US20060241658A1 - Method and apparatus for suture placement - Google Patents

Method and apparatus for suture placement Download PDF

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Publication number
US20060241658A1
US20060241658A1 US11/110,432 US11043205A US2006241658A1 US 20060241658 A1 US20060241658 A1 US 20060241658A1 US 11043205 A US11043205 A US 11043205A US 2006241658 A1 US2006241658 A1 US 2006241658A1
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US
United States
Prior art keywords
cannula
needle
suture
longitudinal axis
lumen
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.)
Abandoned
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US11/110,432
Inventor
Daniel Cerundolo
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Arthroscopic Innovations LLC
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Arthroscopic Innovations LLC
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Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=37188025&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=US20060241658(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Application filed by Arthroscopic Innovations LLC filed Critical Arthroscopic Innovations LLC
Priority to US11/110,540 priority Critical patent/US7569059B2/en
Priority to US11/110,419 priority patent/US7833244B2/en
Priority to US11/110,432 priority patent/US20060241658A1/en
Priority to US11/110,004 priority patent/US7771441B2/en
Priority to US11/110,584 priority patent/US7833230B2/en
Priority to PCT/US2006/013579 priority patent/WO2006115773A2/en
Priority to AU2006240354A priority patent/AU2006240354B2/en
Priority to JP2008507715A priority patent/JP5058154B2/en
Priority to EP06740879A priority patent/EP1887942A2/en
Priority to PCT/US2006/013617 priority patent/WO2006115782A2/en
Assigned to ARTHROSCOPIC INNOVATIONS LLC reassignment ARTHROSCOPIC INNOVATIONS LLC ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CERUNDOLO, DANIEL
Priority to CA2605189A priority patent/CA2605189C/en
Publication of US20060241658A1 publication Critical patent/US20060241658A1/en
Assigned to ARTHROSCOPIC INNOVATIONS LLC reassignment ARTHROSCOPIC INNOVATIONS LLC RE-RECORD TO CORRECT ASSIGNEE'S ADDRESS PREVIOUSLY RECORDED AT REEL 017476 FRAME 0916. Assignors: CERUNDOLO, DANIEL
Priority to US11/799,972 priority patent/US7955341B2/en
Abandoned legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1778Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1796Guides or aligning means for drills, mills, pins or wires for holes for sutures or flexible wires
    • AHUMAN NECESSITIES
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    • A61B17/0483Hand-held instruments for holding sutures
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0485Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
    • AHUMAN NECESSITIES
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    • A61B17/0487Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • AHUMAN NECESSITIES
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    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1714Guides or aligning means for drills, mills, pins or wires for applying tendons or ligaments
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0404Buttons
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    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409Instruments for applying suture anchors
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0445Suture 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
    • AHUMAN NECESSITIES
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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0456Surface features on the anchor, e.g. ribs increasing friction between the suture and the anchor
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06052Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066Needles, e.g. needle tip configurations
    • A61B2017/06076Needles, e.g. needle tip configurations helically or spirally coiled
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • A61B2017/3445Cannulas used as instrument channel for multiple instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564Methods for bone or joint treatment

Definitions

  • This invention relates to methods and apparatus for suture placement.
  • Surgical procedures frequently involve the placement of suture in a material, such as body tissue, a prosthetic or other medical implant or device, or combinations thereof.
  • a material such as body tissue, a prosthetic or other medical implant or device, or combinations thereof.
  • Many different approaches and devices have been developed for suture placement.
  • suturing instruments exist for placing sutures in body tissues or other materials.
  • One such device is the SMARTSTITCH suturing device sold by Opus Medical of San Juan Capistrano, Calif.
  • This device may be used in an arthroscopic technique to place a mattress stitch in a rotator cuff tendon when reattaching the tendon to the humerus.
  • the device has a set ofjaws that are used to clamp the tendon, and then fire a pair of retractable needles that extend through the tendon, engage suture, and draw the suture through the tendon as the needles retract.
  • FIG. 1 shows a schematic diagram of a humerus 1 and a portion of a rotator cuff tendon 2 that is normally attached to the head of the humerus.
  • the tendon 2 may detach or be partially torn from the humerus 1 , such as that shown schematically in FIG. 2 .
  • Such damage may be repaired by reattaching the rotator cuff tendon to the humerus 1 by a suture or other fixation so that the body's normal healing processes can naturally effect reattachment of the tendon to the bone.
  • One repair technique for reattaching the rotator cuff 2 to the humerus 1 involves fixing an anchor 101 at a margin between the articulating portion 11 of the humerus 1 and the humerus' greater tuberosity 12 .
  • a suture 102 is secured to the rotator cuff 2 , e.g., using the suturing device described above, and is secured to the anchor 101 .
  • the suture 102 is then tensioned so that the rotator cuff 2 is held in place close to the humerus 1 . Thereafter, the body may reestablish the proper attachment of the rotator cuff 2 to the humerus 1 .
  • an apparatus in one aspect of the invention, includes a cannula having at least one lumen and that is constructed and arranged to be used in a minimally-invasive surgical procedure.
  • a cannula may be usable in an arthroscopic procedure when performing surgery on a shoulder or knee.
  • a needle may be attached to the cannula and may have a tissue penetrating portion adapted to carry a suture. The needle may be manipulated by movement of the cannula to place the suture in a material.
  • One feature that may be provided in some embodiments is to allow the cannula to be used for other additional purposes, such as visualization of the surgical site through the same cannula used to place a suture by providing an endoscopic camera in the cannula lumen.
  • another surgical instrument may be provided in the cannula, such as a grasping device that is used to hold a material in place while the needle is used to place a suture in the material.
  • the needle may be selectively attached to and/or separated from the cannula.
  • the cannula and needle may include complementary locking members that engage with each other and allow the needle to be used to place a suture by manipulation of the cannula.
  • the cannula may be usable in a minimally-invasive procedure, and then the needle engaged with/disengaged from the cannula as needed.
  • aspects of the invention provided a cannula and needle arrangement that may be used to place a stitch in a rotator cuff during a surgical repair. However, not all aspects of the invention are restricted to use in rotator cuff repair.
  • FIG. 1 is a schematic diagram of a head of a humerus and attached rotator cuff tendon
  • FIG. 2 shows a prior art technique for repairing a rotator cuff injury
  • FIG. 3 is a schematic diagram of a tissue repair arrangement in accordance with an aspect of the invention.
  • FIGS. 4-6 show the use of a needle for placing a suture in a tissue in accordance with the invention
  • FIG. 7 shows a needle in engagement with a cannula in accordance with an aspect of the invention
  • FIG. 8 shows an illustrative arrangement for engaging a needle with a cannula in one embodiment
  • FIG. 9 shows an illustrative arrangement for engaging a sleeve and needle assembly with a cannula in accordance with another embodiment
  • FIG. 10 shows a guide apparatus used in forming a passageway in accordance with the invention
  • FIG. 11 shows the use of a guide apparatus for passing a suture or other element through a transosseous passageway in accordance with the invention
  • FIG. 12 shows a technique for passing a suture placed in a tissue through a passageway
  • FIG. 13 shows the engagement of a suture with a suture fixation device in accordance with the invention
  • FIG. 14 shows the placement of a suture fixation device relative to the bone in accordance with the invention
  • FIG. 15 shows a suture fixation device engagement tool in engagement with a suture fixation device in accordance with the invention.
  • FIGS. 16 A-B and 17 A-B show side and rear views, respectively, of illustrative embodiments of suture fixation devices in accordance with the invention.
  • aspects of the invention are described below with reference to specific embodiments. For example, aspects of the invention are described in the context of performing a rotator cuff repair. However, it should be understood that aspects of the invention are not necessarily restricted to rotator cuff repair techniques, or even to surgical techniques performed on a shoulder. Rather, various aspects of the invention may be used in any suitable surgical procedure. Also, aspects of the invention are described in a procedure involving the formation of a transosseous passageway, securing a suture in the passageway, etc. However, it should be understood that aspects of the invention, such as aspects relating to a cannula and attached needle, may be used in any surgical procedure, such as a rotator cuff repair that involves the use of an anchor like that shown in FIG. 2 .
  • aspects of the invention may be used in an open surgical procedure or in a closed or minimally-invasive procedure, such as an arthroscopic procedure. Also, various aspects of the invention may be used in any suitable surgical or other procedure involving any suitable body portions, such as bone, muscle, skin, vascular structures, digestive structures or other tissue, implants, mesh, or other medical devices, etc. Aspects of the invention may be used alone, and/or in combination with any other aspects of the invention.
  • a needle used to place a suture in a material may be engaged with a cannula, such as an arthroscopic cannula.
  • a cannula such as an arthroscopic cannula.
  • the needle and cannula may have complementary locking members or otherwise arranged so that the needle may be selectively engaged with the cannula.
  • the cannula may be usable as a standard arthroscopic cannula, and if needed, may be engaged with the needle. Thereafter, the needle and cannula may be used to place the suture in the selected tissue.
  • FIG. 3 shows a schematic diagram of a surgical repair in accordance with aspects of the invention.
  • aspects of the invention are described with reference to a rotator cuff repair for ease of reference and understanding, aspects of the invention may be used in any surgical or other procedure, and may involve any suitable body portions, such as bone, muscle, other tissue or combinations thereof, the brain, medical implants or other devices, etc. Thus, aspects of the invention are in no way limited to the specific embodiments and examples described herein.
  • a rotator cuff tendon 2 is secured by a suture 3 relative to a humerus 1 .
  • the suture 3 is placed in the tendon 2 , for example, using a mattress stitch or other arrangement, and is passed through a passageway 5 formed through the humerus 1 .
  • the passageway 5 is formed by first and second intersecting holes.
  • a first hole 51 is formed vertically as shown in FIG. 3 from a first opening at or near a margin between the articulating surface 11 and the greater tuberosity 12 of the humerus 1 .
  • the second hole 52 is formed horizontally as shown in FIG. 3 from a lateral position on the humerus 1 .
  • the suture 3 is secured at the second opening of the second hole using a suture fixation device 4 that is positioned adjacent the second opening.
  • a suture fixation device 4 that is positioned adjacent the second opening.
  • the first and second holes 51 and 52 are arranged at approximately right angles, the first and second holes may be arranged at any suitable angle and may be colinear (i.e., at a 180 degree angle relative to each other).
  • a wire, other material or the suture 3 may be manipulated in the passageway 5 so as to cut through or crush the relatively soft cancellous bone of the humerus in the passageway 5 so that the suture follows a relatively straight path between the first and second openings into the first and second holes 51 and 52 .
  • the relatively straight pathway may be formed by a “flossing” operation, such as by using a wire that is passed through the passageway 5 and is manipulated, e.g., tensioned and reciprocally drawn between the first and second openings, so as to cut through or crush the cancellous bone, thereby forming a relatively straight path for the suture 3 .
  • a surgeon When deciding where to locate the first hole 51 for the passageway 5 , a surgeon often will wish to first determine the final position for the tissue relative to the bone. To do so, the surgeon may wish to place a suture in the tendon 2 and tension the suture 3 (and thus the tendon 2 ) so that a desired position for the first hole 51 may be determined, e.g., based on the position of the tendon 2 relative to the bone when under tension.
  • FIGS. 4-6 show an embodiment of a needle 6 having a hook-shaped tissue penetrating portion 61 at a distal end in accordance with the invention.
  • the tissue penetrating portion 61 of the needle 6 has a semi-circular shape and is arranged at an angle, such as 90 degrees to a longitudinal axis of a straight portion 62 of the needle 6 .
  • the needle 6 may be formed as a hollow tube so that the suture 3 may pass through the needle 6 .
  • Suture may be loaded in the hollow portion of the needle 6 before the surgical procedure is begun, e.g., at the time of manufacture of the needle, or at any suitable time, such as during the surgical procedure.
  • the suture may be fed into the hollow portion of the needle 6 before the tissue penetrating portion 61 is formed, e.g., by bending a tube to form a curved end shape.
  • the arrangement of the needle 6 may allow placement of a mattress stitch in the tissue 2 by rotating the needle as shown in FIGS. 4-6 so that a tip of the tissue penetrating portion 61 passes through a top side of the tissue 2 and exits from a bottom side of the tissue 2 as shown in FIG. 5 , and then passes upwardly through the tissue 2 to reemerge at a top side of the tissue 2 as shown in FIG. 6 .
  • the suture 3 extending from the tip of the tissue penetrating portion 61 may be grasped, such as by forceps or other gripping device, and the needle 6 may be rotated in reverse so as to again position the needle 6 as shown in FIG.
  • the needle 6 may be used to place a suture in any material, including a tissue, such as a tendon as shown, a prosthetic or other surgical implant, etc.
  • tissue or other material may be held in place, or may be manipulated, by a grasper or other device inserted into the lumen of the cannula.
  • the tissue or other material may also be held in place, or manipulated, by another device, such as a grasper or clamp positioned external to the cannula.
  • the tissue penetrating portion 61 of the needle 6 may have any suitable shape and may be arranged in a plane that is transverse at any angle to an axis of rotation of the tissue penetrating portion 61 when placing a suture in tissue. That is, although in the illustrated embodiment the tissue penetrating portion 61 has a semi-circular form that lies in a plane at 90 degrees to the rotation axis of the tissue penetrating portion 61 when placing a suture, the tissue penetrating portion 61 need not have a semi-circular form and may lie at any desired angle to the rotation axis. For example, the tissue penetrating portion 61 may be arranged so as to place an inclined mattress stitch in a tissue 2 .
  • the needle 6 need not be used only to form a mattress stitch, but rather may be used to form any other suitable stitch type. Also, it is not necessary that the tissue penetrating portion 61 of the needle 6 include a portion that lies in a single plane. Instead, the tissue penetrating portion 61 may not lie in a single plane, e.g., may have a corkscrew-type or partially helical configuration.
  • all or portions of a tissue repair procedure may be performed arthroscopically.
  • one or more cannulas may be provided in one or more portals formed in the patient so as to provide access to the operative site.
  • a needle used to place a suture in a tissue such as the needle 6 shown in FIG. 4 , may be used in an arthroscopic procedure.
  • the needle 6 may be secured to a cannula so that the needle may be operated by manipulation of the cannula.
  • FIG. 7 shows an illustrative embodiment of a needle 6 that is secured to a cannula 7 .
  • the cannula 7 may have any suitable features found in cannulas used for closed or minimally-invasive surgical techniques, such as one or more valves to resist fluid flow through the cannula 7 , an opening through which to introduce a fluid pressure or vacuum, spiral threads or other features on the cannula to aid in placement of the cannula in a portal and/or to help prevent inadvertent removal of the cannula from the portal, and so on.
  • the cannula 7 may be arranged for any type of procedure, such as arthroscopic procedures.
  • the needle 6 may be secured to the cannula 7 in any suitable way.
  • the needle 6 may be molded into the body of the cannula 7 , inserted into the wall of the cannula, may be secured by adhesive, welding, clamps, fasteners, interlocking channels, open channels, or any other suitable device.
  • a proximal end of the needle 6 may terminate at any suitable point, such as midway between a proximal end 71 and a distal end 72 of the cannula 7 as shown, or, more preferably at a position proximal to the proximal end 71 .
  • the needle 6 may also be axially movable relative to the cannula, e.g., so that the tissue penetrating portion 61 may be moved axially so as to extend away from or toward the distal end 72 of the cannula 7 .
  • the needle 6 is shown as positioned on an outer surface of the cannula 7
  • the needle 6 or at least a portion thereof, may be molded into the cannula 7 , positioned within the cannula lumen, positioned in the cannula wall, may be arranged within a groove on the outer surface of the cannula, and so on.
  • the needle 6 is shown as arranged in an approximately straight fashion along the length of the cannula 7 , the needle 6 may be bent, curved or arranged in any suitable way, such as following a spiral path around an outer surface of the cannula 7 .
  • a semicircular-shaped tissue penetrating portion 61 of the needle 6 may be arranged relative to the cannula 7 so that a centerpoint of the semicircle lies on a central longitudinal axis 73 of the cannula lumen.
  • the tissue penetrating portion 61 may travel in a circular or arc-shaped path about the axis 73 .
  • the tissue penetrating portion 61 may be arranged in any suitable way relative to the axis 73 .
  • a plane in which the tissue penetrating portion 61 lies may be arranged at any angle transverse to the axis 73 , and thus need not be arranged at an angle of 90 degrees to the axis 73 , as shown in FIG. 7 .
  • the needle 6 may be removeably engaged with the cannula 7 so that the needle 6 can be selectively engaged or disengaged with the cannula 7 .
  • a cannula 7 may be positioned in a portal in use during a surgical procedure without an attached needle 6 .
  • the surgeon may wish to attach a needle 6 to the cannula 7 and manipulate the cannula 7 so as to use the needle 6 to place a suture in a material.
  • the needle 6 may be secured to the cannula while the cannula remains in place in the portal (e.g., by inserting the needle 6 into the cannula lumen), or the cannula may be removed from the portal, the needle attached, and the cannula and attached needle inserted into the portal.
  • the cannula lumen may remain available for use with other instruments, such as an endoscope, grasper or other surgical instrument.
  • the cannula lumen may not remain open for other use, such as if the needle is secured to a cylindrical plug that is inserted into, and completely or partially blocks, the cannula lumen when the needle is engaged with the cannula.
  • FIG. 8 shows one illustrative embodiment in which a needle 6 may be removably secured to a cannula 7 .
  • the cannula 7 includes a dovetail-shaped groove 74 into which a correspondingly shaped portion of the needle 6 is inserted.
  • the complementary locking arrangement used by the cannula 7 and the needle 6 need not necessarily be dovetail-shaped as shown in FIG. 8 , but rather may have any suitable arrangement.
  • the cannula 7 may have an oval-shaped groove that extends into the wall of the cannula 7
  • the needle 6 may have a complementary oval shape that engages with the groove.
  • the needle 6 may be selectively secured to the cannula 7 so that rotation (e.g., about a longitudinal axis of the cannula lumen) or other manipulation of the cannula 7 can cause the needle to be manipulated so as to place a suture in a material.
  • the complementary locking arrangement between the needle 6 and the cannula 7 may also allow for axial movement of the needle 6 relative to the cannula 7 , e.g., so the tissue penetrating portion 61 can be moved relative to the distal end 72 of the cannula 7 .
  • FIG. 9 shows an alternative embodiment in which a needle 6 is fixed to a sleeve member 63 that has one or more complementary locking features that mesh with or otherwise engage with complementary features on the cannula 7 .
  • the complementary locking features have a tooth-like or gear-like form, but the complementary locking features may be arranged in any suitable way. Accordingly, in this embodiment, the needle 6 may be secured to the cannula 7 by sliding the sleeve 63 over the distal end 72 of the cannula 7 .
  • the sleeve 63 may fit within the internal lumen of the cannula 7 , or within a slot in the cannula 7 , if desired.
  • a first hole 51 of the passageway 5 will be formed vertically from a superolateral position so that the first hole 51 is generally aligned along the length of the humerus 1 and extends into the bone from an opening formed at the margin between the articulating surface 11 and the greater tuberosity 12 .
  • This first hole 51 may be formed using a perforator, such as a drill, awl, punch or other suitable device.
  • the first hole 51 may be formed using an arthroscopic portal at a superolateral position, or may be formed in an open surgical procedure.
  • a guide apparatus may be used to form the first and/or second holes of the passageway (e.g., used to locate a starting point or opening for the first and second holes, used to orient a bone perforator when making the holes, or used alone to form the first and/or second holes), or may be used to help feed a suture or suture-like material through the passageway.
  • a first guide member 81 may be secured relative to the first hole 51 , as shown in FIG. 10 .
  • the first guide member 81 may be part of a guide apparatus 8 used to guide the formation of holes used to form a passageway in bone and/or to pass a suture or other material through the passageway.
  • the first hole 51 has been formed in a vertical direction along the length of the humerus 1 , e.g., by drilling the hole in a freehand manner.
  • the first hole 51 may be formed by forcing the first guide member 81 into the bone as with an awl or similar instrument.
  • the first guide member 81 may include a feature to help secure the first guide member 81 relative to the first hole 51 , such as a threaded distal end that allows the first guide member 81 to be screwed into the bone to a desired depth in the first hole 51 . It should be understood, however, that the distal end of the first guide member 81 need not be threaded, but instead may unthreaded and inserted into the first hole 51 .
  • the distal end of the first guide member 81 may be positioned outside of, but adjacent to, the first hole 51 so that a lumen in the first guide member 81 aligns with the first hole 51 .
  • the first hole 51 may be formed so as to be deeper than thought to be needed, e.g., 0.5 cm deeper than a hole depth believed to be required. This overdrilling of the first hole 51 may allow for more flexibility in positioning the first guide member 81 to a desired depth in the bone.
  • the first guide member 81 may be arranged with respect to a reference structure 83 used to position first and second guide members 81 and 82 relative to each other with respect to the passageway 5 , as is discussed in more detail below.
  • the reference structure 83 is arranged so that the first and second guide members 81 and 82 are positioned at a 90 degree angle relative to each other when engaged with the reference structure 83 .
  • the reference structure 83 may be arranged in any suitable way so as to orient the first and second guide members 81 and 82 at any desired angle relative to each other, including arranging the first and second guide members 81 and 82 in a co-linear fashion.
  • the reference structure 83 may be made so as to be adjustable, thereby allowing the orientation of the first and second guide members 81 and 82 to be changed.
  • the arc-shaped connecting portion of the reference structure 83 may be made so as to be adjustable in length, e.g., having one arc-shaped portion sliding relative to another arc-shaped portion to allow adjustment of the length of the connecting portion.
  • engagement portions 84 and 85 of the reference structure 83 that engage with the first and second guide members 81 and 82 may be adjustable in orientation relative to the arc-shaped connecting portion.
  • the reference structure 83 may be arranged in any suitable way so as to allow adjustment in the orientation of the guide members 81 and 82 .
  • the engagement portions 84 and 85 include sleeves that receive at least a portion of the guide members 81 and 82 , e.g., the guide members 81 and 82 may be received in bores in the sleeves.
  • the sleeves may be arranged so that the guide members 81 and 82 are movable linearly along their longitudinal axes and rotationally about their longitudinal axes relative to the engagement portions 84 and 85 , but otherwise may be relatively restricted in their range of movement.
  • the second guide member 82 When a stop on the first guide member 81 , such as a knob 811 on the proximal end of the guide member 81 , contacts an engagement surface on the reference structure, such as a portion of the engagement portion 84 , the second guide member 82 may be positioned by the reference structure 83 so that its longitudinal axis passes a point adjacent the extreme distal end of the first guide member 81 .
  • the second guide member 82 may be used to guide the use of a perforator 9 (such as a drill, punch, awl or other bone perforating device) so that the perforator 9 forms a second hole 52 that intersects with the first hole 51 at a location adjacent the distal end of the first guide member 81 .
  • the guide member 82 may guide the movement of the perforator 9 , e.g., guide the movement of a drill or punch inserted into a lumen of the guide member 82 as shown, or may guide a starting location for forming the second hole, e.g., be used to mark or otherwise determine a starting location for the perforator 9 , but otherwise not interact with the perforator 9 .
  • the location where the second hole 52 is formed can be adjusted in position (e.g., in a vertical direction as shown in the figures). For example, by screwing the first guide member 81 into or out of the first hole 51 , a surgeon may select a location where the second hole 52 is to be formed in the bone.
  • the engagement portion 85 may itself function as a perforator guide with the second guide member 82 being withdrawn from the engagement portion 85 .
  • the engagement portions 84 and 85 are shown as relatively short cylindrical sleeves, the engagement portions 84 and 85 may be arranged in any suitable way, e.g., may be elongated so as to more closely approach the humerus 1 and provide improved guidance for a perforator 9 and/or the first and second guide members 81 and 82 .
  • the first guide member 81 may be arranged so that is rotationally movable about its longitudinal axis relative to the reference structure 83 , but is otherwise held by the engagement portion 84 so that the first guide member 81 is not movable axially. This may aid is appropriately positioning the first guide member 81 and reference structure 83 when forming the second hole 52 .
  • the second guide member 82 may be screwed into the second hole 52 until a stop on the second guide member 82 , such as a knob 821 at a proximal end of the guide member 82 , contacts an engagement surface on the engagement portion 85 , such as a portion of the sleeve.
  • a stop on the second guide member 82 such as a knob 821 at a proximal end of the guide member 82
  • the extreme distal ends of the first and second guide members 81 and 82 may be adjacent to each other in the passageway 5 formed by the first and second holes 51 and 52 .
  • a surgeon may be assured that if the first and second guide members 81 and 82 are positioned within the bone and stops on the guide members 81 and 82 are respectively in contact with appropriate engagement surfaces on the guide apparatus 8 , the extreme distal ends of the guide members 81 and 82 will be positioned adjacent each other.
  • the surgeon may be assured that a wire 10 or other element may be fed into one of the guide members and retrieved from the other of the guide members, e.g., using a retriever 21 having a hook at a distal end.
  • a retriever 21 having a hook at a distal end.
  • the guide members 81 and 82 may be positioned relative to the reference structure 83 in any suitable way.
  • the guide members 81 and 82 may have indicator marks on them that may be aligned with a portion of the engagement portions 84 and 85 , respectively.
  • the alignment of certain indicator marks on the guide members 81 and 82 may be used to indicate, for example, that the distal ends of the guide members 81 and 82 are adjacent each other.
  • the position of the guide members 81 and 82 relative to the reference structure 83 and relative to each other may be determined in other ways.
  • first and second guide members 81 and 82 need not necessarily be positioned so that their distal ends are adjacent in the passageway to assist in feeding a suture from one guide member to the other.
  • the first and second guide members 81 and 82 may be made to suitably communicate with the passageway in any way so as to facilitate feeding of the suture.
  • the first guide member 81 is shown as having a smaller diameter (at least at the distal end) than the second guide member 82 .
  • This may allow the guide apparatus 8 to be used with an arrangement where the first hole 51 is smaller than the second hole 52 .
  • a relatively small first hole 51 may allow for more rapid healing and/or provide additional space for other holes in the margin, if needed.
  • the guide apparatus 8 and/or the holes that form the passageway 5 may be made in any suitable way, e.g., the first and second holes 51 and 52 may have the same diameter or the first hole 51 may have a larger diameter than the second hole 52 .
  • the guide apparatus 8 may also include additional guide members if desired, e.g., to provide for the formation of a third hole that is formed in the margin and is approximately parallel to the first hole 51 , but also intersects with the second hole 52 .
  • the guide apparatus 8 may include two pairs of guide members like that in the illustrative embodiment that are arranged to form side-by-side passageways 5 in the bone or other body portion.
  • the guide apparatus 8 is used to guide the formation of the second hole 52
  • the guide apparatus 8 need not necessarily be used to guide the formation of the second hole 52 . That is, the guide apparatus 8 may be used only to help feed the wire 10 , suture or other material through a passageway that is pre-formed in the bone or other body portion.
  • the first and second guide members 81 and 82 may be arranged so that the members 81 and 82 can be secured in a body portion without requiring holes to be predrilled or otherwise formed.
  • the first and second guide members 81 and 82 may be arranged like an awl or other device capable of forming a hole in a body portion, e.g., capable of being forced into bone, forming the passageway 5 by their entry and/or providing a means to help feed a wire, suture or other material through the passageway 5 .
  • the wire 10 may be used to pull the suture 3 through the passageway 5 .
  • the wire 10 or other material Prior to being used to pull the suture 3 through the passageway 5 , the wire 10 or other material may be used to create a relatively straight pathway for the suture 3 once the suture 3 is tensioned and fixed in place.
  • the wire 10 may be tensioned between the first and second openings 53 and 54 of the first and second holes 51 and 52 or otherwise manipulated so as to cut or crush the body portion, e.g., bone, between the first and second openings 53 and 54 .
  • Such manipulation of the wire 10 may perform a kind of “flossing” effect in the bone, allowing the suture 3 to follow a more straight pathway through the passageway 5 , reducing the length of suture 3 needed between the rotator cuff 2 and a point of fixation of the suture 3 , e.g., near the second opening 54 .
  • the wire 10 may have barbs or other saw-like features to aid in cutting bone and forming the pathway.
  • the more straight pathway could be formed by manipulating the suture 3 itself, e.g., by tensioning the suture 3 when securing the tendon or other material. Reducing the length of suture 3 in the passageway 5 may improve the suture's ability to maintain appropriate tension on the rotator cuff 2 , e.g., by reducing the amount of stretch of the suture when under tension.
  • the suture 3 may be engaged with a suture fixation device 4 as shown in FIG. 13 .
  • a suture fixation device may improve an ability to securely fixate the suture 3 (and the tissue 2 ) relative to the bone.
  • the suture fixation device 4 may be arranged in any suitable way, but in this illustrative embodiment has an arrangement similar to a button.
  • the suture fixation device 4 may have two through holes formed in a disk-shaped member through which leading ends of the suture 3 are passed. The suture ends 3 may be passed through respective holes in the suture fixation device 4 using one or more feed members 41 .
  • the feed members 41 may have an elongated shape that is passed through a respective hole in the suture fixation device 4 .
  • a loop at one end of the feed member 41 may receive an end of the suture 3 and thereafter the feed member 41 may be pulled through a respective hole in the suture fixation device 4 so as to pull the suture 3 through the hole.
  • the suture 3 may be fed through the suture fixation device 4 in any other suitable way.
  • the suture 3 may be fed through the suture fixation device 4 either inside or outside of the body cavity.
  • the suture fixation device 4 may be positioned relative to the second opening 54 of the passageway 5 using an applier 42 which removably engages with the suture fixation device 4 and may be selectively disengaged from the suture fixation device when the suture fixation device 4 is positioned as desired.
  • the applier 42 may have a pair of tines 421 that engage with recesses or other features on the suture fixation device 4 so as to removably engage with the suture fixation device 4 .
  • the tines 421 may be resilient so that the tines are squeezed together when engaged with the suture fixation device 4 .
  • an elastic force biasing the tine ends apart may help maintain engagement of the tines with the grooves 48 in the suture fixation device 4 .
  • the tine ends may be force-fit into grooves 48 in the suture fixation device so that engagement is maintained based on friction.
  • the applier 42 may engage with the suture fixation device 4 in any other suitable way, such as a screw-in or snap configurations.
  • the suture 3 may be tensioned so as to appropriately position the rotator cuff 2 relative to the humerus 1 .
  • the suture 3 may be fixed relative to the suture fixation device 4 , such as by tying a knot with the suture ends.
  • the suture fixation device 4 may provide not only a structure to support the suture knot, but also may spread the force of the suture 3 to portions of the relatively hard cortical bone surrounding or otherwise adjacent to the second opening 54 .
  • the suture fixation device 4 may provide a relatively stable and secure fixation point for the suture 3 .
  • the suture fixation device 4 may also incorporate a mechanism for knotless fixation of the suture, such as an interference pin, a locking passageway, a locking cap, etc.
  • both ends of the suture 3 are passed through the passageway 5 and secured at or near the second opening 54 of the passageway 5
  • the suture 3 may be secured in other ways, such as by passing one end of the suture 3 through the passageway 5 and passing another end of the suture 3 around the outside of the bone (e.g., over a portion of the greater tuberosity) where it is secured to the other suture end.
  • two passageways 5 may be formed through the bone and one end of the suture 3 may be passed through one passageway and the other end of the suture 3 may be passed through the other passageway.
  • first holes 51 may be formed so as to intersect with one or more second holes 52 .
  • Suture 3 may be passed through the two or more first holes 51 and be secured at the second opening 54 of the one or more second holes 52 .
  • Such an arrangement may allow for the use of a single second hole 52 and suture fixation device 4 to secure the rotator cuff at two or more points on the humeral head using two or more sutures that pass through different first holes 51 .
  • Other suture fixation techniques may be used as desired.
  • FIGS. 16 A-B and 17 A-B show illustrative embodiments of suture fixation devices 4 in accordance with the invention.
  • the suture fixation device 4 includes a restriction in a pathway through the suture fixation device 4 so that suture or other material passing through the suture fixation device is relatively freely moved in one direction through the pathway, but movement of the suture or other material in the other direction in the pathway is resisted.
  • movement of a suture though the suture fixation devices shown in FIGS. 16A and 17A in a direction to the left in the side view of the suture fixation devices 4 may be freely allowed, while movement of the suture toward the right may be resisted.
  • This may aid in tensioning the suture 3 because the suture 3 may be pulled from the second hole 52 through the suture fixation device 4 until the rotator cuff or other tissue is appropriately positioned. Thereafter, tension on the suture may be temporarily released, e.g., in preparation for forming a knot, but movement of the suture back through the suture fixation device 4 may be resisted so that the rotator cuff or other tissue is maintained in place until the suture knot is tied or otherwise is secured.
  • the suture fixation device includes an outer end having a flange portion 43 that is sized and arranged to contact the cortical bone adjacent the opening in the passageway at which the suture fixation device 4 is positioned, e.g., the second opening 54 .
  • One or more pathways 44 may be formed through the suture fixation device 4 , such as by a hole or holes formed through the flange 43 (see also FIG. 15 ). Instead of having multiple holes, the pathway 44 may include a single slot arranged to receive one or more sutures.
  • a recess 49 may be provided in the flange portion 43 to receive one or more knots, if formed with the suture(s) in the pathway 44 .
  • a pair of duck bill members 45 at an inner end of the suture fixation device 4 may extend rearwardly from the flange 43 and may be arranged as to be positionable in the second hole 54 .
  • the duck bill members 45 may be separated from each other by a groove that extends across the inner end of the suture fixation device 4 and be resiliently biased toward each other so as to resist the passage of suture or other material through the pathway 44 .
  • One or both of the duck bill structures 45 may include serrations 46 or other features that may aid in engaging a suture or other material.
  • the groove separating the duck bill structures 45 extends to the flange portion 43 so that the structures 45 are pivotable at a point near the flange portion 43 .
  • the FIG. 17A -B embodiment similarly includes a flange 43 and one or more pathways 44 .
  • Duck bill structures 45 are also provided. However, in this embodiment rather than being hinged at a point near respective connection points with the flange 43 , the duck bill portions 45 are hinged at a point positioned away from the flange 43 . Providing the effective hinge points for the duck bill structures 45 in this manner may provide improved engagement of the duck bill structures 45 with a suture or other material when the suture is urged to move from the outer end toward the inner end through the pathway 44 .
  • the duck bill structures in the FIG. 16 and 17 embodiments or other suitable suture engagement arrangements may provide a knotless fixation for the suture.
  • the structures may resist movement of the suture so as to aid the surgeon's ability to maintain tension on the suture while forming a knot.
  • the device may be positioned in a hole which has a counterbore, or countersink, in order to prevent any interference between the flange and other bone or tissues that may come in contact with the site either at rest or during movement. Even in the case where the device is positioned in a counterbore or countersink feature, the device may contact cortical bone. Alternately, the device may only contact the outer, cortical surface of the bone, and not extend into a hole in the bone.
  • suture fixation devices may be provided in any suitable form.
  • the duck bill portions 45 extending from the flange 43 in the FIGS. 16 and 17 embodiments may be sized to closely fit into a mating hole formed in bone. This close fit may help in maintaining the suture fixation devices 4 in a desired position in the bone.
  • the duck bill structures 45 may be formed so as to be tapered on their outer surfaces. Thus, when the suture fixation device 4 is inserted into a hole in the bone, the tapered surfaces of the duck bill structures 45 may contact the sides of the hole and urge the duck bill structures to move toward each other as the suture fixation device 4 is pressed into the hole.
  • a portion of the suture fixation device 4 that is inserted into a hole may be threaded or otherwise be arranged so as to engage the hole and help prevent the suture fixation device from falling from the hole, e.g., before the suture is secured in place.
  • the mechanism form to retain the suture with respect to the device may require a knot for final fixation.
  • Other capturing mechanisms may provide sufficient locking of the suture such that a knot is not required. Theses are typically known as “knotless” devices.

Abstract

An apparatus and method for placing a suture by manipulating a cannula and attached needle. The cannula may be usable in a minimally-invasive surgical procedure, and the needle may be selectively attached to and/or separated from the cannula. The cannula and needle may include complementary locking members that engage with each other and allow the needle to be used to place a suture by manipulation of the cannula.

Description

    BACKGROUND OF INVENTION
  • 1. Field of Invention
  • This invention relates to methods and apparatus for suture placement.
  • 2. Discussion of Related Art
  • Surgical procedures frequently involve the placement of suture in a material, such as body tissue, a prosthetic or other medical implant or device, or combinations thereof. Many different approaches and devices have been developed for suture placement. For example, suturing instruments exist for placing sutures in body tissues or other materials. One such device is the SMARTSTITCH suturing device sold by Opus Medical of San Juan Capistrano, Calif. This device may be used in an arthroscopic technique to place a mattress stitch in a rotator cuff tendon when reattaching the tendon to the humerus. The device has a set ofjaws that are used to clamp the tendon, and then fire a pair of retractable needles that extend through the tendon, engage suture, and draw the suture through the tendon as the needles retract.
  • FIG. 1 shows a schematic diagram of a humerus 1 and a portion of a rotator cuff tendon 2 that is normally attached to the head of the humerus. In one type of damage to the rotator cuff, the tendon 2 may detach or be partially torn from the humerus 1, such as that shown schematically in FIG. 2. Such damage may be repaired by reattaching the rotator cuff tendon to the humerus 1 by a suture or other fixation so that the body's normal healing processes can naturally effect reattachment of the tendon to the bone. One repair technique for reattaching the rotator cuff2 to the humerus 1 involves fixing an anchor 101 at a margin between the articulating portion 11 of the humerus 1 and the humerus' greater tuberosity 12. A suture 102 is secured to the rotator cuff 2, e.g., using the suturing device described above, and is secured to the anchor 101. The suture 102 is then tensioned so that the rotator cuff 2 is held in place close to the humerus 1. Thereafter, the body may reestablish the proper attachment of the rotator cuff2 to the humerus 1.
  • SUMMARY OF INVENTION
  • In one aspect of the invention, an apparatus includes a cannula having at least one lumen and that is constructed and arranged to be used in a minimally-invasive surgical procedure. For example, such a cannula may be usable in an arthroscopic procedure when performing surgery on a shoulder or knee. A needle may be attached to the cannula and may have a tissue penetrating portion adapted to carry a suture. The needle may be manipulated by movement of the cannula to place the suture in a material. One feature that may be provided in some embodiments is to allow the cannula to be used for other additional purposes, such as visualization of the surgical site through the same cannula used to place a suture by providing an endoscopic camera in the cannula lumen. In addition, or alternately, another surgical instrument may be provided in the cannula, such as a grasping device that is used to hold a material in place while the needle is used to place a suture in the material.
  • In one aspect of the invention, the needle may be selectively attached to and/or separated from the cannula. For example, the cannula and needle may include complementary locking members that engage with each other and allow the needle to be used to place a suture by manipulation of the cannula. The cannula may be usable in a minimally-invasive procedure, and then the needle engaged with/disengaged from the cannula as needed.
  • Aspects of the invention provided a cannula and needle arrangement that may be used to place a stitch in a rotator cuff during a surgical repair. However, not all aspects of the invention are restricted to use in rotator cuff repair.
  • BRIEF DESCRIPTION OF DRAWINGS
  • Various aspects of the invention are described with reference to illustrative embodiments, wherein like numerals reference like elements, and wherein:
  • FIG. 1 is a schematic diagram of a head of a humerus and attached rotator cuff tendon;
  • FIG. 2 shows a prior art technique for repairing a rotator cuff injury;
  • FIG. 3 is a schematic diagram of a tissue repair arrangement in accordance with an aspect of the invention;
  • FIGS. 4-6 show the use of a needle for placing a suture in a tissue in accordance with the invention;
  • FIG. 7 shows a needle in engagement with a cannula in accordance with an aspect of the invention;
  • FIG. 8 shows an illustrative arrangement for engaging a needle with a cannula in one embodiment;
  • FIG. 9 shows an illustrative arrangement for engaging a sleeve and needle assembly with a cannula in accordance with another embodiment;
  • FIG. 10 shows a guide apparatus used in forming a passageway in accordance with the invention;
  • FIG. 11 shows the use of a guide apparatus for passing a suture or other element through a transosseous passageway in accordance with the invention;
  • FIG. 12 shows a technique for passing a suture placed in a tissue through a passageway;
  • FIG. 13 shows the engagement of a suture with a suture fixation device in accordance with the invention;
  • FIG. 14 shows the placement of a suture fixation device relative to the bone in accordance with the invention;
  • FIG. 15 shows a suture fixation device engagement tool in engagement with a suture fixation device in accordance with the invention; and
  • FIGS. 16A-B and 17A-B show side and rear views, respectively, of illustrative embodiments of suture fixation devices in accordance with the invention.
  • DETAILED DESCRIPTION
  • This invention is not limited in its application to the details of construction and the arrangement of components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and of being practiced or of being carried out in various ways. Also, the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting.
  • Various aspects of the invention are described below with reference to specific embodiments. For example, aspects of the invention are described in the context of performing a rotator cuff repair. However, it should be understood that aspects of the invention are not necessarily restricted to rotator cuff repair techniques, or even to surgical techniques performed on a shoulder. Rather, various aspects of the invention may be used in any suitable surgical procedure. Also, aspects of the invention are described in a procedure involving the formation of a transosseous passageway, securing a suture in the passageway, etc. However, it should be understood that aspects of the invention, such as aspects relating to a cannula and attached needle, may be used in any surgical procedure, such as a rotator cuff repair that involves the use of an anchor like that shown in FIG. 2.
  • Various aspects of the invention may be used in an open surgical procedure or in a closed or minimally-invasive procedure, such as an arthroscopic procedure. Also, various aspects of the invention may be used in any suitable surgical or other procedure involving any suitable body portions, such as bone, muscle, skin, vascular structures, digestive structures or other tissue, implants, mesh, or other medical devices, etc. Aspects of the invention may be used alone, and/or in combination with any other aspects of the invention.
  • In another aspect of the invention, a needle used to place a suture in a material, such as a rotator cuff tendon and/or implant, may be engaged with a cannula, such as an arthroscopic cannula. Thus, the needle may be operated to place the suture by manipulating the cannula. The needle and cannula may have complementary locking members or otherwise arranged so that the needle may be selectively engaged with the cannula. Thus, the cannula may be usable as a standard arthroscopic cannula, and if needed, may be engaged with the needle. Thereafter, the needle and cannula may be used to place the suture in the selected tissue.
  • FIG. 3 shows a schematic diagram of a surgical repair in accordance with aspects of the invention. As discussed above, although aspects of the invention are described with reference to a rotator cuff repair for ease of reference and understanding, aspects of the invention may be used in any surgical or other procedure, and may involve any suitable body portions, such as bone, muscle, other tissue or combinations thereof, the brain, medical implants or other devices, etc. Thus, aspects of the invention are in no way limited to the specific embodiments and examples described herein.
  • In this illustrative embodiment, a rotator cuff tendon 2 is secured by a suture 3 relative to a humerus 1. The suture 3 is placed in the tendon 2, for example, using a mattress stitch or other arrangement, and is passed through a passageway 5 formed through the humerus 1. In this embodiment, the passageway 5 is formed by first and second intersecting holes. A first hole 51 is formed vertically as shown in FIG. 3 from a first opening at or near a margin between the articulating surface 11 and the greater tuberosity 12 of the humerus 1. The second hole 52 is formed horizontally as shown in FIG. 3 from a lateral position on the humerus 1. The suture 3 is secured at the second opening of the second hole using a suture fixation device 4 that is positioned adjacent the second opening. Although in this embodiment the first and second holes 51 and 52 are arranged at approximately right angles, the first and second holes may be arranged at any suitable angle and may be colinear (i.e., at a 180 degree angle relative to each other).
  • A wire, other material or the suture 3 may be manipulated in the passageway 5 so as to cut through or crush the relatively soft cancellous bone of the humerus in the passageway 5 so that the suture follows a relatively straight path between the first and second openings into the first and second holes 51 and 52. The relatively straight pathway may be formed by a “flossing” operation, such as by using a wire that is passed through the passageway 5 and is manipulated, e.g., tensioned and reciprocally drawn between the first and second openings, so as to cut through or crush the cancellous bone, thereby forming a relatively straight path for the suture 3.
  • When deciding where to locate the first hole 51 for the passageway 5, a surgeon often will wish to first determine the final position for the tissue relative to the bone. To do so, the surgeon may wish to place a suture in the tendon 2 and tension the suture 3 (and thus the tendon 2) so that a desired position for the first hole 51 may be determined, e.g., based on the position of the tendon 2 relative to the bone when under tension.
  • In one aspect of the invention, use of a needle having a hook-shaped or curved end portion may be preferred. FIGS. 4-6 show an embodiment of a needle 6 having a hook-shaped tissue penetrating portion 61 at a distal end in accordance with the invention. In the illustrated embodiment, the tissue penetrating portion 61 of the needle 6 has a semi-circular shape and is arranged at an angle, such as 90 degrees to a longitudinal axis of a straight portion 62 of the needle 6. The needle 6 may be formed as a hollow tube so that the suture 3 may pass through the needle 6. Suture may be loaded in the hollow portion of the needle 6 before the surgical procedure is begun, e.g., at the time of manufacture of the needle, or at any suitable time, such as during the surgical procedure. In some cases, the suture may be fed into the hollow portion of the needle 6 before the tissue penetrating portion 61 is formed, e.g., by bending a tube to form a curved end shape.
  • The arrangement of the needle 6 may allow placement of a mattress stitch in the tissue 2 by rotating the needle as shown in FIGS. 4-6 so that a tip of the tissue penetrating portion 61 passes through a top side of the tissue 2 and exits from a bottom side of the tissue 2 as shown in FIG. 5, and then passes upwardly through the tissue 2 to reemerge at a top side of the tissue 2 as shown in FIG. 6. At this point, the suture 3 extending from the tip of the tissue penetrating portion 61 may be grasped, such as by forceps or other gripping device, and the needle 6 may be rotated in reverse so as to again position the needle 6 as shown in FIG. 4, thereby leaving the suture 3 positioned in the tissue 2 to form a mattress stitch. Of course, the needle 6 may be used to place a suture in any material, including a tissue, such as a tendon as shown, a prosthetic or other surgical implant, etc. During the passage of the suture, the tissue or other material may be held in place, or may be manipulated, by a grasper or other device inserted into the lumen of the cannula. The tissue or other material may also be held in place, or manipulated, by another device, such as a grasper or clamp positioned external to the cannula.
  • The tissue penetrating portion 61 of the needle 6 may have any suitable shape and may be arranged in a plane that is transverse at any angle to an axis of rotation of the tissue penetrating portion 61 when placing a suture in tissue. That is, although in the illustrated embodiment the tissue penetrating portion 61 has a semi-circular form that lies in a plane at 90 degrees to the rotation axis of the tissue penetrating portion 61 when placing a suture, the tissue penetrating portion 61 need not have a semi-circular form and may lie at any desired angle to the rotation axis. For example, the tissue penetrating portion 61 may be arranged so as to place an inclined mattress stitch in a tissue 2. Further, the needle 6 need not be used only to form a mattress stitch, but rather may be used to form any other suitable stitch type. Also, it is not necessary that the tissue penetrating portion 61 of the needle 6 include a portion that lies in a single plane. Instead, the tissue penetrating portion 61 may not lie in a single plane, e.g., may have a corkscrew-type or partially helical configuration.
  • In one aspect of the invention, all or portions of a tissue repair procedure may be performed arthroscopically. In this case, and as is known in the art, one or more cannulas may be provided in one or more portals formed in the patient so as to provide access to the operative site. In one aspect of the invention, a needle used to place a suture in a tissue, such as the needle 6 shown in FIG. 4, may be used in an arthroscopic procedure. For example, the needle 6 may be secured to a cannula so that the needle may be operated by manipulation of the cannula.
  • FIG. 7 shows an illustrative embodiment of a needle 6 that is secured to a cannula 7. The cannula 7 may have any suitable features found in cannulas used for closed or minimally-invasive surgical techniques, such as one or more valves to resist fluid flow through the cannula 7, an opening through which to introduce a fluid pressure or vacuum, spiral threads or other features on the cannula to aid in placement of the cannula in a portal and/or to help prevent inadvertent removal of the cannula from the portal, and so on. The cannula 7 may be arranged for any type of procedure, such as arthroscopic procedures.
  • The needle 6 may be secured to the cannula 7 in any suitable way. For example, the needle 6 may be molded into the body of the cannula 7, inserted into the wall of the cannula, may be secured by adhesive, welding, clamps, fasteners, interlocking channels, open channels, or any other suitable device. A proximal end of the needle 6 may terminate at any suitable point, such as midway between a proximal end 71 and a distal end 72 of the cannula 7 as shown, or, more preferably at a position proximal to the proximal end 71. By having the proximal end of the needle 6 positioned proximally of the cannula 7, a user may be better able to access the suture 3 entering the proximal end of the needle 6. The needle 6 may also be axially movable relative to the cannula, e.g., so that the tissue penetrating portion 61 may be moved axially so as to extend away from or toward the distal end 72 of the cannula 7. In addition, although the needle 6 is shown as positioned on an outer surface of the cannula 7, the needle 6, or at least a portion thereof, may be molded into the cannula 7, positioned within the cannula lumen, positioned in the cannula wall, may be arranged within a groove on the outer surface of the cannula, and so on. Although the needle 6 is shown as arranged in an approximately straight fashion along the length of the cannula 7, the needle 6 may be bent, curved or arranged in any suitable way, such as following a spiral path around an outer surface of the cannula 7.
  • In one illustrative embodiment, a semicircular-shaped tissue penetrating portion 61 of the needle 6 may be arranged relative to the cannula 7 so that a centerpoint of the semicircle lies on a central longitudinal axis 73 of the cannula lumen. Thus, when the cannula 7 is rotated about the central longitudinal axis 73, the tissue penetrating portion 61 may travel in a circular or arc-shaped path about the axis 73. However, it should be understood that the tissue penetrating portion 61 may be arranged in any suitable way relative to the axis 73. Further, a plane in which the tissue penetrating portion 61 lies (if present) may be arranged at any angle transverse to the axis 73, and thus need not be arranged at an angle of 90 degrees to the axis 73, as shown in FIG. 7.
  • In one aspect of the invention, the needle 6 may be removeably engaged with the cannula 7 so that the needle 6 can be selectively engaged or disengaged with the cannula 7. For example, a cannula 7 may be positioned in a portal in use during a surgical procedure without an attached needle 6. At some point during the procedure, the surgeon may wish to attach a needle 6 to the cannula 7 and manipulate the cannula 7 so as to use the needle 6 to place a suture in a material. The needle 6 may be secured to the cannula while the cannula remains in place in the portal (e.g., by inserting the needle 6 into the cannula lumen), or the cannula may be removed from the portal, the needle attached, and the cannula and attached needle inserted into the portal.
  • By attaching a needle to a cannula like that shown above, the cannula lumen may remain available for use with other instruments, such as an endoscope, grasper or other surgical instrument. However, in some embodiments the cannula lumen may not remain open for other use, such as if the needle is secured to a cylindrical plug that is inserted into, and completely or partially blocks, the cannula lumen when the needle is engaged with the cannula.
  • FIG. 8 shows one illustrative embodiment in which a needle 6 may be removably secured to a cannula 7. In this embodiment, the cannula 7 includes a dovetail-shaped groove 74 into which a correspondingly shaped portion of the needle 6 is inserted. The complementary locking arrangement used by the cannula 7 and the needle 6 need not necessarily be dovetail-shaped as shown in FIG. 8, but rather may have any suitable arrangement. For example, the cannula 7 may have an oval-shaped groove that extends into the wall of the cannula 7, and the needle 6 may have a complementary oval shape that engages with the groove. Thus, the needle 6 may be selectively secured to the cannula 7 so that rotation (e.g., about a longitudinal axis of the cannula lumen) or other manipulation of the cannula 7 can cause the needle to be manipulated so as to place a suture in a material. The complementary locking arrangement between the needle 6 and the cannula 7 may also allow for axial movement of the needle 6 relative to the cannula 7, e.g., so the tissue penetrating portion 61 can be moved relative to the distal end 72 of the cannula 7.
  • FIG. 9 shows an alternative embodiment in which a needle 6 is fixed to a sleeve member 63 that has one or more complementary locking features that mesh with or otherwise engage with complementary features on the cannula 7. In this embodiment, the complementary locking features have a tooth-like or gear-like form, but the complementary locking features may be arranged in any suitable way. Accordingly, in this embodiment, the needle 6 may be secured to the cannula 7 by sliding the sleeve 63 over the distal end 72 of the cannula 7. It will be understood that rather than having a sleeve 63 that fits over the cannula 7, the sleeve 63 may fit within the internal lumen of the cannula 7, or within a slot in the cannula 7, if desired.
  • Once a suture is placed in the tissue, such as a rotator cuff tendon, the tissue may be tensioned to determine a location for the opening of the first hole 51 to be formed in the bone. When performing a rotator cuff repair, typically, a first hole 51 of the passageway 5 will be formed vertically from a superolateral position so that the first hole 51 is generally aligned along the length of the humerus 1 and extends into the bone from an opening formed at the margin between the articulating surface 11 and the greater tuberosity 12. This first hole 51 may be formed using a perforator, such as a drill, awl, punch or other suitable device. As with other procedures performed, the first hole 51 may be formed using an arthroscopic portal at a superolateral position, or may be formed in an open surgical procedure.
  • In accordance with an aspect of the invention, a guide apparatus may be used to form the first and/or second holes of the passageway (e.g., used to locate a starting point or opening for the first and second holes, used to orient a bone perforator when making the holes, or used alone to form the first and/or second holes), or may be used to help feed a suture or suture-like material through the passageway. For example, a first guide member 81 may be secured relative to the first hole 51, as shown in FIG. 10. The first guide member 81 may be part of a guide apparatus 8 used to guide the formation of holes used to form a passageway in bone and/or to pass a suture or other material through the passageway. In the illustrated embodiment, the first hole 51 has been formed in a vertical direction along the length of the humerus 1, e.g., by drilling the hole in a freehand manner. (Alternately, the first hole 51 may be formed by forcing the first guide member 81 into the bone as with an awl or similar instrument.) The first guide member 81 may include a feature to help secure the first guide member 81 relative to the first hole 51, such as a threaded distal end that allows the first guide member 81 to be screwed into the bone to a desired depth in the first hole 51. It should be understood, however, that the distal end of the first guide member 81 need not be threaded, but instead may unthreaded and inserted into the first hole 51. Alternately, the distal end of the first guide member 81 may be positioned outside of, but adjacent to, the first hole 51 so that a lumen in the first guide member 81 aligns with the first hole 51. The first hole 51 may be formed so as to be deeper than thought to be needed, e.g., 0.5 cm deeper than a hole depth believed to be required. This overdrilling of the first hole 51 may allow for more flexibility in positioning the first guide member 81 to a desired depth in the bone.
  • The first guide member 81 may be arranged with respect to a reference structure 83 used to position first and second guide members 81 and 82 relative to each other with respect to the passageway 5, as is discussed in more detail below. In this illustrative embodiment, the reference structure 83 is arranged so that the first and second guide members 81 and 82 are positioned at a 90 degree angle relative to each other when engaged with the reference structure 83. However, the reference structure 83 may be arranged in any suitable way so as to orient the first and second guide members 81 and 82 at any desired angle relative to each other, including arranging the first and second guide members 81 and 82 in a co-linear fashion. Further, the reference structure 83 may be made so as to be adjustable, thereby allowing the orientation of the first and second guide members 81 and 82 to be changed. For example, the arc-shaped connecting portion of the reference structure 83 may be made so as to be adjustable in length, e.g., having one arc-shaped portion sliding relative to another arc-shaped portion to allow adjustment of the length of the connecting portion. Alternately, or in addition, engagement portions 84 and 85 of the reference structure 83 that engage with the first and second guide members 81 and 82 may be adjustable in orientation relative to the arc-shaped connecting portion. In short, the reference structure 83 may be arranged in any suitable way so as to allow adjustment in the orientation of the guide members 81 and 82.
  • In this illustrative embodiment, the engagement portions 84 and 85 include sleeves that receive at least a portion of the guide members 81 and 82, e.g., the guide members 81 and 82 may be received in bores in the sleeves. The sleeves may be arranged so that the guide members 81 and 82 are movable linearly along their longitudinal axes and rotationally about their longitudinal axes relative to the engagement portions 84 and 85, but otherwise may be relatively restricted in their range of movement. When a stop on the first guide member 81, such as a knob 811 on the proximal end of the guide member 81, contacts an engagement surface on the reference structure, such as a portion of the engagement portion 84, the second guide member 82 may be positioned by the reference structure 83 so that its longitudinal axis passes a point adjacent the extreme distal end of the first guide member 81. Thus, the second guide member 82 may be used to guide the use of a perforator 9 (such as a drill, punch, awl or other bone perforating device) so that the perforator 9 forms a second hole 52 that intersects with the first hole 51 at a location adjacent the distal end of the first guide member 81. As discussed above, the guide member 82 may guide the movement of the perforator 9, e.g., guide the movement of a drill or punch inserted into a lumen of the guide member 82 as shown, or may guide a starting location for forming the second hole, e.g., be used to mark or otherwise determine a starting location for the perforator 9, but otherwise not interact with the perforator 9. By adjusting the depth of the first guide member 81 in the first hole 51, the location where the second hole 52 is formed can be adjusted in position (e.g., in a vertical direction as shown in the figures). For example, by screwing the first guide member 81 into or out of the first hole 51, a surgeon may select a location where the second hole 52 is to be formed in the bone.
  • In another embodiment, the engagement portion 85 may itself function as a perforator guide with the second guide member 82 being withdrawn from the engagement portion 85. Although in this illustrative embodiment the engagement portions 84 and 85 are shown as relatively short cylindrical sleeves, the engagement portions 84 and 85 may be arranged in any suitable way, e.g., may be elongated so as to more closely approach the humerus 1 and provide improved guidance for a perforator 9 and/or the first and second guide members 81 and 82. Further, the first guide member 81 may be arranged so that is rotationally movable about its longitudinal axis relative to the reference structure 83, but is otherwise held by the engagement portion 84 so that the first guide member 81 is not movable axially. This may aid is appropriately positioning the first guide member 81 and reference structure 83 when forming the second hole 52.
  • Upon formation of the second hole 52, the second guide member 82 may be screwed into the second hole 52 until a stop on the second guide member 82, such as a knob 821 at a proximal end of the guide member 82, contacts an engagement surface on the engagement portion 85, such as a portion of the sleeve. In this configuration shown in FIG. 11 (stops on the first and second guide members 81 and 82 engaged with respective engagement surfaces on the reference structure 83), the extreme distal ends of the first and second guide members 81 and 82 may be adjacent to each other in the passageway 5 formed by the first and second holes 51 and 52. Accordingly, a surgeon may be assured that if the first and second guide members 81 and 82 are positioned within the bone and stops on the guide members 81 and 82 are respectively in contact with appropriate engagement surfaces on the guide apparatus 8, the extreme distal ends of the guide members 81 and 82 will be positioned adjacent each other. Thus, the surgeon may be assured that a wire 10 or other element may be fed into one of the guide members and retrieved from the other of the guide members, e.g., using a retriever 21 having a hook at a distal end. Such an arrangement may be advantageous when using the guide apparatus 8 in an arthroscopic procedure where the operative site may not be easily visualized.
  • Although in the above embodiment, stops on the first and second guide members 81 and 82 contact corresponding engagement surfaces on the engagement portions 84 and 85, the guide members 81 and 82 may be positioned relative to the reference structure 83 in any suitable way. For example, the guide members 81 and 82 may have indicator marks on them that may be aligned with a portion of the engagement portions 84 and 85, respectively. The alignment of certain indicator marks on the guide members 81 and 82 may be used to indicate, for example, that the distal ends of the guide members 81 and 82 are adjacent each other. Those of skill in the art will understand that the position of the guide members 81 and 82 relative to the reference structure 83 and relative to each other may be determined in other ways. For example, the first and second guide members 81 and 82 need not necessarily be positioned so that their distal ends are adjacent in the passageway to assist in feeding a suture from one guide member to the other. Instead, the first and second guide members 81 and 82 may be made to suitably communicate with the passageway in any way so as to facilitate feeding of the suture.
  • In this illustrative embodiment, the first guide member 81 is shown as having a smaller diameter (at least at the distal end) than the second guide member 82. This may allow the guide apparatus 8 to be used with an arrangement where the first hole 51 is smaller than the second hole 52. A relatively small first hole 51 may allow for more rapid healing and/or provide additional space for other holes in the margin, if needed. However, it should be understood that the guide apparatus 8 and/or the holes that form the passageway 5 may be made in any suitable way, e.g., the first and second holes 51 and 52 may have the same diameter or the first hole 51 may have a larger diameter than the second hole 52.
  • The guide apparatus 8 may also include additional guide members if desired, e.g., to provide for the formation of a third hole that is formed in the margin and is approximately parallel to the first hole 51, but also intersects with the second hole 52. Similarly, the guide apparatus 8 may include two pairs of guide members like that in the illustrative embodiment that are arranged to form side-by-side passageways 5 in the bone or other body portion.
  • Although in this illustrative embodiment, the guide apparatus 8 is used to guide the formation of the second hole 52, the guide apparatus 8 need not necessarily be used to guide the formation of the second hole 52. That is, the guide apparatus 8 may be used only to help feed the wire 10, suture or other material through a passageway that is pre-formed in the bone or other body portion. In addition, the first and second guide members 81 and 82 may be arranged so that the members 81 and 82 can be secured in a body portion without requiring holes to be predrilled or otherwise formed. Thus, in one embodiment, the first and second guide members 81 and 82 may be arranged like an awl or other device capable of forming a hole in a body portion, e.g., capable of being forced into bone, forming the passageway 5 by their entry and/or providing a means to help feed a wire, suture or other material through the passageway 5.
  • Once the wire 10, suture or other material has been passed through the passageway 5, as shown in FIG. 12, the wire 10 may be used to pull the suture 3 through the passageway 5. Prior to being used to pull the suture 3 through the passageway 5, the wire 10 or other material may be used to create a relatively straight pathway for the suture 3 once the suture 3 is tensioned and fixed in place. For example, the wire 10 may be tensioned between the first and second openings 53 and 54 of the first and second holes 51 and 52 or otherwise manipulated so as to cut or crush the body portion, e.g., bone, between the first and second openings 53 and 54. Such manipulation of the wire 10 may perform a kind of “flossing” effect in the bone, allowing the suture 3 to follow a more straight pathway through the passageway 5, reducing the length of suture 3 needed between the rotator cuff2 and a point of fixation of the suture 3, e.g., near the second opening 54. The wire 10 may have barbs or other saw-like features to aid in cutting bone and forming the pathway. Of course, the more straight pathway could be formed by manipulating the suture 3 itself, e.g., by tensioning the suture 3 when securing the tendon or other material. Reducing the length of suture 3 in the passageway 5 may improve the suture's ability to maintain appropriate tension on the rotator cuff 2, e.g., by reducing the amount of stretch of the suture when under tension.
  • After the suture 3 has been passed through the passageway 5, the suture 3 may be engaged with a suture fixation device 4 as shown in FIG. 13. Although use of a suture fixation device is not required, the suture fixation device 4 may improve an ability to securely fixate the suture 3 (and the tissue 2) relative to the bone. The suture fixation device 4 may be arranged in any suitable way, but in this illustrative embodiment has an arrangement similar to a button. For example, the suture fixation device 4 may have two through holes formed in a disk-shaped member through which leading ends of the suture 3 are passed. The suture ends 3 may be passed through respective holes in the suture fixation device 4 using one or more feed members 41. The feed members 41 may have an elongated shape that is passed through a respective hole in the suture fixation device 4. A loop at one end of the feed member 41 may receive an end of the suture 3 and thereafter the feed member 41 may be pulled through a respective hole in the suture fixation device 4 so as to pull the suture 3 through the hole. Of course, it should be understood that the suture 3 may be fed through the suture fixation device 4 in any other suitable way. When performing this technique arthroscopically, the suture 3 may be fed through the suture fixation device 4 either inside or outside of the body cavity.
  • As shown in FIG. 14, after the suture 3 is engaged with the suture fixation device 4, the suture fixation device 4 may be positioned relative to the second opening 54 of the passageway 5 using an applier 42 which removably engages with the suture fixation device 4 and may be selectively disengaged from the suture fixation device when the suture fixation device 4 is positioned as desired. As shown in FIG. 15, the applier 42 may have a pair of tines 421 that engage with recesses or other features on the suture fixation device 4 so as to removably engage with the suture fixation device 4. The tines 421 may be resilient so that the tines are squeezed together when engaged with the suture fixation device 4. Thus, an elastic force biasing the tine ends apart may help maintain engagement of the tines with the grooves 48 in the suture fixation device 4. Alternately, the tine ends may be force-fit into grooves 48 in the suture fixation device so that engagement is maintained based on friction. Of course, it will be understood that the applier 42 may engage with the suture fixation device 4 in any other suitable way, such as a screw-in or snap configurations.
  • With the suture fixation device 4 in place relative to the second opening 54, the suture 3 may be tensioned so as to appropriately position the rotator cuff2 relative to the humerus 1. At this point, the suture 3 may be fixed relative to the suture fixation device 4, such as by tying a knot with the suture ends. Thus, the suture fixation device 4 may provide not only a structure to support the suture knot, but also may spread the force of the suture 3 to portions of the relatively hard cortical bone surrounding or otherwise adjacent to the second opening 54. By having the suture fixation device 4 engage with this cortical bone, the suture fixation device 4 may provide a relatively stable and secure fixation point for the suture 3. The suture fixation device 4 may also incorporate a mechanism for knotless fixation of the suture, such as an interference pin, a locking passageway, a locking cap, etc.
  • Although in the illustrative embodiment described above both ends of the suture 3 are passed through the passageway 5 and secured at or near the second opening 54 of the passageway 5, the suture 3 may be secured in other ways, such as by passing one end of the suture 3 through the passageway 5 and passing another end of the suture 3 around the outside of the bone (e.g., over a portion of the greater tuberosity) where it is secured to the other suture end. In another embodiment, two passageways 5 may be formed through the bone and one end of the suture 3 may be passed through one passageway and the other end of the suture 3 may be passed through the other passageway. The suture ends may then be secured to each other at or near respective second openings of the passageways 5 on the lateral side of the humerus 1. In yet another embodiment, two or more first holes 51 may be formed so as to intersect with one or more second holes 52. Suture 3 may be passed through the two or more first holes 51 and be secured at the second opening 54 of the one or more second holes 52. Such an arrangement may allow for the use of a single second hole 52 and suture fixation device 4 to secure the rotator cuff at two or more points on the humeral head using two or more sutures that pass through different first holes 51. Other suture fixation techniques may be used as desired.
  • FIGS. 16A-B and 17A-B show illustrative embodiments of suture fixation devices 4 in accordance with the invention. In these embodiments, the suture fixation device 4 includes a restriction in a pathway through the suture fixation device 4 so that suture or other material passing through the suture fixation device is relatively freely moved in one direction through the pathway, but movement of the suture or other material in the other direction in the pathway is resisted. For example, movement of a suture though the suture fixation devices shown in FIGS. 16A and 17A in a direction to the left in the side view of the suture fixation devices 4 may be freely allowed, while movement of the suture toward the right may be resisted. This may aid in tensioning the suture 3 because the suture 3 may be pulled from the second hole 52 through the suture fixation device 4 until the rotator cuff or other tissue is appropriately positioned. Thereafter, tension on the suture may be temporarily released, e.g., in preparation for forming a knot, but movement of the suture back through the suture fixation device 4 may be resisted so that the rotator cuff or other tissue is maintained in place until the suture knot is tied or otherwise is secured.
  • In the FIG. 16A-B embodiment, the suture fixation device includes an outer end having a flange portion 43 that is sized and arranged to contact the cortical bone adjacent the opening in the passageway at which the suture fixation device 4 is positioned, e.g., the second opening 54. One or more pathways 44 may be formed through the suture fixation device 4, such as by a hole or holes formed through the flange 43 (see also FIG. 15). Instead of having multiple holes, the pathway 44 may include a single slot arranged to receive one or more sutures. A recess 49 may be provided in the flange portion 43 to receive one or more knots, if formed with the suture(s) in the pathway 44. A pair of duck bill members 45 at an inner end of the suture fixation device 4 may extend rearwardly from the flange 43 and may be arranged as to be positionable in the second hole 54. The duck bill members 45 may be separated from each other by a groove that extends across the inner end of the suture fixation device 4 and be resiliently biased toward each other so as to resist the passage of suture or other material through the pathway 44. One or both of the duck bill structures 45 may include serrations 46 or other features that may aid in engaging a suture or other material. In the FIG. 16 embodiment, the groove separating the duck bill structures 45 extends to the flange portion 43 so that the structures 45 are pivotable at a point near the flange portion 43.
  • The FIG. 17A-B embodiment similarly includes a flange 43 and one or more pathways 44. Duck bill structures 45 are also provided. However, in this embodiment rather than being hinged at a point near respective connection points with the flange 43, the duck bill portions 45 are hinged at a point positioned away from the flange 43. Providing the effective hinge points for the duck bill structures 45 in this manner may provide improved engagement of the duck bill structures 45 with a suture or other material when the suture is urged to move from the outer end toward the inner end through the pathway 44. That is, if the suture is pulled to move toward the inner end, serrations 46 or other features will engage with the suture and increased force on the suture will cause an increased force urging the duck bill structures 45 to move toward each other and further squeeze the suture. The duck bill structures in the FIG. 16 and 17 embodiments or other suitable suture engagement arrangements (such as interference pins, locking caps, etc.) may provide a knotless fixation for the suture. Alternatively, the structures may resist movement of the suture so as to aid the surgeon's ability to maintain tension on the suture while forming a knot.
  • Although this embodiment depicts the flange of the device resting on the outer cortical surface of the bone, the device may be positioned in a hole which has a counterbore, or countersink, in order to prevent any interference between the flange and other bone or tissues that may come in contact with the site either at rest or during movement. Even in the case where the device is positioned in a counterbore or countersink feature, the device may contact cortical bone. Alternately, the device may only contact the outer, cortical surface of the bone, and not extend into a hole in the bone.
  • Of course, it should be understood that suture fixation devices may be provided in any suitable form. For example, the duck bill portions 45 extending from the flange 43 in the FIGS. 16 and 17 embodiments may be sized to closely fit into a mating hole formed in bone. This close fit may help in maintaining the suture fixation devices 4 in a desired position in the bone. Alternately, the duck bill structures 45 may be formed so as to be tapered on their outer surfaces. Thus, when the suture fixation device 4 is inserted into a hole in the bone, the tapered surfaces of the duck bill structures 45 may contact the sides of the hole and urge the duck bill structures to move toward each other as the suture fixation device 4 is pressed into the hole. In another embodiment, a portion of the suture fixation device 4 that is inserted into a hole may be threaded or otherwise be arranged so as to engage the hole and help prevent the suture fixation device from falling from the hole, e.g., before the suture is secured in place. There are many variations of the mechanism form to retain the suture with respect to the device. Some of these forms may require a knot for final fixation. Other capturing mechanisms may provide sufficient locking of the suture such that a knot is not required. Theses are typically known as “knotless” devices.
  • Having thus described several aspects of at least one embodiment of this invention, it is to be appreciated various alterations, modifications, and improvements will readily occur to those skilled in the art. Such alterations, modifications, and improvements are intended to be part of this disclosure, and are intended to be within the spirit and scope of the invention. Accordingly, the foregoing description and drawings are by way of example only.

Claims (43)

1. An apparatus comprising:
a cannula having at least one lumen, the cannula being constructed and arranged to be placed in an arthroscopic portal in a minimally-invasive surgical procedure and allow an instrument to be passed through the at least one lumen of the cannula; and
a needle attached to the cannula and having a tissue penetrating portion adapted to carry a suture;
wherein the needle, when carrying a suture, is manipulable by movement of the cannula to penetrate a material to place the suture in the material.
2. The apparatus of claim 1, wherein the cannula has a groove with a shape, and the needle has a portion with a shape that engages with the groove.
3. The apparatus of claim 1, wherein rotation of the cannula causes rotation of the tissue penetrating portion of the needle.
4. The apparatus of claim 1, wherein the needle has a hollow portion that accommodates a suture.
5. The apparatus of claim 1, wherein the needle has a cannula engaging portion that engages with the cannula and the tissue penetrating portion is positioned distally of the cannula engaging portion.
6. The apparatus of claim 1, wherein the cannula has a longitudinal axis and the tissue penetrating portion includes a curved end portion positioned in a plane that is transverse to the longitudinal axis.
7. The apparatus of claim 6, wherein rotation of the cannula about the longitudinal axis causes the curved end portion to travel along an arc-shaped path.
8. The apparatus of claim 1, wherein the cannula has a longitudinal axis, and rotation of the cannula about the longitudinal axis causes the tissue penetrating portion to move in an arc-shaped path.
9. The apparatus of claim 1, wherein the cannula has a longitudinal axis, and the tissue penetrating portion is positioned in a plane that is transverse to the longitudinal axis.
10. The apparatus of claim 1, wherein the cannula has a longitudinal axis, and the tissue penetrating portion includes a semicircular end portion that lies in a plane perpendicular to the longitudinal axis.
11. The apparatus of claim 10, wherein the cannula has a longitudinal axis that passes through a center of a lumen of the cannula and passes through a center of the semicircular end portion.
12. The apparatus of claim 1, wherein the tissue penetrating portion includes a hollow section adapted to carry a suture.
13. The apparatus of claim 1, wherein the needle is hollow along its length to carry a suture.
14. The apparatus of claim 1, wherein the cannula includes a valve that inhibits the flow of fluid through a lumen of the cannula.
15. The apparatus of claim 1, wherein the cannula and needle are constructed and arranged to place a suture in a rotator cuff.
16. The apparatus of claim 1, wherein the cannula and needle are constructed and arranged to form a mattress stitch in a rotator cuff.
17. The apparatus of claim 1, wherein the needle is movable axially relative to the cannula.
18. The apparatus of claim 1, wherein the cannula has a longitudinal axis, and the needle is movable in a direction generally along the longitudinal axis relative to the cannula.
19. The apparatus of claim 1, wherein the cannula and the needle have complementary locking members that are engagable so that the needle is operable to place the suture based on movement of the cannula.
20. The apparatus of claim 19, wherein the cannula has an oval-shaped groove and the needle has at least one oval-shaped portion that engages with the oval-shaped groove.
21. The apparatus of claim 1, wherein the needle is selectively separable from the cannula.
22. A method of performing a surgical procedure, comprising:
attaching a needle to a cannula, the needle being constructed and arranged to carry a suture;
providing the cannula and needle in an arthroscopic portal, the cannula being constructed and arranged to allow an instrument to be passed through a lumen of the cannula and used at a surgical site; and
manipulating the cannula so as to use the needle to penetrate a material to place a suture in the material.
23. The method of claim 22, wherein the material is a rotator cuff tendon.
24. The method of claim 23, further comprising:
securing the suture and rotator cuff tendon to a portion of a humerus.
25. The method of claim 22, wherein the step of manipulating comprises rotating the cannula about a longitudinal axis of the cannula.
26. The method of claim 22, wherein the step of manipulating comprises placing a mattress stitch in the material.
27. The method of claim 22, wherein the needle is removably attached to the cannula.
28. The method of claim 22, further comprising moving the needle axially relative to the cannula.
29. The method of claim 22, wherein the needle includes a material engaging portion that is hollow and accommodates the suture.
30. The method of claim 22, further comprising inserting a surgical instrument in a lumen of the cannula while the needle is attached to the cannula.
31. An apparatus comprising:
a cannula having at least one lumen and constructed and arranged to be used in a minimally-invasive surgical procedure and allow an instrument to be passed through the at least one lumen of the cannula, the cannula having at least one feature adapted to engage with a needle such that the needle, when carrying a suture, is manipulable by movement of the cannula to place the suture in a material.
32. The apparatus of claim 31, wherein the cannula is arranged to allow the needle to be movable axially relative to the cannula while remaining engaged with the cannula.
33. The apparatus of claim 32, wherein the cannula has a longitudinal axis, and the cannula is arranged to allow movement of the needle in a direction generally along the longitudinal axis relative to the cannula.
34. The apparatus of claim 31, wherein the cannula has at least one locking member that is complementary and engagable with at least one locking member associated with the needle.
35. The apparatus of claim 31, wherein the lumen of the cannula has a longitudinal axis, and the cannula is arranged to engage with the needle so that rotation of the cannula about the longitudinal axis causes rotation of a tissue penetrating portion of the needle.
36. The apparatus of claim 31, wherein the needle is removably engagable with the cannula.
37. The apparatus of claim 31, wherein the cannula includes at least one groove adapted to engage with at least a portion associated with the needle.
38. An apparatus comprising:
a needle constructed and arranged to carry a suture and to engage with a cannula having at least one lumen, the cannula being constructed and arranged to be placed in an arthroscopic portal in a minimally-invasive surgical procedure and allow an instrument to be passed through the at least one lumen of the cannula and used at a surgical site, engagement of the needle and the cannula being arranged so that the needle is manipulable by movement of the cannula in a minimally-invasive surgical procedure to place a suture in a material.
39. The apparatus of claim 38, wherein the needle has at least one locking member that is complementary and engagable with at least one locking member associated with the cannula.
40. The apparatus of claim 38, wherein the needle is arranged to engage with at least one groove associated with the cannula.
41. The apparatus of claim 38, wherein the needle is removably engagable with the cannula.
42. The apparatus of claim 38, wherein the needle includes a curved tissue penetrating portion that is arranged to move in a circular path when the needle is engaged with the cannula and the cannula is rotated about a longitudinal axis.
43. The apparatus of claim 38, wherein the needle includes a hollow portion adapted to carry a suture.
US11/110,432 2005-04-20 2005-04-20 Method and apparatus for suture placement Abandoned US20060241658A1 (en)

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US11/110,540 US7569059B2 (en) 2005-04-20 2005-04-20 Method and apparatus for surgical repair
US11/110,419 US7833244B2 (en) 2005-04-20 2005-04-20 Suture fixation device and method for surgical repair
US11/110,432 US20060241658A1 (en) 2005-04-20 2005-04-20 Method and apparatus for suture placement
US11/110,004 US7771441B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing suture in a passageway
US11/110,584 US7833230B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing a passageway
CA2605189A CA2605189C (en) 2005-04-20 2006-04-12 Method and apparatus for suture placement
AU2006240354A AU2006240354B2 (en) 2005-04-20 2006-04-12 Method and apparatus for suture placement
PCT/US2006/013579 WO2006115773A2 (en) 2005-04-20 2006-04-12 Method and apparatus for suture placement
JP2008507715A JP5058154B2 (en) 2005-04-20 2006-04-12 Method and apparatus for attaching a suture
EP06740879A EP1887942A2 (en) 2005-04-20 2006-04-12 Method and apparatus for suture placement
PCT/US2006/013617 WO2006115782A2 (en) 2005-04-20 2006-04-12 Method and apparatus for surgical repair
US11/799,972 US7955341B2 (en) 2005-04-20 2007-05-03 Method and apparatus for providing suture in a passageway

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US11/110,540 US7569059B2 (en) 2005-04-20 2005-04-20 Method and apparatus for surgical repair
US11/110,419 US7833244B2 (en) 2005-04-20 2005-04-20 Suture fixation device and method for surgical repair
US11/110,432 US20060241658A1 (en) 2005-04-20 2005-04-20 Method and apparatus for suture placement
US11/110,004 US7771441B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing suture in a passageway
US11/110,584 US7833230B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing a passageway

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US11/110,432 Abandoned US20060241658A1 (en) 2005-04-20 2005-04-20 Method and apparatus for suture placement
US11/110,419 Expired - Fee Related US7833244B2 (en) 2005-04-20 2005-04-20 Suture fixation device and method for surgical repair
US11/110,004 Expired - Fee Related US7771441B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing suture in a passageway
US11/110,584 Expired - Fee Related US7833230B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing a passageway
US11/799,972 Expired - Fee Related US7955341B2 (en) 2005-04-20 2007-05-03 Method and apparatus for providing suture in a passageway

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US11/110,004 Expired - Fee Related US7771441B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing suture in a passageway
US11/110,584 Expired - Fee Related US7833230B2 (en) 2005-04-20 2005-04-20 Method and apparatus for providing a passageway
US11/799,972 Expired - Fee Related US7955341B2 (en) 2005-04-20 2007-05-03 Method and apparatus for providing suture in a passageway

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Cited By (49)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060241694A1 (en) * 2005-04-20 2006-10-26 Daniel Cerundolo Suture fixation device and method for surgical repair
US20100228271A1 (en) * 2006-05-22 2010-09-09 Peter Marshall Meniscal repair device
US20110046646A1 (en) * 2006-05-22 2011-02-24 Scandius Biomedical, Inc. Method and apparatus for meniscal repair
US7996967B2 (en) 2001-08-31 2011-08-16 Quill Medical, Inc. System for variable-angle cutting of a suture to create tissue retainers of a desired shape and size
US8032996B2 (en) 2003-05-13 2011-10-11 Quill Medical, Inc. Apparatus for forming barbs on a suture
US8083770B2 (en) 2002-08-09 2011-12-27 Quill Medical, Inc. Suture anchor and method
US8246652B2 (en) 1993-05-03 2012-08-21 Ethicon, Inc. Suture with a pointed end and an anchor end and with equally spaced yieldable tissue grasping barbs located at successive axial locations
US8460338B2 (en) 2008-02-25 2013-06-11 Ethicon, Inc. Self-retainers with supporting structures on a suture
US8615856B1 (en) 2008-01-30 2013-12-31 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
US8641732B1 (en) 2008-02-26 2014-02-04 Ethicon, Inc. Self-retaining suture with variable dimension filament and method
US8721664B2 (en) 2004-05-14 2014-05-13 Ethicon, Inc. Suture methods and devices
US8721681B2 (en) 2002-09-30 2014-05-13 Ethicon, Inc. Barbed suture in combination with surgical needle
US8734485B2 (en) 2002-09-30 2014-05-27 Ethicon, Inc. Sutures with barbs that overlap and cover projections
US8747437B2 (en) 2001-06-29 2014-06-10 Ethicon, Inc. Continuous stitch wound closure utilizing one-way suture
US8771313B2 (en) 2007-12-19 2014-07-08 Ethicon, Inc. Self-retaining sutures with heat-contact mediated retainers
US8777987B2 (en) 2007-09-27 2014-07-15 Ethicon, Inc. Self-retaining sutures including tissue retainers having improved strength
US8793863B2 (en) 2007-04-13 2014-08-05 Ethicon, Inc. Method and apparatus for forming retainers on a suture
US8801727B2 (en) 2011-07-08 2014-08-12 Smith & Nephew, Inc. Orthopedic suture passer and method
US20140257391A1 (en) * 2004-04-20 2014-09-11 James L. Chappuis Internal Pedicle Insulator Apparatus and Method of Use
US8876865B2 (en) 2008-04-15 2014-11-04 Ethicon, Inc. Self-retaining sutures with bi-directional retainers or uni-directional retainers
US8875607B2 (en) 2008-01-30 2014-11-04 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
US8882834B2 (en) 2011-07-08 2014-11-11 Smith & Nephew, Inc. Soft tissue repair
US8888849B2 (en) 2011-07-08 2014-11-18 Smith & Nephew, Inc. Soft tissue repair
US8916077B1 (en) 2007-12-19 2014-12-23 Ethicon, Inc. Self-retaining sutures with retainers formed from molten material
US8932328B2 (en) 2008-11-03 2015-01-13 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US8951263B2 (en) 2011-07-08 2015-02-10 Smith & Nephew, Inc. Orthopedic suture passer and method
US8961560B2 (en) 2008-05-16 2015-02-24 Ethicon, Inc. Bidirectional self-retaining sutures with laser-marked and/or non-laser marked indicia and methods
USRE45426E1 (en) 1997-05-21 2015-03-17 Ethicon, Inc. Surgical methods using one-way suture
US9044225B1 (en) 2007-12-20 2015-06-02 Ethicon, Inc. Composite self-retaining sutures and method
US9125647B2 (en) 2008-02-21 2015-09-08 Ethicon, Inc. Method and apparatus for elevating retainers on self-retaining sutures
US9131937B2 (en) 2011-11-16 2015-09-15 VentureMD Innovations, LLC Suture anchor
US9248580B2 (en) 2002-09-30 2016-02-02 Ethicon, Inc. Barb configurations for barbed sutures
US9357997B2 (en) 2011-07-08 2016-06-07 Smith & Nephew, Inc. Suture passer and method
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
US9675341B2 (en) 2010-11-09 2017-06-13 Ethicon Inc. Emergency self-retaining sutures and packaging
US9687221B2 (en) 2013-02-13 2017-06-27 Venture MD Innovations, LLC Method of anchoring a suture
US9782165B2 (en) 2011-11-11 2017-10-10 VentureMD Innovations, LLC Transosseous attachment
US9955962B2 (en) 2010-06-11 2018-05-01 Ethicon, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US9962174B2 (en) 2015-07-17 2018-05-08 Kator, Llc Transosseous method
US10143462B2 (en) 2015-08-04 2018-12-04 Kator, Llc Transosseous suture anchor method
US10154868B2 (en) 2015-07-17 2018-12-18 Kator, Llc Transosseous method
US10188384B2 (en) 2011-06-06 2019-01-29 Ethicon, Inc. Methods and devices for soft palate tissue elevation procedures
US10420546B2 (en) 2010-05-04 2019-09-24 Ethicon, Inc. Self-retaining systems having laser-cut retainers
US10470756B2 (en) 2011-11-16 2019-11-12 VentureMD Innovations, LLC Suture anchor and method
US10492780B2 (en) 2011-03-23 2019-12-03 Ethicon, Inc. Self-retaining variable loop sutures
US10548585B2 (en) 2011-11-16 2020-02-04 VentureMD Innovations, LLC Soft tissue attachment
US10675014B2 (en) 2011-11-16 2020-06-09 Crossroads Extremity Systems, Llc Knotless soft tissue attachment
US11007296B2 (en) 2010-11-03 2021-05-18 Ethicon, Inc. Drug-eluting self-retaining sutures and methods relating thereto
US11504140B2 (en) 2015-07-17 2022-11-22 Crossroads Extremity Systems, Llc Transosseous guide and method

Families Citing this family (146)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7163541B2 (en) 2002-12-03 2007-01-16 Arthrosurface Incorporated Tibial resurfacing system
US8177841B2 (en) 2000-05-01 2012-05-15 Arthrosurface Inc. System and method for joint resurface repair
US6610067B2 (en) 2000-05-01 2003-08-26 Arthrosurface, Incorporated System and method for joint resurface repair
US7678151B2 (en) 2000-05-01 2010-03-16 Ek Steven W System and method for joint resurface repair
US6520964B2 (en) 2000-05-01 2003-02-18 Std Manufacturing, Inc. System and method for joint resurface repair
US7713305B2 (en) 2000-05-01 2010-05-11 Arthrosurface, Inc. Articular surface implant
US7901408B2 (en) 2002-12-03 2011-03-08 Arthrosurface, Inc. System and method for retrograde procedure
US8388624B2 (en) 2003-02-24 2013-03-05 Arthrosurface Incorporated Trochlear resurfacing system and method
CA2593182A1 (en) 2003-11-20 2006-07-13 Arthrosurface, Inc. System and method for retrograde procedure
US7951163B2 (en) 2003-11-20 2011-05-31 Arthrosurface, Inc. Retrograde excision system and apparatus
WO2005051231A2 (en) 2003-11-20 2005-06-09 Arthrosurface, Inc. Retrograde delivery of resurfacing devices
JP2008504107A (en) 2004-06-28 2008-02-14 アースロサーフィス・インコーポレーテッド Joint surface replacement system
US20180228621A1 (en) 2004-08-09 2018-08-16 Mark A. Reiley Apparatus, systems, and methods for the fixation or fusion of bone
US20060036251A1 (en) 2004-08-09 2006-02-16 Reiley Mark A Systems and methods for the fixation or fusion of bone
US9949843B2 (en) 2004-08-09 2018-04-24 Si-Bone Inc. Apparatus, systems, and methods for the fixation or fusion of bone
US9662158B2 (en) 2004-08-09 2017-05-30 Si-Bone Inc. Systems and methods for the fixation or fusion of bone at or near a sacroiliac joint
US8414648B2 (en) 2004-08-09 2013-04-09 Si-Bone Inc. Apparatus, systems, and methods for achieving trans-iliac lumbar fusion
US8388667B2 (en) 2004-08-09 2013-03-05 Si-Bone, Inc. Systems and methods for the fixation or fusion of bone using compressive implants
US20070156241A1 (en) 2004-08-09 2007-07-05 Reiley Mark A Systems and methods for the fixation or fusion of bone
US8425570B2 (en) 2004-08-09 2013-04-23 Si-Bone Inc. Apparatus, systems, and methods for achieving anterior lumbar interbody fusion
US7828853B2 (en) 2004-11-22 2010-11-09 Arthrosurface, Inc. Articular surface implant and delivery system
US20060167481A1 (en) * 2005-01-25 2006-07-27 Esophyx, Inc. Slitted tissue fixation devices and assemblies for deploying the same
US9504461B2 (en) 2005-05-20 2016-11-29 Neotract, Inc. Anchor delivery system
US8425535B2 (en) 2005-05-20 2013-04-23 Neotract, Inc. Multi-actuating trigger anchor delivery system
US7758594B2 (en) 2005-05-20 2010-07-20 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US7645286B2 (en) 2005-05-20 2010-01-12 Neotract, Inc. Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures
US8668705B2 (en) 2005-05-20 2014-03-11 Neotract, Inc. Latching anchor device
US10925587B2 (en) 2005-05-20 2021-02-23 Neotract, Inc. Anchor delivery system
US8945152B2 (en) 2005-05-20 2015-02-03 Neotract, Inc. Multi-actuating trigger anchor delivery system
US10195014B2 (en) 2005-05-20 2019-02-05 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US8603106B2 (en) 2005-05-20 2013-12-10 Neotract, Inc. Integrated handle assembly for anchor delivery system
US8628542B2 (en) 2005-05-20 2014-01-14 Neotract, Inc. Median lobe destruction apparatus and method
US9549739B2 (en) 2005-05-20 2017-01-24 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US20070005067A1 (en) 2005-06-21 2007-01-04 Brian Dross Arthoscopic method and apparatus for tissue attachment to bone
DE602006016904D1 (en) 2005-11-10 2010-10-28 Arthrex Inc Apparatus for reconstructing the anterior cruciate ligament using a drill for the retrograde shaping of canals
GB0607958D0 (en) * 2006-04-21 2006-05-31 Imp College Innovations Ltd Tendon repair
US7713284B2 (en) * 2006-09-13 2010-05-11 Crofford Theodore W Self-opening skin staple
EP2136717B1 (en) 2006-12-11 2013-10-16 Arthrosurface Incorporated Retrograde resection apparatus
US8043308B2 (en) 2006-12-14 2011-10-25 Depuy Mitek, Inc. Bone suture
US7846211B2 (en) * 2007-07-09 2010-12-07 Moximed, Inc. Surgical implantation method and devices for an extra-articular mechanical energy absorbing apparatus
US20090018665A1 (en) * 2007-07-09 2009-01-15 Exploramed Nc4, Inc. Surgical implantation method and devices for an extra-articular mechanical energy absorbing apparatus
CA2694650C (en) * 2007-07-26 2016-11-15 Marshall S. Levine Surgical suturing device, method and tools used therewith
US9226748B2 (en) 2007-07-26 2016-01-05 Alpha Scientific Corporation Surgical suturing device, method and tools used therewith
US8206445B2 (en) * 2008-01-21 2012-06-26 Ion Surgical Technologies, Inc. Method of arthroscopically assisted ligament reconstruction
MX2010009000A (en) 2008-02-28 2010-10-25 T A G Medical Products Corp Ltd Medical apparatus and method for attaching a suture to a bone.
AU2014201225B2 (en) * 2008-02-28 2015-08-13 T.A.G. Medical Devices - Agriculture Cooperative Ltd. Medical Apparatus and Method for Attaching a Suture to a Bone
WO2009111481A1 (en) * 2008-03-03 2009-09-11 Arthrosurface Incorporated Bone resurfacing system and method
GB2458878A (en) * 2008-03-04 2009-10-07 Xiros Plc An implantable prosthetic cord
US20090234386A1 (en) * 2008-03-11 2009-09-17 Dean John C Suture Cleat for Soft Tissue Injury Repair
WO2010014825A1 (en) * 2008-07-30 2010-02-04 Neotract, Inc. Slotted anchor device
US9289202B2 (en) * 2008-08-06 2016-03-22 Syntorr, Inc. Suture-retaining device and anchor
JP2012501757A (en) * 2008-09-08 2012-01-26 セテリックス オーソペディクス インコーポレイテッド Knotless suture anchor
AU2009222580B2 (en) 2008-10-10 2014-11-27 Depuy Mitek, Inc. Method for replacing a ligament in a knee
US8361079B2 (en) * 2008-11-13 2013-01-29 Pandya Rajiv D Method for drilling enlarged sections of angled osteal tunnels
US20100121375A1 (en) * 2008-11-13 2010-05-13 Pandya Rajiv D Suture anchoring system and method
JP2010251529A (en) * 2009-04-16 2010-11-04 Sony Corp Semiconductor memory device and method of manufacturing the same
WO2016154393A1 (en) 2009-04-17 2016-09-29 Arthrosurface Incorporated Glenoid repair system and methods of use thereof
WO2010121246A1 (en) 2009-04-17 2010-10-21 Arthrosurface Incorporated Glenoid resurfacing system and method
US9662126B2 (en) 2009-04-17 2017-05-30 Arthrosurface Incorporated Glenoid resurfacing system and method
US20110106124A1 (en) * 2009-06-16 2011-05-05 Marc Beauchamp Method and apparatus for arthroscopic rotator cuff repair using transosseous tunnels
CA2802554A1 (en) * 2009-06-16 2010-12-23 Marc Beauchamp Method and apparatus for arthroscopic rotator cuff repair using transosseous tunnels
ITMI20091178A1 (en) * 2009-07-03 2011-01-04 Matteo Regusci ORTHOPEDIC INSTRUMENT FOR THE REPAIR OF INJURIES HEADPHONES OF THE HEADPHONE OF THE ROTATORS OF THE ARROSCOPIC SHOULDER
US9421109B2 (en) 2010-01-13 2016-08-23 Jcbd, Llc Systems and methods of fusing a sacroiliac joint
WO2012174485A1 (en) 2011-06-17 2012-12-20 Jcbd, Llc Sacroiliac joint implant system
US9381045B2 (en) 2010-01-13 2016-07-05 Jcbd, Llc Sacroiliac joint implant and sacroiliac joint instrument for fusing a sacroiliac joint
WO2014015309A1 (en) 2012-07-20 2014-01-23 Jcbd, Llc Orthopedic anchoring system and methods
US9333090B2 (en) 2010-01-13 2016-05-10 Jcbd, Llc Systems for and methods of fusing a sacroiliac joint
EP3138533B1 (en) 2010-01-13 2021-12-01 Jcbd, Llc Sacroiliac joint fixation fusion system
AU2011222404A1 (en) 2010-03-05 2012-09-27 Arthrosurface Incorporated Tibial resurfacing system and method
US9161751B2 (en) 2010-12-02 2015-10-20 Coloplast A/S Suture system and assembly
US9220495B2 (en) * 2011-02-10 2015-12-29 Coloplast A/S Suture system and assembly including a suture clip
US9707069B2 (en) 2011-02-25 2017-07-18 Avinash Kumar Suture mesh and method of use
US9066716B2 (en) 2011-03-30 2015-06-30 Arthrosurface Incorporated Suture coil and suture sheath for tissue repair
US9161749B2 (en) 2011-04-14 2015-10-20 Neotract, Inc. Method and apparatus for treating sexual dysfunction
US8926661B2 (en) 2011-06-02 2015-01-06 Smith & Nephew, Inc. Surgical fastening
WO2013009986A1 (en) * 2011-07-14 2013-01-17 Dgimed Ortho, Inc. Flexible guide tube and methods of use thereof
US8986314B1 (en) 2011-10-20 2015-03-24 Christopher S. Jordan Positional dual drill guide
EP2804565B1 (en) 2011-12-22 2018-03-07 Arthrosurface Incorporated System for bone fixation
US9155542B2 (en) * 2012-01-23 2015-10-13 Gregory Markarian Arthroscopic method and apparatus for rotator cuff repair
EP2811927B1 (en) 2012-02-07 2017-05-10 MNR Device Corporation Apparatus for treating a bone fracture
US10363140B2 (en) 2012-03-09 2019-07-30 Si-Bone Inc. Systems, device, and methods for joint fusion
WO2013134670A1 (en) 2012-03-09 2013-09-12 Si-Bone Inc. Integrated implant
US10292801B2 (en) 2012-03-29 2019-05-21 Neotract, Inc. System for delivering anchors for treating incontinence
ES2828357T3 (en) 2012-05-04 2021-05-26 Si Bone Inc Fenestrated implant
US10130353B2 (en) 2012-06-29 2018-11-20 Neotract, Inc. Flexible system for delivering an anchor
US9468448B2 (en) 2012-07-03 2016-10-18 Arthrosurface Incorporated System and method for joint resurfacing and repair
CN102836002B (en) * 2012-09-10 2014-12-10 苏州大学 Kirschner wire guiding device
US9192390B2 (en) 2012-12-14 2015-11-24 DePuy Synthes Products, Inc. Surgical saw blade
US9636110B2 (en) 2013-03-13 2017-05-02 Alpha Scientific Corporation Structural support incorporating multiple strands
US9826986B2 (en) 2013-07-30 2017-11-28 Jcbd, Llc Systems for and methods of preparing a sacroiliac joint for fusion
US10245087B2 (en) 2013-03-15 2019-04-02 Jcbd, Llc Systems and methods for fusing a sacroiliac joint and anchoring an orthopedic appliance
US9700356B2 (en) 2013-07-30 2017-07-11 Jcbd, Llc Systems for and methods of fusing a sacroiliac joint
US9717539B2 (en) 2013-07-30 2017-08-01 Jcbd, Llc Implants, systems, and methods for fusing a sacroiliac joint
WO2014145902A1 (en) 2013-03-15 2014-09-18 Si-Bone Inc. Implants for spinal fixation or fusion
AU2014232723A1 (en) 2013-03-15 2015-10-08 Alpha Scientific Corporation Surgical suturing device with transverse engagement
US9492200B2 (en) 2013-04-16 2016-11-15 Arthrosurface Incorporated Suture system and method
US9089375B2 (en) 2013-10-12 2015-07-28 Interfix, Llc Combined intramedullary and extramedullary surgical aiming system and method
WO2015057866A1 (en) * 2013-10-15 2015-04-23 Si-Bone Inc. Implant placement
US11147688B2 (en) 2013-10-15 2021-10-19 Si-Bone Inc. Implant placement
US10206694B2 (en) * 2014-01-31 2019-02-19 Arthrex, Inc. Proximal biceps tenodesis with biceps button
US10123813B2 (en) 2014-02-17 2018-11-13 Smith & Nephew, Inc. Drill guide
US10624748B2 (en) 2014-03-07 2020-04-21 Arthrosurface Incorporated System and method for repairing articular surfaces
US20150250472A1 (en) 2014-03-07 2015-09-10 Arthrosurface Incorporated Delivery System for Articular Surface Implant
US11607319B2 (en) 2014-03-07 2023-03-21 Arthrosurface Incorporated System and method for repairing articular surfaces
US9801546B2 (en) 2014-05-27 2017-10-31 Jcbd, Llc Systems for and methods of diagnosing and treating a sacroiliac joint disorder
US20150359530A1 (en) 2014-06-16 2015-12-17 Dauntless Innovations, LLC Vector fixation device
WO2016010628A1 (en) 2014-07-15 2016-01-21 University Of South Florida Reversible anchoring devices
US10166033B2 (en) 2014-09-18 2019-01-01 Si-Bone Inc. Implants for bone fixation or fusion
ES2826600T3 (en) 2014-09-18 2021-05-18 Si Bone Inc Matrix implant
US10499900B2 (en) * 2014-09-26 2019-12-10 Tensyn Medical, Inc. Implant devices and systems for stabilized fixation of bone and soft tissue
US11317903B2 (en) 2014-09-26 2022-05-03 Tensyn Medical, Inc. Implant devices and systems for stabilized fixation of bone and soft tissue
US10076374B2 (en) 2014-10-23 2018-09-18 Medos International Sárl Biceps tenodesis delivery tools
US10034742B2 (en) 2014-10-23 2018-07-31 Medos International Sarl Biceps tenodesis implants and delivery tools
US10729419B2 (en) 2014-10-23 2020-08-04 Medos International Sarl Biceps tenodesis implants and delivery tools
US10751161B2 (en) 2014-10-23 2020-08-25 Medos International Sárl Biceps tenodesis anchor implants
US10856966B2 (en) 2014-10-23 2020-12-08 Medos International Sarl Biceps tenodesis implants and delivery tools
US10376206B2 (en) 2015-04-01 2019-08-13 Si-Bone Inc. Neuromonitoring systems and methods for bone fixation or fusion procedures
US9693856B2 (en) 2015-04-22 2017-07-04 DePuy Synthes Products, LLC Biceps repair device
US11523812B2 (en) 2016-02-01 2022-12-13 Medos International Sarl Soft tissue fixation repair methods using tissue augmentation constructs
US11484401B2 (en) 2016-02-01 2022-11-01 Medos International Sarl Tissue augmentation scaffolds for use in soft tissue fixation repair
US10130377B2 (en) 2016-02-08 2018-11-20 Crossroads Extremity Systems, Llc Plantar plate repair
US10722228B2 (en) 2016-02-12 2020-07-28 Medos International Sarl Suture anchors having location placement identification features
US11419684B2 (en) 2016-02-19 2022-08-23 Rajiv D. Pandya System and technique for accessing extra articular lesions or abnormalities or intra osseous lesions or bone marrow lesions
US9925010B2 (en) 2016-02-19 2018-03-27 Rajiv D. Pandya System and technique for accessing extra articular lesions or abnormalities or intra osseous lesions or bone marrow lesions
US11376079B2 (en) 2016-02-19 2022-07-05 Rajiv D. Pandya System and technique for accessing extra articular lesions or abnormalities or intra osseous lesions or bone marrow lesions
US10064632B2 (en) 2016-02-19 2018-09-04 Rajiv D. Pandya System and technique for accessing extra articular lesions or abnormalities or intra osseous lesions or bone marrow lesions
US10231824B2 (en) 2016-04-08 2019-03-19 Medos International Sárl Tenodesis anchoring systems and tools
US10231823B2 (en) 2016-04-08 2019-03-19 Medos International Sarl Tenodesis implants and tools
KR102558680B1 (en) 2017-06-05 2023-07-24 콘메드 코포레이션 Multi-barrel drill guide and anchor deployment assembly
US10631884B2 (en) 2017-06-05 2020-04-28 Conmed Corporation Multi-barrel drill guide
WO2019028344A1 (en) 2017-08-04 2019-02-07 Arthrosurface Incorporated Multicomponent articular surface implant
US10603055B2 (en) 2017-09-15 2020-03-31 Jcbd, Llc Systems for and methods of preparing and fusing a sacroiliac joint
US10646216B2 (en) 2017-09-22 2020-05-12 Arthrex, Inc. Knotless surgical technique
EP3687422A4 (en) 2017-09-26 2021-09-22 SI-Bone, Inc. Systems and methods for decorticating the sacroiliac joint
JP7150871B2 (en) 2017-12-23 2022-10-11 テレフレックス ライフ サイエンシズ リミテッド Expandable tissue engagement device and method
US10722229B2 (en) 2018-07-30 2020-07-28 DePuy Synthes Products, Inc. Suture crimp plate
US11266492B2 (en) 2019-02-02 2022-03-08 Daniel M Hoopes Tension to compression tendon fixation
AU2020223180A1 (en) 2019-02-14 2021-07-22 Si-Bone Inc. Implants for spinal fixation and or fusion
US11369419B2 (en) 2019-02-14 2022-06-28 Si-Bone Inc. Implants for spinal fixation and or fusion
GB2609338B (en) 2019-03-12 2023-06-14 Arthrosurface Inc Humeral and glenoid articular surface implant systems and methods
US11832806B2 (en) * 2019-09-11 2023-12-05 Acumed Llc Near bone suture button
US11331112B2 (en) 2019-11-06 2022-05-17 Mason James Bettenga Adjustable depth limiting drill guide and suture transporting method
EP4065015A4 (en) 2019-11-27 2024-01-03 Si Bone Inc Bone stabilizing implants and methods of placement across si joints
DK3989844T3 (en) 2020-08-03 2023-10-30 Teleflex Life Sciences Ltd Handle and cartridge system for medical inventions
CZ309145B6 (en) * 2020-09-30 2022-03-09 Sportbalance s.r.o. Rotator cuff suture target and method of its use
AU2021397743A1 (en) 2020-12-09 2023-06-22 Si-Bone Inc. Sacro-iliac joint stabilizing implants and methods of implantation

Citations (89)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3976079A (en) * 1974-08-01 1976-08-24 Samuels Peter B Securing devices for sutures
US4103683A (en) * 1977-06-03 1978-08-01 Neufeld John A Sub-trochanteric nail
US4535768A (en) * 1981-08-26 1985-08-20 South African Inventions Development Corporation Set of surgical instruments
US4633869A (en) * 1985-12-23 1987-01-06 Arthrex Arthroscopy Instruments, Inc. Tension retaining device for surgical procedures
US4672957A (en) * 1983-10-04 1987-06-16 South African Inventions Development Corporation Surgical device
US4722331A (en) * 1985-09-03 1988-02-02 Fox James M Orthopaedic tool guide
US4739751A (en) * 1986-10-03 1988-04-26 Temple University Apparatus and method for reconstructive surgery
US4781182A (en) * 1986-10-03 1988-11-01 Purnell Mark L Apparatus and method for use in performing a surgical operation
US4920958A (en) * 1986-11-05 1990-05-01 Minnesota Mining And Manufacturing Company Drill guide assembly
US4945904A (en) * 1989-10-25 1990-08-07 W. L. Gore & Associates, Inc. Orthopedic drill guide device
US5042958A (en) * 1990-05-14 1991-08-27 Stenersen Raymond W Method and apparatus for installing sewer and drainage pipe
US5042983A (en) * 1989-10-30 1991-08-27 Rayhack John M Precision bone cutting guide
US5112337A (en) * 1991-02-05 1992-05-12 Depuy Du Pont Orthopaedics Variable angle, selective length tibial drill guide
US5152769A (en) * 1991-11-04 1992-10-06 Will Baber Apparatus for laparoscopic suturing with improved suture needle
US5163940A (en) * 1991-03-04 1992-11-17 American Cyanamid Company Surgical drill guide for tibia
US5178621A (en) * 1991-12-10 1993-01-12 Zimmer, Inc. Two-piece radio-transparent proximal targeting device for a locking intramedullary nail
US5211647A (en) * 1992-02-19 1993-05-18 Arthrex Inc. Interference screw and cannulated sheath for endosteal fixation of ligaments
US5217471A (en) * 1991-05-30 1993-06-08 Burkhart Stephen S Endoscopic suture knotting instrument
US5222962A (en) * 1992-04-23 1993-06-29 Burkhart Stephen S Endoscopic surgical instrument for releasably grasping a curved needle
US5234434A (en) * 1992-08-17 1993-08-10 Marlowe Goble E Mutliple guide sleeve drill guide
US5320626A (en) * 1992-02-19 1994-06-14 Arthrex Inc. Endoscopic drill guide
US5330468A (en) * 1993-10-12 1994-07-19 Burkhart Stephen S Drill guide device for arthroscopic surgery
US5334205A (en) * 1993-06-30 1994-08-02 The United States Of America As Represented By The Secretary Of The Air Force Sacroiliac joint fixation guide
US5350383A (en) * 1992-02-20 1994-09-27 Arthrex, Inc. Adjustable drill guide with interchangeable marking hooks
US5368596A (en) * 1992-03-18 1994-11-29 Burkhart; Stephen S. Augmented awl for creating channels in human bone tissue
US5403321A (en) * 1993-12-15 1995-04-04 Smith & Nephew Richards Inc. Radiolucent drill guide
US5425733A (en) * 1992-02-19 1995-06-20 Arthrex, Inc. Interference screw with rounded back end and cannulated sheath for endosteal fixation of ligaments
US5431651A (en) * 1993-02-08 1995-07-11 Goble; E. Marlowe Cross pin and set screw femoral and tibial fixation method
US5462562A (en) * 1993-05-17 1995-10-31 Henry Ford Hospital Suture passer and method of using
US5466243A (en) * 1994-02-17 1995-11-14 Arthrex, Inc. Method and apparatus for installing a suture anchor through a hollow cannulated grasper
US5503634A (en) * 1993-04-28 1996-04-02 Christy; William J. Surgical stab wound closure device and method
US5584839A (en) * 1994-12-12 1996-12-17 Gieringer; Robert E. Intraarticular drill guide and arthroscopic methods
US5601562A (en) * 1995-02-14 1997-02-11 Arthrex, Inc. Forked insertion tool and metnod of arthroscopic surgery using the same
US5603716A (en) * 1995-02-16 1997-02-18 Arthrex Inc. Method of ligament reconstruction using double socket graft placement and fixation
US5620449A (en) * 1994-07-28 1997-04-15 Orthofix, S.R.L. Mechanical system for blind nail-hole alignment of bone screws
US5626613A (en) * 1995-05-04 1997-05-06 Arthrex, Inc. Corkscrew suture anchor and driver
US5643293A (en) * 1993-12-29 1997-07-01 Olympus Optical Co., Ltd. Suturing instrument
US5665109A (en) * 1994-12-29 1997-09-09 Yoon; Inbae Methods and apparatus for suturing tissue
US5681333A (en) * 1995-11-08 1997-10-28 Arthrex, Inc. Method and apparatus for arthroscopic rotator cuff repair utilizing bone tunnels for suture attachment
US5690677A (en) * 1994-02-17 1997-11-25 Arthrex, Inc. Method for installing a suture anchor through a cannulated tissue-shifting guide
US5716368A (en) * 1993-06-02 1998-02-10 General Surgical Innovations, Inc. Knotmaker with curved elongate member used in tying a ligature
US5743916A (en) * 1990-07-13 1998-04-28 Human Factors Industrial Design, Inc. Drill guide with removable ferrules
US5746752A (en) * 1995-11-08 1998-05-05 Arthrex, Inc. Double-diameter knot pusher
US5766179A (en) * 1997-03-05 1998-06-16 Orthofix S.R.L. Mechanical system for blind nail-hole alignment of bone screws
US5797928A (en) * 1995-01-20 1998-08-25 Olympus Optical Co., Ltd. Ligating apparatus
US5833691A (en) * 1997-07-10 1998-11-10 Bimman; Lev A. Apparatus and method for drilling strictly aligned holes in bones to be connected intramedullary nailing
US5918604A (en) * 1997-02-12 1999-07-06 Arthrex, Inc. Method of loading tendons into the knee
US5919196A (en) * 1995-02-16 1999-07-06 Arthrex, Inc. Method and apparatus for osteochondral autograft transplantation
US5951559A (en) * 1996-07-25 1999-09-14 Arthrex, Inc. Method for installing a threaded suture anchor with a cannulated suture anchor drill guide
US5954733A (en) * 1996-11-27 1999-09-21 Yoon; Inbae Suturing instrument with rotatably mounted needle driver and catcher
US5964783A (en) * 1997-11-07 1999-10-12 Arthrex, Inc. Suture anchor with insert-molded suture
US6027523A (en) * 1997-10-06 2000-02-22 Arthrex, Inc. Suture anchor with attached disk
US6039742A (en) * 1996-05-04 2000-03-21 Synthes (U.S.A.) Alignment device for locking the base part of intramedullary nails
US6074403A (en) * 1997-10-29 2000-06-13 Arthrex, Inc. Suture retriever
US6099538A (en) * 1999-02-02 2000-08-08 T.A.G. Medical Products Set of surgical tools and surgical method for connecting soft bone parts to one another or to connective tissue
US6113604A (en) * 1997-01-14 2000-09-05 Ethicon, Inc. Method and apparatus for fixing a graft in a bone tunnel
US6117162A (en) * 1996-08-05 2000-09-12 Arthrex, Inc. Corkscrew suture anchor
US6120511A (en) * 1997-11-18 2000-09-19 Chan; Kwan-Ho Drill guide assembly and method for producing a bone tunnel
US6221084B1 (en) * 1999-01-15 2001-04-24 Pare Surgical, Inc. Knot tying apparatus having a notched thread cover and method for using same
US6221085B1 (en) * 1999-01-18 2001-04-24 Zarija Djurovic Djurovic suturing device
US6267766B1 (en) * 1999-05-28 2001-07-31 Stephen S. Burkhart Suture anchor reel device kit and method
US6270503B1 (en) * 1999-02-03 2001-08-07 Arthrex, Inc. System for ostechondral flap repair and method
US6306159B1 (en) * 1998-12-23 2001-10-23 Depuy Orthopaedics, Inc. Meniscal repair device
US20020013608A1 (en) * 2000-06-22 2002-01-31 Arthrex, Inc. Graft fixation using a screw or plug against suture or tissue
US20020022862A1 (en) * 1996-08-05 2002-02-21 Arthrex, Inc. Hex drive bioabsorbable tissue anchor
US20020032466A1 (en) * 1996-08-05 2002-03-14 Arthrex, Inc. Headed bioabsorbable tissue anchor
US6387129B2 (en) * 1998-03-18 2002-05-14 Arthrex, Inc. Bicortical tibial fixation of ACL grafts
US6416518B1 (en) * 2001-07-09 2002-07-09 Imp Inc. Combined surgical drill and surgical screw guide
US20020120275A1 (en) * 2001-02-26 2002-08-29 Arthrex, Inc. Torque driver for interference screw
US6461373B2 (en) * 2000-05-26 2002-10-08 Arthrex, Inc. Biointerference screw fixation technique
US20030004545A1 (en) * 2001-05-25 2003-01-02 Burkhart Stephen S. Interference fit knotless suture anchor fixation
US6517564B1 (en) * 1999-02-02 2003-02-11 Arthrex, Inc. Bioabsorbable tissue tack with oval-shaped head and method of tissue fixation using same
US6517552B1 (en) * 1997-10-29 2003-02-11 Arthrex, Inc. Suture retriever
US6524317B1 (en) * 1999-12-30 2003-02-25 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US20030050666A1 (en) * 2001-09-13 2003-03-13 Arthrex, Inc. High strength suture material
US6533795B1 (en) * 2000-04-11 2003-03-18 Opus Medical, Inc Dual function suturing apparatus and method
US6575976B2 (en) * 2000-06-12 2003-06-10 Arthrex, Inc. Expandable tissue anchor
US6592588B1 (en) * 1995-02-16 2003-07-15 Arthrex, Inc. Apparatus for osteochondral autograft transplantation
US6616674B2 (en) * 2000-03-14 2003-09-09 Arthrex, Inc. Notched suture hook
US6623524B2 (en) * 2000-06-09 2003-09-23 Arthrex, Inc. Method for anterior cruciate ligament reconstruction using cross-pin implant with eyelet
US6629977B1 (en) * 1999-11-15 2003-10-07 Arthrex, Inc. Tapered bioabsorbable interference screw and method for endosteal fixation of ligaments
US6629984B1 (en) * 1998-07-07 2003-10-07 Kwan-Ho Chan Surgical repair kit and its method of use
US20040093031A1 (en) * 2000-06-22 2004-05-13 Burkhart Stephen S. Graft fixation using a plug against suture
US20040106950A1 (en) * 2002-09-12 2004-06-03 Grafton R. Donald Fully threaded suture anchor with insert-molded suture
US20050038437A1 (en) * 1990-09-24 2005-02-17 Ethicon, Inc. Methods and apparatus for preventing migration of sutures through transosseous tunnels
US20050261674A1 (en) * 2004-05-14 2005-11-24 Nobis Rudolph H Medical devices for use with endoscope
US6974467B1 (en) * 2002-11-04 2005-12-13 Gonzales Jr Antonio Method and apparatus for making a precise surgical incision
US7153312B1 (en) * 1999-12-02 2006-12-26 Smith & Nephew Inc. Closure device and method for tissue repair
US20070100375A1 (en) * 2003-06-06 2007-05-03 Olympus Corporation Suturing instrument

Family Cites Families (47)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US36020A (en) * 1862-07-29 Improvement in corn-planters
GB1542319A (en) * 1975-11-26 1979-03-14 Exxon Research Engineering Co Halogenated organoaluminium catalyst compositions and method of their preparation
US4257411A (en) 1979-02-08 1981-03-24 Cho Kenneth O Cruciate ligament surgical drill guide
US5417691A (en) 1982-05-20 1995-05-23 Hayhurst; John O. Apparatus and method for manipulating and anchoring tissue
US5601557A (en) 1982-05-20 1997-02-11 Hayhurst; John O. Anchoring and manipulating tissue
US4533768A (en) * 1984-05-03 1985-08-06 General Electric Company Zinc oxide catalyzed dealkylation of alkylated phenols
DE4119054A1 (en) * 1990-06-18 1991-12-19 Sandoz Ag POLYAETHERESTERS, THEIR PRODUCTION AND USE
US5242444A (en) 1991-11-04 1993-09-07 University Of Florida Lumbosacral fixation and fusion method and device
US5269786A (en) 1992-02-20 1993-12-14 Arthrex Inc. PCL oriented placement tibial guide method
US5250055A (en) 1992-06-08 1993-10-05 Orthopedic Systems Inc. Method and apparatus for tying suture to bone
US5391173A (en) 1994-02-10 1995-02-21 Wilk; Peter J. Laparoscopic suturing technique and associated device
JP3332676B2 (en) * 1994-08-02 2002-10-07 キヤノン株式会社 Electron emitting element, electron source, image forming apparatus, and method of manufacturing them
US5643320A (en) * 1995-03-13 1997-07-01 Depuy Inc. Soft tissue anchor and method
US5669935A (en) 1995-07-28 1997-09-23 Ethicon, Inc. One-way suture retaining device for braided sutures
WO1997029802A2 (en) * 1996-02-20 1997-08-21 Advanced Bionics Corporation Improved implantable microstimulator and systems employing the same
DE19616122C1 (en) * 1996-04-23 1997-08-14 Aesculap Ag Implant for fixture of tendon replacement plastic in channel in knee area of tibia
US6013083A (en) * 1997-05-02 2000-01-11 Bennett; William F. Arthroscopic rotator cuff repair apparatus and method
US6491714B1 (en) * 1996-05-03 2002-12-10 William F. Bennett Surgical tissue repair and attachment apparatus and method
US5891150A (en) 1996-12-04 1999-04-06 Chan; Kwan-Ho Apparatus and method for fixing a ligament in a bone tunnel
US5931869A (en) * 1997-07-23 1999-08-03 Arthrotek, Inc. Apparatus and method for tibial fixation of soft tissue
US6066173A (en) * 1998-01-28 2000-05-23 Ethicon, Inc. Method and apparatus for fixing a graft in a bone tunnel
EP1016377B1 (en) * 1998-12-30 2006-04-26 Ethicon Inc. Suture locking device
US6117192A (en) * 1999-05-24 2000-09-12 Tatecraft Industries, Inc. Dye composition, dyeing apparatus and dyeing method
DE29912712U1 (en) 1999-07-21 2000-04-20 Sarbu Joan Instrument for making a knot in a thread, in particular for endoscopic surgery
US6499486B1 (en) * 1999-07-29 2002-12-31 Ethicon, Inc. Method for reconstructing a ligament
AU6532500A (en) * 1999-08-10 2001-03-05 Ethicon Inc. Apparatus and method for reconstructing a ligament
US6558389B2 (en) * 1999-11-30 2003-05-06 Ron Clark Endosteal tibial ligament fixation with adjustable tensioning
US6878166B2 (en) * 2000-08-28 2005-04-12 Ron Clark Method and implant for securing ligament replacement into the knee
US7530999B2 (en) * 2000-08-28 2009-05-12 Biomet Sports Medicine, Llc Method and implant for securing ligament replacement into the knee
US6994725B1 (en) * 2000-10-03 2006-02-07 Medicinelodge, Inc. Method and apparatus for reconstructing a ligament
US6517546B2 (en) 2001-03-13 2003-02-11 Gregory R. Whittaker Method and apparatus for fixing a graft in a bone tunnel
US6605096B1 (en) * 2001-07-20 2003-08-12 Opus Medical Inc, Percutaneous suturing apparatus and method
US6712849B2 (en) * 2001-10-01 2004-03-30 Scandius Biomedical, Inc. Apparatus and method for reconstructing a ligament
US6652563B2 (en) 2001-10-02 2003-11-25 Arthrex, Inc. Suture anchor with internal suture loop
US6656183B2 (en) * 2001-11-08 2003-12-02 Smith & Nephew, Inc. Tissue repair system
US7588595B2 (en) * 2002-10-29 2009-09-15 Stryker Endoscopy Graft fixation device and method
US7713286B2 (en) * 2002-11-15 2010-05-11 Linvatec Corporation Knotless suture anchor
DE10259411A1 (en) 2002-12-19 2004-07-08 Forschungszentrum Karlsruhe Gmbh Medical clip and device for applying such a device
US7238189B2 (en) 2003-03-18 2007-07-03 Arthrex, Inc. ACL reconstruction technique using retrodrill
US7201756B2 (en) * 2003-03-24 2007-04-10 Herbert Earl Ross Device and method to assist in arthroscopic repair of detached connective tissue
US7032599B2 (en) 2003-05-15 2006-04-25 Mitek Surgical Products Div. Of Ethicon, Inc. Method of replacing an anterior cruciate ligament in the knee
US7491206B2 (en) * 2003-06-27 2009-02-17 Ethicon, Inc. Adjustable drill guide assembly and method of use
US6926720B2 (en) * 2003-10-15 2005-08-09 Hand Innovations, Llc Jig assembly for implantation of a fracture fixation device
US7207995B1 (en) * 2004-01-29 2007-04-24 Biomer Manufacturing Corp. Method and apparatus for retaining a guide wire
US7527648B2 (en) * 2004-12-21 2009-05-05 Mitek Surgical Products Div Of Ethicon, Inc. Method of replacing an anterior cruciate ligament in the knee
US7569059B2 (en) * 2005-04-20 2009-08-04 Arthroscopic Innovations Llc Method and apparatus for surgical repair
US20070005067A1 (en) * 2005-06-21 2007-01-04 Brian Dross Arthoscopic method and apparatus for tissue attachment to bone

Patent Citations (103)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3976079A (en) * 1974-08-01 1976-08-24 Samuels Peter B Securing devices for sutures
US4103683A (en) * 1977-06-03 1978-08-01 Neufeld John A Sub-trochanteric nail
US4535768A (en) * 1981-08-26 1985-08-20 South African Inventions Development Corporation Set of surgical instruments
US4672957A (en) * 1983-10-04 1987-06-16 South African Inventions Development Corporation Surgical device
US4722331A (en) * 1985-09-03 1988-02-02 Fox James M Orthopaedic tool guide
US4633869A (en) * 1985-12-23 1987-01-06 Arthrex Arthroscopy Instruments, Inc. Tension retaining device for surgical procedures
US4739751A (en) * 1986-10-03 1988-04-26 Temple University Apparatus and method for reconstructive surgery
US4781182A (en) * 1986-10-03 1988-11-01 Purnell Mark L Apparatus and method for use in performing a surgical operation
US4920958A (en) * 1986-11-05 1990-05-01 Minnesota Mining And Manufacturing Company Drill guide assembly
US4945904A (en) * 1989-10-25 1990-08-07 W. L. Gore & Associates, Inc. Orthopedic drill guide device
US5042983A (en) * 1989-10-30 1991-08-27 Rayhack John M Precision bone cutting guide
US5042958A (en) * 1990-05-14 1991-08-27 Stenersen Raymond W Method and apparatus for installing sewer and drainage pipe
US5743916A (en) * 1990-07-13 1998-04-28 Human Factors Industrial Design, Inc. Drill guide with removable ferrules
US20050038437A1 (en) * 1990-09-24 2005-02-17 Ethicon, Inc. Methods and apparatus for preventing migration of sutures through transosseous tunnels
US5112337A (en) * 1991-02-05 1992-05-12 Depuy Du Pont Orthopaedics Variable angle, selective length tibial drill guide
US5163940A (en) * 1991-03-04 1992-11-17 American Cyanamid Company Surgical drill guide for tibia
US5217471A (en) * 1991-05-30 1993-06-08 Burkhart Stephen S Endoscopic suture knotting instrument
US5152769A (en) * 1991-11-04 1992-10-06 Will Baber Apparatus for laparoscopic suturing with improved suture needle
US5178621A (en) * 1991-12-10 1993-01-12 Zimmer, Inc. Two-piece radio-transparent proximal targeting device for a locking intramedullary nail
US5211647A (en) * 1992-02-19 1993-05-18 Arthrex Inc. Interference screw and cannulated sheath for endosteal fixation of ligaments
US5320626A (en) * 1992-02-19 1994-06-14 Arthrex Inc. Endoscopic drill guide
US5425733A (en) * 1992-02-19 1995-06-20 Arthrex, Inc. Interference screw with rounded back end and cannulated sheath for endosteal fixation of ligaments
US5350383A (en) * 1992-02-20 1994-09-27 Arthrex, Inc. Adjustable drill guide with interchangeable marking hooks
US5368596A (en) * 1992-03-18 1994-11-29 Burkhart; Stephen S. Augmented awl for creating channels in human bone tissue
US5222962A (en) * 1992-04-23 1993-06-29 Burkhart Stephen S Endoscopic surgical instrument for releasably grasping a curved needle
US5234434A (en) * 1992-08-17 1993-08-10 Marlowe Goble E Mutliple guide sleeve drill guide
US5431651A (en) * 1993-02-08 1995-07-11 Goble; E. Marlowe Cross pin and set screw femoral and tibial fixation method
US5503634A (en) * 1993-04-28 1996-04-02 Christy; William J. Surgical stab wound closure device and method
US5462562A (en) * 1993-05-17 1995-10-31 Henry Ford Hospital Suture passer and method of using
US5716368A (en) * 1993-06-02 1998-02-10 General Surgical Innovations, Inc. Knotmaker with curved elongate member used in tying a ligature
US5334205A (en) * 1993-06-30 1994-08-02 The United States Of America As Represented By The Secretary Of The Air Force Sacroiliac joint fixation guide
US5330468A (en) * 1993-10-12 1994-07-19 Burkhart Stephen S Drill guide device for arthroscopic surgery
US5403321A (en) * 1993-12-15 1995-04-04 Smith & Nephew Richards Inc. Radiolucent drill guide
US5643293A (en) * 1993-12-29 1997-07-01 Olympus Optical Co., Ltd. Suturing instrument
US5683401A (en) * 1994-02-17 1997-11-04 Arthrex, Inc. Method and apparatus for installing a suture anchor through a hollow cannulated grasper
US5466243A (en) * 1994-02-17 1995-11-14 Arthrex, Inc. Method and apparatus for installing a suture anchor through a hollow cannulated grasper
US5575801A (en) * 1994-02-17 1996-11-19 Arthrex, Inc. Method and apparatus for arthroscopic rotator cuff repair
US5690677A (en) * 1994-02-17 1997-11-25 Arthrex, Inc. Method for installing a suture anchor through a cannulated tissue-shifting guide
US5620449A (en) * 1994-07-28 1997-04-15 Orthofix, S.R.L. Mechanical system for blind nail-hole alignment of bone screws
US5584839A (en) * 1994-12-12 1996-12-17 Gieringer; Robert E. Intraarticular drill guide and arthroscopic methods
US5665109A (en) * 1994-12-29 1997-09-09 Yoon; Inbae Methods and apparatus for suturing tissue
US5797928A (en) * 1995-01-20 1998-08-25 Olympus Optical Co., Ltd. Ligating apparatus
US5601562A (en) * 1995-02-14 1997-02-11 Arthrex, Inc. Forked insertion tool and metnod of arthroscopic surgery using the same
US5603716A (en) * 1995-02-16 1997-02-18 Arthrex Inc. Method of ligament reconstruction using double socket graft placement and fixation
US6592588B1 (en) * 1995-02-16 2003-07-15 Arthrex, Inc. Apparatus for osteochondral autograft transplantation
US5919196A (en) * 1995-02-16 1999-07-06 Arthrex, Inc. Method and apparatus for osteochondral autograft transplantation
US5626613A (en) * 1995-05-04 1997-05-06 Arthrex, Inc. Corkscrew suture anchor and driver
US5681333A (en) * 1995-11-08 1997-10-28 Arthrex, Inc. Method and apparatus for arthroscopic rotator cuff repair utilizing bone tunnels for suture attachment
US5746752A (en) * 1995-11-08 1998-05-05 Arthrex, Inc. Double-diameter knot pusher
US6039742A (en) * 1996-05-04 2000-03-21 Synthes (U.S.A.) Alignment device for locking the base part of intramedullary nails
US5951559A (en) * 1996-07-25 1999-09-14 Arthrex, Inc. Method for installing a threaded suture anchor with a cannulated suture anchor drill guide
US6117162A (en) * 1996-08-05 2000-09-12 Arthrex, Inc. Corkscrew suture anchor
US6511499B2 (en) * 1996-08-05 2003-01-28 Arthrex, Inc. Corkscrew suture anchor
US6616665B2 (en) * 1996-08-05 2003-09-09 Arthrex, Inc. Method of rotator cuff repair
US20020032466A1 (en) * 1996-08-05 2002-03-14 Arthrex, Inc. Headed bioabsorbable tissue anchor
US20020022862A1 (en) * 1996-08-05 2002-02-21 Arthrex, Inc. Hex drive bioabsorbable tissue anchor
US6214031B1 (en) * 1996-08-05 2001-04-10 Arthrex, Inc. Corkscrew suture anchor
US5954733A (en) * 1996-11-27 1999-09-21 Yoon; Inbae Suturing instrument with rotatably mounted needle driver and catcher
US6113604A (en) * 1997-01-14 2000-09-05 Ethicon, Inc. Method and apparatus for fixing a graft in a bone tunnel
US6132433A (en) * 1997-02-12 2000-10-17 Arthrex, Inc. Apparatus of loading tendons into the knee
US6537319B2 (en) * 1997-02-12 2003-03-25 Arthrex, Inc. Method of loading tendons into the knee
US6733529B2 (en) * 1997-02-12 2004-05-11 Arthrex, Inc. Method of loading tendons into the knee
US5918604A (en) * 1997-02-12 1999-07-06 Arthrex, Inc. Method of loading tendons into the knee
US6371124B1 (en) * 1997-02-12 2002-04-16 Arthrex, Inc. Method of loading tendons into the knee
US5766179A (en) * 1997-03-05 1998-06-16 Orthofix S.R.L. Mechanical system for blind nail-hole alignment of bone screws
US5833691A (en) * 1997-07-10 1998-11-10 Bimman; Lev A. Apparatus and method for drilling strictly aligned holes in bones to be connected intramedullary nailing
US6027523A (en) * 1997-10-06 2000-02-22 Arthrex, Inc. Suture anchor with attached disk
US6517552B1 (en) * 1997-10-29 2003-02-11 Arthrex, Inc. Suture retriever
US6074403A (en) * 1997-10-29 2000-06-13 Arthrex, Inc. Suture retriever
US5964783A (en) * 1997-11-07 1999-10-12 Arthrex, Inc. Suture anchor with insert-molded suture
US6120511A (en) * 1997-11-18 2000-09-19 Chan; Kwan-Ho Drill guide assembly and method for producing a bone tunnel
US6387129B2 (en) * 1998-03-18 2002-05-14 Arthrex, Inc. Bicortical tibial fixation of ACL grafts
US6629984B1 (en) * 1998-07-07 2003-10-07 Kwan-Ho Chan Surgical repair kit and its method of use
US6306159B1 (en) * 1998-12-23 2001-10-23 Depuy Orthopaedics, Inc. Meniscal repair device
US6221084B1 (en) * 1999-01-15 2001-04-24 Pare Surgical, Inc. Knot tying apparatus having a notched thread cover and method for using same
US6221085B1 (en) * 1999-01-18 2001-04-24 Zarija Djurovic Djurovic suturing device
US6099538A (en) * 1999-02-02 2000-08-08 T.A.G. Medical Products Set of surgical tools and surgical method for connecting soft bone parts to one another or to connective tissue
US6517564B1 (en) * 1999-02-02 2003-02-11 Arthrex, Inc. Bioabsorbable tissue tack with oval-shaped head and method of tissue fixation using same
US6270503B1 (en) * 1999-02-03 2001-08-07 Arthrex, Inc. System for ostechondral flap repair and method
US6540750B2 (en) * 1999-05-28 2003-04-01 Stephen S. Burkhart Suture anchor reel device, kit and method
US6267766B1 (en) * 1999-05-28 2001-07-31 Stephen S. Burkhart Suture anchor reel device kit and method
US20040172062A1 (en) * 1999-05-28 2004-09-02 Burkhart Stephen S. Suture anchor reel device, kit and method
US20020143364A1 (en) * 1999-05-28 2002-10-03 Burkhart Stephen S. Suture anchor reel device, kit and method
US6629977B1 (en) * 1999-11-15 2003-10-07 Arthrex, Inc. Tapered bioabsorbable interference screw and method for endosteal fixation of ligaments
US7153312B1 (en) * 1999-12-02 2006-12-26 Smith & Nephew Inc. Closure device and method for tissue repair
US6524317B1 (en) * 1999-12-30 2003-02-25 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US6616674B2 (en) * 2000-03-14 2003-09-09 Arthrex, Inc. Notched suture hook
US6533795B1 (en) * 2000-04-11 2003-03-18 Opus Medical, Inc Dual function suturing apparatus and method
US6461373B2 (en) * 2000-05-26 2002-10-08 Arthrex, Inc. Biointerference screw fixation technique
US6623524B2 (en) * 2000-06-09 2003-09-23 Arthrex, Inc. Method for anterior cruciate ligament reconstruction using cross-pin implant with eyelet
US6575976B2 (en) * 2000-06-12 2003-06-10 Arthrex, Inc. Expandable tissue anchor
US6544281B2 (en) * 2000-06-22 2003-04-08 Arthrex, Inc. Graft fixation using a screw or plug against suture or tissue
US20020013608A1 (en) * 2000-06-22 2002-01-31 Arthrex, Inc. Graft fixation using a screw or plug against suture or tissue
US20040093031A1 (en) * 2000-06-22 2004-05-13 Burkhart Stephen S. Graft fixation using a plug against suture
US20020120275A1 (en) * 2001-02-26 2002-08-29 Arthrex, Inc. Torque driver for interference screw
US20030004545A1 (en) * 2001-05-25 2003-01-02 Burkhart Stephen S. Interference fit knotless suture anchor fixation
US6416518B1 (en) * 2001-07-09 2002-07-09 Imp Inc. Combined surgical drill and surgical screw guide
US20030050666A1 (en) * 2001-09-13 2003-03-13 Arthrex, Inc. High strength suture material
US6716234B2 (en) * 2001-09-13 2004-04-06 Arthrex, Inc. High strength suture material
US20040106950A1 (en) * 2002-09-12 2004-06-03 Grafton R. Donald Fully threaded suture anchor with insert-molded suture
US6974467B1 (en) * 2002-11-04 2005-12-13 Gonzales Jr Antonio Method and apparatus for making a precise surgical incision
US20070100375A1 (en) * 2003-06-06 2007-05-03 Olympus Corporation Suturing instrument
US20050261674A1 (en) * 2004-05-14 2005-11-24 Nobis Rudolph H Medical devices for use with endoscope

Cited By (88)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8246652B2 (en) 1993-05-03 2012-08-21 Ethicon, Inc. Suture with a pointed end and an anchor end and with equally spaced yieldable tissue grasping barbs located at successive axial locations
USRE45426E1 (en) 1997-05-21 2015-03-17 Ethicon, Inc. Surgical methods using one-way suture
US8777988B2 (en) 2001-06-29 2014-07-15 Ethicon, Inc. Methods for using self-retaining sutures in endoscopic procedures
US8764776B2 (en) 2001-06-29 2014-07-01 Ethicon, Inc. Anastomosis method using self-retaining sutures
US8747437B2 (en) 2001-06-29 2014-06-10 Ethicon, Inc. Continuous stitch wound closure utilizing one-way suture
US7996968B2 (en) 2001-08-31 2011-08-16 Quill Medical, Inc. Automated method for cutting tissue retainers on a suture
US7996967B2 (en) 2001-08-31 2011-08-16 Quill Medical, Inc. System for variable-angle cutting of a suture to create tissue retainers of a desired shape and size
US8011072B2 (en) 2001-08-31 2011-09-06 Quill Medical, Inc. Method for variable-angle cutting of a suture to create tissue retainers of a desired shape and size
US8015678B2 (en) 2001-08-31 2011-09-13 Quill Medical, Inc. Method for cutting a suture to create tissue retainers of a desired shape and size
US8020263B2 (en) 2001-08-31 2011-09-20 Quill Medical, Inc. Automated system for cutting tissue retainers on a suture
US8028387B2 (en) 2001-08-31 2011-10-04 Quill Medical, Inc. System for supporting and cutting suture thread to create tissue retainers thereon
US8028388B2 (en) 2001-08-31 2011-10-04 Quill Medical, Inc. System for cutting a suture to create tissue retainers of a desired shape and size
US8926659B2 (en) 2001-08-31 2015-01-06 Ethicon, Inc. Barbed suture created having barbs defined by variable-angle cut
US8690914B2 (en) 2002-08-09 2014-04-08 Ethicon, Inc. Suture with an intermediate barbed body
US8083770B2 (en) 2002-08-09 2011-12-27 Quill Medical, Inc. Suture anchor and method
US8652170B2 (en) 2002-08-09 2014-02-18 Ethicon, Inc. Double ended barbed suture with an intermediate body
US8679158B2 (en) 2002-08-09 2014-03-25 Ethicon, Inc. Multiple suture thread configuration with an intermediate connector
US9248580B2 (en) 2002-09-30 2016-02-02 Ethicon, Inc. Barb configurations for barbed sutures
US8852232B2 (en) 2002-09-30 2014-10-07 Ethicon, Inc. Self-retaining sutures having effective holding strength and tensile strength
US8821540B2 (en) 2002-09-30 2014-09-02 Ethicon, Inc. Self-retaining sutures having effective holding strength and tensile strength
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US8721681B2 (en) 2002-09-30 2014-05-13 Ethicon, Inc. Barbed suture in combination with surgical needle
US8734485B2 (en) 2002-09-30 2014-05-27 Ethicon, Inc. Sutures with barbs that overlap and cover projections
US8032996B2 (en) 2003-05-13 2011-10-11 Quill Medical, Inc. Apparatus for forming barbs on a suture
US9289242B2 (en) * 2004-04-20 2016-03-22 James L. Chappuis Internal pedicle insulator apparatus and method of use
US20140257391A1 (en) * 2004-04-20 2014-09-11 James L. Chappuis Internal Pedicle Insulator Apparatus and Method of Use
US10548592B2 (en) 2004-05-14 2020-02-04 Ethicon, Inc. Suture methods and devices
US11723654B2 (en) 2004-05-14 2023-08-15 Ethicon, Inc. Suture methods and devices
US10779815B2 (en) 2004-05-14 2020-09-22 Ethicon, Inc. Suture methods and devices
US8721664B2 (en) 2004-05-14 2014-05-13 Ethicon, Inc. Suture methods and devices
US20060241694A1 (en) * 2005-04-20 2006-10-26 Daniel Cerundolo Suture fixation device and method for surgical repair
US7833244B2 (en) * 2005-04-20 2010-11-16 Arthroscopic Innovations Llc Suture fixation device and method for surgical repair
US8926638B2 (en) 2006-05-22 2015-01-06 Covidien Lp Method and apparatus for meniscal repair
US20110046646A1 (en) * 2006-05-22 2011-02-24 Scandius Biomedical, Inc. Method and apparatus for meniscal repair
US8876842B2 (en) 2006-05-22 2014-11-04 Covidien Lp Meniscal repair device
US20100228271A1 (en) * 2006-05-22 2010-09-09 Peter Marshall Meniscal repair device
US8267948B2 (en) 2006-05-22 2012-09-18 Tyco Healthcare Group Lp Method and apparatus for meniscal repair
US7918868B2 (en) 2006-05-22 2011-04-05 Scandius Biomendical, Inc. Method and apparatus for meniscal repair
US8793863B2 (en) 2007-04-13 2014-08-05 Ethicon, Inc. Method and apparatus for forming retainers on a suture
US8915943B2 (en) 2007-04-13 2014-12-23 Ethicon, Inc. Self-retaining systems for surgical procedures
US8777987B2 (en) 2007-09-27 2014-07-15 Ethicon, Inc. Self-retaining sutures including tissue retainers having improved strength
US9498893B2 (en) 2007-09-27 2016-11-22 Ethicon, Inc. Self-retaining sutures including tissue retainers having improved strength
US8916077B1 (en) 2007-12-19 2014-12-23 Ethicon, Inc. Self-retaining sutures with retainers formed from molten material
US8771313B2 (en) 2007-12-19 2014-07-08 Ethicon, Inc. Self-retaining sutures with heat-contact mediated retainers
US9044225B1 (en) 2007-12-20 2015-06-02 Ethicon, Inc. Composite self-retaining sutures and method
US8875607B2 (en) 2008-01-30 2014-11-04 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
US8615856B1 (en) 2008-01-30 2013-12-31 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
US9125647B2 (en) 2008-02-21 2015-09-08 Ethicon, Inc. Method and apparatus for elevating retainers on self-retaining sutures
US8460338B2 (en) 2008-02-25 2013-06-11 Ethicon, Inc. Self-retainers with supporting structures on a suture
US8641732B1 (en) 2008-02-26 2014-02-04 Ethicon, Inc. Self-retaining suture with variable dimension filament and method
US8876865B2 (en) 2008-04-15 2014-11-04 Ethicon, Inc. Self-retaining sutures with bi-directional retainers or uni-directional retainers
US8961560B2 (en) 2008-05-16 2015-02-24 Ethicon, Inc. Bidirectional self-retaining sutures with laser-marked and/or non-laser marked indicia and methods
US11234689B2 (en) 2008-11-03 2022-02-01 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US8932328B2 (en) 2008-11-03 2015-01-13 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US10441270B2 (en) 2008-11-03 2019-10-15 Ethicon, Inc. Length of self-retaining suture and method and device for using the same
US11234692B2 (en) 2010-05-04 2022-02-01 Cilag Gmbh International Self-retaining system having laser-cut retainers
US10952721B2 (en) 2010-05-04 2021-03-23 Ethicon, Inc. Laser cutting system and methods for creating self-retaining sutures
US10420546B2 (en) 2010-05-04 2019-09-24 Ethicon, Inc. Self-retaining systems having laser-cut retainers
US9955962B2 (en) 2010-06-11 2018-05-01 Ethicon, Inc. Suture delivery tools for endoscopic and robot-assisted surgery and methods
US11007296B2 (en) 2010-11-03 2021-05-18 Ethicon, Inc. Drug-eluting self-retaining sutures and methods relating thereto
US9675341B2 (en) 2010-11-09 2017-06-13 Ethicon Inc. Emergency self-retaining sutures and packaging
US10492780B2 (en) 2011-03-23 2019-12-03 Ethicon, Inc. Self-retaining variable loop sutures
US11690614B2 (en) 2011-03-23 2023-07-04 Ethicon, Inc. Self-retaining variable loop sutures
US10188384B2 (en) 2011-06-06 2019-01-29 Ethicon, Inc. Methods and devices for soft palate tissue elevation procedures
US8801727B2 (en) 2011-07-08 2014-08-12 Smith & Nephew, Inc. Orthopedic suture passer and method
US8882834B2 (en) 2011-07-08 2014-11-11 Smith & Nephew, Inc. Soft tissue repair
US8888849B2 (en) 2011-07-08 2014-11-18 Smith & Nephew, Inc. Soft tissue repair
US8951263B2 (en) 2011-07-08 2015-02-10 Smith & Nephew, Inc. Orthopedic suture passer and method
US11006947B2 (en) 2011-07-08 2021-05-18 Smith & Nephew, Inc. Suture passer and method
US10335138B2 (en) 2011-07-08 2019-07-02 Smith & Nephew, Inc. Suture passer and method
US9357997B2 (en) 2011-07-08 2016-06-07 Smith & Nephew, Inc. Suture passer and method
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
US9782165B2 (en) 2011-11-11 2017-10-10 VentureMD Innovations, LLC Transosseous attachment
US9131937B2 (en) 2011-11-16 2015-09-15 VentureMD Innovations, LLC Suture anchor
US10136883B2 (en) 2011-11-16 2018-11-27 VentureMD Innovations, LLC Method of anchoring a suture
US11701101B2 (en) 2011-11-16 2023-07-18 Crossroads Extremity Systems, Llc Suture anchor and method
US10675014B2 (en) 2011-11-16 2020-06-09 Crossroads Extremity Systems, Llc Knotless soft tissue attachment
US10470756B2 (en) 2011-11-16 2019-11-12 VentureMD Innovations, LLC Suture anchor and method
US11684355B2 (en) 2011-11-16 2023-06-27 Crossroads Extremity Systems, Llc Suture anchor
US10194898B2 (en) 2011-11-16 2019-02-05 VentureMD Innovations, LLC Suture anchor
US10548585B2 (en) 2011-11-16 2020-02-04 VentureMD Innovations, LLC Soft tissue attachment
US9687221B2 (en) 2013-02-13 2017-06-27 Venture MD Innovations, LLC Method of anchoring a suture
US10258401B2 (en) 2015-07-17 2019-04-16 Kator, Llc Transosseous guide
US11504140B2 (en) 2015-07-17 2022-11-22 Crossroads Extremity Systems, Llc Transosseous guide and method
US9962174B2 (en) 2015-07-17 2018-05-08 Kator, Llc Transosseous method
US10154868B2 (en) 2015-07-17 2018-12-18 Kator, Llc Transosseous method
US10226243B2 (en) 2015-08-04 2019-03-12 Kator, Llc Transosseous suture anchor
US10143462B2 (en) 2015-08-04 2018-12-04 Kator, Llc Transosseous suture anchor method

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US7833244B2 (en) 2010-11-16
US20060241620A1 (en) 2006-10-26
WO2006115782A2 (en) 2006-11-02
US7569059B2 (en) 2009-08-04
WO2006115773A2 (en) 2006-11-02
US20060241657A1 (en) 2006-10-26
US7771441B2 (en) 2010-08-10
US7833230B2 (en) 2010-11-16
WO2006115773A3 (en) 2006-12-28
US20070208356A1 (en) 2007-09-06
WO2006115782A3 (en) 2007-01-18
US20060241619A1 (en) 2006-10-26
US20060241694A1 (en) 2006-10-26
US7955341B2 (en) 2011-06-07

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