Method and apparatus for meniscal repair

• US 20080091219A1
• Filed: 05/22/2007
• Published: 04/17/2008
• Est. Priority Date: 05/22/2006
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Enterprises Holdings Inc (Mallinckrodt plc)
• Inventors: Hubbard, Dennis, Marshall, Peter
• Granted Patent: US 7,918,868 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
• CPC Class Codes: A61B 2017/0646 for insertion into cartillege, e.g. meniscus

Abstract

In one form of the present invention, there is provided apparatus for suturing tissue, wherein the apparatus comprises: a housing; a first needle mounted to the housing; a second needle mounted to the housing; a suture having a leading portion and a trailing portion; a first structure associated with the first needle for passing the leading portion of the suture from a near side of the tissue to a far side of the tissue; and a second structure associated with the second needle for retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue. In another form of the present invention, there is provided apparatus for suturing tissue, wherein the apparatus comprises: a housing; a first needle mounted to the housing; a second needle mounted to the housing; a suture having a leading portion and a trailing portion; a first structure associated with the first needle for passing the leading portion of the suture from a near side of the tissue to a far side of the tissue; a second structure associated with the second needle for retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue; a pre-formed, uncinched knot formed in the trailing portion of the suture; and a support for releasably supporting the pre-formed, uncinched knot relative to the housing. In another form of the present invention, there is provided a method for suturing tissue, the method comprising the steps of: providing a suture having a leading portion and a trailing portion, wherein a pre-formed, uncinched knot is formed in the trailing portion of the suture; passing the leading portion of suture from a near side of the tissue to a far side of the tissue; retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue; passing the retracted leading portion of the suture through the pre-formed, uncinched knot formed in the trailing portion of the suture; and cinching the knot so as to secure the suture in the tissue.

Claims

1. Apparatus for suturing tissue, wherein the apparatus comprises:

a housing;

a first needle mounted to the housing;

a second needle mounted to the housing;

a suture having a leading portion and a trailing portion;

a first structure associated with the first needle for passing the leading portion of the suture from a near side of the tissue to a far side of the tissue; and

a second structure associated with the second needle for retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue.

2. Apparatus according to claim 1 wherein the first structure comprises a lumen extending through the first needle, and the second structure comprises a snare extendable out of the second needle.

3. Apparatus according to claim 2 wherein the snare comprises a collapsible loop formed at the end of an angled shaft.

4. Apparatus according to claim 3 wherein the snare engages the leading portion of the suture adjacent the distal end of the first needle.

5. Apparatus according to claim 1 wherein the first structure comprises a suture holder extendable out of the first needle and comprising a suture engager formed at the end of an angled shaft, and the second structure comprises a snare extendable out of the second needle.

6. Apparatus according to claim 5 wherein the snare comprises a collapsible loop formed at the end of a straight shaft.

7. Apparatus according to claim 6 wherein the snare engages the leading portion of the suture adjacent the distal end of the second needle.

8. Apparatus according to claim 1 wherein the first structure comprises a suture holder extendable out of the first needle and comprising a suture engager formed at the end of an angled shaft, and the second structure comprises an opening formed in the second needle.

9. Apparatus according to claim 8 wherein the second structure further comprises an obturator for capturing the leading portion of the suture within the opening.

10. Apparatus according to claim 1 wherein the apparatus further comprises a pre-formed, uncinched knot formed in the trailing portion of the suture.

11. Apparatus according to claim 10 wherein the pre-formed, uncinched knot is supported relative to the housing on the near side of the tissue.

12. Apparatus according to claim 10 wherein the pre-formed, uncinched knot is supported about the exterior of the second needle.

13. Apparatus according to claim 10 wherein the apparatus further comprises a support, and further wherein the pre-formed, uncinched knot is releasably supported on the support on the near side of the tissue.

14. Apparatus according to claim 13 wherein the support is releasably mounted to the housing.

15. Apparatus according to claim 13 wherein the apparatus further comprises a suture threader movably mounted to the support, wherein the suture threader is configured to selectively pass the leading portion of the suture through the pre-formed, uncinched knot.

16. Apparatus according to claim 15 wherein the suture threader comprises a collapsible loop.

17. Apparatus according to claim 13 wherein the support further comprises a shaft for pushing the pre-formed, uncinched knot off the support.

18. Apparatus according to claim 17 wherein the support further comprises cutting structure for cutting the suture after the pre-formed, uncinched knot is pushed off the support.

19. Apparatus according to claim 18 wherein the cutting structure is configured to cut the suture after the pre-formed, uncinched knot is cinched.

20. Apparatus according to claim 18 wherein the cutting structure comprises an opening in the support and an opening in the shaft, and further wherein cutting is effected when the opening in the support and the opening in the shaft are moved out of alignment with one another.

26. Apparatus according to claim 1 wherein at least one of the first needle and the second needle are movable mounted to the housing.

21. Apparatus for suturing tissue, wherein the apparatus comprises:

a housing;

a first needle mounted to the housing;

a second needle mounted to the housing;

a suture having a leading portion and a trailing portion;

a first structure associated with the first needle for passing the leading portion of the suture from a near side of the tissue to a far side of the tissue;

a second structure associated with the second needle for retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue;

a pre-formed, uncinched knot formed in the trailing portion of the suture; and

a support for releasably supporting the pre-formed, uncinched knot relative to the housing.

22. Apparatus according to claim 21 wherein:

the first structure comprises a suture holder extendable out of the first needle and comprising a suture engager formed at the end of an angled shaft; and

the second structure comprises an opening formed in the second needle and an obturator for capturing the leading portion of the suture within the opening.

23. Apparatus according to claim 21 wherein:

the support is releasably mounted to the housing;

the apparatus further comprises a suture threader movably mounted to the support, wherein the suture threader is configured to selectively pass the leading portion of the suture through the pre-formed, uncinched knot; and

the support further comprises a shaft for pushing the pre-formed, uncinched knot off the support.

27. Apparatus according to claim 21 wherein at least one of the first needle and the second needle are movably mounted to the housing.

24. A method for suturing tissue, the method comprising the steps of:

providing a suture having a leading portion and a trailing portion, wherein a pre-formed, uncinched knot is formed in the trailing portion of the suture;

passing the leading portion of suture from a near side of the tissue to a far side of the tissue;

retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue;

passing the retracted leading portion of the suture through the pre-formed, uncinched knot formed in the trailing portion of the suture; and

cinching the knot so as to secure the suture in the tissue.

25. A method according to claim 24 wherein passing the leading portion of the suture from the near side of the tissue to the far side of the tissue is effected using a first needle, wherein retracting the leading portion of the suture from the far side of the tissue back to the near side of the tissue is effected using a second needle, wherein the first needle and the second needle are mounted to a housing, and further wherein the pre-formed, uncinched knot is supported on a support which is releasably mounted to the housing.

28. A method according to claim 25 wherein at least one of the first needle and the second needle are movably mounted to the housing.