KNOTLESS SUTURE ANCHOR AND METHODS OF USE
Various devices, systems and methods for knotless suturing of tissue are disclosed. These devices allow sutures to be anchored to bone, and more specifically provide a suture anchor which eliminates the need for knotting the suture. Thus, damaged tissue may be re-attached to a substrate tissue. The anchors have a minimum of moving parts may be suited to being a single molded polymer construction. The anchors will find particular utility in hip and shoulder arthroscopy, e.g. labral re-attachment and similar procedures.
1 . A knotless suture anchoring system, said system comprising:
a first anchor positionable in tissue and having a longitudinal axis;
a cinching mechanism coupled to the first anchor, the cinching mechanism comprising a body having first and second transverse apertures spaced apart along the longitudinal axis and separated by a bar; and
a length of suture threaded through the first and second apertures so as to form a loop around the bar, the suture having first and second extremities extending respectively from the first and second apertures on the same side of the body, the first and second extremities being generally parallel to and overlying one another such that the second extremity is sandwiched between the first extremity and the body,
wherein exerting tension on the first extremity compresses the second extremity against the body to prevent movement of the suture relative to the body, and wherein exerting tension on the second extremity allows the suture to move longitudinally relative to the body.
2 . The system of claim 1 , wherein the suture comprises a flat cross-sectional profile.
3 . The system of claim 1 , wherein the suture comprises a round cross-sectional profile.
4 . The system of claim 2 , wherein the anchor has a proximal end, a distal end, and the longitudinal axis extends therebetween, the first and second apertures extending through the body in a direction transverse to the longitudinal axis.
5 . The system of claim 1 , wherein the cinching mechanism is positioned in a central channel of the anchor.
6 . The system of claim 5 , wherein the anchor has a proximal end, a distal end, and the longitudinal axis extends therebetween, the central channel being aligned with the longitudinal axis, the channel having an opening at the proximal end, and wherein at least one of the first and second extremities extend through the opening.
7 . The system of claim 1 , wherein the apertures are disposed along the body in a single line substantially parallel with the longitudinal axis.
8 . The system of claim 1 , wherein the body comprises a plate and the first and second apertures comprise slots extending through the plate.
9 . The system of claim 8 , wherein the anchor has a proximal end, a distal end, and the longitudinal axis extends therebetween, the plate being oriented generally parallel to the longitudinal axis.
10 . The system of claim 8 , wherein the plate is disposed in a central channel of the anchor.
11 . The system of claim 1 , wherein the body has a face against which the second extremity is compressed, the bar being laterally offset from the face.
12 . The system of claim 1 , wherein the body has a face against which the second extremity is compressed, the first aperture intersecting the face so as to define a corner which engages the second extremity.
13 . The system of claim 12 , wherein the corner has an edge which locks the second extremity when the first extremity is tensioned.
14 . The system of claim 12 , wherein the corner defines an angle of no more than about 90 degrees.
15 . The system of claim 12 , wherein the face comprises one or more features to induce friction with the second extremity when the first extremity is tensioned.
16 . The system of claim 1 , wherein the body comprises a barrel disposed in an aperture in a sidewall of the anchor transverse to the longitudinal axis of the anchor.
17 . The system of 16 , wherein the barrel is rotatably disposed in the sidewall aperture, the rotatable barrel having a locked position and an unlocked position, the unlocked position allowing the suture to move, the locked position constraining movement of the suture.
18 . The system of claim 17 , wherein the apertures extend through the barrel parallel to a first axis, and in the unlocked position, the first and second extremities extend from the apertures substantially parallel to the first axis.
19 . The system of claim 17 , wherein the apertures extend through the barrel parallel to a first axis, and in the locked position, the first and second extremities extend from the apertures in a direction transverse to the first axis.
20 . The system of claim 1 , wherein the cinching mechanism is integral with the first anchor.
21 . The system of claim 20 , wherein the cinching mechanism and the first anchor are a single molded part.
22 . The system of claim 1 , wherein the cinching mechanism is on a separate member configured to be attached to the first anchor at a surgical site.
23 . The system of claim 1 , wherein the cinching mechanism is coupled to a second anchor adapted for being positioned in tissue and which may be coupled to the first anchor.
24 . The system of claim 1 , wherein the cinching mechanism requires no movement of parts relative to the first anchor to prevent the suture from moving when the first extremity is tensioned.
25 . The system of claim 1 , wherein the cinching mechanism is a single molded part.
26 . The system of claim 1 , wherein the first anchor has an outer diameter which is no more than about 3.5 mm along its entire length.
27 . The system of claim 1 , further comprising a second anchor positionable in the tissue.
28 . The system of claim 27 , wherein one of the two anchors is positioned concentrically in the other of the two anchors.
29 . The system of claim 27 , wherein one of the two anchors is positioned end to end with the other of the two anchors.
30 . A knotless suture anchoring system, said system comprising:
a first anchor component having a longitudinal axis and a first cinching mechanism;
a second anchor component initially detached from the first anchor component, at least one of the first and second anchor components being adapted for placement directly into bone or other tissue and comprising a retention feature on an exterior surface thereof for retaining the first or second anchor component in said bone or tissue;
a coupling mechanism for coupling the second anchor component to the first anchor component; and
a length of suture at least partially disposed in the first cinching mechanism, the suture having a free end,
wherein the first cinching mechanism allows the suture to pass through the first cinching mechanism in a first direction when the free end is tensioned and constrains movement of the suture through the first cinching mechanism in a second direction opposite the first direction.
31 . A knotless suture anchor system as in claim 30 , wherein the second anchor component is received within a cavity in the first anchor component.
32 . A knotless suture anchor system as in claim 30 , wherein the first anchor component is received within a cavity in the second anchor component.
33 . A knotless suture anchor system as in claim 30 , wherein the first anchor component is coupled end-to-end with the second anchor component.
34 . A knotless suture anchor system as in claim 30 , wherein the suture has a second end coupled to the second anchor component.
35 . A knotless suture anchor system as in claim 30 , wherein the first cinching mechanism has no parts movable relative to the first anchor component.
36 . A knotless suture anchor system as in claim 30 , further comprising a second cinching mechanism coupled to the second anchor component, the suture having a second end coupled to the second cinching mechanism.
37 . A knotless suture anchor system as in claim 30 , wherein the second anchor component has a suture retention structure for retaining a second end of the suture therein.
38 . A knotless suture anchor system as in claim 30 , wherein the first anchor component and the first cinching mechanism are an integral molded construction.
39 . A knotless suture anchoring system, said system comprising:
a first anchor having a proximal end and a distal end, and being positionable in tissue;
a second anchor having a proximal end and a distal end;
a first cinching mechanism coupled to either the first anchor or the second anchor;
a coupling element attached to one or both of the first and second anchors and adapted to couple the first and the second anchors together end-to-end; and
a length of suture coupled to either the first anchor or the second anchor, the suture having a free end and being at least partially disposed in the first cinching mechanism,
wherein the first cinching mechanism is adapted to allow the suture to be tensioned by pulling the free end so that the suture passes through the first cinching mechanism in a first direction while movement of the suture through the first cinching mechanism in a second direction opposite the first direction is constrained.
40 . The system of claim 39 , wherein the coupling element comprises a threaded post, and wherein the first anchor is threadably engaged with the second anchor.
41 . The system of claim 39 , wherein the coupling element comprises a post having a plurality of barbs disposed thereon.
42 . The system of claim 39 , wherein the coupling element comprises a compression fitting.
43 . The system of claim 39 , wherein the suture is fixed to the first anchor and the cinching mechanism is on the second anchor.
44 . The system of claim 43 , wherein each of the first and second anchors is adapted to be placed in tissue separately from the other of the first and second anchors.
45 . A method for re-joining damaged tissue with substrate tissue, said method comprising:
providing a suture coupled with a first anchor and a second anchor;
positioning the first anchor in the substrate tissue;
capturing the damaged tissue with the suture;
positioning the second anchor in the substrate tissue, the second anchor axially aligned end-to-end with the first anchor; and
adjusting the length of the suture so that the damaged tissue is apposed to the substrate tissue.
46 . The method of claim 45 , wherein the substrate tissue comprises bone and the step of positioning the first anchor in the substrate tissue comprises drilling a hole in the bone followed by positioning the first anchor therein.
47 . The method of claim 45 , wherein the step of positioning the first anchor comprises advancing the first anchor from an elongate shaft of a delivery instrument.
48 . The method of claim 45 , wherein the step of capturing the damaged tissue comprises at least partially encircling the damaged tissue with the suture.
49 . The method of claim 45 , wherein the step of capturing comprises passing at least one of the suture anchors through a penetration in the damaged tissue.
50 . The method of claim 45 , wherein the step of positioning the second anchor comprises coupling the first anchor with the second anchor.
51 . The method of claim 50 , wherein the step of coupling comprises interconnecting a proximal region of the first anchor with a distal region of the second anchor.
52 . The method of claim 50 , wherein the step of coupling comprises engaging a plurality of threads or ribs on a proximal end of the first anchor with the second anchor.
53 . The method of claim 45 , wherein the step of adjusting the length comprises pulling the suture through a cinching mechanism disposed in either the first or the second anchor, the cinching mechanism adapted to allow the suture to move in a first direction, while the suture is constrained from moving in a second direction opposite the first direction.
54 . A method for anchoring suture to substrate tissue, said method comprising:
drilling a first hole into the substrate tissue;
placing a suture anchor into the first hole, the suture anchor coupled to a first extremity of a suture;
capturing damaged tissue with the suture, wherein the damaged tissue obstructs visualization of the first hole;
transmitting light through the damaged tissue such that the first hole is visible therethrough; and
coupling a second extremity of the suture to the first anchor.
55 . The method of claim 54 , wherein the second extremity of the suture is coupled to an anchor component and coupling the second extremity comprises coupling the anchor component to the first anchor.
56 . The method of claim 55 , wherein the anchor component is inserted concentrically in the first anchor.
57 . The method of claim 55 , wherein the anchor component is coupled end-to-end with the first anchor.
58 . The method of claim 55 , wherein at least one of the first anchor and the anchor component has a cinching mechanism which allows the suture to move in a first direction and constrains the suture from moving in a second direction opposite the first direction, the method further comprising tightening the suture by pulling it through the cinching mechanism.
59 . The method of claim 54 wherein the first anchor is placed by means of a delivery instrument to which the first anchor is releasably coupled, and the light is transmitted from a light emission device coupled to the delivery instrument.
60 . The method of claim 54 , wherein the substrate tissue comprises an acetabular or glenoid rim.
61 . The method of claim 54 , wherein the damaged tissue comprises a torn labrum.
62 . A method for fabricating a suture anchor, said method comprising:
molding the suture anchor from a polymer, the suture anchor being of a unitary construction without moving parts and having a cinching mechanism adapted to allow a suture to pass therethrough in a first direction while movement of the suture in a second direction opposite the first direction is constrained.
63 . A knotless suture anchoring system, said system comprising:
a first anchor having a proximal end, a distal end, a central channel extending therebetween, and positionable in tissue;
a tissue piercing needle positionable in the central channel;
a first cinching mechanism coupled to either the first anchor or the tissue piercing needle;
a coupling element attached to the first anchor or the tissue piercing needle, the coupling element adapted to couple the first anchor and the tissue piercing needle together when the tissue piercing needle is positioned in the central channel; and
a length of suture coupled to the first anchor and the tissue piercing needle, the suture having a free end and at least partially disposed in the first cinching mechanism,
wherein the first cinching mechanism is adapted to allow the suture to be tensioned by pulling the free end so that the suture passes through the first cinching mechanism in a first direction while movement of the suture through the first cinching mechanism in a second direction opposite the first direction is constrained.
64 . The system of claim 63 , wherein the suture is tied to the first anchor and wherein the first cinching mechanism is coupled to the tissue piercing needle.
65 . The system of claim 63 , wherein the coupling element comprises a snap fit between the tissue piercing element and the first anchor.
66 . The system of claim 63 , wherein the distal end of the first anchor comprises a plurality of slits parallel with a longitudinal axis of the first anchor, the slits forming a plurality of deflectable arms in the anchor.
67 . The system of claim 63 , wherein an outer surface of the first anchor comprises a plurality of barbs.
68 . The system of claim 63 , wherein the tissue piercing needle comprises a central channel substantially parallel with a longitudinal axis of the needle.
69 . The system of claim 63 , wherein the suture is fixedly attached to the tissue piercing needle, and wherein the first cinching mechanism is coupled with the first anchor.
70 . A method for re-joining damaged tissue with a substrate tissue, said method comprising:
providing a suture anchor system having an anchor, a tissue piercing needle, and a suture coupled to the anchor and the needle;
positioning the anchor in the substrate tissue;
piercing the damaged tissue with the needle;
passing the suture through the damaged tissue;
coupling the needle to the anchor; and
adjusting the length of the suture so that the damaged tissue is apposed to the substrate tissue.
71 . The method of claim 70 , wherein the substrate tissue comprises bone and the step of positioning the first anchor comprises drilling a hole in the bone followed by positioning of the first anchor therein.
72 . The method of claim 70 , wherein the step of positioning the first anchor comprises advancing the first anchor from an elongate shaft of a delivery instrument.
73 . The method of claim 70 , further comprising at least partially encircling the damaged tissue with the suture.
74 . The method of claim 70 , wherein the step of adjusting the length comprises pulling the suture through a cinching mechanism disposed in either the first anchor or the tissue piercing needle, the cinching mechanism adapted to allow the suture to move in a first direction, while the suture is constrained from moving in a second direction opposite the first direction.
75 . The method of claim 70 , wherein the damaged tissue comprises a torn labrum.
76 . The method of claim 70 , wherein the step of coupling comprises positioning the tissue piercing needle in a central channel of the first anchor.