Systems, devices, and methods for securing tissue using hard anchors
Systems, devices, and methods are provided for securing soft tissue to bone. One exemplary embodiment of a device includes an anchor, a repair filament, and a connecting filament that is coupled to the repair filament, is in contact with the anchor's distal end, and is effective to connect the repair filament to the anchor such that the repair filament slides with respect to the anchor. The anchor can be rigid, and can include an axial bore extending therethrough. At least one of the repair filament and the connecting filament can extend through at least a portion of the axial bore, and the bore can be sized such that a portion of the filament extending therethrough barely fits to help maintain the connection between the anchor, repair filament, and connecting filament. Embodiments of the systems and devices disclosed can be used in a number of methods for repairing soft tissue.
1. A surgical soft tissue repair device, comprising:
an anchor having a proximal end and a distal end with an axial bore extending therethrough from the proximal end to the distal end, the anchor having a plurality of bone-engaging features disposed on an outer surface thereof, and the anchor being configured to be fixated in bone;
a repair filament;
a connecting filament disposed through the axial bore, the connecting filament being configured to couple to the repair filament, with the repair filament being configured to bring the connecting filament from an unstressed configuration in which the connecting filament is not fixedly coupled to the anchor into an anchoring configuration in which the connecting filament engages the anchor within a distal portion of the axial bore and positions the repair filament with respect to the anchor,
wherein a distal end of the connecting filament has a diameter that is greater than a diameter of the axial bore when the connecting filament is in the anchoring configuration.
2. The device of claim 1 , wherein the repair filament is in sliding engagement with the connecting filament.
3. The device of claim 1 , wherein the connecting filament comprises a loop disposed in the axial bore, the loop extending from a proximal end of the connecting filament to the distal end of the connecting filament when the connecting filament is in the anchoring configuration, the distal end of the connecting filament closing the loop within the distal portion of the axial bore.
4. The device of claim 3 , wherein the connecting filament extends proximal of the proximal end of the anchor.
5. The device of claim 3 ,
wherein a width of the connecting filament in the unstressed configuration is less than the diameter of the axial bore such that the connecting filament in the unstressed configuration is capable of being moved from the proximal end to the distal end of the anchor by passing the connecting filament distally through the axial bore.
6. The device of claim 5 , wherein the distal end of the connecting filament is configured to be actuated to transition the connecting filament from the unstressed configuration to the anchoring configuration.
7. The device of claim 1 , wherein the connecting filament does not pass through the axial bore when tension is applied to the repair filament in a proximal direction when the connecting filament is in the anchoring configuration.
8. The device of claim 1 , wherein the repair filament comprises a snare assembly having a collapsible snare at one end thereof, a terminal end opposite the collapsible snare, and an intermediate portion therebetween, the anchor being positioned along the intermediate portion.
9. The device of claim 1 , wherein the axial bore comprises a stepped portion such that the distal portion of the axial bore has a diameter that is larger than a proximal portion of the axial bore.
10. The device of claim 1 , wherein the connecting filament is disposed through the axial bore from the distal portion of the axial bore to a location that is at least one of proximate to the proximal end of the anchor, at the proximal end of the anchor, or proximal of the proximal end of the anchor.
11. A surgical method, comprising:
implanting an anchor in a bore formed in a bone, the anchor having a proximal end and a distal end with an axial bore extending between a proximal-most end of the proximal end to a distal-most end of the distal end such that an inner diameter of the axial bore is stepped to have a first, smaller diameter at the proximal-most end that extends towards a second, greater diameter at the distal-most end, the anchor having a plurality of bone-engaging features disposed on an outer surface thereof, and the anchor having a connecting filament disposed through the axial bore such that a distal end of the connecting filament is disposed within a distal portion of the axial bore and a proximal end of the connecting filament is disposed at least one of proximate to the proximal end of the anchor, at the proximal end of the anchor, or proximal of the proximal end of the anchor;
passing a terminal end of a repair filament coupled to the connecting filament into and through at least a portion of tissue detached from the bone; and
operating the repair filament to draw the tissue towards the bone.
12. The method of claim 11 , wherein the repair filament comprises a 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, and operating the repair filament to draw the tissue towards the bone further comprises:
inserting the terminal end of the at least one elongate filament through the collapsible snare;
collapsing the collapsible snare around the at least one elongate filament; and
sliding the collapsed snare toward the tissue to apply tension to the at least one filament between the anchor and the tissue so as to bring the tissue into proximity with the bone.
13. The method of claim 11 , wherein coupling the repair filament to the connecting filament occurs prior to implanting the anchor in the bore formed in the bone.
14. The method of claim 11 , wherein coupling the repair filament to the connecting filament occurs after implanting the anchor in the bore formed in the bone.
15. The method of claim 14 , further comprising coupling the repair filament to the connecting filament.
16. The method of claim 15 , wherein coupling the repair filament to the connecting filament further comprises passing the repair filament through a loop formed by the connecting filament to cause a sliding engagement between the repair filament and the connecting filament proximate to the proximal end of the anchor, the loop being disposed in the axial bore.
17. The method of claim 16 , wherein the sliding engagement occurs proximal of the proximal end of the anchor.
18. The method of claim 17 , wherein the connecting filament is disposed in an anchoring configuration in which the connecting filament engages the anchor within the distal portion of the axial bore to set a location of the connecting filament with respect to the anchor and the distal end of the connecting filament is unable to pass proximally through the axial bore.
19. The method of claim 18 , further comprising:
after implanting the anchor in the bore formed in the bone, actuating the connecting filament to cause the connecting filament to transition from an unstressed configuration in which the connecting filament is capable of being passed fully through the axial bore to the anchoring configuration in which a width of the connecting filament increases to a size that prevents the connecting filament from passing through the axial bore.
20. The method of claim 11 , wherein the connecting filament is disposed in an anchoring configuration in which the connecting filament engages the anchor within the distal portion of the axial bore to set a location of the connecting filament with respect to the anchor and the distal end of the connecting filament is unable to pass proximally through the axial bore.
21. The method of claim 20 , further comprising:
actuating the connecting filament to cause the connecting filament to transition from an unstressed configuration in which the connecting filament is capable of being passed fully through the axial bore to the anchoring configuration in which a width of the connecting filament increases to a size that prevents the connecting filament from passing through the axial bore.
22. The method of claim 11 , further comprising:
passing the connecting filament through the axial bore such that the distal end of the connecting filament is disposed within the distal portion of the axial bore and the proximal end of the connecting filament is disposed at least one of proximate to the proximal end of the anchor, at the proximal end of the anchor, or proximal of the proximal end of the anchor.
23. The method of claim 11 , wherein the inner diameter is substantially uniform from the proximal end to a location adjacent to the distal portion in which the connecting filament is disposed.
24. The method of claim 11 , wherein the inner diameter does not decrease from the proximal-most end to the distal-most end.
25. A surgical method, comprising:
implanting an anchor in a bore formed in a bone, the anchor having a proximal end and a distal end with an axial bore extending therethrough from the proximal end to the distal end, the anchor having a plurality of bone-engaging features disposed on an outer surface thereof, and the anchor having a connecting filament disposed through the axial bore such that a distal end of the connecting filament is disposed within a distal portion of the axial bore and a proximal end of the connecting filament is disposed at least one of proximate to the proximal end of the anchor, at the proximal end of the anchor, or proximal of the proximal end of the anchor;
coupling a repair filament to the connecting filament;
passing a terminal end of the repair filament coupled to the connecting filament into and through at least a portion of tissue detached from the bone; and
operating the repair filament to draw the tissue towards the bone,
wherein coupling the repair filament to the connecting filament occurs after implanting the anchor in the bore formed in the bone.
26. The method of claim 25 , wherein coupling the repair filament to the connecting filament further comprises passing the repair filament through a loop formed by the connecting filament to cause a sliding engagement between the repair filament and the connecting filament proximate to the proximal end of the anchor, the loop being disposed in the axial bore.
27. The method of claim 26 , wherein the sliding engagement occurs proximal of the proximal end of the anchor.
28. The method of claim 27 , wherein the connecting filament is disposed in an anchoring configuration in which the connecting filament engages the anchor within the distal portion of the axial bore to set a location of the connecting filament with respect to the anchor and the distal end of the connecting filament is unable to pass proximally through the axial bore.
29. The method of claim 28 , further comprising:
after implanting the anchor in the bore formed in the bone, actuating the connecting filament to cause the connecting filament to transition from an unstressed configuration in which the connecting filament is capable of being passed fully through the axial bore to the anchoring configuration in which a width of the connecting filament increases to a size that prevents the connecting filament from passing through the axial bore.