U.S. patent application number 16/291782 was filed with the patent office on 2019-06-27 for tensionable constructs with multi-limb locking mechanism through single splice and methods of tissue repair.
The applicant listed for this patent is Arthrex, Inc.. Invention is credited to Peter S. Borden, Thomas Dooney, JR., Peter J. Dreyfuss, Alan M. Hirahara.
Application Number | 20190192135 16/291782 |
Document ID | / |
Family ID | 58156900 |
Filed Date | 2019-06-27 |
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United States Patent
Application |
20190192135 |
Kind Code |
A1 |
Dooney, JR.; Thomas ; et
al. |
June 27, 2019 |
TENSIONABLE CONSTRUCTS WITH MULTI-LIMB LOCKING MECHANISM THROUGH
SINGLE SPLICE AND METHODS OF TISSUE REPAIR
Abstract
Systems and methods for soft tissue to bone repairs, without
knot tying. Soft tissue repair systems include self-cinching
constructs with a fixation device, a flexible strand with multiple
flexible limbs, and a shuttle/pull device attached to the flexible
strand to shuttle the multiple flexible limbs through the flexible
strand and form a locking splice.
Inventors: |
Dooney, JR.; Thomas;
(Naples, FL) ; Hirahara; Alan M.; (Gold River,
CA) ; Borden; Peter S.; (Palos Verdes Estates,
CA) ; Dreyfuss; Peter J.; (Naples, FL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Arthrex, Inc. |
Naples |
FL |
US |
|
|
Family ID: |
58156900 |
Appl. No.: |
16/291782 |
Filed: |
March 4, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
14831511 |
Aug 20, 2015 |
10265060 |
|
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16291782 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F 2/0811 20130101;
A61B 2017/0477 20130101; A61B 17/0485 20130101; A61B 2017/0464
20130101; A61B 2017/0445 20130101; A61B 2017/0458 20130101; A61B
17/0401 20130101; A61B 2017/0414 20130101; A61B 2017/0427 20130101;
A61B 2017/0456 20130101; A61B 2017/0496 20130101; A61B 17/0487
20130101; A61B 2017/0412 20130101; A61F 2002/0888 20130101 |
International
Class: |
A61B 17/04 20060101
A61B017/04; A61F 2/08 20060101 A61F002/08 |
Claims
1. A surgical construct for tissue repairs, comprising: a
tensionable construct comprising a flexible strand with a plurality
of limbs, and a shuttling device attached to the flexible strand,
wherein the shuttling device allows the plurality of limbs of the
flexible strand to pass through the flexible strand and form a
locking splice and multiple adjustable closed loops.
2. The surgical construct of claim 1, wherein the tensionable
construct consists of the flexible strand with the plurality of
limbs and the shuttling device attached to the flexible strand.
3. The surgical construct of claim 1, wherein the flexible strand
is a suture or suture tape with an end region split into the
plurality of limbs.
4. The surgical construct of claim 1, wherein the flexible strand
is formed of ultrahigh molecular weight polyethylene.
5. The surgical construct of claim 1, wherein the shuttling device
is a suture passing instrument or a wire loop.
6. A surgical system for tissue repairs, comprising: a fixation
device comprising a body, a longitudinal axis, a proximal end, and
a distal end; and a tensionable construct pre-loaded on the
fixation device, the tensionable construct consisting of a flexible
strand and a shuttling device attached to the flexible strand,
wherein the flexible strand has one end which terminates in a knot
and another end which is split into multiple limbs.
7. The surgical system of claim 6, wherein the flexible strand is
affixed to the body of the fixation device by passing the flexible
strand through an opening at a distal end of the body and tying the
knot.
8. The surgical system of claim 6, wherein the shuttling device is
configured to be pulled out of the body of the fixation device to
allow the multiple limbs of the flexible strand to pass through the
flexible strand and form a locking splice.
9. The surgical system of claim 8, wherein the locking splice is
formed outside the body of the fixation device.
10. The surgical system of claim 8, wherein the locking splice is
formed inside the body of the fixation device.
11. The surgical system of claim 6, wherein at least a portion of
the body is cannulated and the tensionable construct extends
through the body.
12. The surgical system of claim 6, wherein the flexible strand is
fixed to the body of the fixation device, or to a part of the body
of the fixation device.
13. The surgical system of claim 6, wherein the body has an opening
at a most proximal end configured to receive a driver head for
driving the fixation device, and an opening at a most distal end
configured to receive and house the knot of the flexible
strand.
14. The surgical system of claim 6, wherein the fixation device is
an anchor with an anchor body provided with a plurality of
circumferential ribs or ridges extending from an outer surface of
the anchor body.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This is a divisional of U.S. application Ser. No.
14/831,511, filed on Aug. 20, 2015, the entire disclosure of which
is incorporated by reference herein in its entirety.
BACKGROUND
[0002] The present invention relates to surgical devices and, in
particular, to devices and methods for repair or fixation of soft
tissue to bone without the need for knots.
SUMMARY
[0003] Surgical constructs, systems, and techniques for knotless
soft tissue repair and fixation, such as fixation of soft tissue
(ligament, tendon, graft, etc.) to bone are disclosed.
[0004] A surgical construct includes a tensionable construct in the
form of a multi-limb locking construct formed through a single
splice. A flexible strand is split into a plurality of limbs that
are shuttled back through a flexible strand, to create a locking
splice construct that is tensionable after insertion in bone. A
surgical construct allows attached tissue to be brought proximate
to bone and does not require tying of any knots. A flexible strand
may be fixed to a fixation device and split into a plurality of
limbs that are shuttled back through a flexible strand, to create a
locking splice construct that is tensionable after insertion in
bone.
[0005] In an embodiment, a surgical construct includes an anchor, a
suture that is attached to the anchor and that splits into two or
more limbs, and a suture shuttle with a looped end. A suture can be
fixed within the anchor by a knot or similar construct. A suture
shuttle is inserted into a center of a single suture with a
plurality of suture limbs, to shuttle the suture limbs back through
the suture, creating a multi-limb locking mechanism through a
single locking splice.
BRIEF DESCRIPTION OF THE DRAWINGS
[0006] FIG. 1 illustrates a tensionable knotless construct
according to an exemplary embodiment.
[0007] FIGS. 2 and 3 illustrate an exemplary method of tissue
repair with the tensionable knotless construct of FIG. 1.
[0008] FIGS. 4 and 5 illustrate another exemplary method of tissue
repair with the tensionable knotless construct of FIG. 1.
DETAILED DESCRIPTION
[0009] Surgical constructs, systems, and techniques for knotless
soft tissue repair and fixation, such as fixation of soft tissue
(ligament, tendon, graft, etc.) to bone are disclosed.
[0010] The surgical constructs comprise tensionable knotless
anchors that are inserted into bone and are provided with a
multi-limb suture locking mechanism through single splice
(tensionable construct). The tensionable knotless anchor may be
formed essentially of suture or suture-like material (i.e., a soft
anchor without a solid body) or may be attached to a fixation
device.
[0011] The multi-limb suture locking mechanism through single
splice is formed of a flexible strand (a suture) and a shuttle/pull
device (a suture passing instrument) attached to the flexible
strand. A flexible strand includes an unsplit region or end (a
single main limb of suture or main strand) and a plurality of limbs
attached to the unsplit region (main strand). A shuttle/pull device
attached to the unsplit region allows passing of the plurality of
limbs through the tissue and then spliced back through the unsplit
region. In this manner, multiple locking limbs with variable loop
lengths are locked through just one splice. If a fixation device
(such as a solid anchor, for example) is employed, a splice may be
formed outside the body of the fixation device or inside the body
of the fixation device. A multi-limb suture locking mechanism
through single splice may be employed for tissue repairs.
[0012] In an embodiment, a flexible strand (for example, suture) is
split into multiple strands or limbs. The strands are passed
through the tissue and then spliced back through the single main
limb of suture. The individual limbs can slide with variable
tension and all could lock within the jacket.
[0013] In an embodiment, a surgical construct includes an anchor, a
suture that is fixed to the anchor and that splits into two or more
limbs, and a suture shuttle with a looped end. A suture can be
fixed within the anchor by a knot at the end of the suture. A
suture shuttle is inserted into a center of the single suture, and
is designed to help shuttle the suture limbs back through the
suture, creating a single locking splice. A locking splice may be
formed outside an anchor body or inside an anchor body.
[0014] In another embodiment, a surgical construct comprises (i) a
suture or suture-like material that has at least two regions: a
first region or unsplit region; and a second region or split region
that splits into two or more limbs; and (ii) a suture shuttle with
a looped end. A suture shuttle can be pre-assembled to the first
region of the suture or suture-like material. A suture shuttle may
be inserted into a center of the first region (unsplit region) of
the suture or suture-like material. A suture shuttle shuttles the
suture limbs back through the suture or suture-like material,
creating a single locking splice in the first region (unsplit
region) and a plurality of multiple adjustable closed loops.
Multiple adjustable closed loops may have adjustable perimeters,
and the perimeters may be all similar or different, or at least one
perimeter of one loop different than a perimeter of another loop. A
surgical construct may consist essentially of (i) a suture or
suture-like material that has at least two regions: a first region
or unsplit region; and a second region or split region that splits
into two or more limbs; and (ii) a suture shuttle with a looped
end.
[0015] In another embodiment, a surgical construct includes (i) an
anchor; (ii) a suture that is fixed to the anchor and that has at
least two regions: a first region or unsplit region; and a second
region or split region that splits into two or more limbs; and
(iii) a suture shuttle with a looped end. A suture can be fixed
within the anchor by a knot at the end of the suture. A suture
shuttle can be pre-assembled to the first region of the suture. A
suture shuttle may be inserted into a center of the first region
(unsplit region) of the suture. A suture shuttle shuttles the
suture limbs back through the suture, creating a single locking
splice in the first region (unsplit region).
[0016] In an embodiment, a surgical system for tissue repairs
includes a fixation device comprising a body, a longitudinal axis,
a proximal end, and a distal end; and a tensionable construct
pre-loaded on the fixation device. A tensionable construct may
include a flexible strand with a plurality of limbs, and a
shuttling device attached to the flexible strand. A flexible strand
may have one end which terminates in a knot, and another end which
is split into multiple flexible limbs.
[0017] Methods of soft tissue repair which do not require tying of
knots and allow adjustment of both the tension of the suture and
the location of the tissue with respect to the bone are also
disclosed. An exemplary method of tissue repair comprises (i)
installing a fixation device in bone, the fixation device
comprising a body, a flexible strand split into a plurality of
multiple flexible limbs, the flexible strand extending through at
least a portion of the body of the fixation device, and a passing
device attached to the flexible strand; and (ii) forming, with the
multiple flexible limbs of the flexible strand and with the passing
device, multiple knotless closed loops having adjustable
perimeters, after the step of installing the fixation device in
bone.
[0018] In one embodiment, two or more suture limbs extending from
the split suture are passed through soft tissue. The limbs are then
inserted into the suture shuttle loop. The tail of the suture
shuttle is pulled, advancing the shuttle loop and two or more
suture limbs through the locking splice. The ends of each of the
two or more suture limbs are then independently advanced until the
desired tension is achieved, creating simple stitches along the
soft tissue.
[0019] In another embodiment, two or more suture limbs, as well as
the suture shuttle loop and tail, are all passed through soft
tissue. The limbs are then inserted into the suture shuttle loop.
The suture shuttle loop and the two or more suture limbs loaded
onto it are advanced through the locking splice by pulling the
suture shuttle tail. The two or more suture limbs are then
independently advanced until the desired tension is achieved,
creating a mattress stitch on the soft tissue.
[0020] Another exemplary method of soft tissue repair comprises
inter alia: (i) inserting a fixation device of a surgical construct
into bone, the surgical construct comprising a fixation device (for
example, an anchor) with a flexible strand (for example, suture)
that is attached to the fixation device and that is split into
multiple strands/limbs, and with a shuttle/pull device (a suture
passing instrument) attached to the flexible strand; (ii) passing
the multiple strands/limbs around or through tissue to be fixated
(or reattached) to bone, and then through an eyelet/loop of the
shuttle/pull device; and (iii) subsequently, pulling on the
shuttle/pull device to allow the multiple strands/limbs to pass
through the flexible strand and to form a locking splice. In an
embodiment, individual multiple strands/limbs are each advanced
until desired tension is achieved creating simple stitches along
the tissue. In an embodiment, individual multiple strands/limbs may
be sequentially advanced through the flexible strand.
[0021] According to another embodiment, a method of soft tissue
repair comprises inter alia: (i) inserting a fixation device of a
surgical construct into bone, the surgical construct comprising a
fixation device (for example, an anchor) with a flexible strand
(for example, suture) that is attached to the fixation device and
that is split into multiple strands/limbs, and with a shuttle/pull
device (a suture passing instrument) attached to the flexible
strand; (ii) passing the multiple strands/limbs together with the
shuttle/pull device around or through tissue to be fixated (or
reattached) to bone; (iii) subsequently, passing the multiple
strands/limbs through an eyelet/loop of the shuttle/pull device;
and (iv) subsequently, pulling on the shuttle/pull device to allow
the multiple strands/limbs to pass through the flexible strand and
to form a locking splice. In an embodiment, individual multiple
strands/limbs are each advanced until the desired tension is
achieved creating a mattress stitch on the tissue. In an
embodiment, individual multiple strands/limbs may be sequentially
advanced through the flexible strand.
[0022] Referring now to the drawings, where like elements are
designated by like reference numerals, FIGS. 1-5 illustrate device
100 (surgical construct, integrated system, surgical system, or
assembly 100) which includes fixation device 10 assembled with
construct 99 (tensionable construct 99) formed of flexible strand
or flexible material 30 and shuttle/pull device 40 (suture passing
instrument 40) attached to the flexible strand 30. Tensionable
construct 99 may be pre-loaded on the fixation device 10. Although
the embodiments below will be described with reference to construct
99 (tensionable construct 99) attached to at least a part of
fixation device 10, the disclosure is not limited to these
exemplary embodiments and contemplates embodiments wherein
construct 99 (tensionable construct 99) acts as a soft anchor,
i.e., without being attached to any fixation device such as
fixation device 10.
[0023] In an exemplary embodiment, fixation device 10 is a
tensionable knotless anchor having a solid anchor body 11 provided
with a longitudinal axis 11a, a proximal end 13, a distal end 12,
and a plurality of ribs or ridges 15 extending circumferentially
around body 11. Cannulation 11b extends along the body 11 to allow
passage of flexible strand 30 and of a suture passing device, as
detailed below. Proximal end 13 of the anchor 10 may contain a
socket 19 (FIG. 1) configured to securely engage a tip of a
driver.
[0024] In an exemplary embodiment, fixation device 10 is an anchor
10 which may be a screw-in anchor or a push-in style anchor. Anchor
10 may be formed of metal, biocompatible plastic such as PEEK, or a
bioabsorbable PLLA material. Socket 19 at the distal end 13 of the
anchor 10 may have any shape adapted to receive a driver tip for
pushing tap-in or screw-in style anchors. Anchor 10 may be made of
one or more pieces (a multi-piece construct), or may be provided as
an integrated device (a unitary device). Anchor 10 may have various
sizes (various diameters and/or lengths) and may be formed of
biocompatible materials such as PEEK, biocomposite materials,
metals and/or metal alloys, or combination of such materials, among
others.
[0025] In an embodiment, construct 99 (tensionable construct 99)
may be formed of flexible strand 30 (flexible material, suture, or
tie down suture 30) and shuttle/pull device 40 (suture passing
instrument such as FiberLink.TM. 40, wire loop 40, or nitinol loop
40) attached to the flexible strand 30. In an exemplary embodiment,
the flexible strand 30 is a suture strand 30 and the shuttle/pull
device 40 is a suture passing device 40. The flexible strand 30
includes an end 32 (unsplit end, unsplit region, or unsplit suture
32) which terminates in knot 31, and another end which is split
into multiple limbs 33a, 33b . . . 33n (where "n" may be any number
greater than 2). For simplicity, FIGS. 1-5 illustrate flexible
strand 30 split into two limbs 33a, 33b; however, the constructs
detailed below encompass any number of multiple limbs (suture
limbs). Knot 31 may be a static knot 31 which prevents suture 30
from passing through distal blind hole 12a.
[0026] Suture 30, which is typically braided or multi-filament or
tape, may be preloaded onto the anchor by tying static knot 31
which prevents suture 30 from passing through distal blind hole
12a. The suture may also be preloaded by insert molding or by any
other means known in the art. Suture 30 passes through cannulation
11b and terminates in limbs 33a, 33b exiting proximal end 13 of
body 11. Tensionable knotless anchor 10 is loaded onto a driver
(not shown in FIGS. 1-5), and suture 30 is secured to the driver
(for example, wrapped around a cleft of the driver) to fasten
tensionable knotless anchor 10 securely to the driver.
[0027] Prior to the fastening of the anchor 10 to the driver,
suture passing device 40 (for example, a FiberLink.TM., a wire
loop, or a nitinol loop) is threaded through suture 30 (i.e.,
attached to a center of the suture 30 through splice region 39 of
unsplit end or region 32), as shown in FIG. 1. Suture passing
device 40 includes closed eyelet/loop 44 for passing suture, and
tail 42. Suture passing device 40 passes through an aperture 32a of
suture 30, within the body of suture 30 and within the tensionable
knotless anchor 10, and then exits an aperture 32b of suture 30. A
distance between apertures 32a, 32b of suture 30 corresponds to
splice or splice region 39. Tensionable knotless anchor 10 loaded
with tensionable construct 99 (formed of suture 30 attached to the
suture passing device 40) is then secured into bone 80 (for
example, into a hole/socket/tunnel formed in bone 80) by using a
driver.
[0028] FIGS. 2 and 3 depict exemplary repair 200 with tensionable
knotless anchor 10 of construct 100 after it has been inserted into
a drilled hole in bone 80, the suture released from the driver, and
the driver removed. Suture limbs 33a, 33b are passed through (or
around) tissue 50 which is to be moved to a desired location (for
example, brought into proximity of a drilled hole or socket in bone
80, to be reattached, for example, to bone 80). Suture limbs 33a,
33b are subsequently passed through eyelet/loop 44 of the suture
passing device 40. Tail 42 of suture passing device 40 is then
pulled, thereby pulling suture limbs 33a, 33b towards tensionable
knotless anchor 10, so that each of the suture limbs 33a, 33b is
passed/advanced through locking splice 39 (splice region 39) of
suture 30, i.e., each of the suture limbs 33a, 33b doubles on
itself within suture 30 and inside tensionable knotless anchor 10,
to form multiple adjustable tensionable loops 88a, 88b, . . . 88n
(where "n" has any value greater than 2). For simplicity, FIGS. 2
and 3 show only two multiple adjustable loops 88a, 88b
corresponding to respective multiple limbs 33a, 33b; however, the
constructs disclosed herein contemplate any number of multiple
adjustable tensionable loops (corresponding to the number of
multiple limbs). The suture passing device 40 has also been further
pulled through the splice region 39 of suture 30.
[0029] FIG. 3 illustrates surgical construct 100 with limbs 33a,
33b after the limbs have been pulled through themselves, creating
locking splice 39 and tensionable loops 88a, 88b. The suture
passing device (not visible) helps create single locking splice 39
within tensionable knotless anchor 10 by facilitating suture limbs
33a, 33b of suture 30 to pass through (shuttle back through) the
unsplit end or unslpit suture 32. Locking splice 39 may be formed
within body 11 of fixation device 10, or outside body 11 of
fixation device 10. In an embodiment, locking splice 39 may be
formed outside body 11 of fixation device 10 and within a bone
tunnel formed within bone 80 (wherein construct 100 is
inserted).
[0030] Once limbs 33a, 33b have been fully passed through suture
30, each of the limbs 33a, 33b may be pulled to reduce the
perimeter of loops 88a, 88b and until tissue 50 has been moved to
the desired location, such as near a drilled hole in bone 80. Once
the desired tension and location is achieved, ends of limbs 33a,
33b may be clipped off to complete the soft tissue repair or
fixation 200.
[0031] FIGS. 4 and 5 illustrate another exemplary method of soft
tissue repair 300 which does not require tying of knots and allows
adjustment of both tension of the suture limbs and the location of
the tissue with respect to the bone. According to this embodiment,
two or more suture limbs 33a, 33b, as well as the suture shuttle
loop 44 and tail 42, are all passed through tissue 50. The limbs
33a, 33b are then inserted into the suture shuttle loop 44. The
suture shuttle loop 44, together with the two or more suture limbs
33a, 33b loaded onto the suture shuttle loop 44, are advanced
through the locking splice 39 by pulling the suture shuttle tail
42, to form adjustable tensionable loops 88a, 88b, as shown in FIG.
5. As in the previously-described embodiment, loops 88a, 88b are
multiple adjustable tensionable loops 88a, 88b, each corresponding
to a respective one of multiple limbs 33a, 33b. Loops 88a, 88b have
an adjustable perimeter and are self-locking, tensionable
constructs formed of a splice (spliced region) and a continuous
adjustable closed loop attached to the splice. The two or more
suture limbs 33a, 33b may be then independently advanced until the
desired tension is achieved, creating a mattress stitch on the
tissue 50 and completing repair 300. In an embodiment, the two or
more suture limbs 33a, 33b may be sequentially or simultaneously
advanced, and then independently tensioned so that desired tension
is achieved and final repair completed.
[0032] Surgical construct 100 with the knotless anchor 10 and
tensionable construct 99 may be employed in following exemplary
repairs:
[0033] 1) Used in subscapularis repair for simple partial tears:
place anchor 10, pass sutures, shuttle using FiberLoop.RTM.
(Arthrex, Inc., Naples, Fla.), and tighten.
[0034] 2) Full rotator cuff (RC) tears (subscapularis,
supraspinatus, infraspinatus). [0035] a. Same technique for single
row fixation: this will allow for simple repairs passing only one
limb of each suture separately through the RC, then shuttle with
FiberLink.RTM. (Arthrex, Inc., Naples, Fla.), tighten. [0036] b.
Single row fixation with horizontal mattress: pass sutures
separately, pass FiberLink.RTM. through RC as well, shuttle
sutures, tighten. [0037] c. Double row fixation with one anchor 10:
pass sutures separately, pass FiberLink.RTM. through RC, shuttle
sutures, tighten, and bring sutures to lateral row anchor(s).
[0038] d. Double row fixation with multiple anchors 10: [0039] i.
Pass sutures/FiberLink.RTM. up through RC either as unit or
separately as desired; shuttle sutures into opposing anchor with
opposing FiberLink.RTM. for interconnection medially. [0040] ii.
Since multiple limbs are available, may also shuttle one suture
into same anchor for individual anchor fixation. This would be a
suture from same anchor/FiberLink.RTM. that was passed through RC
separately from FiberLink.RTM.. This allows for SutureBridge.TM.
fixation without knots. [0041] 1. All passes may be passed through
the RC with both anchors done before shuttling sutures. [0042] 2.
The technique could feature only two sutures per anchor with two
anchors medially and two vented SwiveLock.RTM. (Arthrex, Inc.,
Naples, Fla.) anchors laterally.
[0043] 3) Partial Articular-sided Supraspinatus Tendon Avulsion
(PASTA) Repair: [0044] a. Pass anchor 10 through slit in RC or
create a sheath to come through the RC easily, then fixate anchor
into bone through tendon [0045] b. Pass sutures separately via
Lasso or BirdBeak.RTM. (Arthrex, Inc., Naples, Fla.) [0046] c.
Shuttle sutures back into FiberLink.RTM., or if hole too big,
shuttle FiberLink.RTM. through RC as well into a different, smaller
hole [0047] d. Tighten
[0048] 4) A tape such as FiberTape.RTM. could be incorporated into
anchor 10: [0049] a. This would allow for SpeedBridge.TM. plus
repairs as above to get better fixation and take away that doctors
want to "tie" sutures medially to "help with fixation." By
interconnecting anchors 10 and passing a suture through the medial
tissue, fixing it to its same anchor, surgeons get individual
anchor fixation and construct fixation together. [0050] b. This
would also decrease potential for suture cut-through.
[0051] 5) InternalBrace.TM.--preferably employed with tape.
InternalBrace.TM. may be employed with anchor 10 and interlock
anchors across a joint. This would allow a surgeon to "dial in" how
much tension to place on the construct. Instead of trying to fix
the tension with the initial fixation with the proper length of the
FiberTape.RTM. (Arthrex, Inc., Naples, Fla.), this technique would
allow a surgeon to tighten sequentially. Any external ligament
reconstruction or repair like medial collateral ligament (MCL),
medial patella-femoral ligament (MPFL), lateral collateral ligament
(LCL), anterior cruciate (AC), ankle, etc. would be appropriate.
Any internal reconstruction or repair like anterior cruciate
ligament (ACL) or posterior cruciate ligament (PCL) could
potentially be internally braced with this anchor as well.
[0052] 6) Any use of a SwiveLock.RTM. would be appropriate usage of
anchor 10 in lieu of a free suture and vented SwiveLock.RTM. (VSL).
[0053] a. This would include ankle or elbow or hip. [0054] b. SCR
would be included in this list as a replacement for VSL. [0055] c.
These could replace the VSL anchors In the SpeedBridge.TM. kit once
the tapes were applied.
[0056] Although tensionable knotless anchor 10 has been depicted
above having ridges 15, and thus designed to be pushed into bone
80, it could instead be fabricated with threads and thereby
designed to be twisted or screwed into bone.
[0057] Surgical system 100 of FIGS. 1-5 (with knotless tensionable
anchor 10, suture 30 with suture limbs 33a, 33b, and suture passing
device 40 attached to suture 30) may be employed in exemplary
methods of tissue repair such as a Bankart or SLAP repair, wherein
the knotless suture anchor 10 (i.e., a modified knotless
SutureTak.TM. with suture limbs) simplifies arthroscopic
glenohumeral joint instability repair by combining a proven and
reproducible suture anchor insertion procedure with knotless soft
tissue fixation.
[0058] The knotless suture constructs and systems detailed above
may be used in conjunction with any knotless fixation devices which
can allow a flexible strand and attached suture passing device to
form a single locking splice with attached multiple adjustable
loops formed by multiple suture limbs. The knotless suture
constructs and systems detailed above may be used in conjunction
with any additional fixation devices (which may be similar to or
different from construct 100) depending on the characteristics of
the repair site.
[0059] A flexible strand may be a suture strand, a tape such as
suture tape, or any suture-like material known in the art that
could pass through tissue. A flexible strand may include a
high-strength suture, such as an ultrahigh molecular weight
polyethylene (UHMWPE) suture. High strength suture may be a
FiberWire.RTM. suture (Arthrex). FiberWire.RTM. suture is formed of
an advanced, high-strength fiber material, namely ultrahigh
molecular weight polyethylene (UHMWPE), sold under the tradenames
Spectra.RTM. (Honeywell International Inc., Colonial Heights, Va.)
and Dyneema.RTM. (DSM N.V., Heerlen, the Netherlands), braided with
at least one other fiber, natural or synthetic, to form lengths of
suture material.
[0060] A flexible strand may be also formed of TigerWire.RTM.
suture, or suture chain (such as FiberChain.RTM. disclosed in U.S.
Pat. No. 7,803,173), or suture tape (such as FiberTape.RTM.
disclosed in U.S. Pat. No. 7,892,256), the disclosures of which are
all incorporated in their entireties herein.
[0061] At least one of a flexible strand and a shuttle/pull device
may be made of any known suture material, such as UHMWPE material
or the FiberWire.RTM. suture. The UHWMPE suture may be without a
core to permit ease of splicing. The shuttle/pull device may be a
shuttle/pull suture device such as a FiberLink.TM. or a Nitinol
loop.
[0062] The limbs may also be formed of a flexible material, a stiff
material, or combination of stiff and flexible materials, depending
on the intended application. Both the limbs and the splice region
may be also coated and/or provided in different colors. The
knotless anchors of the present invention can be used with any type
of flexible material or suture that forms a splice and a loop.
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