Methods for Tissue Repair

• US 20100114162A1
• Filed: 01/08/2010
• Published: 05/06/2010
• Est. Priority Date: 12/02/1999
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Sikora, George, Ek, Steven, Bojarski, Ray, Torrie, Paul Alexander
• Granted Patent: US 9,220,494 B2
• Time in Patent Office: Days
• US Class Current: 606/228
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• 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 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/0646 : for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2017/0647 : having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0648 : threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61F 2/0805 : Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0829 : without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
• CPC Class Codes: A61F 2002/0852 : Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0858 : Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0882 : Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
• CPC Class Codes: A61F 2002/0888 : Anchor in or on a blind hole or on the bone surface without formation of a tunnel

Abstract

A method of closing a tissue wound includes providing a wound closure device having a first fastener, a second fastener, and a flexible member extending between the first and second fasteners and movably attached to the second fastener by a one-way knot formed in the flexible member between the first and second fastener, positioning the first fastener against tissue, passing the flexible member across the wound, positioning the second fastener against tissue, and pulling on a free end of the flexible member to shorten a length of the flexible member between the first and second fasteners, thereby closing the wound.

Claims

1. A method of closing a tissue wound comprising:

providing a wound closure device having a first fastener, a second fastener, and a flexible member extending between the first and second fasteners and movably attached to the second fastener by a one-way knot formed in the flexible member between the first and second fastener;

positioning the first fastener against tissue;

passing the flexible member across the wound;

positioning the second fastener against tissue; and

pulling on a free end of the flexible member to shorten a length of the flexible member between the first and second fasteners, thereby closing the wound.

2. The method of claim 1, wherein the flexible member is slidably attached to the second fastener by the one-way knot, such that after completion of the pulling step, the length of the flexible member between the first and second fasteners remains shortened.

3. The method of claim 1, wherein the first positioning step includes positioning the first fastener on a first side of the wound, the passing step includes passing the flexible member from the first side to a second side of the wound, engaging tissue on the second side, and returning the flexible member to the first side, and the second positioning step includes positioning the second fastener on the first side of the wound.

4. The method of claim 1, wherein the providing step includes providing a needle having an open tip and defining a bore that connects to the open tip, the first and second fasteners being at least partially disposed within the bore.

5. The method of claim 1, wherein the needle further defines a slit that connects to the bore and to the open tip, the first fastener includes a projection that protrudes through the slit, and the first positioning step includes engaging the projection with tissue to remove the first fastener from the bore.

6. The method of claim 2, wherein the providing step includes providing a second fastener that defines a partially enclosed region, the partially enclosed region housing at least a portion of the one-way knot, and the partially enclosed region being located such that during the pulling step, the portion of the one-way knot disposed within the partially enclosed region avoids contact with tissue.

7. The method of claim 1, wherein the providing step includes providing a device in which the flexible member passes through a through-hole in the second fastener, and the device further includes a second flexible member that also passes through the through-hole, the second flexible member having a thickened portion that is wider than the through hole, and the method further comprises:

pulling the second flexible member until the thickened portion wedges into the through hole.

8. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a retainer against soft tissue to be attached to the bone tissue, the fastener and retainer being connected by a flexible member; and

pulling a free end of the flexible member to shorten a length of the flexible member between the fastener and the retainer to urge the soft tissue against the bone tissue.

9. The method of claim 8, wherein the flexible member is a suture.

10. The method of claim 8, wherein pulling a free end of the flexible member moves a slip knot formed in the flexible member along a length of the flexible member to allow the length of the flexible member between the fastener and the retainer to be shortened, but not lengthened.

11. The method of claim 8, wherein the retainer is positioned between the slip knot and the fastener such that when the fastener and retainer are in position, the slip knot is positioned against the retainer.

12. A surgical method for repairing a meniscal tear comprising:

positioning a delivery device comprising a needle against a first position on soft tissue;

advancing the needle through the soft tissue, a first fixation member being positioned within a longitudinal channel of a lumen of the needle and including a protrusion extending from the first fixation member through a longitudinal slot in the needle;

withdrawing the needle from the soft tissue such that the first fixation member is pulled from the needle by the interaction of the protrusion and the soft tissue;

positioning the delivery device against a second position on the soft tissue;

advancing the delivery device and the needle through the soft tissue, a second fixation member being positioned within the longitudinal channel of the lumen and including a protrusion extending from the second fixation member through the longitudinal slot in the needle; and

withdrawing the delivery device from the soft tissue such that the second fixation member is pulled from the needle by the interaction of the protrusion and the soft tissue.

13. The method of claim 12, wherein positioning the delivery device against the first position on soft tissue and positioning the delivery device against the second position on the soft tissue comprises positioning the first fixation member and the second fixation member on opposite sides of a meniscal tear.

14. The method of claim 12, wherein positioning the delivery device against the first position on soft tissue and positioning the delivery device against the second position on the soft tissue comprises positioning the first fixation member and the second fixation member on a same side of a meniscal tear.

15. The method of claim 12, further comprising:

pulling on a free end of a flexible member coupling the first and second fixation members to shorten a length of the flexible member between the first and second fixation members, thereby closing the meniscal tear.

16. A method of closing a tissue wound comprising:

providing a wound closure device having a first fixation member, a second fixation member, and a flexible member including a slip knot between the first and second fixation members, the flexible member coupling the first and second fixation members and being movably attached to the second fixation member;

passing the first fastener through tissue;

passing the flexible member across the wound;

passing the second fastener through tissue; and

pulling on a free end of the flexible member to shorten a length of the flexible member between the first and second fasteners, thereby closing the wound, the slip knot allowing the length of the flexible member to be shortened, but not lengthened.

17. The method of claim 16, wherein the flexible member comprises a suture.

18. The method of claim 16, wherein the knot is spaced from the first and second fixation members.

19. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a retainer against soft tissue to be attached to the bone tissue, the fastener and retainer being coupled by a closed loop of a flexible member movably attached to the retainer and the fastener, the retainer not being made of the flexible member; and

pulling a free end of the flexible member extending from the closed loop to shorten a length of the flexible member between the fastener and the retainer to urge the soft tissue against the bone tissue.

20. The apparatus of claim 19, wherein the flexible member comprises a suture.