THREADABLE KNOT SOFT TISSUE DEFECT REPAIR SYSTEM

• US 20100249809A1
• Filed: 03/11/2010
• Published: 09/30/2010
• Est. Priority Date: 03/11/2009
• Status: Active Grant

• Current Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Original Assignee: Synthes USA LLC (Johnson & Johnson)
• Inventors: Fussell, Garland, Delamarter, Brian Rick, Schmidt, Brian, Singhatat, Wamis, Talbot, James, Manos, Jamie, Messerli, Dominique, Miller, William, Smith, Nigel G.
• Granted Patent: US 8,608,758 B2
• Time in Patent Office: Days
• US Class Current: 606/145
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• 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 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 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle

Abstract

A soft tissue defect repair system for approximating defects, such as defects in the annulus fibrosus of an intervertebral disc, includes a cannulated rod through which is disposed a suture retrieval device. A strand of suture includes a locking or ratcheting knot pre-tied around the outside of the cannulated rod and a free end that is guided in and out of the soft tissue. A knot pusher fits around the cannulated rod, which is used to push the knot off of the cannulated rod after the stitching of the tissue is accomplished. The defect is approximated by tensioning the free end. Various suturing methods or patterns are disclosed for defect approximation.

Claims

1. A soft tissue defect repair system comprising:

a rod defining opposing proximal and distal ends, the rod defining a target knot location about which a knot of a suture is tied, the rod having a channel extending therethrough;

a suture retrieving device housed interior to and translatable within the channel of the rod, wherein (i) the suture retrieving device includes a distal end configured to capture a free end of the suture, and (ii) the suture retrieving device is configured to pass the free end of the suture through the channel of the rod from a distal end of the rod and out through a proximal end of the rod subsequent to the free end being passed through soft tissue adjacent the defect; and

a knot pusher coupleable to the rod, the knot pusher configured to slide the knot distally off of the rod toward the defect.

2. The soft tissue defect repair system as recited in claim 1, further comprising a strand of surgical suture having a free end and a pre-tied knot disposed about the rod.

3. The soft tissue defect repair system as recited in claim 1, wherein the distal end of the suture retrieving device is flexible.

4. The soft tissue defect repair system as recited in claim 3, wherein the flexible distal end is configured to compress when it passes through the internal channel of the rod.

5. The soft tissue defect repair system of claim 1, wherein the suture includes a suture ball adjacent the knot.

6. The soft tissue defect repair system of claim 1, wherein the free end of the suture strand is attached to a shuttling element.

7. The soft tissue defect repair system of claim 6, wherein the shuttling element is detachably coupled to a needle.

8. The soft tissue defect repair system of claim 1, wherein the rod is configured to retract proximally relative to the knot pusher to thereby slide the knot distally off of the rod toward the defect.

9. The soft tissue defect repair system of claim 1, wherein the knot pusher is configured to advance distally relative to the rod to thereby slide the knot distally off of the rod toward the defect.

10. The soft tissue defect repair system of claim 1, wherein the rod has a sharp distal end.

11. The soft tissue defect repair system of claim 1, further comprising a needle coupled to the free end of the suture strand.

12. The soft tissue defect repair system of claim 1, further comprising:

a second rod defining opposing proximal and distal ends, the second rod defining a target knot location about which a knot of a second suture is tied, the second rod having a channel extending therethrough;

a second suture retrieving device housed interior to and translatable within the channel of the second rod, wherein (i) the second suture retrieving device includes a distal end configured to capture a free end of the second suture, and (ii) the second suture retrieving device is configured to pass the free end of the suture through the internal channel of the second rod from a distal end of the second rod and out through a proximal end of the second rod subsequent to the free end being passed through soft tissue adjacent the defect.

13. The soft tissue defect repair system of claim 1, further comprising:

a suture passing device including;

a body member defining a needle receiving channel;

a boom arm extending from the body member, the boom arm having a boom arm housing that is spaced from the body member, wherein a tissue-receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing; and

a shuttling element configured to detachably couple to the needle, and to the boom arm housing, wherein the free end of the suture strand is initially attached to the shuttling element.

14. The soft tissue defect repair system of claim 13, wherein the suture passing device is configured to:

(i) translate the needle from its retracted position, to its advanced position, (ii) detachably couple the shuttling element to the boom arm housing, (iii) translate the needle back to its retracted position while the shuttling element is attached to the boom arm housing, (iii) translate the needle back to its advanced position, (iv) detachably couple the shuttling element back to the needle, and (v) translate the needle with the shuttling element attached thereto back to its retracted position.

15. The soft tissue defect repair system of claim 14, wherein (i) the needle includes an engagement feature, and the shuttling element includes a corresponding engagement feature, and (ii) the shuttling element is detachably coupled to the needle when the engagement features engage each other.

16. The soft tissue defect repair system of claim 15, wherein the engagement features are corresponding threads.

17. The soft tissue defect repair system of claim 1, further comprising an adhesive applicator.

18. The soft tissue defect repair system of claim 1, further comprising a heat cutting instrument configured to cut the free end of the suture strand to form a cut end.

19. The soft tissue defect repair system of claim 18, wherein the heat cutting instrument is also configured to melt the cut end of the suture strand to form a ball.

20. The soft tissue defect repair system of claim 1, wherein the knot is either a ratcheting knot, a locking knot, or a sliding knot.

21. The soft tissue defect repair system of claim 1, further comprising a plug disposed about the rod.

22. The soft tissue defect repair system of claim 21, wherein the plug includes strands of suture enclosed by a suture loop construct.

23. The soft tissue defect repair system of claim 21, wherein the plug comprises woven suture.

24. The soft tissue defect repair system of claim 23, wherein the woven suture is a bag.

25. The soft tissue defect repair system of claim 24, wherein the bag contains strands of suture.

26. The soft tissue defect repair system of claim 21, wherein the plug includes adhesive properties.

27. The soft tissue defect repair system of claim 21, wherein the plug is made of a biocompatible material that is configured to adhere to the surrounding tissue.

28. The soft tissue defect repair system of claim 27, wherein the biocompatible material is collagen.

29. The soft tissue defect repair system of claim 27, wherein the material adheres to the surrounding tissue when the material is induced by an activating agent.

30. The soft tissue defect repair system of claim 1, wherein the suture strand includes a plug tethered to the knot.

31. The soft tissue defect repair system of claim 30, wherein the plug includes strands of suture enclosed by a suture loop construct.

32. The soft tissue defect repair system of claim 30, wherein the plug comprises woven suture.

33. The soft tissue defect repair system of claim 32, wherein the woven suture is a bag.

34. The soft tissue defect repair system of claim 33, wherein the bag contains strands of suture.

35. The soft tissue defect repair system of claim 30, wherein the plug includes adhesive properties.

36. The soft tissue defect repair system of claim 30, wherein the plug is made of a biocompatible material that is configured to adhere to the surrounding tissue.

37. The soft tissue defect repair system of claim 36, wherein the material adheres to the surrounding tissue when the material is induced by an activating agent.

43. The soft tissue defect repair system of claim 32, wherein the plug includes strands of suture enclosed by a suture loop construct.

44. The soft tissue defect repair system of claim 32, wherein the plug comprises woven suture.

45. The soft tissue defect repair system of claim 44, wherein the woven suture is a bag.

46. The soft tissue defect repair system of claim 45, wherein the bag contains strands of suture.

38. A soft tissue defect repair system comprising:

a longitudinally extending guide tube having a channel extending therethrough;

a boom arm extending from the guide tube, the boom arm having a boom arm housing that is spaced from the guide tube, wherein a tissue-receiving gap is disposed between the boom arm housing and the guide tube;

a needle reciprocally translatable within the channel of the guide tube between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing;

a shuttling element configured to detachably couple to the needle, and to the boom arm housing; and

a strand of suture having a free end and a pre-tied knot, wherein the pre-tied knot is tied about a target knot location defined by the guide tube, and the free end is attached to the shuttling element.

39. The soft tissue defect repair system of claim 38, wherein the shuttling element is configured to detachably couple to a distal end of the needle.

40. The soft tissue defect repair system of claim 38, wherein the needle is configured to retract and pull the free end of the suture strand through a proximal end of the guide tube.

41. The soft tissue defect repair system of claim 38, wherein the shutting element is configured to detachably couple to an external surface of the needle.

42. The soft tissue defect repair system of claim 38, further comprising a plug attached to the strand of suture.

47. The soft tissue defect repair system of claim 42, wherein the plug includes adhesive properties.

48. The soft tissue defect repair system of claim 42, wherein the plug is made of a biocompatible material that is configured to adhere to the surrounding tissue.

49. The soft tissue defect repair system of claim 48, wherein the material adheres to the surrounding tissue when the material is induced by an activating agent.

50. The soft tissue defect repair system of claim 42, wherein the plug is disposed about the guide tube proximate to the knot.

51. The soft tissue defect repair system of claim 38, wherein the system is configured to (i) translate the needle from its retracted position, to its advanced position, (ii) detachably couple the shuttling element to the boom arm housing, (iii) translate the needle back to its retracted position while the shuttling element is attached to the boom arm housing, (iii) translate the needle back to its advanced position, (iv) detachably couple the shuttling element back to the needle, and (v) translate the needle with the shuttling element attached thereto back to its retracted position.

52. The soft tissue defect repair system of claim 38, further comprising an adhesive applicator.

53. The soft tissue defect repair system of claim 38, further comprising a heat cutting device.

54. The soft tissue defect repair system of claim 38, wherein the knot is either a ratcheting knot, a locking knot, or a sliding knot.

55. The soft tissue defect repair system of claim 38, wherein the guide tube is a body member.

56. A method for repairing soft tissue, the method comprising:

advancing a needle having a shuttling element detachably coupled thereto from a guide tube, through soft tissue, and toward a boom arm housing, wherein the shuttling element has a free end of a suture strand attached thereto, and the suture stand has a pre-tied knot that is tied about a target knot location of the guide tube;

detachably coupling the shuttling element to the boom arm housing;

retracting the needle from the boom arm housing while the shuttling element remains attached to the boom arm housing;

advancing the needle back towards the boom arm housing;

re-coupling the shuttling element to the needle;

retracting the needle back toward the guide tube while the shuttling element is coupled to the needle; and

sliding the pre-tied knot of the suture strand off a distal end of the guide tube.

57. The method of claim 56, wherein prior to advancing the needle for a first time, the shuttling element is initially detachably coupled to the boom arm housing.

58. The method of claim 56, wherein the free end of the suture strand is pulled through a proximal end of the guide tube when the needle is retracted for the last time.

59. The method of claim 56, wherein the pre-tied knot is either a ratcheting knot, a locking knot, or a sliding knot.

60. A method for repairing soft tissue, the method comprising:

advancing a rod through a piece of tissue by puncturing the tissue with a distal end of the rod, the rod defining a target knot location about which a knot of a suture strand is tied, the rod having a channel extending therethrough;

capturing a free end of the suture strand with the distal end of a suture capturing device, the suture capturing device being disposed within the channel of the rod;

pulling the suture capturing device along with the captured free end of the suture strand proximally through the channel of the rod; and

pushing the knot distally off of the rod.

61. The method of claim 60, wherein the rod is advanced through a first piece of tissue, and a second piece of tissue overlying the first piece of tissue.

62. The method of claim 60, wherein the rod is advanced through a first piece of tissue and then through a second piece of tissue after the free end of the suture strand is captured by the suture capturing device.

63. The method of claim 60, wherein the rod includes a sharp distal end.

64. A method for repairing soft tissue, the method comprising:

forming a trans-osseous tunnel through a bony element proximate to a defect;

passing a free end of a suture strand through the tunnel;

passing the free end of the suture stand through soft tissue;

passing the free end of the suture strand through a pre-tied knot of the suture strand; and

sliding the pre-tied knot adjacent the defect.

65. The method of claim 64, wherein the bony element is a vertebral body.

66. The method of claim 65, further comprising:

inserting a cannulated element into the tunnel, wherein the free end of the suture strand is passed through a channel of the cannulated element.

67. The method of claim 66, wherein the cannulated element is made of allograft bone.

68. The method of claim 66, wherein the cannulated element includes a body having angled ends.

69. The method of claim 66, wherein the cannulated element includes an internal rod extending across the channel of the cannulated element.

70. The method of claim 66, wherein the cannulated element is press fit.

71. A soft tissue defect repair system comprising:

a rod having a channel extending therethrough;

a strand of suture having a pre-tied knot tied about a target knot location of the rod; and

a plug having a bore, wherein (i) the rod extends at least partially through the bore of the plug such that the plug is positioned proximate to the target knot location of the rod, and (ii) both the pre-tied knot and the plug are configured to slide off a distal end of the rod.

72. The soft tissue defect repair system of claim 71, wherein the plug includes strands of suture enclosed by a suture loop construct

73. The soft tissue defect repair system of claim 71, wherein (i) the plug includes one or more strands extending out from the plug, and (ii) the plug is configured to compress when tension is applied to one or more of the strands.

74. The soft tissue defect repair system of claim 71, wherein the plug comprises woven suture.

75. The soft tissue defect repair system of claim 74, wherein the woven suture is a bag.

76. The soft tissue defect repair system of claim 75, wherein the bag contains strands of suture.

77. The soft tissue defect repair system of claim 71, wherein the plug includes adhesive properties.

78. The soft tissue defect repair system of claim 71, wherein the plug is made of a biocompatible material that is configured to adhere to the surrounding tissue.

79. The soft tissue defect repair system of claim 78, wherein the material adheres to the surrounding tissue when the material is induced by an activating agent.

80. The soft tissue defect repair system of claim 79, wherein the material is collagen.

81. The soft tissue defect repair system of claim 71, wherein the bore is compressible.

82. A kit comprising:

a suture finishing device including;

a rod defining opposing proximal and distal ends, the rod defining a target knot location about which a knot of a suture is tied, the rod having a channel extending therethrough;

a suture retrieving device housed interior to and translatable within the channel of the rod, wherein (i) the suture retrieving device includes a distal end configured to capture a free end of the suture, and (ii) the suture retrieving device is configured to pass the free end of the suture through the channel of the rod from a distal end of the rod and out through a proximal end of the rod subsequent to the free end being passed through soft tissue adjacent the defect; and

a knot pusher coupleable to the rod, the knot pusher configured to slide the knot distally off of the rod toward the defect, and

a suture passing device including;

a body member defining a needle receiving channel;

a boom arm extending from the body member, the boom arm having a boom arm housing that is spaced from the body member, wherein a tissue-receiving gap is disposed between the boom arm housing and the body member;

a needle reciprocally translatable within the channel of the body member between an advanced position in which a distal end of the needle extends into the boom arm housing, and a retracted position in which the distal end of the needle is retracted from the boom arm housing; and

a shuttling element configured to detachably couple to the needle, and to the boom arm housing, wherein the free end of the suture strand capable of being attached to the shuttling element.

83. The kit of claim 82, further comprising a strand of suture.

84. The kit of claim 83, wherein the strand of suture includes a plug.

85. The kit of claim 82, further comprising a strand of suture having a knot and a free end, wherein the knot is tied about the target knot location of the suture finishing device, and the free end is attached to the shuttling element of the suture passing device.