Methods and devices for tissue repair

• US 20050033363A1
• Filed: 08/16/2004
• Published: 02/10/2005
• Est. Priority Date: 12/02/1999
• Status: Active Grant

• 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
• Granted Patent: US 7,651,509 B2
• Time in Patent Office: Days
• US Class Current: 606/228
• 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 for applying suture clamps, clips or locks A61B2017/0488
• 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 lateral eyelet for attaching suture to needle A61B2017/06019
• 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 suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• 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,

a flexible member coupled to the first and second fixation members, and

a limiting element coupled to the flexible member, the limiting element being movable relative to the second fixation member and acting to limit loosening of the flexible member relative to the second fixation member.

2. The apparatus of claim 1, wherein the limiting element comprises a knot formed in the flexible member.

3. The apparatus of claim 2, wherein the knot comprises a slip knot.

4. The apparatus of claim 1, wherein the flexible member comprises a suture.

5. The apparatus of claim 1, wherein the limiting element defines a through bore for receiving the flexible member.

6. The apparatus of claim 1, wherein the limiting element defines an angled channel for receiving the flexible member.

7. The apparatus of claim 1, wherein the limiting element is slidably received on the flexible member.

8. The apparatus of claim 1, wherein the flexible member is secured to the first fixation member with a knot.

9. The apparatus of claim 1, wherein the flexible member is movably coupled to the second fixation member with a one-way knot.

10. The apparatus of claim 1, wherein the fixation members include a cylindrical portion.

11. The apparatus of claim 1, wherein the second fixation member includes a T shape.

12. The apparatus of claim 1, wherein the second fixation member includes a crescent shape.

13. The apparatus of claim 1, wherein the first fixation member includes a button-shaped portion.

14. The apparatus of claim 1, wherein the flexible member is substantially immovably secured to the first fixation member.

15. The apparatus of claim 1, wherein the flexible member is movably coupled to the second fixation member.

16. The apparatus of claim 1, wherein at least one of the first and second fixation members includes a retainer.

17. The apparatus of claim 1, wherein at least one of the first and second fixation members includes a fastener.

18. An apparatus, comprising:

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 being slidably received by the flexible member and acting to limit loosening of the flexible member relative to the second fixation member.

19. An apparatus, comprising:

a fixation member, and

a flexible member movably coupled to the fixation member, a first end of the flexible member being looped back and secured to the flexible member for forming a loop, the loop being remote from the fixation member.

20. A surgical assembly comprising:

a first fastener;

a second fastener; and

a flexible member connecting the first fastener to the second fastener, the flexible member being movably attached to the second fastener, such that pulling on a free end of the flexible member shortens a length of the flexible member between the first and second fasteners.

21. The surgical assembly of claim 20, wherein the movable attachment of the flexible member to the second fastener enables the length of the flexible member between the first and second fasteners to be shortened, but not lengthened.

22. The surgical assembly of claim 21, wherein the movable attachment includes a knot formed in the flexible member at the second fastener.

23. A surgical assembly comprising:

a fastener configured to be secured within bone tissue;

a retainer for engaging tissue; and

a flexible member connecting the fastener to the retainer, the flexible member being movably attached to the retainer such that pulling on a free end of the flexible member shortens a length of the flexible member between the fastener and the retainer to urge the tissue against the bone tissue.

24. A surgical assembly comprising:

a delivery device comprising a handle and a cannula, the cannula extending from the handle and including a longitudinal channel and a longitudinal slot in the cannula along at least a portion of the length of the channel; and

a surgical device comprising a first fixation member, a second fixation member, a flexible member coupling the first fixation member and the second fixation member, the flexible member being movably attached to the first fixation member such that pulling on a free end of the flexible member shortens a length of the flexible member between the first fixation member and the second fixation member,

wherein the first fixation member is positioned within the longitudinal channel, the second fixation member is positioned adjacent to an outer surface of the cannula, and the flexible member passes from the longitudinal channel through the longitudinal slot.

25. The surgical assembly of claim 24, further comprising a pusher tube slidably positioned within the cannula and including a thumb switch extending through the longitudinal slot for advancing and retracting the pusher tube.

26. The surgical assembly of claim 24, wherein the movable attachment comprises a slip knot.

27. The surgical assembly of claim 26, wherein the movable attachment is positioned within the longitudinal channel.

28. The surgical assembly of claim 26, wherein the movable attachment is positioned outside of the longitudinal channel.

29. A device for repairing a tear in a tissue, comprising:

a needle having a distal region and a proximal region, the distal region being defined between two holding elements,

a first fixation member positioned within the distal region and a second fixation member positioned within the proximal region, and

a flexible member coupled to the first and second fixation members.

30. A wound closure kit comprising:

a needle having an open tip and defining a longitudinal bore that connects to the open tip;

first and second fasteners disposed within the needle bore; and

a flexible member connecting the first fastener to the second fastener.

31. The kit of claim 30, wherein the needle defines a longitudinal slit that connects to the bore and to the open tip.

32. The kit of claim 31, wherein the first fastener includes a projection that protrudes through the slit.

33. The kit of claim 31, wherein the second fastener includes an appendage that protrudes through the slit, and the flexible member is attached to the appendage.

34. The kit of claim 31, wherein the flexible member is fixed to the first fastener, and movably attached to the second fastener.

35. The kit of claim 30, wherein the flexible member comprises a suture.

36. A method of closing a tissue wound comprising:

providing a wound closure device having a first fastener, a second fastener, and a flexible member movably attached to the second fastener;

positioning the first fastener against tissue;

passing the flexible member across the wound;

positioning the second fastener against tissue; and

pulling on a free end of the flexible member to shorten a length of the flexible member between the first and second fasteners, thereby closing the wound.

37. The method of claim 36, wherein the flexible member is slidably attached to the second fastener by a one-way knot, such that after completion of the pulling step, the length of the flexible member between the first and second fasteners remains shortened.

38. The method of claim 36, wherein the first positioning step includes positioning the first fastener on a first side of the wound, the passing step includes passing the flexible member from the first side to a second side of the wound, engaging tissue on the second side, and returning the flexible member to the first side, and the second positioning step includes positioning the second fastener on the first side of the wound.

39. The method of claim 36, wherein the providing step includes providing a needle having an open tip and defining a bore that connects to the open tip, the first and second fasteners being at least partially disposed within the bore.

40. The method of claim 36, wherein the needle further defines a slit that connects to the bore and to the open tip, the first fastener includes a projection that protrudes through the slit, and the first positioning step includes engaging the projection with tissue to remove the first fastener from the bore.

41. The method of claim 37, wherein the providing step includes providing a second fastener that defines a partially enclosed region, the partially enclosed region housing at least a portion of the one-way knot, and the partially enclosed region being located such that during the pulling step, the portion of the one-way knot disposed within the partially enclosed region avoids contact with tissue.

42. The method of claim 36, wherein the providing step includes providing a device in which the flexible member passes through a through-hole in the second fastener, and the device further includes a second flexible member that also passes through the through-hole, the second flexible member having a thickened portion that is wider than the through hole, and the method further comprises:

pulling the second flexible member until the thickened portion wedges into the through hole.

43. A surgical method, comprising:

positioning a fixation member relative to tissue,

moving a flexible member coupled to the fixation member relative to the fixation member to bring two tissue surfaces together, and

moving a limiting element coupled to the flexible member relative to the fixation member, the limiting element acting to limit loosening of the flexible member relative to the fixation member.

44. A method for repairing a tear in soft tissue, comprising:

advancing a fixation member coupled to a flexible member through tissue on either side of the tear and through a loop of the flexible member, and

tensioning the flexible member to bring two tissue surfaces on either side of the tear together.

45. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a retainer against soft tissue to be attached to the bone tissue, the fastener and retainer being connected by a flexible member, the flexible member being movably attached to the retainer; and

pulling a free end of the flexible member to shorten a length of the flexible member between the fastener and the retainer to urge the soft tissue against the bone tissue.

46. A surgical method comprising:

drilling a channel through bone tissue and soft tissue;

pulling a first flexible member to pull a fastener in a first direction through the channel such that the fastener passes through the bone tissue and the soft tissue;

pulling a second flexible member to pull the fastener in a second direction against the soft tissue, the second flexible member connecting the fastener to a retainer; and

pulling a free end of the second flexible member to shorten a length of the second flexible member between the fastener and the retainer, whereby pulling the free end of the second flexible member positions the retainer against the bone.

47. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a first retainer against soft tissue to be attached to the bone tissue, the fastener and first retainer being movably attached by a flexible member;

positioning a second retainer against soft tissue to be attached to the bone tissue, the fastener, the first retainer, and the second retainer being movably attached by the flexible member;

pulling a free end of the flexible member to shorten a length of the flexible member between at least any two of the fastener, the first retainer and the second retainer.

48. A surgical method comprising:

positioning a fastener within bone tissue;

advancing a delivery device including a needle under a first soft tissue member;

advancing the curved delivery device through a second soft tissue member and positioning a retainer against the second soft tissue member, the fastener and retainer being connected by a flexible member, the flexible member being movably attached to the retainer; and

pulling a free end of the flexible member to shorten a length of the flexible member between the fastener and the retainer.

49. A surgical method for repairing a meniscal tear comprising:

positioning a delivery device comprising a needle against a first position on soft tissue;

advancing the needle through the soft tissue, a first fixation member being positioned within a longitudinal channel of a lumen of the needle and including a protrusion extending from the first fixation member through a longitudinal slot in the needle;

withdrawing the needle from the soft tissue such that the first fixation member is pulled from the needle by the interaction of the protrusion and the soft tissue;

positioning the delivery device against a second position on the soft tissue;

advancing the delivery device and the needle through the soft tissue, a second fixation member being positioned within the longitudinal channel of the lumen and including a protrusion extending from the second fixation member through the longitudinal slot in the needle; and

withdrawing the delivery device from the soft tissue such that the second fixation member is pulled from the needle by the interaction of the protrusion and the soft tissue.