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EP-3944822-B1 - MINIMALLY INVASIVE SYSTEMS FOR APPROXIMATING TISSUE WITH A SUTURE

EP3944822B1EP 3944822 B1EP3944822 B1EP 3944822B1EP-3944822-B1

Inventors

  • Gustafson, Adam C.

Dates

Publication Date
20260506
Application Date
20210730

Claims (6)

  1. A surgical repair system, comprising: a suture construct formed from a suture filament (100), the suture construct including a first tail (101), a second tail (102), and an adjustable loop (110), an opening of the adjustable loop (110) being defined by the second tail (102) passing through and being slidably disposed within the first tail (101) such that applying tension to the second tail (102) collapses the opening of the adjustable loop (110); and an inserter (200, 700) having a proximal handle (210, 710), a coupling region (230, 730), and a distal end, the distal end including a needle (220, 720), the coupling region (230, 730) being configured to retain the adjustable loop (110) at the coupling region (230, 730) during insertion of the needle (220, 720) through a patient's target tissue when the adjustable loop (110) is collapsed around the coupling region (230, 730); wherein, when the adjustable loop (110) is collapsed around the coupling region (230, 730) and the needle (220, 720) is inserted through the target tissue, the first tail (101) and the second tail (102) are configured to extend out of an incision in the patient's body and the surgical repair system is configured such that tension applied to the second tail (102) tightens the adjustable loop (110) around the coupling region (230, 730) and tension applied to the first tail (101) loosens or enlarges the adjustable loop (110) for disengaging the suture construct from the inserter (200, 700).
  2. The surgical repair system of claim 1, wherein the first tail (101) comprises an eyelet (109) formed therein, with the second tail (102) slidably disposed through the eyelet (109).
  3. The surgical repair system of claim 1 or claim 2, wherein the suture filament (100) is a braided suture, and the braided suture is bifurcated at a location at which the second tail (102) is slidably disposed within the first tail (101).
  4. The surgical repair system of any of claims 1-3, wherein the coupling region (230, 730) of the inserter (200, 700) comprises a reduced diameter section of an outer surface of the inserter (200, 700).
  5. The surgical repair system of claim 4, wherein the reduced diameter section defines at least one of a proximal transition section or a distal transition section having a chamfered edge (231) disposed between two different diameter sections of the inserter (200, 700).
  6. The surgical repair system of any of claims 1-5, wherein the first tail (101) and the second tail (102) are part of a single length of the suture filament (100).

Description

FIELD The present disclosure relates to systems for securing soft tissue together, and more particularly relates to systems for approximating tissue with a mattress stitch and luggage tag knot through a single incision without needing to establish a subcutaneous plain to retrieve the suture limbs during, for example, meniscal repair and soft tenodesis of the long head of the biceps. BACKGROUND A common injury, especially among athletes and people of advancing age, is the complete or partial tear of tendons, ligaments, or other soft tissues. Soft tissue tears may occur during a fall, by overexertion, or for a variety of other reasons. Surgical intervention is often needed, particularly when tissue is partially or completely torn. Currently available devices for tissue attachment include screws, staples, suture anchors, and tacks. Currently available devices for patients of advancing age can be particularly insufficient due to degenerated tissue leading to inadequate suture-to-anchor fixation and further damage to the soft tissue. US Patent Application Publication 2018/0280016 describes a suture passer device used in procedures of robotic assisted minimally invasive suspension of the hyoid and tongue base in treatment of sleep apnea. The suture passer device is a dual use suture passer, having both suture inserter and extractor functionality on a single unitary instrument section of the device by means of insertion and extraction hooks positioned on an elongated needlelike body which is connected to a handle grip. The insertion and extraction hooks receive a suture via an opening in the body of the instrument, with the suture capable of removal and fastening to the extraction hook by robotic forceps. US Patent Application Publication 2013/0090670 describes a suture delivery system including an anchor and a cooperating driver, the driver facilitating a delivery of the anchor into the abdominal cavity. The system allows for the deployment of a suture internally into an abdominal wall. US Patent Application Publication 2015/0012094 describes a method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone. The apparatus includes a member to pull the soft tissue implant into a femoral tunnel. The member includes a suture having first and second ends which are passed through first and second openings associated with the longitudinal passage to forma pair of loops. A collapsible tube is positioned about the suture. US Patent Application Publication 2004/0087978 describes a surgical instrument for closure of fascia and other laparoscopic procedures that use large operative ports or trocars and is intended to help prevent post-operative hernia defects and is also used to stop acute bleeding from the abdominal wall. The instrument shaft with the needle tip is attached to a hand piece allowing the operator to control the retractable grasping surface. The needle guide directly applies onto the shaft of a trocar and it slides down to the level of the subcutaneous tissue helping the operator to place the needle. Once the suture is passed through the abdominal wall, it is released then the needle is re-inserted through the opposite guide port. The suture creates an intra-abdominal loop of suture outside the abdomen. Suture ends are tied, allowing closure of the fascia defect within the abdominal wall. EP2282679 A1 describes an apparatus for suture-based tissue repair, preferably for the annulus of a spinal disc, that includes a suture loop preferably pre-tied with a sliding knot, a clasp-type component that captures the ends of the suture loop, and an optional plug member that fills the tissue defect. Also disclosed is a method that places the suture loop in a full thickness stitch encircling the tissue defect, secures the ends of the suture loop to the clasp, and cinches the suture loop to approximate the tissue without the need to tie knots. There is a desire with these types of injuries to operate in a minimally invasive manner. Current techniques for passing a mattress stitch (e.g., during an inside-out meniscal repair) typically require establishing a subcutaneous plain to allow retrieval and tying of the suture limbs without capturing superficial tissue in the repair. Additionally, in current procedures the surgeon typically must tie a series of knots that can require several throws to achieve the desired strength and security. It is desirable to reduce this knot stack to alleviate repetitive work, the complexity of tying a proper knot, reduce the potential for interference or harm to tissue based on the space consumed by the knot stack, and to reduce the material implanted in the patient. Accordingly, there is a need for improved systems, methods, and devices for minimally invasive method for approximating tissue in an accurate, more efficient, and less disruptive manner by using a single incision and minimal disruption to the target tissue. SUMMARY The present invention is define