Surgical Constructs with Collapsing Suture Loop and Methods for Securing Tissue

• US 20140277132A1
• Filed: 12/31/2013
• Published: 09/18/2014
• Est. Priority Date: 03/15/2013
• Status: Active Grant

• Current Assignee: Medos International Sarl (Johnson & Johnson)
• Original Assignee: Depuy Mitek LLC (Johnson & Johnson)
• Inventors: Sengun, Mehmet Z., Whittaker, Gregory R., Tang, Howard C.
• Granted Patent: US 9,737,293 B2
• Time in Patent Office: Days
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0446 Means for attaching and blocking the suture in the suture 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

Abstract

Surgical constructs and methods are provided for securing soft tissue to bone. One exemplary embodiment of a construct is formed from a suture filament and includes two terminal ends of filament and an intermediate portion disposed along at least a portion of a length extending between the terminal ends. The construct can have a first terminal end that is the first terminal end of the filament, and a second terminal end that includes a loop. The loop can be formed by disposing the second terminal end of the filament within a volume of a portion of the intermediate portion of the filament. In some disclosed methods, both terminal ends of the filament can be passed through tissue when performing soft tissue repairs. Various other embodiments of constructs and methods are provided, including constructs having two or more filaments associated with an anchor and methods of using such constructs.

Claims

1. A surgical construct formed from a suture filament, comprising:

a first terminal end of the filament, a second terminal end of the filament, and an intermediate portion of the filament disposed along at least a portion of a length extending between the first and second terminal ends;

a coaxial region formed by the first terminal end being disposed within a volume of a portion of the intermediate portion; and

a continuous, closed loop extending from a first side of the coaxial region, the loop having a first end directly adjacent to the first side of the coaxial region and a second, opposed end formed by a fold in the suture filament,

wherein the second, opposed end of the loop is a first terminal end of the construct, and

wherein the second terminal end of the filament extends from a second side of the coaxial region and is a second terminal end of the construct.

2. The construct of claim 1, wherein a length of the coaxial region is at least about 15.24 centimeters.

3. The construct of claim 1, wherein a length of the loop is at least about 20.32 centimeters.

4. The construct of claim 1, wherein a length of the loop is configured to be adjusted by moving the first terminal end of the filament with respect to the coaxial region.

5. The construct of claim 1, wherein a pick count of the coaxial region is in the range of about 30 picks per 2.54 centimeters to about 60 picks per 2.54 centimeters.

6. The construct of claim 1, further comprising an anchor having a filament engagement feature at a distal end thereof, wherein the suture filament engages the filament engagement feature such that the first terminal end of the construct extends from one side of the filament engagement feature and the second terminal end of the construct extends from an opposite side of the filament engagement feature.

7. A surgical repair method, comprising:

inserting an anchor having surgical filament associated therewith in bone in proximity to detached soft tissue, the surgical filament having a first portion with a loop formed therefrom, a second portion that includes a terminal end, and a coaxial region formed between the first and second portions by disposing a portion of the filament into its own volume;

passing the terminal end of the second portion of the filament through a portion of the detached soft tissue;

forming a snare in the loop of the first portion of the filament after the anchor has been inserted in bone in proximity to detached soft tissue;

passing the terminal end of the second portion through the snare;

collapsing the snare to engage the soft tissue;

advancing the collapsed snare distally to bring the tissue into proximity with the bone; and

deconstructing the coaxial region by removing the portion of the filament from the volume of the filament in which it was disposed.

8. The method of claim 7, further comprising passing the loop through a portion of the detached soft tissue before forming the snare in the loop.

9. The method of claim 8, wherein the anchor has a second surgical filament associated therewith, the second surgical filament having a first portion with a loop formed therefrom, a second portion that includes a terminal end, and a coaxial region formed between the first and second portions by disposing a portion of the filament into its own volume, the method further comprising:

passing the terminal end of the second portion of the second filament through a portion of the detached soft tissue;

passing the loop of the second filament through a portion of the detached soft tissue;

after passing the loop of the second filament through a portion of the detached soft tissue, forming a snare in the loop of the first portion of the second filament;

passing the terminal end of the second portion of the second filament through the snare of the second filament;

collapsing the snare of the second filament to engage the soft tissue;

advancing the collapsed snare of the second filament distally to bring the tissue into proximity with the bone;

deconstructing the coaxial region of the second filament by removing the portion of the second filament from the volume of the second filament in which it was disposed,

wherein deconstructing the coaxial region of the first filament results in a first limb and a second limb extending from the collapsed snare of the first filament, and deconstructing the coaxial region of the second filament results in a first limb and a second limb extending from the collapsed snare of the second filament;

attaching the first and second limbs of the first filament and the first and second limbs of the second filament to a second anchor; and

applying tension to the first and second limbs of the first and second filaments to secure a location of the limbs with respect to the second anchor.

10. The method of claim 9, wherein applying tension to the first and second limbs of the first and second filaments to secure a location of the limbs with respect to the second anchor further comprises inserting the second anchor into bone with the first and second limbs of the first and second filaments being disposed between an outer wall of the anchor and the bone.

11. The method of claim 9, wherein the locations of the first and second limbs of the first and second filaments with respect to the second anchor are secured without tying a knot in either of the first or second filaments.

12. The method of claim 8, wherein the anchor has a second surgical filament associated therewith, the second surgical filament having a first portion with a snare formed therein, a second portion that includes a terminal end, and a coaxial region formed between the first and second portions by disposing a portion of the filament into its own volume, the method further comprising:

passing the terminal end of the second portion of the second filament through a portion of the detached soft tissue;

passing the terminal end of the second portion of the second filament through the snare of the second filament;

collapsing the snare of the second filament to engage the soft tissue; and

advancing the collapsed snare of the second filament distally to bring the tissue into proximity with the bone, the first filament being disposed between the collapsed snare of the second filament and the soft tissue.

13. The method of claim 7, further comprising tying at least one locking knot with the filament at a location that is proximate to the collapsed snare to secure a location of the filament with respect to the tissue.

14. A surgical repair method, comprising:

inserting an anchor having a surgical construct associated therewith in bone in proximity to detached soft tissue, the surgical construct having a first terminal end and a second terminal end;

passing the first terminal end through a portion of the detached soft tissue;

passing the second terminal end through a portion of the detached soft tissue;

forming a Lark'"'"'s Head cinch loop in the second terminal end of the surgical construct after the first and second terminal ends have been passed through portions of the detached tissue, the Lark'"'"'s Head cinch loop defining a receiving opening;

passing the first terminal end of the construct through the receiving opening;

collapsing the receiving opening of the Lark'"'"'s Head cinch loop; and

advancing the collapsed Lark'"'"'s Head cinch loop distally to bring the tissue into proximity with the bone.

15. The method of claim 14, wherein the surgical construct is formed from a surgical filament having a first terminal end, a second terminal end, and an intermediate portion extending therebetween, with the first terminal end of the construct being the first terminal end of the filament, and the second terminal end of the construct having a loop formed by the second terminal end of the filament being disposed in a portion of the intermediate portion of the filament.

16. The method of claim 15, further comprising:

removing the second terminal end of the filament from the intermediate portion of the filament after collapsing the receiving opening of the Lark'"'"'s Head cinch loop; and

tying at least one knot with the filament at a location that is proximate to the collapsed Lark'"'"'s Head cinch loop to secure a location of the filament with respect to the tissue.

17. The method of claim 15, wherein the anchor has a second surgical construct associated therewith, the second surgical construct being formed from a second surgical filament having a first terminal end, a second terminal end, and an intermediate portion extending therebetween, with a first terminal end of the second construct being the first terminal end of the second filament, and a second terminal end of the construct having a loop formed by the second terminal end of the second filament being disposed in a portion of the intermediate portion of the second filament, the method further comprising:

passing the terminal end of the second construct through a portion of the detached soft tissue;

passing the second terminal end of the second construct through a portion of the detached soft tissue;

forming a Lark'"'"'s Head cinch loop in the second terminal end of the second construct after the first and second terminal ends of the second construct have been passed through portions of the detached tissue, the Lark'"'"'s Head cinch loop of the second construct defining a receiving opening;

passing the first terminal end of the second construct through the receiving opening of the second construct;

collapsing the receiving opening of the Lark'"'"'s Head cinch loop of the second construct;

advancing the collapsed Lark'"'"'s Head cinch loop of the second construct distally to bring the tissue into proximity with the bone;

removing the second terminal end of the first filament from the intermediate portion of the first filament after collapsing the receiving opening of the Lark'"'"'s Head cinch loop of the first construct;

removing the second terminal end of the second filament from the intermediate portion of the second filament after collapsing the receiving opening of the Lark'"'"'s Head cinch loop of the second construct,

wherein removing the second terminal ends of the first and second filaments from their respective intermediate portions results in respective first and second limbs extending from each of the collapsed Lark'"'"'s Head cinch loops;

attaching the first and second limbs of the first filament and the first and second limbs of the second filament to a second anchor; and

applying tension to the first and second limbs of the first and second filaments to secure a location of the limbs with respect to the second anchor.

18. The method of claim 17, wherein applying tension to the first and second limbs of the first and second filaments to secure a location of the limbs with respect to the second anchor further comprises inserting the second anchor into bone with the first and second limbs of the first and second filaments being disposed between an outer wall of the anchor and the bone.

19. The method of claim 17, wherein the locations of the first and second limbs of the first and second filaments with respect to the second anchor are secured without tying a knot in either of the first or second filaments.

20. The method of claim 15, wherein the anchor has a second surgical construct associated therewith, the second surgical construct having a first terminal end and a second terminal end, the second terminal end having a snare formed therein, the method further comprising:

passing the first terminal end of the second construct through a portion of the detached soft tissue;

passing the first terminal end of the second construct through the snare of the of the second construct;

collapsing the snare of the second construct to engage the soft tissue; and

advancing the collapsed snare of the second construct distally to bring the tissue into proximity with the bone, the first construct being disposed between the collapsed snare of the second construct and the soft tissue.