HK1177881B - Suture anchor - Google Patents

Description

Suture anchor

Technical Field

The present invention generally relates to a device for fixing the position of a suture.

Background

When ligaments or tendons become completely or partially detached from the associated bone or are damaged by tearing, surgical intervention may be used to assist repair and reattachment (reduction). While both open and arthroscopic surgical techniques may be used, the surgeon's clinical assessment of the nature of the problem, the reduction technique selection, the associated surgical elements (sutures, anchors, tools required), and the accessibility of the reduction area and associated reduction area will determine the actual surgical approach. Arthroscopic surgical techniques are currently gaining popularity for a variety of reasons, such as increased access during surgery and potential ease of use of surgical elements, less disturbance of the patient's body organs and tissues, and generally shortened recovery periods (especially important for athletes) with less patient discomfort.

Unfortunately, intracorporeal suturing is difficult and therefore time consuming, and only basic knot and stitch patterns can be used. Furthermore, the tension applied on the suture and thus on the ligaments and tendons attached thereto may be difficult to maintain during the knotting procedure and may make it difficult to achieve an acceptable degree of knot tightness. Furthermore, once formed, it is often not possible to adjust the tension of the suture or knot. Furthermore, the knot and end of the fixation suture (knob) must protrude from the reduction area (so that the patient may feel one or more of the ends after surgery), which can create a potential source of pain and increase scarring during the healing process. Open surgical techniques allow full spectrum suturing, knotting, and knot placement, although palpation of the knot or finish may still be performed in some cases depending on the surgical site.

A variety of anchors are used for glenohumeral joint instability, superior labral anterior-posterior damage, and rotator cuff repair, and these anchors are commonly used to secure the ends of sutures to the skeletal structures of the body. However, these anchors and the manner in which they achieve attachment to bone and sutures present various problems. Anchors comprising a screw portion for providing a mechanical bond to bone are known. The difference in density between cortical bone (the relatively dense and hard outer layer of bone) and cancellous bone (the relatively less dense, soft and sometimes normally dense bone), the diameter of any pilot hole created by the surgeon, and the ability to grow around and sometimes over the anchor. Furthermore, such anchors can typically only be inserted in one motion and do not provide depth or angle adjustability.

Another method of bone anchor design uses a split hollow shaft inserted into a hole formed in the cortical bone. The anchor carries a tapered plug that extends through the entire length of the hollow shaft of the anchor, with the widest end of the inner end of the shaft (relative to the bone) positioned such that when the plug is pulled toward the outer end of the shaft, the tapered portion of the plug expands the hollow shaft body radially outward, effectively locking the device in the cortical bone structure. Such anchors also require insertion in one motion and do not provide depth or angle adjustability.

Anchors of the type described in the preceding paragraph may be used in suitable bone and if used in conjunction with sutures will fixedly typically incorporate two or more lengths of suture material which may then be used to attach to the relevant tissue and securely knot if desired. An alternative is to provide an eyelet (eyelet) on the outer end of the anchor through which and/or to which suture material may be threaded. One problem with such anchors is that, except for placement of the suture material in soft tissue, looping and tying through the anchor eyelets, all of which are done during arthroscopic surgery, the eyelets can break or excessively abrade the suture material. Such anchors are also preferably inserted in one motion and do not provide depth or angle adjustability.

Other methods of securing soft tissue to bone, such as staples, tacks, etc., are known to fail when tension is applied or self-relaxes and may cause inflammation, pain, or be unsuitable for certain locations in the body, and furthermore, are difficult to locate when they become dislodged post-operatively.

Disclosure of Invention

In one broad aspect of the invention, an arthroscopic transosseous knotless suture anchoring device for retaining a suture relative to a cortical portion of a bone comprises: a hollow body for at least partial insertion into a cortical portion of a bone; and a retaining element having an elongate body sized to fit with and within the hollow of the body to retain the portion of the suture within the hollow body relative to the cortical portion of the bone.

In another aspect of the invention, an apparatus for capturing and retaining a suture under tension relative to a cortical bone portion comprises: a hollow elongate body having an inner surface forming a hollow, at least a portion of the body for seating in a cavity located in a portion of cortical bone, the hollow body having a rim extending radially from one end of the body, the rim being adapted to receive a force urging at least a portion of the rim against the cortical bone in the vicinity of the cavity in the cortical bone; and a retaining element sized to fit with and within the hollow portion of the body; wherein a portion of the suture is located within the hollow body and the retaining element is interference fitted within the hollow body to capture the portion of the suture located within the hollow body that is subject to the pulling force when the free end of the suture is subjected to the pulling force resulting from the force applied to the suture in a direction away from the outer surface of the cortical bone and another force in a substantially opposite direction is applied to the rim of the body, while the rim of the body abuts the cortical bone portion and also retains the captured portion of the suture relative to the cortical bone portion.

Throughout this specification and the claims, unless the context requires otherwise, the word "comprise", and variations such as "comprises" and "comprising", will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.

The reference to any prior art in this specification is not, and should not be taken as, an acknowledgment or any form of suggestion that such prior art forms part of the common general knowledge.

A detailed description of one or more preferred embodiments of the invention is provided below along with accompanying figures that illustrate the principles of the invention. While the invention will be described in conjunction with these embodiments, it will be understood that the invention is not limited to any embodiment. Rather, the scope of the invention is limited only by the appended claims and the invention encompasses numerous variations, modifications and equivalents. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. The present invention may be practiced according to the claims without some or all of these specific details. For the purpose of clarity, technical material that is known in the technical fields related to the invention has not been described in detail so that the invention is not unnecessarily obscured.

Drawings

FIG. 1 shows a cut-away front view of a muscular-skeletal view of a human rotator cuff;

FIG. 2 shows a cross-sectional view of a torn rotator cuff;

FIG. 3 shows the attachment of sutures to the rotator cuff through the lateral skin aperture;

fig. 4 shows an examination and possible preparation of the top of the humerus through a lateral cutaneous aperture, including the formation of a hole or groove in the humerus;

fig. 5 shows a suture delivery guide instrument inserted through one of the arthroscopic cutaneous apertures and into a hole in the upper humerus and positioned in preparation for forming a lateral humeral hole;

FIG. 6 shows the trocar and suture retrieval sleeve positioned and about to be inserted into the guide sleeve on the outer arm of the suture delivery guide;

FIG. 7 shows the trocar inserted into the suture retrieval sleeve and about to be inserted into the guide sleeve on the outer arm of the suture delivery guide;

fig. 8 shows the suture retrieval sleeve with the trocar of the sleeve advanced through the lower skin aperture, through the hole in the side of the humerus, and into the humeral medullary to a point near the intra-osseous portion of the suture delivery guide;

FIG. 9 shows the trocar withdrawn leaving the suture retrieval sleeve in place;

fig. 10 shows the suture delivery guide in place with the suture retrieval sleeve in place near the aperture (foramen) located at the distal portion of the intra-osseous portion of the guide;

figure 11 shows a guide wire passing through a central hole in the intra-osseous part of the suture delivery guide and then exiting through the suture retrieval sleeve so that the guide wire passes through two holes in the humerus;

FIG. 12 shows the suture retrieval sleeve withdrawn but leaving the guide wire in place;

fig. 13 shows the intraosseous arm of the suture delivery guide removed from the humerus, with care being taken to hold the guide wire in place;

FIG. 14 shows the suture delivery guide device detached from the guide wire;

figure 15 shows both the suture attached to the rotator cuff and the guide wire through the bone;

FIG. 16 shows the suture still attached to the rotator cuff after being pulled through the hole in the bone;

FIG. 17 shows the rotator cuff being pulled through a hole in the bone by a suture;

FIG. 18 shows the hollow body portion threaded over the suture;

figure 19 shows the hollow body embedded within bone;

FIG. 20 shows the placement of the retaining element towards the hollow body through one of the two lateral skin openings;

figure 21 shows the seating of the retaining element in the hollow body;

FIG. 22 shows the retaining element and repair suture fitted within the hollow body with the suture spaced at the outer surface of the retaining body;

figure 23 shows a guide for feeding the holding element into the hollow body with the aid of a plug and which also impacts the hollow body into the bone;

figure 24 shows a diagrammatic representation of the retaining element and the hollow body;

FIG. 25 shows a graphical representation of the positioning of the retaining element when two sutures are passed through the hollow body;

FIG. 26 shows a graphical representation of the insertion of a retaining element into the hollow body capturing the suture;

FIG. 27 shows a graphical representation of the mated position of the retaining element within the hollow body and the capture of the repair suture.

Detailed Description

The devices described herein may be used to secure sutures in bone. The disclosed devices have many applications, which surgeons have the ability to determine. However, only one example of the use of the disclosed device is provided herein, which involves the use of arthroscopic surgery to repair and correct rotator cuff injuries.

The rotator cuff includes muscles and their tendons including the subscapularis, supraspinatus, infraspinatus and teres minor, which surround the shoulder and connect between the humerus and the scapula. They will adhere along the head of the humerus and their main role is to help stabilize the shoulder during active movement, which is usually done under the action of the deltoid muscle.

All muscles must work in concert to contract and relax in a synchronized manner to provide a stable and active shoulder with the desired range of motion.

The procedure used here by way of example involves tightening and positioning a pathologically separate rotator cuff back onto the prepared bone.

After the rotator cuff and the surrounding tissue and bone are examined and determined for extent of damage or disease, the rotator cuff is cleaned prior to bone cleaning in preparation for surgery to assist in apposition of the connected tissue to the prepared bone.

Figure 1 shows a cut-away front view of a muscular-skeletal view of a human rotator cuff.

As shown in FIG. 1, the rotator cuff muscle group is shown at 10 with the subscapularis 12 and supraspinatus 14.

Fig. 2 shows a cut-away view of the rotator cuff with the supraspinatus 14 shown partially separated from the humerus 16.

As described above, arthroscopic surgery will be used, and in preparation for the surgery, an opening is formed in the skin of the patient through which various surgeries are performed. In fig. 3, a graphical representation of the aperture is shown as 18. More than one aperture is typically formed for surgery, but only one is shown diagrammatically in fig. 3. Both the superior skin apertures 18 (fig. 3 and 4) and the inferior apertures 29 on the superior arm skin are shown in fig. 5 and are the only passages to access deeper tissues and humerus during surgery. For simplicity of illustration, these apertures are not included in the other figures, but it is inherent in the described procedure that surgical access is only via these particular apertures.

Fig. 3 shows the suture attached to the torn tendon of the infraspinatus muscle of the rotator cuff muscle, and in particular shows the suture 19 being pulled through the aperture 18 to the outside of the patient, outside the patient's body. Subsequently, during surgery, the suture or guide wire 28 will also be pulled through the upper skin aperture 18, which will allow the guide wire to be attached to the repair suture 19, as described in detail below.

Fig. 4 shows inspection and possible preparation of the humeral head through the lateral skin aperture 18, and includes preparation for forming a hole or groove in the humerus 16.

Fig. 5 shows a preliminary step in forming a hole or sulcus 20 in the upper region of the humerus suitable for receiving a suture transfer guide post 23. The hole 20 to be formed is the first of the two holes to be formed in the humerus, and the second hole needs to be formed to meet the first hole inside the bone and thus provide a passageway through the bone.

Fig. 5 also shows diagrammatically how it is determined where in the humerus where the first and second two holes should be formed using a suture transfer guide instrument. The suture delivery guide instrument has a guide post 23 that is inserted through the aperture 18 in the patient's skin and then into the groove/first bore 20 under arthroscopic visual control.

The suture delivery guide instrument has a second guide arm 24, the second guide arm 24 being positioned parallel to the guide post 23 by the first guide arm 22, a sufficient distance between the guide post 23 and the second guide arm 24 to account for the thickness of soft tissue above the bone including deltoid, subcutaneous fat, and skin. At the bottom of the second guide arm 24 is provided a hollow cylindrical appendage 25, which appendage 25 is at right angles to the second guide arm 24 and has a sufficient aperture and shape to allow passage of a longitudinal trocar 26 and a suture retrieval sleeve 27a, to be described further.

The guide post 23 has an aperture of a full length of sufficient size to allow easy passage of a guide wire 28 or suture having sufficient rigidity (for example, a braided wire or thread coated with rigid plastic) to allow it to be fed without coiling or knotting. The hole at the bottom of the guide post 23 is at right angles to the longitudinal axis of the guide post 23 and is guided laterally towards the second guide arm 24 and in particular aligned with the centre of the guide sleeve 25.

Positioning the guide post 23 within the planned hole 20 and positioning the second guide arm 24 at or near the top of the humerus near the location where the second hole 27 (fig. 8) is to be formed in the humerus depends on the surgeon's judgment.

The process of forming the second hole 27 (fig. 8) is accomplished by placing the trocar 26 and suture retrieval trocar 27a and guide sleeve 25 and forming the hole 27 in the humerus bone through the cortical bone, as diagrammatically shown in fig. 8. Once the second hole is made, trocar 26 and suture retrieval sleeve 27a are advanced within the humerus until contact is made with first post 23. The trocar 26 is then removed as shown in fig. 9 and the suture retrieval sleeve 27a is left in place (fig. 10).

As shown in fig. 11, a rigid suture or thin guide wire 28 is inserted into the upper exposed hole of the guide post 23 and advanced into the hole. When the hole at the bottom of guide post 23 is substantially aligned with the center of suture retrieval sleeve 27a, suture or guide wire 28 is advanced through suture retrieval sleeve 27a to exit its lateral end. The suture or guide wire 28 is then advanced a sufficient distance to ensure that it can be secured at both ends outside the body.

As shown in fig. 12, suture retrieval sleeve 27a is then withdrawn laterally until it passes over guide sleeve 25 and slides away from suture or guide wire 28, thereby ensuring that suture or guide wire 28 remains present at upper 18 and lower 29 skin apertures (not shown).

The guide post 23, first guide arm 22 and second guide arm 24 are then collectively separated from the sulcus 20 in the humerus 16 and withdrawn from the upper skin aperture 18. The guide post 23 is then first slid away from the suture or guide wire 28 (fig. 13), followed by sliding the guide sleeve 25 away from the suture or guide wire (fig. 14).

Fig. 14 shows a suture or guide wire 28 passing through the passageway formed by the two holes in the humerus via the upper and lower skin apertures 18, 29.

The suture 19 attached to the tendons of the rotator cuff muscle group is then attached at its upper end to a suture or guide wire 28 by an in-line knot or by passing the suture 19 through a braided snared segment in the suture or guide wire 28 (fig. 15).

The suture or guide wire 28 is pulled in a distal direction by pulling the suture or guide wire 28 from outside the lower skin aperture 29. The suture 19 is attached to the tendons of the rotator cuff muscle group at the other end of the suture. The suture and attached tendon are thus pulled back through the first skin aperture 18 and further through the bone tunnel formed beginning at 20. The suture path then follows the tunnel and exits the body via the lower skin aperture 29 and reaches outside the patient's body as shown in fig. 16 (the figure does not show the tendon attached to the other end of the suture).

By applying further tension to the free ends of the sutures 19 from outside the body (which is the ideal location for applying tension because space and leverage is available as opposed to applying tension arthroscopically from inside the body), the attached tendons are drawn a short distance into the first hole 20 in the humerus 16 as the primary purpose of the force applied by the sutures is to bring the tendons into contact with the prepared bone surface so that they can form a permanent bond by natural means, as shown in figure 17.

Figures 18 and 20 show an arthroscopic transosseous knotless suture anchor comprising a hollow body and a suture retaining element. The hollow body may also be referred to as an anchor in this specification.

The hollow body 30 has an outer surface 31 which abuts against the inside of the aperture 27 in the cortical bone of the humerus 16 and is therefore at least partially inserted into the cortical bone. In one embodiment, at one end of the hollow body 30, there is a rim 33 extending radially from the hollow body. The rim 33 is adapted to receive forces on the lateral side (relative to the bone and the patient) by providing the force application surface 32 in one embodiment and thus abutting the inward portion of the rim 33 (the underside of the rim) against the outer surface of the humerus 16 adjacent and around the bone cavity of the second hole 27. Fig. 19 and 20 only diagrammatically illustrate a hollow body 30 in the humerus 16, with the free ends 19 of the sutures exiting from a centrally located aperture 34 (fig. 19) of the hollow body 30 and the sutures still being visible in the bone, which in reality would not occur.

Figure 20 shows a retaining element 35, which retaining element 35 is shaped and sized to fit with and within the hollow of the body 30, and when fitted within the hollow, retains the portion of the suture 19 within the hollow body relative to the cortical bone in which it is at least partially inserted.

The retaining element 35 may also be shaped and sized to interferingly fit with and fit within the hollow of the body 30, which may be accomplished by slightly oversizing the retaining element relative to the internal shape of the hollow in the hollow body. The retaining element 35 may also be shaped and sized to interference fit with and fit within the hollow of the body 30 by having the outside of the retaining element and the inside of the hollow element have closely complementary shapes and still slightly oversize the retaining element relative to the interior shape of the hollow in the hollow body, but the surface is not flat and may include a tip (tan) and tab (tab) sufficient to allow a one-way fit.

The holding element 35 may also be shaped and sized to removably mate with and fit within the hollow of the body 30, which may be achieved using the oversized means described above or by allowing one way mating and reverse release means such as tips and tabs that interact to provide such engagement and release into and out of the internal shape of the hollow in the hollow body.

The shape provided in a preferred embodiment of the invention consists of a hollow in the body 30 in the form of a single wall of circular cross-section along the longitudinal axis of the body 30, having its largest inner diameter at the rim end of the body and its smallest inner diameter at the other end of the body. Thus, in a preferred embodiment, the retaining element 35 preferably has a complementary shape so as to provide an interference fit of the retaining element with the hollow body that is sufficient to retain the retaining element within the hollow body while also receiving and securing at least a portion of the suture material within (i.e., through) the hollow body. In another embodiment, the circular cross-section of the interior hollow of the body and the diameter of the outer surface of the retaining element are varied to be tapered (i.e. the radius varies at a constant rate along the length) such that the side walls of both the hollow and the outer surface of the retaining element are straight in side cross-section, as shown at least with respect to the hollow body shown in fig. 24. Although the outer surface of the retaining element 35 is shown with ridges 36 in this figure, more details thereof will be provided later in the description.

Furthermore, the holding element 35 should be removable from the hollow body 30, if desired. There may be many ways of enabling the retaining element to be removed, one of which includes providing an engagement surface on the surface that remains exposed to the surgeon even though the retaining element has been mated with the hollow body. Furthermore, if these engagement surfaces as described above are not provided on the holding element 35, the surgeon may employ extraction techniques, which may be like extracting the stopper from the bottle, or other techniques, as the case may be. In one example, the retaining element 35 shown in fig. 24 is itself hollow and a tool of appropriate shape may be inserted into the hollow to assist in removing the hollow element from the hollow body.

The result of the following steps is shown graphically in fig. 21. When a portion of the suture 19 is located within the hollow body 30, and when the free ends 19a of the suture 19 are subjected to a pulling force resulting from a force exerted on the suture in a direction away from the outer surface of the humerus, which force is exerted by the surgeon pulling the free ends of the suture 19 with a force sufficient to bring the tendon into abutment with the prepared bone surface, another force in a substantially opposite direction is exerted on the force receiving portion 32 of the rim 33 of the hollow body 30, the retaining element 35 being interference-fitted in the hollow body so as to capture the portion of the suture 19 subjected to the pulling force and at the same time the inwardly facing portion of the rim 31 of the hollow body abuts against the cortical bone portion. The captured portions of the sutures are thus held in place relative to the outer surface of the humerus, thereby anchoring the sutured tendon to the stable portion of the body. The fixation of the hollow body on the cortical portion of the bone is also assisted by the tension between the captured suture and the rotator cuff tending to retract towards the muscle.

In one embodiment, a tool or other suitable medical implement may be used to apply the desired force to the holding element 35. Figure 23 provides an illustration of one embodiment of such a tool. The holding element delivery device 200 comprises an elongate body with an internal longitudinal aperture, the length of the device having an internal diameter greater than the maximum external diameter of the holding element. In one embodiment, a recessed shape 204 (one view of which is shown in fig. 23) is provided at one end of the retaining element delivery device to allow the end to be interference fit and temporarily attached over the perimeter of the rim 32 of the hollow body 30, although this feature is only preferred for retaining the hollow body when it is inserted into the body and inserted into an aperture in a bone and also to stabilize the retaining element delivery device and partially inserted hollow body as a whole during the retaining element mating process.

After the suture 19 attached to the tendon of the rotator cuff muscle group is inserted through the hollow body 30 and along the hollow body of the tool 200, the tool 200 is used to guide the hollow body 30 through the skin aperture 29 and then into the lateral surgical access aperture second hole 27 in the humerus 16 until the hollow body 30 contacts the outer cortical surface of the humerus with the underside of the rim 32.

Applying suitable pressure to the tool 200 from outside the body allows the surgeon to firmly seat the hollow body in the humerus 16. With the guide in place, tension is applied to the suture 19 to ensure that the tendons of the rotator cuff muscle group are advanced sufficiently into the first humeral bore 20. Once the proper position of the rotator cuff tendon has been confirmed, typically by arthroscopy, the retaining element 35 is inserted into the open end of the guide device 200 and pushed along the length of the retaining element delivery device 200 using the retaining element deployment device 202 while maintaining the proper tension on the free end of the suture 19 as previously described.

In one embodiment, the retaining element placement device 202 has a length and an outer diameter that is less than the smallest inner diameter of the retaining element delivery device 200.

The holding element delivery device has an end shaped to conform to at least a portion of the shape of the end of the hollow body outside the cortical portion of the bone. In another embodiment of the invention, the retaining element seating arrangement comprises on its outer surface at least one longitudinal channel shaped and sized to receive at least a suture.

In yet another embodiment, the retaining element seating device includes at least two longitudinal channels on an outer surface thereof shaped and sized to receive at least a suture in each channel.

The desired location of the two strands of suture 19 is on opposite sides of the retaining element 35, and one feature of the retaining element placement device 202 is a channel (not shown) on either side that is used to ensure that the strands of suture 19 are properly positioned. The holding element placement device is provided with a marking or indicia 202a indicating the length of the shaft that needs to be inserted into the holding element delivery device 200 in order to ensure that the holding element 35 is located within the hollow body 30. The amount of force applied will depend on the surgeon's judgment.

Fig. 24 provides a cross-sectional view of the hollow body 30 and retaining element 35 in the cortical portion of the bone 16. The relative dimensions of the body and the elements are merely illustrative and should not limit the scope of the invention.

The materials of which the hollow body and the holding element are made are preferably biocompatible and may not be of the same material, colour, density or hardness.

The shape of the outer surface as shown in the cross-section of one embodiment of the retaining element 35 indicates the use of a plurality of ridges 36 along the length of the retaining element. The ridge is only shown in cross-section and may extend all or only partially around the outer surface of the element. At least a portion of one or more of the ridges helps to inhibit the interference fit force of the retaining element from being displaced from the hollow body and to apply a retaining force to the captured portion of the suture 19. The use of ridges configured as described above or even the use of ridges is not essential as long as both forms of retention are provided. It should be noted that the profile cross-sectional shape of the retaining element substantially conforms to the internal shape of the hollow body, which facilitates the application of the above-mentioned forces. In this embodiment of the holding element 35, the holding element 35 is hollow, but this is also not an essential feature. As previously described in this specification, the fit may be of any type, including interference, engagement, and one or the other of the fits may allow the retaining element to be removable from the hollow body portion.

Fig. 25 shows the bone 16 and the suture 19 with its free end 19a, with the retaining element 35 outside the hollow body 30. Fig. 26 illustrates only the fitting of the holding member 35 in the hollow body 30.

Fig. 27 shows the seating configuration of the retaining element 35 and the hollow body 30, illustrating the capture of the suture 19 therein and the removal of the free end 19a of the suture. As shown, this device provides a substantially flat surface on the outer surface of the bone, which is an improvement, if not an alternative to existing suture termination techniques; the prior art requires tying the free ends of the suture in knots and thus securing with a plurality of knots projecting from any associated anchor.

Fig. 27 shows the results of a procedure using sutures for capturing and maintaining tension against cortical bone.

Surgical rehabilitation is prescribed for each surgical patient and typically involves holding the arm in a bandage for several weeks to fix the repair area as much as possible. Further processing after weeks includes physical therapy to increase the range of motion of the shoulder while minimizing load bearing activity to allow the rotator cuff to bond to the bone without being unnecessarily disturbed. Still further treatments after several more weeks include further physical therapy and initial strength training to increase range of motion, but are still not fully load bearing. After about six months, the repair should be complete and normal activities can begin.

It will be appreciated by persons skilled in the art that the present invention is not limited to its use in the particular application illustrated. The present invention is also not limited to the preferred embodiments thereof with respect to the specific elements and/or features described or illustrated herein. It will be understood that various modifications may be made without departing from the principles of the invention. Accordingly, the invention is to be construed as including all such modifications within its scope.

Claims (12)

1. An arthroscopic through-bone knotless suture anchoring device for retaining a suture relative to a cortical portion of a bone, comprising:

a hollow body for at least partial insertion into a cavity in a cortical portion of a bone, the hollow of the body extending throughout the length of the body and varying in diameter so as to be wider at least at one end of the body than at the other end, the outer surface of the body being flat for insertion into the cavity in the cortical portion of the bone, and further comprising a rim extending radially from one end of the body, the rim having an inwardly facing portion abutting the outer surface of the bone adjacent the cavity and being adapted to receive a force urging at least a portion of the rim against the cortical bone adjacent the cavity in the cortical bone;

a retaining element having an elongate body sized to fit with and within the hollow of the body so as to retain the portion of the suture within the hollow body relative to the cortical portion of the bone;

a holding element delivery device adapted to guide the holding element into the hollow body; and

a holding element placement device adapted to be inserted into the holding element delivery device,

wherein the retaining element seating device includes a marking or indicia indicating the length of the retaining element seating device that needs to be inserted into the retaining element delivery device to ensure that the retaining element mates with and fits within the hollow body.

2. The arthroscopic transosseous knotless suture anchoring device according to claim 1, wherein said retaining element and hollow body are adapted to be interference fit together.

3. The arthroscopic transosseous knotless suture anchoring device according to claim 1, wherein said retaining element and hollow body are adapted to be removably fitted together.

4. The arthroscopic transosseous knotless suture anchoring device according to claim 1, wherein said hollow portion is tapered in diameter, wider at least at one end of said body portion than at the other end.

5. The arthroscopic transosseous knotless suture anchoring device according to claim 1, wherein said hollow body has an inner surface shaped to assist said retaining element to fit therein.

6. The arthroscopic transosseous knotless suture anchoring device according to claim 1, wherein said retaining element has an outer surface shaped to assist said retaining element in fitting in said hollow body.

7. The arthroscopic transosseous knotless suture anchoring device of claim 1 wherein:

the retaining element delivery device has an elongated body with an internal longitudinal aperture, the retaining element delivery device has an internal diameter greater than a maximum external diameter of the retaining element, and the retaining element delivery device is further adapted to at least partially guide the hollow body into a cortical portion of a bone.

8. The arthroscopic transosseous knotless suture anchoring device of claim 7 wherein:

the holding element placement device has a length and an outer diameter that is less than the smallest inner diameter of the holding element delivery device,

the holding element delivery device is adapted to guide a holding element into the hollow body when the holding element placement device is inserted into the holding element delivery device after the holding element.

9. The arthroscopic transosseous knotless suture anchoring device according to claim 7, wherein said holding element delivery device has an end shaped to conform to at least a portion of the shape of the end of said hollow body outside the cortical portion of the bone.

10. The arthroscopic transosseous knotless suture anchoring device according to claim 7, wherein said retaining element seating device includes at least one longitudinal channel on an outer surface shaped and sized to at least receive a suture.

11. The arthroscopic transosseous knotless suture anchoring device according to claim 10, wherein said retaining element seating device includes at least two longitudinal channels on an outer surface shaped and sized to at least partially receive a suture in each channel.

12. A device for capturing and retaining a suture under tension relative to a cortical bone portion, comprising:

a hollow elongate body for at least partial insertion into a cavity in a cortical portion of a bone, the body having an inner surface forming a hollow throughout its length, the hollow varying in diameter so as to be wider at least at one end than at the other end, the outer surface of the body being flat for insertion into a cavity in a cortical portion of a bone, at least a portion of the body for seating in a cavity located in a cortical bone portion, the hollow body having a rim extending radially from one end of the body, the rim having an inwardly facing portion which abuts the outer surface of a bone adjacent the cavity and being adapted to receive a force urging at least a portion of the rim against cortical bone adjacent the cavity in cortical bone;

a retaining element sized to fit with and within the hollow portion of the body;

a holding element delivery device adapted to guide the holding element into the hollow body; and

a holding element placement device adapted to be inserted into the holding element delivery device,

wherein the retaining element seating device includes a marking or indicia indicating the length of the retaining element seating device that needs to be inserted into the retaining element delivery device to ensure that the retaining element mates with and fits within the hollow body;

wherein a portion of the suture is located within the hollow body and when a free end of the suture is subjected to a pulling force resulting from a force exerted on the suture in a direction away from an outer surface of cortical bone and another force in a substantially opposite direction is exerted on the rim of the body, the retaining element is interference fit within the hollow body so as to capture the portion of the suture located within the hollow body that is subjected to the pulling force, while the rim of the body abuts a cortical bone portion and also retains the captured portion of the suture relative to the cortical bone portion.