Method and apparatus for securing a suture

• US 6,159,234 A
• Filed: 07/07/1999
• Issued: 12/12/2000
• Est. Priority Date: 08/01/1997
• Status: Expired due to Term

• Current Assignee: Advanced Skeletal Innovations LLC (Acacia Research Corporation), Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Liu, Ping, Cremens, Matthew J., Bonutti, Peter M.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): NGO, LIEN M
• Application Number:
  US09/348,940
• Time in Patent Office: 524 Days
• Field of Search: 606/232, 606/233, 606/148, 606/151, 606/220, 606/75, 606/139-145
• US Class Current: 606/232
• 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 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0453 threaded elements, e.g. set screws
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• 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 2017/0488 Instruments for applying suture clamps, clips or locks

Abstract

An improved method is provided to secure a suture relative to body tissue. A suture retainer is moved along first and second sections of a suture toward the body tissue. When a predetermined minimum force is being transmitted between the suture retainer and the body tissue, the first and second sections of the suture are gripped with the suture retainer by plastically deforming material of the suture retainer. The material of the suture retainer cold flows under the influence of force applied against the surface areas on the suture retainer. One or more bends are formed in each of the sections of the suture to increase the holding action between the suture retainer and the sections of the suture. The bends may be formed by wrapping a turn of the suture around a portion of the suture retainer. During movement of the suture retainer toward the body tissue, the bends are moved along the first and second sections of the suture.

Claims

1. A method of securing a suture relative to body tissue, said method comprising the steps of selecting a suture of a known size and strength, connecting the selected suture with at least a portion of the body tissue, tensioning the selected suture with a first force which is a function of the known size and strength of the selected suture, sliding a suture retainer along the selected suture toward the body tissue, transmitting a second force which is a function of the known size and strength of the selected suture from the suture retainer to the body tissue, and gripping the selected suture with the suture retainer while tensioning the selected suture with the first force and while transmitting the second force from the suture retainer to the body tissue.

2. A method as set forth in claim 1 wherein said step of gripping the selected suture with the suture retainer includes plastically deforming the material of the suture retainer.

3. A method as set forth in claim 2 wherein said step of plastically deforming the material of the suture retainer includes cold flowing the material of the suture retainer under the influence of force applied against surface areas on the suture retainer.

4. A method as set forth in claim 2 wherein said step of deforming the material of the suture retainer includes heating at least a portion of the suture retainer.

5. A method as set forth in claim 2 wherein said step of plastically deforming the material of the suture retainer includes applying at least a predetermined minimum force against the suture retainer for at least a predetermined minimum period of time.

6. A method as set forth in claim 1 wherein said step of transmitting a second force which is a predetermined function of the selected suture size from the suture retainer to the body tissue includes pressing the suture retainer against the body tissue.

7. A method as set forth in claim 1 wherein said step of transmitting a second force from the suture retainer to the body tissue includes transmitting a force which is at least as great as the first force.

8. A method as set forth in claim 1 wherein said step of selecting a suture of known size and strength includes selecting a suture from a range of available suture sizes of known strengths.

9. A method as set forth in claim 1 wherein said step of connecting the selected suture with at least a portion of the body tissue includes anchoring an end potion of the suture against the body tissue.

10. A method as set forth in claim 1 wherein said step of connecting the selected suture with at least a portion of the body tissue includes positioning first and second sections of the selected suture in engagement with the body tissue, said step of sliding a suture retainer along the selected suture includes sliding the suture retainer along the first and second sections of the selected suture.

11. A method as set forth in claim 1 wherein said step of connecting the selected suture with the body tissue includes connecting a first end portion of the selected suture with the body tissue, said step of tensioning the selected suture with a first force includes pulling on a second end portion of the selected suture.

12. A method as set forth in claim 11 wherein said step of sliding the suture retainer along the selected suture toward the body tissue includes maintaining a portion of the selected suture disposed between the first and second end portions of the selected suture straight under the influence of tension in the selected suture.

13. A method as set forth in claim 11 wherein said step of sliding the suture retainer along the selected suture toward the body tissue includes moving a bend in the selected suture at a location between the first and second end portions of the selected suture along the selected suture toward the body tissue.

14. A method of securing a suture relative to body tissue, said method comprising the steps of providing a suture retainer, selecting a suture of known size and strength, moving the suture retainer along the suture toward the body tissue, tensioning the suture with a first force which is a function of the known strength of the suture, transmitting a second force which is a function of the known strength of the suture from the suture retainer to the body tissue, and gripping the suture with the suture retainer while tensioning the suture with the first force and while transmitting the second force from the suture retainer to the body tissue.

15. A method as set forth in claim 14 wherein said step of gripping the suture includes cold flowing material of the suture retainer under the influence of a third force applied against surface areas on the suture retainer.

16. A method as set forth in claim 14 wherein said step of gripping the suture includes heating at least a portion of the material of the suture retainer and flowing heated material of the suture retainer under the influence of a third force applied against surface areas on the suture retainer.

17. A method as set forth in claim 14 wherein said step of gripping the suture with the suture retainer includes pressing an inner side surface of the suture retainer against first and second sections of the suture and pressing the first and second sections of the suture against at least a portion of an outer side surface of the suture retainer while tensioning the suture with the first force and transmitting the second force from the suture retainer to the body tissue.

18. A method as set forth in claim 14 wherein said step of gripping the suture with the suture retainer includes pressing an inner side surface of the suture retainer against a single section of the suture while tensioning the suture with the first force and transmitting the second force from the suture retainer to the body tissue.

19. A method as set forth in claim 14 further including the steps of inserting a section of the suture through a passage in the suture retainer and forming a bend in the section of the suture, said step of moving the suture retainer along the suture toward the body tissue includes moving the bend along the section of the suture toward the body tissue.

20. A method as set forth in claim 19 wherein said step of gripping the suture with the suture retainer is performed after performance of said step of moving the suture retainer along the suture toward the body tissue.

21. A method as set forth in claim 14 further including the step of inserting a section of the suture through a passage in the suture retainer and forming a loop in the section of the suture retainer, said step of moving the suture retainer along the suture toward the body tissue includes moving the loop along the section of the suture toward the body tissue.

22. A method as set forth in claim 14 wherein said step of transmitting a second force from the suture retainer to the body tissue is initiated prior to tensioning of the suture with a first force.

23. A method as set forth in claim 14 further including the step of inserting a first section of the suture through a passage in the suture retainer and forming a first loop in the first section of the suture, inserting a second section of the suture through the passage in the suture retainer and forming a second loop in the second section of the suture, said step of moving the suture retainer along the suture toward the body tissue includes moving the first and second loops along the first and second sections of the suture toward the body tissue.

24. A method as set forth in claim 23 further including the step of tensioning the first and second sections of the suture with a force which is less than the first force during at least a portion of the movement of the first and second loops along the first and second sections of the suture toward the body tissue.

25. A method as set forth in claim 14 further including inserting the suture through first and second segments of body tissue, said step of transmitting a second force from the suture retainer to the body tissue includes transmitting the second force from the suture retainer to the second segment of body tissue and pressing the second segment of body tissue against the first segment of body tissue with the second force.

26. A method as set forth in claim 25 further including the step of maintaining a portion of the suture disposed in engagement with the first and second segments of the body tissue straight under the influence of tension in the suture during performance of said step of tensioning the suture.

27. A method as set forth in claim 14 further including inserting the suture through first and second segments of body tissue, and maintaining a portion of the suture extending through the first and second segments of body tissue straight under the influence of the tension in the suture during performance of said step of gripping the suture with the suture retainer.

28. A method as set forth in claim 27 further including the step of pressing the first and second segments of the body tissue together under the influence of force transmitted from the suture to the first segment of body tissue and under the influence of force transmitted from the suture retainer to the second segment of body tissue.

29. A method as set forth in claim 14 further including the steps of inserting the suture through first and second segments of body tissue, transmitting force from a first end portion of the suture to the first segment of body tissue while performing said step of tensioning the suture with the first force, transmitting force from the suture retainer to the second segment of body tissue while performing said step of transmitting a second force form the suture retainer to the body tissue, and pressing surfaces on the first and second segments of body tissue under the combined influence of force transmitted from the first end portion of the suture to the first segment of body tissue and force transmitted from the suture retainer to the second segment of body tissue.

30. A method as set forth in claim 29 further including the step of maintaining a portion of the suture extending between the first end portion of the suture and the suture retainer straight after performing said step of gripping the suture with the suture retainer.

31. A method of securing a suture relative to body tissue, said method comprising the steps of positioning a first end portion of a suture relative to a first segment of body tissue, inserting the suture through a second segment of body tissue, moving a suture retainer along the suture in a direction away from a second end portion of the suture toward the second segment of body tissue, applying a first force to the second end portion of the suture to tension the suture, transmitting the first force to the first segment of body tissue through the first end portion of the suture, applying a second force against the suture retainer, transmitting the second force from the suture retainer to the second segment of body tissue, pressing surfaces on the first and second segments of body tissue together under the combined influence of the first and second forces, and gripping the suture with the suture retainer while continuing to press surfaces on the first and second segments of body tissue together under the combined influence of the first and second forces.

32. A method as set forth in claim 31 wherein a portion of the suture extending between the first and second end portions of the suture is pulled straight by the first force upon initiation of said step of gripping the suture with the suture retainer.

33. A method as set forth in claim 31 wherein the second force applied against the suture retainer is at least as great as the first force applied to the second end portion of the suture.

34. A method as set forth in claim 31 wherein said step of positioning a first end portion of the suture relative to a first segment of the body tissue includes engaging the first segment of the body tissue with a suture anchor connected with the first end portion of the suture.

35. A method as set forth in claim 31 wherein said step of gripping the suture includes cold flowing material of the suture retainer under the influence of a third force applied against surface areas on the suture retainer.

36. A method as set forth in claim 31 wherein said step:

of gripping the suture includes heating at least a portion of the material of the suture retainer and flowing heated material of the suture retainer under the influence of a third force applied against surface areas on the suture retainer.

37. A method as set forth in claim 31 wherein said step of gripping the suture with the suture retainer includes pressing an inner side surface of the suture retainer against the suture while tensioning the suture with the first force and transmitting the second force from the suture retainer to the body tissue.

38. A method as set forth in claim 31 further including the steps of inserting the suture through a passage in the suture retainer and forming a bend in the suture, said step of moving the suture retainer along the suture away from the second end portion of the suture and toward the second segment of body tissue includes moving the bend along the suture toward the body tissue.

39. A method as set forth in claim 38 wherein said step of gripping the suture with the suture retainer is performed after performance of said step of moving the suture retainer along the suture toward the body tissue.

40. A method as set forth in claim 31 further including the step of inserting the suture through a passage in the suture retainer and forming a loop in the suture retainer, said step of moving the suture retainer along the suture includes moving the loop along the suture away from the first end portion of the suture and toward the second segment of body tissue.

41. A method as set forth in claim 31 wherein said step of transmitting the second force from the suture retainer to the body tissue is initiated prior to applying the first force to the second end portion of the suture.

42. A method as set forth in claim 31 further including the step of tensioning the suture with a force which is less than the first force during at least a portion of the movement of the suture retainer along the suture away from the second end portion of the suture toward the second segment of body tissue.

43. A method as set forth in claim 31 wherein said step of transmitting the second force from the suture retainer to the second segment of the body tissue includes pressing the suture retainer against the second segment of body tissue.

44. A method of securing a suture relative to body tissue, said method comprising the steps of positioning first and second sections of a suture relative to a first segment of body tissue, positioning a portion of a second segment of body tissue between the first and second sections of the suture, moving a suture retainer along the first and second sections of the suture in a direction away from end portions of the first and second sections of the suture toward the second segment of body tissue, applying a first force to the end portions of the first and second sections of the suture to tension the suture, transmitting the first force to the first segment of the body tissue through the first and second sections of the suture, applying a second force against the suture retainer, transmitting the second force from the suture retainer to the second segment of body tissue, pressing the first and second segments of body tissue together under the combined influence of the first and second forces, and gripping the first and second sections of the suture with the suture retainer while continuing to press surfaces on the first and second segments of the body tissue together under the combined influence of the first and second forces.

45. A method as set forth in claim 44 wherein said step of positioning the first and second sections of the suture relative to the first segment of body tissue includes moving the first section of the suture through a first passage in the first segment of body tissue and moving the second section of the suture through a second passage in the first segment of body tissue, said step of transmitting the first force to the first segment of the body tissue includes transmitting force from a portion of the suture extending between the first and second sections of the suture to the first segment of the body tissue.

46. A method as set forth in claim 44 wherein said step of transmitting the first force to the first segment of the body tissue includes pressing the portion of the suture which extends between the first and second sections of the suture against the first segment of body tissue.

47. A method as set forth in claim 45 wherein said step of positioning a portion of the second segment of body tissue between the first and second sections of the suture includes moving the first section of the suture through a first passage in the second segment of body tissue and moving the second section of the suture through a second passage in the second segment of body tissue.

48. A method as set forth in claim 44 wherein said step of transmitting the second force from the suture retainer to the second segment of body tissue includes pressing the suture retainer against the second segment of body tissue.

49. A method as set forth in claim 44 wherein said step of gripping the first and second sections of the suture with the suture retainer includes plastically deforming the material of the suture retainer by cold flowing the material of the suture retainer under the influence of a third force applied against the suture retainer.

50. A method of securing a suture relative to body tissue, said method comprising the steps of connecting a suture with at least a portion of the body tissue, applying a first force to an end portion of the suture to tension the suture, sliding a suture retainer along the suture toward the body tissue, applying a second force to the suture retainer urging the suture retainer toward the body tissue while applying the first force to the end portion of the suture, and gripping the suture with the suture retainer while applying the first force to the end portion of the suture and while applying the second force to the suture retainer, said step of gripping the suture with the suture retainer includes plastically deforming the suture retainer.

51. A method as set forth in claim 50 wherein said step of applying the second force to the suture retainer includes moving a force application member into engagement with a side of the suture retainer which faces toward the end portion of the suture to which the first force is applied and pressing the force application member against the side of the suture retainer.

52. A method as set forth in claim 50 wherein said step of plastically deforming the suture retainer includes applying a third force to the suture retainer while applying the second force to the suture retainer and while applying the first force to the suture.

53. A method as set forth in claim 50 wherein said step of connecting a suture with at least a portion of the body tissue includes engaging the body tissue with a suture anchor.

54. A method as set forth in claim 50 wherein said step of connecting a suture with at least a portion of the body tissue includes positioning first and second sections of the suture relative to a first segment of the body tissue and positioning a portion of a second segment of body tissue between the first and second sections of the suture.

55. A method as set forth in claim 54 wherein said step of positioning the first and second sections of the suture relative to the first segment of body tissue includes moving the first section of the suture through a first passage in the first segment of body tissue and moving the second section of the suture through a second passage in the first segment of the body tissue.

56. A method as set forth in claim 50 wherein a portion of the suture extending between a location where the suture is connected with the body tissue and the end portion of the suture is pulled straight under the influence of tension in the suture during at least a portion of a time during which the first force is applied to the suture.

57. A method as set forth in claim 50 wherein said first force pulls the end portion of the suture in a first direction and said second force pushes the suture retainer in a second direction which is opposite to said first direction.

58. A method as set forth in claim 50 wherein said step of sliding the suture retainer along the suture toward the body tissue includes moving the suture retainer along a portion of the suture which is maintained straight under the influence of tension in the suture.

59. A method as set forth in claim 50 further including the step of transmitting the second force from the suture retainer to the body tissue while applying the first force to the end portion of the suture.

60. A method as set forth in claim 50 further including the step of forming a bend in the suture and maintaining the bend in the suture during application of the first force to the end portion of the suture.

61. A method as set forth in claim 50 wherein said step of sliding the suture retainer along the suture toward the body tissue includes moving the bend in the suture along the suture toward the body tissue with the suture retainer.

62. A method as set forth in claim 50 further including the step of forming a loop in the suture around a portion of the suture retainer and maintaining the loop in the suture during application of the first force to the end portion of the suture.

63. A method as set forth in claim 62 wherein said step of sliding the suture retainer along the suture toward the body tissue includes moving the loop in the suture along the suture toward the body tissue with the suture.

64. A method as set forth in claim 50 wherein said step of plastically deforming the suture retainer includes cold flowing material of the suture retainer under the influence of force applied against surface areas on the suture retainer.

65. A method as set forth in claim 50 wherein said step of plastically deforming the suture retainer includes heating at least a portion of the material of the suture retainer and moving the heated material of the suture retainer relative to the suture under the influence of force applied against the suture retainer.

66. A method as set forth in claim 50 wherein said step of sliding the suture retainer along the suture includes moving the suture retainer into engagement with the body tissue, said step of applying a second force to the suture retainer includes transmitting at least a portion of the second force from the suture retainer to the body tissue.

67. A method as set forth in claim 50 wherein said step of applying a first force to an end portion of the suture includes applying a predetermined force which is a function of the strength of the suture to the end portion of the suture.

68. A method as set forth in claim 50 further including the step of maintaining a portion of the suture extending between the suture retainer and a location where the suture is connected with the body tissue straight under the influence of tension in the suture after performance of said step of gripping the suture with the suture retainer.

69. A method as set forth in claim 50 wherein the body tissue includes first and second segments of body tissue, said step of connecting the suture with the body tissue includes connecting the suture with the first segment of the body tissue, said step of applying a second force to the suture retainer includes pressing the second segment of the body tissue against the first segment of the body tissue under the influence of force transmitted from the suture retainer to the second segment of body tissue.

70. A method as set forth in claim 50 wherein a portion of the suture extending between a location where the suture is connected with the first segment of the body tissue and the retainer straight while pressing the second segment of the body tissue against the first segment of the body tissue.