construct for surgical repair

专利摘要:
SYSTEMS, DEVICES, AND METHODS FOR FIXING TISSUE. The present invention relates to systems, devices, and methods for attaching soft tissue to bone, for attaching one or more objects using a surgical filament, and for pulling two or more tissues together so that they can be attached An exemplary modality of a construct for surgical repair that is configured to pass through the soft tissue in a non-traumatic way to fix the tissue without knotting includes a loop-shaped connection, a retractable curve, and a suture pin flexible. A loop-shaped connection can include a retractable loop to receive the retractable curve, and in use the loop can be retracted around the retractable curve and advanced distally in the direction of the bone to bring the loop closer to the tissue, and at the same time the curve retractable can be retracted distally towards the bone to bring the tissue closer to the bone. Other systems, devices and methods for use with soft tissue are also provided.
公开号:BR102013011235B1
申请号:R102013011235-6
申请日:2013-05-07
公开日:2021-02-02
发明作者:Mehmet Sengun
申请人:Depuy Mitek, Llc；
IPC主号:

专利说明:

FIELD OF THE INVENTION
[0001] The present invention relates to systems, devices and methods for attaching soft tissue to bone, and is particularly concerned with attaching soft tissue by minimizing or eliminating the creation of knots to tension and secure the tissue. The systems, devices and methods provided here can also be used to attach one or more objects, such as a fragment of bone or tissue, and to pull two or more tissues towards each other, so that they can be attached to one desired location. BACKGROUND
[0002] A common injury, specifically among athletes and elderly people, is the total or partial tearing of tendons, ligaments, or other soft tissues of the bone. Tissue disruption can occur during a fall, overexertion, or for a variety of other reasons. Surgical intervention is often necessary, particularly when the tissue is completely separated from its associated bone. The devices currently available for fixing tissue include screws, staples, suture anchors and pins. The devices currently available for elderly patients may be particularly insufficient due to the fact that soft, weak bones lead to improper suture fixation to the anchor.
[0003] Arthroscopic knot tying is commonly practiced in instability and shoulder rotator cuff procedures. Typically, a suture-loaded anchor is firstly attached to the bone. The suture is usually slidably attached to the anchor through an eyelet or around a pivot, so that a single suture length has two free loops. A loop of the suture is passed through the soft tissue to be repaired like a tendon or labyrinth. The two ends of the suture are then tied together, thereby capturing the soft tissue in a curve with the anchor. By tying the curve, the soft tissue is brought to the bone through the anchor.
[0004] Typically, surgeons tie the suture ends using a surgical sliding knot like the Tennessee Slider or Loop Duncan knot. After advancing the knot distally to tie the curve, a number of additional half knots or other knots are tied in an effort to secure the sliding knot's new location. Additional knots are required due to the fact that a conventional sliding knot used in current repair constructs does not provide the necessary protection against loosening or slipping, specifically when it is applied first on the curve handles. The generally accepted practice is to follow the sliding knot with at least three half-inverted knots in alternating suture pivots.
[0005] Before one or more half nodes or other nodes can be added to the sliding node, however, there is a potential for the sliding node to slide, that is, for the curve to increase as the fabric applies tension on the curve. This has been called "curve safety" and can, presumably, occur even in the hands of very experienced surgeons. Sometimes, even fully tied knots can slip. In addition to this "curve safety" problem, conventional knots are typically of a general size that can be obstructive or intrusive, specifically in tight joints, which can damage cartilage or other tissue through abrasion with the knot.
[0006] Suture anchor systems with sliding and locking knots to repair torn or damaged tissue include U.S. Patent No. 6,767,037 to Wenstrom, Jr. Other suture anchor systems suitable specifically for meniscus repair are presented in US Patent No. 7,390,332 to Selvitelli et al. and are used in the OmniSpan ™ meniscus repair system commercially available from DePuy Mitek Inc., 325 Paramount Drive, Raynham, Massachusetts, USA, 02767. Thread-like anchors typically require anchor fixation prior to suture operation, which can lead to changes related to the connection between the suture and the tissue.
[0007] There are numerous suture implant systems that claim to be "knotless," that is, they do not require a surgeon to tie a knot during surgery. Many of these systems control the tension in the tissue by the depth at which an anchor is directed into the bone. Lizardi US Patent Nos. 5,782,864 and 7,381,213 show certain types of suture anchors that capture a fixed suture length curve. Knotless anchor assemblies with adjustable curves that use an anchor element inserted into a sleeve are described by Thal in U.S. Patent Nos. 5,569,306 and 6,045,574 and in U.S. Patent Application Publication No. 2009/0138042. Other systems that have clamps or other locking mechanisms include U.S. Patent No. 5,702,397 to Goble et al. and the publication of US patent application No. 2008/0091237 by Schwartz et al. Currently, the models called "without a knot", however, suffered, in general, from suture fixation to the inadequate anchor and / or inadequate anchor fixation to the bone, among other deficiencies.
[0008] Therefore, it is desirable to obtain systems, devices and methods for use in the repair of soft tissue that are robust and strong, minimizing or even eliminating the number and size of knots to be tied by a surgeon, particularly during arthroscopic procedures. of repair. SUMMARY
[0009] Systems, devices and methods are generally provided for attaching soft tissue to bone, as well as for attaching one or more objectives, such as a bone fragment or tissue, and for extracting two or more tissues together, in order to that they can be secured in a desired location. In one embodiment, a surgical repair construct includes a loop-shaped connection, a retractable curve, and a flexible suture pin, with the construct configured to traverse, without causing trauma, the soft tissue to secure the tissue in a knot-free manner. . The loop-shaped connection may have a retractable loop at a first end, a second end that is configured to receive the retractable curve, and a connecting neck extending between the first and second ends. The retractable curve may have a first end coupled to the second end of the loop-shaped connection, a sliding knot, and a retractable filament tail extending from the sliding knot. The loop-shaped connection can be produced from a first suture filament, which can be braided or cannulated, and the retractable curve can be produced from a second suture filament. The flexible suture pin, which can be produced from a third suture filament, can have a first portion that is removably disposed through the connection neck and configured to prevent retraction of the loop. The pin can maintain approximately the size of the loop opening that is present in the attenuate to avoid premature loop retraction.
[00010] In some embodiments, the loop may be configured, so that the first suture filament is coaxially disposed through itself, so that at least a portion of the connecting neck is a coaxial sliding neck that is slidable along another portion of the connecting neck. As a result, the coaxial neck can be movable towards the second end of the loop-shaped connection to retract the loop and movable away from the second end of the loop-shaped connection to increase a loop size. The first portion of the suture pin can be removably disposed through the coaxial sliding neck, thus immobilizing the coaxial sliding neck. In addition, a second portion of the removable suture pin can be arranged through a portion of the first suture filament that forms the retractable loop. In such an embodiment, a stationary knot can be formed between the first and second portions of the suture pin at a position on a curve formed by the loop, and a terminal portion of the pin can extend beyond the curve.
[00011] In various embodiments, a thickness of the first filament can be in the range (from about 20 caliber to about 32 caliber), a thickness of the second filament can be in the range (from about 21 caliber to about 34 caliber), and / or a thickness of the third filament can be in the range (from about 25 caliber to about 40 caliber).
[00012] In some other modalities, the loop can be formed by a second sliding knot located close to the connection neck. The sliding knot can be movable to retract or expand a loop size. For example, the sliding knot can be movable away from the second end of the loop-shaped connection to retract the loop and movable towards the second end of the loop-shaped connection to increase a loop size.
[00013] The second end of the loop-shaped connection can include an eyelet, and the retractable curve can be attached to the loop-shaped connection by the eyelet. Alternatively, the retractable curve can be coupled to the second end of the loop-shaped connection through a portion of the retractable curve, for example, the second suture filament, through a portion of the second end of the loop-shaped connection, for example, the first suture filament. In some embodiments, the construct may include a suture round-trip filament that can be attached to the loop for use in advancing the loop-shaped connection through the tissue.
[00014] In some embodiments, a flexible sleeve can removably encapsulate at least a portion of the retractable curve, including the sliding knot. The retractable filament tail can be operable to retract the retractable curve when the sliding knot is moved towards the first end of the retractable curve. The construct can also include a terminal filament tail formed from a portion of the second suture filament. The terminal filament tail can extend from the sliding knot, adjacent to the retractable filament tail, and can be substantially stationary with respect to the sliding knot. The construct can also include an anchor that has a filament hitch feature. In such embodiments, a portion of the retractable curve can be slidably arranged around a portion of the filament engagement feature for coupling the sliding knot to the anchor, so that the sliding knot extends on one side of the anchor and the connection loop-shaped extends across the anchor.
[00015] In an exemplary embodiment of a surgical repair method, the method includes selecting a surgical repair construct that has a loop-shaped connection, a retractable curve and a flexible suture pin, attaching an anchor to the bone near the tissue separate soft, and traverse the loop-shaped connection and a portion of the retractable curve through a separate soft tissue portion and around an anchor engagement feature. The resulting configuration can be one in which the loop-shaped connection extends on one side of the anchor and the sliding knot extends on the other side of the anchor. The selected surgical repair construct can include numerous features, for example, the loop-shaped connection may have a retractable loop at a first end, a second end that is configured to receive the retractable curve, and a connecting neck extending between the first and second ends. For additional examples, the retractable curve may have a first end coupled to the second end of the loop-shaped connection, a sliding knot, and a retractable filament tail extending from the sliding knot, and the flexible suture pin it can have a first portion that is removably disposed through the connection neck. The loop-shaped connection can be produced from a first suture filament, the retractable curve can be produced from a second suture filament, and the flexible suture pin can be produced from a third suture filament.
[00016] The method may also include crossing the second end of the retractable curve, including the sliding knot, through the loop while capturing the separated tissue. The suture pin can be removed from the connecting neck, and the loop can be retracted around the retractable curve, so that the loop is distal to the sliding knot. The loop can be advanced distally towards the bone until the loop is close to the tissue, and the retractable curve can be retracted by moving the sliding knot distally towards the bone to place the tissue close to the bone. The steps of passing, retracting and advancing the method can be performed without tying a knot in the first or second filaments. In some modalities, the step of advancing the loop may occur before the step of retracting the loop, although in other modalities, the step of advancing the loop may occur after the step of retracting the loop. The step of advancing the loop distally may include tensioning the retractable curve. Additionally, in some modalities, advancing the loop distally by tensioning the retractable curve may allow the loop to be advanced distally incrementally without loosening the construct. The retractable step of the retractable curve may include tensioning the retractable filament tail.
[00017] In some embodiments, the method may include traversing the second end of the retractable curve through a second portion of the separate soft tissue before traversing the second end of the filament through the loop. A flexible sleeve can encapsulate at least a portion of the second end of the retractable curve, including the sliding knot, during the passage steps. The glove can be removed from the surgical repair construct before retracting the retractable curve distally in the direction of the bone. In some embodiments, a portion of the suture pin may include a needle attached thereto, and the suture pin may be traversed by the separate soft tissue by first pulling the loop-shaped connection through the soft tissue. A portion of the suture pin can extend through the retractable loop, a stationary knot can be arranged on a portion of the suture pin arranged within a curve formed by the loop, and a terminal end of the suture pin can extend beyond the curve loop, with the needle attached to the terminal end. In some other embodiments, a suture round-trip filament can be attached to the loop, and the suture round-trip filament can be traversed by the separate soft tissue by first pulling the loop-shaped connection through the soft tissue.
[00018] Another exemplary modality of a surgical repair method includes selecting a surgical repair construct that has a loop-shaped connection, a retractable curve and a flexible suture pin and attaching an anchor that has an attachment feature to the nearby bone separate soft tissue. The anchor may have a suture round-trip filament slidably coupled to the engagement feature with a first end of the suture round-trip filament extending from one side of the anchor and a second end of the forward filament and suture loop extending from the other side of the anchor. The selected surgical repair construct can include numerous features, for example, the loop-shaped connection may have a retractable loop at a first end, a second end that is configured to receive the retractable curve, and a connecting neck extending between the first and second ends. For additional examples, the retractable curve may have a first end coupled to the second end of the loop-shaped connection, a sliding knot, and a retractable filament tail extending from the sliding knot, and the flexible suture pin it can have a first portion that is removably disposed through the connection neck. The loop-shaped connection can be produced from a first suture filament, the retractable curve can be produced from a second suture filament, and the flexible suture pin can be produced from a third suture filament.
[00019] The method may also include traversing the first end of the suture back and forth filament through a portion of the separate soft tissue and coupling the second end of the retractable curve to the first end of the suture back and forth filament. A force can be applied to the second end of the suture back and forth filament to pull the second end of the retractable curve distally towards the bone and to the other side of the anchor. The resulting configuration can be one in which the loop-shaped connection extends on one side of the anchor and the sliding knot extends on the other side of the anchor. The second end of the retractable curve, including the sliding knot, can be traversed by the loop while capturing the separated tissue. The suture pin can be removed from the connecting neck, and the loop can be retracted around the retractable curve, so that the loop is distal to the sliding knot. The loop can be advanced distally towards the bone until the loop is close to the tissue, and the retractable curve can be retracted by moving the sliding knot distally towards the bone to place the tissue close to the bone. The steps of passing, retracting and advancing the method can be performed without tying a knot in the first or second filaments. In some modalities, the step of advancing the loop may occur before the step of retracting the loop, although in other modalities, the step of advancing the loop may occur after the step of retracting the loop. The step of advancing the loop distally may include tensioning the retractable curve. Additionally, in some modalities, advancing the loop distally by tensioning the retractable curve may allow the loop to be advanced distally incrementally without loosening the construct. The retractable step of the retractable curve may include tensioning the retractable filament tail.
[00020] In some embodiments, the second end of the suture round-trip filament may be traversed by a second portion of the separated tissue before applying force to the second end of the suture round-trip filament to pull the second end of the retractable curve distally in the direction of the bone. The method may also include uncoupling the suture back and forth filament from the second end of the retractable curve. A flexible sleeve can encapsulate at least a portion of the second end of the retractable curve, including the sliding knot, during the passage steps. The glove can be removed from the surgical repair construct before retracting the retractable curve distally in the direction of the bone.
[00021] In an exemplary embodiment of a surgical method, the method includes selecting a flexible surgical filament that has a loop at one end of the same and an opposite anterior end and positioning the surgical filament substantially around an object to form a first curve. The front end of the filament can be traversed by the loop, so that the front end remains on one side of the loop and a second curve formed by the portion of the filament on the loop is on the other side of the loop. The loop can be retracted around the filament disposed therein to secure the first and second curves, with the first curve completely surrounding the object and the second curve adjacent to the object. The first curve can then be retracted around the object to engage the object with the filament. The front end of the filament can be traversed by the second curve, and then the second curve can be retracted around the filament to secure the filament to the object. In some embodiments, the retraction step of the first curve around the object may include pulling the retracted loop towards the object. Additionally, in some embodiments, the step of retracting the second curve around the filament may include tensioning the front end of the filament. BRIEF DESCRIPTION OF THE DRAWINGS
[00022] The present invention will be more fully understood from the detailed description below, together with the accompanying drawings, in which: Figure 1 is a schematic view of an exemplary embodiment of a surgical repair construct; Figure 2 is a schematic view of an exemplary embodiment of a loop-shaped connection for use as part of a surgical repair construct; Figure 3A-3D are sequential views of an exemplary modality for forming a loop of a loop-shaped connection with the loop having a coaxial sliding neck; Figure 4 is a schematic view of an exemplary embodiment of a loop of a loop-shaped connection, the loop having a coaxial sliding neck and a flexible element arranged through the neck; Figure 5A is a schematic view of another exemplary embodiment of a loop of loop-shaped connection and a flexible element, the loop having a coaxial sliding neck, this view illustrates how the flexible element can be arranged through the neck and the link; Figure 5B is a schematic view of the loop-shaped connection and flexible element of Figure 5A, which illustrates the flexible element disposed through the neck and the loop; Figure 6 is a schematic view of an exemplary embodiment of a loop of a loop-shaped connection and a flexible element with the loop having a coaxial sliding neck and the flexible element being arranged through the loop; Figure 7 is a schematic view of another exemplary embodiment of a loop of a loop-shaped connection and a flexible element with the flexible element being arranged through a neck of the loop and a round-neck suture is placed in shape. curve through the loop; Figure 8 is a schematic view of another exemplary embodiment of a loop-shaped connection for use as part of a surgical repair construct; Figure 9 is a schematic view of another exemplary embodiment of a surgical repair construct; Figure 10 is a schematic view of the surgical repair construct of Figure 9 coupled to an anchor; Figure 11 is a schematic view of a round-trip suture coupled to an anchor; Figures 12A to 12G are sequential views of an exemplary embodiment for using the surgical repair construct of Figure 10 to attach tissue to the bone; Figures 13A through 13D are sequential views of an exemplary embodiment for using the round-trip suture and the anchor in Figure 11 and the surgical repair construct in Figure 9 to secure tissue to the bone; Figures 14A to 14C are sequential views of an exemplary embodiment for using a surgical repair construct to more closely join two tissues together; Figures 15A to 15G are sequential views of an exemplary embodiment for using a surgical filament to secure an object; Figure 16 is a schematic view of an exemplary embodiment of using a surgical filament to join two tissues more closely together; Figure 17 is a schematic view of an exemplary embodiment of using a surgical filament to join tissue closer to the bone; Figure 18 is a schematic view of an exemplary embodiment of using two surgical filaments to join two tissues more closely together; Figure 19 is a schematic view of an exemplary embodiment of using two surgical filaments to join tissue closer to the bone; Figure 20 is a schematic view of another exemplary embodiment of using two surgical filaments to join tissue closer to the bone; Figure 21 is a schematic view of an exemplary embodiment of using a surgical repair construct and a filament to join tissue closer to the bone; and Figure 22 is a schematic view of another exemplary embodiment of using a surgical repair construct and a filament to join tissue closer to the bone. DETAILED DESCRIPTION
[00023] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of such modalities are illustrated in the attached drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting embodiments, and that the scope of the present invention is defined only by the claims. The characteristics illustrated or described in connection with an exemplary modality can be combined with the characteristics of other modalities. It is our intention that such modifications and variations are within the scope of the present invention. Additionally, in the present description, the components with the same numerical reference of the modalities have, in general, similar resources, and, therefore, in a particular modality, each resource of each component with the same numerical reference is not necessarily fully elaborated on this. In addition, to the extent that linear or circular measurements are used in describing the systems, devices and methods presented, these dimensions are not intended to limit the types of formats that can be used in conjunction with such systems, devices and methods. One skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. Sizes and formats of the systems and devices, and the components thereof, may depend at least on the anatomy of the individual with the systems and devices being used, the size and shape of components with which the systems and devices will be used, and the methods and procedures in which the systems and devices will be used.
[00024] The Figures presented here are not necessarily scaled. In addition, to the extent that the arrows are used to describe a direction in which a component can be tensioned or tightened, these arrows are illustrative and in no way limit the direction in which the respective component can be tensioned or tightened. One skilled in the art will recognize other shapes and directions to create the desired tension. Similarly, although in some modalities, the movement of one component is described in relation to another, one skilled in the art will recognize that other movements are possible. As a non-limiting example, in modalities in which a filament is passed through it to form a coaxial sliding neck, the movement described in relation to the inner portion (i.e., the coaxial sliding neck as discussed in this document) that moves in relation to the outer portion may similarly involve movement of the outer portion in relation to the inner portion. In addition, numerous terms can be used interchangeably throughout the description, but will be understood by one skilled in the art. As a non-limiting example, the terms suture and filament can be used interchangeably.
[00025] Soft tissue repair systems, devices and methods are generally provided and generally involve the use of surgical filaments that are configured in a variety of ways to minimize and / or eliminate knot tying during a surgical procedure. . The systems and devices described in this document provide superior strength for use in a number of different surgical procedures, such as rotator cuff repair and instability procedures and other types of tendon and tissue repair procedures. They also allow fixations that have a lower profile than existing systems and devices, which allows the filaments to become associated with the fabric, for example, crossing the filaments through the fabric or wrapping the filaments around the fabric, with minimal trauma to the tissue. fabric and less space occupied by the general construction. This results in systems and devices that can be attached to the tissue without trauma to secure the tissue without a knot.
[00026] In addition to improving existing surgical procedures by providing repair constructs that are superior in strength and performance than existing constructs, the systems and devices provided here also allow for new and improved procedures for soft tissue repair. For example, the systems and devices provided in this document can be used to advance the tissue towards the bone incrementally without the opposite reaction of the construct causing the tissue to move away from the bone and / or not to be retained in any way. just in place in relation to the bone. In addition, the present description results in countless different methods, some new and some improved, to fully attach objectives, such as tissue and / or bone fragments, with the use of a single filament and to attach tissue to bone or tissue to another tissue in locations desired with the use of one or more filaments or repair constructs.
[00027] As shown by an exemplary embodiment of a surgical repair construct 10 in Figure 1, the constructs of the present description generally include a retractable curve 20 that has a first end 22 that is coupled to a loop-shaped connection 40 and a second end 24 that includes a sliding knot 26 formed therein. In the illustrated embodiment, the loop-shaped connection 40 has a loop 46 at a first end 42 thereof and a second end 44 configured to receive the first end 22 of curve 20. Loop 46 includes an aperture 48 that is configured to receive the second end 24 of the curve 20 and retract around the second end 24 after being arranged in the opening 48. The sliding knot 26 formed in the retractable curve 20 can be operable to retract into a size of an opening 28 formed by the curve 20. In particular, the sliding knot 26 can be movable towards the first end 22 to retract the curve 20, and it can also be movable away from the first end 22 to expand a size of the opening 28. In one embodiment, the retractable curve 20 and the loop-shaped connection 40 are each formed by different surgical filaments.
[00028] As shown, the retractable curve 20 can include two tails, a retractable tail 30, is operable to move the sliding knot 26 towards the first end 22 similarly to the ratchet or incrementally, and a stationary terminal tail 32 configured to remain stationary in relation to the sliding knot 26. Construct 10 can be traversed by one or more fabrics, so that the passage of the second end 24 through loop 46 and the retraction of loop 46 around the second end 24 and the advance of loop 46 distally (for example, in the direction of the bone) can cause the tissue through which construct 10 is arranged to be joined in the direction of a bone, an anchor, or other tissue to which construct 10 is also attached, as described in more detail below. Due to the features of the constructs presented in this document, many repair methods can be performed without trauma and without tying knots to fix and move tissue to desired locations during the course of a surgical procedure.
[00029] Figure 2 provides an exemplary embodiment of a loop-shaped connection 140 for use as part of a surgical repair construct. The first end 142 of the loop-shaped connection 140 can include a loop 146 which is configured to retract under tension, a second end 144 of the loop-shaped connection 140 can be configured to slide into a retractable curve 120 of the construct to allow relative movement between the connection 140 and the curve 120, and a connection neck 150 can extend between the two ends 142, 144. As shown in Figure 2, the connection neck 150 can be formed by a surgical filament which has a coaxial sliding neck 152 that is slid in a cannulated portion 154 of the connecting neck 150. The movement of the coaxial sliding neck 152 in approximately a first direction A, in the opposite direction to the second end 144, can expand a size of the opening loop 148, although the movement of the coaxial sliding neck 152 in approximately a second direction B, in the direction of the second end 144, can retract the opening of loop 148. One skilled in the art will recognize that the coaxial sliding neck 152 moves in relation to the cannulated portion 154, and thus, although the movement is described in this document based on the movement of the coaxial sliding neck 152, the cannulated portion 154 it can also be slid in relation to the coaxial sliding neck 152. Passing the loop forming filament 140 through itself to form the coaxial sliding neck 152 allows the loop shaped connection 140 to have a low profile that minimizes and / or it eliminates the trauma associated with passing the loop-shaped connection 140 through the tissue, particularly compared to existing surgical repair constructs. In addition, this construction can eliminate any sharp features that could be present in existing surgical repair constructs, which can present difficulties, including trauma, when trying to pass surgical repair constructs through the tissue.
[00030] Figures 3A to 3D illustrate a loop forming method 140 'having a loop 146' and a coaxial sliding neck 152 'for use in a surgical repair construct. In this exemplary embodiment, loop 146 'is formed from a bifurcated suture filament that has a tubular portion 153' with a core removed therefrom to form a cannulated portion 154 'and the first and second end loops 156', 158 ' . As shown in Figure 3B, the end loops 156 ', 158' can be rolled back towards the tubular portion 153 'to form a curve having an opening 148' that defines loop 146 '. As shown in Figure 3C, a hole 160 'can be formed on one side of the tubular portion 153' and the end handles 156 ', 158' can be placed on the cannulated tubular portion 154 'through the hole 160'. The ends of the terminal loops 156 ', 158' can be fed through the cannulated portion 154 ', and, as shown in Figure 3D, the terminal loops 156', 158 'can be tightened distally (direction C in Figure 3D) through the portion tubular 153 ', so that the tubular portion 153' is fed through itself. Consequently, loop 146 'can be retracted by tensioning the handles 156', 158 'in approximately a first direction C, and / or the coaxial portion of the tubular portion 153' extending outside the connection neck 150 ', and the loop 146 'can be expanded by applying force to loop 146' approximately in a second opposite direction D, which grips handles 156 ', 158' in the direction of loop 146 '.
[00031] The sizes of the connection components in loop shape 140 'may depend, at least in part, on the procedure in which they are used, the components with which it is used, and other factors recognized by the person skilled in the art. In one embodiment, the overall length of the loop-shaped connection can be in the range of about 5 millimeters to about 50 millimeters, and in one embodiment, it is about 36 millimeters. Additionally, in modalities in which the loop-shaped connection is formed by a filament that has end loops that extend coaxially through a connection neck, as shown in Figures 3A to 3D, a length of the filament used to form the A loop-shaped connection can range from about 15 centimeters to about 125 centimeters, and in one embodiment, it is about 60 centimeters.
[00032] Ties can also be formed in a variety of ways known to the person skilled in the art. For example, a number of different sliding nodes can be used to form the loop of the loop-shaped link, including, but not limited to, a Buntline Hitch, a Tennessee Slider, a Duncan Loop and a Hangman's Noose. To the extent that the sliding knot used to form a loop affects the operation of the loop, for example, either a loop is tightened through a knot to change the position of the knot or a knot is slid along a loop to change the position of the knot, one skilled in the art would be able to adapt these types of knots for use with the teachings of the present invention without departing from the spirit of the present description. As described in this document, except where otherwise noted, a knot used to form a loop in a loop-shaped connection is movable away from a second end of the loop-shaped connection, that is, away from the retractable curve, to retract the loop and in the direction of the second end, that is, in the direction of the retractable curve, to increase a loop size.
[00033] The loop-shaped connection can be produced from a variety of materials, but, in an exemplary embodiment, the loop-shaped connection is formed using a surgical filament, such as a cannulated filament, a braided filament and a monofilament. The type, size and strength of the filament may depend, at least in part, on the other materials in the system, including the material (s) of the retractable curve with which it is used, the fabric and other components through of which it will be passed or coupled to, and the type of procedure in which it is used. In an exemplary embodiment, the loop-shaped connection is formed from a No. 2 filament (about 23 gauge to about 24 gauge), such as an Orthocord ™ filament that is commercially available from DePuy Mitek, Inc. or an Ethibond ™ filament that is commercially available from Ethicon, Inc., Route 22 West, Somerville, NJ, USA 08876. The cores of these filaments can be removed to form a cannulated configuration if desired. The thickness of the loop-shaped connection should provide strength in the connection, but at the same time, minimize the trauma caused to the tissue through which it passes. In some embodiments, the loop-shaped connection may be between about No. 5 filament (about 20 gauge to about 21 gauge) and about No. 3-0 filament (about 29 gauge to approx. 32 caliber). The No. 2 Orthocord ™ filament can be useful due to the fact that it has a braided configuration, which allows other components, such as flexible elements or retractable curves as discussed below, to pass through subcomponents of the braid without causing damage to the filament. The filaments configured to allow a cannulated configuration, such as removing a core from it or having a preformed cannulated configuration, can also be used to form the loop-shaped connection. The Orthocord ™ suture has approximately fifty-five to sixty-five percent polydioxanone PDS ™, which is bioabsorbable, and the remaining thirty-five to forty-five percent, highly high molecular weight polyethylene, while the Ethibond ™ suture is first, high strength polyester. The amount and type of absorbable material, if any, used in the filaments of the present description is, first of all, a matter of surgeon's preference for the particular surgical procedure to be performed.
[00034] In use, the length of portions of the loop-shaped connection, and in particular the loop and the connecting neck, may change as the loop is retracted. In an exemplary embodiment, a diameter of the loop opening in a non-retracted position is in the range of about 2 millimeters to about 15 millimeters, and, in one embodiment, it is about 10 millimeters as a length of the connecting neck. when the loop is in a non-retracted configuration it is in the range of about 0 millimeter (excluding the length of the connecting neck) to about 45 millimeters (excluding the length of the connecting neck), and, in one embodiment, is about 5 mm (excluding the length of the connecting neck). A neck length after the loop is retracted, on the other hand, can be in the range of about 3 millimeters (excluding the length of the connecting neck) to about 45 millimeters (excluding the length of the connecting neck), and , in one embodiment, it is about 27 millimeters (excluding the length of the connecting neck).
[00035] Due to the fact that the connecting neck, and particularly the sliding neck 152 and the cannulated portion 154, can allow the loop to expand and contract, a flexible element, such as a suture pin, can be removably arranged across the neck to prevent unintentional movement of the loop while the loop passes through an obstruction, such as fabric. In embodiments in which a connecting neck 250 (figure 4) includes a coaxially sliding neck 252, as in loop 246 of a loop-shaped connection 240 shown in Figure 4, a flexible element 270 can extend through neck 250 to immobilize the coaxially sliding neck 252 relative to the connecting neck 250. Since loop 246 is traversed by the obstruction and the risk of unintended and premature expansion or retraction is reduced, flexible element 270 can be removed. The use of a flexible element of the type described in this document to prevent unintentional loop retraction in tissue repair procedures is advantageous as it can allow the loop-shaped connection to pass without trauma through the fabric while still preventing retraction unintentionally from a loop.
[00036] In another embodiment, shown in Figures 5A and 5B, a flexible element 370 can immobilize a loop 346 of a loop-shaped connection 340 and serve as a round-trip suture to guide the loop-shaped connection 340 through obstructions during the course of a procedure. As shown in Figure 5A, a first end 372 of flexible element 370 can be passed through connection and coaxial necks 350, 352 of the loop-shaped connection 340, so that a first portion of flexible element 370 is arranged through the neck 350, while a second end 374 of flexible element 370 is passed through and arranged in loop 346. A protrusion 376, for example, a stationary knot that can be preformed or formed or modified during a procedure, can be arranged on flexible element 370 at a location between the first and second ends 372, 374. Protrusion 376 can serve to hold flexible element 370 in an arrangement coupled to the loop-shaped connection 340, and, as shown in Figure 5B, protrusion 376 can be arranged in the opening or curve 348 formed by the loop 346, which is contiguous to a surface of the loop, with a terminal portion 378 extending through and beyond the curve 348 for use as a round trip. Optionally, a needle or similar tool or device can be coupled to the terminal portion 378 to assist in the loop-shaped connection filament 340 through the fabric.
[00037] Other configurations in which a flexible element is used as both a suture pin and a suture round-trip pin are also possible, depending, at least in part, on the configuration of the loop-shaped connection and obstructions through which the loop-shaped connection will be passed, without departing from the spirit of the present description. For example, flexible element 370 can be arranged through another portion of connection neck 350 or a different portion of loop 346. A benefit of using a flexible element to maintain a loop shape and pass the loop into a loop is that this can improve filament management by limiting the number of filaments used in a procedure. In addition, such a construction allows a simple action to remove the pin and the return link from the connection, as applying tension to a second terminal end 379 of the flexible element 370 to decouple the flexible element 370 from the loop-shaped connection 340.
[00038] In yet other modalities, a flexible element can be used, in the first place, for the purpose of passing the loop-shaped connection through obstructions. Figures 6 and 7 illustrate two examples of ways in which a flexible element 470, 470 'can be coupled to a loop-shaped connection 440, 440' for passage purposes. As shown in Figure 6, flexible element 470 is passed through an upper portion 447 of loop 446, with a protrusion 476 formed on flexible element 470 to maintain a coupling between the flexible element and the loop assembly during passage. The protrusion 476 may be arranged in the opening or curve 448, in contiguity with a surface of the curve, with a terminal portion 478 extending through and beyond curve 448 for use as a round trip. A needle or similar tool or device can optionally be coupled to the end portion 478 to assist in the loop-shaped connection filament 440 through the fabric. Although not illustrated, it may be useful to include another flexible element arranged through a connection neck 450 of the loop-shaped connection 440 to immobilize a coaxially sliding neck 452 arranged therein while the loop-shaped connection 440 is passed through obstructions.
[00039] As shown in Figure 7, a first flexible element 470 'is coupled to a loop-shaped connection 440' through the curved arrangement of flexible element 470 'through a loop 446', and a second flexible element 471 ' it is arranged through a connection neck 450 'to immobilize the neck 450' while the loop-shaped connection 440 'is passed through obstructions. In the absence of a flexible element 471 'through the neck 450', or another suture pin mechanism in place, the tension applied to the first flexible element 470 'in approximately an F direction to pass the loop-shaped connection 440' through obstructions would cause the size of the loop opening 448 'to decrease.
[00040] The flexible element (s) for any of the modalities described in this document, can be produced from a variety of materials, but, in an exemplary modality, it is a surgical filament separated from the surgical filament that forms the loop-shaped connection. In some embodiments, the flexible element is formed using a surgical filament, such as a cannulated filament, a braided filament and a monofilament. The type, size and strength of the filament may depend, at least in part, on the other materials in the system, including the neck material (s) through which it will pass, the obstructions through which the loop will pass. , how the filament is used (for example, as a suture pin, as a suture back and forth, or as a suture pin and suture round and pin), and the type of procedure in which the same is used. In an exemplary embodiment, the flexible element is formed from a # 2-0 filament (about 28 gauge), such as an Orthocord ™ filament that is commercially available from DePuy Mitek, Inc. or Ethibond ™ filament available from Ethicon Inc. In general, the flexible element is relatively thin to minimize any of the fabric through which it passes, and typically the flexible element is thinner than the loop-shaped connection. In some embodiments, the flexible element can be between about a No. 1 filament (about 25 gauge to about 26 gauge) and about a No. 6-0 filament (about 38 gauge to about 40 gauge) ). A length of the flexible element can be in the range of about 1 centimeter to about 100 centimeters. In an embodiment in which the flexible element is only used as a suture pin, it can be about 1 cm long. In a modality in which the flexible element is used as a suture pin and a suture round-trip pin, it can have a length of about 50 centimeters. In a modality in which the flexible element is only used as a round-trip suture, it can have a length of about 100 centimeters.
[00041] One skilled in the art will find that countless different configurations can be used to slip a retractable curve into a loop-shaped connection. Two such modalities are shown in Figures 2 and 8. As shown in Figure 2, the second end 144 of the loop-shaped connection 140 includes an eyelet 180 configured to receive the retractable curve 120. Eyelet 180 is generally circular in shape, and can , in general, have a substantially fixed diameter. Eyelet 180 can be formed in a number of ways, but in an embodiment in which the loop-shaped connection 140 is formed of a cannulated or braided surgical filament, a first portion 182 of the filament can be traversed by a second portion 184 to form eyelet 180, similar to the formation of loop 146 at the first end 142. However, to maintain a substantially fixed diameter, the first portion 182, which serves as a coaxially sliding neck, can be fixed in relation to the second portion 184, which serves as a an external neck. Numerous techniques can be used to fix the location of the sliding neck 182, including using an adhesive, hot bonding the filament, or discarding a pin or other fastenings through it. Passing the filament through itself to form eyelet 180, the loop-shaped connection 140 maintains a low profile at the second end 144. Although an eyelet size may depend, at least in part, on the other components of the construct, the obstructions through which the loop-shaped connection will pass, and the type of procedure in which it is used, an eyelet diameter can be in the range of about 1 millimeter to about 10 millimeters, and, in a modality , is about 3 millimeters.
[00042] Figure 8 provides an alternative configuration for a second end 544 of a loop-shaped connection 540. As shown, a retractable curve 520 is coupled to the loop-shaped connection 540 by passing curve 520 through the filament in the second end 544. The filament that forms the loop-shaped connection 540 can be a cannulated filament, a braided filament or a monofilament that allows curve 520 to pass through the filament and maintain a sliding engagement with it without causing damage to the filament of the connection in the shape of a loop 540 or a curve 520. One skilled in the art will find that the second end 544 of the filament can be treated in order to avoid unintended fraying. For example, the second end of the filament can be heat bonded, coated, or otherwise treated to prevent fraying. Alternative configurations and materials in addition to those provided in Figures 2 and 8 can also be used by the person skilled in the art to allow a sliding engagement between the second end of the connection and the retractable curve.
[00043] Although in the illustrated modalities the loop is part of a separately formed loop-shaped connection, in other modalities, a single filament can be used to form both the loop and the retractable curve. Other techniques can also be used to form the loop and the curve, including those discussed in US Patent Application Serial No. 13 / 218,810 filed August 26, 2011, and entitled "SURGICAL FILAMENT SNARE ASSEMBLIES," the contents of which it is incorporated here in its entirety, by way of reference.
[00044] The retractable curve 20 shown in Figure 1 can, in general, be a flexible elongated element having a first end 22 coupled to the loop-shaped connection 40 and a second end 24 closed by a sliding knot 26. The sliding knot 26 allows curve 20 to be retracted as desired, and thus, when a portion of curve 20 is coupled to or traverses a fabric, the retraction of curve 20 can tension the fabric to extract it in the direction of a desired location. As shown in Figure 1, as node 26 is moved towards the first end 22, curve 20 retracts, and as node 26 is moved away from first end 22, the size of the opening 28 of curve 20 increases. The sliding knot 26 can be formed in a variety of ways using a variety of techniques well known to the person skilled in the art. Non-limiting examples of the types of nodes that can be used as the sliding curve node include a Buntline Hitch, a Tennessee Slider, a Duncan Loop, a Hangman's Noose, and a curve that has a coaxial sliding neck.
[00045] As shown in Figure 1, curve 20 can also have a retractable tail 30 and a stationary terminal tail 32 that extends from sliding knot 26. Tails 30, 32 can be end ends of two strands of a filament used to form the sliding knot 26 that completes the retractable curve 20. The retractable tail 30 can be operable to tension and retract the curve 20 by moving the sliding node 26 towards the first end of curve 22. More particularly, apply tension to the retractable tail 30 in approximately E direction can cause knot 26 to slide distally towards the first end 22. As a result, sliding knot 26 can move in a similar way to a ratchet or incremental, so that knot 26 moves in the direction of the first end 22 without counter reaction and without causing the retractable curve 20 to increase in size. When no tension is applied, the location of the sliding node 26 remains substantially fixed, and additional tensioning of the retractable tail 30 can cause additional distal movement of the node 26 until the tension is released or an obstruction prevents further distal movement of the node 26. The self-locking capabilities provided by that sliding knot 26 that result from the general formation of construct 10 are beneficial at least due to the ability to incrementally advance knot 26 without an opposite reaction.
[00046] As shown, the stationary terminal tail 32 is in a position adjacent to the retractable filament tail 30 and is stationary in relation to the sliding knot 26. In the illustrated embodiment, the stationary terminal tail 32 is shorter than the retractable tail 30, but , in other instances, it may be the same length or even longer than the retractable tail 30. A larger stationary tail 32 may provide some beneficial aspects. For example, in some embodiments, a long stationary tail 32 can be used as a round-trip suture to pass the retractable curve 20 through the tissue. The use of the stationary tail 32 as a round trip can avoid premature retraction of the curve 20. In such embodiments, a needle or tool or similar device can optionally be coupled to the stationary tail 32 to assist in the tail filament 32 through the tissue. Additionally, since a procedure is terminated with the use of construct 10 which has a larger stationary tail 32, one or more means nodes can optionally be formed on stationary tail 32 in order to provide additional system strength. Such knots can also be formed on the retractable tail 30 if desired for additional strength. In addition, larger stationary and retractable tails 32, 30 can be used in conjunction with other types of procedures, such as double row procedures, as described in more detail below.
[00047] Similar to the other components of the surgical repair construct, the flexible curve can be produced from a variety of materials, but, in an exemplifying embodiment, it is a surgical filament. The surgical filament that forms the retractable curve is typically a filament separate from that used to form the loop-shaped connection or flexible element. In addition, the retractable curve filament can be any suitable suture material such as a cannulated filament, a braided filament and a monofilament. The type, size and strength of the filament may depend, at least in part, on the other materials of the system, including the materials of any loop-shaped or bone anchor connection with which the curve can be associated, obstructions through which the curve will pass, and the type of procedure in which it is used. In an exemplary embodiment, the flexible curve is formed from a No. 0 filament (about 26 gauge to about 27 gauge), such as an Orthocord ™ filament that is commercially available from DePuy Mitek, Inc or Ethibond ™ filament available from Ethicon, Inc. In general, the retractable curve is relatively thin to minimize any trauma to the tissue through which it passes, and the curve can typically be thinner than the loop-shaped connection. In some embodiments, the retractable curve may have a size between about No. 4 filament (about 21 gauge to about 22 gauge) and about a No. 4-0 filament (about 32 gauge to about 34 gauge) ). A length of the curve in its non-retracted configuration can be in the range of about 2 centimeters to about 60 centimeters, and, in one embodiment, it can be about 40 centimeters. In addition, a diameter of the sliding knot of the curve will depend, at least in part, on the size of the filament used to form this, the type of sliding knot it is, and the type of procedure with which it will be used. In an exemplary embodiment, a diameter of the sliding knot can be in the range of about 0.5 millimeter to about 3 millimeters, and, in one embodiment, it can be about 1 millimeter.
[00048] Optionally, a flexible sleeve can be provided to encapsulate at least a portion of a retractable curve. As shown in Figure 9, in one embodiment of a repair construct 610, a sleeve 690 can be arranged around retractable and stationary terminal tails 630, 632, a sliding knot 626, and a portion of curve 620 at a second end 624 , extending towards a first end 622. Sleeve 690 may have a generally cylindrical configuration and may be flexible to allow it to flex as shown in the various embodiments provided herein. Glove 690 can be useful when passing construct 610 through obstructions like fabric for a number of reasons. The glove 690 can protect the knot 626 against unintentional tying while it goes through an obstruction. In addition, the glove 690 can be configured to have a smoother surface that is configured to pass through the tissue more satisfactorily than a knot, thus facilitating the trauma caused by the passage of construct 610 through the tissue. In addition, due to the fact that the glove 690 can encapsulate a plurality of filament loops, the glove 690 can facilitate filament management by keeping the filaments in the confined glove 690. The glove 690 can be removable, and is typically removed before retraction of curve 620, so that sleeve 690 does not interfere with the movement of sliding node 626.
[00049] Figure 9 illustrates only one of the many possible configurations of which portions of construct 610 can be encapsulated by sleeve 690. In some embodiments, one or both retractable and stationary terminal tails 630, 632 may extend beyond sleeve 690. Alternatively , the glove 690 may extend to a length beyond the end ends of the retractable and stationary end tails 630, 632, so that a portion of the glove 690 is empty. Such a configuration can assist a surgeon to pull construct 610 through a portion of the structure by providing extra length on which it can hold. Preferably, the glove 690 can extend outside of a structure and a cannula placed in the structure, since construct 610 is implanted, so that glove 690 can be easily removed.
[00050] The glove can be produced from a wide variety of flexible biocompatible materials, including a flexible polymer or it can be another filament. In one embodiment, the glove is produced from a polymeric material. In another embodiment, the glove is a flexible filament, such as a braided suture, for example, filament No. 0 Ethibond ™ or filament No. 2 Orthocord ™, which is typically braided at sixty times by 2.54 centimeters. For use as a glove, a more relaxed braid of approximately thirty to forty abstractions per 2.54 centimeters is preferred, more preferably, about 36 abstractions per 2.54 centimeters. If the glove material is formed around a core, preferably that core is removed to facilitate insertion of the filament loops, which can be formed from a typical suture such as No. 0 Orthocord ™ or No. 2 suture braided at sixty abstractions by 2.54 centimeters. Additional convenience can be provided by perceptible indicators on the glove such as different markings, colors, diameters, braid or model patterns, or others or tactile or visual marking areas, specifically if multiple fabric fixings or anchors are used.
[00051] A length and diameter of the glove may depend, at least in part, on the size and configuration of the components of the construct with which it is used, the obstructions through which the glove can pass, and the surgical procedure in which the same is used. In any event, the glove is typically one size, so that it can pass through the fabric without trauma. In embodiments in which the glove is a filament, a size of the glove can be in the range of about a No. 5 filament (about 20 gauge to about 21 gauge) to about a No. 2-0 filament ( about 28 gauge), and, in one embodiment, the size can be about filament no. 0 (about 26 gauge to about 27 gauge). One skilled in the art will recognize sizes of comparable diameter that can be used in examples where the glove is produced from a polymeric material or other non-filamentary material. The glove can have a length in the range of about 10 centimeters to about 60 centimeters, and, in one embodiment, it has a length of about 40 centimeters.
[00052] Figure 10 illustrates an exemplary embodiment of the repair construct 610 of Figure 9 coupled with a bone anchor 608. One skilled in the art will find that a variety of types of bone anchor can be used in conjunction with the constructs provided in this document. However, for illustrative purposes, anchor 608 is a Healix Ti ™ anchor that is commercially available from DePuy Mitek, Inc. Anchor 608 may include a 609 filament hitch feature, which can be over any part of the anchor, but, in the example mode, it is at a distal end 608 d of anchor 608 and allows construct 610 to be slidably attached to anchor 608. Regardless of the type of anchor used, construct 610 should be slidably attached to anchor 608 by means of of the filament hitch feature 609, so that the loop-shaped connection 640 extends on one side of anchor 608 and the sliding knot 626 extends on the other side of anchor 608. The use of this construct 610 is described below in relation to Figures 12A-12G.
[00053] Figure 11 illustrates an exemplary modality of a round-trip suture 800 coupled to a bone anchor 708. Again, virtually any type of bone anchor can be used in conjunction with the round-trip anchors and constructs provided in this document, but the illustrated anchor 708 is a Healix Ti ™ anchor that is commercially available from DePuy Mitek, Inc. The anchor 708 may include a 709 filament hitch feature, which may be on a 708 distal end d of anchor 708 and which allows the round trip 800 to be slidably engaged with anchor 708. As shown, the round trip 800 is slidably coupled to anchor 708 in filament hitch 709 in such a way that a first end 802 of the round trip 800 extends on one side of anchor 708 and a second end 804 of the round trip 800 extends on the other side of anchor 708. The first end 802 can be configured to be coupled to a repair construct, such as the repair construct 610 of Figure 9. As shown, the first end 802 includes a retractable loop 806, but any other suitable coupling mechanism can be used at the first end 802 without departing from the spirit of the present description. For example, the first end 802 may include a clamp or a claw-like element around a repair construct. Since the repair construct 610 is coupled to the first end 802, the second end 804 can be used to position the repair construct 610 in a desired location as described below in relation to Figures 13A-13D.
[00054] An exemplary embodiment of a method for performing a rotator cuff repair using the repair construct illustrated in Figure 10 is illustrated in Figures 12A-12G. A surgical opening can be formed through the skin 1000 and a cannula can be passed through it to create a surgical repair site in a manner well known to the person skilled in the art. Although cannulas are often used to define a channel through which the procedure can be performed, the cannula is not shown in Figures 12A-12G to facilitate illustration. Consequently, as the Figures show components of the systems and devices that pass through the skin 1000, these components would typically be extending through the cannula, which is itself, through the skin 1000. Additionally, although the devices and methods described in present document are particularly useful for minimally invasive surgery, such as arthroscopic surgery, they can also be used in open surgical procedures.
[00055] As shown in Figure 12A, anchor 608 shown in Figure 10 can be attached to bone 1001 using common techniques, such as a screwdriver or putting anchor 608 in place. In the illustrated embodiment, construct 610, which includes a flexible element 670 that serves as a suture pin and a round-trip pin, is already attached to this, although in other embodiments, construct 610 can be slidably attached to the anchor. 608 after anchor 608 is positioned in its desired location.
[00056] As shown in Figures 12B and 12C, a terminal portion 679 of flexible element 670 can be passed over and through a tendon 1003 separated from bone 1001 to tighten the loop-shaped connection 640, and a portion of the retractable curve 620, through the tendon 1003. Optionally, a needle or tool or similar device can be coupled to the terminal portion 679 to assist in the filament of construct 610 through the tendon 1003. Similarly, other passing techniques, including those described in this document and those known to a person skilled in the art, can also be used to pass the loop-shaped connection 640 through and / or around the tendon 1003. The other end of construct 610 on which the sliding node 626 is placed can also cross the tendon 1003 at a second location on tendon 1003. As shown, optional sleeve 690 can be arranged around handles 630, 632, sliding knot 626 and a portion of curve 620, fa thus facilitating any trauma caused by the passage of this portion of construct 610 through tendon 1003 and assisting in the management of the filament loops. As a result, on one side of anchor 608 there is the loop-shaped connection 640 that was crossed by the tendon 1003 in a first location and is accessible to the surgeon outside the body, and on the other side of anchor 608, there is the sliding knot 626 that was crossed by the tendon 1003 in a second location and is accessible to the surgeon outside the body.
[00057] As shown in Figure 12D, a portion of the second end of curve 624 can be traversed by loop 646, so that loop 646 is distal to sliding node 626, thus allowing tendon 1003 through which construct 610 is willing to be captured. The flexible element 670 can be removed from the loop-shaped connection 640, and the loop 646 can be retracted or lined around the portion of the second end 624 that is arranged therethrough, with the loop 646 remaining distal to the sliding node 626. The flexible element 670 can, in fact, be removed from the loop-shaped connection 640 at any time after traversing any fabric, so that its purpose of serving as a round trip to construct 610 and a pin to prevent unintended retraction 646 are no longer desired.
[00058] As shown in Figure 12E, tension can be applied to the second end 624 by squeezing approximately in one direction G, thus causing the retracted loop 646 to slide distally towards the tendon 1003 in a similar way to the zip line until the loop 646 is adjacent to tendon 1003. Alternatively, tension can be applied to second end 624 before loop 646 is lined and after loop 646 is adjacent to tendon 1003, or some combination of the two actions can be used, such as partially lining the loop 646 before ziplining it in the direction of tendon 1003. As shown in Figure 12E, when loop 646 is retracted, the additional filament that was previously part of loop 646 forms an elongated connecting neck 651 between the first and second loop-shaped connection ends 640. As shown, a portion of this elongated connection neck 651 can become arranged around the filament engaging feature No. 609.
[00059] If a glove 690 is included as part of construct 610, it can be removed as it is used to assist in the passage of the second end of construct 610 through the fabric. However, it may be useful to keep glove 690 arranged around a portion of the second curve end 624 to prevent unintentional movement of knot 626, to continue to help guide the filament loops, and to aid in the zip-line transport of the loop 646 towards the tendon 1003 due to the fact that there is typically less friction created by the glove 690 as opposed to the filament that the glove 690 encapsulates. As shown in Figure 12F, since sleeve 690 is no longer desired, it can be removed from construct 610 to expose sliding knot 626 and retractable tail 630. Tension can be applied to retractable tail 630 by squeezing approximately at direction H, thus causing node 626 to move distally towards tendon 1003, so that it can be adjacent to loop 646 and, in turn, bring tendon 1003 closer to bone 1001, as shown in Figure 12G. The configuration of construct 610 allows node 626 to be advanced in a similar way to the incremental ratchet when the retractable tail 630 is tightened in the H direction without the risk of reversing the progress of node 626 as a result of sliding backward, sometimes referred to as recoil , counter reaction, or loosening that of the filament. Alternatively, in a mode in which no glove is used and thus knot 626 is free to slide, loop 646 and curve 620 can be retracted at the same time by applying tension to the retractable tail 630 in approximately the H direction.
[00060] As shown in Figure 12G, optionally, one or more half nodes 631 can be added to the filament in a position adjacent to the sliding node 626 to provide additional strength, since the filaments have finally been positioned to bring tissue together. Half nodes 631 can be formed on either or both of the retractable and stationary terminal tails 630, 632. The formation of one or more half nodes, however, can delay the ability of the retractable tail 630 to provide incremental movement of the sliding node. 626. Consequently, in examples where multiple constructs are used together as part of a procedure, it may be desirable to add half nodes after all constructs are placed, installed and tensioned as desired. In addition to the optional half-knots, no knots need to be tied during the course of the illustrated procedure.
[00061] In addition, also as illustrated, excess portions of one or both tails 630, 632 can be removed if desired. The bridge pattern resulting from the methods and shown in Figure 12G is a mattress stitch pattern, but one skilled in the art would have the ability to use other desired stitch patterns without departing from the spirit of the present description. The tensile strength resulting from the point formed can be in the range of about 130 Newtons to about 225 Newtons without the formation of any half knots, and, in one embodiment, the tensile strength can be about 156 Newtons without the formation of no half-knots. The use of knots means typically increases the load capacity.
[00062] Although in the illustrated embodiment, the stationary terminal tail 632 is short, in other embodiments, it may be longer for the reasons described above and for other procedures. As a non-limiting example, in a procedure, after loop 646 and sliding knot 626 advance to be positioned adjacent to tendon 1003, at least one half knot can be added to stationary terminal tail 632 and then the remaining length of the tail 632 can be used for fixing middle row in a double row procedure, so that two tails 630, 632 can span middle row anchor (s). As an additional non-limiting example, a retractable tail 630 can traverse a side row anchor without locking the repair construct with an additional half-knot. In this example, however, the middle and side row fixings would not be independent of each other.
[00063] Additional modifications to the method described in relation to Figures 12A-12G may include slidingly attaching multiple repair constructs to the same anchor, which would provide the ability to incrementally and independently tension each construct in relation to the same anchor. Consequently, a new repair technique can be implemented, in which the tension throughout the repair construct can be customized incrementally in order to eliminate unwanted stains such as wrinkles and the formation of "folds". Alternatively, multiple anchors, each having one or more repair constructs slidably coupled to it, can be arranged at the surgical site and, again, the incremental repair can be customized for a more desirable result.
[00064] An exemplary embodiment of a method for performing a rotator cuff repair using the repair construct illustrated in Figures 9 and 11 is illustrated in Figures 13A-13D. A surgical opening can be formed through the skin 1000 and a cannula can therefore be passed through to create a surgical repair site according to well-known techniques. Similar to Figures 12A-12G, although cannulas are often used to define a channel through which the procedure can be performed, the cannula is not shown in Figures 13A-13D to facilitate illustration. Consequently, as the Figures show components of the systems and devices that pass through the skin 1000, these components would typically be extending through the cannula, which is itself, through the skin 1000.
[00065] As shown in Figure 13A, anchor 708 shown in Figure 11 can be attached to bone 1001 using common techniques, such as using a wrench to thread or put anchor 708 in place. In the illustrated modality, the round-trip suture 800, which includes the first end 802 that has the loop 806 formed in it, is already coupled to it, although in other modalities, the round-trip suture 800 can be coupled from sliding way to anchor 708 after anchor 708 is positioned in its desired location.
[00066] As shown in Figure 13B, the first and second ends 802, 804 of the round-trip suture 800 can be traversed by separate soft tissue, such as tendon 1003. As shown in Figure 13C, a portion of the construct of repair 610 of Figure 9 can be traversed by loop 806. Loop 806 can then be retracted, thus coupling repair construct 610 to round trip 800. Although loop 806 is the mechanism used to couple the forward and turn 800 and construct 610, a variety of other coupling techniques can also be used to couple repair construct 610 to the round-trip suture 800. A force in approximately J direction can then be applied to the second end 804 to tighten the first end 802, and thus the repair construct 610, through the tendon 1003 in a first location, around the filament engagement feature 709, and through the tendon 1003 in a second location. As a result, the loop-shaped connection 640 can be arranged on one side of anchor 708 and sliding knot 626 can be arranged on the other side of anchor 708, with the retractable curve 620 slidably engaged with filament hitch feature 709 The optional removable glove 690 can be particularly useful in this modality due to the fact that node 626 crosses the tendon 1003 twice, and also around the anchor 708, and, thus, the suture management and less friction capabilities that this provides can be useful. Additionally, since round trip 800 moved construct 610 to the desired location, round trip 800 can be decoupled from repair construct 610. Since construct 610 is in place as shown in Figure 13D, the construct 610 can be operated in a similar manner as described in connection with Figures 12D-12G.
[00067] In some embodiments, anchor 708 may include multiple round-trip sutures coupled to this to allow multiple repair constructs that can be independently and sequentially installed to be used in a surgical procedure. Alternatively, a surgeon can use a single round-trip to install multiple constructs on the same anchor or, in addition, multiple anchors can be attached for a procedure with each having its own repair or round-trip construct, or one of suture roundtrip can be used to place one or more constructs on multiple anchors.
[00068] Although in the illustrated modalities construct 610 passes through two portions of tendon 1003, alternatively, construct 610 can pass through only one portion of the tendon or tissue while the second portion of construct 610 can be free from the tendon or tissue. Either end can be an end that does not go through the tendon or tissue, however, if a loop-shaped connection 640 does not go through the tissue, a flexible element 670 to serve as a suture pin can be omitted and can be replaced , if desired, by any technique or mechanism used to prevent unintentional retraction of the 646 loop, such as a spacer or tube. In addition, instead of traversing the tissue, a repair construct can be attached to the tissue using other techniques, such as, for example, wrapping the construct around the tissue.
[00069] In an alternative embodiment, a repair construct can be used to tighten two or more tissues in close proximity to each other. Any of the repair constructs provided in this document, or derivations thereof, can be used in conjunction with techniques of this nature. As shown in Figure 14A, a repair construct 710 includes a retractable loop 746 that has a filament element 770 that is operable as both a suture pin and a suture back and forth pin, with two end loops 756, 758 extending from a tubular portion 753. A terminal portion 779 of flexible element 770 can pass through a first fabric 2003, optionally using a needle or tool or similar device coupled to terminal portion 779 to assist in the filament of flexible element 770 through the first fabric 2003, for tightening loop 746 and a portion extending distally from loop 746 through the first fabric 2003, as shown in Figure 14B. Also as shown in Figure 14B, the end loops 756, 758 can pass through a second fabric 2005, also optionally using a needle or tool or similar device for each loop 756, 758 to assist in the filament of loops 756, 758 through the second fabric 2005. Since loop 746 and the two end loops 756, 758 are on an upper side of fabric 2003, 2005, at least a portion of loops 756, 758 can pass through loop 746, as shown in Figure 14C, and , then loop 746 can be lined to extract the two pieces of fabric 2003, 2005. The handles 756, 758 can subsequently be tensioned to tighten the two closest fabrics 2003, 2005. Additionally, although the modality illustrated in Figures 14A-14C is aimed at tightening the two fabrics together 2003, 2005, one skilled in the art would be able to adapt these techniques to three or more fabrics crossing the repair construct, or repair constructs, for additional tissue which you want to be wrapped.
[00070] Other methods are provided in this document that allow objects, such as tissue, bone fragments, or a variety of other objects, to be fully attached using a single filament. An example is illustrated in Figures 15A-15G.
[00071] As shown in Figure 15A, a flexible surgical filament 810 for use in a procedure can be provided, with filament 810 including a first end 812 that has a loop 816 formed therein and a second second end 814. Loop 816 can be formed in a variety of ways, including the use of techniques provided in this document, as well as other known techniques. The front end 814 can similarly have a variety of configurations, including multiple loops as provided in other forms of filament repair constructs presented herein, but, as shown, the front end 814 is a single loop.
[00072] As shown in Figure 15B, filament 810 can be positioned substantially around an object 3000, such as fragments of tissue or bone, to form a first curve 811, and the front end 814 can be folded, so that a portion thereof is substantially U-shaped. In other embodiments, filament 810 may be preformed at the front end 814 to have a substantially U-shaped configuration. The front end 814 can be moved approximately in the K direction, so that at least a portion of the substantially U-shaped front end 814 passes through loop 816, as shown in Figure 15C. As a result, a portion of the front end 814 remains on a first side of loop 816 and a second curve 813 is formed by the portion of the filament that is in loop 816, where the second curve 813 is on the other side of loop 816.
[00073] As shown in Figure 15D, loop 816 can be retracted or lined using techniques suitable for the type of loop that is formed in filament 810. Retracting loop 816 holds the first and second curves 811, 813, with the first curve 811 completely surrounding object 3000 and the second curve 813 adjacent to object 3000. As shown in Figure 15E, the first curve 811 can then be retracted around object 3000, so that curve 811 engages and retain the object 3000. The first curve 811 can be retracted, for example, by tightening the retracted loop 816, which operates as a sliding knot, towards the object 3000 in the L direction. The retracted loop 816 can be tightened using a knot tightening device, manually, or by other techniques and mechanisms to advance retracted loops and sliding knots. The retracted loop 816 can be advanced in the L direction until no additional tension can be provided and, thus, the filament of the first curve 811 is attached to the object 3000 as much as possible.
[00074] As shown in Figure 15F, the front end 814, which begins with the end end 819 thereof, can cross the second curve 813. Since the front end 814 crosses the entire curve 813, tension can be applied to the front end 814 in an M direction to retract the second curve 813, as shown in Figure 15G. The retraction of the second curve 813 results in a safer retention of the object 3000 at least due to the fact that it holds the previously retracted loop 816 in place and provides additional load-bearing force without adding half nodes. The 3000 object is thus securely and securely attached by filament 810 and can be moved and / or used as part of a number of surgical procedures.
[00075] Figures 16 to 22 illustrate a sample of other procedures that can be performed in the light of the systems and devices presented in this document. As these Figures illustrate a loop, retractable curve, filaments and repair constructs, the various types of loops, curves, filaments and repair constructs provided by the present invention can be used in conjunction with these procedures. Thus, the illustrated procedures are not limited to being performed only by the systems and devices illustrated in Figures 16 to 22. Additionally, although in these modalities the filaments are shown as arranged in the fabric, other techniques for associating the fabric and filaments can be used, including wrapping the filaments around the fabric.
[00076] Figure 16 illustrates a filament 910 having a loop 916 and the front end 914 as the surgical filament 810 of Figures 15A-15G. As shown, filament 910 is disposed through two separate fabrics 3003, 3005, for example, through the front end 914 through fabrics 3003, 3005, or through loop 916 through a fabric 3003 and through the front end 914 through another fabric 3005 The front end 914 can then be folded into a substantially U-shaped configuration and filament 910 can be operated in a manner similar to that as described with reference to Figures 15A-15G. In this way, a second curve can be formed by retracting the loop 916 around the front end 914. The retracted loop 916 can be advanced in the direction of the fabric 3003, 3005 to extract the fabric 3003, 3005 more closely. In addition, the second curve can be advanced distally by applying tension to the anterior end 914, which can assist in maintaining the location of the retracted loop 916, and thus the fabric 3003, 3005.
[00077] Figure 17 is similar to Figure 16 except that one of the tissues includes an anchor 3008 attached to the bone 3001. Thus, the filament 910 'passes through the tissue 3005 and a connection mechanism 3009 of the anchor 3008 in the bone 3001. The connection mechanism 3009 can have numerous components used in bone anchors to allow the suture to be attached to this, including, but not limited to, eyelet, pivots and other filament engagement features. Similar to the embodiment of Figure 16, a second curve can be formed by retracting loop 916 'around the front end 914'. The retracted loop 916 'can be distally advanced to extract tissue 3005 to the bone 3001. Additionally, the second curve can be distally advanced by applying tension to the anterior end 914', which can assist in maintaining the location of the retracted loop 916 ', and thus, tissue 3005 in relation to bone 3001.
[00078] Figures 18 and 19 are similar to Figures 16 and 17, respectively, except that instead of using a single filament 910, 910 ', two filaments 1010, 1010' and 1011, 1011 'are used. A filament 1010, 1010 'includes loop 1016, 1016' and the second filament 1011, 1011 'includes portion 1014, 1014' previously described as an anterior end. As shown, the first filament 1010, 1010 'is associated with tissue 3003 (figure 18) or an anchor 3008 attached to bone 3001 (figure 19) and a second filament 1011, 1011' is associated with tissue 3005 (figures 18 and 19 ). The methods are then carried out in a similar manner as described above in relation to Figures 16 and 17. In this way, a second curve can be formed by retracting the loop 1016, 1016 'around the second portion of filament 1014, 1014' . The retracted loop 1016, 1016 'can be advanced distally to extract tissue 3005 closest to tissue 3003 or bone 3001. Additionally, the second curve can be advanced distally by applying tension to portion 1014, 1014', which can assist in maintenance of the location of the respective components 3001, 3003, 3005 and 3008 coupled to filaments 1010, 1010 'and 1011, 1011'.
[00079] Figure 20 illustrates another embodiment in which two filaments 1110, 1111 are used to extract tissue 3005 closest to an anchor 3008 disposed in bone 3001. The operation of this construct may be similar to that described above in relation to Figures 15A- 19. As shown, a first filament 1110 having a loop 1116 and a terminal end 1115 is coupled to an anchor 3008 attached to the bone 3001. Anchor 3008 can include a one-way sliding mechanism 3009 to allow the end end 1115 to be used as a tensioning tail to retract the loop 1116. The second filament 1111 can be coupled to the fabric 3005, the second filament 1111 having an anterior end 1114 which can be folded to have a substantially U-shaped configuration. The anterior end 1114 it can be arranged on loop 1116 and the loop can be retracted to form a second curve. The retracted loop 1116 can be distally advanced to extract tissue 3005 towards bone 3001, for example, by applying tension to the terminal end 1115. In addition, the second curve can be advanced distally by applying tension to the anterior end 1114, which can assist in maintaining the location of tissue 3005 in relation to bone 3001. Final tensioning can be carried out by applying tension to terminal end 1115.
[00080] Figures 21 and 22 further illustrate two additional modalities of constructs for use to extract tissue from the bone, the operation may be similar to that described above in relation to Figures 15A-20. Figure 21 includes a first filament 1210 having a first end 1212 configured to be coupled to a repair construct 1310 and a second front end 1214, with the first end 1212 coupled to an anchor 3008 disposed in bone 3001 and the second end 1214 arranged through fabric 3005. A second filament forms a repair construct 1310 which has a retractable curve 1320, a loop 1346 and a connecting neck 1350 disposed between them. The curve 1320 includes a sliding knot 1326 and has a retractable tail 1330 and is operable to retract the curve 1320 by moving the knot 1326 distally in the direction of anchor 3008. Similar to other modalities described in this document, the retractable tail 1330 can advance the sliding knot. 1326 similarly to the ratchet or incremental. The front end 1214 can be folded to have a substantially U-shaped portion, which can pass through loop 1346. Loop 1346 can be retracted around front end 1214 to form a second curve. The sliding knot 1326 can be advanced distally, for example, by tensioning the tail 1330 in an N direction, thus extracting the tissue 3005 in the direction of the bone 3001. In addition, the second curve can be advanced distally by applying tension to the anterior end 1214, which can assist in maintaining the location of the sliding knot 1326, and thus the tissue 3005 in relation to the bone 3001. The final tensioning can be carried out by applying tension to the retractable tail 1330.
[00081] The method illustrated in Figure 22 is operated similarly to the method described in relation to Figure 21, but the retractable curve 1320 'of the repair construct 1310' is coupled directly to anchor 3008. Since a first filament 1210 'is coupled to the repair construct 1310 'by retracting loop 1346' around the front end 1214 'of the first filament 1210' arranged therein, the retraction of curve 1320 'extracts tissue 3005 in the direction of bone 3001 where the anchor is arranged .
[00082] The methods in Figures 21 and 22 could also be used in conjunction with multiple tissues and no anchors or bones, and any of the methods in Figures 16 to 22 can be used with numerous components extracted together, such as anchors, bone and tissue , including more than two components, as well as numerous combinations of filament and construct without departing from the spirit of the present description.
[00083] An individual skilled in the art will appreciate other aspects and advantages of the invention based on the modalities described above. Accordingly, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. In addition, although the systems, devices and methods provided for the present invention are, in general, directed to surgical techniques, at least part of the systems, devices and methods can be used in applications outside the surgical field. As a non-limiting example, the methods of holding objects described in relation to Figures 15A-15G can be used in contexts outside of surgical procedures and outside the medical field. All publications and references cited herein are hereby expressly incorporated, by reference, in their entirety.

权利要求:
Claims (15)
[0001]
1. Surgical repair construct, comprising: a loop-shaped connection (40, 140, 140 ', 240, 340, 440', 540, 640) formed from a first suture filament and having a retractable loop (46, 146, 146 ', 246, 346, 446, 446', 746) at a first end, a second end (44, 144) which is configured to receive a second suture filament, and a connecting neck (150, 250, 350, 450) between the first and the second ends; a retractable curve (20, 120, 520, 620) formed by the second suture filament, the retractable curve (20, 120 520,620) having a first end (22) coupled to the second end of the loop-shaped connection, a knot sliding (26, 1326), and a retractable filament tail (30, 1330) extending from the sliding knot (26, 1326); in which the construct is configured to cross non-traumatically the soft tissue and fix the tissue without knotting; characterized by the fact that the construct for surgical repair comprises a flexible suture pin (270, 370, 470, 470 ', 670, 770) having a first portion in the same removable arrangement through the connection neck (150, 250, 350, 450) and configured to prevent loop retraction and maintain approximately the size of the loop opening when the suture pin is present on the connecting neck,
[0002]
2. Construct according to claim 1, characterized by the fact that the loop is configured so that the first suture filament is coaxially arranged through itself, so that at least a portion of the connecting neck (150, 250, 350, 450) is a sliding coaxial neck (152, 152 ', 252) that is slidable along another portion (154) of the connecting neck, the sliding coaxial neck (152, 152', 252) it is movable towards the second end (144) of the loop-shaped connection to retract the loop and movable away from the second end (144) of the loop-shaped connection to increase a loop size.
[0003]
3. Construct according to claim 2, characterized by the fact that the first portion of the suture pin is removably disposed through the sliding coaxial neck (152, 152 ', 252) to immobilize the sliding coaxial neck.
[0004]
4. Construct according to claim 3, characterized by the fact that a second portion of the removable suture pin is also arranged through a portion of the first suture filament that forms the retractable loop (46, 146, 146 ' , 246, 346, 446, 446 ', 746), with the suture pin having a stationary knot (376) formed between the first and second portions of the suture pin in a position on a curve formed by the loop and a portion terminal that extends beyond the curve formed by the loop.
[0005]
5. Construct according to claim 1, characterized by the fact that the loop (46, 146, 146 ', 246, 346, 446, 446', 746) is formed by a second sliding node adjacent to the connection neck ( 150, 250, 350, 450), the second sliding node being movable away from the second end of the loop-shaped connection to retract the loop and move towards the second end of the loop-shaped connection to increase a size of the loop.
[0006]
6. Construct according to claim 1, characterized by the fact that the first suture filament comprises one of a cannulated suture filament and a braided suture filament.
[0007]
7. Construct according to claim 1, characterized by the fact that it still comprises a suture round-trip filament (800) coupled to the loop for use in advancing the loop-shaped connection through the fabric.
[0008]
8. Construct according to claim 1, characterized by the fact that the second end (144) of the loop-shaped connection (140) comprises an eyelet (180) and the retractable curve (120) is coupled to the shaped connection loop through the eyelet (180).
[0009]
9. Construct according to claim 1, characterized by the fact that the retractable curve (20, 120, 520, 620) is coupled to the second end of the loop-shaped connection through a portion of the second suture thread passing through a portion of the first suture filament at the second end of the loop-shaped connection.
[0010]
10. Construct according to claim 1, characterized by the fact that it still comprises a flexible sleeve (690) that removably encapsulates at least a portion of the retractable curve (20, 120, 520, 620), including the sliding knot (26, 1326).
[0011]
11. Construct according to claim 1, characterized by the fact that the retractable filament tail (30, 1330) has the purpose of retracting the retractable curve (20, 120, 520, 620) when the sliding knot (26, 1326) is moved towards the first end of the retractable curve.
[0012]
12. Construct according to claim 1, characterized by the fact that it still comprises an anchor (608, 708, 3008) having a filament hitch feature (609, 709, 3009), in which a retractable curve portion ( 20, 120, 520, 620) is slidably arranged around a portion of the filament engagement feature (609, 709, 3009) to couple the sliding knot (26, 1326) to the anchor so that the sliding knot ( 26, 1326) extends from one side of the anchor and the loop-shaped connection (40, 140, 140 ', 240, 340, 540', 540, 640) extends from another side of the anchor.
[0013]
13. Construct according to claim 1, characterized by the fact that it still comprises a terminal filament tail (32) formed from a portion of the second suture filament and extending from the sliding knot (26), the terminal filament tail (32) is adjacent to the retractable filament tail (30) and stationary with respect to the sliding knot (26).
[0014]
14. Construct according to claim 1, characterized by the fact that the suture pin (270, 370, 470, 470 ', 670, 770) is formed of a third suture filament, and in which, optionally, a thickness of the third filament is in the range of 0.16 mm2 to 0.005 mm2 (from 25 caliber to 40 caliber).
[0015]
15. Construct according to claim 1, characterized by the fact that a thickness of the first filament is in the range of 0.52 mm2 to 0.032 mm2 (from 20 caliber to 32 caliber) and / or a thickness of the second filament is in the range from 0.41 mm2 to 0.02 mm2 (from 21 caliber to 34 caliber).

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同族专利:

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公开号 | 公开日

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US20150245832A1|2015-09-03|

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US20170367690A1|2017-12-28|

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US20130296931A1|2013-11-07|

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US20200178952A1|2020-06-11|

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BR102013011235A2|2016-09-06|

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JP6271153B2|2018-01-31|

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JP2013233434A|2013-11-21|

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AU2017258860A1|2017-11-30|

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AU2013205724A1|2013-11-21|

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AU2017258860A9|2019-04-04|

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CN103385738A|2013-11-13|

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US9060763B2|2015-06-23|

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AU2017258860B2|2019-04-04|

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EP2662032B1|2015-10-28|

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CA2815794A1|2013-11-07|

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US9757116B2|2017-09-12|

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US10524777B2|2020-01-07|

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EP2662032A1|2013-11-13|

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CN103385738B|2017-04-12|

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法律状态:
2016-09-06| B03A| Publication of an application: publication of a patent application or of a certificate of addition of invention|

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2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|

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2019-11-19| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|

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2020-12-01| B09A| Decision: intention to grant|

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2021-02-02| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 07/05/2013, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US13/465,288|2012-05-07|

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US13/465,288|US9060763B2|2012-05-07|2012-05-07|Systems, devices, and methods for securing tissue|

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