PRE-TIED SURGICAL KNOTS FOR USE WITH SUTURE PASSERS

• US 20160302789A1
• Filed: 04/18/2016
• Published: 10/20/2016
• Est. Priority Date: 07/03/2007
• Status: Active Grant

• Current Assignee: Ceterix Orthopaedics, Inc (Smith & Nephew PLC)
• Original Assignee: Justin D. Saliman, Mark Y. Hirotsuka, Michael J. Hendricksen, Michael Murillo, Stephen J. Peter, Yoav Ben-Haim
• Inventors: QUITUGUA, Victoria C., CHAN, Sarah-Marie, FASMAN, Jennifer B., HIROTSUKA, Mark Y., MURILLO, Michael, BEN-HAIM, Yoav, SALIMAN, Justin D., BENDER, Christopher P., HENDRICKSEN, Michael J., PETER, Stephen J.
• Granted Patent: US 10,441,273 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• 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 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06042 located close to needle tip

Abstract

Sutures with pre-tied knots for use in percutaneous surgical procedures and devices for easily and quickly tying complex suture knots are disclosed.

Claims

1. A suture having a pre-tied knot, the suture comprising:

an elongate flexible length of suture material having a first end and a second end;

a pre-tied knot body formed from the suture material at a region near the first end of the suture, the pre-tied knot body having one or more loops of the suture material, wherein each loop has at least one crossing point; and

a leader snare formed of a length of linear and flexible material, wherein the pre-tied knot body is tied around the leader snare so that the leader snare passes through the one or more loops of the knot body, wherein a bight region of the leader snare extends from a first end of the knot body and a pull tail extends from a second end of the knot body,

wherein the knot body and leader snare are sufficiently flexible and narrow of profile to be pulled through a tissue behind a tissue penetrator.

2. The suture of claim 1, wherein the pre-tied knot body comprises three or more loops of suture material.

3. The suture of claim 1, wherein the leader snare is formed of a second suture material.

4. The suture of claim 1, wherein the bight region of the leader snare extends towards the second end of the suture and the pull tail of the leader snare extends towards the first end of the suture.

5. The suture of claim 1, wherein the material forming the leader snare has a larger diameter than the suture.

6. The suture of claim 1, wherein the knot body is configured to slide along the length of the suture.

7. A method of passing a suture through a tissue, the method comprising:

placing a first jaw of a suture passer on one side of a tissue to be sutured;

placing a second jaw of the suture passer on the opposite side of the tissue to be sutured;

passing a knotted end of a suture through the tissue from the second jaw to the first jaw, wherein the knot is located at or near the distal end of the suture; and

holding the knot in the first jaw.

8. A knot tying accessory comprising:

a device body that is configured to open to expose an interior space, wherein the interior space defines a convoluted pathway that crosses over itself at multiple locations within the device body;

a guide thread with a capture loop at a first end of the guide thread, wherein the guide thread is threaded into the convoluted path of the device body such that the first end of the capture loop is situated at a first location at a first opening outside of and adjacent to the device body and able to receive a first end of a suture;

a first pull tab coupled to an intermediate position on the guide thread that extends out of the device body at a second location at a second opening on the device body;

a third opening at a third location on the device body wherein when the capture loop has exited the device body at the second location, the capture loop is pulled to the third opening and wherein the capture loop is able to receive a second end of a suture; and

a second pull tab at a second end of the guide thread, wherein the second end extends out of the device body at a fourth location from a fourth opening on the device body.

9. The knot tying accessory of claim 8, wherein the convoluted pathway is planar.

10. The knot tying accessory of claim 8, wherein the convoluted pathway comprising a series of connected curves, the series of connected curves having angles that are greater than 90 degrees.

11. The knot tying accessory of claim 8, wherein the device body further comprising a series of channels that define the convoluted pathway.

12. The knot tying accessory of claim 8, wherein the device body further comprising a series of protrusions that define the convoluted pathway.

13. The knot tying accessory of claim 8, wherein the device body further comprising a combination of a series of channels and a series of protrusion for defining the convoluted pathway.

14. The knot tying accessory of claim 8, wherein the capture loop comprising a sliding knot for coupling to a suture end.

15. The knot tying accessory of claim 8, wherein the capture loop comprising a coupler for coupling to the suture end.

16. The knot tying accessory of claim 15, wherein the coupler for coupling to the suture end is a clip.

17. The knot tying accessory of claim 8, wherein the capture loop has an open state such that a bight of suture may be threaded through;

and a closed state, such that the capture loop is able to maintain the bight of suture as it travels the convoluted pathway through the interior of the device body.

18. The knot tying accessory of claim 8, wherein the capture loop and the guide thread comprising a material having a frictional coefficient of 0.5 or less.

19. The knot tying accessory of claim 8, wherein the first and the second pull tab each comprising detachable couplers for removable attaching to the guide thread at the second and the third location at the device body.

20. The knot tying accessory of claim 8, wherein the overall dimensions of the first and the second pull tabs are greater than the second and the third opening on the device body, such that the first and the second pull tabs cannot be pulled into the interior space of the device body.

21. A method of tying a suture knot comprising:

threading a first leg of a suture through a capture loop disposed at a first end of a guide thread, wherein the capture loop is disposed at a first location on an openable device body and the guide thread has been laced through a convoluted path defined within an interior space of the openable device body;

pulling a first pull tab disposed on the guide thread at a second location on the device body to draw the first leg of the suture through a first portion of the convoluted pathway within the device body until the capture loop exits the interior space of the device body at the second location;

releasing the first leg of the suture from the capture loop;

threading a second leg of the suture through the capture loop;

pulling a second pull tab disposed on the guide thread at a third location on the device body to draw the second leg of the suture travel through a second portion of the convoluted pathway within the device body interior space until the capture loop exits the interior space of the device body at the third location; and

opening the device body to remove the suture knot from the device body and pushing the suture knot towards tissue to be sewn together.

22. The method of claim 21, further comprising cinching or clamping the first leg of the suture within the capture loop so that it does not detach from the capture loop when pulled before pulling the first tab.

23. The method of claim 21, further comprising cinching or clamping the second leg of the suture within the capture loop before pulling the second pull tab.

24. The method of claim 21, wherein the first leg and the second leg of the suture are a first end and a second end of the same piece of suture.

25. The method of claim 21, wherein the first pull tab can only be pull the guide thread from one side.

26. The method of claim 21, wherein the guide thread may be threaded in a variety of patterns within the interior space of the device body.

27. A knot typing accessory device comprising:

a device body configured to hold a portion of a thread in a pattern within the device body, wherein the thread has a first end and a second end, the first end and the second end of the thread able to couple with a first end and a second end of a suture; and

at least one pull disposed on the thread, such that when the at least one pull is coupled to the first or the second end of the suture is pulled, the first end or the second end of the suture is pulled through the pattern to form a knot between the first and the second end of the suture.

28. The device of claim 27, wherein the device body comprises a cartridge having at least one pull, wherein the cartridge is coupled to a knot pusher.

29. The device of claim 27, wherein the device body comprises a cartridge having at least one pull in a loose knot configuration disposed around a shaft of a suture passer.

30. The device of claim 27, wherein the device body comprising a cartridge able to pass a preloaded suture and able to form a loose knot configuration at the pull.

31. The device of claim 27, wherein the pull comprises a snare.

32. The device of claim 27, wherein the device body is a tubular body having the pull configured as a snare that is wound around the tubular body in a knot bundle configuration able to receive a piece of suture.

33. The device of claim 27, wherein the device body is a tubular body further comprising an array of protrusions arrange about the tubular body able to maintain different portions of the snare allow formation of portions of the slide-able knot in discrete phases.

34. The device of claim 33, wherein the tubular body is collapsible allowing easy release of the slide-able knot.

35. The device of claim 27, wherein the device body further comprises a rotatable piece, a series of positioning guides, and a winding tool for positioning the length of suture into the knot pattern desired.

36. The device of claim 27, wherein the device body is a three-dimensional geometric shape configured to receive the length of suture for threading the length of suture into the knot pattern desired, and collapsible to release the knot pattern formed.

37. The device of claim 27, the device further comprising a bearing and a series of guides able to receive the bearing, the bearing having a coupler for coupling and drawing the length of suture through the guides for forming the knot.

38. The device of claim 27, wherein the device body further comprising cams.