Note: Descriptions are shown in the official language in which they were submitted.
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SUTURE COLLET
This invention relates to ~uLuLe fastening.
one traditional method of fastening ~uL~e is
5 simply by tying a knot in the ~uLu-e. Alternatively, a
~uLu~e clamp may be used, in a typical ~uLuLe clamp, the
~uLure is positioned between an open pair of arms which
are then pivoted closed to capture the ~uL~e between
them.
However, this method of fastening may not provide
sufficient holding power and it is an object of the
present invention to meet this need.
Accordingly, there is provided a suture securing
device comprising an outer -- h.~t~ and inner member, said
15 member defining a ~uLu-e receiving op~ning wherein said
inner member is configured for ~Lo~Lessive insertion
within said outer member to progressively constrict said
opening to secure a suture between said inner member and
said outer member.
A suture securing device includes an outer member
with a ~uI~Le receiving passage and an inner member
configured for progressive insertion within the ~uLur e
receiving passage and engagement with the outer member in
any one of a plurality of locked positions to secure a
25 suture between the inner member and the outer member.
Preferred embodiments may include one or more of
the following features.
The suture receiving passage includes a threaded
portion and the inner member includes a ridge for
30 ~yLessive engagement with threads of the threaded
portion. The inner member includes a plurality of ridges
for progressive engagement with the threads of the outer
member. The inner member defines a long axis and a
distal surface of the ridge is inclined relative to the
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long axis to slide post the threads during insertion, and
a proximal surface of the ridge is oriented perpendicular
to the long axis to lockingly engage the threads when the
inner member has been inserted within the ~uL~Le
5 receiving passage by a desired amount.
Preferably, the proximal end of the suture
receiving passage tapers distally from a wider diameter
to a smaller diameter, and a distal end of the inner
he~ is conically shaped. The taper and the conical
10 shape aid in the insertion of the inner member within the
suture receiving passage.
In another emhoA; -nt. an assembly is provided
comprising a suture securing cartridge which includes a
sleeve having an axial bore and a suture securing device
15 with an outer member ~i~ros~ in the bore at a distal end
of the sleeve and an inner member disposed in the bore
proximally of the outer member. The inner member being
configured for insertion into a suture receiving passage
in the outer member.
A carrier may be disposed in the bore proximally
of the outer member and the carrier engages the inner
mem~er to align the inner member with a suture receiving
passage. The carrier defines an opening and the inner
mem~er is disposed in the opening.
A proximal end of the sleeve may be configured to
receive an actuator for moving the inner member into the
suture receiving passage.
The sleeve may have a distal cl~mp for selectively
preventing the outer member from exiting the bore in a
30 distal direction. The distal clamp may include a
resilient arm which is outwardly flexible to permit the
outer - he~ to exit the bore in the distal direction.
The sleeve may include an inclined aperture
extending through a wall of the sleeve and a suture
35 threader extending through the inclined aperture and
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through the suture receiving passage. The suture
threader may include a cap covering an open end of the
bore at a proximal end of the sleeve.
In another embodiment, there is provided a
5 suturing apparatus includes the suture securing cartridge
and a drive tool having an outer sheath which fits over
the sleeve, an intermediate tube which engages the sleeve
to secure the cartridge to the drive tool, and a movable
element located within the intermediate tube for
10 progressively inserting the inner member into the passage
of the outer member.
Preferably, the sleeve has a circumference groove
in the bore, and the intermediate tube has a grasper
which engages the groove to secure the cartridge to the
15 drive tool.
Another aspect of the invention features a method
of securing a ~ LUL e. The method includes threading a
suture through a passage in an outer member, and
progressivçly inserting an inner member into the outer
20 member to engage the inner member with the outer member
in any one of a plurality of locked positions to secure
the ~u LU~ e between the inner member and the outer member.
In another emho~;ment r a method of using a suture
securing device includes providing a preassembled ~uLu-e
25 securing cartridge; inserting the preassembled ~uL~Le
securing cartridge into a drive tool; and advancing a
movable element of the drive tool to progressively insert
the inner member into the passage.
We have found that the holding power of ~uLuLe
30 securing device is substantially greater than that of a
st~n~rd open surgical knot.
Other features and advantages of the invention
will be apparent from the following detailed description,
and from the claims.
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-- 4
Fig. 1 shows a suture collet for securing ~LuLe;
Fig. 2 is a perspective view of the suture collet
of Fig. l;
Fig. 3 i8 a side view of an outer -- h~r of the
5 suture collet of Fig. l;
Fig. 3A is an end view of the outer member of
Fig~ 3, taken along lines 3A-3A;
Figs. 4 and 4A are side views (rotated by 90~ with
respect to each other) of an inner member of the ~Lure
lO collet of Fig. 1;
Fig. 4B i8 an end view of the inner member, taken
along lines 4B-4B of Fig. 4A;
Fig. 5 is a perspective view of the suture collet
with the inner and outer members interco~n~cted in a
15 first position;
Fig. 5A is a side view of the suture collet of
Fig. 5;
Fig. 6 is a side view of the suture collet of
Fig. 6, ta~en along lines 6A-6A;
20Fig. 7 shows a drive tool for use with the suture
collet of Fig. 1;
Figs. 8-8C show the drive tool in use with the
~uLu~e collet;
Fig. 9 shows an additional embodiment of a suture
25 collet for securing ff~ L~Le;
Fig. 10 is a cross-sectional view of an outer
member of the ~uLuLe collet of Fig. g;
~ig. 11 is a side view of an inner member of the
suture collet of Fig. 9;
30Fig. 12 is an exploded perspective view of a
cartridge and the ffuLuLe collet of Fig. 9;
Fig. 13 is a cross-sectional view of the cartridge
of Fig. 12 preloaded with the suture collet of Fig. g;
Fig. 14 is a side view of the inner member of
35 Fig. 11 shown with an attached extension;
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Fig. 15 shows a drive tool for use with the suture
collet of Fig. 9;
Figs. 16-16B show the drive tool in use with the
suture collet; and
Fig. 17 is a side view of an alternative
embodiment of a drive tool.
Referring to Fig. 1, a suture collet 10 is used in
place of conventional securing t~c~niques (e.g. ~not
tying) to secure a ~LuLe 8 in place. Su~u~ e collet 10
10 can be used in a wide variety of applications--in the
operation shown schematically in Fig. 1, suture collet 10
clamps a loop of suture 8 in place between a ligament 2
and a bone 4 (suture 8 is attached to bone 4 by a suture
anchor 6 or other suitable device). As discussed in more
15 detail below, suture collet lO includes an outer locking
ring 12 and an inner locking pin 14 each of which include
inclined clamping surfaces which progressively constrict
~uLu~e openings (and thus securely fasten suture 8 in
place) when pin 14 is inserted into ring 12.
Referring to Fig. 2, suture collet 10 is shown in
more detail. Ring 12 includes an axially-oriented
cylindrical bore 16. A portion of the interior surface
of ring 12 which defines bore 16 is threaded 36. Pin 14
is generally cylindrical in shape and is sized to enter
25 bore 16. A portion of the exterior surface of pin 14
includes a series Of axially spaced ridges 22 for
lockingly engaging threads 36 in a ratchet~ e ~nn~
when pin 14 is inserted into bore 16 and secure ring 12
and pin 14 together.
Ring 12 includes a pair of ~ lly oriented,
inclined tunnels 18, 20 which intersect bore 16. A pair
of inclined, concave surfaces 24, 26 (Fig. 4A) on the
exterior of pin 14 are circumferentially aligned with
tunnels 18, 20 when pin 14 is inserted into ring 12 to
35 respectively define a pair of suture receiving openings
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52, 53 (Fig. 5) through which suture 9 (Fig. 1) is
passed. AB ~ C11.C~ 3 in more detail below, as pin 14 is
inserted axially into bore 16 (in the direction of arrow
34, Fig. 2), inclined surfaces 24, 26 slide axially with
5 respect the inclined surfaces which define tllnn~ls 18,
20, thereby progressively constricting suture receiving
op-~n; ngS 52, 53 and securely clamping ~uLu~e 8 therein.
The inclined nature of these clamping surfaces provides a
significant -ch~n ical advantage during insertion ~;o that
10 the clamping force applied to suture 6 ~~YC~ the force
used to insert pin 14 into ring 12.
Referring to Figs. 3 and 3A, ring 12 is shown in
more detail. Threaded bore 16 extends completely through
ring 12, from proximal end 12a to distal end 12b, along a
15 longi~ in~l central axis 44 of ring 12. Tunnels 18, 20
are diametrically opposed (i.e., spaced by 180 degrees)
at the periphery of bore 16 and extend axially from ring
proximal end 12a along axes 40, 42 respectively. Tunnels
18, 20 interrupt, concave smooth surfaces 19, 21,
20 (Fig. 3A) which are spaced from axes 40, 42 by a radius
45 of, e.g. 0.012 inches.
Tunnel axes 40, 42 are inclined with respect to
longi~ inA1 axis 44, and thus tunnels 18, 20 decrease in
cross-sectional area (from a maximum at prox; -l end 12a)
25 as they extend axially along bore 16. The angle at which
tunnels 18, 20 are inclined is between about 5~ and 20~,
and preferably is 11~. Each tunnel 18, 20 ends
approximately mid-way between proximal and distal ends
12a, 12b. The walls 13 of ring 12 are relatively
30 constant in thickness along the length of ring 12. Thus,
proximal end 12a has a flared outer diameter with respect
to distal end 12b.
Referring to Figs. 4-4B, the circumferentially
oriented ridges 22 of pin 14 are axially spaced along pin
35 14 between proximal end 14a and distal end 14b. The
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leading (distal) surfaces of ridges 22 inclined (e.g. at
45 degrees) to slide past threads 36 of ring 12 during
insertion, and the trailing (proximal) surfaces of ridges
22 are transversely oriented to lockingly engaging
5 threads 36 when pin 14 has been inserted by the desired
amount. A pair of diametrically opposed tunnels 24, 26
which interrupt ridges 22 are formed in the exterior
surface of pin 14. Tunnels 24, 26 are respectively
defined by concave inclined surfaces 25, 27 (Fig. 4A)
10 which are respectively spaced from tunnel axes 46, 48 by
a radius 51 of, e.g. 0.012 inches.
Tunnel axes 46, 48 are inclined with respect to
the longitll~; nA 1 axis 50 of pin 14. The inclined angle
is, e.g. between about 5~ and 20~, and preferably is 11~;
15 not that in the embodiment shown, tllnnels 24, 26 are
inclined at the same angle as ring tunnels 18, 20, but
they needn't be. Accordingly, tunnels 24, 26 taper from
a maximum cross-sectional area at their distal end (near
pin distal end 14b) and terminate near prox; ~1 end 14a.
Distal end 14b of pin 14 is noncylindrical and
includes a pair of flat, bevelled surfaces 30a (only one
of which is shown in Fig. 4) which are tapered together
and meet along a straight edge 30 at the extreme distal
tip of pin 14. As disc~lcce~ below, bevelled surfaces 3~a
25 help guide ~LuLe 8 into ~L~re receiving open;ngs 52, 53
when pin 14 in inserted into ring 12. Pin 14 can
optionally include a proximal opening 49 for receiving a
drive pin.
The overall size of suture collet 10 with pin 14
30 inserted into ring 12 corresponds approximately to the
cize of three successive throws of a ~uLuLe know. For
example, ring 12 is 0.15 inches along and has a maximum
outer diameter of 0.14 inches; pin 14 i5 only 0.095
inches long (and thus can fit entirely within ring 12)
35 and has a maximum outer diameter of 0.045 inches. Ring
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12 and pin 14 can be made from a non-absorbable material
such as polyacetal available from M. Holland Co.,
Northbrook, Ill., or a bio-absorbable mat~rial, such as
Maxon, a polyglyconate, available from Davis & Geck.
~eferring to Figs. 5 and 5A, ~uLure collet 10
clamps ~ L~Le as follows. After suture (not shown) has
been r~s~ through bore 16 (a tool and proc~7~e for
doing so are described below) and positioned within
tunnels 18, 20, pin 14 is inserted into ring 12 so that
10 tunnels 18, 24 are aligned (to define ~uLuLe receiving
opening 52) and tl~nnels 20, 26 are aligned (which defines
~L~.e receiving opening 53). Bevelled surfaces 30a of
pin distal end, 14b help guide the ~Lule into ttlnn~l~
24, 2S as pin 14 enters ring 12. With pin 14 partially
15 inserted into ring 12 in the Position shown in Figs. 5
and 6A, ~uL~re receiving openin~s 52 and 53 are circular
in cross section and form elongated, cylindrical channels
70 and 72 between ring 12 and pin 14. At this point,
channels 70, 72 have a diameter 54 of about 0.024 inches.
20 The radius of the tllnn~, and thus the diameter of the
channels in the position shown in Figs. 5 and 5A, is
selected to correspond to a particular size of suture,
the suture is the illustrated embodiment being a #2
~uLur e with a diameter of about 0.020 to o. 023 i nch~.
Referring also to Figs. 6 and 6A, as pin 14 is
~L~yr essively advanced into ring 12, pin inclined
surfaces 26, 27 slide axially with respect to ring
inclined surfaces 19, 21 respectively, thereby
progressively constructing ~u~e receiving op~nings 52,
30 53 (and channels 70, 72 formed thereby) and clamping the
suture (not known) therein. Openings 52, 53 lose their
circular cross section and become ~ essively more
oblong (Fig. 6A~ as pin 14 is inserted still further.
With pin 14 fully inserted (Fig. 5), suture receiving
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openings 52, 63 have a short dimension 56 of about 0.001
inches and a long fl; ?~:ion 58 of about 0.015 inches.
This ~o~lessive construction of suture receiving
openings 52, 53 compresses the suture thread located
5 therein to securely clamp the suture in place therein.
Similarly to the action of a door wedge--which pro~ a
strong force at right angles to the direction of movement
as the wedge is inserted under a door--the movement of
inclined surfaces 25, 27 of pin 14 toward inclined
lo surfaces 19, 21 or ring 12 exerts a strong radial force
Fl (Fig. 6) on the ~uLuLe thread. The mec-h~nical
advantage gained with the inclined surfaces results in
radial force Fl being greater than the axial force F2
re~uired to insert pin 14 into ring 12.
Figs. 7 and 8 illustrate instruments which can be
used to emplace suture collet 10 in the body and insert
pin 14 into ring 12 to clamp suture in place in the
manner discussed above. A cartridge 80 which carries
ring 12 and pin 14 is shown in Fig. 7. Cartridge 80
20 includes a hollow sleeve 82 the distal end of which is
provided with a pair of axial slots 130, 132 to define a
pair of resilient arms 134, 136 which form a clamp 88 to
hold suture collet ring 12 in place therebetween. Arms
134, 136 are curved to conform to the shape of ~uLuLe
25 collet ring 12, and interior lips 90 on arms 134, 136
snap fit (due to the resiliency of arms 134, 136) within
a circular groove 92 in ring 12 ~groove 92 is not shown
in Figs~ 1-6A and may be omitted).
Sleeve 82 has a generally cylindrical exterior
30 surface, but includes a r~A-1ceA diameter waist proximally
of the proximal ends of slots 130, 132 for purposes to be
described. The outer diameter of arms 134, 136 is
enlarged relative to that of the remainder of sleeve 82,
such that a shoulder 95 is defined, al80 for purposes to
35 be disclosed. As shown in Fig. 8, an axial passage 94
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extends through sleeve 82. Pin 14 is supported within
passage 94 by an interference fit with the walls of
pAqPA~e g4 to maintain pin 14 axially spaced from ring 12
until it is to be inserted into ring 12.
Cartridge 80 also includes a plunger 84 which is
slidable within and is approximately the same diameter as
passage 94. The proximal end of plunger 84 ~loL ~des
~rom the proximal end 82a of sleeve 82. ~he distal end
85 of plunger 84 is cone shaped and engages pin proximal
10 end 14a. The cone chAre~ distal end 85 acts to centre
the drive load opening 49, the cone shaped distal end is
received in the opening.
A suture threader which includes a collar 88
slidable over an outer tube 114 of a delivery system 110
15 is used to thread ~uL~.e through ring 12 during
operation. Collar 86 is connected to the proximal ends
of a pair of suture threader wires 98, 100 which
respectively pass through slots 130, 132 and into passage
94. With collar 88 held in the position shown in Fig. 7
20 by an interference fit over clamp 88, the free ends of
wires 98, 100 pass through bore 16 of suture collet ring
12 and terminate in a pair of thre~; ng loops 102, 104,
respectively.
Referring in particular to Fig. 8, delivery system
25 110 is used to convey cartridge 80 (preloaded with ring
12 and pin 14) to the surgical site, delivery system 110
includes a hollow grasper 112 ~OAY; Al ly disposed within a
slidable outer tube 114. Grasper 112 has a pair of
flexible arms 120, 122 the distal ends 124, 126 of which
30 are configured to fit within narrow waste 128 of sleeve
82. An actuator 116 is slidable within grasper 112 to
engage and actuate cartridge plunger 84.
Cartridge 80 is inserted into delivery system 110
by retracting outer tube 114 distally (in the direction
35 of arrow 118) to expose grasper ends 124, 126 and allow
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them to flex outwardly. Cartridge 80 is then inserted
between grasper arms 120, 122, until ends 124, 126 reach
and snap ~it within waist 128. Outer tube 114 is then
returned to the position shown in Fig. 8, in which the
5 di~;tal ends of tube 114 engages shoulder 88a sleeve 82.
Delivery system 110 is now ready to install suture collet
10 in the body.
Referring also to Figs. 8A-8C, suture collet 110
is emplaced with delivery system 110 as ~ollows. For
10 example, as a preliminary step, suture 6 can be mounted
to bone 4 with anchor 6 and tied through ligament 2
(Fig. 1). The user then passes the ends o~ xuL~Ile 8
(which may now be positioned inside or outside of the
body) through threading loops 102, 104 (Fig. 7) and
15 retracts outer tube 114 to expose slots 130, 132
(Fig. 8A). Next, suture threader collar 85 is moved
proximally (arrow 118) to pull the ends of :juLu~e 8
through suture collet ring 12, pz~:c~ge 94, and slots 130,
132. Outer tube 114 is then allowed to return to its
20 extended position against clamp 88. Delivery system 110
is then advanced, for example, through a conventional
trocar used in arthroscopic or laproscopic surgery, to
the fixation site.
Referring to Fig. 8B, delivery system 110 is
25 maneuvered at the surgical site to position suture collet
ring 12 as desired (e.g. against the upper surface of
ligament 2, Fig. 1). Note that in the configuration
shown, outer tube 114 envelopes all but the distal ends
of clamping arms 134, 136, thereby holding them securely
30 in place against suture collet ring 12. The user then
advances actuator 116 distally (along arrow 139), thereby
driving plunger 84 distally to slide pin 14 axially into
bore 10 of locking ring 12. As discussed above, the
insertion o~ pin 14 securely clamps suture 8 within
35 ~ ,e receiving openings 52, 53. Tube 114 holds suture
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collet ring 12 securely in place while pin 14 is being
inserted. (Note that with tube 1 14 extended, suture 8
exits slots 130 and 132 in distal regions 131 exposed by
tube 114).
Referring to Fig. 8C, the assembled suture collet
10 is removed from cartridge 80 simply by retracting
outer tube 114 proximally to unsheath clamp 88, advancing
actuator 116 further distally, thereby driving plunger 84
further distally which pushes suture collet 10 distally
10 releasing the suture collet from cartridge 80, followed
by pulling the delivery system proximally as a unit. The
retraction of outer tube 114 permits clamping arms 134,
136 to flex outwardly,
Note that the placement of suture 8 within ring 12
15 acts as the first throw of the suture knot to reduce the
tissue and allows sliding travel of the ~lL~lLe much like
the first throw of a conventional knot. ~he frictionless
contact between ring 12 and the suture permits the
surgeon to feel how much tension is being put into the
20 ~i~;sue even more precisely than the first throw of a
conventional knot which has some friction. This is
particularly advantageous when suturing v~c~-c with thin
walls or suturing delicate tissue. In addition, the
tension on the suture, instead of acting to pull the
25 ~u~lLe loose, increases the holding force on the ~uLu~e
applied by ~-lLule collet 10.
Referring to Fig. 9, in a preferred embo~i ~nt, a
suture collet 210 includes an outer locking ring 212 and
an inner locking pin 214 which securely fasten ~llL~I~e 8
30 in place when pin 214 is inserted into ring 212.
Referring to Fig. 10, ring 212 includes an
axially--oriented cylindrical bore 216. A portion of the
interior surface of,ring 212 which defines bore 216 is
threaded 236. Bore 216 extends completely through ring
35 212, from proximal end 212a to distal end 212b, along
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longit~l~;n~ central axis 244 or ring 212. Bore 216 is
tapered 216a from a larger diameter at proximal end 212a
to a smaller diameter where threads 236 begin at 216b.
Ring 212 has an outer diameter, D2, of 0.123 inches over
5 the majority 236a of its length, and a smaller outer
diameter, D2, of 0.105 ; nr-hec over the remainder 236b of
its length. A circumferential ledge 220 is located at
the junction of diameters D1 and D2.
Referring to ~ig. 11, pin 214 is generally
10 cylindrical in shape and is sized to enter bore 216. A
portion of the exterior surface of pin 214 includes a
series of axially spaced ridges 222 ~or lockingly
engaging ring threads 236 in a ratchet-like manner when
pin 214 i5 progressively inserted into bore 216 thus
1~ securing pin 214 in any one of a plurality of locked
positions in ring 212 to secure x~L~r e 8 between ring 212
and pin 214.
The circumferentially oriented ridges 222 of pin
214 are axially spaced along pin 214 between proximal end
20 214a and distal end 214b. The leading (distal) surfaces
222a o~ ridges 222 are inclined (e.g. at ~5 degrees)
relative to a long axis A of pin 214 to slide past
threads 236 of ring 212 during insertion, and the
trailing (proximal) surfaces 222b of ridges 222 are
25 oriented perpendicular to long axis A to lockingly
engaging threads 236 when pin 214 has been inserted by
the desired amount. Distal end 214b of pin 214 is
conically shaped to help guide pin 214 into bore 216.
Referring to Figs. 12 and 13, to aid in the
30 placement of suture collet 210, a cartridge 280 carries
ring 212 and pin 214 and couples to a drive tool,
described below, which inserts pin 214 into ring 212.
Cartridge 280 includes a hollow sleeve 282 with an axial
passage 294 ex~n~;ng completely through sleeve 262, from
35 pro~; -1 end 294a to distal end 294b. The distal end
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294b of ~leeve 282 is provided with a pair of axial slots
330 (only one slot being shown) to define a pair of
resilient arm 334, 336 which form a clamp 388 to hold
~uture collet ring 212 in place therebetween. Interior
5 lips 290 on arms 334, 336 form a close fit against the
smaller diameter regions 236b of ring 212.
Sleeve 282 has proximal slots 296, 298. Inclined
apertures 331, 333, and a circumferential yLoo~ 328 in
inner wall 282a of sleeve 282 for purposes to be
lo described. A distal end of arms 334, 336 has an enlarged
outer diameter relative to that of the remainder of
sleeve 282, such that a shoulder 295 is defined, also for
purposes to be discussed.
Pin 214 is ~ Led within passage 294 by a
15 carrier 215. Pin 214 is located within an opening 217 in
carrier 215 ext~n~ing from a proximal end 215a of carrier
215 to a distal end 215b. Carrier 215 acts to centre pin
214 within cartridge passage 294.
A suture threader 400 is used to thread suture
20 through ring 212 during operation. A proximal cap 402 is
connected to the proximal ends of a pair of ~Lu~e
threader wires 404, 406 which respectively pass through
apertures 331, 333 and into passages 294. The free ends
of wires 404, 331, 333 and into passage 294. The free
25 ends of wires 404, 406 pass through bore 216 o~ ~Lu~e
collet ring 212 and terminate in a pair of threading
loops 408, 410 respectively.
To assemble the cartridge assembly of Fig. 13,
ring 212 is first placed within rA~ e 204 and slid
30 forward so that ledge 220 engages lips 2gO. Wires 404,
408 of suture threader 400 are pA~ through apelL~Les
331, 333 and through ring bore 216. Pin 214 is then
placed within carrier 215 and carrier 215 with pin 214
are together placed within passage 294 and positioned
35 just pro~; -lly of ring 212.
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Referring to Fig. 14, to assist in the hAn~ll ing of
pin 214, a proximal extension 213 (not shown in Figs. 11
and 12) is formed on pin 214 which tapers distally to a
~mall neck 213a at proximal end 214a of pin 214. Neck
5 213a permits proximal extension 213 to be easily broken
off of pin 214 after pin 214 is inserted in Carrier 215.
With ring 212, pin 214, and carrier 215 in place, cap 402
of suture threader 400 is placed over passage opening
294a to contain the ring, pin and carrier within passage
10 294. Alternatively, cap 402 can be sized to fit within
passage 294 to plug proximal end 294a of cartridge 280.
Fig. 15 illustrates a drive instrument 350 which
can be used to emplace suture collet 210 in the body and
insert pin 214 into ring 212 to clamp suture in place in
15 the manner ~;~cll~ed above.
Referring also to Fig. 16, instrument 350 has an
outer sheath 360 which fits over sleeve 282. A distal
and 362 of outer sheath 360 engages shoulder 295 of
sleeve 282. outer sheath 360 includes axial slots 420,
20 422 aligned with apertures 331, 333 for passage of ~E~r e
8. A grasper 364 of instrument 350 has a circumferential
groove 366 with a distal ridge 370 configured to fit
within groove 328 of sleeve 282, and a shoulder 373 which
engages proximal end 294a of sleeve 252 to secure
25 cartridge 280 within instrument 350.
A plunger 376 is slidable within grasper 364 and
has a smaller diameter extension 378 which fits within
carrier 215 to engage pin 214 and progressively insert
pin 214 into passage 216 of ring 212. A spring (not
30 shown) biases plunger 376 away from engagement with pin
214. A ~e~on~ spring 377 acts to bias outer sheath 360
toward engagement with shoulder 295. Alternatively, a
position locking mechAn;sm (not shown) can serve to lack
outer sheath 360 in position against shoulder 295.
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Carrier 215 acts to centre pin 214 such that plunger 376
squarely engages pin 214.
Cartridge 280 with ring 212, pin 214, carrier 215,
~nd suture threader 400 preinstalled as described above,
5 is inserted into instrument 350 by retracting outer tube
360 proximally (in the direction of arrow 316) to e
grasper groove 366. Cartridge 280, with cap 402 moved
aside to expose passage 294, is then inserted onto
grasper 364 until distal ridge 370 reaches and snap fits
10 within groove 328. Proximal slots 296, 298 in sleeve 283
permit proximal end 294a of sleeve 282 to widen during
insertion of grasper 384. Outer tube 360 is then
returned to the position shown in Fig. 16 with spring 377
acting to maintain engagement of distal end 362 of tube
15 360 with shoulder 295 of sleeve 282. Instrument 350 is
now ready to install ~uLu~e collet 210 in the body.
Suture collet 210 is emplaced in the ~ody with
cartridge 280 and drive instrument 350 as follows. For
example, as a preliminary step, suture 8 can be mounted
20 to bone 4 with anchor 6 and pA~ce~ through ligament 2
(Fig. 9). The user then r~ ~C~c the ends of suture 8
(which may bow be positioned inside or outside of the
body) through threading loops 408, 410. Next, suture
threader 400 is moved proximally (arrow 318) using cap
25 402 to pull the ends of suture 8 through ~Lu~e collet
ring 212, apertures 331, 333 and slots 420, 422.
Instrument 350 is then advanced, for example, through a
conventional trocar used in arthroscopic or laproscopic
surgery, to the fixation site.
Referring to Fig. 16A, inxLLl -nt 350 is
manoeuvred at the surgical site to position suture collet
ring 212 as desired (e.g., against the upper surface of
ligament 2, Fig. 9). Note that in the configuration
shown, outer tube 360 envelopes all but the distal ends
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of clamping arms 334, 336, thereby holding them securely
in place against ~uL~-e collet ring 212. The user then
advances plunger 376 distally (along arrow 339), thereby
driving plunger extension 378 distally. Plunger 376 acts
5 to initially slide carrier 215 with pin 214 distally.
When carrier 215 contacts ring 212, carrier 215 stops
while plunger extension 378 continues to move distally,
thereby progressively inserting pin 214 axially into bore
216 or ring 212. Tube 360 holds cartridge 280 securely
10 in place while pin 214 is being inserted. Pin 214 is
~r~Lessively inserted into bore 216 or ring 212. Tube
360 holds cartridge 280 securely in place while pin 214
is being inserted. Pin 214 is progressively inserted
into bore 215 until pin 214 reaches a desired locked
15 position in ring 212 securing suture 8 between ring 212
and pin 214.
Referring to Fig. 16B, the assembled x~LuLe collet
210 is removed from cartridge 280 simply by retracting
tube 360 axially away from shoulder 295 and advancing
20 plunger 378 further distally. With tube 360 retracted,
arms 334, 336 of cartridge 280 flex outwardly as suture
collet 210 is moved distally thereby permitting extension
378 to push suture collet 210 distally from cartridge
280. The distance that plunger 376 can be moved distally
25 is limited by travel stops or limits (not shown) such
that carrier 215 is not also pll~h~ from cartridge 280.
Other embodiments are within the scope of the
following claims.
For example, referring to Fig. 17, in a preferred
30 embodiment, drive instrument 450 includes a handle 452
and a trigger 454 pivotably mounted to handle 452 and a
trigger 454 pivotably mounted to handle 452 about pivot
pin 455. Plunger 376 is snapped into or permanently
mounted to handle 452 and linked to trigger 454 such that
35 mo~, ~nt of trigger 454 controls the movement of plunger
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376, outer sheath 360, grasper 364 and plunger 376 act as
described above with reference ~o drive instrument 350.
The tlln~ls of ring 12 and pin 14 can be inclined
at other angles, as desired. In fact, a sur~ace of only
5 one of these members can be inclined (i.e. the
corresponding surface of the other member can be parallel
to the longitll~ l axis of the collet.)
The relative positions of suture receiving
openings 52, 53 can be changed as desired. For example,
10 openings 52, 53 can be positioned adjacent to each other.
More or fewer ~uE~Le receiving or~ningS can be provided,
as desired.
Plunger 84 and pin 14 can be manufactured as one
unit. After the pin is inserted into the ring, rotation
15 of plunger 84 would dislodge the pin from the plunger.
Plunger 84 would dislodge the pin from the plunger.
Plunger 84 can include a distal cam surface such that
rotation of the plunger acts to force arms 134, 136 apart
to faci~itate removal of the suture collet ~rom cartridge
20 80.
Suture collets 10 and 210 can be used wherever a
~uL~re knot would be tied, for example, in ligating
branches of v~sfi~lc, in soft-tissue repair, in reducing
tissues, and in securing other types of tissue to bone.
Ring 12 and pin 14 and ring 212 and pin 214 can be
connected in other ways. For example, in the ratcheting
techni~ue di~Cllc~ herein, pin 214 may be threaded and
ring 212 can include ridges 222. A single ridge 222 can
be used in place of the axially spaced series of ridges
30 discussed above.
The suture collet members need not be insertable
one into the other, and they can be connected together in
other ways (such as by rotating one member with respect
to the other). In a rotating embodiment, the clamping
35 surfaces should be inclined with respect to the direction
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of rotation to provide the me~-h~nical advantage discus~ed
above. An inner pin can be positioned first and an outer
ring can be driven over the inner pin.
Other materials can be used according to the
5 suturing application.
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