Knotless self-locking anchor constructs and methods of tissue fixation
Systems and methods for soft tissue to bone repairs, without knot tying. The soft tissue repair systems include self-cinching constructs with a fixation device, a flexible coupler and an optional shuttle/pull device attached to the flexible strand. An accordion-style weave region is formed by pulling on the shuttle/pull device subsequent to the fixation device being secured into the bone, to allow desired tensioning of soft tissue to be fixated or repaired relative to the bone and secured self-locking of the construct.
1. A surgical system for tissue repairs, comprising:
a fixation device comprising a cannulated body, a longitudinal axis, a proximal end and a distal end; and
a tensionable construct pre-loaded in the fixation device, the tensionable construct comprising a flexible coupler and a shuttling device provided within the flexible coupler, wherein both the flexible coupler and the shuttling device of the tensionable construct extend through the cannulated body of the fixation device, and wherein the shuttling device is pulled out of the body of the fixation device such that the flexible coupler passes through an eyelet of the shuttling device and through itself multiple times to form a knotless closed loop with an adjustable perimeter and an accordion-style region.
2. The surgical system of claim 1 , wherein the tensionable construct is pre-loaded onto the fixation device by tying a static knot which prevents the flexible coupler from passing through a hole at the distal end.
3. The surgical system of claim 1 , wherein the tensionable construct is pre-loaded onto the fixation device by insert molding.
4. The surgical system of claim 1 , wherein the tensionable construct consists of suture tape and the shuttling device attached to the suture tape.
5. The surgical system of claim 1 , wherein the flexible coupler is a suture tape with a plurality of sections of different tapers.
6. The surgical system of claim 1 , wherein the accordion-style region is configured to be formed subsequent to insertion of the fixation device within bone and subsequent to attachment of soft tissue to be repaired or fixated to allow the user to control tension of the flexible coupler on the soft tissue to be attached to the bone.
7. The surgical system of claim 1 , wherein the fixation device is an anchor with a post and a pair of openings symmetrically positioned relative to the post, the pair of openings extending in a direction about transversal to the longitudinal axis of the body such that the tensionable construct passes through the body of the fixation device and around the post.
8. The surgical system of claim 1 , wherein the flexible coupler is a suture tape formed of ultrahigh molecular weight polyethylene.
9. The surgical system of claim 1 , wherein the shuttling device is a suture passing instrument.
10. The surgical system of claim 9 , wherein the shuttling device is a nitinol loop.
11. The surgical system of claim 1 , wherein the body has an opening at a most proximal end for receiving a driver head for driving the fixation device, and an opening at a most distal end for receiving and housing a knot of the flexible coupler.
12. The surgical system of claim 1 , wherein the accordion-style region is formed within the body of the fixation device.
13. The surgical system of claim 1 , wherein the accordion-style region is formed outside the body of the fixation device.
14. A method of tissue repair, comprising the steps of:
installing a fixation device in bone, the fixation device comprising a body, a flexible coupler extending through at least a portion of the body and a shuttling device passing through the flexible coupler multiple times to form a first accordion-style region in the flexible coupler;
after installing the fixation device in bone, passing an end of the flexible coupler around or through soft tissue to be fixated, and then attaching the end of the flexible coupler to the shuttling device; and
pulling the end of the flexible coupler through the first accordion-style region of the flexible coupler, thereby forming a knotless closed loop having an adjustable perimeter and a second accordion-style region.
15. The method of claim 14 , wherein the flexible coupler extends through a cannulation of the body of the fixation device.
16. The method of claim 14 , wherein the body of the fixation device is solid.
17. The method of claim 14 , further comprising the step of adjusting the length of the knotless closed loop to approximate tissue to bone.
18. The method of claim 14 , further comprising the step of passing the flexible coupler around or through soft tissue to be fixated, and then through an eyelet of the shuttling device.
19. The method of claim 14 , further comprising the steps of:
pre-loading the fixation device with the flexible coupler and the shuttling device;
securing the fixation device to a driver by tying the flexible coupler and the shuttling device to the driver;
inserting the fixation device into a hole in the bone;
passing the flexible coupler through or around the soft tissue to be fixated;
subsequently, threading the flexible coupler through an eyelet the shuttling device; and
pulling on the shuttling device such that the flexible coupler is passed numerous times through itself to create the knotless closed loop and the second accordion-style region, for approximating the soft tissue to the bone.