Processing

Please wait...

Settings

Settings

Goto Application

1. WO2020109817 - IMPLANT ASSEMBLY AND ASSOCIATED METHODS OF MANUFACTURING

Note: Text based on automatic Optical Character Recognition processes. Please use the PDF version for legal matters

[ EN ]

CLAIMS

1. An implant assembly for use in tissue repair, the implant assembly having an adjustable length and comprising:

a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

a flexible elongate element secured to the fixation device, the flexible elongate element having a first free end and a second free end, in which the flexible elongate element passes through apertures of the fixation device so that:

at least two bone-side loops are formed which each extend from at least one of the apertures at the bone facing surface of the fixation device, at least one of the bone-side loops forming a support loop adapted to be located at least partly within a bone tunnel; at least one fixation loop is formed which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device; and

an adjustable knot arrangement is formed comprising an adjustable knot which is positionable on the outer surface of the fixation device, a first leg extending from the knot to the first free end of the elongate element and a second leg extending from the knot to the second free end of the elongate element;

in which the flexible elongate element is securable to the fixation device by the fixation loop, the fixation loop passing over at least part of the adjustable knot arrangement to clamp the knot arrangement to the fixation device when the bone-side loops are tensioned relative to the fixation device;

so as to allow a length of each of the bone-side loops to be adjusted.

2. An implant assembly as claimed in claim 1, in which the adjustable knot assembly is an overhand knot assembly comprising an overhand knot.

3. An implant assembly as claimed in either of claims 1 or 2, in which the flexible elongate element is arranged so that it follows a path which extends continuously through the apertures in the fixation device to form the at least two bone-side loops, the at least one fixation loop, and the adjustable knot.

4. An implant assembly as claimed in claim 3, in which the flexible elongate element is arranged so that it successively forms a first one of the bone-side loops, the fixation loop, a second one of the bone-side loops, and the adjustable knot.

5. An implant assembly as claimed in any preceding claim, in which the adjustable knot and the fixation loop together form a self-locking knot assembly which self-locks under load.

6. An implant assembly as claimed any preceding claim, in which the adjustable knot is positioned between the outer surface of the fixation device and the fixation loop.

7. An implant assembly as claimed in any preceding claim, comprising at least one further bone-side loop which extends from one of the apertures at the bone facing surface of the fixation device to another one of the apertures at the bone facing surface.

8. An implant assembly as claimed in any preceding claim, in which the implant assembly comprises at least one further fixation loop which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device, the further fixation loop passing over at least part of the adjustable knot arrangement.

9. An implant assembly as claimed in any preceding claim, in which the implant assembly is an implant fixation assembly for fixing an implant within a tunnel in a bone, the at least one bone-side loop forming an implant support loop adapted to receive the implant, for suspending the implant in the bone tunnel from the fixation device.

10. An implant assembly as claimed in any one of claims 1 to 8, in which the at least one bone-side loop forming a support loop defines at least part of an implant which serves to replicate the function of damaged tissue.

11. An implant assembly as claimed in any preceding claim, in which:

the bone-side loops each have a first loop portion extending from one of the apertures to an apex of the loop, and a second loop portion extending from another one of the apertures to the apex of the loop;

the fixation loop has a first loop portion extending from one of the apertures to an apex of the loop, and a second loop portion extending from another one of the apertures to the apex of the loop;

the adjustable knot has a first knot portion extending from one side of the knot to one of the apertures, and a second knot portion extending from the other side of the knot to another one of the apertures;

the first loop portion of one of the bone-side loops extends from one side of the knot, and the second loop portion of the first bone-side loop extends from one of the first and second loop portions of the fixation loop; and

the first loop portion of the other bone-side loop extends from the other side of the knot, and the second loop portion of the other bone-side loop extends from the other one of the first and second loop portions of the fixation loop.

12. An implant assembly as claimed in any preceding claim, in which the fixation device is a first fixation device, and the assembly comprises a second fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface.

13. An implant assembly as claimed in claim 12, in which the first fixation device is adapted to be secured relative to a surface of a first bone of a joint and the second fixation device relative to a surface of a second bone of the joint, at least one of the bone-side loops adapted to extend along a bone tunnel between the fixation devices to maintain the bones in their proper position, a length of the loop being selected to define a desired distance between the two fixation devices.

14. An implant assembly as claimed in either of claims 12 or 13, in which the flexible elongate element also passes through one of the apertures of the second fixation device and then back through another one of said apertures of the second fixation device.

15. An implant assembly as claimed in any claim 14, in which the second fixation device is arranged so that its bone facing surface faces towards the bone facing surface of the first fixation device, the second fixation device being located at a position which is spaced along a length of said bone-side loop from the first fixation device.

16. An implant assembly as claimed in claim 15, in which portions of said bone-side loop extending between the bone facing surfaces of the first and second fixation devices define an implant adapted to be located in a bone tunnel.

17. An implant assembly as claimed in any preceding claim, in which one or more of the bone-side loops forms a first implant and the implant assembly comprises a further implant coupled directly to the fixation device and tensionable independently of the first implant.

18. An implant assembly as claimed in claim 17, when dependent on any one of claims 12 to 16, in which the further implant is coupled to the further fixation device.

19. An implant assembly as claimed in any preceding claim, comprising a tubular sheath positioned around the bone-side loop forming a support loop adapted to be located in the bone tunnel.

20. An implant assembly as claimed in any preceding claim, in which the fixation loop is arranged so that it passes: over the adjustable knot; over one of the first and second legs; and/or over both the first and second legs, to clamp the knot arrangement to the fixation device when the bone-side loops are tensioned.

21. An implant assembly as claimed in any preceding claim, in which at least one bone-side loop forms a locking loop which is drawn into contact with the bone-facing

surface of the fixation device, said bone-side loop cooperating with the fixation loop and the knot assembly to secure the flexible elongate element to the fixation device.

22. An implant assembly as claimed in claim 21, in which the bone-side loops each have a first loop portion extending from one of the apertures to an apex of the loop, and a second loop portion extending from another one of the apertures to the apex of the loop, and in which:

a length of the support loop is adjustable by applying tension to the loop portion which extends from one side of the knot; and

the length of the support loop is locked by applying tension to the other loop portion, which extends from the fixation loop.

23. An implant assembly as claimed in claim 22, comprising a knot-adjusting element for adjusting the knot, the knot-adjusting element being coupled to the loop portion which extends from said side of the knot.

24. An implant assembly as claimed in any preceding claim, in which the flexible elongate element is braided, comprising:

a first set of fibres passing in a first direction around a circumference of the elongate element, and a second set of fibres passing in a second direction around a circumference of the elongate element, the first fibres disposed transverse to the second fibres and transverse to a longitudinal axis of the elongate element;

and in which a braid angle is defined between the fibres and the longitudinal axis.

25. An implant assembly as claimed in claim 24, in which the braid angle is between around 15° and around 30°.

26. An implant assembly as claimed in any preceding claim, in which one or more of the bone-side loops that are formed extends from one of the apertures at the bone facing surface of the fixation device to another one of the apertures at the bone facing surface. 27. An implant assembly as claimed in any preceding claim, in which one or more of the bone-side loops that are formed extends from a same aperture at the bone facing surface of the fixation device.

28. A method of manufacturing an implant assembly for use in tissue repair, the method comprising the steps of:

providing a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

coupling a flexible elongate element to the fixation device by passing the elongate element through apertures of the fixation device to form:

at least two bone-side loops which each extend from at least one of the apertures at the bone facing surface of the fixation device, at least one of the bone- side loops forming a support loop adapted to be located at least partly within a bone tunnel;

at least one fixation loop which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device; and

an adjustable knot arrangement comprising an adjustable knot, a first leg extending from the knot to a first free end of the elongate element and a second leg extending from the knot to a second free end of the elongate element;

and arranging the fixation loop so that it passes over at least part of the adjustable knot arrangement.

29. A method as claimed in claim 28, comprising a step A of:

directing the flexible elongate element through the first aperture of the fixation device and through another aperture, so that a portion of the flexible elongate element including the first free end and a portion of the flexible elongate element including the second free end both extend from the apertures on an outer surface side of the fixation device, to form one of the bone-side loops.

30. A method as claimed in claim 29, comprising a step B of:

directing the portion of the flexible elongate element which extends from the first aperture on the outer surface side of the fixation device through another aperture, so that said portion extends from said other aperture on the bone facing surface side of the fixation device, to form the fixation loop.

31. A method as claimed in claim 30, comprising a step C of:

directing the portion of the flexible elongate element which extends from said other aperture on the bone facing surface side of the fixation device through a different aperture, so that the portions of the flexible elongate element including the first and second free ends both extend from the apertures on the outer surface side of the fixation device, to form the other one of the bone-side loops.

32. A method as claimed in claim 31 , comprising a step D of:

manipulating the portions of the flexible elongate element to form the adjustable knot.

33. A method as claimed in claim 32, comprising a step E of:

manipulating the adjustable knot so that it is positioned between the outer surface of the fixation device and the fixation loop, by directing at least one of the portions of the flexible elongate element through an eye of the fixation loop.

34. A method as claimed in claim 33, comprising a step F of:

manipulating the fixation loop to clamp the adjustable knot arrangement to the fixation device and thereby secure the flexible elongate element to the fixation device.

35. A method as claimed in claim 34, in which steps E and F are carried out by tensioning the bone-side loops.

36. A method as claimed in either of claims 34 or 35, in which the steps A to F are carried out sequentially.

37. A method as claimed in any one of claims 31 to 36 comprising a step C2 which is carried out following step C, step C2 comprising:

directing the portion of the flexible elongate element which extends from the first aperture on the outer surface side of the fixation device back through an aperture of the fixation device, so that said portion extends from said aperture on the bone facing surface side of the fixation device, to form a further fixation loop.

38. A method as claimed in claim 37 comprising a step C3 which is carried out following step C2, step C3 comprising:

directing the portion of the flexible elongate element which extends from said aperture of the fixation device on the bone facing surface side through a different aperture, so that the portions of the flexible elongate element including the first and second free ends again both extend from the apertures on the outer surface side of the fixation device, to form a further bone-side loop.

39. A method as claimed in claim 38, in which step E involves directing said portion of the flexible elongate element through eyes of both fixation loops.

40. A method as claimed in claim 39, in which step F involves manipulating both of the fixation loops to clamp the adjustable knot arrangement to the fixation device and thereby secure the flexible elongate element to the fixation device.

41. A method as claimed in claim 29, in which:

the fixation device is a first fixation device, and the method comprises providing a further fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the further fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the further fixation device from the outer surface to the bone facing surface; and

the method, in step A, comprises directing the flexible elongate element through the first and second apertures of the further fixation device so that the further fixation device is disposed on the bone-side loop that is formed in step A.

42. A method as claimed in any one of claims 28 to 41 , comprising drawing one of the bone-side loops into contact with the bone- facing surface of the fixation device by shortening the loop, said bone-side loop cooperating with the fixation loop and the knot assembly to secure the flexible elongate element to the fixation device.

43. A method as claimed in claim 42, in which the support loop comprises a first loop portion extending from one of the apertures to an apex of the loop, and a second loop portion extending from another one of the apertures to the apex of the loop, and in which the method comprises:

adjusting a length of the support loop by applying tension to the loop portion which extends from one side of the knot.

44. A method as claimed in any one of claims 28 to 43, comprising directing the free ends of the flexible elongate element from the outer surface side of the fixation device and through the fixation device.

45. A method of carrying out tissue repair involving the fixation of an implant within a tunnel in a bone, the method comprising use of the implant assembly of any one of claims 1 to 27 to locate an implant in a tunnel in a bone.

46. A method as claimed in claim 43, in which the method is a method of repairing damaged connective tissue.

47. A method as claimed in any one of claims 28 to 46, in which one or more of the bone-side loops that are formed extends from one of the apertures at the bone facing surface of the fixation device to another one of the apertures at the bone facing surface.

48. A method as claimed in any one of claims 28 to 47, in which one or more of the bone-side loops that are formed extends from a same aperture at the bone facing surface of the fixation device.

49. An implant construction device for forming an implant assembly adapted to be used in tissue repair, the implant construction device comprising:

a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

a flexible elongate element coupled to the fixation device; and

a manipulating element for use in constructing the implant assembly, the manipulating element being flexible and elongate and comprising a first end forming at least part of a capturing loop and a second end, the manipulating element extending through an aperture of the fixation device so that a portion of the manipulating element comprising its first end extends from the aperture at the bone facing surface of the fixation device and a portion of the manipulating element comprising its second end extends from the aperture at the outer surface of the fixation device; and

an adjustable knot which is positionable on the outer surface of the fixation device;

in which the flexible elongate element has a first end and a second end, and the flexible elongate element passes through apertures of the fixation device so that:

a bone-side loop is formed which extends from at least one of the apertures at the bone facing surface of the fixation device;

a knot fixation loop is formed which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device; and

a portion of the flexible elongate element comprising the first end extends from one of the apertures at the outer surface of the fixation device and a portion of the flexible elongate element comprising the second end extends from one of the apertures at the bone facing surface of the fixation device;

and in which the adjustable knot is formed by the portion of the manipulating element extending from said aperture of the fixation device and comprising its second end, and the portion of the flexible elongate element extending from said aperture of the fixation device and comprising its first end.

50. An implant construction device for forming an implant assembly adapted to be used in tissue repair, the implant construction device comprising:

a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

a flexible elongate element coupled to the fixation device; and

first and second manipulating elements for use in constructing the implant assembly, the manipulating elements being flexible and elongate and each comprising a first end forming at least part of a capturing loop and a second end, the manipulating elements each extending through an aperture of the fixation device so that portions of the manipulating elements comprising their first ends extend from said aperture at the bone facing surface of the fixation device and portions of the manipulating elements comprising their second ends extend from said aperture at the outer surface of the fixation device; and an adjustable knot which is positionable on the outer surface of the fixation device;

in which the flexible elongate element has a first end and a second end, and the flexible elongate element passes through apertures of the fixation device so that:

a bone-side loop is formed which extends from at least one of the apertures at the bone facing surface of the fixation device;

a first knot fixation loop is formed which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device;

a second knot fixation loop is formed which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device;

a portion of the flexible elongate element comprising the first end, and a portion of the flexible elongate element comprising the second end, each extend from one of the apertures at the bone facing surface of the fixation device;

and in which the adjustable knot is formed by a portion of the first manipulating element extending from said aperture of the fixation device and comprising its second end, and a portion of the second manipulating element extending from said aperture of the fixation device and comprising its second end.

51. An implant construction device as claimed in either of claims 49 or 50, in which the portion of the manipulating element comprising the first end and extending from said aperture at the bone facing surface of the fixation device defines the entire capturing loop.

52. An implant construction device as claimed in either of claims 49 or 50, in which the capturing loop is defined partly by the portion of the manipulating element comprising the first end and extending from said aperture at the bone facing surface of the fixation device, and partly by the portion of the manipulating element comprising the second end and extending from said aperture at the outer surface of the fixation device.

53. An implant construction device as claimed in any one of claims 49 to 52, in which the manipulating element is defined by a single elongate element which is folded at a point along its length to form the capturing loop.

54. An implant construction device as claimed in claim 53, in which the manipulating element is of a textile material and generally tubular, and in which a part of the

manipulating element extends through a side wall of the element and along an internal cavity, to form the capturing loop.

55. An implant construction device as claimed in claim 49, in which the second end of the flexible elongate element is positionable through the capturing loop of the manipulating element, and the manipulating element is manipulatable to draw the second end through the fixation device to its outer surface and through the adjustable knot, so that the portion of the knot formed by the manipulating element is replaced by the portion of the flexible elongate element comprising its second end.

56. An implant construction device as claimed in either of claims 49 or 55, in which the adjustable knot forms part of an adjustable knot arrangement comprising the adjustable knot, a first leg extending from the knot and a second leg extending from the knot, the

portions of the manipulating element and the flexible elongate element forming the knot also forming the first and second knot legs.

57. An implant construction device as claimed in claim 49, or either of claims 55 or

56, in which the flexible elongate element is arranged so that it follows a path which extends continuously through the apertures in the fixation device to form the bone-side loop, the at least one fixation loop, and its part of the adjustable knot.

58. An implant construction device as claimed in claim 49, or any one of claims 55 to

57, in which the first end of the manipulating element is adapted to be located through a plug.

59. An implant construction device as claimed in claim 49, or any one of claims 55 to 57, in which the bone side loop is adapted to be located through a plug.

60. An implant construction device as claimed in claim 50, in which the first end of the flexible elongate element is positionable through the loop of the first manipulating element; the second end of the flexible elongate element is positionable through the loop of the second manipulating element; and the manipulating elements are manipulatable to draw the first and second ends of the flexible elongate element through the fixation device to its outer surface and through the adjustable knot, so that the portion of the adjustable knot formed by the first manipulating element is replaced by the portion of the flexible elongate element comprising its first end, and so that the portion of the adjustable knot formed by the second manipulating element is replaced by the portion of the flexible elongate element comprising its second end.

61. An implant construction device as claimed in either of claims 50 or 60, in which the flexible elongate element is arranged so that it follows a path which extends

continuously through the apertures in the fixation device to form one of the fixation loops, the bone-side loop, and the other the fixation loop.

62. An implant construction device as claimed in claim 50, or either of claims 60 or

61, in which the adjustable knot forms part of an adjustable knot arrangement comprising the adjustable knot, a first leg extending from the knot and a second leg extending from the knot, said portions of the manipulating elements forming the first and second knot legs.

63. An implant construction device as claimed in claim 50, or any one of claims 60 to

62, in which the first ends of both the first and second manipulating elements are adapted to be located through a plug.

64. An implant construction device as claimed in any one of claims 49 to 63, in which one or more of the bone-side loops that are formed extends from one of the apertures at the bone facing surface of the fixation device to another one of the apertures at the bone facing surface.

65. An implant construction device as claimed in any one of claims 49 to 64, in which one or more of the bone-side loops that are formed extends from a same aperture at the bone facing surface of the fixation device.

66. A method of manufacturing an implant construction device for use in forming an implant assembly adapted to be used in tissue repair, the method comprising the steps of: providing a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

coupling a flexible elongate element comprising a first end and a second end to the fixation device;

providing a flexible elongate manipulating element comprising a first end forming at least part of a capturing loop and a second end, and locating the manipulating element through an aperture of the fixation device so that a portion of the manipulating element comprising its first end extends from the aperture at the bone facing surface of the fixation device and a portion of the manipulating element comprising its second end extends from the aperture at the outer surface of the fixation device;

in which the step of coupling the flexible elongate element to the fixation device involves passing the flexible elongate element through apertures of the fixation device to form a bone-side loop which extends from at least one of the apertures at the bone facing surface of the fixation device, and a knot fixation loop which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device, a portion of the flexible elongate element comprising the first end extending from one of the apertures at the outer surface of the fixation device and a portion of the flexible elongate element comprising the second end extending from one of the apertures at the bone facing surface of the fixation device (which may be different apertures for each portion);

and in which the method further comprises:

forming an adjustable knot using the portion of the manipulating element extending from said aperture of the fixation device and comprising its second end, and the portion of the flexible elongate element extending from said aperture of the fixation device and comprising its first end; and

arranging the adjustable knot so that fixation loop passes over the knot.

67. A method as claimed in claim 66, comprising positioning the second end of the flexible elongate element through the capturing loop of the manipulating element, and using the manipulating element to draw the second end through the fixation device to its outer surface and through the adjustable knot, so that the portion of the knot formed by the manipulating element is replaced by the portion of the flexible elongate element comprising its second end, and so that a further bone-side loop is formed by the flexible elongate element.

68. A method as claimed in either of claims 66 or 67, comprising locating the first end of the manipulating element through a passage in a plug, and using the manipulating element to draw the second end of the flexible elongate element through the plug and through the fixation device to its outer surface side, to form a bone side loop with the plug positioned on the loop.

69. A method as claimed in either of claims 66 or 67, comprising locating the bone side loop through a passage in a plug, locating the second free end of the flexible elongate element through a part of the bone side loop protruding from the plug, and then positioning the second free end through the capturing loop of the manipulating element.

70. A method as claimed in claim 69, comprising using the manipulating element to draw the second end of the flexible elongate element through the fixation device to its outer surface side, to form a second bone side loop coupled to the bone side loop carrying the plug.

71. A method of manufacturing an implant construction device for use in forming an implant assembly adapted to be used in tissue repair, the method comprising the steps of: providing a fixation device comprising a bone facing surface, an outer surface opposite the bone facing surface, a first aperture extending through the fixation device from the outer surface to the bone facing surface, and at least a second aperture extending through the fixation device from the outer surface to the bone facing surface;

coupling a flexible elongate element comprising a first end and a second end to the fixation device;

providing first and second flexible elongate manipulating elements, each manipulating element comprising a first end forming at least part of a capturing loop and a second end, and locating the manipulating elements through an aperture of the fixation device (which may be different apertures for each manipulating element) so that portions of the manipulating elements comprising their first ends extend from the aperture at the bone facing surface of the fixation device and portions of the manipulating elements comprising their second ends extend from the aperture at the outer surface of the fixation device;

in which the step of coupling the flexible elongate element to the fixation device involves passing the flexible elongate element through apertures of the fixation device to form:

a bone-side loop which extends from at least one of the apertures at the bone facing surface of the fixation device;

a first knot fixation loop which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device; and

a second knot fixation loop which extends from one of the apertures at the outer surface of the fixation device to another one of the apertures at the outer surface of the fixation device;

in which a portion of the flexible elongate element comprising the first end, and a portion of the flexible elongate element comprising the second end, each extend from one of the apertures at the bone facing surface of the fixation device (which may be different apertures for each portion);

and in which the method further comprises:

forming an adjustable knot using the portion of the first manipulating element extending from said aperture of the fixation device and comprising its second end, and the portion of the second manipulating element extending from said aperture of the fixation device and comprising its second end; and

arranging the adjustable knot so that the fixation loops pass over the knot.

72. A method as claimed in claim 71 , comprising positioning the first end of the flexible elongate element through the capturing loop of the first manipulating element, and using the first manipulating element to draw the first end through the fixation device to its outer surface and through the adjustable knot, so that the portion of the knot formed by the first manipulating element is replaced by the portion of the flexible elongate element comprising its first end, and so that a further bone-side loop is formed by the flexible elongate element.

73. A method as claimed in either of claims 71 or 72, comprising positioning the second end of the flexible elongate element through the capturing loop of the second manipulating element, and using the second manipulating element to draw the second end through the fixation device to its outer surface and through the adjustable knot, so that the portion of the knot formed by the second manipulating element is replaced by the portion of the flexible elongate element comprising its second end, and so that a further bone-side loop is formed by the flexible elongate element.

74. A method as claimed in any one of claims 71 to 73, comprising locating the first ends of the manipulating elements through a passage in a plug, and using the manipulating elements to draw the first and second ends of the flexible elongate element through the plug and through the fixation device to its outer surface side, to form further bone side loops with the plug positioned on the loops.

75. A method as claimed in any one of claims 66 to 74, in which one or more of the bone-side loops that are formed extends from one of the apertures at the bone facing surface of the fixation device to another one of the apertures at the bone facing surface.

76. A method as claimed in any one of claims 66 to 75, in which one or more of the bone-side loops that are formed extends from a same aperture at the bone facing surface of the fixation device.

77. A method of manufacturing an implant assembly for use in tissue repair, involving a preparatory step of manufacturing an implant construction device according to any one of claims 66 to 76.