Adjustable knotless loops

• US 7,959,650 B2
• Filed: 08/22/2008
• Issued: 06/14/2011
• Est. Priority Date: 09/29/2006
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Denham, Gregory J., Stone, Kevin T., Kaiser, Ryan A.
• Primary Examiner(s): Woo; Julian W
• Assistant Examiner(s): DANG, PHONG SON H
• Application Number:
  US12/196,398
• Publication Number:
  US 20090082805A1
• Time in Patent Office: 1,026 Days
• Field of Search: 606223-225, 606/228, 606/74, 606/103, 52/22, 604/103.04, 600 29- 30, 600/37, 241/15.H
• 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 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/00858 high friction, non-slip on handles A61B2017/00429
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• 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

Methods of attaching a soft tissue to an adjacent bone at a defect site are provided. At least one adjustable loop of a flexible construct is passed through the soft tissue. The at least one adjustable loop is passed through a passage construct. A locking member is passed through the at least one adjustable loop and the adjustable loop is reduced about or within the locking member such that the at least one loop is frictionally retained in the passage construct and locked in place by the locking member to thereby secure the soft tissue.

Claims

1. A method of attaching a first tissue to a second tissue at a site comprising:

a. passing at least one adjustable loop of a flexible construct through at least the first tissue, wherein the first flexible construct includes a flexible member having a body, and an end of the flexible member extends through a passage formed in the body of the flexible member to form the first flexible construct having the at least one adjustable loop;

b. passing a locking member formed by a body of a flexible member of a second flexible construct through the at least one adjustable loop of the first flexible construct; and

c. reducing the at least one adjustable loop of the flexible construct about the locking member such that the at least one adjustable loop is frictionally retained at the passage and locked in place by the locking member to thereby secure at least the first tissue.

2. The method of claim 1, wherein passing the locking member of the second flexible construct through the at least one adjustable loop of the second flexible construct is performed extra corporeally.

3. The method of claim 1, wherein reducing the at least one adjustable loop of the first flexible construct comprises engaging an adjusting arm defined flexible member of the first by the flexible construct.

4. The method of claim 1, further comprising selectively displacing the locking member to allow the at least one adjustable loop of the flexible construct to selectively move during the reducing of the at least one adjustable loop.

5. The method of claim 1, wherein the locking member is selected from the group consisting of a post, a knotted length of suture, a bar, a dumbbell, and an elbow.

6. The method of claim 1, further comprising pressing the locking member within, about, or adjacent to the at least one adjustable loop.

7. The method of claim 1, further comprising placing the locking member relative to the at least one adjustable loop to selectively add slack to the at least one adjustable loop.

8. The method of claim 1, further comprising passing the first and second flexible constructs through a pathway construct.

9. The method of claim 1, further comprising forming a pathway construct as a coil about the first and second flexible constructs.

10. A method of attaching a first tissue to a second tissue at a site comprising:

a. passing at least one adjustable loop of a first adjustable flexible construct through at least the first tissue, the first flexible construct defining a first passage construct;

b. passing at least one adjustable loop of a second adjustable flexible construct through at least the second tissue, the second flexible construct defining a second passage construct;

c. passing a locking member through each of the at least one adjustable loops of the first and second flexible constructs; and

d. reducing each of the at least one adjustable loops of the first and second flexible constructs about the respective locking members such that each of the at least one adjustable loops are frictionally retained at the respective passage constructs of the first and second flexible constructs and locked in place by the locking members to thereby secure at least the first tissue to the second tissue.

11. The method of claim 10, wherein reducing each of the at least one adjustable loops includes engaging an adjusting arm defined by each of the first and second flexible constructs.

12. The method of claim 10, wherein passing the at least one adjustable loop of the first and second flexible constructs through the respective first and second tissues includes positioning the first and second passage constructs between the first tissue and the second tissue.

13. The method of claim 12, further comprising substantially aligning the passage constructs of the first and second flexible constructs with each other.

14. The method of claim 12, wherein passing a locking member through each of the at least one adjustable loops includes passing a first locking member through one of the at least one adjustable loops between the first tissue and the first passage construct of the first flexible construct, and passing a second locking member through the other of the at least one adjustable loops between the second tissue and the second passage construct of the second flexible construct.

15. The method of claim 10, wherein passing a locking member through each of the at least one adjustable loops includes passing a knotted restriction element defined by each of the first and second flexible constructs through the at least one adjustable loops.

16. The method of claim 15, wherein passing a locking member through each of the at least one adjustable loops includes passing a first knotted restriction element defined by the first flexible construct through the at least one adjustable loop of the second flexible construct, and passing a second knotted restriction element defined by the second flexible construct through the at least one adjustable loop of the first flexible construct.

17. The method of claim 10, wherein the locking member includes a knotted length of suture.

18. The method of claim 10, further comprising forming a pathway construct as a coil around the first and second flexible constructs.

19. The method of claim 18, wherein forming the pathway construct as a coil around the first and second flexible constructs includes forming the pathway construct as an adjustable coil substantially around the first and second passage constructs defined by the respective first and second flexible constructs.

20. The method of claim 18, wherein forming the pathway construct as a coil around the first and second flexible constructs includes:

a. positioning the first and second flexible constructs adjacent to each other;

b. passing an adjusting arm defined by the first flexible construct through the at least one adjustable loop of the second flexible construct;

c. passing the adjusting arm through the at least one adjustable loop of the first flexible construct;

d. wrapping the adjusting arm around the first and second flexible constructs to form an adjustable coil around the first and second flexible constructs to form the pathway construct; and

e. passing the adjusting arm through the at least one adjustable loop of the second flexible construct.

21. The method of claim 20, further comprising passing an adjusting arm defined by the second flexible construct through the at least one adjustable loop of the first flexible construct;

wherein reducing each of the at least one adjustable loops of the first and second flexible constructs about the respective locking members includes tensioning the adjusting arms of the first and second flexible constructs.

22. A method of attaching a first tissue to a second tissue at a site comprising:

a. passing at least one adjustable loop of a first adjustable flexible construct through at least the first tissue, the first flexible construct defining a first passage construct and including at least one first adjusting arm;

b. passing at least one adjustable loop of a second adjustable flexible construct through at least the second tissue, the second flexible construct defining a second passage construct and including at least one second adjusting arm;

c. positioning the first and second passage constructs between the first tissue and the second tissue;

d. forming a pathway construct around the first and second flexible constructs by wrapping one of the first and second adjusting arms around the first and second flexible constructs to form a coil around the first and second flexible constructs;

e. passing a locking member through each of the at least one adjustable loops of the first and second flexible constructs; and

f. tensioning each of the at least one first and second adjusting arms thereby reducing each of the at least one adjustable loops of the first and second flexible constructs about the respective locking members such that each of the at least one adjustable loops are frictionally retained at the respective passage constructs and locked in place by the locking members to thereby secure at least the first tissue to the second tissue.

23. The method of claim 22, wherein passing a locking member through each of the at least one adjustable loops includes passing a first locking member through one of the at least one adjustable loops between the first tissue and the first passage construct of the first flexible construct, and passing a second locking member through the other of the at least one adjustable loops between the second tissue and the second passage construct of the second flexible construct.

24. The method of claim 22, wherein passing a locking member through each of the at least one adjustable loops includes passing a first knotted restriction element defined by the first flexible construct through the at least one adjustable loop of the second flexible construct, and passing a second knotted restriction element defined by the second flexible construct through the at least one adjustable loop of the first flexible construct.

25. The method of claim 22, wherein the locking member includes a knotted length of suture.

26. The method of claim 22, wherein passing a locking member through each of the at least one adjustable loops of the first and second flexible constructs includes passing a locking member through each of the at least one adjustable loops between the loops and a side of the respective soft tissue opposite a side facing the first and second passage constructs.

27. The method of claim 22, further comprising forming the coil with the at least one first adjusting arm and passing the at least one first adjusting arm through the at least one adjustable loop of the second flexible construct, and passing the at least one second adjusting arm through the at least one adjustable loop of the first flexible construct before tensioning each of the at least one first and second adjusting arms.