CN120813309A - Tensionable knotless surgical technique - Google Patents

Abstract

A surgical construct having a lacing loop and a stop that does not require knot tying is disclosed. The surgical construct includes a loop having a drawstring knot terminating in a single tail. Mechanical pressure is applied to the single tail to deform the region of the surgical construct and form a protrusion that acts as a stop. A ferrule having internal features may be attached to the cerclage construction adjacent the drawstring knot (RACKING HITCH) to act as a stop and prevent loosening of the cerclage construction.

Description

Tensionable knotless surgical technique

Cross reference to related applications

The present application claims priority from U.S. patent application Ser. No. 18/158,614, filed 24 at 1 month 2023, and also claims priority from U.S. patent application Ser. No. 18/420,828, filed 24 at 1 month 2024, and claims the benefit of U.S. provisional application Ser. No. 63/586,076, filed 28 at 9 month 2023, the entire disclosures of which are incorporated herein by reference.

Background

The present disclosure relates to the field of surgery, and more particularly, to tensionable knotless surgical constructions and associated knotless surgical techniques.

Disclosure of Invention

Surgical constructs and tissue repair are disclosed. The surgical construct may produce knotless, tensionable, self-locking repair without tying any knots. The surgical construct may include (i) a ring, (ii) a ring interconnect, and (iii) a locking mechanism. The surgical construct may be a suture construct. The surgical construct may be a cerclage construct.

The surgically constructed ring may be a closed, flexible, continuous suture ring. The surgically-configured ring may be a cerclage ring. The loop interconnect may be in the form of an interconnected loop chain, such as a lacing knot (RACKING HITCH) or a half-knot. The ring interconnect may be located between the ring and the locking mechanism. The locking mechanism may be a stop. The stop may be a suture bulge or deformation formed by applying mechanical pressure to the suture construct. The stop may be a ferrule having internal features that allow for unidirectional tensioning of the cerclage configuration.

The surgical construct may be used to reattach anatomical structures, such as a first tissue, to a second tissue, such as bone-to-bone, soft tissue, tendons, ligaments, and/or bone, reattach them to each other, and/or any combination of each other, by employing a self-locking, knotless, tensionable mechanism. The self-locking arrangement may be used as a stand-alone arrangement or with additional fixtures, e.g. attached to one or more fixtures.

Methods of knotless, tensionable surgical repair are also disclosed. In an embodiment, a portion of the flexible strand may be deformed by the application of mechanical pressure and/or compression to form at least one protrusion or deformation adjacent the drawstring knot. The at least one protrusion or deformation may impede loosening of the suture through the knot of the drawstring knot type. Suture techniques eliminate the need for knots.

In another embodiment, a ferrule with internal features is attached to the cerclage repair adjacent the cerclage locking mechanism to tension the cerclage repair and lock the cerclage material. The cerclage locking mechanism may be an interconnected cerclage link, such as a belt loop or a half-loop.

In another embodiment, an exemplary locking collar for performing tissue repair may include a body including an outer diameter wall, an inner diameter wall, and a cannula defined by the inner diameter wall. A plurality of locking barbs extend into the cannula and are configured to lock a suture received through the cannula relative to the body.

An exemplary surgical method may include loading a suture through a cannula of a locking collar, tensioning the suture in a first direction, and locking the suture within the cannula to prevent movement of the suture in a second direction.

Another exemplary surgical method may include loading a suture through a cannula of a locking collar, inserting the locking collar into a socket formed in a bone, tensioning the suture in a first direction relative to the bone, and locking the suture within the cannula to prevent movement of the suture in a second direction relative to the bone.

Embodiments, examples and alternatives of the preceding paragraphs, claims or the following description and drawings, including any of the various aspects or corresponding individual features thereof, may be made independently or in any combination. Unless features described in connection with one embodiment are incompatible, such features apply to all embodiments.

Various features and advantages of this disclosure will become apparent to those skilled in the art from the following detailed description. The drawings that accompany the detailed description can be briefly described as follows.

Drawings

Fig. 1 illustrates a surgical configuration for use in tissue repair according to an exemplary embodiment.

Fig. 2,3 and 4 illustrate exemplary steps for forming the surgical construct of fig. 1.

Fig. 5, 6, 7, 8, 9, 10 and 11 illustrate exemplary subsequent steps for tissue repair with the surgical construct of fig. 1.

Fig. 12 illustrates a surgical configuration for use in tissue repair according to another exemplary embodiment.

Fig. 13 is an enlarged view of the locking mechanism of the surgical configuration of fig. 12.

Fig. 14 illustrates a locking collar that may be used to perform various tensionable knotless tissue repairs.

Fig. 15 is an end view of the locking collar of fig. 14.

Fig. 16 is a cross-sectional view through section 3-3 of fig. 14.

Fig. 17 is a cross-sectional view through section 4-4 of fig. 15.

Fig. 18 schematically illustrates loading a suture through a locking collar.

Fig. 19 schematically illustrates locking of the suture relative to the locking collar.

Fig. 20, 21, 22, 23, 24, 25, 26, 27, 28 and 29 schematically illustrate a surgical method for performing tissue repair.

FIGS. 30, 31 and 32 schematically illustrate another exemplary surgical method for performing tissue repair.

Fig. 33 illustrates a suture locking system.

34A, 34B, 34C and 34D illustrate another exemplary suture locking system.

Detailed Description

Surgical constructs, assemblies, and methods for knotless fixation of tissue are disclosed.

The surgical construct may produce a knotless, tensionable, self-locking repair. The surgical construct may include (i) a ring, (ii) a ring interconnect, and (iii) a locking mechanism. The surgical construct may be a suture construct. The surgical construct may be a cerclage construct.

The suture configuration may include (i) a closed, flexible, adjustable, continuous suture loop, (ii) an interconnecting loop chain, such as a drawstring knot or half-knot, and (iii) a locking mechanism (stop). The stop may be a suture bulge or deformation formed by applying mechanical pressure to the suture construct. The suture construct may consist essentially of sutures. The suture construction may consist essentially of a braid having a monofilament core. The suture construct may be used to attach or reattach anatomical structures, such as a first tissue, to a second tissue, such as soft tissue, tendons, ligaments, and/or bones, to each other, and/or to any combination of each other, by employing a self-locking, knotless mechanism. The suture configuration may be used as a stand-alone configuration or with additional fixation devices, such as attached to one or more knotted or knotless suture anchors.

The cerclage configuration may include (i) a cerclage ring, (ii) an interconnecting cerclage chain, such as a drawstring knot or half-knot, and (iii) a locking mechanism (stop). The stop may be a ferrule having internal features that allow for unidirectional tensioning of the cerclage configuration. The cerclage construction may consist essentially of cerclage stitches. The cerclage construction may consist essentially of a cerclage suture tape. The cerclage configuration may be used to reattach anatomical structures, such as reattach bones to bones. The cerclage construction may be used as a stand-alone construction or with additional fixation devices, such as attachment to one or more fixation devices, such as bone plates, screws, and/or implants.

Methods of surgical repair are also disclosed. An exemplary method includes, among other steps, (i) passing a flexible construct through and/or around tissue to be repaired, (ii) passing a tail of the flexible construct through a loop of the flexible construct to form a ligament, and (iii) preventing the flexible construct from loosening by forming a locking mechanism adjacent the ligament. The flexible construction may be a suture construction. The flexible construct may be a bone cerclage construct.

In an exemplary embodiment, a portion of the suture construct may be deformed by applying mechanical pressure and/or compression to form at least one protrusion, enlargement, or deformation in the suture adjacent to the drawstring knot type knot. At least one of the protrusions, expansion or deformation may impede loosening of the suture through the knot of the drawstring knot type. Suture techniques eliminate the need for knots. Tension is applied to the drawstring knot and then mechanical pressure is applied to the suture. The mechanical pressure creates one or more monofilament protrusions protruding through the braid, acting as a stop.

In another exemplary embodiment, cerclage repair may be performed with cerclage material (e.g., a cerclage strap) secured by a tie-down type tie. A ferrule with internal features is slid over the end of the loop tie and tensioned down to the knot where the ferrule locks in a unidirectional manner. When the ferrule acts as a stop, the knot retains most of the tension of the repair.

An exemplary surgical construct may include a flexible strand comprising loops and a single tail. A single tail is disposed through the ring to establish a ring interconnect. A stop is positionable adjacent the ring interconnect and configured to lock the flexible strand against loosening through the ring interconnect.

In any further embodiment, the surgical configuration is a knotless, tensionable, self-locking suture configuration.

In any further embodiment, the stop comprises at least one protrusion or deformation formed by applying mechanical pressure or mechanical force to the flexible strand.

In any further embodiment, the flexible strand comprises a braid having a monofilament core.

In any further embodiment, the flexible strand is a suture tape.

In any further embodiment, the surgical configuration is a cerclage configuration.

In any further embodiment, the stop comprises a collar that allows one-way passage of the flexible strand, and the collar comprises an internal feature that allows one-way passage of the flexible strand.

In any further embodiment, the loop interconnect is a tie.

In any further embodiment, the loop interconnect is a drawstring knot or a half-knot.

In any further embodiment, the stop is a protrusion having a width greater than a width of the flexible construct, and the flexible construct includes a monofilament core protruding through the braid to establish the protrusion, and the braid is formed of Ultra High Molecular Weight Polyethylene (UHMWPE).

A locking collar including a one-way locking mechanism may be used as part of a tensionable knotless tissue repair for tensioning and locking one or more strands of suture.

An example locking collar for performing tissue repair may include a body including an outer diameter wall, an inner diameter wall, and a cannula defined by the inner diameter wall, and a plurality of locking barbs extending into the cannula and configured to lock a suture received through the cannula relative to the body.

In any further embodiment, the plurality of locking barbs are an integral feature of the body.

In any further embodiment, each locking barb of the plurality of locking barbs includes a pointed end.

In any further embodiment, the body extends along the longitudinal axis between a proximal end and a distal end.

In any further embodiment, each locking barb of the plurality of locking barbs is angled in a proximal direction.

In any further embodiment, the plurality of locking barbs each protrude inwardly from the inner radial wall.

In any further embodiment, the plurality of locking barbs are arranged in at least a first row and a second row.

In any further embodiment, the first portions of the plurality of locking barbs in the first row are staggered relative to the second portions of the plurality of locking barbs in the second row.

In any further embodiment, the plurality of locking barbs are disposed across the entire length of the body.

In any further embodiment, the suture comprises a varying thickness.

Referring now to the drawings, in which like elements are designated by like reference numerals, FIGS. 1-12 illustrate surgical configurations 100, 200 for use in surgical tissue repair according to an exemplary embodiment. Fig. 1-4 illustrate a surgical configuration 100 for use in suture repair according to an exemplary embodiment. Fig. 5-11 illustrate subsequent steps in performing a tissue suture repair 101 with the surgical construct 100 of fig. 1. Fig. 12 and 13 illustrate a surgical construct 200 for use in a bone cerclage repair according to another exemplary embodiment of the present disclosure.

Suture construct 100 (surgical construct 100; suture 100; self-locking construct 100; knotless, tensionable construct 100; knotless closed suture 100; flexible construct 100; side-to-side knotless suture 100) is formed from flexible strands 50 (flexible material 50, suture construct 50) for securing a first tissue to a second tissue. In an exemplary embodiment, the suture construction 100 is formed from flexible strands 50 that include a central strand (first strand or filament; inner strand) of the core suture 10 and an outer strand (second strand or filament; outer strand; coreless suture) of the suture 11 covering the central strand. The central strand 10 may be a monofilament core. In an embodiment, the outer strands 11 completely cover the central strands 10 in at least two directions, namely the longitudinal and transverse directions. Fig. 4 shows more details of the flexible strand 50.

Suture construct 100 also includes one or more ring interconnects 66 and one or more locking mechanisms 77 (stop mechanisms 77). In one embodiment, and as shown in fig. 5-7, the suture configuration 100 is provided with a small loop 51 for forming a drawstring knot 66 (drawstring knot type knot 66; drawstring 66; luggage tag type suture 66) and a flexible, closed, adjustable, self-locking, tensionable loop 55. The small loop 51 may be integrally formed with the suture formation or separate. The loops 51 may be part of the outer strands 11 or, alternatively, part of the inner strands 10. In yet another embodiment, the loops 51 may be part of both strands 10, 11. In further embodiments, the small loop 51 may be attached to the suture construction (e.g., to one or both of the outer and inner strands) by any method known in the art. The small loops 51 may be integral with the flexible strands 50.

Reference is now made to fig. 3 and 4. After forming loop interconnect 66, locking mechanism 77 is formed by applying mechanical pressure, compression, or force F to the area of suture construct 100 adjacent to loop interconnect 66 to form a puncture or crimp zone 77 (stop mechanism or locking mechanism 77) in flexible strand 50. The locking mechanism 77 acts as a stop. Fig. 4 (a) and 4 (b) show enlarged views of the strands 10, 11 before and after mechanical pressure and compression are applied. The protrusions 77 of fig. 4 (b) are formed after mechanical pressure or mechanical force is applied to the flexible strands 50. When mechanical pressure is applied, the monofilament core 10 protrudes from and through the braid 11 (UHMWPE braid 11), piercing the braid 11, as clearly shown in fig. 4 (b). The protrusions 77 may be any deformation, expansion, protrusion, or flat region/area of the flexible strand 50 that is sized not to allow movement or passage through the loop interconnect 66. The monofilament suture 11 with the solid core 10 may be flattened to distort its cross-sectional view and achieve a more oval cross-sectional view.

While the protrusion 77 locks the construct 100, it is important to note that the protrusion 77 primarily acts as a stop for the suture, thereby impeding the loosening of the suture through the drawstring knot type knot 66. In this way, without using any electrical welding/deformation source of the suture, only mechanical pressure eliminates knots while providing a secure, reinforced lock of the suture 50.

Referring now to fig. 8-11, a suture repair 101 (fig. 11) having an exemplary surgical configuration 100 is illustrated. The flexible strand 50 is passed through a first tissue 90 (soft tissue 90) attached to a second tissue 80 (bone 80) by a suturing apparatus 40, such as a needle 40.

Figures 9 and 10 illustrate the formation of loop interconnects 66 (drawknot type knots 66) and the passage of a single tail of flexible strand 50 through the drawknot type knots 66. Tension is applied to tension the construction by pulling on the individual tail portions of the flexible strands 50. Mechanical force and/or pressure and/or compression is applied to the region of the flexible strand 50 adjacent to the loop interconnect 66 to form a stop mechanism/locking mechanism 77 (protrusion or deformation 77) in the strand 50.

The final repair 101 includes a suture configuration 100 having a bulge or enlargement 77 formed in the flexible strand 50 by application of mechanical pressure and locked in place by the drawstring knot 66, unable to slide or slip out of a loop formed around a first tissue 90 (e.g., soft tissue 90) attached to a second tissue 80 (e.g., bone 80).

The flexible strands 50 (suture constructions 50) may comprise monofilaments or fibers, or may comprise a plurality of continuous filaments, segments, or filament regions having different constructions (e.g., different diameters and/or different compositions) and allowing the formation of at least one protrusion 77 by the application of mechanical pressure and/or compression.

The flexible strands 50 may be made of any known suture construction, such as multifilament, braided, knitted, woven sutures, or include ultra-high molecular weight polyethylene (UHMWPE) fibers orSutures (disclosed in US 6,716,234, the disclosure of which is incorporated herein by reference in its entirety). The flexible strands may also be formed from suture bands such as ArthrexIt is a woven high strength suture tape having a rectangular cross section, as disclosed in US 7,892,256, the disclosure of which is incorporated herein by reference in its entirety.

Fig. 12 and 13 illustrate a schematic view of a surgical construct 200 of the present disclosure. The surgical configuration 200 of fig. 12 is generally similar to the surgical configuration 100 detailed above in that it is also a knotless, tensionable, self-locking configuration, including a loop 150 having one or more loop interconnects 166, such as a tie-tie type knot 166, and one or more stop/lock mechanisms 177. However, surgical construct 200 also differs from construct 100 in that (i) surgical construct 200 is a cerclage construct having flexible strands 150 formed of cerclage material such as metal and/or tape such as suture tape, and (ii) surgical construct 200 includes a ferrule 177 or collet 177 having internal features 178 that form a stop mechanism/locking mechanism.

Cerclage repair with tie 166 (drawstring knot 166) is created around bone 80 and/or tissue 90. Ferrule 177 has an internal feature 178 that allows for unidirectional tensioning and unidirectional suture direction and movement. The ferrule 177 sliding over the end of the flexible strand 150 (loop tie 150) is tensioned down to the knot 166 where it locks in a unidirectional manner. When the ferrule 166 acts as a stop, the knot 166 retains most of the tension of the cerclage repair. The cerclage repair of the present disclosure is tensionable and knotless because it eliminates knots in suturing techniques such as cerclage and side-to-side repair. With the drawstring knot geometry of the cerclage technique disclosed above, the ferrule 177 no longer needs to hold the full force of repair, but rather acts as a stop. This aspect alone provides additional strength for the overall cerclage repair.

Suture construct 100 may include (i) a closed, flexible, adjustable, continuous suture loop 55, (ii) an interconnecting loop chain 66, such as a drawstring knot 66 or half-knot 66 or tie 66, and (iii) a locking mechanism 77 or stop 77. The stop 77 may be a suture bulge or deformation formed by applying mechanical pressure to the suture construct. Suture construct 100 may consist essentially of suture 50. The suture construction 100 may consist essentially of a braid 11 having a monofilament core 10. Suture construct 10 may be used to attach or reattach an anatomical structure, such as first tissue 90, to second tissue 80, such as soft tissue, tendons, ligaments, and/or bones, to each other, or to any combination of each other, by employing a self-locking, knotless mechanism. Suture construct 100 may be used as a stand alone construct or with additional fixation devices, such as attached to one or more fixation devices.

The cerclage construction 200 may include (i) a cerclage loop 150, (ii) an interconnecting cerclage loop chain 166, such as a strap knot 166 or half-knot 166 or tie strap 166, and (iii) a locking mechanism 177 or stop 177. The stop 177 may be a ferrule 177 provided with an internal feature 178 that allows for unidirectional tensioning of the cerclage configuration. Cerclage construction 200 may consist essentially of suture tape 150. The cerclage construction 200 may be used to reattach anatomical structures, such as reattach bones to bones, or reattach bones to soft tissue. Cerclage construction 200 may be used as a stand-alone construction or with additional fixation devices, such as attachment to one or more fixation devices, such as bone plates, anchors, screws, and/or implants.

The flexible strands 50, 150 may be in the form of any elongated member, fiber, or material, or combination thereof. The flexible strands 50, 150 may be coated (partially or completely) with wax (beeswax, petroleum wax, polyethylene wax, or others), silicone (dawster silicone fluid 202A, or others), silicone rubber (NusilMed 2245, nusilMed 2174 with a binding catalyst, or others), PTFE (Teflon, hostaflon, or others), PBA (polybutyrate), ethylcellulose (Filodel), or other coatings, for example, to improve the lubricity, loop security, flexibility, handleability, or abrasion resistance of the suture.

The flexible strands 50, 150 may be made of any known suture construction, such as multifilament, braided, knitted, woven sutures, or include ultra-high molecular weight polyethylene (UHMWPE) fibers orSutures (disclosed in US 6,716,234, the disclosure of which is incorporated herein by reference in its entirety). The flexible strands 50, 150 may also be formed from suture bands, such as ArthrexIt is a woven high strength suture tape having a rectangular cross section, as disclosed in US 7,892,256, the disclosure of which is incorporated herein by reference in its entirety.

The flexible strands 50, 150 may also be provided with colored trace strands or otherwise visually contrasted with other areas/regions of construction, such as remaining free of patterns, solid colors, or displaying different trace patterns. The various structural elements of the flexible strands 50, 150, such as the loops 55, 155 and/or the tail, may be visually encoded to make identification and handling of the suture loops and ends simpler. It is advantageous to easily identify the suture in situ during a surgical procedure.

The term "high strength suture" is defined as any elongated flexible member, the choice of material and dimensions depending on the particular application. For purposes of illustration and not limitation, the term "suture" as used herein may be a cable, filament, tape, thread, wire, fabric, or any other flexible member suitable for performing in vivo tissue fixation.

The term "luggage tag type suture" is defined as any tie or loop formed by luggage tag type technology.

Fig. 14-19 illustrate an exemplary locking collar 210 that may be used in performing various tensionable knotless tissue repairs. For example, the locking collar 210 may be used during a surgical method for attaching tissue (e.g., ligaments, tendons, grafts, etc.) to bone or for repairing any other type of tissue effect. The locking collar 210 may be used in conjunction with a variety of orthopedic surgical procedures including, but not limited to, rotator cuff repair, achilles tendon repair, patellar tendon repair, biceps tendon repair, and the like.

The locking collar 210 may include a body 212 extending along a longitudinal axis a between a proximal end 214 and a distal end 216. The body 212 may be tubular and may be constructed of a metallic material or a plastic material. However, the particular size, shape, and materials of construction of the body 212 are not intended to limit the present disclosure.

The cannula 218 may extend through the body 212 and may establish an internal passageway for receiving one or more strands of suture 220 (see, e.g., fig. 18 and 19). The cannula 218 may extend across the entire length of the body 212 and thus extend from the proximal end 214 to the distal end 216. The longitudinal axis a may bisect the cannula 218.

The body 212 may include an outer diameter wall 222 and an inner diameter wall 224. The outer diameter wall 222 may be smooth or may alternatively include threads, barbs, or other features for facilitating bone fixation. The inner diameter wall 224 may define the cannula 218. In some embodiments, the cannula 218 may taper in a direction toward the distal end 216 and thus be narrower within the distal end 216 than within the proximal end 214.

A plurality of locking barbs 226 may project inwardly from the inner diameter wall 224. Thus, the locking barbs 226 may occupy at least a portion of the open space of the cannula 218. In an embodiment, the locking barb 226 is an integrally formed (e.g., molded) feature of the body 212 of the locking collar 210. The locking barbs 226 may be disposed along the entire length of the cannula 218 or only at selected portions thereof. The locking barbs 226 may be rigid or flexible structures.

The locking barbs 226 may be arranged in rows along the length of the cannula 218. For example, the locking barbs 226 may be arranged in at least a first row R1 and a second row R2 (see fig. 17). In one embodiment, the locking barbs 226 in the second row R2 are staggered relative to the locking barbs 226 in the first row R1 (see fig. 17).

Each locking barb 226 may include a sharp end or tip 228, and each locking barb 226 may be angled in a direction toward the proximal end 214. Thus, the locking barbs 226 may establish a one-way locking mechanism that allows one or more sutures 220 to pass through the cannula in the first direction D1 while preventing the sutures 220 from tensioning or otherwise moving in the second direction D2. Once the suture 220 passes through the cannula 218, the staggered relationship of the rows of locking barbs 226 may provide maximum engagement with the suture.

Referring now primarily to fig. 18 and 19, and with continued reference to fig. 14-17, one or more sutures 220 may be passed through the cannula 218. Suture 220 may beOr any other suitable suture product.AndIs a suture product marketed and sold by the sharp company (Arthrex, inc.). However, other suture products may be used as suture 220 within the scope of the present disclosure. The size and type of suture used in conjunction with the locking collar 210 is not intended to limit the present disclosure.

Suture 220 may include varying thicknesses. Accordingly, the suture 220 may include one or more tapered regions 230, wherein the suture 220 transitions between a thickened section 232 and a thinned section 234. The thinned section 234 may facilitate passage of the suture 220 through the cannula 218, such as via a suitable suture loader 236, which may be provided as part of a suture locking system including, for example, the locking collar 210, and the thickened section 232 may provide greater surface area for the locking barb 226 to adequately lock the suture 220 relative to the locking collar 210.

In one embodiment, the thickness of thickened section 232 of suture 220 is about twice the thickness of thinned section 234. However, other ratios (e.g., 1.5:1, 3:1, etc.) between the relative thicknesses (e.g., outer diameters) of thickened section 232 and thinned section 234 are contemplated within the scope of the present disclosure.

Suture loader 236 may be used to pass one or more sutures 220 through the cannula 218 of the locking collar 210. The aperture 238 of the suture loader 236 may be passed through the cannula 218 (e.g., by inserting the aperture 238 at the distal end 216 of the body 212 and then moving the suture loader 236 in the second direction D2). One or more thinned sections 234 of suture 220 may then be loaded through eyelet 238. Suture loader 236 may then be pulled in a first direction D1 via handle 240 to pass suture 220 through cannula 218.

Once the suture 220 has passed through the cannula 218, the suture 220 may be further tensioned in the first direction D1 to lock the suture 220 relative to the locking collar 210. The locking barbs 226 prevent the suture 220 from reversing sliding or otherwise moving in the second direction D2. The pointed end 228 of the locking barb 226 may interdigitate with one or more of the thickened sections 232 to lock the suture 220 and prevent movement thereof in the second direction D2.

Although shown as locking a single folded suture 220 in the above embodiments, the locking collar 210 may be configured to receive and lock multiple suture strands and/or sutures of different sizes.

In the above embodiment, a single locking collar 210 is used to tighten and knotless secure the suture 220. However, two or more of the locking ferrules 210 may be used together to establish a suture locking system 299 for tensioning and knotless securing of the suture 220 (see, e.g., fig. 33).

The locking collar 210 described above and shown in fig. 14-19 may be used to tighten and knotless secure one or more sutures 220 as part of various surgical procedures. Fig. 20-29 schematically illustrate one such surgical method for attaching tissue 242 to bone 244. For example, during strenuous or athletic activity, tissue 242 may tear from bone 244. When such tears occur, reattachment is often required to repair the tissue defect.

The surgical methods schematically illustrated in fig. 20-29 may be used in conjunction with a variety of orthopedic surgical repairs, including, but not limited to, for example, rotator cuff repairs. Accordingly, bone 244 may be associated with any joint of the human musculoskeletal system (e.g., shoulder, knee, hip, ankle, etc.).

In one embodiment, the surgical method is performed as an arthroscopic procedure by passing through various arthroscopic portals. However, the exemplary surgical method may alternatively be performed as an open procedure within the scope of the present disclosure. An exemplary surgical method may be used to reduce tissue 242 in a manner that enhances space-consuming compression and then attach it knotless to bone 244 to maximize tissue-to-bone contact.

Referring first to fig. 20, after the bone 244 is properly prepared (e.g., by debridement, formation of a bleeding bone bed, preparation of a bone socket, etc.), an inner row of fixation devices may be implanted into the bone 244. The fixation device of the inner row may include one or more suture anchors 246. The suture anchor 246 may be a knotless suture anchor that does not require any of the various structures to be tied together for reducing tissue 242 and securing it to bone 244, or may be a conventional knotted suture anchor. In addition, the suture anchors 246 may be "soft" anchors made exclusively of soft, suture-based materials, or may be relatively rigid structures made of plastic or metal.

In one embodiment, an inner row of suture anchors 246 are placed at the articular edge of the bone 244. However, other implantation locations may be selected based on the preference of the performing surgeon. Notably, although in the illustrated embodiment, two suture anchors 246 are illustrated as part of the medial row, a greater or lesser number of suture anchors (or other fixation devices) may be used as part of the surgical method within the scope of the present disclosure. For example, the medial row may include only a single suture anchor 246.

Each suture anchor 246 may be preloaded with one or more sutures 220. Suture 220 may include individual suture strands, multiple suture strands, suture tape, or any other suture-like product. As shown in FIG. 21, after each suture anchor 246 of the medial row is sufficiently secured within bone 244, suture 220 may be passed up through tissue 242.

Referring now to fig. 22, the surgical method may continue by implanting lateral rows of fixation devices into bone 244. The lateral rows of fixation devices may include one or more suture anchors 248. The suture anchor 248 may include an anchor body 250 and a shuttle device 252 housed through the anchor body 250. The anchor body 250 may be a "soft" body made exclusively of soft, suture-based material, or may be a relatively rigid plastic or metal body. For example, the shuttle device 252 may be a pass-through thread or another suture.

The lateral rows of suture anchors 248 can be placed laterally relative to the edge 254 of the tissue 242 and slightly away from the larger tuberosity of the bone 244. Thus, the suture anchors 248 may be laterally positioned relative to the inner row of suture anchors 246. However, other implantation locations may be selected based on the preference of the performing surgeon and depending on the type of orthopedic procedure being performed. Notably, although in the illustrated embodiment, two suture anchors 248 are illustrated as part of a lateral row, a greater or lesser number of lateral fixation devices may be used as part of the surgical method within the scope of the present disclosure.

The anchor body 250 of each suture anchor 248 may be inserted into a socket 264 formed in the bone 244. Each socket 264 may be a preformed opening formed in bone 244, each sized to receive anchor body 250 of one of suture anchors 248.

Next, the surgical method can be performed by shuttling the suture 220 from the inner row of suture anchors 246 through the anchor body 250 of the lateral row of suture anchors 248. For example, as shown in fig. 23, one branch 256 of the suture 220 from each suture anchor 246 may be passed through the eyelet 255 of the shuttle device 252 of a first one of the suture anchors 248, and then the free end 260 of the shuttle device 252 may be pulled (e.g., in the direction of arrow 262) to allow the branch 256 to pass through the anchor body 250 of the suture anchor 248. This shuttle process may be repeated to shuttle additional branches 258 of the suture 220 from each suture anchor 246 through the anchor body 250 of a second one of the laterally-running suture anchors 248 (see fig. 24). Thus, the branches 256, 258 may be arranged in a cross pattern P that provides a desired footprint compression area over the top of the tissue 242 (see fig. 25).

In the surgical method, the suture 220 of the suture anchor 246 is initially fixed relative to the bone 244 by the suture anchor 248. The suture 220 may then be further tensioned and locked in place using the locking collar 210. For example, as shown in fig. 26 and 27, after loading the thinned section 234 of the branch 256 connected to a first one of the suture anchors 248 through the cannula 218 of the locking collar 210 (e.g., in the manner shown in fig. 18-19), the branch 256 may be tensioned in the direction D1 to allow the locking collar 210 to slide the branch 256 downward in the direction D2 and be received within the socket 264. Further tensioning of the branch 256 in the direction D1 allows the pointed end 228 of the locking barb 226 to interdigitate with the thickened section 232 of the suture 220 to lock the suture 220 and prevent it from sliding in the second direction D2. Once positioned in the socket 264, the locking collar 210 may be positioned over the top of a first one of the lateral rows of suture anchors 248 (see fig. 28).

The process shown in fig. 26-28 can be repeated to tighten and lock the branch 258 associated with the second one of the suture anchors 248 with the additional locking collar 210. The final configuration achieved by the surgical approach is shown in fig. 29. Once tensioning and locking is complete, excess length of suture 220 extending outside of cannula 218 of locking collar 210 may be removed (e.g., cut).

Fig. 30-32 schematically illustrate another surgical method in which the locking collar 210 of fig. 14-19 may be used to tighten and lock a suture during a surgical repair. In this embodiment, the surgical method may involve securing tissue 266 (e.g., a tendon) to bone 268, such as part of a pectoral biceps tenodesis procedure.

Referring first to fig. 30, the surgical method may include creating a looped suture 270 (e.g., with a suture) within tissue 266, and inserting a suture button 272 into bone 268 at a desired attachment point of tissue 266. The suture button 272 may include a button body 274 in the form of a sheath and a shuttle device 276 received through the button body 274. For example, shuttle 276 may be a pass-through thread or suture.

The button body 274 of the suture button 272 may be inserted into a pocket 278 formed in 268. The socket 278 may be a preformed opening formed in the bone 268 that is sized to receive the button body 274 of the suture button 272.

Next, the surgical method may be performed by shuttling the suture branches 280 of the annular suture 270 through the button body 274 of the suture button 272. For example, suture branch 280 may pass through eyelet 282 of shuttle device 276 of suture button 272. The free end 286 of the shuttle device 276 may then be pulled (in the direction of arrow 284) to allow the suture branch 280 to pass through the button body 274 of the suture button 272.

During the surgical procedure, the tissue 266 is reduced to a proper position relative to the bone 268. The suture limbs 280 may then be tensioned and locked in place using the locking collar 210. For example, as shown in fig. 31, after loading suture branch 280 through cannula 218 of locking collar 210, suture branch 280 may be tensioned in direction D1 to allow locking collar 210 to slide down in direction D2 and into socket 278. Further tensioning of the suture branch 280 allows the pointed end 228 of the locking barb 226 to interdigitate with a section of the suture branch 280 received within the cannula 218, thereby locking the suture branch 280 in place and preventing it from sliding back in the second direction D2. Thus, tissue 266 is firmly tensioned and fixed relative to bone 268. Once positioned in the pocket 278, the locking collar 210 may be positioned over the top of the suture button 272 (see fig. 32).

Figures 34A-34D illustrate an exemplary suture locking system 399. The suture locking system 399 may include one or more locking collars 210 and a suture loader 336 for shuttling sutures 220 through the locking collars 210. The locking collar 210 may include a design such as that shown in fig. 14-17.

Suture loader 336 may include handle 340 and eyelet 338. The handle 340 may include a first handle section 390 and a second handle section 392 that is detachable from the first handle section 390. The proximal section 394 of the eyelet 338 may pass through the first handle section 390 and may be attached to the second handle section 392 such that movement of the second handle section 392 results in movement of the eyelet 338. The eyelet may be received through the cannula 218 of the locking collar 210 prior to shuttling the suture 220 through the eyelet 338. In one embodiment, the locking collar 210 and suture loader 336 are preassembled with one another prior to performing the suture shuttle procedure.

The thinned section 234 of the suture 220 may be loaded through the eyelet 338 (see fig. 34B). The second handle section 392 can then be disconnected from the first handle section 390 and then moved in the first direction D1 to shuttle the suture 220 through the cannula 218 of the locking collar 210. Once the suture 220 has passed through the cannula 218 of the locking collar 210, the suture 220 may be tensioned in the first direction D1 to lock the suture 220 relative to the locking collar 210 and prevent movement in the second direction D2 in the manner described above.

In an embodiment, the locking collar 210 may be received within the recessed opening 396 of the first handle section 390 of the suture loader 336 prior to shuttling the suture 220 through the locking collar 210 (see fig. 34C). In another embodiment, the locking collar 210 may be preloaded within a separate surgical device 398 (e.g., sleeve, button, suture anchor, screw, bone plate, arthroplasty implant, etc.) of the suture locking system 399 prior to shuttling the suture 220 through the locking collar 210 (see fig. 34D).

The locking collar of the present disclosure may be used with one or more additional securing devices (e.g., anchors, buttons, etc.) for performing various tensionable knotless tissue repairs. The locking collar is provided at various points of tissue repair, including after implantation of the attached fixation device, to tension and re-tension the suture, thus providing a number of advantages over existing tissue repair techniques.

Although the different non-limiting embodiments are shown with particular components or steps, embodiments of the present disclosure are not limited to those particular combinations. It is possible to use some components or features from any non-limiting embodiment in combination with features or components from any other non-limiting embodiment.

It should be understood that throughout the several drawings, the same reference numerals identify corresponding or similar elements. It should also be understood that while particular component arrangements are disclosed and illustrated in these exemplary embodiments, other arrangements may benefit from the teachings of this disclosure.

The foregoing description is to be construed in an illustrative and not a limitative sense. A worker of ordinary skill in this art would recognize that certain modifications would come within the scope of this disclosure. For these reasons, the following claims should be studied to determine the true scope and content of this disclosure.

Claims (20)

1. A surgical construct comprising: a flexible strand comprising a loop and a single tail; The single tail is arranged to pass through the ring to establish a ring interconnect; and A stop is positionable adjacent the ring interconnect and is configured to lock the flexible strand from coming loose through the ring interconnect. 2. The surgical construct of claim 1, wherein the surgical construct is a knotless, tensionable, self-locking suture construct. 3. The surgical construct of claim 1 or 2, wherein the stop comprises at least one protrusion or deformation formed by applying mechanical pressure or force to the flexible strand. 4. The surgical construct of any one of the preceding claims, wherein the flexible strand comprises a braid having a monofilament core. 5. The surgical construct of any one of the preceding claims, wherein the flexible strand is a suture tape. 6. The surgical construct of any one of the preceding claims, wherein the surgical construct is a cerclage construct. 7. The surgical construct of claim 1 wherein the stop comprises a collar that permits one-way passage of the flexible strand, and further wherein the collar comprises internal features that permit the one-way passage of the flexible strand. 8. The surgical construct of any one of the preceding claims, wherein the ring interconnect is a lace. 9. The surgical construct of any one of the preceding claims, wherein the ring interconnect is a racking hitch or a half hitch. 10. The surgical construct of claim 1 , wherein the stop is a protrusion having a width greater than a width of the flexible construct, and further wherein the flexible construct comprises a monofilament core protruding through a braid to create the protrusion, and wherein the braid is formed of ultra-high molecular weight polyethylene (UHMWPE). 11. A locking collar for performing tissue repair, the locking collar comprising: a body comprising an outer diameter wall, an inner diameter wall, and a cannula defined by the inner diameter wall; and A plurality of locking barbs extend into the cannula and are configured to lock a suture received through the cannula relative to the body. 12. The locking collar of claim 11, wherein the plurality of locking barbs are an integral feature of the body. 13. The locking collar of claim 11 or 12, wherein each locking barb of the plurality of locking barbs comprises a pointed end. 14. The locking collar of any one of claims 11 to 13, wherein the body extends along a longitudinal axis between a proximal end and a distal end. 15. The locking collar of claim 14, each locking barb of the plurality of locking barbs being angled in a direction toward the proximal end. 16. The locking collar of any one of claims 11 to 15, wherein the plurality of locking barbs each project inwardly from the inner diameter wall. 17. The locking collar of claim 16, wherein the plurality of locking barbs are arranged in at least a first row and a second row. 18. The locking collar of claim 17, wherein a first portion of the plurality of locking barbs in the first row are staggered relative to a second portion of the plurality of locking barbs in the second row. 19. The locking collar of claim 16, wherein the plurality of locking barbs are arranged across the entire length of the body. 20. The locking collar of any one of claims 11 to 19, wherein the suture comprises a varying thickness.