Methods of meniscus repair

• US 8,663,253 B2
• Filed: 04/19/2011
• Issued: 03/04/2014
• Est. Priority Date: 07/03/2007
• Status: Active Grant

• Current Assignee: Ceterix Orthopaedics, Inc (Smith & Nephew PLC)
• Original Assignee: Ceterix Orthopaedics, Inc (Smith & Nephew PLC)
• Inventors: Saliman, Justin D.
• Primary Examiner(s): McDermott, Corrine M
• Assistant Examiner(s): Templeton, Christopher L
• Application Number:
  US13/090,089
• Publication Number:
  US 20110218557A1
• Time in Patent Office: 1,050 Days
• Field of Search: 606/139, 606/144, 606/145, 606/142, 606/143, 606205-209, 2271751-1821
• US Class Current: 606/145
• 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 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/06042 located close to needle tip
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle

Abstract

Methods of repairing knee meniscus tears are described which use suture passer devices and suture shuttles. These methods may be used with continuous suture passing, so that the suture passer device may remain on or in the tissue while passing a suture shuttle, and therefore a suture, back and forth from one side of the tissue to the other. These methods may be used minimally invasively for repairing meniscus tissue while avoiding further damage to the meniscus.

Claims

1. A method of repairing or reconstructing a meniscus of a knee, the method comprising:

arthroscopically positioning a first arm of a suture passer on a superior side of the meniscus before positioning a second arm of the suture passer on an inferior side of the meniscus, positioning the second arm on the inferior side of the meniscus so that the meniscus is within a distal-facing opening of the arms, wherein the suture passer has an elongate body having a proximal to distal long axis, and at least one of the first or second arms of the suture passer is axially movable relative to the other arm in the proximal to distal direction of the long axis;

passing a first limb of suture through the meniscus by extending a tissue penetrator between the distal-facing opening formed by the first and second arms, along a first path through the meniscus and retracting the tissue penetrator back through the meniscus along the first path;

repositioning the suture passer relative to the meniscus; and

passing a second limb of suture through the meniscus by extending the tissue penetrator between the distal-facing opening formed by the first and second arms, along a second path through the meniscus and retracting the tissue penetrator back through the meniscus along the second path.

2. The method of claim 1, wherein passing the suture through the meniscus by extending the tissue penetrator between the distal-facing opening formed by the first and second arms along the first path through the meniscus comprises engaging the suture with the tissue penetrator proximal to a distal tip of the tissue penetrator.

3. The method of claim 1, wherein repositioning the suture passer relative to the meniscus comprises moving the suture passer relative to the meniscus without removing the first and second arms of the suture passer from around the meniscus.

4. The method of claim 1, further comprising minimally invasively accessing the meniscus to position the suture passer.

5. The method of claim 1, wherein the first and second paths through the meniscus are curved paths.

6. The method of claim 1, wherein retracting the tissue penetrator back through the meniscus along the first path comprises retracing the tissue penetrator back into the first arm.

7. The method of claim 1, further comprising pulling the suture through the meniscus when retracting the tissue penetrator back through the meniscus.

8. The method of claim 1, wherein repositioning the suture passer comprises repositioning the suture passer so that at least one of the first or second arms of the suture passer moves from one side of a tear in the meniscus to another side of the tear.

9. The method of claim 1, wherein positioning the first arm and the second arm comprises pushing against the meniscus capsule with one of the first arm or second arm.

10. The method of claim 1, further comprising inserting the suture passer into the patient'"'"'s knee with either the first or second arms proximally retracted so that the suture passer does not have a distal-facing opening between the first arm and the second arm of the suture passer.

11. The method of claim 1, further comprising inserting the suture passer into the patient'"'"'s knee and then forming the distal-facing opening of the suture passer at the distal end of the suture passer by distally extending either the first or second arm axially relative to the other arm.

12. A method of repairing or reconstructing a torn meniscus of a knee using a suture passer having an elongate body with a proximal to distal long axis, a first arm and a second arm, wherein the second arm is axially movable relative to the first arm in the proximal to distal direction of the long axis, the method comprising:

arthroscopically positioning the first arm of the suture passer on a superior side of the meniscus;

axially sliding the second arm of the suture passer on to an inferior side of the meniscus after positioning the first arm so that the meniscus is at least partially within a distal-facing opening formed between the first and second arms;

passing a first limb of suture through the meniscus by extending a tissue penetrator across the distal-facing opening, along a first path through the meniscus and retracting the tissue penetrator back through the meniscus along the first path;

repositioning at least one arm of the suture passer relative to the meniscus;

passing a second limb of suture through the meniscus by extending the tissue penetrator across the distal-facing opening, along a second path through the meniscus and retracting the tissue penetrator back through the meniscus along the second path.

13. The method of claim 12, wherein repositioning at least one arm of the suture passer relative to the meniscus comprises moving one arm of the suture passer relative to the other arm.

14. The method of claim 12, further comprising minimally invasively accessing the meniscus to position the suture passer.

15. The method of claim 12, further comprising pulling the suture through the meniscus.

16. The method of claim 12, wherein retracting the tissue penetrator back through the meniscus comprises pulling the suture through the meniscus.

17. A method of arthroscopic meniscus repair or reconstruction using a suture passer having an elongate body with a proximal to distal long axis, a first arm and a second arm, wherein the second arm is axially movable relative to the first arm in the proximal to distal direction of the long axis, the method comprising:

arthroscopically accessing a meniscus with the suture passer wherein the second arm is retracted proximally relative to the elongate body of the suture passer so that it does not form a distal-facing opening with the first arm;

extending the second arm distally, relative to the first arm, after positioning the first arm on the meniscus, by sliding the second arm distally in the long axis so that the arms of the suture passer form a distal-facing opening around the meniscus;

extending a tissue penetrator along a first path through the meniscus and retracting the tissue penetrator back through the meniscus along the first path, to pass a first limb of suture through the meniscus;

repositioning at least one arm of the suture passer relative to the meniscus; and

extending the tissue penetrator along a second path through the meniscus and retracting the tissue penetrator back through the meniscus along the second path, to pass a second limb of suture through the meniscus.