APPARATUS AND METHOD FOR REPAIRING TISSUE

• US 20110022061A1
• Filed: 10/30/2009
• Published: 01/27/2011
• Est. Priority Date: 07/24/2009
• Status: Active Grant

• Current Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Original Assignee: DePuy Mitek Incorporated (Johnson & Johnson)
• Inventors: Orphanos, Stephen J., Fromm, Stuart E., Roosa, William Arthur, Helmick, Marc R.
• Granted Patent: US 8,790,369 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0459 Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied
• 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 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle

Abstract

Assemblies and methods suitable for knotless arthroscopic repair of tissue defects include two fixation members coupled by two limbs of suture comprising a continuous loop. A unidirectional restriction element that can be a preformed locking, sliding suture knot proximate to one of the fixation members, provides tensioning of the repair.

Claims

1. An apparatus comprising:

first and second fixation members, each of the first and the second fixation members having a first surface, an opposing second surface, first and second through openings defined between the first surface and the second surface;

a flexible element coupling the first and the second fixation members, the flexible element having a first end, a second end and a length therebetween, the length extending from the first end, in order, along a first end section of suture, through the first opening in the first fixation member from the respective first surface to the respective second surface, through the first opening in the second fixation member from the respective second surface to the respective first surface, through the second opening in the second fixation member from the respective first surface to the respective second surface, through the second opening in the first fixation member from the respective second surface to the respective first surface, and along a second end section of suture;

the first fixation member further comprising a third through opening defined between the respective first and second surface;

a sliding, locking knot formed between the first end section and the second end section, the first end section positioned slidably through the knot, the first end section extending from the knot and through the third opening from the first surface to the second surface.

2. The apparatus according to claim 1 wherein the first, second and third openings through the first fixation member are arranged in substantially a straight line along the respective first and second surface.

3. The apparatus according to claim 1 wherein the first and the second fixation members comprise rounded surfaces between adjacent openings on each respective surface, for sliding the flexible element therealong.

4. The apparatus of claim 1 wherein each of the openings has a substantially circular cross section.

5. The apparatus of claim 1 wherein one or more of the openings has an elongated cross section.

6. The apparatus according to claim 1 wherein tension applied to the second end section with respect to the first fixation member is effective to decrease a distance between the first and the second fixation member along the flexible member coupling the first and the second fixation member.

7. The apparatus according to claim 1 wherein each of the first and the second fixation members further comprises a substantially linear groove in each of the respective first and second surfaces, the groove extending from a first end of the respective surface to an opposite end of the respective surface, the groove in the second surface being substantially parallel to the groove in the first surface.

8. The apparatus according to claim 1 further comprising a delivery device having an elongated delivery member within which at least a portion of each of the first and the second fixation members, coupled by the flexible element, is longitudinally and slidably received.

9. The apparatus according to claim 8 wherein each of the first and the second fixation member further comprises a substantially linear groove in each of the respective first and second surface, the groove extending from a first end of the respective surface to an opposite end of the respective surface, the groove in the second surface being substantially parallel to the groove in the first surface, the groove slidably engaged with a slot in the delivery member.

10. The apparatus according to claim 1 wherein the flexible element comprises a suture.

11. The apparatus according to claim 1 wherein the flexible element comprises polyethylene.

12. The apparatus according to claim 1 wherein the flexible element comprises polyethylene and a bioabsorbable polymer.

13. The apparatus according to claim 12 wherein the bioabsorbable polymer comprises polydioxanone.

14. The apparatus according to claim 1 wherein the sliding, locking knot is a bunt line knot.

15. The apparatus according to claim 7, further comprising a delivery device, the delivery device comprising:

a cannula having a proximal end and a distal end, a longitudinal slot in a wall of the cannula, the slot extending from the distal end toward the proximal end, the cannula comprising opposing longitudinal edges along the slot, the cannula adapted to receive the first and the second fixation device along the slot, with the edges slidingly engaged in the respective grooves in the first and the second fixation devices.

16. The apparatus according to claim 15 further comprising a deployment rod positioned in the cannula, a handle mechanically coupled to the proximal end of the cannula, and a manually actuable member associated with the handle, the actuable member actuable to translate the deployment rod distally in the cannula for expelling one of the first and the second fixation device slidingly from the distal end of the cannula.

47. A method according to claim 1 wherein the first fixation member has a first side and a second side with the slip knot abutting the first side and wherein the method comprises the step of placing the second side against the second surface on the meniscus.

17. An apparatus comprising:

first and second fixation members, each of the first and the second fixation members having a first surface and an opposing second surface, first, second and third through openings defined between the first surface and the second surface of the first fixation device, and one or more through opening defined between the first surface and the second surface of the second fixation device;

a flexible element coupling the first and the second fixation members, the flexible element having a first end, a second end and a length therebetween, the length extending from the first end, in order, along a first end section of suture, through the first opening in the first fixation member from the respective first surface to the respective second surface, through at least one of the one or more opening in the second fixation member from the respective second surface to the respective first surface, through the second opening in the first fixation member from the respective second surface to the respective first surface, and along a second end section of suture;

a sliding, locking knot formed between the first end section and the second end section, the second end section extending from the knot and through the third opening from the first surface to the second surface.

18. The apparatus according to claim 17 wherein the first, second and third openings through the first fixation member are arranged in substantially a straight line along the respective first and second surface.

19. The apparatus of claim 18 wherein each of the openings has a substantially circular cross section.

20. The apparatus of claim 17 wherein one or more of the openings has a cross section that is elongated in a direction transverse to a substantially straight line between respective adjacent openings.

21. The apparatus according to claim 17 wherein tension applied to the second end section with respect to the first fixation member is effective to decrease a distance between the first and the second fixation member.

22. The apparatus according to claim 17 further comprising a delivery device within which at least a portion of each of the first and second fixation members, coupled by the flexible element, are slidably received.

23. The apparatus according to claim 17 wherein the flexible element comprises a suture

24. The apparatus according to claim 17 wherein the flexible element comprises polyethylene.

25. The apparatus according to claim 17 wherein the flexible element is at least partially bioabsorbable.

26. The apparatus according to claim 17 wherein the sliding, locking knot is a bunt line knot.

27. An apparatus comprising:

first and second fixation members, the first fixation member having a first surface and an opposing second surface, the first and the second fixation member coupled by two continuous sections of suture extending therebetween, the two continuous sections being continuous with one another and slidable through an opening through the second fixation member, each of the two sections of suture extending through respective first and second through openings in the first fixation member from the second surface to the first surface, a sliding, locking knot joining the two continuous sections of suture adjacent to the first surface, a third through opening between the first surface and the second surface, one of the two continuous sections of suture extending from the knot and through the third opening from the first surface to the second surface.

28. An apparatus for repairing a defect in a body tissue, the apparatus comprising:

a first fixation member having a first surface and an opposing second surface, first, second and third through openings between the first and the second surface, a second fixation member having one or more through openings, the first and the second fixation members coupled by a continuous length of suture defining a loop joined by a sliding, locking knot positioned substantially adjacent to the first side of the first fixation member, the loop extending from the knot and slidably through, in order, the first opening in the first fixation member, at least one of the one or more openings in the second fixation member, the second opening in the first fixation member, and returning to the knot, an end section of the continuous length of suture extending from the knot and through the third opening from the first side to the second side; and

wherein the knot is configured so that tensioning the end section with respect to the first fixation member is effective to shorten the loop.

29. The apparatus according to claim 28 wherein the knot is a bunt line knot.

30. The apparatus of claim 28 wherein the second surface is adapted to contact the tissue being repaired, and the knot is maintained adjacent to the first surface.

31. A method for repairing a defect in a body tissue, the method comprising:

passing a first fixation member along a first delivery path through the tissue to a first location on a first surface area of the tissue, the first fixation member having opposing first and second surfaces, a sliding and locking suture knot adjacent to the first surface, the suture knot comprising suture, three limbs of suture extending from the second surface along the delivery path, the three limbs of suture each continuous with the suture comprising the knot, a first two of the three limbs together comprising a continuous loop of suture slidingly connected to a second fixation member, the loop having a loop length;

tensioning at least one of the three sections of suture to deploy the second surface against the tissue at the first location;

passing the second fixation member along a second delivery path through the tissue to a second location on a second surface area of the tissue; and

tensioning the third limb of suture to reduce the loop length between the first fixation member and the second fixation member.

32. The method according to claim 31 wherein tensioning the third limb of suture deploys the second fixation member against the tissue at the second location.

33. The method according to claim 31 wherein tensioning the third limb applies a compressive force to reduce the tissue defect.

34. The method according to claim 31 wherein the first fixation member comprises a first, a second, and a third through opening between the first side and the second side, each of the first, second and third limb positioned through the respective opening.

35. The method according to claim 31 wherein the second fixation member comprises two through openings, and the loop passes slidingly through both openings.

36. The method of claim 31 wherein the first location and the second location are on a single surface of the tissue.

37. The method according to claim 31 wherein the first location and the second location are on opposing surfaces of the tissue.

38. An apparatus comprising:

a first fixation member having opposing first and second surfaces, a sliding and locking suture knot adjacent to the first surface, the suture knot comprising suture, three limbs of suture extending from the second surface, each of the three limbs of suture continuous with the suture comprising the knot, each of the three limbs positioned through a respective through opening between the first surface and the second surface, a first two of the three limbs together comprising a continuous loop of suture slidingly connected to a second fixation member, the loop having a loop length, and wherein the knot is configured such that tension applied to the third limb with respect to the first fixation member is effective to reduce the loop length

39. An apparatus comprising:

a first fixation member having opposing first and second surfaces, first, second and third through openings between the first and the second surface;

respective first, second and third limbs of suture positioned through the respective first, second and third openings, the first and the third limbs being positioned slidably through the respective first and third opening, and the first and the second limbs being continuous with one another to form a suture loop extending from the second surface;

a second fixation member having one or more openings therethrough, the loop being positioned slidably through at least one of the one or more openings through the second fixation member;

a restriction element associated with the first fixation member, the restriction member adapted to slidably pass suture therethrough in a first direction, but not in a second, opposite direction, and the first and the third limbs being continuous with one of them passing through the restriction member adjacent the first surface; and

wherein tension applied to the third limb with respect to the first fixation member is effective to reduce the loop length by sliding the third and the first limb through the respective third and first opening.

40. An apparatus comprising:

a first fixation member and a second fixation member, at least one opening through the second fixation member, two limbs of suture comprising a continuous loop of suture extending from the first fixation member, a portion of the loop positioned slidably through the at least one opening through the second fixation member, the first fixation member comprising a restriction element through which an extension of one of the two limbs is positioned to pass slidingly in a first longitudinal direction, but is restricted from sliding in a second, opposite longitudinal direction, and the two limbs and the extension extending from a common surface of the first fixation member.

41. An apparatus for repairing a body tissue having a surface, the apparatus comprising:

first and second fixation members, each of the first and the second fixation members having a respective contact surface adapted to be positioned in contact with the tissue surface;

a continuous loop of suture extending between respective contact surfaces of the first and the second fixation member, the loop having a length, and being slidably positioned through one or more opening through the second fixation member;

a tensioning limb of suture extending from the contact surface of the first fixation member; and

wherein tension applied to the tensioning limb with respect to the first fixation member is effective to reduce the length of the loop.

42. The apparatus of claim 41 wherein the tensioning limb is continuous with the suture comprising the loop.

43. The apparatus of claim 42 wherein the first fixation member comprises a locking, sliding knot through which the tensioning limb is positioned.

44. The apparatus of claim 43 wherein the sliding knot is position adjacent a non-contact surface on the first fixation member, the non-contact surface being opposed and opposite to the contact surface.

45. The apparatus of claim 43 wherein the tensioning limb can pass slidingly through the knot in a first longitudinal direction along the suture, and is restricted from sliding through the knot in an opposite longitudinal direction.

46. A method of repairing a defect in meniscus, the meniscus having a first surface facing an associated femur and a second, opposing surface away from the femur and away from a tibia, the method comprising the steps of:

placing a first fixation member against the second surface at a first location adjacent the defect;

placing a second fixation member against the second surface at a second location adjacent the defect;

arranging a flexible member between the first fixation member and the second fixation member across the defect, the flexible member passing through the meniscus and comprising a loop upon which the second fixation member is slidably affixed and which comprises a slip knot affixed to the flexible member adjacent the first fixation member beyond the second surface; and

tensioning a portion of the flexible member through the slip knot to shorten the loop and close the defect.