Systems, devices, and methods for securing tissue using snare assemblies and soft anchors
Systems, devices, and methods are provided for securing soft tissue to bone. One exemplary embodiment of a surgical soft tissue repair device includes a snare assembly coupled to a soft anchor in which the soft anchor has a first, unstressed configuration that can be used to insert the anchor into bone and a second, anchoring configuration that can be used to fixate the anchor in the bone. The snare assembly can be configured to actuate the anchor from the first configuration to the second configuration, and it can also be used to engage and approximate tissue by drawing the tissue closer to the anchor fixated in the bone. The snare assembly can be used in conjunction with a number of different anchor configurations, and other exemplary systems, devices, and methods for use with soft tissue repair are also provided.
1. A surgical soft tissue repair device, comprising:
a soft anchor configured to be fixated in bone and formed of a flexible construct having a central lumen disposed therethrough, the soft anchor having a plurality of openings formed in an outer surface thereof, the plurality of openings being in communication with the central lumen; and
a suture construct defined between opposed first and second terminal ends, the suture construct being configured to pass through the plurality of openings in the soft anchor into the central lumen, the suture construct being slidably disposed relative to the soft anchor so as to move through the soft anchor when tension is applied to one of the first and second terminal ends of the suture construct,
a flexible sleeve that removably encapsulates at least a portion of the suture construct within the central lumen of the soft anchor,
wherein the soft anchor and the suture construct are configured to transition from an unstressed configuration with a first length and a first diameter to an anchoring configuration with a second length and a second diameter following application of tension to the filament, the second length being smaller than the first length and the second diameter being larger than the first diameter to fixate the soft anchor in bone, and
wherein a distance between adjacent openings of the plurality of openings is reduced in the anchoring configuration relative to the unstressed configuration.
2. The device of claim 1 , wherein the flexible sleeve is configured to translate relative to the suture construct such that the flexible sleeve can be removed from encapsulating the suture construct.
3. The device of claim 1 , wherein the flexible sleeve is configured to extend more proximal than the first and second terminal ends of the suture construct.
4. The device of claim 1 , wherein the adjacent openings of the plurality of openings are on the same side of the soft anchor.
5. The device of claim 1 , wherein the adjacent openings of the plurality of openings face each other in the unstressed configuration.
6. The device of claim 1 , wherein the soft anchor is a crocheted suture anchor and the filament extends through openings defined between filament limbs of the crocheted suture anchor along the length thereof.
7. The device of claim 1 , wherein the first length is approximately in a range of about 5 millimeters to about 50 millimeters, and the second length is approximately in a range of about 2 millimeters to about 10 millimeters.
8. The device of claim 1 , wherein the first diameter is approximately in a range of about 0.5 millimeters to about 5 millimeters, and the second diameter is approximately in a range of about 1 millimeters to about 10 millimeters.
9. The assembly of claim 1 , further comprising a flexible sleeve removably encapsulating at least a portion of the filament.
10. The device of claim 1 , wherein the first terminal end comprises a snare assembly formed thereon, the soft anchor being disposed on an intermediate portion of the suture construct.
11. The device of claim 10 , wherein the second terminal end is configured to pass through the opening in the snare assembly to create a tensionable construct to draw an object closer to the bone.
12. The device of claim 10 , wherein the snare assembly is configured to pass through the plurality of openings in the soft anchor into the central lumen.
13. A surgical repair method, comprising:
inserting a flexible anchor into a hole in a bone at a location proximate to detached soft tissue, the anchor having a first configuration with a first length and a first diameter and a second configuration with a second length that is less than the first length and a second diameter that is greater than the first diameter, the anchor being coupled to a snare assembly that passes through at least a portion of the anchor, the snare assembly having a collapsible snare at one end thereof and at least one elongate filament extending therefrom, the at least one elongate filament having a terminal end opposite the collapsible snare;
passing at least one of the snare and the terminal end of the elongate filament through at least a portion of the detached soft tissue;
collapsing the snare; and
sliding the collapsed snare toward the soft tissue to apply tension to the filament between the anchor and the tissue so as to bring the tissue into proximity with the bone,
wherein the anchor being coupled to the snare assembly further comprises:
passing the snare assembly across the anchor at a proximal end of the anchor,
passing the snare assembly back-and-forth across the anchor at a location distal to the proximal end of the anchor towards a distal end of the anchor;
looping back from the distal end of the anchor to the proximal end of the anchor; and
passing the snare assembly across the anchor at the proximal end after looping back the snare assembly.
14. The method of claim 13 , wherein the flexible anchor-, in its second configuration, impinges the walls of the hole to substantially fix the anchor with respect to the hole in the bone.
15. The method of claim 13 , wherein the anchor is defined by a suture.
16. The method of claim 15 , further comprising inserting a device having a body that defines a cavity and a piston disposed within the cavity into a distal end of the hole formed in the bone to position the anchor distally within the hole.
17. The method of claim 16 , further comprising removing the body while the piston remains stationary to hold the flexible anchor in place.
18. The method of claim 17 , further comprising removing the piston to leave the anchor disposed within the bore.
19. The method of claim 16 , wherein the snare assembly and the anchor are prevented from passing together through a central lumen formed in the piston.
20. The method of claim 13 , further comprising positioning the device adjacent to a proximal end of the bore and actuating the piston to move the anchor from the device and into the bore.
21. The method of claim 13 , wherein inserting the device further comprises shuttling the flexible anchor to a desired location within the hole.
22. The method of claim 21 , wherein shuttling the flexible anchor further comprises passing the device through a top layer of skin, through the bore, and out of a bottom layer of skin.
23. The method of claim 22 , further comprising applying a tension to a fish tail located on the terminal end opposite the collapsible snare in an insertion direction to pull the anchor through the hole and to the desired location.
24. The method of claim 13 , further comprising applying a tension to the snare assembly in a direction opposite to the insertion direction to actuate the flexible anchor to transition from the first configuration to the second configuration to fix the flexible anchor relative to the bone.