(19)
(11)EP 2 667 787 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
04.11.2020 Bulletin 2020/45

(21)Application number: 12702737.3

(22)Date of filing:  29.01.2012
(51)International Patent Classification (IPC): 
A61B 17/04(2006.01)
A61B 17/06(2006.01)
A61B 17/00(2006.01)
(86)International application number:
PCT/US2012/023056
(87)International publication number:
WO 2012/103536 (02.08.2012 Gazette  2012/31)

(54)

TISSUE REPAIR

GEWEBEREPARATUR

RÉPARATION TISSULAIRE


(84)Designated Contracting States:
AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

(30)Priority: 28.01.2011 US 201113016389

(43)Date of publication of application:
04.12.2013 Bulletin 2013/49

(60)Divisional application:
20185550.9

(73)Proprietor: Smith & Nephew, Inc.
Andover, MA 01810 (US)

(72)Inventors:
  • ASTORINO, Steven, William
    Norfolk, MA 02056 (US)
  • SORENSEN, Peter, Klindt
    Salem, MA 01970 (US)
  • MILLS, Laura, Lindsey
    Brighton, MA 02135 (US)

(74)Representative: Smith & Nephew 
Group Legal Department PO Box 81 101 Hessle Road
Hull HU3 2BN
Hull HU3 2BN (GB)


(56)References cited: : 
WO-A1-2007/005394
US-A1- 2007 016 244
US-A1- 2007 185 532
WO-A1-2009/029914
US-A1- 2007 156 174
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description

    TECHNICAL FIELD



    [0001] This disclosure relates to apparatus and methods for repairing tissue, and more particularly, to apparatus and methods for coupling soft tissue to bone.

    BACKGROUND



    [0002] Arthroscopic procedures using sutures and suture anchors have been used in tissue repair to, for example, secure soft tissue to bone. Suture anchors, such as metallic or other absorbable or non-absorbable polymer materials, tend to displace a certain volume of bone to provide adequate fixation strength. The larger a necessary repair may require multiple anchors to properly reattach torn soft tissue to bone. The size of many of these anchors can limit the number and location of fixation points as well as affect the anatomic nature of some tissue repairs. Small anchors typically do not provide sufficient holding strength to be effective in some tissue repair procedures or certain bone areas. WO 2007/005394 A1 discloses the features of the preamble of claim 1 and describes a tissue anchor including a flexible anchor member and an activation member. WO 2009/029914 A1 discloses a closure device configured to bunch within a tissue tract.

    SUMMARY



    [0003] The invention is defined in the appended claims. In one general aspect, an apparatus comprises a flexible fixation member comprising a body with a longitudinal extent and a width, the body defining a plurality of openings through the body, each of the plurality of openings formed substantially cross wise through the width of the body, and a suture comprising two terminal ends, the suture being interwoven through each of the plurality of openings in the body of the fixation member such that multiple portions of the fixation member are slidably coupled to the suture and configurable to form a cluster within a surgical site.

    [0004] Implementations may include one or more of the following features. For example, the flexible fixation member comprises one of a suture, tape, braid, or mesh. The flexible

    [0005] Implementations may include one or more of the following features. For example, the flexible fixation member comprises one of a suture, tape, braid, or mesh. The flexible fixation member is non-tubular. The flexible fixation member and the suture comprise a size 2 suture. The apparatus further comprises a delivery device comprising a cannula configured to receive the flexible fixation member therein. The delivery device further comprises an elongated member configured to slide within the cannula from a retracted position to an advanced position and configured to eject the flexible fixation member from the cannula when the elongated member is in the advanced position. The portions of the fixation member are configured to slide relative to the suture to form a cluster comprising a group of folds within a surgical site. The suture is interwoven through the plurality of openings in the fixation member to form two substantially parallel tail sections of suture. The fixation member comprises at least one curved portion that comprises, in series along the curved portion, a first opening receiving a portion of one of the two parallel tail sections, a second and third opening receiving portions of the other of the two parallel tail sections, and a fourth opening receiving another portion of the one of the two parallel tail sections. The fixation member and the suture are formed from a material that is absorbable within a body of a patient. The fixation member comprises a biologic growth material. In addition, the apparatus further comprises a second suture having two terminal ends, the second suture being interwoven through each of the plurality of openings in the body of the fixation member such that portions of the fixation member are slidably coupled to the suture.

    [0006] In another general aspect, an assembly comprises a non-tubular tissue anchor formed from one of a suture, mesh, braid, or tape, the tissue anchor comprising a body with a longitudinal extent and a width, the body defining a plurality of openings along the longitudinal extent of the body and through the width of the body, a suture interwoven through each of the plurality of openings in the body of the tissue anchor such that portions of the tissue anchor are slidable relative to the suture and configurable to form a cluster within a surgical site, and a delivery device comprising a cannula configured to receive the flexible fixation member therein.

    [0007] Implementations may include one or more of the following features. For example, the delivery device further comprises an elongated member configured to slide within the cannula from a retracted position to an advanced position and configured to eject the flexible fixation member from the cannula when the elongated member is in the advanced position. The tissue anchor and the suture comprise a size 2 suture. The portions of the tissue anchor are configured to slide relative to the suture to form a cluster comprising a group of folds within a surgical site. The suture is interwoven through each of the plurality of openings in the tissue anchor to form two substantially parallel tail sections of suture. The tissue anchor and the suture are formed from a material that is absorbable within a body of a patient. The tissue anchor comprises a biologic growth material.

    [0008] In another general aspect, an apparatus comprises a tissue anchor comprising a plurality of connected knots, and a suture comprising two terminal ends, the suture passing through one or more of the plurality of connected knots such that the tissue anchor is slidably coupled to the suture.

    [0009] Implementations may include one or more of the following features. For example, the plurality of connected knots comprise, in sequence, a first square knot, two free alternating post half hitch knots, a second square knot, two free alternating post half hitch knots, and a third square knot. The suture passes through each of the first, second, and third square knots. The apparatus further comprises a second suture having two terminal ends, the second suture passing through one or more of the plurality of connected knots such that the tissue anchor is slidably coupled to the second suture. The tissue anchor and the suture are formed from a material that is absorbable within a body of a patient. The tissue anchor comprises a biologic growth material. The apparatus further comprises a delivery device comprising a cannula configured to receive the tissue anchor therein. The delivery device further comprises an elongated member configured to slide within the cannula from a retracted position to an advanced position and configured to eject the tissue anchor from the cannula when the elongated member is in the advanced position.

    [0010] In another general aspect, a wound closure assembly comprises a tissue anchor comprising a plurality of connected knots, and a suture comprising two terminal ends, the suture passing through one or more of the plurality of connected knots such that the tissue anchor is slidably coupled to the suture, and a delivery device comprising a cannula configured to receive the tissue anchor therein.

    [0011] Implementations may include one or more of the following features. For example, the delivery device further comprises an elongated member configured to slide within the cannula from a retracted position to an advanced position and configured to eject the tissue anchor from the cannula when the elongated member is in the advanced position.

    [0012] In another general aspect, a method of closing a tissue wound comprises delivering a wound closure device to a surgical site, the wound closure device comprising a flexible fixation member having a body with a longitudinal extent and a width, the body defining a plurality of openings through the body, each of the plurality of openings formed substantially cross wise through the width of the body, and a suture having two terminal ends, the suture being interwoven through each of the plurality of openings in the body of the fixation member such that multiple portions of the fixation member are slidably coupled to the suture and configurable to form a cluster within a surgical site, removing the flexible fixation member from the wound closure device at the surgical site, and pulling on the terminal ends of the suture to form a cluster of the multiple portions of the fixation member at the surgical site.

    [0013] Implementations may include one or more of the following features. For example, the method further comprises drilling a hole into the tissue. The removing step comprises ejecting the flexible fixation member from the device into the hole. The hole passes completely through the tissue and the delivering step comprises delivering the device through the hole and the removing step comprises placing the flexible fixation member on an opposite side of the hole. The method further comprises maintaining the wound closure device in position at the surgical site as the terminal ends of the suture are pulled to form the cluster of the multiple portions of the fixation member at the surgical site.

    [0014] In another general aspect, a method of closing a tissue wound, comprises delivering a wound closure device to a surgical site, the wound closure device comprising a tissue anchor having a plurality of connected knots, and a suture having two terminal ends, the suture passing through one or more of the plurality of connected knots such that the tissue anchor is slidably coupled to the suture, removing the tissue anchor from the wound closure device at the surgical site, and pulling on the terminal ends of the suture to form a cluster of the plurality of connected knots at the surgical site.

    [0015] Implementations may include one or more of the following features. For example, the method further comprises drilling a hole into the tissue. The removing step comprises ejecting the tissue anchor from the device into the hole. The hole passes completely through the tissue and the delivering step comprises delivering the device through the hole and the removing step comprises placing the tissue anchor on an opposite side of the hole. The method further comprises maintaining the wound closure device in position at the surgical site as the terminal ends of the suture are pulled to form the cluster of the plurality of connected knots at the surgical site.

    [0016] The details of one or more implementations of the disclosure are set forth in the accompanying drawings and the description below. Other features and advantages will be apparent from the description and drawings, and from the claims.

    DESCRIPTION OF DRAWINGS



    [0017] 

    FIG. 1A illustrates an implementation of a tissue repair apparatus.

    FIG. 1B illustrates another implementation of a tissue repair apparatus.

    FIG. 2 illustrates the tissue repair apparatus of FIG. 1A including an additional suture interwoven through the construct.

    FIG. 3 illustrates an alternative implementation of weaving the suture through the fixation member of FIG. 1A.

    FIG. 4 illustrates another implementation of a tissue repair apparatus.

    FIG. 5 illustrates the tissue repair apparatus of FIG. 4 including an additional suture interwoven through the construct.

    FIGS. 6A-6G illustrate implementations of delivery devices used for delivery and placement of the tissue repair apparatuses of FIGS. 1A-5 at a surgical site.


    DETAILED DESCRIPTION



    [0018] Referring to FIG. 1A, a tissue repair apparatus 100 includes a fixation member or anchor 10 and a flexible member or suture 20 interwoven through the fixation member 10. The fixation member 10 is formed of a malleable or flexible braided body 12 having a longitudinal extent extending between a first end 12a and a second end 12b and a width W. The body 12 defines a plurality of openings 14 formed crosswise through, or substantially along, the width W of the body 12. The suture 20 includes two terminal ends, 20a and 20b. One of the terminal ends 20a, 20b is passed through each of the openings 14 in the body 12 forming multiple curved portions 30 of the fixation member 10 and two substantially parallel sections 22, 24 of the suture 20. As shown in FIG. 1A, the curved portions 30 pass from one section 22, 24 to the other of the sections 22, 24 along the length of the fixation member 10 to form substantially S-shaped curved portions 30. The curved portions 30 may slide with respect to the suture 20 to form a cluster or bunch 30 including a number of folds as shown in FIG. 1C. The cluster 30, in conjunction with the terminal ends 20a, 20b, may be used to secure tissue within a surgical site as will be described in more detail below.

    [0019] In the implementation shown in FIG. 1A, the fixation member 10 and the suture 20 are made from size 2 non-tubularbraided sutures. However, the fixation member 10 may be a tape, mesh, tube, or other type of malleable or flexible structure, and the suture 20 may be made from a suture of different size depending upon the surgical procedure or application. For example, in another exemplary implementation, the fixation member 10 and/or the suture 20 are made from a flattened tubular suture. In addition, while the fixation member 10 of FIG. 1A includes at least four curved portions 30, other configurations are possible, such as the implementation shown in FIG. 1B, where the fixation member 10 has a smaller length dimension and therefore includes three curved portions 30 when the suture 20 is interwoven therethrough. In yet another implementation, the fixation member 10 can include two curved portions 30 and be formed substantially in a S-shaped configuration. Varying the length and width dimensions of the fixation member 10, and/or varying the size of the suture 20, and/or the number of openings through the fixation member 10 through which the suture 20 passes, may affect the size of the cluster 30 formed by the fixation member 10 within the surgical site. These varying configurations may provide the user with flexibility to meet the needs for a number of various surgical procedures.

    [0020] Referring to FIG. 2, the tissue repair apparatus 100 of FIG. 1A may also include an additional flexible member or suture 40 having two terminal ends 40a, 40b. One of the two ends 40a, 40b may be interwoven around or through the fixation member 20 forming a construct yielding four free ends 20a, 20b, 40a, and 40b. An apparatus with four free ends may have advantages over two free ends in certain implementations. For example, in some applications, such as rotator cuff repair, it is often necessary to tie down the tissue to the bone at two locations in order to secure the tissue to the bone. In these applications, providing four free ends with only one fixation member within the bone reduces the number of fixation members needed, which may lower procedure time and cost. Reducing the number of fixation members may also reduce the risk of stress concentrations due to multiple drilled holes causing a risk of fracture at the repair site post-operatively.

    [0021] Referring to FIG. 3, an alternative implementation of weaving the suture 20 through the fixation member 10 of FIG. 1A is illustrated. One of the terminal ends 20a, 20b is passed through each of the openings 14 in the body 12 forming multiple curved portions 3 0 of the fixation member 10 and two substantially parallel sections 22, 24 of the suture 20. Unlike the curved portions 30 formed by the weaving pattern illustrated in FIG. 1A, the curved portions 30 of FIG. 3 do not pass from one tail section 22, 24 to the other of the tail sections 22, 24 along the length of the fixation member 10 to form substantially S-shaped curved portions 30. Instead, in the implementation shown in FIG. 3, curved portions 30 form substantially S-shaped curved portions 30 along the length of the portion of the suture 10 that is interwoven through the fixation member 10. This weaving pattern may allow for a smaller diameter hole to be drilled into bone for receiving the fixation member 10, which may aid in the reduction of stress concentrations and fracture. In addition, the weaving pattern may permit access to surgical sites that are too small or confined for existing tissue anchor assemblies.

    [0022] Referring to FIG. 4, in another implementation, an apparatus for tissue repair 200 includes a fixation member or anchor 210 and the flexible member or suture 20 interwoven through the fixation member 210. The fixation member 210 may be formed as a sequence of connected knots 215. In the particular implementation shown in FIG. 4, the sequence of knots 215 includes a square knot 220, two free alternating post half hitch knots 222, 224, a square knot 226, two free alternating post half hitch knots 228, 230, and a square knot 232. The suture 20 may pass through each of the square knots 220, 226, and 232, or any combination of one or more openings formed by the connected knots 215 that permits the fixation member 210 to slide relative to the suture 20 so that the fixation member 210 may form a cluster or bunch within the surgical site and cooperate with the suture 20 to secure tissue within the surgical site as will be described in more detail below. The fixation member 210 and the suture 20 are made from size 2 braided sutures, however, other suture sizes may be employed or tailored for, for example, drill size and strength requirements.

    [0023] Referring to FIG. 5, the tissue repair apparatus 200 of FIG. 4 may also include an additional flexible member or suture 40 having two terminal ends 40a, 40b. One of the two ends 40a, 40b may be interwoven around or through the fixation member 210, and more particularly, through one or more openings formed by the sequence of knots 215, forming a construct yielding four free ends 20a, 20b, 40a, and 40b. As discussed above, an apparatus with four free ends may have advantages over two free ends in various implementations.

    [0024] FIGS. 6A-6E represent a tool or delivery device 300 used to deliver any one of the fixation members 10, 210 described with respect to FIGS. 1A, 1B, and 2-3 to a surgical site for repairing, as an example, soft tissue 314. Referring to FIG. 6A, the delivery device 300 includes an inserter tube or cannula 302. One of the fixation members 10, 210 is loaded into the tube or cannula 302 as shown by the arrow in FIG. 6A such that the free ends 20a, 20b of the suture 20 extend through a proximal end 302a of the inserter tube 302 such that the free ends 20a, 20b may be manipulated by a physician. As shown in FIG. 6B, a drill guide 304 is placed within the surgical site 400 and a drill (not shown) is placed within the drill guide 304 and is used to drill a hole 306 of sufficient depth through the cortical layer 310 and into the cancellous bone tissue 312. Alternatively, the drill may be used to drill completely through the cancellous bone tissue 312 in the case of transosseous repair applications. Once the hole 306 is formed in the surgical site 400, the inserter tube 302 containing the loaded fixation member 10, 210 is inserted through the drill guide 304 and into a desired position at the surgical site 400, for example, the inserter tube 302 is tapped into the cortical layer 310..

    [0025] Referring to FIG. 6C, the inserter tube 302 may then be moved or tapped further into the hole 306 with the fixation member 10, 210 remaining in position within the inserter tube 302. Once the tube 302 is in the desired position within the hole 306, the user may then draw the inserter tube 302 back leaving the fixation member 10, 210 within the hole 306 in the bone (FIG. 6D), or alternatively, on an opposite side of the bone in a transosseous application.

    [0026] Referring to FIG. 6E, with the fixation member 10, 210 positioned within the hole 306 and a distal end 302b of the inserter tube 302 positioned at the surgical site 400, for example, at or below the cortical layer 310, the user may then pull on one or both of the free ends 20a, 20b of the suture 20. Pulling one or both of the free ends 20a, 20b (and/or the free ends 40a, 40b in those implementations employing two sutures, such as sutures 20, 40 shown in FIG. 2) causes the fixation member 10, 210 to seat against the distal end 302b of the inserter tube 302. As the user continues to pull one or both of the free ends 20a, 20b, the fixation member 10, 210 slides relative to the suture 20, and more particularly, the curved portions 30 of the fixation member 10, or the sequence of knots 215 of the fixation member 210, slide relative to the suture 20 to come together to form a bunch or cluster 30 within the hole 306, for example, at or below the cortical layer 310. With the fixation member 10, 210 in the desired position, the user may then remove the inserter tube 302 and drill guide 304 from the surgical site 400 and tie the free ends 20a, 20b (and/or the free ends 40a, 40b) to secure the tissue 314 to the bone 312.

    [0027] Maintaining the inserter tube 302 in place throughout insertion and deployment of the fixation member 10, 210 into the surgical site 400 may provide the user with tactile feedback that the fixation member 10, 210 is seated against the inserter tube 302. This may be advantageous over procedures that rely instead on the cortical layer 310 to provide a hard-stop against deployment of the fixation member 10, 210 within the surgical site 400. In those systems, the user feels a fixation member seat or deploy once it contacts the cortical layer 310, which is of various densities across patients. Therefore, the cortical layer 310 in some patients may feel like a hard stop, and in some patients may feel like a soft stop. Thus, there is an increased risk of pulling the fixation member out when trying to deploy or seat the fixation member when relying on the cortical layer to provide a stop to fixation member deployment. In contrast, in the present implementation, the user is provided with a tactile feedback through the inserter tube 302 that the fixation member 10, 210 has deployed and has formed the requisite bunch or cluster within the surgical site 400. This helps reduce the risk of pulling the fixation member 10, 210 out when deploying and seating the fixation member 10, 210.

    [0028] A number of implementations of the invention have been described. Nevertheless, it will be understood that various modifications may be made. For example, the fixation members and the flexible members may include a growth factor, such as, for example, an angiogenic factor. The fixation members and the flexible members may also be loaded with a bioactive material, a stimulant, or any substance that promotes healing of the tissue. In addition, while the openings formed in the body of the fixation member are described as being formed substantially crosswise through the body, they may be formed in other orientations depending on the particular application. Moreover, the openings may be formed in the body of the fixation member prior to passing the flexible member through the openings, or the opening may be formed by passing the flexible member through the body of the fixation member, such as, for example, by passing a needle loaded with the flexible member through the body of the fixation member to form a desired number of openings in the fixation member.

    [0029] In addition, although the process has been described for applications where the fixation member is secured within a hole drilled into bone, the fixation members may also be used in transosseous applications where the depth of the hole is not a constraint. In these applications, the fixation member may be passed entirely through the hole and secured on the backside of the bone. In an alternative implementation (FIG. 6F), the inserter tube 302 may be maintained on top of the cortical layer 310 throughout insertion of the fixation member 10, 210 into the hole 306. In such an implementation, the delivery device 300 includes a slide member 320 disposed within the inserter tube 302 and coupled to the fixation member 10, 210. The user may move the slide member 320 forward within the inserter tube 302 to deploy the fixation member 10, 210 from the inserter tube 302 and into the hole 306. In yet another alternative implementation (FIG. 6G), the delivery device 300 may include a tube 330 placed through the drill guide 304. The tube 330 is tapped into the cortical layer 310 and then receives the inserter tube 302 therethrough. In addition, although the delivery device 300, including the inserter tube 302, has been shown with a straight configuration, the delivery device 300, including the inserter tube 302, may have a curved shape or other suitable configuration depending on the particular surgical location and procedure to be performed.

    [0030] Moreover, in addition to the particular knot sequence described with respect to the fixation member 210 of FIG. 4, it should be understood that various knot sequences and sizes, and suture sizes, may be used depending on the particular application. Accordingly, other implementations are within the scope of the following claims.


    Claims

    1. A tissue anchor apparatus for coupling soft tissue to bone comprising:

    a flexible fixation member (10) comprising a body with a longitudinal extent and a width, the body defining a plurality of openings through the body, each of the plurality of openings formed substantially cross wise through the width of the body; and

    a suture (20) comprising two terminal ends, the suture being interwoven through each of the plurality of openings (14) in the body of the fixation member (10) to form two substantially parallel tail sections of suture (20) and such that multiple portions of the fixation member (10) are slidably coupled to the suture (20) and configurable to form a cluster within a bone hole at a surgical site to secure the fixation member in the bone hole and anchor the suture to the bone,

    wherein the portions of the fixation member comprise substantially S-shaped curved portions along the length of the portion of the suture (14) interwoven through the fixation member,

    characterized in that the S-shaped curved portions do not pass from one tail section to the other.


     
    2. The apparatus of claim 1, wherein the flexible fixation member (10) comprises one of a suture, tape, braid, or mesh.
     
    3. The apparatus of claim 1, wherein the flexible fixation member (10) is non-tubular.
     
    4. The apparatus of any one of claims 1 to 3, further comprising a delivery device comprising a cannula configured to receive the flexible fixation member (10) therein.
     
    5. The apparatus of claim 4, wherein the delivery device further comprises an elongated member configured to slide within the cannula from a retracted position to an advanced position and configured to eject the flexible fixation member (10) from the cannula when the elongated member is in the advanced position.
     
    6. The apparatus of any one of claims 1 to 5, wherein the portions of the fixation member (10) are configured to slide relative to the suture (20) to form a cluster comprising a group of folds within a surgical site.
     
    7. The apparatus of any one of claims 1 to 6, wherein the fixation member (10) and the suture are formed from a material that is absorbable within a body of a patient.
     
    8. The apparatus of any one of claims 1 to 7, wherein the fixation member (10) comprises a biologic growth material.
     
    9. The apparatus of any one of claims 1 to 8, further comprising a second suture having two terminal ends, the second suture being interwoven through each of the plurality of openings (14) in the body of the fixation member (10) such that portions of the fixation member (10) are slidably coupled to the suture.
     
    10. The apparatus of claim 1, wherein the fixation member has a first end and a second end and wherein, compared with the second end of the flexible fixation member, the first end of the flexible fixation member is closer to the first free terminal end (20a) of the suture (20), wherein the S-shaped curved portions are formed along the first parallel tail section and the second parallel tail section.
     
    11. The apparatus of claim 1, wherein the curved portions comprise, in series along the curved portions, a first and a second opening each receiving a portion of a first one of the two parallel tail sections, and a third and a fourth opening each receiving a portion of a second one of the two parallel tail sections, wherein the S-shaped curved portions are formed along the first parallel tail section and the second parallel tail section.
     


    Ansprüche

    1. Ein Gewebeankergerät zum Koppeln von Weichgewebe an Knochen, das Folgendes beinhaltet:

    ein flexibles Fixierungselement (10), das einen Körper mit einer Längsausdehnung und einer Breite beinhaltet, wobei der Körper eine Vielzahl von Öffnungen durch den Körper definiert, wobei jede der Vielzahl von Öffnungen im Wesentlichen kreuzweise durch die Breite des Körpers gebildet ist; und

    ein Nahtmaterial (20), das zwei terminale Enden beinhaltet, wobei das Nahtmaterial durch jede der Vielzahl von Öffnungen (14) in dem Körper des Fixierungselements (10) verflochten ist, um zwei im Wesentlichen parallele Schwanzabschnitte des Nahtmaterials (20) zu bilden, und, sodass mehrere Teile des Fixierungselements (10) verschiebbar mit dem Nahtmaterial (20) gekoppelt und konfigurierbar sind, um einen Cluster innerhalb eines Knochenlochs an einer Operationsstelle zu bilden, um das Fixierungselement in dem Knochenloch zu sichern und das Nahtmaterial an dem Knochen zu verankern,

    wobei die Teile des Fixierungselements im Wesentlichen S-förmig gekrümmte Teile entlang der Länge des Teils des Nahtmaterials (14) beinhalten, die durch das Fixierungselement verflochten sind,

    dadurch gekennzeichnet, dass die S-förmig gekrümmten Teile nicht von einem Schwanzteilabschnitt zum anderen verlaufen.


     
    2. Gerät gemäß Anspruch 1, wobei das flexible Fixierungselement (10) eines von einem Nahtmaterial, Band, Geflecht oder Netz beinhaltet.
     
    3. Gerät gemäß Anspruch 1, wobei das flexible Fixierungselement (10) nicht röhrenförmig ist.
     
    4. Gerät gemäß einem der Ansprüche 1 bis 3, ferner beinhaltend eine Abgabevorrichtung, beinhaltend eine Kanüle, die konfiguriert ist, um das flexible Fixierungselement (10) darin aufzunehmen.
     
    5. Gerät gemäß Anspruch 4, wobei die Abgabevorrichtung ferner ein längliches Element beinhaltet, das konfiguriert ist, um innerhalb der Kanüle von einer zurückgezogenen Position in eine vorgerückten Position verschoben zu werden, und konfiguriert ist, um das flexible Fixierungselement (10) aus der Kanüle auszuwerfen, wenn das längliche Element in der vorgerückten Position ist.
     
    6. Gerät gemäß einem der Ansprüche 1 bis 5, wobei die Teile des Fixierungselements (10) konfiguriert sind, um relativ zum Nahtmaterial (20) verschoben zu werden, um einen Cluster zu bilden, der eine Gruppe von Falten innerhalb einer Operationsstelle beinhaltet.
     
    7. Gerät gemäß einem der Ansprüche 1 bis 6, wobei das Fixierungselement (10) und das Nahtmaterial aus einem Material gebildet sind, das in einem Körper eines Patienten absorbierbar ist.
     
    8. Gerät gemäß einem der Ansprüche 1 bis 7, wobei das Fixierungselement (10) ein biologisches Wachstumsmaterial beinhaltet.
     
    9. Gerät gemäß einem der Ansprüche 1 bis 8, ferner beinhaltend ein zweites Nahtmaterial mit zwei terminalen Enden, wobei das zweite Nahtmaterial durch jede der Vielzahl von Öffnungen (14) in dem Körper des Fixierungselements (10) derart verflochten ist, dass Teile des Fixierungselements (10) verschiebbar mit dem Nahtmaterial gekoppelt sind.
     
    10. Gerät gemäß Anspruch 1, wobei das Fixierungselement ein erstes Ende und ein zweites Ende aufweist und wobei das erste Ende des flexiblen Fixierungselements im Vergleich zu dem zweiten Ende des flexiblen Fixierungselements näher am ersten freien terminalen Ende (20a) des Nahtmaterials (20) liegt, wobei die S-förmigen gekrümmten Teile entlang des ersten parallelen Schwanzabschnitts und des zweiten parallelen Schwanzabschnitts gebildet sind.
     
    11. Gerät gemäß Anspruch 1, wobei die gekrümmten Teile in Reihe entlang der gekrümmten Teile Folgendes beinhalten: eine erste und eine zweite Öffnung, die jeweils einen Teil eines ersten der zwei parallelen Schwanzabschnitte aufnehmen, und eine dritte und eine vierte Öffnung, die jeweils einen Teil eines zweiten der zwei parallelen Schwanzabschnitte aufnehmen, wobei die S-förmigen gekrümmten Teile entlang des ersten parallelen Schwanzabschnitts und des zweiten parallelen Schwanzabschnitts gebildet sind.
     


    Revendications

    1. Un appareil d'ancre pour tissu pour coupler du tissu mou à de l'os comprenant :

    un élément de fixation souple (10) comprenant un corps présentant une étendue longitudinale et une largeur, le corps définissant une pluralité d'ouvertures à travers le corps, chaque ouverture de la pluralité d'ouvertures étant formée de manière substantiellement transversale à travers la largeur du corps ; et

    un fil de suture (20) comprenant deux extrémités terminales, le fil de suture étant entrelacé à travers chaque ouverture de la pluralité d'ouvertures (14) dans le corps de l'élément de fixation (10) afin de former deux sections de queue substantiellement parallèles de fil de suture (20) et de telle sorte que des portions multiples de l'élément de fixation (10) sont couplés, de façon à pouvoir coulisser, au fil de suture (20) et

    peuvent être configurées afin de former un agrégat au sein d'un trou d'os au niveau d'un site chirurgical afin d'assujettir l'élément de fixation dans le trou d'os et d'ancrer le fil de suture à l'os,

    dans lequel les portions de l'élément de fixation comprennent des portions incurvées substantiellement conformées en S le long de la longueur de la portion du fil de suture (14) entrelacé à travers l'élément de fixation,

    caractérisé en ce que les portions incurvées conformées en S ne passent pas d'une section de queue à l'autre.


     
    2. L'appareil de la revendication 1, dans lequel l'élément de fixation souple (10) comprend un élément parmi un fil de suture, une bande, une tresse, ou un maillage.
     
    3. L'appareil de la revendication 1, dans lequel l'élément de fixation souple (10) est non tubulaire.
     
    4. L'appareil de n'importe laquelle des revendications 1 à 3, comprenant en outre un dispositif d'administration comprenant une canule configurée afin de recevoir l'élément de fixation souple (10) dans celle-ci.
     
    5. L'appareil de la revendication 4, dans lequel le dispositif d'administration comprend en outre un élément allongé configuré afin de coulisser au sein de la canule d'une position rétractée à une position avancée et configurée afin d'éjecter l'élément de fixation souple (10) de la canule lorsque l'élément allongé se trouve dans la position avancée.
     
    6. L'appareil de n'importe laquelle des revendications 1 à 5, dans lequel les portions de l'élément de fixation (10) sont configurées pour coulisser relativement au fil de suture (20) afin de former un agrégat comprenant un groupe de plis au sein d'un site chirurgical.
     
    7. L'appareil de n'importe laquelle des revendications 1 à 6, dans lequel l'élément de fixation (10) et le fil de suture sont formés à partir d'un matériau qui est absorbable au sein d'un corps d'un patient.
     
    8. L'appareil de n'importe laquelle des revendications 1 à 7, dans lequel l'élément de fixation (10) comprend un matériau de croissance biologique.
     
    9. L'appareil de n'importe laquelle des revendications 1 à 8, comprenant en outre un deuxième fil de suture ayant deux extrémités terminales, le deuxième fil de suture étant entrelacé à travers chaque ouverture de la pluralité d'ouvertures (14) dans le corps de l'élément de fixation (10) de telle sorte que des portions de l'élément de fixation (10) sont couplées, de façon à pouvoir coulisser, au fil de suture.
     
    10. L'appareil de la revendication 1, dans lequel l'élément de fixation a une première extrémité et une deuxième extrémité et dans lequel, comparé à la deuxième extrémité de l'élément de fixation souple, la première extrémité de l'élément de fixation souple est plus près de la première extrémité terminale libre (20a) du fil de suture (20), dans lequel les portions incurvées conformées en S sont formées le long de la première section de queue parallèle et de la deuxième section de queue parallèle.
     
    11. L'appareil de la revendication 1, dans lequel les portions incurvées comprennent, en série le long des portions incurvées, une première et une deuxième ouverture recevant chacune une portion d'une première section parmi les deux sections de queue parallèles, et une troisième et une quatrième ouverture recevant chacune une portion d'une deuxième section parmi les deux sections de queue parallèles, dans lequel les portions incurvées conformées en S sont formées le long de la première section de queue parallèle et de la deuxième section de queue parallèle.
     




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    Cited references

    REFERENCES CITED IN THE DESCRIPTION



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    Patent documents cited in the description