Method and apparatus for securing a suture

• US 6,569,187 B1
• Filed: 10/10/2000
• Issued: 05/27/2003
• Est. Priority Date: 08/01/1997
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M., Cremens, Matthew J., Liu, Ping
• Primary Examiner(s): Milano, Michael J.
• Assistant Examiner(s): Baxter, Jessica R
• Application Number:
  US09/685,795
• Time in Patent Office: 959 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 for applying suture anchors A61B2017/0409; for applying wound clamps A61B17/10; for applying ligaturing clamps or clips A61B17/128

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, positioning a suture retainer relative to the selected suture and the body tissue, transmitting a second force which is a function of the known size and strength of the selected suture between the suture retainer and the body tissue, and interconnecting the selected suture and the suture retainer while tensioning the selected suture with the first force and while transmitting force from the suture retainer to the body tissue.

2. A method as set forth in claim 1 wherein said step of interconnecting the selected suture and 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 between 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 between the suture retainer and 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 positioning a suture retainer relative to the selected suture includes positioning the suture retainer relative to 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 1 wherein said step of positioning the suture retainer relative to the selected suture 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 positioning the suture retainer relative to the selected suture and 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 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, positioning the suture retainer relative to 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 between the suture retainer and the body tissue, and interconnecting the suture and the suture retainer while tensioning the suture with the first force and while transmitting force from the suture retainer to the body tissue.

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

16. A method as set forth in claim 14 wherein said step of interconnecting the suture and the suture retainer 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 force applied against surface areas on the suture retainer.

17. A method as set forth in claim 14 wherein said step of interconnecting the suture and the suture retainer includes pressing an inner side surface of the suture retainer against first and second sections of the suture and pressing 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 force from the suture retainer to the body tissue.

18. A method as set forth in claim 14 wherein said step of interconnecting the suture and 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 force from the suture retainer to the body tissue.

19. A method as set forth in claim 14 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 positioning the suture retainer relative to the body tissue includes moving the bend along the suture toward the body tissue.

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

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

31. A method as set forth in claim 14 wherein said step of providing a suture retainer includes providing a suture retainer having a side wall with a circular cross sectional configuration and a passage extending between axially opposite ends of the suture retainer, the side wall having a slit which extends between axially opposite ends of the suture retainer, said method further includes moving a portion of the suture through the slit into the passage in the suture retainer, said step of interconnecting the suture and the suture retainer includes deforming material of the suture retainer to grip the suture with the suture retainer.

32. A method as set forth in claim 31 wherein said step of deforming material of the suture retainer includes closing the slit in the suture retainer.

33. A method as set forth in claim 14 wherein said step of interconnecting the suture and the suture retainer includes applying energy to at least a portion of the suture retainer and deforming material of the suture retainer.

34. A method as set forth in claim 14 further including the steps of moving a first portion of the suture through a first passage in the suture retainer, and moving a second portion of the suture through a second passage in the suture retainer, said step of interconnecting the suture and the suture retainer includes decreasing size of the first and second passages in the suture retainer to grip the first and second portions of the suture with the suture retainer.

35. A method as set forth in claim 14 further including the steps of forming a first loop in a first portion of the suture around a first portion of the suture retainer and forming a second loop in a second portion of the suture around a second portion of the suture retainer, said step of interconnecting the suture and the suture retainer includes gripping the loops in first and second portions of the suture with the suture retainer.

36. A method as set forth in claim 14 wherein said step of providing a suture retainer includes providing a suture retainer having a groove which extends around the suture retainer, said method further includes positioning a portion of the suture in the groove, said step of tensioning the suture with a first force being performed with a portion of the suture disposed in the groove, said step of interconnecting the suture and the suture retainer includes deforming a portion of the suture retainer to at least partially close an opening to the groove.

37. A method as set forth in claim 14 further including the step of positioning first and second portions of the suture in a side-by-side relationship in an opening formed in the suture retainer, said step of interconnecting the suture and the suture retainer includes closing the opening in the suture retainer and gripping the first and second portions of the suture with the suture retainer.

38. A method as set forth in claim 37 wherein said step of positioning first and second portions of the suture in a side-by-side relationship in an opening formed in the suture retainer includes positioning the first and second portions of the suture in a passage which extends through the suture retainer.

39. A method as set forth in claim 37 wherein said step of positioning first and second portions of the suture in a side-by-side relationship in an opening formed in the suture retainer includes positioning the first and second portions of the suture in a groove formed in the suture retainer.

40. A method as set forth in claim 14 further including the step of positioning the suture relative to body tissue with first and second portions of the suture extending from the body tissue, moving the first and second portions of the suture through the suture retainer, said step of positioning the suture retainer relative to the body tissue includes sliding the suture retainer along the first and second portions of the suture toward the body tissue.

41. A method as set forth in claim 40 wherein said step of tensioning the suture with a first force includes tensioning the first and second portions of the suture with the first force.

42. A method as set forth in claim 14 wherein the first force with which the suture is tensioned is equal to the second force transmitted between the suture retainer and the body tissue.

43. A method as set forth in claim 14 wherein the first force with which the suture is tensioned is different than the second force transmitted between the suture retainer and the body tissue.