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Referring to FIGS. 87-90, the fastener 1040 can be a thumb screw having a cap 1052 and a shank 1054. The cap 1052 may have a relatively large diameter as compared to the shank 1054. The cap 1052 may fit over a head 1056 of the shank 1054 by way of an interference or friction fit. In one embodiment, the shank 1054 may include external threads that engage within an opening 1044 of the inferior grip plate 1038 or body 1006. In one embodiment, the shank 1054 includes a drive recess 1058. As desired, a user may remove the cap 1052 and use a driver (not shown) to apply high torque to the shank 1054 to increase a compression force on the superior grip plate 1036 and/or inferior grip plate 1038. |
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While certain embodiments, may not include one or more ridges 1042 on one or more of these components of the suture grip member 1010, having one or more ridges 1042 can enhance the engagement of the suture grip member 1010 with the suture. Such increased and/or enhanced engagement can enable greater tension to be applied to the suture coupled to the suture grip member 1010. |
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The superior grip plate 1036, inferior grip plate 1038, boss 1046, recess 1050, one or more ridges 1042, and fastener 1040 cooperate to engage and secure one or more portions of suture positioned between the superior grip plate 1036 and inferior grip plate 1038, and/or between the boss 1046 and a wall of the recess 1050, and/or a combination of these. The fastener 1040 can compress the superior grip plate 1036 against the inferior grip plate 1038 and thereby secure a portion of a suture between the two plates and to the suture grip member 1010. |
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The superior grip plate 1036 may also include a recess 1050. The recess 1050 may extend from an inferior surface of the superior grip plate 1036 into the superior grip plate 1036 but not extend completely through the superior grip plate 1036. In one embodiment, the recess 1050 is sized and shaped to receive the boss 1046. In one embodiment, the boss 1046 and recess 1050 are sized and shaped such that the boss 1046 can be inserted into the recess 1050 and have a clearance fit. In certain embodiments, the fit may be a friction fit. |
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FIG. 82 illustrates one embodiment of a superior grip plate 1036. As with the inferior grip plate 1038, the superior grip plate 1036 can have a variety of shapes such as circular, oval, ovoid, square, elliptical, rectangular, or the like. In the illustrated embodiment, the superior grip plate 1036 has a rectangular shape with two opposite curved ends that together form a slot shape. The superior grip plate 1036 can include an opening 1048 that extends through the superior grip plate 1036. The opening 1048 may be sized and shaped to receive the fastener 1040. |
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Referring now to FIG. 81, the suture grip member 1010 may include a boss 1046 that extends from one of the grip plates 1036, 1038. In certain embodiments, the boss 1046 may also include one or more ridges 1042. In the illustrated embodiment, the boss 1046 extends from the inferior grip plate 1038. |
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At least one opening formed through the sidewall 751 of the proximal member 704 and/or through the sidewall 750 of the anchor body 702 allows one or more sutures to be routed through the anchor body 702 without passing through the proximal end of the proximal member axially through the axial through bore 756. In the illustrative example of FIGS. 52-61, a first, superior “U”-shaped opening 758 is formed through the sidewall 751 near the distal end 754 and a second, inferior “U”-shaped opening 759 is formed through the sidewall 751 near the distal end 754 which may be opposite the first opening 758. |
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In one embodiment, the suture grip member 1010 includes superior grip plate 1036, an inferior grip plate 1038, and a fastener 1040. In certain embodiments, one or the other both the superior grip plate 1036 and the inferior grip plate 1038 can have one or more ridges 1042. |
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FIGS. 79, 81, and 82-90 illustrate different views of different parts of a suture grip member 1010 which may be part of the tensioner 1000 according to one embodiment. The tensioner 1000 is configured, and is operable, to engage the proximal member 704 of the suture anchor 700 and secure one or more sutures 1034, or portions of sutures. In one embodiment, the one or more sutures 1034, or portions of sutures may extend from the anchor body. The suture grip member 1010 serves to removably, and/or adjustably, engage and/or secure a suture or portion of suture to the carriage 1002 before, during, and/or after a surgical procedure. |
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FIGS. 79-81 illustrate a top view, a bottom view, and a front view of the carriage 1002 and puller 1004 of FIG. 66 according to one embodiment. Note, parts of the suture grip member 1010 are omitted in FIGS. 79 and 80. In the illustrated embodiment, the carriage 1002 and puller 1004 are positioned as they would be when assembled for use. In particular, the carriage 1002 and puller 1004 are aligned along a common longitudinal axis and the external threads 1032 of the puller 1004 may be engaged with internal threads 1018 of the carriage 1002. The carriage 1002 and/or puller 1004 can be made from a variety of materials including metal, wood, plastic, ceramic, and the like. |
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FIGS. 75-78 illustrate a top view, a bottom view, a right side view, and a left side view of the system of FIG. 66 according to one embodiment. These figures illustrate that in one embodiment, the shaft 902, carriage 1002, and puller 1004 are coaxial with a longitudinal axis 1005. In the illustrated embodiment, the suture anchor system 800 includes a connected suture anchor 700. FIGS. 75 and 77 illustrate at least two sutures 1034 secured to the suture grip member 1010, the sutures 1034 are under tension. |
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In certain embodiments, the puller 1004 can include external threads 1032 at, or near, the distal end 1030 of the puller 1004. The external threads 1032 can be configured with a suitable pitch and configuration such that the external threads 1032 can engage internal threads 1018 of the carriage 1002. Those of skill in the art of course appreciate that the carriage 1002 can include external threads and the puller 1004 can have corresponding internal threads. |
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FIG. 74 illustrates one example of a puller 1004. In one embodiment, the puller 1004 includes an elongated body 1022 and a second handle 1024. The elongated body 1022 may have a circular cross section and have a longitudinal axis that is coaxial with an opening 1026 that passes through the elongated body 1022 from a proximal end 1028 to a distal end 1030. The opening 1026 is sized, at least on the proximal end 1028, to allow the puller 1004 to accept the collar 908. In one embodiment, the opening 1026 has a larger diameter on the proximal end 1028 of the puller 1004 than at, or near, the distal end 1030 of the puller 1004. In certain embodiments, a diameter of the opening 1026 at the distal end 1030 is smaller than a diameter of the second section 920 of the shaft 902 such that the distal end 1030 can contact the one or more lips 928 but does not slide past the one or more lips 928 along the shaft 902. |
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The body 1006 can include an opening 1012 that passes through the body 1006 and is coaxial with a longitudinal axis of the carriage 1002. The carriage 1002 includes a proximal end 1014 and a distal end 1016. At the distal end 1016, the carriage 1002 includes internal threads 1018. The internal threads 1018 are configured to engage threads of a puller 1004. At the proximal end 1014, the carriage 1002 includes keyed opening 1020. The keyed opening 1020 is configured to accept the second section 920 of the shaft 902. In certain embodiments, FIG. 72 illustrates that the keyed opening 1020 may have a circular cross section and include opposite planar sides that correspond to the planar surfaces 924 on the shaft 902. |
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FIG. 30 is a rear view of the configuration of FIG. 29. |
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Referring to FIG. 37, the proximal portions of the sutures may be pulled to move the knots 420, 421 into the patient to a position adjacent to the rotator cuff 408. Since the suture strands have been kept separate by the suture keeper 300 and the surgical technique, the knots 420, 421 may be independently positioned and tensioned to provide precise control over the final position and tension of the rotator cuff 408. The distal ends 314, 315, 324, 325 of the suture pairs are passed through the loop 284 of the suture threader 280. |
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Referring to FIG. 36, a simple overhand knot 420, 421 has been tied in each suture pair. This may be done easily outside the cannula, outside of the patient’s body without the need for arthroscopic knot tying techniques. |
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Referring to FIG. 35, the second pair of suture strands 320, 321 has been passed through the rotator cuff 408 and the rotator cuff 408 has been repositioned to a desired lateral margin of the humerus. |
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Referring to FIG. 34, the first pair of suture strands 310, 311 has been passed through the rotator cuff 408. |
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Referring to FIG. 33, the suture shuttles 410, 412 have been pulled to shuttle the suture strands through the bone tunnels. |
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