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WO2024258968A1 - Ancrages de suture sans nœud et outils chirurgicaux correspondants - Google Patents

Ancrages de suture sans nœud et outils chirurgicaux correspondants Download PDF

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Publication number
WO2024258968A1
WO2024258968A1 PCT/US2024/033615 US2024033615W WO2024258968A1 WO 2024258968 A1 WO2024258968 A1 WO 2024258968A1 US 2024033615 W US2024033615 W US 2024033615W WO 2024258968 A1 WO2024258968 A1 WO 2024258968A1
Authority
WO
WIPO (PCT)
Prior art keywords
suture
anchor
passage
shuttle
unidirectional
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/US2024/033615
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English (en)
Inventor
S. Wendell HOLMES, Jr.
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Individual
Original Assignee
Individual
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Publication date
Application filed by Individual filed Critical Individual
Publication of WO2024258968A1 publication Critical patent/WO2024258968A1/fr
Priority to PCT/US2025/015839 priority Critical patent/WO2025175041A1/fr
Anticipated expiration legal-status Critical
Pending legal-status Critical Current

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Classifications

    • 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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0445—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors cannulated, e.g. with a longitudinal through-hole for passage of an instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
    • 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
    • A61F2002/0817—Structure of the anchor
    • A61F2002/0841—Longitudinal channel for insertion tool running through the whole tendon anchor, e.g. for accommodating bone drill, guidewire
    • 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

Definitions

  • the present technology is generally related to orthopedic implants broadly related to bone anchors, suture devices, and corresponding surgical tools for driving of an anchor or implant and facilitating the holding and tying of corresponding sutures.
  • suture anchor device In arthroscopic orthopedic surgery, it is often necessary to reattach soft tissue to a boney structure. This occurs frequently in the shoulder and other tissues. In these situations where soft tissue is being reattached to bone, it is useful to use a suture anchor device to make the necessary repair.
  • a suture anchor is typically placed into the bone and will not ordinarily pull out.
  • Such suture anchor typically has sutures of its own that can be used to effectively reattach and tie down soft tissue to the bone. This reattachment allows the soft tissue to eventually heal to the bone, and during the process of healing, the suture anchor holds the tissue stationary on the bone.
  • a suture anchor preferably resists gapping at the tissue bone interface and also resists cyclic loosening of the suture and the tissue from the bone.
  • Anchors can be made of metal, plastic, or absorbable plastics, and designs vary with respect to the number of sutures provided and with respect to whether or not such sutures are allowed to slide within the anchor.
  • suture anchors In the normal use of suture anchors, the sutures are passed through the tissue and then knots are tied which allow the anchor to be held into place.
  • a disadvantage can be that suture anchors are normally used for an arthroscopic situation where the anchor is being implanted into a joint where access is limited, and also, where fiber optic arthroscopic cameras are required for visualization by the surgeon. Tying knots in such circumstances can be laborious and time-consuming.
  • Knotless anchors have been introduced in the surgical device market. However, such anchors may have certain technical pitfalls which the present invention seeks to remedy.
  • the knotless anchors that have been produced to this point typically involve arthroscopically drilling a hole in a bone using a guide, removing the guide from that area, passing sutures through soft tissue. The surgeon must then re-find the hole and insert some sort of push-in anchor or screw-in anchor. As the anchor is screwed or pushed in, it varies as to how much tension is actually developed in the soft tissue. Certain joint geometries and locations make using these types of anchors difficult and/or less effective than desired. The process of drilling the hole and then having to re-find it after removing a specific guide (once the sutures have been passed through the tissue) is a technical difficulty for certain repair locations that have limited access. Additionally, using these types of anchors in certain locations can cause damage to adjacent tissue, which is undesirable.
  • an anchor design which eliminates the need to tie knots, and which provides internal cinching mechanisms would be desirable. Similarly, an anchor design which allows the tying of multiple sutures to adjacent patient tissue would be desirable.
  • the techniques of this disclosure generally relate to bone anchors and suture anchors that may be tightened and maintained at tension without requiring the surgeon to tie a knot.
  • the present disclosure provides for a two-part suture anchor substantially as described herein.
  • the present disclosure provides for a suture anchor including a unidirectional woven sleeve for maintaining tension on a suture.
  • the present disclosure provides for a suture anchor having a plurality of working sutures and at least one shuttle suture.
  • the present disclosure provides for a suture shell including a unidirectional woven sleeve for maintaining tension on a suture.
  • the present disclosure provides for a system including any one of the suture anchors disclosed herein and a corresponding driver having a hollow shaft in which a working suture and a shuttle suture may extend therethrough.
  • a handle of the driver includes a first spool for supporting a free end of the working suture and a second spool for supporting a free end of the shuttle suture.
  • the present invention includes, in one embodiment, an easily implantable suture anchor that is knotless, and that de-couples the angle of insertion of the anchor from the tissue passage step and also other steps of the conventional procedure.
  • the present invention anchor provides an internal locking mechanism, i.e., at least one unidirectional suture locking mechanism, configured such that: suture knots do not have to be tied; suture and tissue tension can be easily adjusted intraoperatively; and suture passage and tensioning can be done at a variety of positions and angles.
  • a surgeon would pass a first suture through the patient's tissue and then through a loop of a shuttle suture. The free end of a shuttle suture would then be pulled until the first suture next passes through an internal suture locking mechanism constructed in accordance with the present invention. Tension would be applied in the first suture until adequate tension is achieved with respect to the tissue, and then the internal locking member automatically engages and secures the first suture against further relative movement with respect to the anchor.
  • the desired tension is applied in the first suture with respect to the tissue, and then the other end of a line or suture, i.e., a “locking limb,” is pulled in the opposite direction until the internal locking mechanism locks the first suture in place.
  • a line or suture i.e., a “locking limb”
  • an anchor for implantation in tissue and for use in cooperation with a suture includes a body member and a cleat connected to the body member that moves between a locking position and an unlocking position.
  • the cleat engages the suture upon being in the locking position and generally fixes movement of the suture with respect to the body member.
  • the cleat substantially permits relative movement between the suture and the body member upon being in the unlocking position, and the cleat automatically moves from the unlocking position to the locking position upon the suture being drawn in a predetermined direction, wherein the anchor is secured to the tissue.
  • the apparatus further comprises a plurality of teeth being provided on the cleat for engaging the suture upon the cleat being in the locking position.
  • a further exemplary implementation includes an anchor for implantation in tissue and for use in cooperation with a suture, comprising a body member and a snap lock mechanism connected to the body member that moves between a locking position and an unlocking position.
  • the snap lock mechanism engages the suture upon being in the locking position and generally fixes movement of the suture with respect to the body member.
  • the snap lock mechanism substantially permits relative movement between the suture and the body member upon being in the unlocking position, and a line is connected to the snap lock mechanism that moves the snap lock mechanism from the unlocking position to the locking position upon the line being drawn in a predetermined direction, wherein the anchor is secured to the tissue.
  • the snap lock device is conically shaped.
  • the present invention also includes in an exemplary implementation a method for implantation of a suture anchor in tissue, comprising: providing a first suture; providing a shuttle suture; providing an internal suture locking mechanism having a suture lock; passing the first suture through the tissue and then through a loop of the shuttle suture; pulling the free end of a shuttle suture until the first suture next passes through the internal suture locking mechanism; applying tension in the first suture until desired tension is achieved with respect to the tissue; and allowing the suture lock to automatically engage and secure the first suture against relative movement with respect to the anchor.
  • an anchor for implantation in tissue includes a shell defining a passage and a first suture in the passage attached to the shell.
  • a longitudinally extending suture entwinement is provided in the passage, and a shuttle suture having a first end and a second end is provided, where the first end is configured to engage the first suture.
  • the shuttle suture passes in a first direction in the at least one passage and loops to pass in a second direction generally opposite to the first direction into and through the longitudinally extending suture entwinement, where, upon the first suture being received by the first end of the shuttle suture and the second end of the shuttle suture being pulled, the first suture first passes into the longitudinally extending suture entwinement, and the longitudinally extending suture entwinement locks the first suture to the anchor.
  • a method of the present invention may further comprise applying tension in the first suture with respect to the tissue from one end of the first suture, and through use of the other end of the first suture, pulling in the opposite direction until the suture lock locks the first suture against relative movement with respect to the anchor.
  • the anchor may further include a first passage and a second passage in the shell, with the longitudinally extending suture entwinement being proximate to the second passage, where the shuttle suture passing in a first direction in the at least one passage incudes the shuttle suture passing in the first passage and looping to pass into the second passage in the second direction into and through the longitudinally extending suture entwinement.
  • a partition defines the first passage and the second passage, and the partition defines a partition passage and a post, where the shuttle suture passes through the partition passage when the shuttle suture passes from the first passage to the second passage and where the first suture is tied to the post to attach the first suture to the shell, and may further include the shell defining a lateral passage in communication with at least one of the first passage, the second passage, and the partition passage and where the lateral passage is configured to allow access to the first suture sufficient for attaching, such as by tying, fusing, adhesion, etc., the first suture to the post.
  • an anchor for implantation in tissue and includes an elongated shell defining a passage and a partition defining a second passage generally perpendicularly intersecting the first passage and in communication with the exterior of the shell.
  • a first suture is provided in the first passage and attached to the partition, and a unidirectional suture locking mechanism is in the first passage.
  • a shuttle suture having a first end and a second end, where the first end is configured to engage the first suture, and where the shuttle suture passes in a first direction in the passage and looping to pass in a second direction generally opposite to the first direction into and through the unidirectional suture locking mechanism, such that upon the first suture being received by the first end of the shuttle suture and the second end of the shuttle suture being pulled, the first suture passes into the unidirectional suture locking mechanism, and the unidirectional suture locking mechanism locks the first suture to the anchor.
  • the unidirectional suture locking mechanism is a woven sleeve finger trap, noose and/or a pre-tied knot.
  • the unidirectional suture locking mechanism is a suture entwinement comprising the shuttle suture and at least one of the first suture, cord, ribbon, strip, strap, or the like, and an entwinement suture.
  • the shell includes a first end in communication with the first passage and the second passage and a second end opposite the first end and body member (which can be pivotable) is attached to the second end and defining a suture passage configured for receiving at least one of the first and shuttle sutures.
  • an anchor for implantation in tissue having a shell defining a passage, a first suture attached to the shell, a unidirectional suture locking mechanism in the passage comprising a plurality of generally opposing teeth configured to receive and engage the first suture and to allow the first suture to move in only one direction with respect to the unidirectional suture locking mechanism.
  • a shuttle suture having a first end and a second end is provided, with the first end being configured to engage the first suture, and the shuttle suture passes in a first direction in the passage and loops to pass in a second direction generally opposite to the first direction into and through the unidirectional suture locking mechanism, where, upon the first suture being received by the first end of the shuttle suture and the second end of the shuttle suture being pulled, the first suture passes into the unidirectional suture locking mechanism, and the unidirectional suture locking mechanism locks the first suture to the anchor.
  • the unidirectional suture locking mechanism may be configured to be insertable into the passage and to automatically couple with the shell upon achieving a predetermined location within the shell.
  • an anchor for implantation in tissue including an elongated woven shell, which may be a generally U-shape, and a passage.
  • a first suture passes through the passage the length of the elongated woven shell and has a first end, which may include a loop, and a second end, the first end being configured to engage with the second end (such as by passing through the loop) in a manner that attaches the first suture to the elongated woven shell.
  • a unidirectional suture locking mechanism is provided in the passage connected to the first suture, and a shuttle suture having a first end and a second end is provided, the first end being configured to engage the first suture, and the shuttle suture passes into and through the unidirectional suture locking mechanism, where upon the first suture being received by the first end of the shuttle suture and the second end of the shuttle suture being pulled, the first suture passes into the unidirectional suture locking mechanism, and the unidirectional suture locking mechanism locks the first suture to the anchor.
  • the shuttle suture passes in a first direction in the at least one passage and loops to pass in a second direction generally opposite to the first direction into and through the unidirectional suture locking mechanism.
  • the unidirectional suture locking mechanisms may include woven sleeves, elongated suture entwinements, Chinese finger trap type devices (a type of woven sleeves), pre-tied knots, and hangman nooses.
  • a further implementation may include providing a system including one or more of the anchors disclosed herein and a corresponding driver having a hollow shaft in which a first suture and a shuttle suture may extend therethrough, where a handle of the driver includes a first spool for supporting a free end of the first suture and a second spool for supporting a free end of the shuttle suture.
  • FIGS. 1 A-1EA illustrate a first embodiment of a suture anchor utilizing a first knotless mechanism for maintaining tension of a suture.
  • FIGS. IF- 1G illustrate a unidirectional woven sleeve that functions as a suture trap type mechanism for maintaining tension of a suture.
  • FIGS. 2A-2EA illustrate a second embodiment of a suture anchor utilizing a second knotless mechanism for maintaining tension of a suture.
  • FIGS. 3 A-3F illustrate a third embodiment of a suture anchor utilizing a third knotless mechanism for maintaining tension of a suture.
  • FIGS. 3G-3GC illustrate an alternate version of the third embodiment of a suture anchor utilizing a third knotless mechanism for maintaining tension of a suture.
  • FIGS. 4A-4DA illustrate a fourth embodiment of a suture anchor utilizing a two-part anchor and a knotless mechanism for maintaining tension of a suture.
  • FIGS. 5A-5CB illustrate a surgical tool for use with any of the suture anchor embodiments disclosed herein.
  • FIG. 6A illustrates a fifth embodiment of a suture anchor with fins utilizing a knotless mechanism for maintaining tension of a suture.
  • FIG. 6B illustrates a fifth embodiment of a suture anchor with threads utilizing a knotless mechanism for maintaining tension of a suture.
  • FIGS. 6C-6DA are production drawings of the embodiment of FIG. 6 A.
  • FIGS. 6E-6FA are production drawings of the embodiment of FIG. 6B.
  • FIGS. 7A-7B illustrate a sixth embodiment of a suture anchor utilizing a knotless mechanism for maintaining tension of a suture.
  • FIGS. 7C-7DA are production drawings of the embodiment of FIGS. 7A-7B.
  • FIGS. 8A-8BA illustrates a seventh embodiment of a suture anchor including an insertable suture shell utilizing a knotless mechanism for maintain tension of a suture.
  • FIG. 9 is a perspective view, with parts cut away, of a knotless suture anchor with an internal suture locking mechanism constructed in accordance with the present invention.
  • FIG. 10 is a perspective view, with parts cut away, of an alternate embodiment of a knotless suture anchor with an internal suture locking mechanism constructed in accordance with the present invention.
  • FIG. 11 is a plan view of a knotless suture anchor with an internal suture locking mechanism constructed in accordance with the present invention.
  • FIG. 12 is a sectional view of an alternate embodiment of a knotless suture anchor with an internal suture locking mechanism constructed in accordance with the present invention.
  • Embodiments of the present disclosure relate generally, for example, to orthopedic implants, bone anchors, suture devices, and corresponding surgical tools for use in an orthopedic surgery.
  • Embodiments of the devices and corresponding methods of use are described below with reference to the Figures.
  • Components of the disclosed embodiments can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics, and bone material and/or their composites.
  • the components individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL®), ceramics and composites thereof such as calcium phosphate, thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers
  • FIG. 1 A - FIG. 8B illustrate various embodiments of surgical tools and a suture anchors (i.e., a bone anchor adapted for use with a suture) and various types of knotless weaves, mechanisms, structures, etc. that capture a working suture to maintain a tension on the suture.
  • a suture anchors i.e., a bone anchor adapted for use with a suture
  • various types of knotless weaves, mechanisms, structures, etc. that capture a working suture to maintain a tension on the suture.
  • Various embodiments may also have the advantage of allowing a surgeon to tighten a suture without requiring the surgeon to tie a knot to maintain tension on the suture.
  • a working suture and a shuttle suture may be used in a cooperative way such that the working suture is attached to adjacent patient tissue and the shuttle suture pulls the working suture towards a bone anchor to a desired tension.
  • the capture means In pulling the working suture the capture means (knotless weaves, mechanisms, structures, etc.) allow the working suture to travel forward in a first direction while preventing the working suture from traveling back in an opposite direction.
  • the various suture capture means disclosed herein may be referred to as “unidirectional” or “knotless” in that they automatically maintain a tension on a working suture. More detailed examples of the various ways the objects of this disclosure may be implemented are discussed below with reference to the detailed figures.
  • FIGS. 1 A-1EA illustrate a first embodiment of a suture anchor 100 utilizing a first knotless mechanism for maintaining tension of a suture.
  • a suture anchor includes a plurality of ridges 10 sequentially disposed along an outside circumference of the anchor 100.
  • the ridges may facilitate and/or be configured to allow the suture anchor 100 to be tapped into an aperture or hole in boney anatomy. For example, a surgeon may tap the anchor 100 into a pre-existing hole in boney anatomy and the anchor 100 may be held in place by a friction fit.
  • the suture anchor 100 may include a central longitudinal passageway 16 extending from a top of the suture anchor towards a bottom of the suture anchor (i.e., a proximal end for receiving a drive tool to a distal end / leading end that is inserted into boney anatomy).
  • the suture anchor 100 may include a first lateral passageway 12 separated from a second lateral passageway 14 by a block 15 which closes or terminates the longitudinal passageway 16.
  • the first lateral passageway 12 may extend through the side of the suture anchor 100 thereby communicating with the central longitudinal passageway 16.
  • the second lateral passageway 14 may extend through the side of the suture anchor 100.
  • FIG. 1C illustrates a working suture 1 having an open end 1 A (or free end 1 A) and a looped end IB.
  • the open, or free, end 1 A may have a hook or needle to puncture through adjacent tissue (not illustrated) and the looped end IB may be integrally formed with the working suture 1 during manufacture or tied by hand in advance of performing a surgery.
  • a shuttle suture 2 may have an open, or free, end 2A and a looped end 2B. In this embodiment, both ends of the shuttle suture 2 are free, e.g., the shuttle suture is not secured to the bone anchor 100 like the working suture 1 is.
  • the working suture 1 is secured at the looped end IB to the block portion 15 by passing through the longitudinal passageway 16 and looped around the block structure 15 through the first lateral passageway 12 and second lateral passageway 14.
  • a surgeon may pass a hook or other piercing structure (not illustrated) attached to the open end 1 A of the working suture 1 through adjacent patient tissue at least once, although often several times.
  • the surgeon may pull on the open end 1 A of the working suture 1 to pull the attached and adjacent patient tissue closer to the anchor 100.
  • the surgeon may loop the open end 1 A of the working suture through the looped end 2B of the shuttle suture and/or attach the working suture 1 open end 1 A to the shuttle suture 2 looped end 2B.
  • shuttle suture open end 2A upwards (arrow 3) and away from longitudinal passageway 16.
  • looped end 2B of the shuttle suture 2 and the open end 1 A of the working suture are pulled downward (arrow 4) into the passageway 16 (at least marginally).
  • shuttle suture 2 has been preloaded through a unidirectional suture locking mechanism, such as through and internal passage of a unidirectional woven sleeve 200 (see FIGS.
  • the internal passage is configured to only allow passage of one or more sutures in a first predetermined direction and attempts to pull one or more of the sutures in a second direction opposing the first direction causes fibers, yams and/or other elements within the internal passage to engage, grip and restrain the one or more sutures from movement in the second direction.
  • the working suture 1 is allowed to move in one direction only, in that attempting to pull working suture 1 in the other direction would cause a tightening process, whereby unidirectional woven sleeve 200 engages and grips working suture to substantially prevent the pulling of working suture 1 in the other direction.
  • the working suture 1 may only move in one direction due to the unidirectional woven sleeve 200 (see FIGS. 1F-1G) which functions similarly to a Chinese finger trap.
  • the surgeon pulls on the shuttle suture 2 the working suture 1 pulls the adjacent tissue closer to the bone anchor 100 and maintains the tension to the working suture by binding or cinching together. As shown in FIGS.
  • the unidirectional woven sleeve 200 may be integrally woven onto a side portion of working suture 1.
  • a cinching function binding function
  • the interior diameter of the woven sleeve may, in effect, decrease and compress against the working suture 1 thereby capturing the working suture 1 in place, i.e., substantially refraining the pulling of the working suture in a direction opposite the direction in which the shuttle suture 2 pulls the working suture 1.
  • the internal passage can be similar to the unidirectional woven sleeve 200 discussed above, in that it only allows passage of sutures in one predetermined direction and attempts to pull one or more sutures in a second direction opposing such predetermined direction causes fibers, yams, or other elements within the internal passage to engage, grip and restrain the one or more sutures from movement in the second direction.
  • FIGS. 1D-1EA are production drawings which show the suture anchor 100 from alternate perspectives, where FIG. IDA is a plan view, FIG. 1DB is an elevational view, and FIGS. 1DC and 1DD are sectional views of anchor 100 (taken along the arrows shown in FIG. IDA), FIG. IDE is a perspective view of anchor 100, and FIG. 1EA is a sectional view taken in the direction of the arrows in FIG. IE.
  • the particular dimensions shown in these drawings are example in nature only, i.e., relative dimensions may be adjusted.
  • FIGS. 2A-2EA illustrate a second embodiment of a suture anchor 101 utilizing a second knotless mechanism for maintaining tension of a suture.
  • Suture anchor 101 may include the same, similar, or substantially the same features and functionality as explained above with respect to suture anchor 100. Accordingly, duplicative description will be omitted and like numbering of parts will be maintained where possible.
  • anchor 101 may include a thread pattern for rotatably screwing the anchor 101 into boney anatomy of a patient.
  • Anchor 101 may also include a central passageway 16 including a lateral passageway 12 that passes through the central longitudinal passageway 16.
  • a first partition or block 22 may be disposed above the lateral passageway 21 (which may be configured to allow access to the working suture 1 sufficient for tying such suture 1 to the post, or block 23) and a second block 23 may be disposed beneath the lateral passage or passageway 21.
  • the working suture 1 may be secured to the anchor 101 by being passed down through passageway 16 and anchored to the second block 23 by a double pass looped end IB.
  • One of the ends of the shuttle suture may extend upwards through the passageway 16 without being woven around the shuttle suture 2 while the other end of the working suture may be coiled around the coils of the shuttle suture to form a unidirectional suture locking mechanism, such as a longitudinally extending suture entwinement which may include a noose like configuration 201, and could also include a knot. As shown in FIGS.
  • the unidirectional suture locking mechanism 201 includes working suture 2 and shuttle suture 2 being intertwined, or enmeshed, with one another, but it is to be understood, however, that other unidirectional suture locking configurations could be used, including without limitation, Chinese finger trap type devices, pre-tied knots, and hangman nooses.
  • the number of coils may vary from about 3 to about 9 depending on the type of suture material. In at least one embodiment, the number of coils may range from about 4-5 coils of the working suture 1 around the shuttle suture 2.
  • at least one or both of the sutures 1, 2 may be circle like or oval like in cross section and in other embodiments at least one or both of the sutures 1, 2 may be ribbon like.
  • the shuttle suture 2 may optionally pierce the working suture 1 at a piercing location 25.
  • the elongated, or longitudinally extending, suture entwinement 201 may include a double helix formation comprising the shuttle suture 2 and a first portion of the first suture 1 and/or a separate entwinement suture apart from working suture 1, if desired.
  • entwinement suture may include use of a suture, cord, string, cable, rope, strand, wire, strap, ribbon, or the like.
  • a surgeon may loop the open end 1 A of the working suture through the looped end 2B of the shuttle suture and/or attach the working suture 1 open end 1 A to the shuttle suture 2 looped end 2B. Thereafter, the surgeon may pull the shuttle suture open end 2A upwards and away (arrow 3) from longitudinal passageway 16. In doing so the looped end 2B of the shuttle suture 2 and the open end 1 A of the working suture are pulled downward (arrow 4) into the passageway 16 (at least marginally). Given the free end 2A shuttle suture 2 has been preloaded through the noose like knot 201 (see FIG.
  • FIGS. 2D-2EA are production drawings which show the suture anchor 101 from alternate perspectives, where FIG. 2DA is a plan view, FIG. 2DB is a sectional view of anchor 101 (taken along the arrows shown in FIG. 2D A); and FIG. 2DC is a perspective view of anchor 101.
  • FIGS. 2D-2EA are production drawings which show the suture anchor 101 from alternate perspectives, where FIG. 2DA is a plan view, FIG. 2DB is a sectional view of anchor 101 (taken along the arrows shown in FIG. 2D A); and FIG. 2DC is a perspective view of anchor 101.
  • the particular dimensions shown in these drawings and the corresponding commentary are example in nature only, i.e., relative dimensions may be adjusted.
  • FIGS. 3A-3FA illustrate a third embodiment of a suture anchor 102 utilizing a third knotless mechanism for maintaining tension of a suture
  • FIG. 3F is a sectional view of anchor 102 taken in the direction of the arrows in FIG. 3FA.
  • Suture anchor 102 may include the same, similar, or substantially the same features and functionality as explained above with respect to suture anchors 100 andlOl. Accordingly, duplicative description will be omitted and like numbering of parts will be maintained where possible.
  • anchor 102 may include a thread pattern for rotatably screwing the anchor 102 into boney anatomy of a patient.
  • Anchor 102 may also include a central passageway 16 including an anchoring block 33 for securing a working suture 1 thereto.
  • Working suture 1 may be secured to or integrally formed with anchoring block 33, e.g., working suture 1 may be secured by a knot (see FIG. 3E) at a lowermost end thereof or adhered by epoxy or the like.
  • anchoring block 33 may include a central passageway for passing working suture 1 therethrough.
  • Anchoring block 33 may include at least one tooth like protrusion 34 that extends at an angle away from anchoring block 33 in the longitudinal passageway 16.
  • the tooth like protrusions 34 may extend towards the adjacent tooth like protrusions 35 formed on an interior sidewall of anchor 102.
  • the generally opposing teeth like protrusions 34, 35 may form a unidirectional suture locking mechanism, namely, a securing structure 202’ that may allow the shuttle suture 2 to be pulled therethrough between the adjacent corresponding teeth in a single direction while binding the shuttle suture 2 and preventing it from being pulled out in the opposing direction.
  • the working suture 1 may be secured to the anchor 102 via the anchoring block 33 at fixed end IB. In this way, the working suture 1 may extend out of passageway 16.
  • the shuttle suture 2 may extend down through passageway 16 and underneath the anchoring block 33 and be passed back upwards between the teeth like protrusions 34, 35 of the unidirectional securing structure 202’.
  • 101 a surgeon may loop the open end 1 A of the working suture through the looped end 2B of the shuttle suture and/or attach the working suture 1 open end 1 A to the shuttle suture 2 looped end 2B.
  • the ratchet teeth like protrusions are disposed directly adjacent to one another on opposing surfaces, e.g., they may be diametrically opposed.
  • the ratchet teeth like protrusions 34, 35 are offset from one another.
  • Ratchet teeth like protrusions 34 may be arranged like a helix or spiral winding up and coiled around the corresponding surfaces of the block 33.
  • the ratchet teeth like protrusions 35 may be arranged like a helix or spiral winding up and coiled around the corresponding sidewall surface of passageway 16.
  • the helix pattern of ratchet teeth like protrusions 34, 35 may form a unidirectional securing structure 203 having helically oriented teeth like protrusions.
  • a method of operation of this type of securing structure 203 may be the same or substantially the same as explained above with respect to securing structure 202’.
  • FIGS. 3D-3FA are production drawings which show the suture anchor 102 from alternate perspectives where FIG. 3DA is a plan view, FIG. 3D is a sectional view of anchor 102 (taken along the arrows shown in FIG. 3DA), FIG. 3DB is a detail view taken from FIG. 3D, and FIG. 3DC is a perspective view of anchor 102.
  • FIG. 3DA is a plan view
  • FIG. 3D is a sectional view of anchor 102 (taken along the arrows shown in FIG. 3DA)
  • FIG. 3DB is a detail view taken from FIG. 3D
  • FIG. 3DC is a perspective view of anchor 102.
  • the particular dimensions shown in these drawings and the corresponding commentary are example in nature only, i.e., relative dimensions may be adjusted.
  • FIGS. 3G-3GC are a production drawings which show an alternate version of the suture anchor 102, where FIG. 3GA is a plan view of anchor 102, FIG. 3G is a sectional view of anchor 102 (taken along the arrows shown in FIG. 3GA), FIG. 3GB is a detail view taken from FIG. 3G, and FIG. 3GC is a perspective view of anchor 102.
  • the particular dimensions shown in these drawings and the corresponding commentary are example in nature only, i.e., relative dimensions may be adjusted.
  • teeth 34, 35 are altematingly offset vertically with respect to one another (in the orientation of FIG. 3G) such that shuttle suture 2 and working suture 1 follow essentially a serpentine path through securing structure 203.
  • FIGS. 4A-4DA illustrate a fourth embodiment of a suture anchor 103 utilizing a two-part anchor and a unidirectional suture locking mechanism, namely, a knotless mechanism 204 for maintaining tension of a suture.
  • Suture anchor 103 may include the same, similar, or substantially the same features and functionality as explained above with respect to suture anchors 100, 101, 102. Accordingly, duplicative description will be omitted and like numbering of parts will be maintained where possible.
  • Anchor 103 may be a two-part anchoring system in which a first component 49 (FIGS. 4 A and 4B) may be configured for anchoring to boney anatomy of a patient and a second component 40 may be disposed within a central passageway 16 of first component 49.
  • first component 49 may include a thread pattern for rotatably screwing the two-part anchor 103 into boney anatomy of a patient. Consistent with the disclosure and inventive spirit herein thread pattern may be substituted for a tap in style anchoring means.
  • First component 40 may be configured to be inserted inside of a central passageway 16 of second component 49.
  • the first component 40 may include an anchor point for securing a working suture 1 thereto.
  • Working suture 1 may be secured to or integrally formed with the first component 40, e.g., working suture 1 may be secured by a knot, adhered by epoxy, interference fit, thermal or ultrasonic welding, or by some other fixation technique.
  • first component 40 may include a central passageway for passing working suture 1 therethrough to secure working suture 1 to the first component 40.
  • the first component 40 may include at least one tooth like protrusion 42 that extends outward at an angle.
  • the teeth like protrusions 42 may extend away at an angle of about 30 degrees to 60 degrees from the longitudinal extension direction of the first component 40.
  • the tooth like protrusions 42 (FIGS. 4AA and 4BA) may extend upwards and through the windows 41 (aperture or opening) extending through a sidewall of second component 49.
  • FIGS. 4C-4D where FIG. 4C is a sectional view of anchor 103 taken along the arrows show in a plan view of anchor 103 in FIG 4CA, and where the teeth like protrusions 42 of the first component may extend upwards and be seated within the windows 41.
  • First component 40 may also include a passageway 45 for passing of the shuttle suture 2 therethrough as will be explained in further detail below.
  • FIG. 4D where FIG. 4D is a sectional view of anchor 103 taken along the arrows show in a plan view of anchor 103 in FIG 4DA, and where the working suture 1 may be secured to the first component 40 at fixed end IB. In this way, the working suture 1 may extend out of passageway 16.
  • the shuttle suture 2 may extend down through passageway 16 and through shuttle passageway 45 of the first component 40 and be passed back upwards between the teeth like protrusions 42 and windows 41 of the unidirectional securing structure 204.
  • a surgeon may loop the open end 1 A of the working suture through the looped end 2B of the shuttle suture and/or attach the working suture 1 open end 1 A to the shuttle suture 2 looped end 2B. Thereafter, the surgeon may pull the shuttle suture open end 2A upwards and away (arrow 3) from longitudinal passageway 16. In doing so the looped end 2B of the shuttle suture 2 and the open end 1 A of the working suture are pulled downward (arrow 4) into the passageway 16 (at least marginally). Given the free end 2A shuttle suture 2 has been preloaded through the unidirectional securing structure 204 (see FIG.
  • shuttle suture 2 continued pulling of shuttle suture 2 upwardly (in the orientation of suture anchor 103 shown in FIG. 4D) eventually draws both shuttle suture looped end 2B and working suture 1 downwardly and around the bottom end of first component 40 and then upwardly through, in serpentine fashion, through the interfaces of teeth 42 and windows 41 of the unidirectional securing structure 204, and still further upward pulling of shuttle suture 2 causes shuttle suture 2 to exit the unidirectional securing structure 204, with working suture 1 passing by itself through the unidirectional securing structure 204.
  • First component 40 may be configured to be insertable into the passageway 16 and to automatically couple, such as by a snap or interference fit, with the anchor, or shell, upon achieving a predetermined location within the shell.
  • FIGS. 5A-5CB illustrate a surgical tool 104 for use with any of the suture anchor embodiments disclosed herein, where FIGS. 5AB and 5CA are sectional views of surgical tool 104 (and FIG. 5 AC is a detail view taken from FIG. 5 AB, and FIG. 5CB is a detail view taken from FIG 5CA), and FIG. 5AA is a plan view with a detail of the top of surgical tool 104.
  • the surgical tool 104 may be used for driving any of the various anchor structures 100, 101, 102, 103, etc. disclosed herein.
  • the surgical tool 104 may be used as a complete pre-arranged system, kit, sterile pack, etc., in which any of the various anchor structures disclosed herein, including the working suture 1, and shuttle suture 2, are pre-attached and the ends thereof are attached to the outside of the surgical tool 104.
  • Surgical tool 104 may include a handle 55 attached to a hollow drive shaft 50.
  • An end of the hollow drive shaft 50 may include a shoulder 51 to provide a stop surface against the top of a corresponding suture anchor 100, 101, 102, 103, etc.
  • the hollow drive shaft 50 and handle 55 may also form a central passageway 56 for passing the working suture 1 and shuttle suture 2 therethrough. In this way, the sutures 1, 2 may pass through the hollow shaft 50 and out of the handle 55.
  • the outside of the handle 55 may include a first mounting spool 52 for coiling the slack of the working suture 1 and a second mounting spool 53 for coiling the slack of shuttle suture 2.
  • the free ends of the working suture 1 and shuttle suture 2 may be coiled around the corresponding mounting spools 52, 53.
  • the working suture 1 and shuttle suture 2 may extend from the suture anchor 100, up through the hollow shaft 50 of the surgical tool through passageway 56 and then be coiled or spooled around the spools 52, 53.
  • FIG. 6A illustrates a fifth embodiment of a suture anchor, namely suture anchor 05.
  • Suture anchor 105 may include the same, similar, or substantially the same features and components as explained previously.
  • suture anchor 105 may include a pivotable first component, or body member, 60 having a passageway 61 in which a corresponding first working suture 1 and first shuttle suture 2 may be passed therethrough.
  • the second component 65 may be the same as, similar too, or substantially the same as any of the relevant anchoring sutures 100, 101, 102, 103, etc. disclosed herein.
  • the second component 65 may include a unidirectional woven sleeve 202 or the like, although it is to be understood that a variety of unidirectional suture locking configurations could be used instead of or in addition to woven sleeve 202, including without limitation, elongated suture entwinements, Chinese finger trap type devices (a type of woven sleeves), pre-tied knots, and hangman nooses.
  • the example suture anchor 105 is configured to provide tension to a first working suture and a second working suture.
  • the first component 60 may be configured to provide and maintain tension to a first working suture 1
  • the second component 65 may be configured to provide and maintain tension to a second working suture 1.
  • a surgeon may first create a corresponding hole in bone by utilizing a drill. Thereafter, the surgeon may attach the first working suture 1 to adjacent soft tissue of a patient as explained previously. The first component 60 may be pushed down into the hole to a first initial depth to retain the first component 60 in place. Once the first component 60 is positioned in place (or sometime before) the surgeon may attach the second working suture 1 to a different location or different soft tissue of the patient. These steps may be performed out of order, e.g., the surgeon need not always position the first component 60 within the hole in honey anatomy first, e.g., they may be secured simultaneously.
  • the suture anchor 105 may be rotatably driven into the pre-existing hole of a corresponding diameter to secure and maintain the tension of the first working suture 1.
  • the first working suture is tensioned by a friction fit against the side surfaces of the boney anatomy.
  • the surgeon may tension the second working suture 1 as explained previously with respect to suture anchor 100.
  • the free end 2 A of the shuttle suture 2 such that the unidirectional woven sleeve 202, or other unidirectional suture locking mechanism as discussed or contemplated herein, will maintain tension on the second working suture.
  • FIG. 6B illustrates a variation of the embodiment shown in FIG. 6A.
  • suture anchor 106 may include the same, similar, or substantially the same components and functionality as previously explained above with respect to suture anchor 105.
  • suture anchor 106 may include a plurality of fins 10 to enable this anchor to be tapped into boney anatomy rather than rotatably driven into boney anatomy.
  • FIGS. 6C-6DA are production drawings of the embodiment of FIG. 6 A, where FIG. 6C is a sectional view of anchor 105 taken along the arrows shown in plan view FIG. 6CA, FIG. 6CB is an elevational view of suture anchor 105, FIG. 6CC is a perspective view of anchor 106, and FIG. 6D is a sectional view taken in the direction of the arrows in plan view FIG. 6DA.
  • FIGS. 6E-6FA are production drawings of the embodiment of FIG. 6B, where FIG. 6EB is a sectional view of anchor 106 taken in the direction of the arrows shown in plan view FIG. 6EA, FIG. 6E is an elevational view of suture anchor 106, FIG. 6EC is a perspective view of anchor 106, and FIG. 6F is a sectional view of anchor 106 taken in the direction of the arrows in FIG. 6FA.
  • FIGS. 7A-7B illustrate a sixth embodiment of a suture anchor 107.
  • Suture anchor 107 may include the same, similar, and or substantially the same features and functionality as explained previously.
  • Suture anchor 107 may include a first component 71 that may be the same as or similar to any of the earlier explained suture anchor embodiments, e.g., 100, 101, 102, 103.
  • First component 71 may include at least one working suture 1 and shuttle suture 2.
  • Some embodiments may include a plurality of working sutures 1 and shuttle sutures 2.
  • the working suture(s) 1 and shuttle sutures (2) may extend upwards through a corresponding passageway (not labeled), up through a sheath or sleeve that may protect the suture(s) during the installation thereof.
  • FIG. 7B is an enlarged view of first portion 71 with example commentary and explanation of parts.
  • Suture anchor 107 also includes one or more unidirectional suture locking mechanisms (not shown) as discussed or contemplated herein.
  • FIGS. 7C-7DA are production drawings of the embodiment of FIGS. 7A-7B, where FIG. 7CB is a sectional view taken in the direction of the arrows in plan view FIG. 7CA of anchor 107, FIG. 7C is an elevational view of anchor 107, and FIG.
  • FIGS. 8A-8BA illustrate a seventh embodiment of an insertable flexible tubular suture shell 108, which could be constructed of woven suture or other material and which itself forms a unidirectional suture locking mechanism, i.e., a knotless mechanism for maintain tension of a suture.
  • Suture shell 108 is, in contrast to the generally rigid anchors, or “shells,” 100, 101, 102, 105, 107, and 107 discussed above, is pliable and manipulatable in form.
  • a tool which may take the general shape of a fork, and in particular, a pickle fork 80, may be used to push a suture shell 81 down into a pre-existing hole in boney anatomy of a patient.
  • the suture shell 81 may bunch or ball up, i.e., wrinkle or fold, or “scrunch up”, etc., to expand and bind itself via an interference fit and form a U-shape in the pre-existing hole, while still maintaining an internal passage sufficient to carry multiple sutures.
  • the outside surface of the suture shell 81 may be a high friction surface that is useful for retaining the suture shell 81 within the pre-existing hole by a friction fit.
  • the internal passage is configured to only allow passage of one or more sutures in a first predetermined direction, and attempts to pull one or more of the sutures in a second direction opposing the first direction causes fibers, yarns and/or other elements within the internal passage to engage, grip and restrain the one or more sutures from movement in the second direction.
  • the working suture 1 and shuttle suture 2 may be passed through a central passageway 16 of the shuttle suture 81 as illustrated. [0084] With the suture shell 81 in place, a surgeon may tighten the working suture 1 similarly as explained above.
  • a surgeon may loop the open end 1 A of the working suture through the looped end 2B of the shuttle suture and/or attach the working suture 1 open end 1 A to the shuttle suture 2 looped end 2B. Thereafter, the surgeon may pull the shuttle suture open end 2 A upwards and away from a passageway 16 extending through the suture shell 81. In doing so the looped end 2B of the shuttle suture 2 and the open end 1 A of the working suture are pulled downward into the passageway 16 (at least marginally). Given the free end 2A of shuttle suture 2 has been preloaded through the suture shell 81 (see FIG. 4D), continued pulling of shuttle suture 2 upwardly (in the orientation of suture anchor 103 shown in FIG.
  • FIGS. 9-12 additional embodiments of a knotless suture anchor (also referred to herein as “suture anchor” and as simply “anchor”) with an internal suture locking mechanism of the present disclosure is indicated generally in FIGS. 9- 12by reference character 1010.
  • suture anchor 1010 includes a shell, generally 1012, which may be similar to conventional suture anchors.
  • Shell 1012 may include, in one preferred embodiment, a screw-in portion 1014 having threaded portions 1016 and/or a tap-in configuration (not shown) with either barbs or threads, based on whether anchor 10 is to be tapped in or screwed into the bone, generally B.
  • Body member, or shell, 1012 may be constructed of a non-absorbable plastic polymer, bioabsorbable plastic polymer, metal, or some other suitable and implantable material.
  • An internal mechanism, generally 1020, of anchor 1010 may include one or more high-strength braided nylon sutures, generally 1022, with one end of such suture 1022 being fixed, as shown in FIGS. 9 and 10, in an elongated passage 1033 a, which extends generally parallel to an elongated passage 1033b, oth passages 1033a, 1033b being defined by a guide 1034 in the body, generally 1024, of anchor 10.
  • Such fixation of suture 1022 to body 1024 can be done in various ways.
  • One way includes actually fusing suture 1022 to a polymer portion of body 1024.
  • Other ways may include using some sort of post, such as post 2108, about which suture 1022 can be securely looped around and tied within anchor 1010.
  • anchor 1010 may also include, in one preferred embodiment, a heavy monofilament nylon shuttle suture, generally 1030, placed in anchor 10.
  • Shuttle suture 1030 has two free ends, one having a suture loop 32 which provides a shuttle through anchor 1010 once the loop 1032 has been passed through tissue (not shown).
  • internal locking mechanism 1020 then allows both the suture shuttle and the braided nylon suture 1022 (which passes through loop 1032 of shuttle suture 1030) to be pulled through anchor 1010 in a unidirectional fashion, with internal locking mechanism 1020 cinching suture 1022 by acting as an internal locking cleat 1023, wherein suture 1022 can pass one way but not the other.
  • shuttle suture 1030 As the free end of shuttle suture 1030 is gradually pulled, it initially passes through internal locking mechanism 1020, but eventually, with continued pulling of shuttle suture 1030, suture 1022 passes into passage 1033b and through internal locking mechanism 1020 to ultimately cinch the tissue down (the tension may be adjusted in the tissue tension “rolling” tissue in either direction), such that the tissue is pulled down to the bone B in and/or near the suture anchor 1010.
  • This allows re-approximation of the attachment of the tissue to the bone and allows adjustment of the tension both within suture 1022, and thus also the tissue to attach itself to bone B.
  • Internal locking mechanism 1020 can be of various configurations, and the present disclosure is not to be limited to the mechanisms disclosed and/or shown herein. Multiple other internal locking mechanisms could be used in anchor 1010, and the internal locking mechanisms disclosed and/or shown herein are for illustrative purposes and are not intended to limit the scope of the internal mechanisms that could be used in connection with anchor 1010.
  • One variation of internal locking mechanism 1020 could be a series of opposing resilient, directional barbs, or teeth, 1020a which allow suture 1022 to be pulled in between teeth 1020a in only one, i.e., a “first” direction.
  • An attempt to pull suture 1022 in the other (“second”) direction would cause the teeth 1020 a to engage and hold suture 1022 against further movement in the second direction.
  • teeth 1020a would release suture 1022 to allow suture 1022 to again be pulled in the first direction.
  • Internal locking mechanism 1020 thus allows passage of sutures 1030, 1022 in one direction, but not in the opposite direction.
  • internal locking mechanism 1020 could be an internal pretied locking knot, such as a hangman's noose knot 1036 adjacent a projection 1037 along a sidewall 1033b' of passage 1033b, as shown in FIG. 10.
  • shuttle suture 30 passes downwardly in passage 1033b in a first direction and then reverses direction before passing upwardly into and through knot 1036.
  • Still another variation could be a woven suture inside a suture anchor which once again allows uni -directional passage of the braided nylon suture.
  • This could be a configuration similar to a Chinese finger trap type of device, which tightens against the suture moving in a predetermined direction.
  • Conical snap locking mechanism generally 1041, includes a generally conical member 1042 which is biased by weight and/or spring force towards a seat 1044.
  • a strap, cable, line, or the like could be used to prevent member 1042 from falling out of anchor 1010'.
  • Suture 1022 may pass in a first direction whereby member 1042 is caused to be lifted slightly above seat 1044, to thereby form a passage for suture 1022.
  • suture 1022 is pulled in the other (“second”) direction, however, member 1042 automatically moves downwardly, with neck portion 1046 ultimately seating in a snap-fit, interference-fit arrangement with respect to seat 1044 and engages suture 1022 and fixes it against movement in the second direction.
  • the surgeon would pass suture 1022 through the patient's tissue and then load suture 1022 in and through loop 1032. The free end of shuttle suture 30 would then be pulled until suture 1022 (moving in the first direction) passes through anchor 10.
  • Tension would be applied in suture 1022 until adequate tension is achieved, and then the other free end of a second, line or suture, 1050, the “locking limb,” which has its other end connected to member 1042, is pulled in the second direction until the conical snap locking mechanism 1041 locks suture 1022 in place. Excess suture extending outwardly from the tissue is then cut and removed.
  • cam mechanism could be provides that flips back to lock upon itself in the event suture is pulled in reverse fashion.
  • anchor 1010 of the present disclosure anchor 1010 could be placed percutaneously through a 3 or 4 mm hole, and then the surgeon would have the freedom to pass the suture through tissue in a variety of other angles within the shoulder. This would likely minimize damage to the adjacent tissue, particularly with respect to the rotator cuff noted in the example above. Labral repair is but one application of the present disclosure. Anchor 1010 could also be used in other repairs, such as rotator cuff repair in the shoulder, biceps tenodesis, and a myriad of other procedures in the shoulder and elsewhere. Anchor 1010 could be used in any other joint in the body in which suture anchor placement is required for soft tissue fixation to bone.
  • anchor 1010 provides a versatile device which could be used in the shoulder, in particular, and for numerous other applications in the musculoskeletal system to facilitate soft tissue fixation to bone, with minimal suture damage.
  • the present disclosure may find particular applications in procedures involving the: shoulder (labrum, rotator cuff, biceps tenodesis, etc.); knee (backup hamstring fixation, MCL/LCL reconstruction, ligament avulsions, etc.); elbow (UCL/LUCL reconstruction, biceps, etc.); foot and ankle; and wrist.
  • the present disclosure also provides a lower profile by eliminating prominent knots on articulating surfaces.
  • aspects of the present disclosure may include a braided nylon suture with one end fixed to an anchor, a heavy monofilament nylon suture shuttle, internal locking mechanisms with multiple variations, and a simplified methodology of how a knotless suture anchor with an internal suture locking mechanism may be constructed in accordance with the present disclosure might be inserted and used. Also disclosed is a simplified technique for insertion and use of an anchor of the present disclosure. For example, in methods disclosed herein, suture 1022 can be single or double loaded as applicable.
  • Anchors 1010, 1010' can be produced in various diameters, including without limitation, diameters between approximately 2 and 6 millimeters.
  • the present disclosure thus provides, among other things, the potential of decreased surgical time, increased surgical accuracy, a decreased dependence on knottying and loosening, lower profile by eliminating prominent knots on articulating surfaces.
  • the knotless anchor of the present disclosure may be inserted through drilling cannula (which reduces the likelihood of losing the hole), and a “normal” suture passage may be used.
  • tissue tension may be adjusted by “rolling” tissue in either direction. This can thus address problems which may occur with current anchor designs, such as losing the hole in the methodology where a hole is drilled, and the devise is removed. Then, the hole must be relocated. This can pose particular difficulty in relation to the lower glenoid quadrants.
  • the angle of insertion of such a conventional anchor may be married to a working portal. Moreover, with such designs, it may be difficult to manipulate tissue as a suture is tensioned.
  • anchor 1010 may include a standard tap-in or screw-in insertion that permits drilling and insertion through the same cannula, which may be 3.0 to 4.5 mm cannula, and as noted above, the anchor may be single or double loaded.
  • Anchor 1010 may include suture 1022 being a wire fixed on one end in the anchor and with a free end.
  • a heavy nylon suture shuttle may be preloaded, and an internal locking mechanism may include a cleat, a locking knot, and a Chinese finger trap type device.
  • Other variations of the present disclosure could include a Chinese finger trap type device including a suture-in suture with unidirectional tensioning, an internal cam, and a second suture to lock a pre-tied knot when adequate tension has been obtained.

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Abstract

L'invention concerne un ancrage de suture sans nœud apte à être implanté qui dissocie l'angle d'insertion de l'ancrage de l'étape de passage de tissu et d'autres étapes d'interventions classiques. Un ancrage comprend un mécanisme de verrouillage interne conçu de telle sorte que : des nœuds de suture n'ont pas besoin d'être noués ; une tension de suture et de tissu peut être facilement ajustée de façon peropératoire ; et un passage et une mise sous tension de suture peuvent être réalisés à une diversité de positions et d'angles. Un procédé comprend : le passage d'une première suture à travers un tissu du patient, puis à travers une boucle d'une navette de suture ; le tirage de l'extrémité ouverte de la navette de suture jusqu'à ce que la première suture passe à travers un mécanisme de verrouillage de suture interne ; l'application d'une tension dans la première suture jusqu'à ce qu'une tension appropriée soit atteinte par rapport au tissu ; la prise de façon automatique d'un élément de verrouillage interne ; et la fixation de la première suture contre un mouvement relatif ultérieur par rapport à l'ancrage.
PCT/US2024/033615 2023-06-12 2024-06-12 Ancrages de suture sans nœud et outils chirurgicaux correspondants Pending WO2024258968A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US2025/015839 WO2025175041A1 (fr) 2024-02-13 2025-02-13 Ancrage de suture sans nœud

Applications Claiming Priority (2)

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US202363507714P 2023-06-12 2023-06-12
US63/507,714 2023-06-12

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WO2024258968A1 true WO2024258968A1 (fr) 2024-12-19

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110270280A1 (en) * 2007-07-03 2011-11-03 Saliman Justin D Suturing and repairing tissue using in vivo suture loading
US20130345749A1 (en) * 2012-06-22 2013-12-26 Arthrex, Inc. Knotless suture anchors and methods of tissue repair
US20200138429A1 (en) * 2012-08-17 2020-05-07 Arthrex, Inc. Soft anchors with soft eyelets
US20210007731A1 (en) * 2018-03-23 2021-01-14 Conmed Corporation Suture anchor driver
US20220175514A1 (en) * 2020-12-07 2022-06-09 Arthrex, Inc. Tensionable knotless anchors and methods of tissue repair
US20220257235A1 (en) * 2012-03-02 2022-08-18 S. Wendell Holmes, Jr. Knotless Suture Anchor with Internal Suture Locking Mechanism

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110270280A1 (en) * 2007-07-03 2011-11-03 Saliman Justin D Suturing and repairing tissue using in vivo suture loading
US20220257235A1 (en) * 2012-03-02 2022-08-18 S. Wendell Holmes, Jr. Knotless Suture Anchor with Internal Suture Locking Mechanism
US20130345749A1 (en) * 2012-06-22 2013-12-26 Arthrex, Inc. Knotless suture anchors and methods of tissue repair
US20200138429A1 (en) * 2012-08-17 2020-05-07 Arthrex, Inc. Soft anchors with soft eyelets
US20210007731A1 (en) * 2018-03-23 2021-01-14 Conmed Corporation Suture anchor driver
US20220175514A1 (en) * 2020-12-07 2022-06-09 Arthrex, Inc. Tensionable knotless anchors and methods of tissue repair

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