US 6,447,516 B1Grant
Method of securing tissue
Issue Date:2002-09-10
•376 Claims
•6 Drawing Sheets
Abstract
A retainer member formed of bone secures tissue against movement relative to a portion of a bone in a patient's body. The retainer member is utilized to form an opening in a compact outer layer of a portion of the bone in the patient's body. The retainer member formed of bone is advantageously enclosed in a tubular member or sleeve to prevent breaking of the retainer member during the forming of the opening in the bone. The extent of movement of the retainer member into the bone in the patient's body is determined as the retainer member is moved into the bone. A suture may be connected with the retainer member and used to connect tissue with the bone. The retainer member may be positioned across a fracture in a bone to hold portions of the bone on opposite sides of the fracture against movement relative to each other. The retainer member may be used at a joint between end portions of bones to immobilize the joint. The joint may be released for movement by breaking the retainer member formed of bone.
Metadata
Inventor
- Peter M. Bonutti
Application Information
Application Number:US 09/370,865
Filing Date:1999-08-09
Priority Date:1999-08-09
Art Unit:7
Classifications
IPC:
A61B 1756
Field of Search:
606 72606 76606 60623 1311623 1314623 1315623 1317623 1312623 1313623 1316
Patent Drawings (6 sheets)
Description
BACKGROUND OF THE INVENTION
[0002] The present invention relates to a new an improved method of securing tissue against movement relative to a portion of a bone in a patient's body.
[0003] Various tissue fixation systems have previously been utilized to hold portions of body tissue against movement relative to each other. When tissue is secured against movement relative to a portion of a bone, it is necessary to interconnect the bone and the tissue. In this situation, it has been a common practice to drill a hole which extends into or through the bone. A retaining member such as a pin, screw or suture anchor is positioned in the hole after it has been drilled in the bone. The concept of utilizing a retainer member formed of bone to anchor a suture is disclosed in U.S. Pat. No. 5,626,612.
SUMMARY OF THE INVENTION
[0004] The present invention relates to a new and improved method of securing tissue against movement relative to a portion of a bone in a patient's body. The method includes positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member with the tissue to be secured. The step of positioning the retainer member formed of bone in the patient's body may include utilizing the retainer member to form an opening in a compact outer layer of the portion of the bone in the patient's body.
[0005] When the retainer member formed of bone is used to form an opening in the portion of the bone in the patient's body, the retainer member may advantageously be at least partially enclosed in a tubular member. Force may be applied against a trailing end portion of the retainer member formed of bone to force a leading end portion of retainer member into the portion of the bone in the patient's body. Movement of the retainer member into the portion of the bone in the patient's body may advantageously be interrupted when the leading end portion of the retainer member has moved to a predetermined depth in the bone in the patient's body.
[0006] The retainer member formed of bone may extend through and/or tension body tissue which is to be connected with the bone in the patient's body by the retainer member. The retainer member formed of bone may have a head end portion which engages body tissue. Alternatively, the retainer member formed of bone may be utilized to anchor a suture which is connected with body tissue. The retainer member formed of bone may be positioned in a bone in the patient's body so as to extend across a fracture and hold the portions of the bone on opposite sides of the fracture against movement relative to each other.
[0007] A retainer member, which may or may not be formed of bone, is utilized to immobilize a joint by having the retainer member extend between bones at the joint. If it is subsequently desired to release the joint for movement, the retainer member may be broken.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The foregoing and other features of the invention will become more apparent upon a consideration of the following description taken in connection with the accompanying drawings wherein:
[0009] FIG. 1 is a fragmentary schematic sectional view illustrating engagement of a retainer member formed of bone with tissue which is to be tensioned and connected with a bone in a patient's body;
[0010] FIG. 2 is a schematic illustration, similar to FIG. 1, illustrating the manner in which the retainer member forms an opening in the bone in the patient's body;
[0011] FIG. 3 is a schematic illustration, similar to FIGS. 1 and 2, illustrating the manner in which the tissue is connected with the bone by the retainer member;
[0012] FIG. 4 is a schematic illustration, similar to FIG. 3, illustrating the manner in which a second embodiment of the retainer member formed of bone is used to secure tissue against movement relative to a bone in a patient's body;
[0013] FIG. 5 is a fragmentary schematic illustration, similar to FIG. 1, illustrating the manner in which a retainer member formed of bone is connected with a suture prior to being positioned in a bone in a patient's body;
[0014] FIG. 6 is a fragmentary schematic illustration, similar to FIG. 5, illustrating the manner in which the retainer member is positioned in the bone in the patient's body and the suture is used to connect tissue with the bone;
[0015] FIG. 7 is a schematic fragmentary sectional view illustrating the manner in which a retainer member formed of bone is used to hold a portion of a bone on one side of a fracture against movement relative to a portion of the bone on the opposite side of the fracture;
[0016] FIG. 8 is a schematic fragmentary sectional view, joined similar to FIG. 7, illustrating the manner in which a second embodiment of the retainer member formed of bone is used to hold a portion of a bone on one side of a fracture against movement relative to a portion of the bone on the opposite side of the fracture;
[0017] FIG. 9 is a schematic illustration depicting the relationship between end portions of bones in patient's body at a joint between the bones;
[0018] FIG. 10 is an enlarged schematic fragmentary sectional view of the joint of FIG. 9 and illustrating the manner in which a retainer member extends across the joint to immobilize the joint and hold tissue against movement relative to the joint;
[0019] FIG. 11 is a schematic fragmentary sectional view, similar to FIG. 10, illustrating the a manner in which a second embodiment of the retainer member is utilized to immobilize a joint and hold tissue against movement relative to the joint; and
[0020] FIG. 12 is a schematic fragmentary sectional view illustrating the manner in which the retainer member of FIG. 11 is broken to release the joint for movement; and
[0021] FIG. 13 is a schematic fragmentary sectional view, similar to FIG. 12, illustrating the manner in which a retainer member is moved into bones at a joint to immobilize the joint and hold tissue against movement relative to the joint.
DESCRIPTION OF SPECIFIC PREFERRED EMBODIMENTS OF THE INVENTION
Embodiment of FIGS.
[0022] In the embodiment of the invention illustrated in FIGS. 1-3, a retainer member 20 formed of bone is utilized to hold body tissue 22 against movement relative to a portion of a bone 24 in a human patient's body. The retainer member 20 may formed of bone which is allograft, autograft, or heterograft. However, it is contemplated that it may be preferred to form the retainer member 20 of freeze dried hard cortical bone.
[0023] The tissue 22 is connective tissue, such as a ligament or tendon. However, the tissue 22 could be other types of tissue if desired.
[0024] When the tissue 22 is to be connected with the bone 24, the retainer member 20 is inserted through an end portion 28 of the tissue 22. The retainer member 20 is then pulled toward the right (as viewed in FIG. 1), in the manner indicated by an arrow 30 in FIG. 1, to tension the tissue 22. The end portion 28 of the tissue 22 is moved rightward from an initial position (FIG. 1) to a connecting position (FIG. 2) as the tissue is tensioned.
[0025] The retainer member 20 is then positioned in the bone 24 in the patient's body in the manner illustrated in FIGS. 2 and 3. The retainer member 20 extends through a compact outer or cortical layer 32 of the bone into cancellous bone 34. A cylindrical outer side surface 36 (FIG. 3) on the installed retainer member 20 engages the end portion 28 of the tissue 22, the compact outer layer 32 of the bone 24, and the cancellous bone 34 to maintain tension in the tissue 22 and hold the tissue against movement relative to the bone 24. Although it is preferred to form the retainer member 20 with a cylindrical outer side surface 36, is contemplated that the retainer member 20 could have a different configuration if desired.
[0026] In accordance one of the features of the present invention, the retainer member 30 is utilized to form an opening 40 (FIGS. 2 and 3) at a location in the bone 24 where there is no naturally occurring opening (FIG. 1). Although it is preferred to initiate formation of the opening 40 with the retainer member 20 at a location in the bone 24 which is free of openings (FIG. 1), it is contemplated that a small opening could be predrilled through the compact outer layer 32 and into the cancellous bone 34 if desired. This small pilot opening would function to facilitate locating a leading end portion 44 of the retainer member 20 relative to the bone 24.
[0027] If a pilot opening is formed in the bone 24, the retainer member 20 would enlarge the pilot opening. As the pilot opening is enlarged by the retainer member 20, the opening 40 in the bone 24 would be formed to a configuration corresponding to the configuration of the outer side surface 36 of the retainer member. For example, if the retainer member 20 has a rectangular outer side surface 36 the opening 40 would be formed to have a rectangular cross-sectional configuration as the retainer member is moved into the pilot opening. Alternatively, if the retainer member 20 has a cylindrical outer side surface 36, the retainer member would form the opening 40 with a cylindrical side surface.
[0028] The illustrated retainer member 30 is a solid cylindrical body of hard cortical bone. However, it is contemplated that an axially extending passage could be formed through the retainer member 20. This axially extending passage would accept a long, thin guide member (not shown), such as a K-wire. The guide member, that is, the K-wire, would be utilized to initiate formation of a small opening extending through the compact outer or cortical layer 32 into the cancellous bone 34.
[0029] The retainer member 20 would then be moved along the guide member until the leading end portion 44 of the retainer member 20 engages the hard, compact outer layer 32 of the bone 24. The retainer member 20 would then be utilized to form an opening 40 in the compact outer layer 32 of the bone 24 with a cross-sectional configuration corresponding to the cross-sectional configuration of the retainer member. During formation of the opening 40 with the retainer member 20, the retainer member would be moved axially along the guide rod or wire. Once the retainer member 20 has been moved to a desired position relative to the bone 24, the guide wire or rod would be removed from the bone and from the retainer member.
[0030] In the embodiment of the invention illustrated in FIGS. 1-3, it is preferred to initiate formation of the opening 40 in the bone 24 with the retainer member 20. Prior to initiation of formation of the opening 40 with the retainer member 20, a hard outer surface 48 is removed from the compact outer layer 32 of bone by a decortication process. The decortication process is performed by abrading the hard outer surface 48 on the compact outer layer 32 of bone to expose an imperforate inner area 50 at a location where the retainer member 20 is to be utilized to form the opening 40 (FIGS. 2 and 3) in the bone 24.
[0031] Once the decortication process has been completed, the retainer member 20 is moved through the end portion 28 of the tissue 22 in the manner illustrated schematically in FIG. 1. The retainer member 20 is then pulled toward the right (as viewed in FIG. 1) to obtain a desired level of tension in the tissue 22. This moves the end portion 28 of the tissue 22 from the initial position of FIG. 1 to the connecting position of FIG. 2.
[0032] A pointed leading end portion 44 of the retainer member 20 is then moved into engagement with the imperforate inner area 50 on the compact outer layer 32 of bone 24. The retainer member 20 initiates formation of the opening 40. The retainer member 20 is then moved axially through the compact outer layer 32 to the cancellous bone 34 (FIGS. 2 and 3). To move the retainer member 20 through the compact outer layer 32, the retainer member 20 may be rotated about its longitudinal central axis 54 and moved axially into the bone 24 in much the same manner in which a drill is rotated about its central axis and moved into a member being drilled.
[0033] It is believed that it will be preferred to move the retainer member 20 into the bone 24 under the influence of an axial force without rotating the retainer member about its central axis 54. Since bone has a relatively high compressive strength, the retainer member 20 formed of bone can be utilized to transmit relatively large forces along the longitudinal central axis 54 of the retainer member 20 to force the retainer member into the bone 24. However, bone has a relatively low tensile strength and cannot transmit large transverse loads. Therefore, when the retainer member 20 is moved into the bone 24 under the influence of axial forces, there may be a tendency for the retainer member to shear or fail by a lateral buckling or fracture of the retainer member rather than by direct compression of the retainer member.
[0034] In order to support the retainer member 20 during movement of the retainer member into the bone 24, the retainer member is advantageously inserted into a tubular cylindrical metal sleeve or member 58 (FIG. 2). An annular end portion 62 of the cylindrical sleeve 58 is positioned in engagement with the inner area 50 on the compact outer layer 32 at a location where the retainer member 20 is to be moved into the bone 24. A point on the conical leading end portion 44 of the retainer member engages the inner area 50 on the bone 24 at a location where the formation of the opening 40 is to be initiated.
[0035] When the retainer member 20 is to be moved through the tissue 32 into the bone 24, the manner illustrated in FIGS. 1 and 2, the tubular cylindrical sleeve or member 58 is also moved through the end portion 28 of the tissue 22 (FIG. 2). However, if desired, the retainer member 20 could be moved into the bone 24 to the position illustrated in FIG. 3 and the end portion 28 of the tissue then positioned in engagement with the retainer member 20. However, it is believed that it will be preferred to insert the retainer member 20 through the end portion 28 of the tissue 22 before the retainer member is moved into the bone 24 (FIG. 1) so that the retainer member 20 can be utilized to tension the tissue 22.
[0036] The tubular member 58 may be moved through the end portion 28 of the tissue 22 (FIG. 2) contemporaneously with the retainer member 20. The conical leading end portion 44 of the retainer member 20 would project from the end of the tubular member 58. This would enable the leading end portion 44 of the retainer member 20 to be utilized to pierce the tissue 22 to initiate the formation of an opening in the tissue. The tubular sleeve 58 can then be utilized to further form the opening in the tissue 22 as the sleeve is moved into the end portion 28 of the tissue. The sleeve 58 may be utilized to apply force to the end portion 28 of the tissue 22 during tensioning of the tissue, that is, during movement of the tissue toward the right (as viewed in FIG. 1).
[0037] The retainer member 20 is removed out of the tubular sleeve 58 into the compact outer layer 32 of the bone 24 (FIG. 2). To move the retainer member 20 out of the sleeve 58 into the bone 24, a pusher member 66 is utilized to apply an axial force to a trailing end portion 68 (FIG. 2) of the retainer member 20. The axial force applied by the pusher member 36 has been indicated schematically by an arrow 70 in FIG. 2.
[0038] The force 70 applied by the pusher member 66 against the trailing end portion 68 of the retainer member 20 moves the pointed leading end portion 44 of the retainer member 20 into the compact outer layer 32 of the bone 24 and initiates the formation of the opening 40. The tubular sleeve 58 engages the cylindrical outer side surface 36 of the retainer member 20 to support the retainer member against sidewise loading. This results in the retainer member being subjected only to compressive forces as the retainer member is forced into the bone 24.
[0039] As the retainer member 20 moves into the bone 24, the material of the compact outer layer 32 of a bone is displaced sideways by the leading end portion 44 of the retainer member. As the retainer member 20 continues to move into the compact outer layer 32 of the bone 24, the material of the compact outer layer supports the retainer member 20 against transverse loading in much the same manner as in which the tubular sleeve 58 supports the retainer member 20. Therefore, the pusher member 68 can apply a relatively large axial force to the retainer member 20 without failure, that is without fracture or buckling, of the retainer member 20. The pusher member 66 has a cylindrical outer side surface with the same diameter as the cylindrical outer side surface 36 of the retainer member 20 and of the passage extending through the tubular sleeve 58.
[0040] In accordance with another of the features of the present invention, the retainer member 20 is moved through a predetermined distance into the bone 24. During movement of the retainer member 20 into the bone 24 under the influence of the axial force 70, the extent of movement of the retainer member into the bone 24 is determined. The step of moving the retainer member 20 axially into the bone 24 is interrupted when the leading end portion 44 of the retainer member 20 has moved through the compact outer layer 32 of the bone 24 and has moved a predetermined distance into the cancellous bone 34.
[0041] In order to enable the extent of penetration of the retainer member 20 into the bone 24 to be determined during movement of the retainer member into the bone, indicia 74 is provided on the pusher member 66. The indicia 74 cooperates with the tubular sleeve 58 to indicate the extent of movement of the retainer member 20 into the bone 24. When the indicia 74 indicates that the retainer member 20 is moved through a desired distance into the bone 24, the application of the force 70 against the retainer member 20 by the pusher member 66 is interrupted.
[0042] In the embodiment of the invention illustrated in FIG. 2, the indicia 74 is provided by a plurality of bands of different color on the pusher member 66. Each of the annular bands on the cylindrical pusher member 66 corresponds to a different extent of movement of the retainer member 20 into the bone 24. When a band of a color corresponding to a desired extent of movement of the retainer member 20 into the bone 24 is aligned with an annular upper end 76 of the tubular sleeve 58, the application of the force 70 to the pusher member is interrupted.
[0043] It should be understood that although the indicia 74 has been illustrated in FIG. 2 as being formed by annular bands of different colors, the indicia 74 could be formed by suitable alphanumeric characters if desired. Rather than providing the indicia 74 on the pusher member 66, a stop element could be provided on the pusher member. The stop element would be moved into engagement with a selected one of a plurality of slots which have different lengths and extend axially along the tubular sleeve 58. Of course, other methods of indicating the extent of movement of the retainer member 20 into the bone 24 could be utilized if desired.
[0044] Once the retainer member 20 has been moved to the desired position relative to the bone 24, the pusher member 66 is removed from the tubular sleeve 58. The tubular sleeve 58 is removed from the end portion 28 of the tissue 22. This results in the tissue 22 being secured against movement relative to the bone 24 by the retainer member 20 (FIG. 3). Therefore, forces resulting from tension in the tissue 22 are transmitted through the retainer member 20 to the bone 24.
[0045] The retainer member 20 is effective to secure the tissue 22 against movement relative to the bone 24 during healing of the tissue. Since the retainer member 20 is formed of bone, the retainer member promotes healing and does not have to be removed after the tissue 22 has healed.
[0046] The foregoing description has assumed that the retainer member 20 is inserted through the end portion 28 of the tissue 22 and then moved into the bone 24. However, if desired, the retainer member 20 could be moved into the bone 24 prior to engaging the tissue 22. If this was done, the end portion 28 of the tissue 22 would be pulled to tension the tissue and would then be forced downward, as viewed in FIGS. 2 and 3, onto the exposed trailing end portion 68 of the retainer member 20. If desired, a point could be provided on the trailing end portion 68 of the retainer member 20 to facilitate movement of the retainer member into the end portion 28 of the tissue 22.
Embodiment of FIG.
[0047] In the embodiment of the invention illustrated in FIGS. 1-3, a cylindrical retainer member 20 is utilized to secure the tissue 22 against movement relative to the bone 24. In the embodiment of the invention illustrated in FIG. 4, a head end portion is provided on the retainer member to clamp the tissue against the bone. Since the embodiment of the invention illustrated in FIG. 4 is generally similar to the embodiment of the invention illustrated in FIGS. 1-3, similar numerals will be utilized to designate similar components, the suffix letter “a” being added to the numerals of FIG. 4 to avoid confusion.
[0048] A retainer member 20a(FIG. 4) is formed of bone and is utilized to secure tissue 22aagainst movement relative to bone 24ain a human patient's body. The retainer member 20ais also utilized to maintain tension in the tissue 22a. The retainer member 20ahas a cylindrical shank portion 80 which extends through an end portion 28aof the tissue 22a. The shank portion 80 of the retainer member 20aextends through a compact outer layer 32aof the bone 24ainto cancellous bone 34awhich is enclosed by the compact outer layer 32a. The shank portion 80 is utilized to form an opening 40ain the bone 24a.
[0049] In accordance with a feature of this embodiment of the invention, the retainer 20ahas a circular head end portion 82 which projects radially outward from the cylindrical shank portion 80 and is effective to apply force against the end portion 28aof the tissue 22a. Both the head end portion 82 and the shank portion 80 of the retainer member 20aare formed of bone. The head end portion 82 and the shank portion 80 are formed by a single piece of hard cortical bone which has been freeze dried.
[0050] The head end portion 82 of the retainer 20ais effective to clamp the end portion 28aof the tissue 22aagainst an inner area 50aon the compact outer layer 32aof the bone 24a. The inner area 50ais formed by a decortication process during which a portion of a hard outer surface 48ais removed. Removal of the hard outer surface 48afacilitates penetration of the bone 24aby the retainer member 20a.
[0051] The end portion 28aof the tissue 22ais engaged by the shank portion 80 of the retainer member 20a, in the same manner as is illustrated in FIG. 1 for the retainer member 20. The tissue 22ais then tensioned by moving the retainer member 20aand the end portion 28aof the tissue toward the right (as viewed in FIG. 4), in the same manner as is schematically illustrated in FIGS. 1 and 2 for the tissue 22. The shank portion 80 of the retainer member 20ais then utilized to form an opening in the bone 24a.
[0052] The head end portion 82 of the retainer member 20ais pressed firmly against the end portion 28aof the tissue 22ato hold the tissue in place and maintain a desired tension in the tissue. Although it is preferred to tension the tissue 22 and 22aof FIGS. 1-4 and to maintain the tension in the tissue with the retainer members 20 and 20a, the retainer members could be utilized to hold the tissue in place without tensioning the tissue.
[0053] In the embodiment of the invention illustrated in FIG. 4, the shank portion 80 of the retainer member 20ais utilized to initiate formation of the opening 40aat a location which is free of naturally occurring openings. However, a small pilot opening could be provided in the manner previously described in connection with the embodiment of the invention illustrated in FIGS. 1-3. As was previously mentioned, the pilot opening could be formed with a drill or a long thin member, such as a K-wire. If a long thin member is used to form the pilot opening, the retainer member 20acould be provided with an axial passage extending through the shank portion 80 and the head end portion 82. The long thin member would be inserted through the passage in the retainer member 20aand utilized to guide movement of the retainer member into the bone 24a.
Embodiment of FIGS.
[0054] In the embodiment of the invention illustrated in FIGS. 1-4, the retainer member 20 formed of bone extends through the tissue 22 to interconnect the retainer member and the bone 24. In the embodiment of the invention illustrated in FIGS. 5 and 6, a retainer member formed of bone is connected with tissue by a suture. Since the embodiment of the invention illustrated in FIGS. 5 and 6 is generally similar to the embodiments of the invention illustrated in FIGS. 1-4, similar numerals will be utilized to designate similar components, the suffix letter “b” being associated with the numerals of FIGS. 5 and 6 to avoid confusion.
[0055] A retainer member 20b(FIGS. 5 and 6) is formed of bone. The retainer member 20bmay be formed of hard cortical bone which has been freeze dried. The retainer member 20bis utilized to secure tissue 22b(FIG. 6) against movement relative to a bone 24bin a human patient's body.
[0056] In accordance with a feature of this embodiment of the invention, a suture 86 is utilized to connect the retainer member 20bwith the body tissue 22b. The suture 86 extends through an opening 88 formed in the retainer member 20b. The suture 86 may be connected with the body tissue 22bby a suitable knot 90 (FIG. 6). Alternatively, a fastener or crimp may be utilized to connect end portions of the suture 86. The crimp could have a construction similar to that disclosed in U.S. Pat. No. 5,593,425.
[0057] The retainer member 20bis disposed in cancellous bone 34b. The retainer member 20bis supported by the cancellous bone 34bin a spaced apart relationship with a compact outer layer 32b(FIG. 6) of bone which encloses the cancellous bone 34b. Therefore, the cancellous bone 34bis effective to support the retainer member 20bagainst movement under the influence of force transmitted to the retainer 20bthrough the suture 86.
[0058] The suture 86 extends through an opening 40bformed in the compact outer layer 32bof the bone 24b. The opening 40bwas formed in the bone 24bby the retainer member 20b. The suture 86 extends from the opening 40binto engagement with an end portion 28bof the tissue 22b.
[0059] The suture 86 may extend through the end portion 28bof the tissue 22b, in much the same manner as in which the retainer 20 of FIG. 3 extends through the end portion 28 of the tissue 22. Alternatively, sections 94 and 96 of the suture 86 could be wrapped around the tissue 22bto secure the tissue against movement relative to the bone 24b. Tension transmitted through the sections 94 and 96 of the suture 86 is applied to the tissue 22band firmly clamps or presses the tissue against an inner area 50bformed on the compact outer layer 32bby removing a hard outer surface 48bof the bone 24bwith a decortication process.
[0060] Tension forces transmitted through the sections 94 and 96 of the suture 86 to the retainer member 20bare transmitted from a cylindrical outer side surface 36bof the retainer member 20bto the cancellous bone 34b. The retainer member 20bis completely enclosed by a matrix of the cancellous bone 34b. Therefore, the outer side surface 36bon the retainer member 20bis pressed against only the cancellous bone 34bunder the influence of forces transmitted through the suture 86 to the retainer member 20b. The cancellous bone 34bresists these tension forces and supports the retainer member 20bin a spaced apart relationship with the compact outer layer 32b. This results in the retainer member 20bbeing supported by the cancellous bone 34b.
[0061] The retainer 20bis moved into the bone 24bin the same manner as previously explained in conjunction with the embodiment of the invention illustrated in FIGS. 1-3. However, the retainer 22bis moved completely through the compact outer layer 32bof the bone 24binto the cancellous bone 34b. Once this has occurred, the orientation of the retainer member 20brelative to the bone 24bis changed by rotating the anchor 20bthrough ninety degrees (90°) with a toggling action in a manner similar to that disclosed in U.S. Pat. Nos. 5,527,343 and 5,534,012.
[0062] To position the retainer member 20brelative to the bone 24b, the conical leading end portion 44b(FIG. 5) on the retainer member 20bis moved into engagement with the imperforate inner area 50bon the compact outer layer 32bof the bone 24b. At this time, a central axis 54bof the retainer member 20bextends perpendicular to the surface 50b. An axially directed force, corresponding to the force 70 in FIG. 2, is then applied to the retainer member 20b. This force results in the pointed leading end portion 44bof the retainer member 20bpenetrating the compact outer layer 32bof the bone 24bto initiate formation of the opening 40b(FIG. 6).
[0063] Continued application of the axial force to the retainer member 20bresults in the opening 40bbeing formed in the compact outer layer 32bof the bone 24b. If desired, a pilot opening could be formed in the compact outer layer 32bof the bone 24bto facilitate locating of the retainer member 20brelative to the bone 24b. The retainer member 20bwould then be utilized to enlarge the pilot opening and form the opening 40bas the retainer member 20bis moved axially through the compact outer layer 32bof the bone 24b.
[0064] The retainer member 20bis moved completely through the compact outer layer 32bof the bone 24bwith the retainer member in the orientation illustrated in FIG. 5, that is, with the central axis 54bof the retainer member extending perpendicular to the inner area 50bon the compact outer layer 32b. Once the retainer member 20bhas been moved completely through the compact outer layer 32b, the sections 94 and 96 of the suture 86 are tensioned and the anchor is rotated through 90 to the orientation illustrated in FIG. 6 with a toggling action.
[0065] During movement of the retainer member 20bthrough the compact outer layer 32bof the bone 24band during formation of the opening 40b, it is contemplated that it. may be desirable to support the retainer member 20bwith a tubular sleeve, similar to the tubular sleeve 58 of FIG. 2. If this is done, the suture 86 would extend axially through the tubular sleeve. The pusher member 66 of FIG. 2, could be provided with a central opening through which the suture 86 extends or the suture 86 could extend along an outer side of the pusher member. It is contemplated that the pusher member 66 may be moved axially through the outer layer 32b(FIGS. 5 and 6) of the bone 24bto apply force against a trailing end portion 68bof the retainer member 20bduring toggling or rotation of the retainer member 20bto the orientation illustrated in FIG. 6. The retainer member 20bmay be moved from the orientation shown in FIG. 5 to the orientation shown in FIG. 6 with a toggling action similar to that disclosed in U.S. Pat. Nos. 5,522,846 and 5,534,012.
[0066] In the embodiment of the invention illustrated in FIGS. 5 and 6, the retainer member 20bis moved through the compact outer layer 32binto the cancellous bone 34b. The orientation of the retainer member 20bis then changed with a togging action. However, it is contemplated that the retainer 20bcould be positioned in the bone 24bin a different manner if desired. For example, the retainer 20bcould be positioned in the bone 24bin the same manner as previously described in conjunction with the embodiment of the invention illustrated in FIGS. 1-3. If this was done, the trailing end portion 68bof the retainer member 20bwould extend from the bone 24bwith the axis 54bextending perpendicular to the inner area 50b.
[0067] If the retainer 20bis positioned in the manner illustrated in FIGS. 1-3, the suture 86 could extend from a suture opening 88 in the trailing end portion 68bof the retainer member 20b. This would facilitate moving the suture 86 relative to the retainer member 20bwhen the retainer member is positioned in the bone 24b. The trailing end portion 68bof the retainer 20bwould extend outward from the inner area 50bon the compact outer layer 32bof the bone 24b. This would result in the suture opening 88 in the retainer 20bbeing exposed so that the bone 24bwould not impede movement of the suture 86 relative to the retainer member 20b.
Embodiment of FIG.
[0068] In an embodiment of the invention illustrated in FIGS. 1-6, a retainer member of bone is utilized to position tissue, such as a tendon or ligament, relative to a bone. In the embodiment of the invention illustrated in FIG. 7, a retainer member formed of bone is utilized in the treatment of a fractured bone. Since the embodiment of the invention illustrated in FIG. 7 is generally similar to the embodiment of the invention illustrated in FIGS. 1-6, similar numerals will be utilized to designate similar components, the suffix letter “c” being associated with the numerals of FIG. 7 to avoid confusion.
[0069] A bone 24chas a fracture 102 which divides the bone 24cinto a first portion 104 at a second portion 106. The two portions 104 and 106 of the bone 24care formed by a compact outer layer 32cwhich encloses cancellous bone 34c. A retainer member 20csecures the first and second portions 104 and 106 of the bone 24cagainst movement relative to each other. The retainer member 20cis formed of bone. The retainer member 20cmay be formed of hard cortical bone which has been freeze dried.
[0070] The retainer member 20cis positioned in the first portion 104 of the bone 24c. The retainer member 20cextends into the second portion 106 of the bone 24cto connect the second portion 106 of the bone 24cwith the first portion 104 of the bone 24c. Thus, the second portion 106 of the bone 24cis tissue which is connected with the first portion 104 of the bone 24cby the retainer member 20c.
[0071] The retainer member 20chas the same construction as the retainer member 20 of FIGS. 1-3. The retainer member 20cis positioned in the bone 24cin the same manner as previously explained in conjunction with the embodiment of the invention illustrated in FIGS. 1-3. Thus, the retainer member 20cis utilized to form an opening 40cin the bone 24c. A tubular sleeve, similar to the tubular sleeve 58 of FIG. 2, may be utilized to enclose the retainer member 20cduring forming of the opening 40c.
[0072] During positioning of the retainer member 20cin the first and second portions 104 and 106 of the bone 24c, the retainer member 20cis utilized to form an opening 40cwhich extends through the first portion 104 of the bone 24cinto the second portion 106 of the bone 24c. In the embodiment of the invention illustrated in FIG. 7, the opening 40cis terminated in the compact outer layer 32cof the second portion 106 of the bone 24c. However, if desired, the opening 40ccould extend through both the first portion 104 and the second portion 106 of the bone 24c. If this was done, the retainer member 20cwould be moved downward (as viewed in FIG. 7) so that the leading end portion 44cof the retainer member would extend beyond the lower surface of the compact outer layer 32con the portion 106 of the bone 24c. The leading end portion 44cof the retainer member could then be cut or abraded so that the lower (as viewed in FIG. 7) end of the retainer member 20cwould be smooth or flush with the lower (as viewed in FIG. 7) surface of the bone 24c.
[0073] When the retainer member 20cis to be positioned relative to the bone 24c, a hard outer surface 48con the bone 24cis removed with a decortication process. This exposes an imperforate inner area 50con the compact outer layer 32cof the bone 24c. The retainer member 20cis positioned in a tubular sleeve or member having the same construction as the tubular sleeve or member 58 of FIG. 2. An end portion of the tubular member is positioned adjacent to the inner area 50cwith the pointed leading end portion 44cof the retainer member 20cdisposed in engagement with the compact outer layer 32cof the bone 24c.
[0074] The retainer member 40cis then utilized to form the opening 20c. If desired, a small pilot opening could be formed through the first portion 104 and into the second portion 106 of the bone 24c. The retainer member 20cwould then be utilized to form the opening 40cby enlarging the small pilot opening.
[0075] To form the opening 40cwith the retainer member 20c, a pusher member, corresponding to the pusher member 66 of FIG. 2, is inserted into the tubular sleeve or member, corresponding to the tubular sleeve or member 58 of FIG. 2, in which the retainer member 20cis disposed. Force is then applied against the trailing end portion 68cof the retainer member 20cwhile the retainer member is supported against sidewise fracturing or buckling by the tubular sleeve.
[0076] The leading end portion 44cof the retainer member 20cmoves through the compact outer layer 32con the portion 104 of the bone 24cunder the influence of the force applied against the trailing end portion 68cof the retainer member 20c. During the continued application of force to the trailing end portion 68cof the retainer member 20c, the leading end portion 44cof the retainer member moves through the cancellous bone 34cand moves across the fracture 102 into the second portion 206 of the bone 24c. When the leading end portion 44cof the retainer member 20chas moved part way through the compact outer layer 32con the second portion 106 of the bone 24cto the position illustrated in FIG. 7, the application of force to the trailing end portion 68cof the retainer member 20cis interrupted.
[0077] To enable movement of the retainer member 20cinto the bone 24cto be interrupted when the retainer member is in the position illustrated in FIG. 7, the extent of movement of the leading end portion 44cof the retainer member 20crelative to the bone 24cis determined during movement of the retainer member 20cinto the bone toward the position illustrated in FIG. 7. Determining the extent of movement of the retainer member 20cinto the bone 24cmay be accomplished by having indicia on the pusher member cooperate with the tubular sleeve which encloses the retainer member 20cduring the application of force to the trailing end portion 68cof the retainer member 20c. The manner in which the indicia on the pusher member cooperates with the tubular sleeve to indicate the extent of movement of the leading end portion 44cof the retainer member 20cis the same as was previously discussed in conjunction with the embodiment of the invention illustrated in FIG. 2.
[0078] As was previously mentioned, a different method of indicating the extent of movement of the pusher member relative to the tubular sleeve could be utilized, for example, suitable slots in the tubular sleeve could be engaged by a indicator pin extending from the pusher member. Indicia could be provided on the tubular sleeve adjacent to the slots or the slots could have stop surfaces which limit the extent of movement of the pusher member and, therefore, the extent of movement of the retainer member 20cinto the bone 24c.
Embodiment of FIG.
[0079] The embodiment of the invention illustrated in FIG. 7, a cylindrical retainer member 20cis utilized to treat a fracture 102 in a bone 24c. In the embodiment of the invention illustrated in FIG. 8, the retainer member used to treat the fracture in a bone has a relatively large head end portion. Since the embodiment of the invention illustrated in FIG. 8 is generally similar to the embodiments of the invention illustrated in FIGS. 1-7, similar numerals will utilized to designate similar components, the suffix letter “d” being associated with the numerals of FIG. 8 to avoid confusion.
[0080] A retainer member 20d(FIG. 8) is utilized to treat a fracture 102din a bone 24d. The retainer member 20dhas a cylindrical shank portion 80dwhich extends across the fracture 102d. A circular head end portion 82dis connected with the shank portion 80d. The retainer member 20dis integrally formed as one piece of bone. The retainer member 20dmay be formed of hard cortical bone which has been freeze dried.
[0081] The fracture 102ddivides the bone 24dinto a first portion 104dand a second portion 106d. The bone 24dhas a compact outer or cortical layer 32dwhich enclosed cancellous bone 34d. The compact outer layer 32dforms part of the first portion 104dand the second portion 106dof the bone 24d. Similarly, the cancellous bone 34dforms part of both the first and second portions 104dand 106dof the bone 24d.
[0082] The fastener 20dis positioned relative to the bone imperforate 24dwith the head end portion 82din engagement with an inner area 50dwhich is exposed by removing a portion of a hard outer surface 48don the compact outer layer 32d. A leading end portion 44don the shank portion 80dof the retainer member 20dis then positioned in engagement with the inner area 50dof the portion 104dof the bone 24d. An axial force is applied against the head end portion 82dof the fastener 20dto move the leading end portion 44dof the fastener through the portion of the compact outer layer 32ddisposed on the first portion 104dof the bone 24d.
[0083] As force continues to be applied against the head end portion 82dof the fastener 20d, the leading end portion 44dof the fastener 20dmoves into the cancellous bone 34dand across the fracture 102d. Movement of the retainer member 20dinto the bone 24dis not interrupted until after the shank portion 80dof the retainer member 24dhas moved through the portion of the compact outer layer 32ddisposed on the portion 106dof the bone 34d. When the fastener 20dhas been moved to the position shown in FIG. 8 with the head end portion 82dfirmly pressed against the inner area 50d, the leading end portion 44dof the fastener 20dis removed. This results in the leading end of the shank portion 80dbeing disposed flush with the outer side surface of the second portion 106dof the bone 24d.
[0084] During movement of the retainer member 20dinto the bone 24d, the shank portion 80dof the retainer member forms an opening 40dwhich extends through the first portion 104dof the bone 24d. The opening 40dextends across the fracture 102dand through the second portion 106dof the bone 24d. A small pilot opening extending to the bone 24dmay be formed prior to movement of the retainer member 20dinto the bone 24d. If this is done, the retainer member 20dapplies force to the bone 24dto enlarge the small pilot opening and form the relatively large opening 40din the bone 24d.
Embodiment of FIGS.
[0085] In the embodiment of the invention illustrated in FIGS. 1-8, the retainer member has been illustrated as being associated with bone at a location which is spaced at least a short distance from a joint. Of course, the retainer members of FIGS. 1-8 could be associated with bone at a joint if desired. In the embodiment of the invention illustrated in FIG. 9, a retainer member extends between bones at a joint where the bones are interconnected. Since the embodiment of the invention illustrated in FIGS. 9 and 10 is generally similar to the embodiment of the invention illustrated in FIGS. 1-8, similar numerals will be utilized to designate similar components, the suffix “e” being associated with the numerals of FIGS. 9 and 10 to avoid confusion.
[0086] Bones 112 and 114 (FIGS. 9 and 10) are interconnected at a joint 116. Tissue 22eextends along the bone 112 into the joint 116. It is contemplated that the joint 116 may be any one of the many joints in a patient's body.
[0087] In accordance with a feature of this embodiment of this invention, a retainer member 20eextends between the bones 112 and 114. The retainer member 20ehas a cylindrical configuration. The retainer member 20eis formed from one piece of bone in the same manner as the retainer members 20 of FIGS. 1-8. The retainer member 20emay be formed of hard cortical bone which has been freeze dried. However, the retainer member 20ecould be formed of other materials if desired.
[0088] The retainer member 20eextends through the tissue 22eto secure the tissue against movement relative to the bones 112 and 114. In addition, the retainer member 20eimmobilizes the joint 116. Thus, the retainer member 20eis effective to prevent relative movement between the bones 112 and 114 at the joint 116.
[0089] The joint 116 may be permanently immobilized. However, after the tissue 22ehas healed, it may be desired to release the bones 112 and 114 for movement relative to each other at the joint 116. This may be accomplished by breaking the retainer member 20e.
[0090] To break the bone forming the retainer member 20e, it is merely necessary to move one of the bones, for example the bone 114, relative to the other bone 112. The force transmitted from the bones 112 and 114 to the retainer member 20ewill cause the retainer member to break or snap and thereby release the bones 112 and 114 for movement. Since the retainer member 20eis formed of bone, it is not necessary to remove the retainer member from the bones 112 and 114 after the tissue 22ehas healed.
[0091] The retainer member 20eis positioned in a cylindrical opening 40ewhich extends through the bone 112 through the tissue 22eand into the bone 114. In the embodiment of the invention illustrated in FIG. 10, the relatively long passage 40eis formed with a drill. However, if desired, the retainer member 20ecould be utilized to form the passage 40ein the manner previously described in conjunction with the embodiments of the invention illustrated in FIGS. 1-8.
[0092] It is believed, due to the relatively long length of the passage 40e, it may be desired to drill a small diameter pilot passage before using the retainer member 20eto form the passage 40e. A pusher member, corresponding to the pusher member 66 of FIG. 2, would move into the passage 40eto apply force against the retainer member 20ewhich is illustrated as having a length which is shorter than the passage 40e. If desired, the length of the retainer member 20ecould be increased so that a trailing end portion of the retainer member 20ewould be flush with the entrance to the passage 40ewhen the leading end portion of the retainer member is in the position illustrated in FIG. 10. Alternatively, the passage 40ecould be drilled only through the bone 112. The remainder of the passage would be formed through the tissue 22eand a portion of the bone 114 by the retainer member 20e.
[0093] The bones 112 and 114 have compact outer layers 32ewhich enclose cancellous bone 34e. The retainer member 20eextends from the cancellous bone 34ein the bone 112 through the compact outer layer 32eof the bone 112 into the tissue 22e. The retainer member 20eextends from the tissue 22ethrough the compact outer layer 32eof the bone 114. The retainer member 20 extends into the cancellous bone 34eof the bone 114.
[0094] Since the retainer member 20eextends through the tissue 22e, the retainer member is effective to secure the tissue 22eagainst movement relative to the bones 112 and 114. Since the retainer member 20eextends between the bones 112 and 114, the retainer member is effective to immobilize the joint 116. Of course, immobilization of the joint can be terminated by merely applying sufficient force to the bones 112 and 114 to break the retainer member 20eat the joint 116.
[0095] The retainer member 20eis formed of bone. The illustrated embodiment of the retainer 20eis formed of hard cortical bone which has been freeze dried. However, the retainer 20ecould be formed of other materials if desired. For example, the retainer 20ecould be formed of biodegradable polymers. Alternatively, the retainer 20ecould be formed of a ceramic material.
Embodiment of FIGS.
[0096] In the embodiment of the invention illustrated in FIGS. 9 and 10, a relatively short retainer member 20eextends between bones 112 and 114 to immobilize a joint 116 and to secure tissue 22eagainst movement relative to the joint. In the embodiment of the invention illustrated in FIGS. 11 and 12, a relatively long retainer member is provided to immobilize the joint and hold tissue against movement relative to the joint. Since the embodiment of the invention illustrated in FIGS. 11 and 12 is generally similar to the embodiment of the invention illustrated in FIGS. 1-10, similar numerals will be utilized to designate similar components, the suffix letter “f” being associated with the numerals of FIGS. 11 and 12.
[0097] Bones 112fand 114fare interconnected at a joint 116f. Tissue 22fextends into the joint 116fand is disposed between the ends of the bones 112fand 114f. A retainer member 20fextends between the bones 112fand 114fand extends through the tissue 22fat the joint 116f. The retainer member 20fimmobilizes the joint, that is, the retainer member secures the bones 112fand 114fagainst movement relative to each other. In addition, the retainer 20fsecures the tissue 22fagainst movement relative to the bones 112fand 114fat the joint 116f
[0098] In accordance with one of the features of the present invention, the retainer member 20fis formed of bone. The retainer member 20fmay be formed of hard cortical bone which has been freeze dried. The retainer member 20fis utilized to form an opening 40fwhich extends through the bone 112f, through the tissue 22f, and into the bone 114f. If desired, the retainer member 20fcould extend through the bone 114fand have a lower (as viewed in FIG. 11) end which is flush with an outer side surface of the bone.
[0099] The retainer member 20fhas a cylindrical configuration and is integrally formed as one piece of bone. The retainer member 20fhas a pointed leading end portion 44fwhich initiates formation of the opening 40f. If desired, a relatively small diameter pilot opening could be drilled through the bone 112f, body tissue 22finto the bone 114f. The retainer member 20fwould then be utilized to form the opening 40fby enlarging the small pilot opening. In the embodiment of the invention illustrated in FIG. 10, it is contemplated that it may be preferred to form the opening 40ewith a drill. However, in the embodiment of the invention illustrated in FIGS. 11 and 12, it is contemplated that it will be preferred to utilize the retainer member 20fto form the opening 40f.
[0100] When the retainer member 20fis to be positioned in the bones 112fand 114f, a hard outer surface 48fof a compact outer layer 32fof the bone 112fis ground or abraded away with a decortication process. This exposes an imperforate inner area 50fon the compact outer layer 32fof the bone 112f. The leading end portion 44fof the retainer member 20fis then positioned in engagement with the inner area 50f.
[0101] A force, corresponding to the force 70 of FIG. 2, is then applied to a trailing end portion 68fof the retainer member 20f. The retainer member 20fmay be enclosed with a tubular member, corresponding to the tubular member 58 of FIG. 2. Force may be applied against the trailing end portion 68fof the retainer member 20fwith a pusher member, corresponding to the pusher member 66 of FIG. 2. The force applied to the trailing end portion 68fof the retainer member 20fextends parallel to a longitudinal central axis 54fof the retainer member 20f.
[0102] The force applied to the trailing end portion 68fof the retainer member 20fcauses the pointed leading end portion 44fof the retainer member to initiate the formation of the opening 40fin the compact outer layer 32fof the bone 112f. The force applied to the trailing end portion 68fof the retainer member 20fmoves the leading end portion 44fof the retainer member through the compact outer layer 32finto cancellous bone 34fwhich is enclosed by the compact outer layer 32f.
[0103] The continued application of force to the trailing end portion 68fof the retainer member 20fmoves the retainer member through the cancellous bone 34f. The leading end portion 44fof the retainer member 20fmoves into engagement with an inner side surface 122 of the compact outer layer 32f. The pointed leading end portion 44fthen penetrates the compact outer layer 32ffor a second time. This results in the formation of an opening 40fwhich extends through the bone 112f.
[0104] The leading end portion 44fof the retainer member 20fthen enters the tissue 22f. The continued application of force against the trailing end portion 68fof the retainer member 20fmoves the leading end portion 44finto the compact outer layer 32fon the bone 114f. If desired, a hard outer surface 48fon the compact outer layer 32fof the bone 114fcould be removed with a decortication process at the location where the leading end portion 44fof the retainer member 20fmoves into initial engagement with the bone 114f.
[0105] The continued application of force against the trailing end portion 68fof the retainer member 20fmoves the retainer member through the compact outer layer 32fof the bone 114finto cancellous bone 34f. Movement of the retainer member 20finto the bone 114fcan be terminated with the leading end portion 44fin the cancellous bone 34fof the bone 114f, as shown in FIG. 11. However, if desired, the movement of the retainer member 20falong its longitudinal central axis 54fcould be continued and the retainer member moved through the compact outer layer 32fof the bone 114ffor a second time.
[0106] When the retainer member 20fis moved through the bone 112fand the tissue 22finto the bone 114f, a shown in FIG. 11, the retainer member immobilizes the joint 116f. In addition, the retainer member 20fsecures the tissue 22fin the joint 116f.
[0107] During movement of the retainer member 20finto and through the bone 112finto and through the tissue 22fand into the bone 114f, it is believed that it may be preferred to enclose the portion of the retainer member 20fwhich is disposed outside of the opening 40fwith a tubular sleeve or member, corresponding to the tubular sleeve or member 58 of FIG. 2. The end of the tubular member would be positioned in engagement with the inner area 50fon the compact outer layer 32fof the bone 112f. A pusher member, corresponding to the pusher member 66 of FIG. 2, would be utilized to apply force against the trailing end portion 68fof the retainer member 20f.
[0108] It is believed that it would be particularly advantageous to utilize indicia which indicates the extent to which the leading end portion 44fof the retainer member 20fis moved along the central axis 54f. This is because the opening 40fhas a relatively long axial extent and the use of indicia, corresponding to the indicia 74 of FIG. 2, on the pushrod will enable a surgeon to determine exactly where the leading end portion 44fof the retainer member 20fis located relative to the bones 112fand 114f. The indicia will also allow the surgeon to terminate movement of the retainer member 20falong the axis 54fwhen the retainer member is moved to the position shown in FIG. 11.
[0109] After the joint 116fhas been immobilized for a sufficient period of time to enable the tissue 22fto heal, it is contemplated that it may be desired to release the joint 116fso that the bones 112fand 114fcan move relative to each other at the joint. To release the joint 116f, force is applied to the bones 112fand 114fto break the retainer member 20fin the manner illustrated schematically in FIG. 12. Thus, force applied to the bones 112fand 114ftends to rotate the bone 114fin a counterclockwise direction from the position illustrated in FIG. 11 to the position shown in FIG. 12. As this occurs, the force applied to the retainer member 20fcauses the retainer member to break or fracture at a location indicated schematically at 126 in FIG. 12. Since the retainer member 20fis formed of bone which is relatively weak in tension, a relatively small amount of force is required to break the retainer member 20f. Since the retainer member 20fis formed of bone, there is no need to remove the retainer member after it has been broken.
Embodiment of FIG.
[0110] In the embodiment of the invention illustrated in FIGS. 11 and 12, the retainer member 20fis utilized to initiate the formation of the opening 40fand to form the opening. In the embodiment of the invention illustrated in FIG. 13, a guide wire or rod is utilized to initiate formation of the opening which is subsequently formed by the retainer member. Since the embodiment of the invention illustrated in FIG. 13 is generally similar to the embodiment of the invention illustrated in FIGS. 1-12, similar numerals will be utilized to designate similar components, the suffix letter “g” being associated with the numerals of FIG. 13 to avoid confusion.
[0111] Tissue 22g(FIG. 13) is disposed between bones 112gand 114gat a joint 116g. A retainer member 20gis utilized to secure the tissue 22gagainst movement relative to the bones 112gand 114gand to secure the bones against movement relative to each other. The retainer member 20ghas a cylindrical configuration and is formed of bone. The retainer member 20gmay be formed of hard cortical bone which has been freeze dried.
[0112] In accordance with one of the features of the embodiment of the invention illustrated in FIG. 13, a cylindrical guide wire or rod 132 extends through a cylindrical passage 134 formed in the retainer member 20g. The guide wire or rod 132 forms small diameter pilot openings which extend through the bone 112g, through the tissue 22gat the joint 116gand into the bone 114g. The guide wire or rod 132 is moved to the position illustrated in FIG. 13 to form the relatively small diameter pilot openings while the retainer member 20gis spaced apart from the guide wire or rod. To move the guide wire or rod 132 to the position shown in FIG. 13, an axial force is applied against the guide wire.
[0113] Once the guide wire 132 has been moved through the bone 112g, the tissue 22g, and into the bone 114gin the manner illustrated in FIG. 13, the retainer member 20gis moved into telescopic engagement with the guide wire 132. To provide for engagement of the guide wire 132 with the retainer member 20g, the upper (as viewed in FIG. 13) end of the guide wire 132 is inserted into the cylindrical passage 134 which extends axially through the retainer member 20g. The retainer member 20gis then moved axially along the guide wire 132 until a conical leading end portion 44gof the retainer member 20gengages an inner area 50gon the compact outer layer 32gof the bone 112g. The inner area 50gis formed by abrading or otherwise removing a hard outer surface layer 48gfrom the compact outer layer 32gwith a decortication process.
[0114] Once the retainer member 20ghas been moved along the guide wire 132ginto engagement with the compact outer layer 32gof the bone 112g, a tubular sleeve or member 58gis moved along the guide wire rod 132 into telescopic engagement with the retainer member 20g. An annular leading end portion 62gof the tubular sleeve 58gis moved into engagement with the area 50gin the manner illustrated in FIG. 13. At this time, the leading end portion 44gof the retainer member 20gis also disposed in engagement with the area 50gon the compact outer layer 32gof the bone 12g.
[0115] The tubular sleeve 58ghas an axial extent which is greater than the axial extent of the retainer member 20g. Therefore, the tubular sleeve 50gextends axially past an upper or trailing end portion of the retainer member 20g. At this time, the retainer member 20gis fully enclosed by the tubular sleeve 58g.
[0116] A pusher member 66ghas a longitudinally extending cylindrical passage 138 through which the guide wire rod 132 extends. When the leading end portion 44gof the retainer member 20gis disposed in engagement with the inner area 50g, the tubular sleeve 58gencloses the retainer member. The pusher member 66gextends axially upward (as viewed in FIG. 13) from the upper end portion of the tubular sleeve or member 58g.
[0117] In order to form the opening 40gwith the retainer member 20g, force, indicated schematically by arrows 70gin FIG. 13, is applied against the upper (as viewed in FIG. 13) end of the pusher member 66g. The force is transmitted from the pusher member 66gto the retainer member 20g. The force transmitted to the retainer member 20gcauses the leading end portion 44gof the retainer member 20gto form the opening 40gin the compact outer layer 32gof the bone 112g.
[0118] As the opening 40gis formed in the compact outer layer 32gof the bone 112gby the retainer member 20g, the retainer member is moved axially along the guide wire 132. Therefore, the guide wire 132 is effective to steer movement of the retainer member 20gthrough the bone 112gand tissue 22ginto the bone 114g. As the force 70gapplied by the pusher member 66gto the trailing end of the retainer member 20gmoves the retainer member 20ginto cancellous bone 34gof the bone 112g, the guide wire 132 cooperates with the retainer member 20gto prevent deviation of the retainer member from its intended course.
[0119] Continued movement of the retainer member 20galong the guide wire 132 under the influence of force 70g, results in the leading end portion 44gof the retainer member 20gmoving into engagement with an inner side surface 122gof the compact outer layer 32gon the bone 112g. Continued application of axial force to the retainer member 20gmoves the retainer member along the guide wire 132 through the compact outer layer 32gand into the tissue 22g. The leading end portion 44gof the retainer member 20gthen moves into engagement with the compact outer layer 32gof the bone 114g.
[0120] Continued movement of the retainer member 20galong the guide wire 132 moves the leading end portion 44gof the retainer member through the compact outer layer 32gof the bone 114g. The leading end portion 44gof the retainer member 20gthen moves into cancellous bone 34gwhich is enclosed by the compact outer layer 32gof the bone 114g. Indicia, corresponding to the indicia 74 of FIG. 2, on the pusher member 66gcooperates with the tubular sleeve 58gto indicate when the leading end portion 44gof the retainer member 20ghas reached the lower (as viewed in FIG. 13) end of the guide wire 132. When this happens, an application of the force 70gto the pusher member 66gis interrupted and axial movement of the retainer member 20galong the guide wire 132 is interrupted. At this time, a trailing end portion of the retainer member 20gwill have reached the end of the tubular sleeve 58 and be adjacent to the inner area 50gon the compact outer layer 32gof the bone 112g.
[0121] The tubular sleeve 58gand pusher member 66gare then disengaged from the guide wire 132 by moving them axially upward (as viewed in FIG. 13) away from the bone 112galong the guide wire. The guide wire 132 is then withdrawn from the retainer member 20g.
[0122] After the guide wire 132 is withdrawn from the retainer member 20g, the retainer member is disposed in the same orientation relative to the bones 112gand 114gas is the retainer member 20frelative to the bones 112fand 114fof FIG. 11. Thus, the retainer member 20gwill extend through the bone 112gand through the body tissue 22ginto the bone 114g. If desired, the retainer member 20gcould be moved through the bone 114gso that the leading end portion 44gof the retainer member 20gextends from the outer side surface of the bone 114g. The leading end portion 44gof the retainer member would then be removed so that the end of the retainer member 209 would be aligned with the outer side surface of the bone 114gto provide a smooth area which would not irritate adjoining tissue. If the retainer member 20gis to extend through the bone 114g, the guide-wire 132 would be moved through the bone 114gto enable the guide wire to guide movement of the retainer member 20gthroughout the extent of axial movement of the retainer member relative to the bone 114.
[0123] Once the retainer member 20ghas been moved to the desired position relative to the bones 112gand 114g, that is to a position corresponding to the position of the retainer member 20fof FIG. 11 relative to the bones 112fand 114f, the joint 116gis immobilized. Thus, the bones 112gand 114gare secured against movement relative to each other. In addition, the tissue 22gis secured against movement relative to the bones 112gand 114g.
[0124] In the embodiment of the invention illustrated in FIG. 13, the retainer member 20gis formed of bone. However, the retainer member 20gmay be formed of other materials if desired. For example, the retainer member 20gcould be formed of a biodegradable material. Alternatively, the retainer member 20gcould be formed of a ceramic material.
Conclusion
[0125] In view of the foregoing description, it is apparent that the present invention relates to a new and improved method of securing tissue 22 against movement relative to a portion of a bone 24 in a patient's body. The method includes positioning a retainer member 20 formed of bone in the portion of the bone 24 in the patient's body and connecting the retainer member with the tissue 22 to be secured. The step of positioning the retainer member 20 formed of bone in the patient's body may include utilizing the retainer member to form an opening 40 in a compact outer layer of the portion of the bone 24 in the patient's body.
[0126] When the retainer member 20 formed of bone is used to form an opening 40 in the portion of the bone 24 in the patient's body, the retainer member may advantageously be at least partially enclosed in a tubular member 58. Force 70 may be applied against a trailing end portion 68 of the retainer member 20 formed of bone to force a leading end portion 44 of retainer member into the portion of the bone 24 in the patient's body. Movement of the retainer member 20 into the portion of the bone 24 in the patient's body may advantageously be interrupted when the leading end portion 44 of the retainer member has moved to a predetermined depth in the bone in the patient's body.
[0127] The retainer member 20 formed of bone may extend through and/or tension body tissue 22 which is to be connected with the bone 24 in the patient's body by the retainer member. The retainer member 20 formed of bone may have a head end portion 82 which engages body tissue 22. Alternatively, the retainer member 20 formed of bone may be utilized to anchor a suture 86 which is connected with body tissue. The retainer member 20 formed of bone may be positioned in a bone 24 in the patient's body so as to extend across a fracture 102 and hold the portions 104 and 106 of the bone on opposite sides of the fracture against movement relative to each other.
[0128] A retainer member 20, which may or may not be formed of bone, is utilized to immobilize a joint 116 by having the retainer member extend between bones 112 and 114 at the joint. If it is subsequently desired to release the joint 116 for movement, the retainer member may be broken.
Claims
Having described the invention, the following is claimed:
1. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member, and forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from the retainer member formed of bone to the portion of the bone in the patient's body while the retainer member is at least partially enclosed by the tubular member, said step of forming an opening in the bone in the patient's body includes moving at least a portion of the retainer member formed of bone out of the end portion of the tubular member into the portion of the bone in the patient's body.
2. A method as set forth in claim 1 wherein said step of forming an opening in the portion of the bone in the patient's body includes pushing material forming a compact outer layer of the portion of the bone in the patient's body aside under the influence of the force transmitted from a leading end portion of the retainer member formed of bone to the compact outer layer.
3. A method as set forth in claim 1 wherein said step of forming an opening in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member formed of bone through a compact outer layer of the portion of the bone in the patient's body into cancellous bone.
4. A method as set forth in claim 1 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured, separating the tubular member from the retainer member formed of bone, and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.
5. A method as set forth in claim 1 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
6. A method as set forth in claim 1 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
7. A method as set forth in claim 1 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the first portion of the bone into the second portion of the bone.
8. A method as set forth in claim 1 wherein the bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
9. A method as set forth in claim 8 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
10. A method as set forth in claim 1 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer into cancellous, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
11. A method as set forth in claim 10 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
12. A method as set forth in claim 11 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
13. A method as set forth in claim 1 wherein said step of applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the tubular member includes engaging the trailing end portion of the retainer member with a pusher member, said step of moving the leading end portion of the retainer member formed of bone out of the end portion of the tubular member being interrupted when the pusher member is in a predetermined position relative to the tubular member.
14. A method as set forth in claim 1 further including the step of forming an initial opening in the portion of the bone in the patient's body, said step of forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes enlarging the initial opening in the portion of the bone in the patient's body.
15. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said steps of positioning the retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, and utilizing the retainer member formed of bone to hold the tissue at the second location by engaging the tissue and an opening formed in the portion of the bone in the patient's body with the retainer member formed of bone.
16. A method as set forth in claim 15 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured at the first location with the retainer member formed of bone, said step of tensioning the tissue to be secured includes moving the engaged portion of the tissue and the retainer member formed of bone together from the first location to the second location.
17. A method as set forth in claim 15 further including the step of utilizing the retainer member formed of bone to form the opening at the second location prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
18. A method as set forth; in claim 15 wherein said step of tensioning the tissue to be secured includes transmitting force from the retainer member formed of bone to the tissue to be secured.
19. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of removing a hard surface area from a location on the portion of the bone in the patient's body, positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
20. A method as set forth in claim 19 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
21. A method as set forth in claim 19 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes applying an axially directed force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force.
22. A method as set forth in claim 19 wherein said step of utilizing the retainer member to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
23. A method as set forth in claim 19 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
24. A method as set forth in claim 19 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
25. A method as set forth in claim 19 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
26. A method as set forth in claim 19 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
27. A method as set forth in claim 19 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
28. A method as set forth in claim 27 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
29. A method as set forth in claim 19 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
30. A method as set forth in claim 29 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
31. A method as set forth in claim 29 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
32. A method as set forth in claim 19 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
33. A method as set forth in claim 19 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
34. A method as set forth in claim 19 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
35. A method as set forth in claim 19 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location.
36. A method as set forth in claim 35 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.
37. A method as set forth in claim 35 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
38. A method as set forth in claim 19 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
39. A method as set forth in claim 19 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
40. A method as set forth in claim 19 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
41. A method as set forth in claim 19 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
42. A method as set forth in claim 41 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body.
43. A method as set forth in claim 19 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving the retainer member formed of bone through the tissue to be secured and into the portion of the bone in the patient's body with a first end portion of the retainer member formed of bone leading and a second end portion of the retainer member formed of bone trailing, and interrupting movement of the retainer member formed of bone relative to the portion of the bone in the patient's body and to the tissue to be secured with the first end portion of the retainer member formed of bone disposed in engagement with the portion of the bone in the patient's body and with the second end portion of the retainer member formed of bone disposed in engagement with the tissue to be secured.
44. A method as set forth in claim 43 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, applying force against a trailing end portion of the retainer member formed of bone, and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the sleeve.
45. A method as set forth in claim 44 further including the step of interrupting movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
46. A method as set forth in claim 43 further including the step of tensioning the tissue to be secured prior to moving the retainer member formed of bone into the portion of the bone in the patient's body.
47. A method as set forth in claim 19 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member, and forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from the retainer member formed of bone to the portion of the bone in the patient's body while the retainer member is at least partially enclosed by the tubular member, said step of forming an opening in the bone in the patient's body includes moving at least a portion of the retainer member formed of bone out of the end portion of the tubular member into the portion of the bone in the patient's body.
48. A method as set forth in claim 47 wherein said step of forming an opening in the portion of the bone in the patient's body includes pushing material forming a compact outer layer of the portion of the bone in the patient's body aside under the influence of the force transmitted from a leading end portion of the retainer member formed of bone to the compact outer layer.
49. A method as set forth in claim 47 wherein said step of forming an opening in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member formed of bone through a compact outer layer of the portion of the bone in the patient's body into cancellous bone.
50. A method as set forth in claim 47 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured, separating the tubular member from the retainer member formed of bone, and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.
51. A method as set forth in claim 47 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
52. A method as set forth in claim 47 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
53. A method as set forth in claim 47 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the first portion of the bone into the second portion of the bone.
54. A method as set forth in claim 47 wherein the bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
55. A method as set forth in claim 54 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
56. A method as set forth in claim 47 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
57. A method as set forth in claim 56 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
58. A method as set forth in claim 57 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
59. A method as set forth in claim 47 wherein said step of applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the tubular member includes engaging the trailing end portion of the retainer member with a pusher member, said step of moving the leading end portion of the retainer member formed of bone out of the end portion of the tubular member being interrupted when the pusher member is in a predetermined position relative to the tubular member.
60. A method as set forth in claim 47 further including the step of forming an initial opening in the portion of the bone in the patient's body, said step of forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes enlarging the initial opening in the portion of the bone in the patient's body.
61. A method as set forth in claim 19 wherein said method further includes the steps of connecting a suture with a retainer member formed of bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging the tissue to be secured with the suture, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving the retainer member into the opening in the portion of the bone in the patient's body with the suture extending from the retainer member formed of bone.
62. A method as set forth in claim 61 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes inserting the retainer member into a tubular member, positioning an end portion of the tubular member adjacent to the portion of the bone in the patient's body, and applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member.
63. A method as set forth in claim 61 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes tensioning the suture, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes retaining the retainer member formed of bone against movement relative to the portion of the bone in the patient's body under the influence of force transmitted from the suture to the retainer member formed of bone by transmitting force between the retainer member formed of bone and cancellous bone in the portion of the bone in the patient's body while the retainer member formed of bone is spaced from a compact outer layer of the portion of the bone in the patient's body.
64. A method as set forth in claim 61 further including the step of changing the orientation of the retainer member formed of bone relative to the portion of the bone in the patient's body after performing said step of moving the retainer member formed of bone into the opening in the portion of the bone in the patient's body.
65. A method as set forth in claim 61 wherein said step of connecting the retainer member formed of bone with the tissue to be secured by engaging the tissue to be secured with the suture includes pulling on first and second sections of the suture which extend from the retainer member formed of bone.
66. A method as set forth in claim 19 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes engaging a compact outer layer of a portion of the bone disposed on a first side of a fracture with a leading end portion of the retainer member formed of bone, said step of positioning the retainer member formed of bone in the patient's body includes moving the leading end portion of the retainer member formed of bone across the fracture, engaging the compact layer of a portion of the bone disposed on a second side of the fracture with the leading end portion of the retainer member formed of bone, and utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the second side of the fracture.
67. A method as set forth in claim 66 further including the steps of positioning the retainer member formed of bone in a tubular member, and positioning an end portion of the tubular member adjacent to the compact outer layer of the portion of the bone disposed on a first side of the fracture, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.
68. A method as set forth in claim 67 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes applying force against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.
69. A method as set forth in claim 66 wherein said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member through an outer area on the compact outer layer of the portion of the bone disposed on the first side of the fracture and subsequently moving the leading end portion of the retainer member through an inner area on the compact outer layer of the portion of the bone disposed on the first side of the fracture, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member through an inner area on the compact outer layer of the portion of the bone disposed on the second side of the fracture.
70. A method as set forth in claim 19 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body, determining an extent of movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body, and interrupting said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body upon determining that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.
71. A method as set forth in claim 19 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a shank portion of the retainer member formed of bone through the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving the shank portion of the retainer member formed of bone into a the portion of the bone in the patient's body, and pressing a head end portion of the retainer member formed of bone against the tissue to be secured while the shank portion of the retainer member formed of bone extends into the portion of the bone in the patient's body.
72. A method as set forth in claim 71 wherein said step of pressing the head end portion of the retainer member formed of bone against the tissue to be secured includes engaging a first side of the tissue to be secured with the head end portion of the retainer member formed of bone and pressing a second side of the tissue to be secured against the portion of the bone in the patient's body under the influence of force transmitted from the head end portion of the retainer member formed of bone.
73. A method as set forth in claim 19 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving the retainer member formed of bone through a portion of a first bone and into a second bone, and holding the first and second bones against movement relative to each other with the retainer member formed of bone.
74. A method as set forth in claim 73 further including the step of releasing the first and second bones for movement relative to each other by breaking the retainer member formed of bone.
75. A method as set forth in claim 73 further including the step of positioning tissue at a joint between the first and second bones prior to performing said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone, said step of moving the retainer member formed of bone through a portion of the first bone into the second bone includes moving the retainer member through the tissue at the joint between the first and second bones.
76. A method as set forth in claim 73 further including the step of determining the extent of movement of a leading end portion of the retainer member formed of bone relative to the first bone and interrupting said step of moving the retainer member formed of bone through a portion of the first bone and into the second bone upon determining that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.
77. A method as set forth in claim 73 further including the step of inserting the retainer member formed of bone into a tubular member, and positioning the tubular member adjacent to the first bone, said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone is at least partially performed with a portion of the retainer member formed of bone disposed in the tubular member.
78. A method as set forth in claim 77 wherein said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone includes applying force against a trailing end portion of the retainer member formed of bone while the trailing end portion of the retainer member formed of bone is enclosed by the tubular member.
79. A method as set forth in claim 19 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body and moving the retainer member formed of bone along the thin elongated member into the portion of the bone in the patient's body.
80. A method as set forth in claim 79 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the thin elongated member into the tissue to be secured and moving the retainer member formed of bone along the thin elongated member into the tissue to be secured.
81. A method as set forth in claim 79 wherein said step of moving a thin elongated member into the portion of the bone in the patient's body includes moving the thin elongated member into the portion of the bone in the patient's body at the location where the hard surface area on the portion of the bone in the patient's body was removed, said step of moving the retainer member formed of bone along the thin elongated member includes moving a leading end portion of the retainer member formed of bone into engagement with the portion of the bone in the patient's body at the location where the hard surface area on the portion of the bone in the patient's body was removed.
82. A method as set forth in claim 79 wherein said steps of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body and moving the retainer member formed of bone along the thin elongated member include utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body by pushing material forming the portion of the bone in the patient's body aside under the influence of force transmitted through the retainer member formed of bone as the retainer member formed of bone moves along the thin elongated member.
83. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location, said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
84. A method as set forth in claim 83 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
85. A method as set forth in claim 83 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
86. A method as set forth in claim 83 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
87. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body further includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body by utilizing the retainer member formed of bone to increase the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
88. A method as set forth in claim 87 wherein said step of moving a member into the portion of the bone in the patient's body to form an opening of a first size includes moving a drill into the portion of the bone in the patient's body to form the opening of a first size.
89. A method as set forth in claim 87 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving the retainer member formed of bone into the portion of the bone in the patient's body without rotating the retainer member formed of bone about its central axis.
90. A method as set forth in claim 87 further including the step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body, said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
91. A method as set forth in claim 87 further including the step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body, said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes applying an axially directed force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force.
92. A method as set forth in claim 87 wherein said step of utilizing the retainer member to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
93. A method as set forth in claim 87 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
94. A method as set forth in claim 87 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
95. A method as set forth in claim 87 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
96. A method as set forth in claim 87 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
97. A method as set forth in claim 87 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
98. A method as set forth in claim 97 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
99. A method as set forth in claim 87 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
100. A method as set forth in claim 99 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
101. A method as set forth in claim 99 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
102. A method as set forth in claim 87 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
103. A method as set forth in claim 87 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
104. A method as set forth in claim 87 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
105. A method as set forth in claim 87 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving a member into the portion of the bone in the patient's body to form an opening of the first size is performed at the second location.
106. A method as set forth in claim 105 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member formed of bone to form the opening.
107. A method as set forth in claim 105 wherein said step of utilizing the retainer member formed of bone to form an opening is performed at the second location prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
108. A method as set forth in claim 87 wherein said step of moving a member into the portion of the bone in the patient's body to form an opening of a first size includes moving a thin elongated member into the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
109. A method as set forth in claim 87 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
110. A method as set forth in claim 87 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
111. A method as set forth in claim 87 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body.
112. A method as set forth in claim 87 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving the retainer member formed of bone through the tissue to be secured and into the portion of the bone in the patient's body with a first end portion of the retainer member formed of bone leading and a second end portion of the retainer member formed of bone trailing, and interrupting movement of the retainer member formed of bone relative to the portion of the bone in the patient's body and to the tissue to be secured with the first end portion of the retainer member formed of bone disposed in engagement with the portion of the bone in the patient's body and with the second end portion of the retainer member formed of bone disposed in engagement with the tissue to be secured.
113. A method as set forth in claim 87 wherein said step of increasing the size of the opening formed in the bone includes increasing the size of an opening formed in a compact outer layer of the portion of the bone in the patient's body.
114. A method as set forth in claim 87 wherein said step of increasing the size of the opening formed in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, aligning the sleeve with the opening formed in the portion of the bone in the patient's body, applying force against a trailing end portion of the retainer member formed of bone while the sleeve is aligned with the opening in the portion of the bone in the patient's body, and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the sleeve.
115. A method as set forth in claim 114 further including the step of interrupting movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
116. A method as set forth in claim 87 further including the step of tensioning the tissue to be secured prior to moving the retainer member formed of bone into the portion of the bone in the patient's body.
117. A method as set forth in claim 87 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, and applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member, said step of increasing the size of the opening formed in the bone in the patient's body from the first size to a second size is performed under the influence of force transmitted from the retainer member formed of bone to the portion of the bone in the patient's body while the retainer member is at least partially enclosed by the tubular member and moving at least a portion of the retainer member formed of bone out of the end portion of the tubular member into the portion of the bone in the patient's body.
118. A method as set forth in claim 87 wherein said step of increasing the size of the opening formed in the portion of the bone in the patient's body includes pushing material forming a compact outer layer of the portion of the bone in the patient's body aside under the influence of the force transmitted from a leading end portion of the retainer member formed of bone to the compact outer layer.
119. A method as set forth in claim 87 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member formed of bone through a compact outer layer of the portion of the bone in the patient's body into cancellous bone.
120. A method as set forth in claim 87 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the first portion of the bone into the second portion of the bone, said step of increasing the size of the opening formed in the bone in the patient's body is at least partially performed in the first portion of the bone.
121. A method as set forth in claim 87 wherein the bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
122. A method as set forth in claim 121 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
123. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
124. A method as set forth in claim 123 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
125. A method as set forth in claim 123 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes applying an axially directed force against the retainer member formed of bone while the retainer member formed of bone is at least partially disposed in the tubular member and pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force.
126. A method as set forth in claim 123 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer while the retainer member is partially disposed in the tubular member.
127. A method as set forth in claim 123 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body.
128. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of removing a hard surface area from a location on a compact outer layer of the portion of the bone in the patient's body, positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member, and forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from the retainer member formed of bone to the portion of the bone in the patient's body while the retainer member is at least partially enclosed by the tubular member, said step of forming an opening in the bone in the patient's body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area on the compact outer layer was removed and moving at least a portion of the retainer member formed of bone out of the end portion of the tubular member into the portion of the bone in the patient's body.
129. A method as set forth in claim 128 wherein said step of forming an opening in the portion of the bone in the patient's body includes pushing material forming a compact outer layer of the portion of the bone in the patient's body aside under the influence of the force transmitted from a leading end portion of the retainer member formed of bone to the compact outer layer.
130. A method as set forth in claim 128 wherein said step of forming an opening in the portion of the bone in the patient's body includes moving the leading end portion of the retainer member formed of bone through a compact outer layer of the portion of the bone in the patient's body into cancellous bone.
131. A method as set forth in claim 128 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured, separating the tubular member from the retainer member formed of bone, and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.
132. A method as set forth in claim 128 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
133. A method as set forth in claim 128 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
134. A method as set forth in claim 128 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the first portion of the bone into the second portion of the bone.
135. A method as set forth in claim 128 wherein the bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
136. A method as set forth in claim 135 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
137. A method as set forth in claim 128 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer into cancellous, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
138. A method as set forth in claim 137 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
139. A method as set forth in claim 138 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
140. A method as set forth in claim 128 wherein said step of applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the tubular member includes engaging the trailing end portion of the retainer member with a pusher member, said step of moving the leading end portion of the retainer member formed of bone out of the end portion of the tubular member being interrupted when the pusher member is in a predetermined position relative to the tubular member.
141. A method as set forth in claim 128 further including the step of forming an initial opening in the portion of the bone in the patient's body, said step of forming an opening in the portion of the bone in the patient's body under the influence of force transmitted from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes enlarging the initial opening in the portion of the bone in the patient's body.
142. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of removing a hard surface area from a location on the compact outer layer of the portion of the bone in the patient's body, positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body, step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area on the compact outer layer was removed, determining an extent of movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body, and interrupting said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body upon determining that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.
143. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes initiating formation of an opening in the portion of the bone in the patient's body by pushing material of the portion of the bone in the patient's body aside under the influence of force applied against the portion of the bone in the patient's body by the retainer member formed of bone.
144. A method as set forth in claim 143 wherein said step of initiating formation of an opening in the portion of the bone in the patient's body includes applying an axially directed force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force without rotating the retainer member formed of bone.
145. A method as set forth in claim 143 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
146. A method as set forth in claim 143 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
147. A method as set forth in claim 143 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
148. A method as set forth in claim 143 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
149. A method as set forth in claim 143 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
150. A method as set forth in claim 143 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
151. A method as set forth in claim 150 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
152. A method as set forth in claim 143 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
153. A method as set forth in claim 152 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
154. A method as set forth in claim 152 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
155. A method as set forth in claim 143 further including the step of enclosing the retainer member formed of bone with a sleeve, said step of initiating formation of an opening in the portion of the bone in the patient's body includes applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
156. A method as set forth in claim 143 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
157. A method as set forth in claim 143 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
158. A method as set forth in claim 143 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes initiating formation of the opening at the second location.
159. A method as set forth in claim 158 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of initiating formation of the opening at the second location.
160. A method as set forth in claim 158 wherein said step of initiating formation of the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
161. A method as set forth in claim 143 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of initiating formation of an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
162. A method as set forth in claim 143 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of initiating formation of an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
163. A method as set forth in claim 162 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body.
164. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of tensioning the tissue to be secured, said step of tensioning the tissue to be secured includes moving a retainer member formed of bone and at least a portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body at the second location by applying force against a trailing end portion of the retainer member formed of bone, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining tension in at least a portion of the tissue to be secured.
165. A method as set forth in claim 164 wherein said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes forming an opening at the second location in the portion of the bone in the patient's body by transmitting an axially directed force applied against the trailing end portion of the retainer member formed of bone to the portion of the bone in the patient's body without rotating the retainer member formed of bone about a central axis of the retainer member formed of bone, and utilizing the retainer member formed of bone to hold the portion of the tissue to be secured at the second location by engaging the portion of the tissue to be secured with the trailing end portion of the retainer member formed of bone while the leading end portion of the retainer member formed of bone is disposed in the portion of the bone in the patient's body at the second location.
166. A method as set forth in claim 164 further including the step of positioning at least a portion of the retainer member formed of bone in a tubular member, said step of applying force against a trailing end portion of the retainer member formed of bone is performed with at least a portion of the retainer member formed of bone disposed in the tubular member.
167. A method as set forth in claim 164 wherein said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes initiating formation of an opening by pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force applied against the trailing end portion of the retainer member formed of bone.
168. A method as set forth in claim 164 further including the step of moving a member into the portion of the bone in the patient's body at the second location to form an opening of a first size, said step of forming an opening at the second location includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
169. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of forming an initial opening in the portion of the bone in the patient's body, moving a retainer member formed of bone into the portion of the bone in the patient's body at a location where the initial opening is formed in the portion of the bone in the patient's body, said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes engaging the initial opening in the portion of the bone in the patient's body with a leading end portion of the retainer member formed of bone and enlarging the initial opening formed in the portion of the bone in the patient's body by applying an axially directed force against a trailing end portion of the retainer member formed of bone and pushing aside material forming the portion of the bone in the patient's body under the influence of the axially directed force which is transmitted to the portion of the bone in the patient's body by the leading end portion of the retainer member formed of bone at the location where the initial opening was formed in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured.
170. A method as set forth in claim 169 wherein said step of pushing aside material forming the portion of the bone in the patient's body is performed without rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
171. A method as set forth in claim 169 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, said step of enlarging the initial opening formed in the portion of the bone in the patient's body is performed while the retainer member formed of bone is at least partially positioned in the tubular member and includes moving the retainer member formed of bone relative to the tubular member.
172. A method as set forth in claim 169 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
173. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with tissue to be secured, said step of moving the retainer member formed of bone into the portion of the bone in the patient body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and forming an opening in he portion of the bone in the patient's body with the leading end portion of the retainer member formed of bone as the leading end portion of the retainer member formed of bone moves into the portion of the bone in the patient's body, determining an extent of movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body by viewing indicia indicative of the extent of movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body, and interrupting said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body when the indicia indicates that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.
174. A method as set forth in claim 173 wherein said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and forming an opening in the portion of the bone in the patient's body with the leading end portion of the retainer member formed of bone include deflecting material of the portion of the bone in the patient's body with the leading end portion of the retainer member without rotating the retainer member.
175. A method as set forth in claim 173 further including the step of removing a hard surface area from a location on the compact outer layer of the portion of the bone in the patient's body, said step of moving the retainer member formed of into the portion of the bone in the patient's body includes moving the retainer member formed of bone into the portion of the bone in the patient's body at the location where the hard surface area on the compact outer layer was removed.
176. A method as set forth in claim 173 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.
177. A method as set forth in claim 173 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
178. A method as set forth in claim 173 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into a second portion of the bone in the patient's body.
179. A method as set forth in claim 173 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
180. A method as set forth in claim 173 wherein said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a tubular member, and applying force against a trailing end portion of said retainer member formed of bone to move the leading end portion of the retainer member formed of bone into a compact outer layer of the portion of the bone in the patient's body.
181. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and forming an opening in the portion of the bone in the patient's body with the leading end portion of the retainer member formed of bone as the leading end portion of the retainer member formed of bone moves into the portion of the bone in the patient's body, said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed without rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
182. A method as set forth in claim 181 wherein said step of forming an opening in the portion of the bone in the patient's body includes initiating formation of an opening in the portion of the bone in the patient's body by transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body.
183. A method as set forth in claim 181 wherein said step of forming an opening in the portion of the bone in the patient's body includes enlarging an initial opening formed in the portion of the bone in the patient's body prior to engagement of the portion of the bone in the patient's body with the leading end portion of the retainer member formed of bone.
184. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
185. A method as set forth in claim 184 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed while the retainer member formed of bone is enclosed by the sleeve.
186. A method as set froth in claim 184 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes initiating formation of an opening in the portion of the bone in the patient's body while the retainer member formed of bone is enclosed by the sleeve.
187. A method as set forth in claim 184 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes pushing material of the portion of the bone in the patient's body aside under the influence of the force applied to the trailing end portion of the retainer member formed of bone.
188. A method as set forth in claim 184 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone in the patient's body into cancellous bone enclosed by the compact outer layer.
189. A method as set forth in claim 184 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
190. A method as set forth in claim 184 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
191. A method as set forth in claim 184 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
192. A method as set forth in claim 184 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
193. A method as set forth in claim 184 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
194. A method as set forth in claim 193 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
195. A method as set forth in claim 184 wherein said step of positioning the retainer member formed of bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
196. A method as set forth in claim 195 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
197. A method as set forth in claim 195 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
198. A method as set forth in claim 184 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
199. A method as set forth in claim 184 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location.
200. A method as set forth in claim 199 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured prior to performing said step of utilizing the retainer member formed of bone to form the opening at the second location.
201. A method as set forth in claim 199 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
202. A method as set forth in claim 184 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient's body includes forming an opening of a first size in the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
203. A method as set forth in claim 184 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
204. A method as set forth in claim 184 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and tensioning the tissue to be secured, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
205. A method as set forth in claim 184 further including the step of disengaging the sleeve from the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body.
206. A method as set forth in claim 184 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes moving a leading end portion of the sleeve into engagement with the portion of the bone in the patient's body, said step of applying force against a trailing end portion of the retainer member formed of bone is performed with the leading end portion of the sleeve in engagement with the portion of the bone in the patient's body.
207. A method as set forth in claim 184 wherein said step of applying force against a trailing end portion of the retainer member includes moving a portion of a pusher member into the sleeve and transmitting force from the pusher member to the retainer member formed of bone.
208. A method as set forth in claim 184 further including the step of moving the sleeve at least part way through tissue to be secured and transmitting force between the tissue to be secured and the sleeve.
209. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location.
210. A method as set forth in claim 209 wherein said step of engaging the portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone.
211. A method as set forth in claim 210 wherein said step of tensioning at least a portion of the tissue to be secured includes transmitting force from the retainer member formed of bone to the tissue to be secured.
212. A method as set forth in claim 209 wherein said step of engaging the portion of the tissue to be secured includes engaging the portion of the tissue to be secured with a tubular member, said step of utilizing the retainer member to form the opening at the second location includes moving a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body.
213. A method as set forth in claim 212 wherein said step of tensioning at least a portion of the tissue to be secured includes transmitting force from the tubular member to the tissue to be secured.
214. A method as set forth in claim 209 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed with the retainer member formed of bone extending at least part way through the tissue to be secured.
215. A method as set forth in claim 209 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force from the head end portion of the retainer member formed of bone to the tissue to be secured.
216. A method as set forth in claim 215 wherein said step of engaging the portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the shank portion of the retainer member formed of bone.
217. A method as set forth in claim 216 wherein said step of tensioning at least a portion of the tissue to be secured includes transmitting force from the shank portion of the retainer member formed of bone to the tissue to be secured.
218. A method as set forth in claim 216 wherein said step of engaging a portion of the tissue to be secured includes piercing the tissue to be secured with the retainer member formed of bone.
219. A method as set forth in claim 209 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.
220. A method as set forth in claim 209 further including the step of removing a hard surface area from the second location on the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening at the second location on the portion of the bone in the patient's body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the second location where the hard surface area was removed.
221. A method as set forth in claim 209 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes initiating formation of an opening in the portion of the bone in the patient's body at the second location with the retainer member formed of bone.
222. A method as set forth in claim 209 wherein said step of utilizing the retainer member formed of bone to form an opening at the second location in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body at the second location.
223. A method as set forth in claim 209 wherein said step utilizing the retainer member formed of bone to form an opening at the second location in the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone at the second location and interrupting movement of the retainer member formed of bone into the portion of the bone at the second location when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
224. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body, said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
225. A method as set forth in claim 224 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body includes transmitting,force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed while maintaining the tension in the tissue to be secured.
226. A method as set forth in claim 225 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone while maintaining the tension in the tissue to be secured.
227. A method as set forth in claim 226 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes applying an axially directed force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the axially directed force while maintaining the tension in the tissue to be secured.
228. A method as set forth in claim 224 wherein said step of utilizing the retainer member to form an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into the patient's body into cancellous bone enclosed by the compact outer layer while maintaining the tension in the tissue to be secured.
229. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning at least a portion of a retainer member formed of bone in a tubular member, moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured while the retainer member formed of bone is at least partially disposed in the tubular member.
230. A method as set forth in claim 229 wherein said step of moving a portion of the retainer member formed of bone into the tissue to be secured includes contemporaneously moving the tubular member and the retainer member formed of bone into the tissue to be secured.
231. A method as set forth in claim 229 wherein said step of moving a portion of the retainer member formed of bone into the tissue to be secured includes initiating formation of an opening in the tissue to be secured with an end portion of the retainer member formed of bone.
232. A method as set forth in claim 229 wherein said step of moving a portion of the retainer member formed of bone into the tissue to be secured includes initiating formation of an opening in the tissue to be secured with an end portion of the retainer member formed of bone and moving the tubular member into the opening in the tissue to be secured.
233. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes forming an opening in the portion of the bone in the patient's body with a leading end portion of the retainer member formed of bone.
234. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes initiating formation of an opening in the portion of the bone in the patient's body.
235. A method as set forth in claim 229 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
236. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
237. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes applying force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the force applied against the retainer member formed of bone without rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
238. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone in the patient's body into cancellous bone enclosed by the compact outer layer.
239. A method as set forth in claim 229 wherein said steps of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the portion of the bone in the patient's body into the tissue to be secured.
240. A method as set forth in claim 229 wherein said steps of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
241. A method as set forth in claim 229 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
242. A method as set forth in claim 229 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
243. A method as set forth in claim 242 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
244. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
245. A method as set forth in claim 244 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
246. A method as set forth in claim 244 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
247. A method as set forth in claim 229 wherein said step moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
248. A method as set forth in claim 247 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
249. A method as set forth in claim 229 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes utilizing the retainer member to form an opening at the second location.
250. A method as set forth in claim 249 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.
251. A method as set forth in claim 229 further including the step of moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
252. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body and guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
253. A method as set forth in claim 229 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and tensioning the tissue to be secured, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
254. A method as set forth in claim 229 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the tubular member into the tissue to be secured and tensioning the tissue to be secured, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while continuing to tension the tissue to be secured.
255. A method as set forth in claim 254 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body.
256. A method as set forth in claim 229 wherein said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body is at least partially performed with the tubular member in engagement with the tissue to be secured, said method further includes the step of disengaging the tubular member from the tissue to be secured after performing said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body.
257. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning at least a portion of a retainer member formed of bone in a tubular member, moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes utilizing the retainer member to form an opening at the second location.
258. A method as set forth in claim 257 wherein said step of engaging the portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone.
259. A method as set forth in claim 258 wherein said step of tensioning at least a portion of the tissue to be secured includes transmitting force from the retainer member formed of bone to the tissue to be secured.
260. A method as set forth in claim 257 wherein said step of engaging the portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the tubular member.
261. A method as set forth in claim 260 wherein said step of tensioning at least a portion of the tissue to be secured includes transmitting force from the tubular member to the tissue to be secured.
262. A method as set forth in claim 257 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient's body is performed with the retainer member formed of bone extending at least part way through the tissue to be secured.
263. A method as set forth in claim 257 wherein said step of engaging a portion of the tissue to be secured includes piercing the tissue to be secured with the retainer member formed of bone.
264. A method as set forth in claim 257 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.
265. A method as set forth in claim 257 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
266. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning at least a portion of a retainer member formed of bone in a tubular member, moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body, connecting the retainer member formed of bone with the tissue to be secured, and moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
267. A method as set forth in claim 266 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
268. A method as set forth in claim 266 wherein said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes applying force against the retainer member formed of bone and pushing material of the portion of the bone in the patient's body aside under the influence of the force applied against the retainer member formed of bone.
269. A method as set forth in claim 266 wherein said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone in the patient's body into cancellous bone enclosed by the compact outer layer.
270. A method as set forth in claim 266 wherein said steps of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the portion of the bone in the patient's body into the tissue to be secured.
271. A method as set forth in claim 266 wherein said steps of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
272. A method as set forth in claim 266 wherein said step of moving at least a portion of the retainer member formed of bone into the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
273. A method as set forth in claim 272 wherein said step of positioning the retainer member formed of bone in the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
274. A method as set forth in claim 272 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
275. A method as set forth in claim 266 wherein said step moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
276. A method as set forth in claim 266 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body includes moving the retainer member into engagement with bone at the second location.
277. A method as set forth in claim 276 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of moving the retainer member into engagement with bone at the second location.
278. A method as set forth in claim 276 wherein said step of moving the retainer member formed of bone into engagement with bone at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
279. A method as set forth in claim 266 wherein said step of moving a member into the portion of the bone in the patient's body to form an opening of a first size includes moving a thin elongated member into the portion of the bone in the patient's body, said step of increasing the size of the opening formed in the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
280. A method as set forth in claim 266 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
281. A method as set forth in claim 266 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the tubular member into the tissue to be secured, and applying force to the tubular member to tension the tissue to be secured, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while continuing to tension the tissue to be secured.
282. A method as set forth in claim 281 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body.
283. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of positioning at least a portion of a retainer member formed of bone in a tubular member, moving at least a portion of the retainer member formed of bone out of the tubular member into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of moving at least a portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
284. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against a trailing end portion of the retainer member formed of bone, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone includes initiating formation of an opening in the portion of the bone in the patient's body by transmitting force from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body and enlarging the opening by continuing to transmit force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body is performed without rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
285. A method as set forth in claim 284 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
286. A method as set forth in claim 284 wherein said step of transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes pushing material of the portion of the bone in the patient's body aside.
287. A method as set forth in claim 284 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
288. A method as set forth in claim 284 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
289. A method as set forth in claim 284 wherein said step of moving the retainer member formed of bone in the portion of the bone into the patient's body includes positioning the retainer member formed of bone in a tubular member, said steps of initiating formation of an opening in the portion of the bone in the patient's body and enlarging the opening are performed while the retainer member formed of bone is at least partially positioned in the tubular member and include moving the retainer member formed of bone relative to the tubular member.
290. A method as set forth in claim 284 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
291. A method as set forth in claim 284 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
292. A method as set forth in claim 284 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
293. A method as set forth in claim 284 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
294. A method as set forth in claim 284 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of moving a retainer member formed of bone in the portion of the bone into the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
295. A method as set forth in claim 294 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
296. A method as set forth in claim 284 wherein said step of moving the retainer member formed of bone into the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
297. A method as set forth in claim 296 wherein said step of moving the retainer member formed of bone into the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
298. A method as set forth in claim 297 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
299. A method as set forth in claim 284 wherein said step of initiating formation of an opening in the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body while a portion of the retainer member formed of bone is enclosed by the sleeve.
300. A method as set forth in claim 284 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
301. A method as set forth in claim 284 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location.
302. A method as set forth in claim 301 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of initiating formation of the opening at the second location.
303. A method as set forth in claim 301 wherein said step of initiating formation of the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
304. A method as set forth in claim 284 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of initiating formation of an opening in the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
305. A method as set forth in claim 284 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of initiating formation of an opening in the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
306. A method as set forth in claim 305 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of initiating formation of an opening in the portion of the bone in the patient's body.
307. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against a trailing end portion of the retainer member formed of bone, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone includes initiating formation of an opening in the portion of the bone in the patient's body by transmitting force from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body and enlarging the opening by continuing to transmit force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes pushing material of the portion of the bone in the patient's body aside under the influence of force applied against the trailing end portion of the retainer member formed of bone.
308. A method as set forth in claim 307 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
309. A method as set forth in claim 307 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
310. A method as set forth in claim 307 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
311. A method as set forth in claim 307 wherein said step of moving the retainer member formed of bone in the portion of the bone into the patient's body includes positioning the retainer member formed of bone in a tubular member, said steps of initiating formation of an opening in the portion of the bone in the patient's body and enlarging the opening are performed while the retainer member formed of bone is at least partially positioned in the tubular member and include moving the retainer member formed of bone relative to the tubular member.
312. A method as set forth in claim 307 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patients body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
313. A method as set forth in claim 307 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient's body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.
314. A method as set forth in claim 307 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
315. A method as set forth in claim 307 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
316. A method as set forth in claim 307 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
317. A method as set forth in claim 307 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
318. A method as set forth in claim 317 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
319. A method as set forth in claim 307 wherein said step of moving the retainer member formed of bone into the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
320. A method as set forth in claim 319 wherein said step of moving the retainer member formed of bone into the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
321. A method as set forth in claim 319 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
322. A method as set forth in claim 307 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes enclosing the retainer member formed of bone with a sleeve and moving a portion of the retainer member formed of bone out of the sleeve into the portion of the bone in the patient's body.
323. A method as set forth in claim 307 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.
324. A method as set forth in claim 307 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes utilizing the retainer member to form the opening at the second location.
325. A method as set forth in claim 324 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.
326. A method as set forth in claim 324 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.
327. A method as set forth in claim 307 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
328. A method as set forth in claim 307 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient's body.
329. A method as set forth in claim 328 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of moving the retainer member formed of bone into the portion of the bone in the patient's body.
330. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against a trailing end portion of the retainer member formed of bone, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone includes initiating formation of an opening in the portion of the bone in the patient's body by transmitting force from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body and enlarging the opening by continuing to transmit force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes positioning the retainer member formed of bone in a tubular member, said steps of initiating formation of an opening in the portion of the bone in the patient's body and enlarging the opening are performed while the retainer member formed of bone is at least partially positioned in the tubular member and include moving the retainer member formed of bone relative to the tubular member.
331. A method as set forth in claim 330 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of initiating formation of an opening in the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
332. A method as set forth in claim 330 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into cancellous bone enclosed by the compact outer layer.
333. A method as set forth in claim 330 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
334. A method as set forth in claim 330 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient's body.
335. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes deflecting material of the portion of the bone disposed in the patient's body under the influence of force transmitted through the retainer member formed of bone without rotating the retainer member formed of bone relative to the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone relative to the portion of the bone in the patient's body with the retainer member formed of bone disposed in engagement with the portion of the bone in the patient's body, said step of moving a retainer member formed of bone into the portion of the bone in the patient's body at least partially includes enclosing the retainer member formed of bone with a tubular member, applying force against a trailing end portion of the retainer member formed of bone, and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body under the influence of force applied against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.
336. A method as set forth in claim 335 wherein said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes moving the retainer member formed of bone to initiate formation of an opening in a compact outer layer of the portion of the bone in the patient's body.
337. A method as set forth in claim 335 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when a leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone in the patient's body.
338. A method as set forth in claim 335 further including the step of tensioning the tissue to be secured prior to moving the retainer member formed of bone into the portion of the bone in the patient's body.
339. A method as set forth in claim 335 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
340. A method as set forth in claim 335 wherein said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes pushing material of the portion of the bone in the patient's body aside under the influence of the force applied against the trailing end portion of the retainer member formed of bone.
341. A method as set forth in claim 335 wherein said step of moving the leading a leading end portion of the retainer member into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone in the patient's body into cancellous bone enclosed by the compact outer layer.
342. A method as set forth in claim 335 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
343. A method as set forth in claim 335 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient's body into the tissue to be secured.
344. A method as set forth in claim 335 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
345. A method as set forth in claim 335 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
346. A method as set forth in claim 335 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
347. A method as set forth in claim 346 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
348. A method as set forth in claim 335 wherein said step of moving the retainer member formed of bone into the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
349. A method as set forth in claim 348 wherein said step of moving the retainer member formed of bone into the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer cancellous bone.
350. A method as set forth in claim 348 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
351. A method as set forth in claim 335 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes moving the retainer member into the portion of the bone in the patient's body at the second location.
352. A method as set forth in claim 351 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of moving the leading end portion of the retainer member into the portion of the bone in the patient's body at the second location.
353. A method as set forth in claim 351 wherein said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secure from the first location to the second location.
354. A method as set forth in claim 335 wherein said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
355. A method as set forth in claim 335 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
356. A method as set forth in claim 335 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body is performed while maintaining the tension in the tissue to be secured.
357. A method as set forth in claim 335 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member.
358. A method as set forth in claim 357 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body.
359. A method of securing tissue against movement relative to a portion of a bone in a patient's body, said method comprising the steps of moving a retainer member formed of bone into the portion of the bone in the patient's body, tensioning the tissue to be secured prior to moving the retainer member formed of bone into the portion of the bone in the patient's body, and connecting the retainer member formed of bone with the tissue to be secured, said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes deflecting material of the portion of the bone disposed in the patient's body under the influence of force transmitted through the retainer member formed of bone without rotating the retainer member formed of bone relative to the portion of the bone in the patient's body and interrupting movement of the retainer member formed of bone relative to the portion of the bone in the patient's body with the retainer member formed of bone disposed in engagement with the portion of the bone in the patient's body.
360. A method as set forth in claim 359 wherein said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes utilizing the retainer member formed of bone to initiate formation of an opening in a compact outer layer of the portion of the bone in the patient's body.
361. A method as set forth in claim 359 wherein said step of moving a retainer member formed of bone into the portion of the bone in the patient's body at least partially includes enclosing the retainer member formed of bone with a tubular member.
362. A method as set forth in claim 359 further including the step of interrupting movement of the retainer member formed of bone into the portion of the bone in the patient's body when a leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone in the patient's body.
363. A method as set forth in claim 359 further including the step of removing a hard surface area from a location on the portion of the bone in the patient's body, said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient's body at the location where the hard surface area was removed.
364. A method as set forth in claim 359 wherein said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes pushing material of the portion of the bone in the patient's body aside under the influence of the force applied against the trailing end portion of retainer member formed of bone.
365. A method as set forth in claim 359 wherein said step of moving a leading end portion of the retainer member into the portion of the bone in the patient's body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone in the patient's body into cancellous bone enclosed by the compact outer layer.
366. A method as set forth in claim 359 wherein said step of tensioning the tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.
367. A method as set forth in claim 359 wherein said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient's body into a second portion of the bone in the patient's body.
368. A method as set forth in claim 359 wherein the bone in the patient's body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.
369. A method as set forth in claim 359 wherein the portion of a bone in the patient's body is a first bone and the tissue to be secured is a second bone in the patient's body, said steps of moving a retainer member formed of bone into the portion of the bone in the patient's body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.
370. A method as set forth in claim 359 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.
371. A method as set forth in claim 359 wherein said step of moving the retainer member formed of bone into the patient's body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.
372. A method as set forth in claim 371 wherein said step of moving the retainer member formed of bone into the patient's body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.
373. A method as set forth in claim 371 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient's body under the influence of force applied against the retainer member formed of bone by the cancellous bone.
374. A method as set forth in claim 359 wherein said step of tensioning the tissue to be secured includes moving a portion of the tissue to be secured from a first location relative to the portion of the bone in the patient's body to a second location relative to the portion of the bone in the patient's body, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes moving the retainer member into the portion of the bone in the patient's body at the seed location.
375. A method as set forth in claim 359 wherein said step of moving a retainer member formed of bone into the portion of the bone in the patient's body includes moving a member into the portion of the bone in the patient's body to form an opening of a first size, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes increasing the size of the opening formed in the bone in the patient's body from the first size to a second size which is larger than the first size.
376. A method as set forth in claim 359 wherein said step of moving the retainer member formed of bone into the portion of the bone in the patient's body includes moving a thin elongated member into the portion of the bone in the patient's body, said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient's body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient's body with the thin elongated member.
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