Methods and devices for tissue repair

• US 7,651,509 B2
• Filed: 08/16/2004
• Issued: 01/26/2010
• Est. Priority Date: 12/02/1999
• Status: Expired due to Fees

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Sikora, George, Ek, Steven, Bojarski, Ray, Torrie, Paul Alexander
• Primary Examiner(s): Nguyen; Anhtuan T
• Assistant Examiner(s): SONNETT, KATHLEEN C
• Application Number:
  US10/918,445
• Publication Number:
  US 20050033363A1
• Time in Patent Office: 1,989 Days
• Field of Search: 606/213, 606/215, 606/216, 606222-232, 606139-141, 606144-157, 606/233, 606/60, 606/103, 606/184, 606/185, D24/145, 227/66, 128/897, 289/1.2, 289/1.5, 289 2- 4, D16/339, 351/156, 351/157
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• 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 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/061 : hollow or tubular
• CPC Class Codes: A61B 2017/0646 : for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2017/0647 : having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0648 : threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61F 2/0805 : Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0829 : without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
• CPC Class Codes: A61F 2002/0852 : Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0858 : Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0882 : Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
• CPC Class Codes: A61F 2002/0888 : Anchor in or on a blind hole or on the bone surface without formation of a tunnel

Abstract

An apparatus includes first and second fixation members, a flexible member coupled to the first and second fixation members, and a limiting element coupled to the flexible member. The limiting element is movable relative to the second fixation member and acts to limit loosening of the flexible member relative to the second fixation member. The limiting element can be slidably received by the flexible member. The flexible member can be coupled to the fixation members such that pulling on a free end of the flexible member shortens a length of the flexible member between the fixation members.

Claims

1. An apparatus, comprising:

first and second fixation members, and

a flexible element coupling the first and second fixation members, the flexible element forming a knot having, in order, along a length of the flexible element, a first section on a first side of the first fixation member, a second section on a second side of the first fixation member, a third section that passes under the first section, a fourth section that passes over the first section, a fifth section that passes under and over the second section forming a loop, a sixth section that passes over the first section, a seventh section that passes under the first section, and an eighth section that passes under the second section and through the loop.

2. The apparatus of claim 1, further comprising a delivery device within which the first and second fixation members coupled by the flexible element are received.

3. The apparatus of claim 2, wherein at least a portion of the knot is spaced from each of the fixation members.

4. The apparatus of claim 2, wherein at least a portion of the knot is off of each of the fixation members.

5. The apparatus of claim 1, further comprising a cannula within which the first and second fixation members coupled by the flexible element are received.

6. The apparatus of claim 1, further comprising a delivery device, the delivery device comprising a handle and a cannula, the cannula extending from the handle and including a longitudinal channel within which the first and second fixation members are slidably received.

7. The apparatus of claim 6, further comprising a member slidably positioned within the cannula, the member including a finger-engageable element for advancing and retracting the member within the cannula.

8. The apparatus of claim 7, wherein the member engages at least one of the first and second fixation members to deploy the at least one of the first and second fixation member from the cannula.

9. The apparatus of claim 1, wherein the knot is formed around a portion of the flexible element and wherein at least a portion of the knot is not formed around either of the first and second fixation members.

10. The apparatus of claim 1, wherein at least one of the first and second fixation members defines a through hole for receiving the flexible element.

11. The apparatus of claim 10, wherein the flexible element passes through the through hole in the at least one of the first and second fixation members.

12. The apparatus of claim 1, wherein at least one of the first and second fixation members comprises a T-shape.

13. The apparatus of claim 1, wherein one of the first and second fixation members is fixedly attached to the flexible element.

14. The apparatus of claim 1, wherein one of the first and second fixation members is slidably attached to the flexible element.

15. The apparatus of claim 1, wherein the flexible element comprises a suture.

16. The apparatus of claim 1, wherein no portion of the flexible element extends from either fixation member to the other fixation member and back to the original fixation member.

17. The apparatus of claim 1, wherein the first and second fixation members comprise substantially the same shape.

18. The apparatus of claim 1, further comprising a delivery device, the delivery device comprising:

a handle,

a cannula, the cannula extending from the handle and including a longitiudinal slot in the cannula along at least a portion of the length of the cannula, and

a pusher member slidably positioned within the cannula, the pusher member including a finger-engageable element for advancing and retracting the pusher member within the cannula,

wherein the first and second fixation members coupled by the flexible element are slidably disposed within the cannula such that upon a(advancement of the pusher member, at least one of the first and second fixation members is deployed from the cannula.

19. An apparatus, comprising:

a delivery device comprising;

a handle,

a cannula extending from the handle, and

a pusher member slidably positioned within the cannula, the pusher member including a finger-engageable element for advancing and retracting the pusher member within the cannula;

first and second fixation members; and

a flexible element coupling the first and second fixation members, the flexible element forming a knot having, in order, along a length of the flexible element, a first section on a first side of the first fixation member, a second section on a second side of the first fixation member, a third section that passes under the first section, a fourth section that passes over the first section, a fifth section that passes under and over the second section forming a loop, a sixth section that passes over the first section, a seventh section that passes under the first section, and an eighth section that passes under the second section and through the loop,

wherein the first and second fixation members coupled by the flexible element are slidably disposed within the cannula such that with advancement of the pusher member at least one of the first and second fixation members is deployed from the cannula.

20. The apparatus of claim 19, wherein at least one of the first and second fixation members defines a through hole for receiving the flexible element.

21. The apparatus of claim 20, wherein the flexible element passes through the through hole in the at least one of the first and second fixation members.

22. The apparatus of claim 19, wherein at least one of the first and second fixation members comprises a T-shape.

23. The apparatus of claim 19, wherein one of the first and second fixation members is fixedly attached to the flexible element.

24. The apparatus of claim 19, wherein one of the first and second fixation members is slidably attached to the flexible element.

25. The apparatus of claim 19, wherein the flexible element comprises a suture.

26. The apparatus of claim 19, wherein no portion of the flexible element extends from either fixation member to the other fixation member and back to the original fixation member.

27. The apparatus of claim 19, wherein the first and second fixation members consist essentially of the same shape.

28. An apparatus for arthroscopically repairing a tear in the meniscus of a knee of a human patient, comprising:

a handle adapted to be held by a surgeon outside the body of the patient;

an elongated cannula adapted to extend from the handle to within the patient, the cannula being attached to the handle;

first and second fixation members having an elongated shape, each of the first and second fixation members being preformed prior to use in a form for use, the fixation members being slidably disposed within the cannula;

a flexible element coupling the first and second fixation members, the flexible element forming a slip knot having, in order, along a length of the flexible element, a first section on a first side of the first fixation member, a second section on a second side of the first fixation member, a third section that passes under the first section, a fourth section that passes over the first section, a fifth section that passes under and over the second section forming a loop, a sixth section that passes over the first section, a seventh section that passes under the first section, and an eighth section that passes under the second section and through the loop;

at least one elongated pusher member slidably positioned within the cannula, the pusher member including a finger-engageable member for advancing and retracting the pusher member, the finger-engageable member being adapted to be engageable by the surgeon from outside the body of the patient, the pusher member adapted to engage at least one of the first and second fixation members such that upon advancement of the pusher member at least one of the fixation members is deployed from the cannula.

29. The apparatus of claim 28, wherein the first fixation member is fixedly attached to the flexible element.

30. The apparatus of claim 28, wherein the second fixation member is slidably attached to the flexible element.

31. The apparatus of claim 28, wherein the second fixation member is fixedly attached to the flexible element such that the length of the flexible element between the slip knot and the second fixation member remains substantially constant.

32. The apparatus of claim 28, wherein the flexible element comprises a suture.