KNOTLESS SUTURE ANCHORS AND METHODS OF TISSUE REPAIR

• US 20130345749A1
• Filed: 06/12/2013
• Published: 12/26/2013
• Est. Priority Date: 06/22/2012
• Status: Active Grant

• Current Assignee: Arthrex Incorporated
• Original Assignee: Arthrex Incorporated
• Inventors: Sullivan, Derek C., Dooney, Thomas Jr., Holowecky, Allen E., Brady, Paul C., Domb, Benjamin G.
• Granted Patent: US 9,737,292 B2
• Time in Patent Office: Days
• US Class Current: 606/232
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• 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 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• 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 2017/0496 for tensioning sutures

Abstract

Systems and methods for soft tissue to bone repairs employing tensionable knotless anchors, without knot tying. The tensionable knotless anchors may be used by themselves or in combination with additional constructs (which may have a similar or different configuration, i.e., modified according to the specific repair) and with the flexible strands provided through tissue, around tissue, or through and around tissue to be repaired or fixated. The tensionable knotless anchors may be used to achieve simple stitch repairs, mattress stitch repairs or interlocked looped mattress repairs, among others. The tensionable knotless anchors may be also provided in a daisy chain configuration, i.e., with the suture from one anchor passed through the eyelet/loop of the shuttle/pull device of another anchor and repeated in a pattern.

Claims

1. A method of tissue repair, comprising the steps of:

installing at least one fixation device in bone, the fixation device comprising a body, a flexible strand extending through the body and a shuttling device attached to the flexible strand, the flexible strand and the attached shuttling device being pre-loaded on the fixation device;

passing the flexible strand through or around tissue to be fixated; and

forming, with the flexible strand and the shuttling device, a knotless closed loop having an adjustable perimeter, after the steps of installing the fixation device in bone and passing the flexible strand through or around the tissue.

2. The method of claim 1, comprising the step of installing two or more fixation devices in the bone and passing a flexible strand from at least one of the two fixation devices around the tissue.

3. The method of claim 2, comprising the step of installing two fixation devices in the bone and passing a flexible strand from each of the two fixation devices around the tissue.

4. The method of claim 1, comprising the step of installing two or more fixation devices in the bone and passing a flexible strand from at least one of the two fixation devices through the tissue.

5. The method of claim 4, comprising the step of installing two fixation devices in the bone and passing a flexible strand from each of the two fixation devices through the tissue.

6. The method of claim 5, further comprising the step of forming two knotless closed loops each having an adjustable perimeter.

7. The method of claim 6, wherein the two knotless closed loops are interlocked with each other.

8. The method of claim 5, further comprising the step of forming a mattress stitch by passing a flexible strand from each of the plurality of fixation devices back and forth through the tissue.

9. The method of claim 1, further comprising the step of installing a plurality of fixation devices in the bone and passing a flexible strand from each of the plurality of fixation devices through the tissue.

10. The method of claim 1, wherein the tissue is soft tissue.

11. The method of claim 1, wherein the tissue is tendon, labrum, Achilles tendon, rotator cuff, biceps or capsular tissue.

12. The method of claim 1, wherein the step of forming the knotless closed loop further comprising forming a splice within the flexible strand, the splice being located within the body of the fixation device.

13. The method of claim 1, further comprising the step of adjusting the length of the knotless closed loop to approximate tissue to bone.

14. The method of claim 1, further comprising the steps of:

installing the at least one fixation device into a hole in the bone;

passing the flexible strand around or through the tissue to be fixated, and then through an eyelet of the shuttling device; and

pulling on the passing device to allow the flexible strand to form a splice through itself and within the fixation device, and provide tensioning of the tissue to be fixated relative to the bone.

15. The method of claim 1, wherein the fixation device is an anchor with a post and a pair of openings symmetrically positioned relative to the post, the pair of openings extending in a direction about transversal to the longitudinal axis of the body, the pair of openings being configured to allow the flexible strand and attached shuttling device to be passed through the body of the fixation device and around the post.

16. The method of claim 1, wherein the flexible strand is a suture formed of ultrahigh molecular weight polyethylene and wherein the shuttling device is a suture passing instrument.

17. The surgical system of claim 1, wherein the shuttling device is configured to be pulled out of the body of the fixation device to allow the flexible strand to pass through itself and form a splice within the body of the fixation device.

18. A method of tissue repair, comprising the steps of:

installing a plurality of fixation devices into bone, each of the fixation devices including a flexible construct extending through the fixation device, the flexible construct comprising a flexible strand and a corresponding shuttling/pulling device attached to the flexible strand;

passing each of the flexible strands around or through tissue to be fixated, and then through an eyelet of the shuttling/pulling devices; and

pulling on each of the shuttling/pulling devices to allow each of the flexible strands to form a splice through itself and within the fixation device, and provide tensioning of the tissue to be fixated relative to the bone.

19. The method of claim 18, comprising the step of passing each of the flexible strands around or through tissue to be fixated, and then through its corresponding eyelet of the shuttling/pulling device.

20. The method of claim 18, comprising the step of passing each of the flexible strands around or through tissue to be fixated, and then through an eyelet of a shuttling/pulling device of an adjacent fixation device.

21. The method of claim 20, wherein each of the flexible strands is passed through tissue to be fixated, and then through an eyelet of a different fixation device.

22. The method of claim 18, comprising the steps of:

installing a first, a second and a third fixation devices into bone, each of the first, second and third fixation devices including a flexible construct extending through each of the first, second and third fixation devices, the flexible construct comprising a flexible strand and a corresponding shuttling/pulling device attached to the flexible strand;

passing each of the flexible strands around or through tissue to be fixated;

passing the flexible strand of the first fixation device through an eyelet of the shuttling/pulling device of the second fixation device, passing the flexible strand of the second fixation device through an eyelet of the shuttling/pulling device of the third fixation device, and passing the flexible strand of the third fixation device through an eyelet of the shuttling/pulling device of the first fixation device; and

pulling on each of the shuttling/pulling devices to allow each of the flexible strands to form a splice through itself and within the fixation device, and provide tensioning of the tissue to be fixated relative to the bone.

23. The method of claim 22, wherein at least one of the first, second and third fixation devices is a knotless anchor.

24. A method of attaching tissue to bone using an anchor assembly including a driver and an anchor, the anchor comprising:

an anchor body having a distal end, a proximal end, a longitudinal axis, and two surgical constructs pre-loaded within the anchor body, each of the two surgical constructs consisting of a suture and a suture passing instrument attached to the suture;

the method comprising the steps of;

providing an anchor pre-loaded with two sutures by passing the sutures around a post of the anchor and extending the sutures within a cannulation of the anchor, the sutures being secured by a knot at a most distal end of the anchor;

securing the anchor pre-loaded with the sutures to a driver by tying the sutures to the driver;

threading two suture passing instruments through the sutures, each of the suture passing instruments being attached to one of the sutures;

installing the anchor, pre-loaded with the sutures and with the attached suture passing instruments, into the bone using the driver;

removing the driver;

passing the sutures around or through tissue to be fixated;

threading each of the sutures through a closed loop of each of their respective suture passing instruments;

pulling each of the suture passing instruments to allow each of the sutures to pass through itself, within the anchor body, and to form a splice in each of the sutures; and

removing the suture passing instruments and pulling on the sutures to approximate tissue to bone.