US20160058435A1 - Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing an object to bone - Google Patents
Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing an object to bone Download PDFInfo
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- US20160058435A1 US20160058435A1 US14/842,183 US201514842183A US2016058435A1 US 20160058435 A1 US20160058435 A1 US 20160058435A1 US 201514842183 A US201514842183 A US 201514842183A US 2016058435 A1 US2016058435 A1 US 2016058435A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1796—Guides or aligning means for drills, mills, pins or wires for holes for sutures or flexible wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L17/00—Materials for surgical sutures or for ligaturing blood vessels ; Materials for prostheses or catheters
- A61L17/04—Non-resorbable materials
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0406—Pledgets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06166—Sutures
- A61B2017/06185—Sutures hollow or tubular
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0876—Position of anchor in respect to the bone
- A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Veterinary Medicine (AREA)
- General Health & Medical Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Rheumatology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Vascular Medicine (AREA)
- Epidemiology (AREA)
- Dentistry (AREA)
- Materials Engineering (AREA)
- Chemical & Material Sciences (AREA)
- Rehabilitation Therapy (AREA)
- Cardiology (AREA)
- Transplantation (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
A suture assembly comprising:
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- a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration.
Description
- This patent application:
- (i) is a continuation-in-part of pending prior U.S. patent application Ser. No. 13/093,634, filed Apr. 25, 2011 by Dennis McDevitt et al. for METHOD AND APPARATUS FOR SECURING AN OBJECT TO BONE, INCLUDING THE PROVISION AND USE OF A NOVEL SUTURE ASSEMBLY FOR SECURING SUTURE TO BONE (Attorney's Docket No. INCUMED-16171821), which patent application in turn claims benefit of (a) prior U.S. Provisional Patent Application Ser. No. 61/410,027, filed Nov. 4, 2010 by Dennis McDevitt et al. for APPARATUS ASSEMBLY AND METHOD FOR SOFT TISSUE REPAIR (Attorney's Docket No. INCUMED-16 PROV); (b) prior U.S. Provisional Patent Application Ser. No. 61/419,334, filed Dec. 3, 2010 by Dennis McDevitt et al. for APPARATUS ASSEMBLY AND METHOD FOR SOFT TISSUE REPAIR (Attorney's Docket No. INCUMED-17 PROV); (c) prior U.S. Provisional Patent Application Ser. No. 61/422,859, filed Dec. 14, 2010 by Dennis McDevitt et al. for APPARATUS ASSEMBLY AND METHOD FOR SOFT TISSUE REPAIR (Attorney's Docket No. INCUMED-18 PROV); and (d) pending prior U.S. Provisional Patent Application Ser. No. 61/443,325, filed Feb. 16, 2011 by Dennis McDevitt et al. for APPARATUS ASSEMBLY AND METHOD FOR SOFT TISSUE REPAIR (Attorney's Docket No. INCUMED-21 PROV); and
- (ii) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 61/443,342, filed Feb. 16, 2011 by Dennis McDevitt et al. for APPARATUS ASSEMBLY AND METHOD FOR SOFT TISSUE REPAIR (Attorney's Docket No. INCUMED-22 PROV).
- The six (6) above-identified patent applications are hereby incorporated herein by reference.
- This invention relates to surgical methods and apparatus in general, and more particularly to surgical methods and apparatus for securing an object to bone.
- Numerous devices are currently available to secure an object to bone. More particularly, screws, staples, cement and sutures have all been used to secure soft tissue (e.g., ligaments, tendons, muscles, etc.), bone and inanimate objects (e.g., prostheses) to bone.
- In certain situations it can be desirable to attach a segment of a suture to bone, such that another segment of that suture can be used to secure an object (e.g., soft tissue) to the bone. This is generally accomplished by attaching a segment of the suture to a suture anchor, and then securing the suture anchor to the bone, such that the suture anchor attaches the suture to the bone. Then another segment of that suture can be used to secure an object (e.g., soft tissue) to the bone. In this respect it should be appreciated that it is common to attach a central segment of the suture to the suture anchor, so as to leave two free ends of the suture available for use in securing an object (e.g., soft tissue) to the bone.
- Among other things, such suture anchors have found widespread application in procedures for re-attaching ligaments to bone, e.g., so as to restore a torn rotator cuff in the shoulder.
- The aforementioned suture anchors generally comprise substantially rigid bodies to which the suture is attached, either at the time of manufacture or at the time of use. The substantially rigid bodies of the suture anchors may be formed out of a variety of materials (e.g., metal, plastic, bone, etc.) according to their particular form and function. By way of example but not limitation, a screw-type suture anchor is typically formed out of metal or plastic, a toggle-type suture anchor is typically formed out of plastic, an expansion-type suture anchor is typically formed out of plastic, etc. In any case, however, the body of the suture anchor is generally formed out of a substantially rigid material which must be reliably secured to the bone, whereby to reliably attach the suture to the bone.
- Prior art suture anchors all suffer from one or more deficiencies. These deficiencies include, but are not limited to:
- (i) various difficulties and/or inconveniences associated with a particular manner of securing the suture anchor to the bone (e.g., screw-type suture anchors require rotational motion, toggle-type suture anchors require toggling within a hole formed in the bone, expansion-type screw anchors require some sort of anchor deformation within a hole formed in the bone, etc.);
- (ii) difficulties in ensuring that the body of the suture anchor is securely attached to the bone (e.g., toggle-type suture anchors can sometimes fail to properly set in a bone hole and may “skid” back out of the bone hole, expansion-type suture anchors may not expand properly within the bone hole and may pull back out of the bone hole, etc.);
- (iii) complications associated with a possible failure of the suture anchor (and the possible subsequent migration of the substantially rigid body of the suture anchor out of the bone hole and into the working portion of a joint);
- (iv) an inability to scale the suture anchor down to a size small enough to allow the suture anchor to be used in and around delicate anatomical structures;
- (v) the need to form relatively large holes in the anatomy in order to secure the suture anchor to the bone;
- (vi) inadequate holding power (e.g., limits to the holding strength which can be provided by a screw-type suture anchor, or the holding strength which can be provided by a toggle-type suture anchor, etc.); and/or
- (vii) inconveniences associated with attaching the suture to the suture anchor (either during manufacture or at the time of use), etc.
- In addition to the foregoing, in some circumstances an object (e.g., soft tissue) may be attached to a bone using a device other than a suture anchor. By way of example but not limitation, a graft ligament (e.g., a graft anterior cruciate ligament, also known as an ACL) may be attached to bone (e.g., the femur) by fixing a portion of the graft ligament in a bone tunnel formed in the bone, e.g., by using an interference screw to wedge the graft ligament against an opposing side wall of the bone tunnel, or by using a crosspin to suspend the graft ligament in the bone tunnel, or by using a suture sling (formed by a button and suture) to suspend the graft ligament in the bone tunnel, etc.
- Such graft ligament fixation devices all suffer from one or more deficiencies, e.g., interference screws prevent bone/soft tissue ingrowth about the entire circumference of the bone hole, crosspins can be difficult to accurately deploy, suture slings can present problems when deploying the button on the far side of the bone, etc.
- As a result, one object of the present invention is to provide a novel suture assembly for securing suture to bone.
- Another object of the present invention is to provide a novel suture assembly for securing suture to bone which does not suffer from the deficiencies associated with the prior art.
- Another object of the present invention is to provide a novel suture assembly for securing an object (e.g., soft tissue) to bone.
- Another object of the present invention is to provide a novel method for securing an object (e.g., soft tissue) to bone.
- These and other objects of the present invention are addressed by the provision and use of a novel suture assembly for securing suture to bone, such that the suture may be used to secure an object (e.g., soft tissue) to the bone.
- In one preferred form of the present invention, there is provided a suture assembly comprising:
- a first suture having a generally U-shaped configuration comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration.
- In another preferred form of the present invention, there is provided a method for attaching an object to an anatomical structure, the method comprising:
- providing a suture assembly comprising:
-
- a first suture having a generally U-shaped configuration comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration;
- inserting the suture assembly into an opening in the anatomical structure while the suture assembly is in its longitudinally-extended, radially-contracted first configuration, with the first and second arms of the first suture extending from the opening in the anatomical structure; and
- transforming the suture assembly from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration in order to secure the suture assembly to the anatomical structure.
- In another preferred form of the present invention, there is provided a system for securing an object to an anatomical structure, the system comprising:
- a suture assembly comprising:
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- a first suture having a generally U-shaped configuration comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration; and
- an inserter assembly for deploying the suture assembly in the anatomical structure, the inserter assembly comprising:
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- an insertion tube for carrying at least a portion of the suture assembly within the insertion tube when the suture assembly is in its longitudinally-extended, radially-contracted first configuration; and
- a push rod for engaging the suture assembly when the suture assembly is disposed within the insertion tube.
- In another preferred form of the present invention, there is provided an assembly comprising:
- a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration.
- In another preferred form of the present invention, there is provided a method for attaching an elongated object to an anatomical structure, the method comprising:
- providing a suture assembly comprising:
-
- a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop;
- a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
- the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
- the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration;
- looping the elongated object through the closed loop of the first suture;
- passing the suture assembly along an opening in the anatomical structure while the suture assembly is in its longitudinally-extended, radially-contracted first configuration, so that a first portion of the suture assembly extends out of the opening on a far side of the anatomical structure; and
- transforming the suture assembly from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration so as to attach the elongated object to the anatomical structure when the elongated object is held under tension.
- In another preferred form of the present invention, there is provided a method for attaching an elongated object to an anatomical structure, the method comprising:
- looping the elongated object through a closed loop of a suture assembly;
- passing the suture assembly along an opening in the anatomical structure so that a first portion of the suture assembly extends out of the opening on a far side of the anatomical structure; and
- transforming the suture assembly from a first configuration to a second configuration so that the first portion of the suture assembly is unable to be retracted back into the opening so as to attach the elongated object to the anatomical structure when the elongated object is held under tension.
- These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein:
-
FIGS. 1 and 2 are schematic views showing how the novel suture assembly of the present invention is assembled; -
FIGS. 3 and 4 are schematic views showing the novel suture assembly ofFIG. 2 in a longitudinally-expanded, radially-contracted first configuration for insertion into a bone hole; -
FIGS. 5 and 6 are schematic views showing the novel suture assembly ofFIG. 2 in a longitudinally-contracted, radially-expanded second configuration for lodging in a bone hole; -
FIG. 7 is a schematic view showing an inserter assembly and associated cannulated drill guide assembly which may be used to deploy the novel suture assembly ofFIG. 2 in a bone; -
FIGS. 8-11 are schematic views showing various aspects of the inserter assembly and associated cannulated drill guide assembly ofFIG. 7 , and showing the novel suture assembly ofFIG. 2 in its longitudinally-expanded, radially-contracted first configuration and loaded in the inserter assembly; -
FIGS. 12-18 are schematic views showing one manner in which the inserter assembly and associated cannulated drill guide assembly ofFIG. 7 can be used to deploy the novel suture assembly ofFIG. 2 in a bone, withFIG. 18 showing the novel suture assembly released from the inserter assembly and in its longitudinally-contracted, radially-expanded second configuration so as to be secured to the bone; -
FIGS. 19-26 are schematic views showing another manner in which the inserter assembly and associated cannulated drill guide assembly ofFIG. 7 can be used to deploy the novel suture assembly ofFIG. 2 in a bone, withFIG. 26 showing the novel suture assembly released from the inserter assembly and in its longitudinally-contracted, radially-expanded second configuration so as to be secured to the bone; -
FIGS. 27-31 are schematic views showing another inserter assembly and associated cannulated drill guide assembly which may be used to deploy the novel suture assembly ofFIG. 2 in a bone; -
FIGS. 32-49 are schematic views showing the inserter assembly and associated cannulated drill guide assembly ofFIGS. 27-31 deploying the novel suture assembly ofFIG. 2 in a bone, withFIG. 49 showing the novel suture assembly released from the inserter assembly and in its longitudinally-contracted, radially-expanded second configuration so as to be secured to the bone; -
FIGS. 50-54 are schematic views showing alternative forms of the novel suture assembly ofFIG. 2 ; -
FIG. 55 is a schematic view showing another form of the novel suture assembly of the present invention; -
FIG. 56 is a schematic view showing the novel suture assembly ofFIG. 55 supporting a plurality of graft ligaments; and -
FIGS. 57-59 are schematic views showing the novel suture assembly ofFIG. 55 being used to suspend a plurality of graft ligaments in a bone tunnel. - Looking first at
FIGS. 1 and 2 , there is shown anovel suture assembly 5 for securing suture to bone, such that the suture may be used to secure an object (e.g., soft tissue) to the bone. - More particularly,
novel suture assembly 5 generally comprises a first length of suture (“first suture”) 10 (FIGS. 1 and 2 ) and a second length of suture (“second suture”) 15 (FIG. 2 ). -
First suture 10 comprises afirst end 20 andsecond end 25 such that whenfirst suture 10 is folded back on itself, it forms afirst arm 30 which includesfirst end 20, and asecond arm 35 which includessecond end 25, withfirst arm 30 being connected tosecond arm 35 via abridge 40. -
Second suture 15 comprises afirst end 45 andsecond end 50 such that whensecond suture 15 is folded back on itself, it forms afirst arm 55 which includesfirst end 45, and asecond arm 60 which includessecond end 50, withfirst arm 55 being connected tosecond arm 60 via abridge 65. -
Second suture 15 is wrapped aroundfirst suture 10 by (i) foldingsecond suture 15 back on itself so as to providefirst arm 55 andsecond arm 60, withfirst arm 55 being connected tosecond arm 60 via abridge 65; (ii) positioningbridge 65 ofsecond suture 15 acrossfirst arm 30 andsecond arm 35 offirst suture 10, withbridge 65 ofsecond suture 15 being spaced frombridge 40 offirst suture 10; and (iii) wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, in the manner shown inFIG. 2 . - More particularly,
first arm 55 ofsecond suture 15 is wrapped aroundfirst arm 30 offirst suture 10 in a first direction, andsecond arm 60 ofsecond suture 15 is wrapped aroundsecond arm 35 offirst suture 10 in a second, opposite direction. In other words,first arm 55 ofsecond suture 15 is arranged in a first helical configuration aboutfirst arm 30 offirst suture 10, andsecond arm 60 ofsecond suture 15 is arranged in a second, oppositely wound helical configuration aboutsecond arm 35 offirst suture 10. This opposite winding offirst arm 55 andsecond arm 65 is a very significant aspect of the present invention, since it provides the novel suture assembly with a highly defined, appropriately shaped and consistently reproducible structure when the novel suture assembly is subsequently transformed from its longitudinally-expanded, radially-contracted first configuration into its longitudinally-contracted, radially-expanded second configuration, as will hereinafter be discussed in further detail. - In one preferred form of the present invention,
first arm 55 ofsecond suture 15 is wrapped three times aroundfirst arm 30 offirst suture 10 in a clockwise direction (when viewed from the frame of reference of bridge 65), andsecond arm 60 ofsecond suture 15 is wrapped three times aroundsecond arm 35 offirst suture 10 in a counterclockwise direction (when viewed from the frame of reference of bridge 65), in the manner shown inFIG. 2 . - In another preferred form of the present invention,
first arm 55 ofsecond suture 15 is wrapped four times aroundfirst arm 30 offirst suture 10 in a clockwise direction (when viewed from the frame of reference of bridge 65), andsecond arm 60 ofsecond suture 15 is wrapped four times aroundsecond arm 35 offirst suture 10 in a counterclockwise direction (when viewed from the frame of reference of bridge 65). - And in another preferred form of the present invention,
first arm 55 ofsecond suture 15 is wrapped two times aroundfirst arm 30 offirst suture 10 in a clockwise direction (when viewed from the frame of reference of bridge 65), andsecond arm 60 ofsecond suture 15 is wrapped two times aroundsecond arm 35 offirst suture 10 in a counterclockwise direction (when viewed from the frame of reference of bridge 65). - On account of the foregoing construction,
novel suture assembly 5 can assume a first configuration in whichsecond suture 15 is wrapped loosely aroundfirst suture 10, i.e., so that the suture assembly assumes a longitudinally-elongated, radially-contracted first configuration (FIGS. 3 and 4 ) which is suitable for insertion into a hole formed in bone. However, whenfirst arm 30 andsecond arm 35 offirst suture 10 are thereafter tensioned while holdingbridge 65 ofsecond suture 15 stationary (or by applying some other holding force tosecond suture 15, e.g., friction from the adjacent side wall of a bone hole containing suture assembly 5),suture assembly 5 can be transformed from the aforementioned longitudinally-elongated, radially-contracted first configuration into a longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ) which is suitable for securing the suture assembly in the hole formed in bone. Significantly, and as will hereinafter be discussed in further detail, whennovel suture assembly 5 is so disposed in a hole formed in bone,first arm 30 andsecond arm 35 offirst suture 10 will extend out of the hole formed in the bone and be available for securing an object (e.g., soft tissue) to the bone. - And significantly, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), it is possible to form the highly defined, appropriately shaped structure shown inFIGS. 5 and 6 in a highly consistent manner whensuture assembly 5 is transformed from its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). - And significantly, the highly defined, appropriately shaped and consistently reproducible structure shown in
FIGS. 5 and 6 is capable of carrying substantial loads without losing its defined shape when loads are applied to the first and second ends 20, 25 offirst suture 10. As a result, whensuture assembly 5 is inserted into a bone hole while in its longitudinally-expanded, radially-contracted first configuration and is thereafter transformed into its longitudinally-contracted, radially-expanded second configuration,novel suture assembly 5 will provide an excellent suture anchor with high holding strength. - Among other things, it should be appreciated that, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), thenovel suture assembly 5 does not form a knot in either its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) or its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). In either configuration, thenovel suture assembly 5 may be disassembled by simply pullingfirst arm 30 offirst suture 10, or by pullingsecond arm 35 offirst suture 10, away fromsecond suture 15, whereby to “undo” the suture assembly. - In one preferred form of the present invention,
first suture 10 comprises a first length of woven suture, andsecond suture 15 comprises a second length of woven suture. - Thus it will be seen that
novel suture assembly 5 constitutes an all-suture construct which can assume (i) a longitudinally-expanded, radially-contracted first configuration for insertion into a hole formed in a bone, and (ii) a longitudinally-contracted, radially-expanded second configuration for lodging in the hole formed in the bone, with the suture assembly providing a pair of free suture arms extending out of the hole formed in the bone for use in securing an object (e.g., soft tissue) to the bone. Significantly, by forming thenovel suture assembly 5 in the specific manner discussed above, the longitudinally-contracted, radially-expanded second configuration of the suture assembly constitutes a highly defined, appropriately shaped and consistently reproducible structure which is able to carry substantial loads without losing its defined shape, whereby to provide a suture anchor with high holding strength. And significantly, by forming thenovel suture assembly 5 in the specific manner discussed above, thenovel suture assembly 5 does not form a knot in either its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) or its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). In either configuration, thenovel suture assembly 5 may be disassembled by simply pullingfirst arm 30 offirst suture 10, or by pullingsecond arm 35 offirst suture 10, away fromsecond suture 15, whereby to “undo” the suture assembly. - Looking next at
FIGS. 7-11 , there is shown aninserter assembly 70 and associated cannulateddrill guide assembly 75 which may be used to deploynovel suture assembly 5 in bone.Inserter assembly 70 in turn comprises aninsertion tube assembly 80 and apush rod assembly 85. - More particularly, cannulated
drill guide assembly 75 generally comprises an elongateddrill guide tube 86 having adistal end 90 carrying distal end prongs 95, and aproximal end 100 carrying adrill guide handle 105. Alumen 106 extends through elongateddrill guide tube 86 anddrill guide handle 105. -
Insertion tube assembly 80 generally comprises anelongated insertion tube 107 having adistal end 110 sized to receive novel suture assembly 5 (either loosely or, more preferably, tightly compressed) when the novel suture assembly is in its aforementioned longitudinally-expanded, radially-contracted first configuration (FIGS. 3 , 4, 10 and 11).Elongated insertion tube 107 ofinsertion tube assembly 80 also comprises aproximal end 115 carrying aninsertion tube handle 120. Alumen 121 extends throughelongated tube insertion 107 andinsertion tube handle 120. - Push
rod assembly 85 generally comprises apush rod 122 having adistal end 125 terminating in adistal end surface 130, and aproximal end 135 carrying apush rod handle 140. -
Insertion tube assembly 80 is sized so that itselongated insertion tube 107 can be received withinlumen 106 of cannulateddrill guide assembly 75 such that, when cannulateddrill guide assembly 75 is used to form a hole in a bone, the distal end ofinsertion tube assembly 80 can be delivered to that hole in a bone, as will hereinafter be discussed. - Push
rod assembly 85 is sized so that itspush rod 122 can be slidably received withinlumen 121 ofinsertion tube assembly 80 such that, whennovel suture assembly 5 is disposed within thedistal end 110 ofelongated insertion tube 107 ofinsertion tube assembly 80, advancement ofpush rod assembly 85 relative toinsertion tube assembly 80, and/or retraction ofinsertion tube assembly 80 while holdingpush rod assembly 85 stationary, will causenovel suture assembly 5 to be released fromdistal end 110 ofelongated insertion tube 107 ofinsertion tube assembly 80, as will hereinafter be discussed. Oncenovel suture assembly 5 has been released fromdistal end 110 ofelongated insertion tube 107 ofinsertion tube assembly 80, tensioningfirst arm 30 andsecond arm 35 offirst suture 10, whilepush rod assembly 85 holdsbridge 65 ofsecond suture 15 from moving proximally, will causenovel suture assembly 5 to transform from its longitudinally-elongated, radially-contracted first configuration (FIGS. 3 , 4, 10 and 11) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). -
Insertion tube assembly 80 is also sized so that itslumen 121 will accommodate first andsecond arms first suture 10 alongsidepush rod 122 ofpush rod assembly 85 whenpush rod 122 is disposed inlumen 121 ofinsertion tube assembly 80. -
Novel suture assembly 5 is intended to be disposed within the distal end ofinsertion tube assembly 80, distal to pushrod assembly 85, withfirst arm 30 andsecond arm 35 offirst suture 10 extending out the proximal end ofinserter assembly 70 vialumen 121 ofinsertion tube assembly 80, withfirst arm 30 andsecond arm 35 offirst suture 10 extending alongsidepush rod 122 ofpush rod assembly 85. Preferablynovel suture assembly 5 is tightly compressed within the distal end ofinsertion tube assembly 80, so as to provide the largest possible differential between the diameter of the radially-elongated, radially-contracted first configuration (FIGS. 3 , 4, 10 and 11) and the longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ), whereby to minimize the size of the bone hole and thereby increase holding power in the bone. In this respect it should be appreciated that by windingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively, it is possible for the first andsecond sutures insertion tube assembly 80, thereby permitting maximum compression of the novel suture assembly within the insertion tube assembly. Furthermore, by leavingfirst end 45 andsecond end 50 ofsecond suture 15 free (i.e., unconnected) relative to one another, the first andsecond sutures insertion tube assembly 80, thereby permitting maximum compression of the novel suture assembly within the insertion tube assembly. Thus it will be appreciated that, by formingnovel suture assembly 5 in the specific manner discussed above, the suture assembly is capable of self-accommodating itself into the smallest possible diameter within the insertion tube assembly, thereby permitting maximum compression of the novel suture assembly within the insertion tube assembly, and hence permitting use of a smaller bone hole and thus providing maximum holding power within the bone. -
Novel suture assembly 5 may be used to secure suture to bone, such that the suture may be used to secure an object (e.g., soft tissue) to the bone. - In one preferred form of the invention,
inserter assembly 70 and its associated cannulateddrill guide assembly 75 may be used to deploynovel suture assembly 5 in bone, in order to secure an object to bone. - More particularly, in one preferred form of the present invention, and looking now at
FIGS. 12-18 , the distal end of cannulateddrill guide assembly 75 is first placed against the surface of a bone 145 (FIG. 12 ) which is to have suture secured thereto. As this occurs, prongs 95 on the distal end of cannulateddrill guide assembly 75 help stabilize the cannulated drill guide assembly against the bone. Then a bone drill (not shown) of the sort well known in the art is advanced throughlumen 106 of the cannulateddrill guide assembly 75 and into the bone so that abone hole 150 of appropriate size (diameter and depth) is formed in the bone. Note thatbone hole 150 extends through thecortical layer 155 ofbone 145 and into thecancellous region 160 of the bone. Then the bone drill is removed from cannulateddrill guide assembly 75 while leaving the drill guide in position againstbone 145. - Next, the
distal end 110 ofinsertion tube assembly 80, carrying novel repair construct 5 therein, is advanced through cannulateddrill guide assembly 75 and intobone hole 150 formed in bone 145 (FIGS. 13 and 14 ). Preferably, pushrod 122 ofpush rod assembly 85 is already disposed withinlumen 121 ofinsertion tube assembly 80 as this occurs, withdistal end 130 ofpush rod assembly 85 sitting againstbridge 65 ofsecond suture 15. Alternatively, pushrod 122 ofpush rod assembly 85 can be inserted intolumen 121 ofinsertion tube assembly 80 after the distal end ofinsertion tube assembly 80 has been inserted intobone hole 150 so thatdistal end 130 ofpush rod assembly 85 sits againstbridge 65 ofsecond suture 15. - Next,
insertion tube assembly 80 is retracted while holdingdistal end 130 ofpush rod assembly 85 stationary, so thatnovel suture assembly 5 is released from thedistal end 110 of insertion tube assembly 80 (FIG. 15 ). - Then, with
push rod assembly 85 still in position againstbridge 65 ofsecond suture 15,first arm 30 andsecond arm 35 offirst suture 10 are tensioned, thereby transformingnovel suture assembly 5 from its longitudinally-extended, radially-contracted first configuration into its longitudinally-contracted, radially-expanded second configuration (FIG. 16 ), whereby to expandnovel suture assembly 5 laterally into thecancellous region 160 ofbone 145. - At this point,
inserter assembly 70 and cannulateddrill guide assembly 75 are removed from the surgical site (FIG. 17 ), andfirst arm 30 andsecond arm 35 offirst suture 10 are tensioned further so as to further laterally expandnovel suture assembly 5 and cause the laterally-expanded novel suture assembly to seat against the underside ofcortical layer 155 of bone 145 (FIG. 18 ), whereby to secure thenovel suture assembly 5 within bone hole 150 (FIG. 18 ), withfirst arm 30 andsecond arm 35 offirst suture 10 extending out of the bone hole. - Significantly, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), it is possible to form the highly defined, appropriately shaped structure shown inFIGS. 5 and 6 in a highly consistent manner whensuture assembly 5 is transformed from its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). - And significantly, the highly defined, appropriately shaped and consistently reproducible structure shown in
FIGS. 5 and 6 is capable of carrying substantial loads without losing its defined shape when loads are applied to the first and second ends 20, 25 offirst suture 10. As a result, whensuture assembly 5 is inserted into a bone hole while in its longitudinally-expanded, radially-contracted first configuration and is thereafter transformed into its longitudinally-contracted, radially-expanded second configuration,novel suture assembly 5 will provide an excellent suture anchor with high holding strength. - Thereafter, one or both of
first arm 30 andsecond arm 35 offirst suture 10 may be used to secure an object (e.g., soft tissue) to the bone. By way of example but not limitation, one or both offirst arm 30 andsecond arm 35 may be passed through a piece of soft tissue (e.g., a ligament) and then tied together so as to secure the soft tissue to bone. - Significantly, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), thenovel suture assembly 5 does not form a knot in either its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) or its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). In either configuration, thenovel suture assembly 5 may be disassembled by simply pullingfirst arm 30 offirst suture 10, or by pullingsecond arm 35 offirst suture 10, away fromsecond suture 15, whereby to “undo” the suture assembly. As a result, if at any time it should be desired to remove thenovel suture assembly 5 frombone hole 150,first arm 30 offirst suture 10, orsecond arm 35 offirst suture 10, is simply pulled away fromsecond suture 15, whereby to “undo” the suture assembly. Oncefirst suture 10 has been pulled clear of the surgical site,second suture 15 may be extracted from bone hole 150 (e.g., with a narrow suture grasper) and removed from the surgical site. - In another preferred form of the present invention, and looking now at
FIGS. 19-26 , the distal end of cannulateddrill guide assembly 75 is first placed against the surface ofbone 145, then a bone drill (not shown) is advanced throughlumen 106 of the cannulateddrill guide assembly 75 and into the bone so that abone hole 150 of appropriate size (diameter and depth) is formed in the bone, then the bone drill is removed from cannulateddrill guide assembly 75 while leaving the cannulated drill guide assembly in position againstbone 145, and then thedistal end 110 ofinsertion tube assembly 80, carryingnovel suture assembly 5 therein, is advanced through cannulateddrill guide assembly 75 and intobone hole 150 formed in bone 145 (FIGS. 19 and 20 ). Preferably, pushrod 122 ofpush rod assembly 85 is already disposed withinlumen 121 ofinsertion tube assembly 80 as this occurs, withdistal end 130 ofpush rod assembly 85 sitting againstbridge 65 ofsecond suture 15. Alternatively, pushrod 122 ofpush rod assembly 85 can be inserted intolumen 121 ofinsertion tube assembly 80 after the distal end ofinsertion tube assembly 80 has been inserted intobone hole 150 so thatdistal end 130 ofpush rod assembly 85 sits againstbridge 65 ofsecond suture 15. - Next, push
rod assembly 85 is advanced distally, againstbridge 65 ofsecond suture 15, so thatnovel suture assembly 5 is ejected from thedistal end 110 of insertion tube assembly 80 (FIGS. 21 and 22 ). - Then, with
push rod assembly 85 still in position againstbridge 65 ofsecond suture 15,first arm 30 andsecond arm 35 offirst suture 10 are tensioned, thereby transformingnovel suture assembly 5 from its longitudinally-extended, radially-contracted first configuration into its longitudinally-contracted, radially-expanded second configuration (FIGS. 23 and 24), whereby to expandnovel suture assembly 5 laterally into thecancellous region 160 ofbone 145. - At this point,
inserter assembly 70 and cannulateddrill guide assembly 75 are removed from the surgical site (FIG. 25 ), andfirst arm 30 andsecond arm 35 offirst suture 10 are tensioned further so as to further laterally expandnovel suture assembly 5 and cause the laterally-expanded novel suture assembly to seat against the underside ofcortical layer 155 of bone 145 (FIG. 26 ), whereby to secure thenovel suture assembly 5 within bone hole 150 (FIG. 26 ), withfirst arm 30 andsecond arm 35 offirst suture 10 extending out of the bone hole. - Again, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), it is possible to form the highly defined, appropriately shaped structure shown inFIGS. 5 and 6 in a highly consistent manner whensuture assembly 5 is transformed from its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). - And again, the highly defined, appropriately shaped and consistently reproducible structure shown in
FIGS. 5 and 6 is capable of carrying substantial loads without losing its defined shape when loads are applied to the first and second ends 20, 25 offirst suture 10. As a result, whensuture assembly 5 is inserted into a bone hole while in its longitudinally-expanded, radially contracted first configuration and is thereafter transformed into its longitudinally-contracted, radially-expanded second configuration,novel suture assembly 5 will provide an excellent suture anchor with high holding strength. - In one test configuration, a
suture assembly 5 constructed as previously described was delivered into a 2 mm foam bone hole approximately 20-25 mm deep. The media was a 3 mm thick, 55-60 durometer foam bone layer over a 20 durometer foam bone block (Pacific Research Sawbones). The ultimate tensile strength of the suture assembly after insertion into foam bone was approximately 77 pounds. The ultimate tensile strength for another suture assembly after insertion into a 1.5 mm foam bone hole was approximately 50 pounds. - Thereafter, one or both of
first arm 30 andsecond arm 35 offirst suture 10 may be used to secure an object (e.g., soft tissue) to the bone. By way of example but not limitation, one or both offirst arm 30 andsecond arm 35 may be passed through a piece of soft tissue (e.g., a ligament) and then tied together so as to secure the soft tissue to the bone. - Again, it should be appreciated that, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), thenovel suture assembly 5 does not form a knot in either its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) or its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). In either configuration, thenovel suture assembly 5 may be disassembled by simply pullingfirst arm 30 offirst suture 10, or by pullingsecond arm 35 offirst suture 10, away fromsecond suture 15, whereby to “undo” the suture assembly. As a result, if at any time it should be desired to remove thenovel suture assembly 5 frombone hole 150,first arm 30 offirst suture 10, orsecond arm 35 offirst suture 10, is simply pulled away fromsecond suture 15, whereby to “undo” the suture assembly. Oncefirst suture 10 has been pulled clear of the surgical site,second suture 15 may be extracted from bone hole 150 (e.g., with a narrow suture grasper) and removed from the surgical site. - Significantly, the novel suture assembly of the present invention can be sized in accordance with a wide range of anatomical applications. By way of example but not limitation, the novel suture assembly can be formed with relatively fine suture, and with a relatively small number of suture loops, so as to provide a relatively small structure for use with small and delicate anatomical structures. And a novel suture assembly of this type can be delivered through extremely small bone holes, e.g., on the order of 1 mm. Correspondingly, the novel suture assembly can be formed with relatively large suture, and with a relatively large number of suture loops, so as to provide a relatively large structure for use with robust anatomical structures. Significantly, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), it is possible to form the highly defined, appropriately shaped structure shown inFIGS. 5 and 6 in a highly consistent manner whensuture assembly 5 is transformed from its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). And, since the highly defined, appropriately shaped and consistently reproducible structure shown inFIGS. 5 and 6 is capable of carrying substantial loads without losing its defined shape when loads are applied to the first and second ends 20, 25 offirst suture 10, thesuture assembly 5 will provide an excellent suture anchor with high holding strength relative to its size (and relative to the size of the hole made in the host bone). - Furthermore, the novel suture assembly of the present invention can be used to attach objects to structures other than bone, e.g., the novel suture assembly can be used to attach skin to muscle.
- Looking next at
FIGS. 27-31 , there is shown aninserter assembly 190 and associated cannulateddrill guide assembly 195 which may be used to deploynovel suture assembly 5 in bone.Inserter assembly 190 in turn comprises aninsertion tube assembly 200 and apush rod assembly 205. - More particularly,
drill guide assembly 195 generally comprises an elongateddrill guide tube 196 having adistal end 210 carrying distal end prongs 211, and aproximal end 215 carrying adrill guide handle 220. Alumen 221 extends through elongateddrill guide tube 196 anddrill guide handle 220. -
Insertion tube assembly 200 generally comprises anelongated insertion tube 201 having adistal end 225 sized to receive novel suture assembly 5 (either loosely or, more preferably, tightly compressed) when the novel suture assembly is in its aforementioned longitudinally-extended, radially-contracted first configuration (FIGS. 3 and 4 ).Elongated insertion tube 201 ofinsertion tube assembly 200 also comprises aproximal end 230 carrying aninsertion tube handle 235. Alumen 231 extends through elongatedinsertion tube 201 andinsertion tube handle 235. - Push
rod assembly 205 generally comprises apush rod 236 having adistal end 240 terminating in adistal end surface 245, and aproximal end 250 terminating in apush rod slide 251. Pushrod slide 251 includes asuture slot 252 andsuture saddle 253 which will hereinafter be discussed. Apush rod handle 255 is slidably mounted onpush rod slide 251 so that the push rod handle is longitudinally movable relative to the push rod slide. A detent mechanism comprising aradial projection 256 onpush rod slide 251, which engages acounterpart element 257 onpush rod handle 255, keeps push rod handle 255 in position onpush rod slide 251 until a force of appropriate magnitude is applied to pushrod handle 255, whereupon push rod handle 255 will move relative to pushrod slide 251, as will hereinafter be discussed. Push rod handle 255 includes anundersized slot 258 for releasably binding a suture to the push rod handle. -
Insertion tube assembly 200 is sized so that itselongated insertion tube 201 can be received withinlumen 221 of cannulateddrill guide assembly 195 such that, when cannulateddrill guide assembly 195 is used to form a hole in a bone, the distal end ofinsertion tube assembly 200 can be delivered to that hole in a bone, as will hereinafter be discussed. - Push
rod assembly 205 is sized so that itspush rod 236 can be slidably received withinlumen 231 ofinsertion tube assembly 200 such that, whennovel suture assembly 5 is disposed within thedistal end 225 ofelongated insertion tube 201 ofinsertion tube assembly 200, advancement ofpush rod assembly 205 relative toinsertion tube assembly 200 will causenovel suture assembly 5 to be ejected fromdistal end 225 ofelongated insertion tube 201 ofinsertion tube assembly 200, as will hereinafter be discussed. Oncenovel suture assembly 5 has been ejected fromdistal end 225 ofinsertion tube 201 ofinsertion tube assembly 200, tensioningfirst arm 30 andsecond arm 35 offirst suture 10, whilepush rod assembly 205 holdsbridge 65 ofsecond suture 15 from moving proximally, will causenovel suture assembly 5 to transform from its longitudinally-elongated, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). Such tensioning offirst arm 30 andsecond arm 35 offirst suture 10 is applied by moving push rod handle 255 longitudinally along push rod slide 251 (i.e., by applying a force of appropriate magnitude to the aforementioned detent mechanism), as will hereinafter be discussed. -
Insertion tube assembly 200 is also sized so that itslumen 231 will accommodate first andsecond arms first suture 10 alongsidepush rod 236 ofpush rod assembly 205 whenpush rod 236 is disposed inlumen 231 ofinsertion tube assembly 200. -
Novel suture assembly 5 is intended to be disposed within the distal end ofinsertion tube assembly 200, distal to pushrod assembly 205, withfirst arm 30 andsecond arm 35 offirst suture 10 extending uplumen 231 of insertion tube assembly 200 (and alongsidepush rod 236 of push rod assembly 205), alongsuture slot 252 ofpush rod slide 251, aroundsuture saddle 253 ofpush rod slide 251 and then intoundersized slot 258 ofpush rod handle 255, whereby to releasably bind first andsecond arms first suture 10 to pushrod handle 255. Preferablynovel suture assembly 5 is tightly compressed within the distal end ofinsertion tube assembly 200, so as to provide the largest possible differential between the diameter of the radially-elongated, radially-contracted first configuration (FIGS. 3 and 4 ) and the longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ), whereby to minimize the size of the bone hole and thereby increase holding power in the bone. In this respect it should be appreciated that by windingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively, it is possible for the first andsecond sutures insertion tube assembly 200, thereby permitting maximum compression of the novel suture assembly within the insertion tube. Furthermore, by leavingfirst end 45 andsecond end 50 ofsecond suture 15 free (i.e., unconnected) relative to one another, the first andsecond sutures insertion tube assembly 200, thereby permitting maximum compression of the novel suture assembly within the insertion tube assembly. Thus it will be appreciated that, by formingnovel suture assembly 5 in the specific manner discussed above, the suture assembly is capable of self-accommodating itself into the smallest possible diameter within the insertion tube assembly, thereby permitting maximum compression of the novel suture assembly within the insertion tube assembly, and hence permitting use of a smaller bone hole and thus providing maximum holding power within the bone. - Significantly, push
rod handle 255 is slidably mounted to pushrod slide 251 using a detent mechanism, and thefirst arm 30 andsecond arm 35 offirst suture 10 are releasably secured to push rod handle 255 after first passing oversuture saddle 253 ofpush rod slide 251, such that (i) by initially applying a force to push rod handle 255 which is below the trigger magnitude of the aforementioned detent mechanism, push rod handle 255 will initially causepush rod assembly 205 to be moved distally relative toinsertion tube assembly 200, whereby to ejectsuture assembly 205 frominsertion tube assembly 200, and (ii) by thereafter applying a force to push rod handle 255 which is above the trigger magnitude of the aforementioned detent mechanism, push rod handle 255 will thereafter move relative to pushrod slide 251, whereby to cause tension to be applied tofirst arm 30 andsecond arm 35 offirst suture 10 without causing further distal motion ofpush rod 236. - Thus, with this form of the invention, once
novel suture assembly 5 has been ejected fromdistal end 225 ofinsertion tube assembly 200,first arm 30 andsecond arm 35 offirst suture 10 are automatically tensioned, whilepush rod assembly 205 holdsbridge 65 ofsecond suture 15 from moving proximally, whereby to causenovel suture assembly 5 to transform from its longitudinally-elongated, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). - In essence, in this form of the invention, progressive distal movement of push rod handle 255 causes
novel suture assembly 5 to first be ejected into a bone hole and then transformed from its longitudinally-elongated, radially-contracted first configuration into its longitudinally-contracted, radially-expanded second configuration. - The
alternative inserter assembly 190 shown inFIGS. 27-31 and its associated cannulateddrill guide assembly 195 may be used to deploynovel suture assembly 5 in bone, in order to secure an object to bone. - Thus, in another preferred form of the present invention, and looking now at
FIGS. 32-49 , the distal end of cannulateddrill guide assembly 195 is first placed against the surface ofbone 145, then a bone drill (not shown) of the sort well known in the art is advanced throughlumen 221 of the cannulated drill guide assembly and into the bone so that abone hole 150 of appropriate size (diameter and depth) is formed in the bone, then the bone drill is removed fromlumen 221 of cannulateddrill guide assembly 195 while leaving the cannulated drill guide assembly in position againstbone 145, and then thedistal end 225 ofinsertion tube assembly 200, carrying novel repair construct 5 therein, is advanced through cannulateddrill guide assembly 195 and intobone hole 150 formed in bone 145 (FIGS. 32-38 ). It will be appreciated thatpush rod 236 ofpush rod assembly 205 is already disposed withinlumen 231 ofinsertion tube assembly 200 as this occurs, withdistal end 240 ofpush rod assembly 205 sitting againstbridge 65 ofsecond suture 15. - Next, push
rod assembly 205 is advanced distally, againstbridge 65 ofsecond suture 15, so thatnovel suture assembly 5 is ejected from thedistal end 225 of insertion tube assembly 200 (FIGS. 39-43 ). This is done by pressing push rod handle 255 distally so thatpush rod assembly 205 advances distally relative toinsertion tube 200. As this occurs, push rod handle 255 remains fixed in position onpush rod slide 251 due to the detent mechanism ofradial projection 256 onpush rod slide 251 andcounterpart element 257 onpush rod handle 255. Pushrod assembly 205 advances distally untilpush rod slide 251 bottoms out in its seat on insertion tube handle 235 (FIG. 41 ). - Then, with
push rod assembly 205 still in position againstbridge 65 ofsecond suture 15,first arm 30 andsecond arm 35 offirst suture 10 are tensioned, thereby transformingnovel suture assembly 5 from its longitudinally-extended, radially-contracted first configuration into its longitudinally-contracted, radially-expanded second configuration (FIGS. 44-47 ), whereby to expandnovel suture assembly 5 laterally into thecancellous region 160 ofbone 145. This is done by pressing push rod handle 255 further distally so thatpush rod handle 255 overcomes the aforementioned detent mechanism withpush rod slide 251, thereby causing push rod handle 255 to move distally alongpush rod slide 251, relative toinsertion tube assembly 200 and pushrod assembly 205. As this occurs, the first andsecond arms first suture 10 are tensioned, due to the increasing length of the suture path created aroundsuture saddle 253. - At this point, first and
second arms first suture 10 are released from inserter assembly 190 (e.g., by dismounting the suture arms fromundersized slot 258 of push rod handle 255),inserter assembly 190 is removed from the surgical site (FIG. 48 ), and thenfirst arm 30 andsecond arm 35 offirst suture 10 are tensioned further so as to further laterally expandnovel suture assembly 5 and cause the laterally-expanded novel suture assembly to seat against the underside ofcortical layer 155 of bone 145 (FIG. 49 ), whereby to secure thenovel suture assembly 5 withinbone hole 150, withfirst arm 30 andsecond arm 35 offirst suture 10 extending out of the bone hole. - Significantly, by forming
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), it is possible to form the highly defined, appropriately shaped structure shown inFIGS. 5 and 6 in a highly consistent manner whensuture assembly 5 is transformed from its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) into its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). - And significantly, the highly defined, appropriately shaped and consistently reproducible structure shown in
FIGS. 5 and 6 is capable of carrying substantial loads without losing its defined shape when loads are applied to the first and second ends 20, 25 offirst suture 10. As a result, whensuture assembly 5 is inserted into a bone hole while in its longitudinally-expanded, radially-contracted first configuration and is thereafter transformed into its longitudinally-contracted, radially-expanded second configuration,novel suture assembly 5 will provide an excellent suture anchor with high holding strength. - Thereafter, one or both of
first arm 30 andsecond arm 35 offirst suture 10 may be used to secure an object (e.g., soft tissue) to the bone. By way of example but not limitation, one or both offirst arm 30 andsecond arm 35 may be passed through a piece of soft tissue (e.g., a ligament) and then tied together so as to secure the soft tissue to bone. - Again, it should be appreciated that, by forming the
novel suture assembly 5 in the manner previously described (e.g., by wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and by wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 andsecond arm 60 being wound in opposite directions onfirst arm 30 andsecond arm 35, respectively), thenovel suture assembly 5 does not form a knot in either its longitudinally-expanded, radially-contracted first configuration (FIGS. 3 and 4 ) or its longitudinally-contracted, radially-expanded second configuration (FIGS. 5 and 6 ). In either configuration, thenovel suture assembly 5 may be disassembled by simply pullingfirst arm 30 offirst suture 10, or by pullingsecond arm 35 offirst suture 10, away fromsecond suture 15, whereby to “undo” the suture assembly. As a result, if at any time it should be desired to remove thenovel suture assembly 5 frombone hole 150,first arm 30 offirst suture 10, orsecond arm 35 offirst suture 10, is simply pulled away fromsecond suture 15, whereby to “undo” the suture assembly. Oncefirst suture 10 has been pulled clear of the surgical site,second suture 15 may be extracted from bone hole 150 (e.g., with a narrow suture grasper) and removed from the surgical site. - Significantly, since the
novel suture assembly 5 is a relatively flexible structure while it is in its aforementioned longitudinally-elongated, radially-contracted first configuration, it is capable of conforming to some extent to the geometry of the bone hole in which it is received as it is ejected frominsertion tube assembly 200 and before it is transformed into its longitudinally-contracted, radially-expanded second configuration. As a result, thenovel suture assembly 5 can be deployed in relatively shallow bone holes, since it is relatively pliable when it is in its longitudinally-elongated, injection-state configuration and before it is transformed into its longitudinally-contracted, anchoring-state configuration. -
FIG. 2 shows the preferred manner of formingnovel suture assembly 5. -
FIG. 50 shows an alternative manner of formingnovel suture assembly 5. In this form of the invention,suture assembly 5 is substantially the same as the suture assembly shown inFIG. 2 , except that twofirst sutures 10, disposed in a parallel arrangement, are provided. This construction can be highly advantageous in some situations since it provides four strands of suture emerging from the bone hole. -
FIG. 51 shows another manner of forming thenovel suture construct 5. In this form of the invention,second suture 15 has aneyelet 180 formed on the end offirst arm 55 and aneyelet 185 formed on the end ofsecond arm 60.First arm 55 ofsecond suture 15 is wrapped (e.g., three times) aroundfirst arm 30 offirst suture 10, withfirst arm 30 offirst suture 10 passing througheyelet 180 ofsecond suture 15, andsecond arm 60 ofsecond suture 15 is wrapped (e.g., three times) aroundsecond arm 35 offirst suture 10, withsecond arm 35 offirst suture 10 passing througheyelet 185 ofsecond suture 15. Again,first arm 55 ofsecond suture 15 is wrapped in the opposite direction fromsecond arm 60 ofsecond suture 15. In this form of the invention,bridge 65 ofsecond suture 15 may be positioned close to, and extend substantially parallel to, bridge 40 offirst suture 10. While this form of the invention may permit enhanced compression of the novel suture assembly within the insertion tube, it is generally not preferred since it presentsseparate eyelets bridge 65, and can be more difficult to reliably engage with the distal end of the push rod assembly. - Additional configurations are shown in
FIGS. 52-54 . More particularly, the suture construct shown inFIG. 52 is substantially the same as the suture assembly shown inFIG. 2 , except that the first and second ends 45, 50 ofsecond suture 15 are joined together at 190 such that the second suture forms a substantially closed loop. Various means may be used to join together the first and second ends ofsecond suture 15, e.g., simply tying the ends into a knot (not shown); gluing or thermal welding, the use of a mechanical means or device such as a pledget that joins the ends together (not shown), etc. Additionally, one end ofsecond suture 15 can be inserted through the body of the other end so as to form a single strand 195 (FIG. 53 ). Furthermore,second suture 15 can be manufactured as a closed loop, i.e., so as to provide a distal bridge 200 (FIG. 54 ). - The constructions shown in
FIGS. 52-54 can work adequately in some situations, e.g., where a larger bone hole size is acceptable and lower holding strengths can be tolerated. However, it must be emphasized that the suture assemblies shown inFIGS. 52-54 are not equivalent to the suture assembly shown inFIGS. 1-6 in either form or function. More particularly, with the suture assemblies shown inFIGS. 52-54 ,second suture 15 effectively forms a substantially closed loop, whereas with the suture assembly ofFIGS. 1-6 , thesecond suture 15 provides two free ends. The provision of two free ends with the suture assembly ofFIGS. 1-6 is a significant advantage over the suture assemblies shown inFIGS. 52-54 , inasmuch as it permits the suture assembly to self-accommodate within the insertion tube, thereby permitting substantially better compression of the suture assembly within the insertion tube. Again, this is significant, since better compression of the suture assembly within the insertion tube permits the use of a smaller bone hole, a smaller insertion tube and provides significantly better binding to the bone. - As noted above, in some circumstances it may be desirable to attach a graft ligament (e.g., a graft anterior cruciate ligament, also known as an ACL) to bone (e.g., the femur) by fixing a portion of the graft ligament in a bone tunnel formed in the bone. As will hereinafter be discussed,
novel suture assembly 5 can be used for this purpose. For purposes of clarity of description,novel suture assembly 5 will hereinafter be discussed in the context of an ACL reconstruction, however, it should be appreciated thatnovel suture assembly 5 may also be used for other forms of ligament reconstruction where a portion of the graft ligament must be fixed in a bone tunnel formed in the bone. - As noted previously, and looking now at
FIG. 55 ,novel suture assembly 5 generally comprises afirst suture 10 and asecond suture 15, whereinsecond suture 15 is wrapped aroundfirst suture 10 by (i) foldingsecond suture 15 back on itself so as to providefirst arm 55 andsecond arm 60, withfirst arm 55 being connected tosecond arm 60 via abridge 65; (ii) positioningbridge 65 ofsecond suture 15 acrossfirst arm 30 andsecond arm 35 offirst suture 10, withbridge 65 ofsecond suture 15 being spaced frombridge 40 offirst suture 10; and (iii) wrappingfirst arm 55 ofsecond suture 15 aroundfirst arm 30 offirst suture 10, and wrappingsecond arm 60 ofsecond suture 15 aroundsecond arm 35 offirst suture 10, withfirst arm 55 ofsecond suture 15 andsecond arm 60 ofsecond suture 15 being wrapped in opposite directions, in the manner previously described and as shown inFIG. 55 . - In this form of the invention,
first arm 30 andsecond arm 35 offirst suture 10 are also joined to one another at abridge 300, such thatfirst suture 10 forms a closed loop. - Furthermore, in this form of the invention, and looking now at
FIG. 56 ,first suture 10 is sized so that one ormore graft ligaments 305 may be looped through the closed loop offirst suture 10, in order thatnovel suture assembly 5 may be used to support the one ormore graft ligaments 305 within a bone tunnel, as will hereinafter be discussed. For purposes of illustration but not limitation, the present invention will hereinafter be discussed in the context of supporting twograft ligaments 305 within a bone tunnel, wherein each of the graft ligaments comprises a pair of ligament strands, such that four ligament strands are supported within a bone tunnel. - More particularly, in this form of the invention, and looking now at
FIG. 57 , a bone tunnel (i.e., hole) 310 is formed within thebone 315 which is to receive the graft ligament. In the case of an ACL reconstruction,bone 315 typically comprises the femur, andbone tunnel 310 typically comprises a bone tunnel opening on the base of the femur and extending upward into the femur.Bone tunnel 310 preferably has a diameter which is substantially the same as, or even undersized slightly relative to, the combined diameter of the twograft ligaments 305 which are to be attached tobone 315. In other words,bone tunnel 310 preferably has a diameter which is substantially the same as (or slightly smaller than) the combined diameter of the four ligament strands which make up the twograft ligaments 305. In any case,bone tunnel 310 has a diameter which is sufficient to accommodate the twograft ligaments 305 without requiring the application of excessive force to move the two graft ligaments within the bone tunnel. - At the base of
bone tunnel 310, a second bone tunnel 320 (of lesser diameter than that of bone tunnel 310) is formed.Bone tunnel 320 extends upward frombone tunnel 310 and opens on thecortical bone surface 325 ofbone 315. In the case of an ACL reconstruction, wherebone 315 typically comprises the femur andbone tunnel 310 typically comprises a bone tunnel opening on the base of the femur and extending upward into the femur,second bone tunnel 320 opens on the anterior surface of the femur, just above the knee joint. In essence, the smalldiameter bone tunnel 320 and the largediameter bone tunnel 310 form a bore/counterbore construct. - If desired,
bone tunnel 320 may be formed inbone 315 beforebone tunnel 310 is formed inbone 315, e.g.,bone tunnel 320 may be formed by passing a guidewire through the bone, and thenbone tunnel 310 may be formed by passing a cannulated drill over the guidewire. -
Graft ligaments 305 are looped through the closed loop offirst suture 10, andsecond suture 15 is attached to a passingpin 330, e.g., by attachingfirst end 45 andsecond end 50 ofsecond suture 15 to theproximal end 335 of passingpin 330. This is done whilenovel suture assembly 5 is in its aforementioned longitudinally-expanded, radially-contracted first configuration. Then, withnovel suture assembly 5 remaining in its aforementioned longitudinally-expanded, radially-contracted first configuration, passingpin 330 is used to pullnovel suture assembly 5 alongbone tunnel 310 andbone tunnel 320, untilbridge 65 ofsecond suture 15 emerges on the distal side ofcortical bone surface 325. At this point,bridge 40 offirst suture 10 will also reside on the distal side ofcortical bone surface 325, with the remainder offirst suture 10 extending proximally alongbone tunnel 320 andbone tunnel 310, and withgraft ligaments 305 extending proximally alongbone tunnel 310. - Next,
graft ligaments 305 are tensioned proximally whilefirst end 45 andsecond end 50 ofsecond suture 15 are held taut outside the bone, thereby transformingnovel suture assembly 5 from its longitudinally-expanded, radially-contracted first configuration (FIG. 57 ) into its longitudinally-contracted, radially-expanded second configuration (FIG. 58 ). This second configuration has a larger cross-sectional area than the first configuration and, significantly, a larger cross-sectional area than the smallerdiameter bone tunnel 320, thereby providing a structure which is too large to be pulled back into the smaller diameter bone tunnel. Thus,novel suture assembly 5 effectively provides an enlarged structure on the distal side ofbone 315 which bears againstcortical bone surface 325 and supports the load ofgraft ligaments 305 carried by the closed loop offirst suture 10. - Thereafter, passing
pin 330 is released from thenovel suture assembly 5, e.g., by cuttingfirst end 45 andsecond end 50 ofsecond suture 15, and the proximal ends ofgraft ligaments 305 may be made fast in ways well known in the art so as to complete the ligament reconstruction procedure. By way of example but not limitation, the proximal ends ofgraft ligaments 305 may be made fast in a bone tunnel formed in the adjacent tibia (not shown). - Thus it will be seen that
novel suture assembly 5 can be used to provide a suspension-type fixation device for ligament repair. - Significantly, using
novel suture assembly 5 to provide suspension-type fixation for ligament repair is highly advantageous, e.g., it allows bone/soft tissue ingrowth about the entire circumference of the bone hole, it is fast and easy to effect, and it eliminates certain deployment complications which may be encountered with prior art graft ligament fixation devices (e.g., difficulty in deploying a button on the far side of the bone). Furthermore,suture assembly 5 can be formed out of absorbable suture, enabling the suture assembly to be eliminated from the surgical site after bone/soft tissue ingrowth is complete. - It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.
Claims (30)
1. An assembly comprising:
a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop;
a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
the assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration.
2. An assembly according to claim 1 wherein the assembly is transformed from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration by moving the wrapped portions of the second suture along the first and second arms of the first suture.
3. An assembly according to claim 1 wherein the wrapped portions of the second suture are in a longitudinally compressed state when the assembly is in its second configuration.
4. An assembly according to claim 1 wherein the assembly is transformed from its first configuration to its second configuration by pulling the first and second arms of the first suture while holding the bridge of the second suture steady.
5. An assembly according to claim 1 wherein the first arm of the second suture terminates in a first end, the second arm of the second suture terminates in a second end, and further wherein the first and second ends are free relative to one another.
6. An assembly according to claim 1 wherein the first arm of the second suture comprises a loop which is mounted to the first arm of the first suture, and wherein the second arm of the second suture comprises a loop which is mounted to the second arm of the first suture.
7. An assembly according to claim 1 wherein the first and second arms of the second suture are connected to one another so as to form a loop.
8. An assembly according to claim 1 wherein the first arm of the second suture is wrapped three times around the first arm of the first suture and the second arm of the second suture is wrapped three times around the second arm of the first suture.
9. An assembly according to claim 1 wherein the first suture comprises woven suture.
10. An assembly according to claim 1 wherein the second suture comprises woven suture.
11. An assembly according to claim 1 further comprising:
a third suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the third suture comprises a closed loop, and further wherein the third suture is disposed substantially parallel to the first suture.
12. An assembly according to claim 1 further comprising at least one graft ligament looped through the closed loop of the first suture.
13. An assembly according to claim 1 wherein a portion of the assembly is disposed within a bone tunnel formed in a bone and a portion of the assembly is disposed outside of the bone tunnel on a far side of the bone, wherein at least one graft ligament is looped through the closed loop of the first suture and extends along the bone tunnel, and further wherein the assembly is in its longitudinally-contracted, radially-expanded second configuration so as to attach the at least one graft ligament to the bone when the at least one graft ligament is held under tension.
14. An assembly according to claim 1 wherein the assembly is formed out of absorbable material.
15. A method for attaching an elongated object to an anatomical structure, the method comprising:
providing a suture assembly comprising:
a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop;
a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm;
the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction;
the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration;
looping the elongated object through the closed loop of the first suture;
passing the suture assembly along an opening in the anatomical structure while the suture assembly is in its longitudinally-extended, radially-contracted first configuration, so that a first portion of the suture assembly extends out of the opening on a far side of the anatomical structure; and
transforming the suture assembly from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration so as to attach the elongated object to the anatomical structure when the elongated object is held under tension.
16. A method according to claim 15 wherein a portion of the suture assembly has a diameter which is larger than the diameter of the opening in the anatomical structure when the suture assembly is in its longitudinally-contracted, radially-expanded second configuration.
17. A method according to claim 15 wherein the suture assembly is transformed from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration by moving the wrapped portions of the second suture along the first and second arms of the first suture.
18. A method according to claim 15 wherein the wrapped portions of the second suture are in a longitudinally compressed state when the suture assembly is in its second configuration.
19. A method according to claim 15 wherein the suture assembly is transformed from its longitudinally-extended, radially-contracted first configuration to its longitudinally-contracted, radially-expanded second configuration by pulling the first and second arms of the first suture while holding the bridge of the second suture steady.
20. A method according to claim 15 wherein the first suture comprises woven suture.
21. A method according to claim 15 wherein the second suture comprises woven suture.
22. A method according to claim 15 wherein the anatomical structure comprises bone.
23. A method according to claim 22 wherein the object comprises soft tissue.
24. A method according to claim 23 wherein the soft tissue comprises a graft ligament.
25. A method according to claim 23 wherein the opening comprises a bore/counterbore configuration.
26. A method according to claim 25 wherein the bore opens on a far side of the bone, and further wherein at least a portion of the graft ligament extends within the counterbore.
27. A method according to claim 26 wherein the graft ligament extends out of the counterbore on the near side of the bone.
28. A method according to claim 26 wherein a suture is secured to the graft ligament, and further wherein the suture extends out of the counterbore on the near side of the bone.
29. A method according to claim 15 wherein the suture assembly is passed along the opening by towing the suture assembly with a passing pin.
30. A method for attaching an elongated object to an anatomical structure, the method comprising:
looping the elongated object through a closed loop of a suture assembly;
passing the suture assembly along an opening in the anatomical structure so that a first portion of the suture assembly extends out of the opening on a far side of the anatomical structure; and
transforming the suture assembly from a first configuration to a second configuration so that the first portion of the suture assembly is unable to be retracted back into the opening so as to attach the elongated object to the anatomical structure when the elongated object is held under tension.
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Families Citing this family (73)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7658751B2 (en) | 2006-09-29 | 2010-02-09 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US8088130B2 (en) | 2006-02-03 | 2012-01-03 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8840645B2 (en) | 2004-11-05 | 2014-09-23 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US9801708B2 (en) | 2004-11-05 | 2017-10-31 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7905904B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US8361113B2 (en) | 2006-02-03 | 2013-01-29 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8298262B2 (en) | 2006-02-03 | 2012-10-30 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8128658B2 (en) | 2004-11-05 | 2012-03-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to bone |
US8137382B2 (en) | 2004-11-05 | 2012-03-20 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US7909851B2 (en) | 2006-02-03 | 2011-03-22 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US9017381B2 (en) | 2007-04-10 | 2015-04-28 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US8118836B2 (en) | 2004-11-05 | 2012-02-21 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7749250B2 (en) | 2006-02-03 | 2010-07-06 | Biomet Sports Medicine, Llc | Soft tissue repair assembly and associated method |
US8303604B2 (en) | 2004-11-05 | 2012-11-06 | Biomet Sports Medicine, Llc | Soft tissue repair device and method |
US8998949B2 (en) | 2004-11-09 | 2015-04-07 | Biomet Sports Medicine, Llc | Soft tissue conduit device |
US8652171B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Method and apparatus for soft tissue fixation |
US8574235B2 (en) | 2006-02-03 | 2013-11-05 | Biomet Sports Medicine, Llc | Method for trochanteric reattachment |
US8801783B2 (en) | 2006-09-29 | 2014-08-12 | Biomet Sports Medicine, Llc | Prosthetic ligament system for knee joint |
US9538998B2 (en) | 2006-02-03 | 2017-01-10 | Biomet Sports Medicine, Llc | Method and apparatus for fracture fixation |
US10517587B2 (en) | 2006-02-03 | 2019-12-31 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US8506597B2 (en) | 2011-10-25 | 2013-08-13 | Biomet Sports Medicine, Llc | Method and apparatus for interosseous membrane reconstruction |
US9468433B2 (en) | 2006-02-03 | 2016-10-18 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US9149267B2 (en) | 2006-02-03 | 2015-10-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US11259792B2 (en) | 2006-02-03 | 2022-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US8597327B2 (en) | 2006-02-03 | 2013-12-03 | Biomet Manufacturing, Llc | Method and apparatus for sternal closure |
US8652172B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Flexible anchors for tissue fixation |
US8968364B2 (en) | 2006-02-03 | 2015-03-03 | Biomet Sports Medicine, Llc | Method and apparatus for fixation of an ACL graft |
US11311287B2 (en) | 2006-02-03 | 2022-04-26 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8562647B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for securing soft tissue to bone |
US8771352B2 (en) | 2011-05-17 | 2014-07-08 | Biomet Sports Medicine, Llc | Method and apparatus for tibial fixation of an ACL graft |
US8562645B2 (en) * | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US9271713B2 (en) | 2006-02-03 | 2016-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for tensioning a suture |
US9078644B2 (en) * | 2006-09-29 | 2015-07-14 | Biomet Sports Medicine, Llc | Fracture fixation device |
US8672969B2 (en) | 2006-09-29 | 2014-03-18 | Biomet Sports Medicine, Llc | Fracture fixation device |
US11259794B2 (en) | 2006-09-29 | 2022-03-01 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US9918826B2 (en) | 2006-09-29 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US8500818B2 (en) | 2006-09-29 | 2013-08-06 | Biomet Manufacturing, Llc | Knee prosthesis assembly with ligament link |
US20100305710A1 (en) | 2009-05-28 | 2010-12-02 | Biomet Manufacturing Corp. | Knee Prosthesis |
US8814903B2 (en) | 2009-07-24 | 2014-08-26 | Depuy Mitek, Llc | Methods and devices for repairing meniscal tissue |
US8828053B2 (en) | 2009-07-24 | 2014-09-09 | Depuy Mitek, Llc | Methods and devices for repairing and anchoring damaged tissue |
JP5763173B2 (en) | 2010-04-27 | 2015-08-12 | ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング | Anchor assembly with expandable anchor |
US9724080B2 (en) | 2010-04-27 | 2017-08-08 | DePuy Synthes Products, Inc. | Insertion instrument for anchor assembly |
US9743919B2 (en) | 2010-04-27 | 2017-08-29 | DePuy Synthes Products, Inc. | Stitch lock for attaching two or more structures |
US9451938B2 (en) | 2010-04-27 | 2016-09-27 | DePuy Synthes Products, Inc. | Insertion instrument for anchor assembly |
US8795334B2 (en) | 2011-01-28 | 2014-08-05 | Smith & Nephew, Inc. | Tissue repair |
KR102126423B1 (en) * | 2011-02-16 | 2020-06-24 | 린바텍 코포레이션 | Method and apparatus for securing an object to bone |
US20130018416A1 (en) * | 2011-04-15 | 2013-01-17 | Linvatec Corporation | Soft suture anchor made of braided or monofilament suture |
EP2736420B1 (en) * | 2011-07-26 | 2018-10-17 | Linvatec Corporation | Apparatus for securing an object to bone, including the provision of a suture assembly for securing an object to bone |
US9357991B2 (en) | 2011-11-03 | 2016-06-07 | Biomet Sports Medicine, Llc | Method and apparatus for stitching tendons |
US9381013B2 (en) | 2011-11-10 | 2016-07-05 | Biomet Sports Medicine, Llc | Method for coupling soft tissue to a bone |
US9370350B2 (en) | 2011-11-10 | 2016-06-21 | Biomet Sports Medicine, Llc | Apparatus for coupling soft tissue to a bone |
US9314241B2 (en) | 2011-11-10 | 2016-04-19 | Biomet Sports Medicine, Llc | Apparatus for coupling soft tissue to a bone |
US9084597B2 (en) | 2012-03-09 | 2015-07-21 | Smith & Nephew, Inc. | Suture-based knotless repair |
US8986327B2 (en) * | 2012-10-18 | 2015-03-24 | Smith & Nephew, Inc. | Flexible anchor delivery system |
US9757119B2 (en) | 2013-03-08 | 2017-09-12 | Biomet Sports Medicine, Llc | Visual aid for identifying suture limbs arthroscopically |
US9918827B2 (en) | 2013-03-14 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US10136886B2 (en) | 2013-12-20 | 2018-11-27 | Biomet Sports Medicine, Llc | Knotless soft tissue devices and techniques |
US9615822B2 (en) | 2014-05-30 | 2017-04-11 | Biomet Sports Medicine, Llc | Insertion tools and method for soft anchor |
US9700291B2 (en) | 2014-06-03 | 2017-07-11 | Biomet Sports Medicine, Llc | Capsule retractor |
US10039543B2 (en) | 2014-08-22 | 2018-08-07 | Biomet Sports Medicine, Llc | Non-sliding soft anchor |
US9955980B2 (en) | 2015-02-24 | 2018-05-01 | Biomet Sports Medicine, Llc | Anatomic soft tissue repair |
US9974534B2 (en) | 2015-03-31 | 2018-05-22 | Biomet Sports Medicine, Llc | Suture anchor with soft anchor of electrospun fibers |
US10251663B2 (en) | 2016-01-11 | 2019-04-09 | Kambiz Behzadi | Bone preparation apparatus and method |
US11241248B2 (en) | 2016-01-11 | 2022-02-08 | Kambiz Behzadi | Bone preparation apparatus and method |
US11234840B2 (en) | 2016-01-11 | 2022-02-01 | Kambiz Behzadi | Bone preparation apparatus and method |
US11751807B2 (en) | 2016-01-11 | 2023-09-12 | Kambiz Behzadi | Invasive sense measurement in prosthesis installation and bone preparation |
US11399946B2 (en) | 2016-01-11 | 2022-08-02 | Kambiz Behzadi | Prosthesis installation and assembly |
CA3184686A1 (en) * | 2017-08-28 | 2019-03-07 | Conmed Corporation | System and method for preparing a soft tissue graft |
US11622760B2 (en) * | 2020-10-14 | 2023-04-11 | Matrixlabs Medical Co., Ltd. | Knotting assembly for surgical suture line |
CN115737030A (en) * | 2021-02-04 | 2023-03-07 | 杭州锐健马斯汀医疗器材有限公司 | Suture anchor implantation device |
WO2023039494A1 (en) * | 2021-09-09 | 2023-03-16 | Responsive Arthroscopy, LLC | All-suture anchor |
CN115670548B (en) * | 2022-11-10 | 2023-07-21 | 尤尼泰科(重庆)医疗科技有限公司 | Pre-tensioned full-suture anchor inserter |
CN115737031B (en) * | 2022-12-15 | 2023-08-29 | 尤尼泰科(重庆)医疗科技有限公司 | Full suture anchor inserter |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9119893B2 (en) * | 2010-11-04 | 2015-09-01 | Linvatec Corporation | Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing an object to bone |
Family Cites Families (119)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2012776A (en) | 1931-05-23 | 1935-08-27 | Roeder Hans Albert | Ligator |
US3580256A (en) | 1969-06-30 | 1971-05-25 | Jack E Wilkinson | Pre-tied suture and method of suturing |
DE2900265A1 (en) | 1979-01-04 | 1980-07-17 | Fritz Dr Sammer | Surgical probe loop - has loop filament wound into self-locking coils (OE 15.8.79) |
JPS60167294A (en) | 1984-02-10 | 1985-08-30 | 株式会社東芝 | Induction heating cooking device |
US5123914A (en) | 1986-05-19 | 1992-06-23 | Cook Incorporated | Visceral anchor for visceral wall mobilization |
US6464713B2 (en) | 1990-06-28 | 2002-10-15 | Peter M. Bonutti | Body tissue fastening |
JPH0624533B2 (en) | 1990-12-29 | 1994-04-06 | 昌貴 鮒田 | Medical instruments |
US5129912B2 (en) | 1991-01-07 | 2000-01-11 | Urohealth Systems Inc | Device and method for applying suture |
US5405352A (en) | 1991-04-09 | 1995-04-11 | Weston; Peter V. | Suture knot, method for its formation and use, and knot forming apparatus |
US5217470A (en) | 1991-04-29 | 1993-06-08 | Weston Peter V | Apparatuses and methods for formation and use of a slipknot as a surgical suture knot |
DE4207854A1 (en) | 1992-03-12 | 1993-09-16 | Klemm Bernd | Preformed surgical thread for easy knotting - thread has elastic section with preformed loops in opposite-handed pairs part of length or end of thread is passed through loop to form knot |
US5549630A (en) | 1993-05-14 | 1996-08-27 | Bonutti; Peter M. | Method and apparatus for anchoring a suture |
US5403348A (en) | 1993-05-14 | 1995-04-04 | Bonutti; Peter M. | Suture anchor |
US5569269A (en) | 1993-07-26 | 1996-10-29 | Innovasive Devices, Inc. | Surgical grasping and suturing device and method |
US5449367A (en) | 1993-08-02 | 1995-09-12 | Kadry; Othman | Pre-tied knot for surgical use and method of using same |
SI0669114T1 (en) | 1994-02-25 | 1999-02-28 | Robert E. Fischell | Stent having a multiplicity of closed circular structures |
JP3375730B2 (en) | 1994-06-07 | 2003-02-10 | マニー株式会社 | Medical threader |
US5549633A (en) | 1994-08-24 | 1996-08-27 | Kensey Nash Corporation | Apparatus and methods of use for preventing blood seepage at a percutaneous puncture site |
US5665110A (en) | 1995-09-21 | 1997-09-09 | Medicinelodge, Inc. | Suture anchor system and method |
US5665111A (en) | 1996-01-22 | 1997-09-09 | Raymedica, Inc. | Method for anchoring a surgical suture to bone |
US5718717A (en) | 1996-08-19 | 1998-02-17 | Bonutti; Peter M. | Suture anchor |
FR2760185B1 (en) | 1997-02-28 | 1999-05-14 | Laurent Fumex | SURGICAL BONE AND ANCILLARY ANCHORING DEVICE FOR ITS PLACEMENT |
US5893592A (en) | 1997-04-08 | 1999-04-13 | Ethicon Endo-Surgery, Inc. | Partially tied surgical knot |
FR2774580B1 (en) | 1998-02-06 | 2000-09-08 | Laurent Fumex | BONE ANCHORING SURGICAL DEVICE |
US6143006A (en) | 1998-04-18 | 2000-11-07 | Chan; Kwan-Ho | Apparatus and method for tying and tensioning knots |
US6113611A (en) | 1998-05-28 | 2000-09-05 | Advanced Vascular Technologies, Llc | Surgical fastener and delivery system |
US6179860B1 (en) | 1998-08-19 | 2001-01-30 | Artemis Medical, Inc. | Target tissue localization device and method |
US6110183A (en) | 1998-12-22 | 2000-08-29 | Cook Incorporated | Suture anchor device |
US6203572B1 (en) * | 1999-02-09 | 2001-03-20 | Linvatec Corporation | Device and method for ligament reconstruction |
EP2078498B1 (en) | 1999-04-09 | 2010-12-22 | Evalve, Inc. | Apparatus for cardiac valve repair |
US6558396B1 (en) | 1999-05-06 | 2003-05-06 | Kanji Inoue | Apparatus for folding instrument and use of the same apparatus |
US20040122456A1 (en) | 2002-12-11 | 2004-06-24 | Saadat Vahid C. | Methods and apparatus for gastric reduction |
BR9917519B1 (en) * | 1999-10-18 | 2008-11-18 | tendon or ligament restoration device. | |
US7153312B1 (en) | 1999-12-02 | 2006-12-26 | Smith & Nephew Inc. | Closure device and method for tissue repair |
US6524317B1 (en) | 1999-12-30 | 2003-02-25 | Opus Medical, Inc. | Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device |
US6500184B1 (en) | 2001-01-31 | 2002-12-31 | Yung C. Chan | Suturing apparatus and method of suturing |
US6767037B2 (en) | 2001-09-27 | 2004-07-27 | Depuy Mitek, Inc. | Sliding and locking surgical knot |
US6712849B2 (en) | 2001-10-01 | 2004-03-30 | Scandius Biomedical, Inc. | Apparatus and method for reconstructing a ligament |
JP3331215B1 (en) | 2002-02-04 | 2002-10-07 | 治郎 蟹江 | Biological suture |
DE50200594D1 (en) | 2002-02-08 | 2004-08-12 | Storz Karl Gmbh & Co Kg | Anchor element for anchoring a ligament graft |
US7048754B2 (en) | 2002-03-01 | 2006-05-23 | Evalve, Inc. | Suture fasteners and methods of use |
US6699263B2 (en) | 2002-04-05 | 2004-03-02 | Cook Incorporated | Sliding suture anchor |
GB0211378D0 (en) | 2002-05-17 | 2002-06-26 | Univ London | A device for transfixing and joining tissue |
US7494496B2 (en) | 2002-05-17 | 2009-02-24 | Ucl Biomedica Plc | Device for transfixing and joining tissue |
US6972027B2 (en) | 2002-06-26 | 2005-12-06 | Stryker Endoscopy | Soft tissue repair system |
JP4295214B2 (en) | 2002-07-10 | 2009-07-15 | カニカ デザイン インコーポレイテッド | System and method for moving and stretching a forming tissue |
ATE428351T1 (en) | 2002-07-31 | 2009-05-15 | Abbott Lab Vascular Entpr Ltd | DEVICE FOR COMPLETING SURGICAL PUNCTURES |
US7303575B2 (en) | 2002-08-01 | 2007-12-04 | Lumen Biomedical, Inc. | Embolism protection devices |
US7090690B2 (en) | 2002-11-19 | 2006-08-15 | Arthrocare Corporation | Devices and methods for repairing soft tissue |
FR2847456B1 (en) | 2002-11-21 | 2005-01-28 | Michel Collette | SCREWS FOR FIXING A LIGAMENT GRAFT |
US7942884B2 (en) | 2002-12-11 | 2011-05-17 | Usgi Medical, Inc. | Methods for reduction of a gastric lumen |
US7491212B2 (en) | 2003-02-19 | 2009-02-17 | Smith & Nephew, Inc. | Transmitting an actuating force along a curved instrument |
WO2004082724A2 (en) * | 2003-03-18 | 2004-09-30 | Opus Medical Inc. | Optimized suture braid |
ES2249661T3 (en) | 2003-07-08 | 2006-04-01 | A- Spine Holding Group Corp. | ANCHORAGE OF SUTURE AND SYSTEM TO ANCHOR BONE FABRIC. |
US20050049634A1 (en) | 2003-08-07 | 2005-03-03 | Scimed Life Systems, Inc. | Medical closure device |
US8308765B2 (en) | 2004-05-07 | 2012-11-13 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
US20050251189A1 (en) | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Multi-position tissue manipulation assembly |
US7361180B2 (en) | 2004-05-07 | 2008-04-22 | Usgi Medical, Inc. | Apparatus for manipulating and securing tissue |
US7347863B2 (en) | 2004-05-07 | 2008-03-25 | Usgi Medical, Inc. | Apparatus and methods for manipulating and securing tissue |
US8864822B2 (en) | 2003-12-23 | 2014-10-21 | Mitralign, Inc. | Devices and methods for introducing elements into tissue |
US7329279B2 (en) | 2003-12-23 | 2008-02-12 | Sadra Medical, Inc. | Methods and apparatus for endovascularly replacing a patient's heart valve |
US7390332B2 (en) | 2004-02-24 | 2008-06-24 | Depuy Mitek, Inc. | Methods and devices for repairing tissue |
US7658750B2 (en) | 2004-03-18 | 2010-02-09 | Warsaw Orthopedic, Inc. | Suture anchoring system and method |
US7390329B2 (en) | 2004-05-07 | 2008-06-24 | Usgi Medical, Inc. | Methods for grasping and cinching tissue anchors |
US8257394B2 (en) | 2004-05-07 | 2012-09-04 | Usgi Medical, Inc. | Apparatus and methods for positioning and securing anchors |
US20050251159A1 (en) | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Methods and apparatus for grasping and cinching tissue anchors |
US8206417B2 (en) | 2004-06-09 | 2012-06-26 | Usgi Medical Inc. | Apparatus and methods for optimizing anchoring force |
US8088146B2 (en) | 2004-06-14 | 2012-01-03 | Teleflex Medical Incorporated | High-strength suture |
JP2006025934A (en) | 2004-07-13 | 2006-02-02 | Jms Co Ltd | Suturing implement for living body |
JP2006025933A (en) | 2004-07-13 | 2006-02-02 | Jms Co Ltd | Suturing implement for living body |
JP2006025932A (en) | 2004-07-13 | 2006-02-02 | Jms Co Ltd | Suturing implement for living body, and suturing method for living body |
JP2006102255A (en) | 2004-10-06 | 2006-04-20 | Nippon Sherwood Medical Industries Ltd | Connecting structure of infusion line and connector with the connecting structure |
JP4669315B2 (en) | 2005-04-21 | 2011-04-13 | 日本シャーウッド株式会社 | Organ fixture and organ fixture set |
US20060190042A1 (en) | 2004-11-05 | 2006-08-24 | Arthrotek, Inc. | Tissue repair assembly |
US7749250B2 (en) | 2006-02-03 | 2010-07-06 | Biomet Sports Medicine, Llc | Soft tissue repair assembly and associated method |
US7905904B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US8088130B2 (en) | 2006-02-03 | 2012-01-03 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8118836B2 (en) | 2004-11-05 | 2012-02-21 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7658751B2 (en) | 2006-09-29 | 2010-02-09 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US7857830B2 (en) | 2006-02-03 | 2010-12-28 | Biomet Sports Medicine, Llc | Soft tissue repair and conduit device |
US8361113B2 (en) * | 2006-02-03 | 2013-01-29 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US9017381B2 (en) | 2007-04-10 | 2015-04-28 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US7909851B2 (en) | 2006-02-03 | 2011-03-22 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US7905903B2 (en) * | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8128658B2 (en) | 2004-11-05 | 2012-03-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to bone |
CN102525591B (en) | 2005-01-25 | 2014-12-10 | 泰科医疗集团有限合伙公司 | Structures for permanent occlusion of a hollow anatomical structure |
JP4823533B2 (en) | 2005-02-04 | 2011-11-24 | オリンパス株式会社 | Medical suture ligation tool and medical suture ligation apparatus |
CA2608107C (en) | 2005-05-04 | 2014-07-08 | Etech Ag | Joining element |
US20070083236A1 (en) | 2005-06-24 | 2007-04-12 | Smith & Nephew, Inc. | Methods and devices for tissue repair |
US8951285B2 (en) | 2005-07-05 | 2015-02-10 | Mitralign, Inc. | Tissue anchor, anchoring system and methods of using the same |
IL170698A (en) | 2005-09-06 | 2011-11-30 | Allium Ltd | System for delivering a medical device to a body location |
US20090115432A1 (en) | 2005-11-15 | 2009-05-07 | Appside Co., Ltd. | Elastic body, electrostatic capacitance force sensor and electrostatic capacitance acceleration sensor |
DE602006007429D1 (en) | 2005-12-26 | 2009-08-06 | Bernard Bouffier | Surgical prosthesis for supporting an organ |
US7959650B2 (en) | 2006-09-29 | 2011-06-14 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US8562647B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for securing soft tissue to bone |
EP1832246B1 (en) * | 2006-03-08 | 2019-06-12 | Arthrex, Inc. | Bundle graft and method of making same |
US7850710B2 (en) | 2006-05-23 | 2010-12-14 | St. Jude Medical Puerto Rico Llc | Puncture closure apparatuses, sealing plugs, and related methods |
CA2653396C (en) | 2006-06-09 | 2015-02-17 | Cordis Corporation | Single disc occlusionary patent foramen ovale closure device |
US20080015636A1 (en) | 2006-06-09 | 2008-01-17 | Daniel Olsen | Single disc intraluminal patent foramen ovale closure device |
US8870916B2 (en) | 2006-07-07 | 2014-10-28 | USGI Medical, Inc | Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use |
US20080033487A1 (en) | 2006-08-07 | 2008-02-07 | Bioduct, Llc | Medical device for repair of tissue and method for implantation and fixation |
US20080147086A1 (en) | 2006-10-05 | 2008-06-19 | Marcus Pfister | Integrating 3D images into interventional procedures |
US7758216B2 (en) | 2006-10-18 | 2010-07-20 | Robert Small | Decorative lamp illuminations structure |
US7850714B2 (en) | 2006-12-15 | 2010-12-14 | Kimberly-Clark Worldwide, Inc. | Segmented tissue-to-tissue anchoring device and method of using the same |
US8197491B2 (en) | 2006-12-19 | 2012-06-12 | Synthes Usa, Llc | Injectable fastener system and method |
US7901431B2 (en) | 2007-01-17 | 2011-03-08 | Arthrex, Inc. | Lisfranc repair using suture-button construct |
WO2008010738A2 (en) | 2007-01-24 | 2008-01-24 | Uros Babic | Patent foramen ovale occluder with suture based anchor |
US20080228265A1 (en) | 2007-03-13 | 2008-09-18 | Mitralign, Inc. | Tissue anchors, systems and methods, and devices |
US8911461B2 (en) | 2007-03-13 | 2014-12-16 | Mitralign, Inc. | Suture cutter and method of cutting suture |
US7771455B2 (en) | 2007-08-31 | 2010-08-10 | Ken Christopher G M | Closure medical device |
US8197511B2 (en) | 2007-09-24 | 2012-06-12 | Miller M Todd | Suture anchor having a suture engaging structure and inserter arrangement |
US8162997B2 (en) | 2007-11-05 | 2012-04-24 | Steven Struhl | Device for treatment of acromioclavicular joint dislocations |
BRPI1008926A2 (en) * | 2009-03-11 | 2019-09-24 | Synthes Gmbh | passable knot system for repairing soft tissue injuries |
US8828053B2 (en) | 2009-07-24 | 2014-09-09 | Depuy Mitek, Llc | Methods and devices for repairing and anchoring damaged tissue |
US8814903B2 (en) | 2009-07-24 | 2014-08-26 | Depuy Mitek, Llc | Methods and devices for repairing meniscal tissue |
JP5763173B2 (en) | 2010-04-27 | 2015-08-12 | ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング | Anchor assembly with expandable anchor |
US9307978B2 (en) * | 2010-11-04 | 2016-04-12 | Linvatec Corporation | Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing an object to bone |
US9307977B2 (en) * | 2010-11-04 | 2016-04-12 | Conmed Corporation | Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing suture to bone |
TW201231010A (en) * | 2011-01-14 | 2012-08-01 | Synthes Gmbh | Stitch lock for attaching two or more structures |
-
2012
- 2012-02-16 KR KR1020197031627A patent/KR102126423B1/en active IP Right Grant
- 2012-02-16 EP EP12746492.3A patent/EP2675363B1/en active Active
- 2012-02-16 AU AU2012217577A patent/AU2012217577B2/en active Active
- 2012-02-16 WO PCT/US2012/025480 patent/WO2012112793A1/en active Application Filing
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- 2012-02-16 CN CN201280018734.1A patent/CN103648405B/en active Active
- 2012-02-16 CA CA2827494A patent/CA2827494C/en active Active
- 2012-02-16 US US13/398,589 patent/US9119893B2/en active Active
-
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- 2015-09-01 US US14/842,183 patent/US20160058435A1/en not_active Abandoned
-
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-
2021
- 2021-01-08 US US17/144,351 patent/US20210121172A1/en active Pending
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9119893B2 (en) * | 2010-11-04 | 2015-09-01 | Linvatec Corporation | Method and apparatus for securing an object to bone, including the provision and use of a novel suture assembly for securing an object to bone |
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WO2012112793A1 (en) | 2012-08-23 |
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