannula defines a distal ejection port, and the first and second anchor bodies are ejected from the instrument through the distal ejection port. 50. The insertion instrument assembly as recited in claim 47, wherein the second pusher member comprises a plug that is disposed such that an ejection port of the cannula extends between the plug and the first pusher member when the latch is in alignment with the second recess, such that the first anchor body can be ejected from the insertion instrument assembly through the ejection port. 51. The insertion instrument assembly as recited in claim 47, wherein when the coupling member moves to a location aligned with the second recess, the coupling member is driven out of the first recess and into the second recess, thereby translatably decoupling the second pusher member from the first pusher member. 52. The insertion instrument assembly according to claim 1, wherein the coupling assembly fixes the first and second pusher members during a first stroke whereby the second anchor body is ejected from the cannula. 53. The insertion instrument assembly according to claim 52, wherein the coupling assembly decouples the first and second pusher members from each other during a second stroke such that the first pusher member is translatable relative to the second pusher member, whereby the first pusher member ejects the first anchor body out the cannula. 54. The insertion instrument assembly according to claim 1, further comprising an attachment member that is translatably fixed to the second pusher member. 55. The insertion instrument assembly according to claim 54, wherein the plunger is translatably fixed to the first pusher member. 56. The insertion instrument assembly according to claim 55, wherein the attachment member is releasably attached to the plunger during translation of the plunger with respect to the casing. 57. The insertion instrument assembly according to claim 56, wherein the coupling assembly comprises a coupling member that is carried by the attachment member, wherein the coupling member is configured to a) extend into a first recess of the plunger so as to translatably couple the attachment member to the plunger prior to rotation of the plunger, and b) be removed from the first recess of the plunger after rotation of the plunger. 58. The insertion instrument assembly according to claim 57, wherein the casing carries a second recess that is spaced from the first recess. 59. The insertion instrument assembly according to claim 58, wherein the casing defines the second recess. 60. The insertion instrument assembly according to claim 59, wherein when the coupling member moves to a location aligned with the second recess, the coupling member is driven out of the first recess and into the second recess, thereby translatably decoupling the attachment member and the plunger. 61. The insertion instrument assembly according to claim 60, wherein the attachment member defines a channel, and the coupling member is configured to move across the channel so as to decouple from the plunger and couple to the casing. 62. The insertion instrument assembly as recited in claim 58, wherein the casing carries an inner housing that carries the second recess. 63. The insertion instrument assembly as recited in claim 62, wherein when the coupling member moves to a location aligned with the second recess, the coupling member is driven out of the first recess and into the second recess, thereby translatably decoupling the attachment member and the plunger. 64. The insertion instrument assembly as recited in claim 63, wherein the coupling member comprises a leaf spring that is attached to the attachment member. 65. The insertion instrument assembly as recited in claim 63, wherein the leaf spring is integral with the attachment member. 66. The insertion instrument assembly according to claim 1, further comprising a depth stop that extends out from the cannula. 67. The insertion instrument assembly according to claim 1, further configured to retain at least one end of a tensioning member that is coupled to the respective actuation members. 68. The insertion instrument assembly according to claim 67, wherein the tensioning member comprises a tensioning strand having first and second ends, and the insertion instrument assembly is configured to retain the first and second ends. 69. The insertion instrument assembly accordingly to claim 68, configured to selectively release one of the first and second ends. 70. The insertion instrument assembly accordingly to claim 69, further comprising a retention assembly that is movable with the first pusher member, and proximal movement of the insertion instrument assembly after the first anchor body has been ejected causes the tensile force to be applied to the respective actuation member of the second anchor. 71. The insertion instrument assembly accordingly to claim 70, wherein the retention assembly is movable with the first pusher member, such that proximal movement of the first pusher member after the first anchor body has been ejected causes the first tensile force to be applied to the respective actuation member of the first anchor, and the first pusher member is configured to be depressed in the elongate opening so as to eject the second anchor body from the cannula, such that when a second tensile force is applied to the respective actuation member of the second anchor, the second anchor body expands, wherein the retention assembly is movable with the first pusher member, such that proximal movement of the first pusher member after the second anchor body has been ejected causes the second tensile force to be applied to the respective actuation member of the second anchor. 72. The insertion instrument assembly as recited in claim 69, further comprising a tapered inner surface that defines a tapered bore, and a first locking member having a cross-sectional dimension less than a cross-sectional dimension of a first end of the tapered bore and greater than a cross-sectional dimension of a second end of the tapered bore, wherein the first locking member is configured to releasably retain at least one of the first and second ends of the tensioning strand between the locking member and the tapered surface. 73. The insertion instrument assembly according to claim 72, further comprising a second locking member that is configured to attach to the second end of the tensioning strand. 74. The insertion instrument assembly according to claim 73, wherein the plunger is translatably fixed to the first pusher member, wherein the plunger is configured to depress the first pusher member in the elongate opening. 75. The insertion instrument assembly according to claim 74, further comprising a release member in communication with the first locking member, wherein movement of the release member biases the first locking member out to release the tensioning strand. 76. The insertion instrument assembly according to claim 75, wherein the release member pushes the first locking member toward the first end of the tapered bore so as to create a gap between the first locking member and the tapered inner surface. 77. The insertion instrument assembly according to claim 73, wherein the second locking member is threadedly attached at a location adjacent the tapered inner surface. 78. The insertion instrument assembly according to claim 77, wherein the second locking member is aligned with the tapered bore, such that the second end of the tensioning strand extends through the tapered bore and is attached to the second locking member. 79. The insertion instrument assembly according to claim 69, further comprising a retention assembly including a first locking body configured to releasably retain the first end of the tensioning strand, and a second locking body configured to retain the second end of the tensioning strand. 80. The insertion instrument assembly according to claim 79, further comprising an actuator operably coupled to the first locking body so as to release the first locking body from the first end of the tensioning strand. 81. The insertion instrument assembly according to claim 79, wherein the actuator becomes operably coupled to the first locking body once the first and second anchor bodies have been ejected. 82. The insertion instrument assembly according to claim 69, further comprising a cutting assembly having a cutting blade, the cutting assembly movable between a disengaged position whereby the cutting blade is spaced from the tensioning strand and an engaged position whereby the cutting blade severs the tensioning strand. 83. The insertion instrument assembly according to claim 82, wherein the cutting assembly includes a longitudinally elongate shaft that is coupled to the cutting blade, and longitudinal translation of the shaft causes the cutting blade to sever the tensioning strand. 84. The insertion instrument assembly according to claim 83, wherein the cutting assembly further includes a switch pivotally coupled between both the elongate shaft and the cutting blade. 85. The insertion instrument assembly according to claim 82, wherein the cutting assembly includes an actuator that is elongate along a direction angularly offset with respect to the cannula, and movement of the actuator along the direction angularly offset with respect to the cannula severs the tensioning strand. 86. The insertion instrument assembly according to claim 1, wherein the first anchor body defines a first plurality of openings spaced apart with respect to each other along the respective direction of elongation of the first anchor body, the respective actuation member of the first anchor extends through at least three of the first plurality of openings of the first anchor body, such that the respective actuation member of the first anchor is configured to apply the tensile force to the first anchor body so as to expand the first anchor body. 87. The insertion instrument assembly according to claim 86, wherein the second anchor body defines a second plurality of openings spaced apart with respect to each other along the respective direction of elongation of the second anchor body, the respective actuation member of the second anchor extends through at least three of the second plurality of openings of the second anchor body, such that the respective actuation member of the second anchor is configured to apply the tensile force to the second anchor body so as to expand the second anchor body. 88. The insertion instrument assembly according to claim 1, wherein the second pusher member defines a cannulation that extends along the distal direction, wherein the first pusher member is insertable into the cannulation of the second pusher member.