US20100305585A1 - Line lock threading systems and methods - Google Patents
Line lock threading systems and methods Download PDFInfo
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- US20100305585A1 US20100305585A1 US12/851,197 US85119710A US2010305585A1 US 20100305585 A1 US20100305585 A1 US 20100305585A1 US 85119710 A US85119710 A US 85119710A US 2010305585 A1 US2010305585 A1 US 2010305585A1
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- Prior art keywords
- passageways
- suture
- line lock
- line
- along
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0404—Buttons
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0459—Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
- A61B2017/0488—Instruments for applying suture clamps, clips or locks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T24/00—Buckles, buttons, clasps, etc.
- Y10T24/39—Cord and rope holders
- Y10T24/3916—One-piece
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T24/00—Buckles, buttons, clasps, etc.
- Y10T24/39—Cord and rope holders
- Y10T24/3916—One-piece
- Y10T24/3927—Slack adjuster
Definitions
- the present invention relates generally to devices to replace knots and more specifically to devices to replace surgical knots tied in open, arthroscopic, and endoscopic procedures.
- Line locks generally operate in one of two ways. Some line locks are manually actuated to secure one or more lines so that tension is maintained in a portion of the line(s). Once actuated, the line lock resists sliding along the line(s) either toward or away from the tensioned portion of the line. Other line locks are continuously adjustable in one direction so that tension is increased in the portion of the line upon which the line lock is advanced. The continuously adjustable line locks resist movement away from the tensioned portion of the line, but can be further advanced toward the tensioned portion of the line with an appropriately applied force.
- the portion of a line that is put under tension, typically to secure some object, is commonly referred to as the standing end.
- the portion of the line that extends toward the line handler is commonly referred to as the working end.
- a knot in a line, or a line lock attached to a line, is the demarcation between the standing end and the working end.
- Continuously adjustable line locks offer several advantages. They are passive locking devices, meaning that no other operation is required to secure the line lock once it is moved along the line to its desired position. Furthermore, these line locks can be used to continuously increase the tension in the standing end until it reaches a desired level of tension.
- FIG. 1 is a perspective view of an adjustable line lock.
- FIG. 2 is a top plan view of line lock shown in FIG. 1 .
- FIG. 3 is an elevated cross sectional side view of the line lock shown in FIG. 1 .
- FIG. 4A is a perspective view of the line lock shown in FIG. 1 with a line routed therethrough in a slack unlocked position.
- FIG. 4B is a perspective view of the line lock shown in FIG. 4A with the line in a tensioned locked position.
- FIG. 5 is a top plan view of the line lock shown in FIG. 4B .
- FIG. 6 is a bottom plan view of the line lock shown in FIG. 4B .
- FIG. 7 is a perspective view of the line lock shown in FIG. 4A with the line routed in a different path.
- FIG. 8 is a perspective view of an alternative embodiment of the line lock shown in FIG. 1 with open working passageways.
- FIG. 9 is a perspective view of another alternative embodiment of the line lock shown in FIG. 1 with open passageways.
- FIG. 10 is a perspective view of another alternative embodiment of the line lock shown in FIG. 1 with dual primary passageways and uniform working passageways.
- FIG. 11 is a perspective view of a line lock for use with a single strand of line.
- FIG. 12A is a perspective view of the line lock shown in FIG. 11 with a line routed therethrough.
- FIG. 12B is a top plan view of the line lock shown in FIG. 12A .
- FIG. 12C is a bottom plan view of the line lock shown in FIG. 12A .
- FIG. 13A is a top perspective view of a line lock having dual strands of line routed therethrough.
- FIG. 13B is a bottom perspective view of the line lock shown in FIG. 13A .
- FIG. 14A is a top perspective view of a line lock having a line secured thereto.
- FIG. 14B is a bottom perspective view of the line lock shown in FIG. 14A .
- FIG. 15 is a perspective view of an alternative embodiment of a line lock.
- FIG. 16A is a perspective view of the line lock shown in FIG. 15 with a line routed therethrough.
- FIG. 16B is a top plan view of the line lock shown in FIG. 16A .
- FIG. 16C is a bottom plan view of the line lock shown in FIG. 16A .
- FIG. 17 is a perspective view of another alternative embodiment of a line lock.
- FIG. 18A is a perspective view of the line lock shown in FIG. 17 with a line routed therethrough.
- FIG. 18B is a top plan view of the line lock shown in FIG. 18A .
- FIG. 18C is a bottom plan view of the line lock shown in FIG. 18A .
- FIG. 19 is a perspective view of a line lock according to another alternative embodiment of the invention, with an associated insertion tool.
- FIG. 20 is a perspective view of the line lock of FIG. 19 , with a suture passing loosely through the passageways of the line lock.
- FIG. 21 is a perspective view of the line lock of FIG. 19 , with suture passing tightly through the passageways of the line lock.
- FIG. 22 is a perspective view of a system including a cartridge with threaders that facilitate the insertion of suture through the passageways of the line lock of FIG. 19 .
- FIG. 23 is a perspective view of the system of FIG. 22 , with the lid of the cartridge open and sutures coupled to the trailing ends of the threaders.
- FIG. 24 is a perspective view of the system of FIG. 22 , with the cartridge open and one of the sutures drawn part-way through the cartridge.
- FIG. 25 is a perspective view of the system of FIG. 22 , with the cartridge open and the sutures fully drawn through the cartridge to pass through the passageways of the line lock.
- FIG. 26 is a perspective view of the system of FIG. 22 , with the cartridge open and the sutures and line lock removed from the cartridge for use.
- the present invention relates to line locks that can be used in part to replace surgical knots tied in sutures in open, arthroscopic, and endoscopic procedures.
- the line locks can be used outside of surgical procedures for any use where it is desired to selectively adjust and/or tie off a line such as a rope, cord, string, or other conventional type of line.
- Line lock 10 comprises an elongated body 12 having a top surface 14 and an opposing bottom surface 16 that each extend between a first end 18 and an opposing second end 20 .
- Body 12 also has a first side 19 and an opposing second side 21 extending between first end 18 and second end 20 .
- body 12 has a substantially rectangular configuration with rounded ends.
- body 12 can be any desired configuration such as triangular, circular, square or any other polygonal or irregular configuration.
- body 12 has a maximum dimension D along its length ( FIG. 2 ) which is typically less than about 2 cm, more commonly less than about 1.5 cm, and even more commonly less than about 1 cm. Other dimensions can also be used.
- body 12 has a height in a range between about 1 mm to about 1.5 mm, a width in a range between about 2 mm to about 3 mm, and length D in a range between about 5 mm to about 8 mm.
- body 12 can be any desired dimension.
- maximum dimension D can be in a range from about 5 cm to about 0.5 m. Again, other dimensions can also be used.
- body 12 can be comprised of any biocompatible material.
- the biocompatible material can be bioabsorbable or non-bioabsorbable. Examples of typical materials include non-bioabsorbable plastic, bioabsorbable plastic, synthetic tissue, and allograft tissue.
- body 12 can be made of any desired material such as metal, plastic, wood, fiberglass, composite, or the like.
- a primary passageway 22 centrally extending through body 10 between top surface 14 and bottom surface 16 is a primary passageway 22 .
- the term “passageway” is broadly intended to include closed apertures, such as depicted by primary passageway 22 , partially bound apertures, open channels, recesses, grooves, slots, and the like, that are capable of receiving a line and at least partially retaining the line therein.
- the term “line” as used in the specification and appended claims is broadly intended to include suture, cord, rope, filament, wire, cable, and any other form of line.
- first secondary passageway 24 Extending between surfaces 14 and 16 at first end 18 of body 12 is a first secondary passageway 24 .
- a second secondary passageway 24 ′ extends between surfaces 14 and 16 at second end 20 .
- Extending through body 12 at a location between primary passageway 22 and first secondary passageway 24 is a first working passageway 28 .
- first working passageway 28 is disposed between primary passageway 22 and first secondary passageway 24 such that a geometric line segment 36 ( FIG. 2 ) can be extended between primary passageway 22 and first secondary passageway 24 so that line segment 36 intersects with first working passageway 28 .
- a second working passageway 28 ′ extends through body 12 at a location between primary passageway 22 and second secondary passageway 24 ′.
- Each working passageway 28 and 28 ′ has an elongated transverse cross sectional area that extends between a first end 38 and an opposing second end 40 .
- Each working passageway 28 , 28 ′ comprises an enlarged access region 32 at first end 38 which communicates with a constricted capture slot 34 at second end 40 .
- Access region 32 is sized to enable easy feeding of a line into and through the corresponding working passageways 28 , 28 ′. Accordingly, although access region 32 can be slightly smaller than the transverse cross sectional area of the line which is to be passed therethrough, access region 32 typically has a transverse cross sectional area that is equal to or slightly larger than the transverse cross sectional area of the line that is to be passed therethrough.
- capture slot 34 has a width W that is substantially equal to or less than the diameter of the line that is to be passed through working passageways 28 , 28 ′.
- width W is less than about 0.9 times the diameter of the line and more commonly less than about 0.75 times the diameter of the line.
- working passageways 28 , 28 ′ can come in a variety of different configurations.
- capture slot 34 can come in a variety of different constricted, tapered, or notched shaped configurations that are capable of securely retaining a line through wedged engagement.
- the required difference between the width W and the diameter of the line may be less than the examples given above.
- central passageway 22 is bounded by an interior surface 42 of body 12 having a substantially triangular transverse cross section.
- Interior surface 42 comprises a first side face 44 disposed toward first working passageway 28 , a second side face 46 disposed toward second working passageway 28 ′ and which intersects with first side face 44 , a third side face 48 extending between first side face 44 and second side face 46 .
- side faces 44 and 46 are shown as being substantially flat, in alternative embodiments side faces 44 and 46 can be curved or irregular. In one embodiment, however, first side face 44 is substantially disposed in or tangent to a first plane illustrated by dashed line 50 .
- plane 50 slopes toward second end 40 of first working passageway 28 as plane 50 extends from first side 19 of body 12 to second side 21 .
- First secondary passageway 24 is bounded by an interior surface 54 of body 12 having an elongated transverse cross section. Interior surface 54 comprises a first side face 56 disposed toward first working passageway 28 and an opposing second side face 58 . Although side faces 56 and 58 are shown as being substantially flat, in alternative embodiments side faces 56 and 58 can also be curved or irregular. Again, in one embodiment first side face 56 is substantially disposed in or tangent to a second plane illustrated by dashed line 60 . With reference to FIG. 2 , second plane 60 slopes toward second end 40 of first working passageway 28 as second plane 60 extends from first side 19 of body 12 to second side 21 .
- first plane 50 and second plane 60 are disposed so as to be converging as they extend from first side 19 of body 12 to second side 21 .
- planes 50 and 60 intersect at a location 62 on body 12 that is at least substantially aligned with a central longitudinal axis of capture slot 34 .
- location 62 can be directly adjacent to body 12 or at a distance from body 12 Likewise, location 62 need not be aligned with the central longitudinal axis of capture slot 34 .
- planes 50 and 60 are disposed at equally opposing angles relative to the central longitudinal axis of capture slot 34 .
- planes 50 and 60 can intersect so as to form an inside angle therebetween in a range between about 5° to about 85°.
- Second secondary passageway 24 ′ has substantially the same configuration as first secondary passageway 24 .
- second secondary passageway 24 ′ has substantially the same relative position to second working passageway 28 ′ and second side face 46 of primary passageway 22 as first secondary passageway 26 has to first working passageway 28 and first side face 44 of primary passageway 22 .
- planes 50 and 60 are also applicable to primary passageway 22 and second secondary passageway 24 ′.
- primary passageway 22 has a length in a range between about 1.3 mm to about 1.5 mm and a width in a range between about 1 mm to about 1.3 mm.
- Secondary passageways 24 and 24 ′ have a width of about 0.8 mm and a length in a range between 1 mm to about 1.3 mm.
- Access region 32 of working passageways 28 and 28 ′ have width in a range between about 0.7 mm to 1 mm while capture slots 17 have a width in a range between about 0.3 mm to 0.4 mm.
- interior surface 42 of primary passageway 22 extends to a top outside corner 66 and an opposing bottom outside corner 68 .
- Top outside corner 66 bounds a top primary opening 70 while bottom outside corner 66 bounds a bottom primary opening 72 .
- first working passageway 28 has an interior surface 74 that extends to a top outside corner 76 and an opposing bottom outside corner 78 .
- Top outside corner 76 bounds a top working opening 80 while bottom outside corner 76 bounds a bottom working opening 82 .
- interior surface 54 of first secondary passageway 24 extends to a top outside corner 86 and an opposing bottom outside corner 88 .
- Top outside corner 86 bounds a top secondary opening 90 while bottom outside corner 86 bounds a bottom secondary opening 92 .
- each of top outside corners 66 , 76 , and 86 has a radius of curvature that is smaller than the radius of curvature of the corresponding bottom outside corners 68 , 78 , 88 .
- top outside corners 66 , 76 , and 86 each have a radius of curvature in a range between about 0 mm to about 1 mm with about 0 mm to about 0.5 mm being more common.
- bottom outside corners 68 , 78 , and 88 each have a radius of curvature in a range between about 0.25 mm to about 2 mm with about 0.5 mm to about 1.5 mm being more common.
- top outside corners and the bottom outside corners can have the same radius of curvature or that only one or more of the top outside corners may be smaller than one or more of the bottom outside corners. In still other embodiments, it is appreciated that only a portion of one or more of the top outside corners may be smaller than a portion of one or more of the bottom outside corners.
- second secondary passageway 24 ′ and second working passageway 28 ′ having substantially the same configuration as first secondary passageway 24 and first working passageway 28 , respectively.
- first secondary passageway 24 and first working passageway 28 respectively.
- the same discussion with regard to the outside corners are also applicable thereto.
- like elements are identified by like reference characters.
- Line 100 adjustably mounted on line lock 12 .
- Line 100 comprises a standing portion 102 in the form of a loop which extends below primary passageway 22 , a first working portion 104 which extends out of first working passageway 28 , and a first locking portion 106 extending therebetween. It is appreciated that each of the sections 102 , 104 , and 106 of line 100 are relative to each other in that they change as line 100 is adjusted on line lock 10 .
- Line 100 further includes a second working portion 104 ′ which extends out of second working passageway 28 ′ and a second locking portion 106 ′ that extends between standing portion 102 and second working portion 104 ′.
- First locking portion 106 extends up through primary passageway 22 , down through first secondary passageway 24 , and then up through first working passageway 28 .
- the section of locking portion 106 extending between primary passageway 22 and first secondary passageway 24 is referred to as compression section 110 .
- Line 100 passes up through first working passageway 28 so that first working portion 104 is disposed between compression section 110 and capture slot 34 .
- Second locking portion 106 ′ is similarly passed through passageways 22 , 24 ′, and 28 ′.
- standing portion 102 of line 100 is typically looped around, embedded within, or passed through tissue, or some other structure.
- unwanted slack is removed from standing portion 102 . This is accomplished by sliding line lock 10 over standing portion 102 and/or pulling on working portion 104 and/or 104 ′ so that the unwanted slack is pulled through line lock 10 . In either event, at least one of working portions 104 and 104 ′ increases in length while standing portion 102 shortens.
- line 100 is passing through enlarged access regions 32 of working passageways 28 and 28 ′.
- relative locking portions 106 and 106 ′ freely slide through corresponding passageways of line lock 10 as the unwanted slack from standing portion 102 is removed.
- a mild tension force is typically applied to working portions 104 and 104 ′ as the unwanted slack is removed.
- the applied force pushes compression section 110 and 110 ′ back toward first side 19 of body 12 and thus away from capture slots 34 , 34 ′.
- the portion of line 100 passing through primary passageway 22 and secondary passageways 24 and 24 ′ also naturally slides back within the passageways toward first side 19 of body 12 . This movement of line 100 helps to decrease frictional resistance on line 100 .
- line 100 is tensioned, compression portions 110 , 110 ′ are shortened causing them to move into a more linear orientation.
- tensioning of line 100 causes compression portions 110 , 110 ′ to force working portions 104 , 104 ′ toward corresponding capture slots 34 , 34 ′.
- at least a portion of line 100 within working passageways 28 and 28 ′ is forced into corresponding capture slots 34 , 34 ′ so that line 100 is secured therein by wedged frictional engagement. That is, line 100 is secured by compression within capture slots 34 , 34 ′ because line 100 has a diameter larger than the width of capture slots 34 , 34 ′.
- line 100 Once line 100 is captured under compression in capture slots 34 , 34 ′, line 100 will remain captured even if there is a complete loss of tension in standing end 102 .
- “locking” of line lock 10 to line 100 ensures that line lock 10 will not become separated from line 100 , even under cyclic changes in line tension in standing end 102 .
- line lock 10 is continuously adjustable in that further tension can be applied to standing portions 104 and/or 104 ′ at any time to remove additional slack from standing portion 102 while retaining line 100 locked to line lock 10 .
- the passageways extending through line lock 10 are also configured such that as compression portions 110 and 110 ′ force line 100 into capture slots 34 and 34 ′, compression portions 110 and 110 ′ also fold and/or bias working ends 104 and 104 ′ over and/or against top outside corner 76 of capture slots 34 and 34 ′.
- compression portions 110 and 110 ′ also fold and/or bias working ends 104 and 104 ′ over and/or against top outside corner 76 of capture slots 34 and 34 ′.
- the engagement between the captured working ends 104 and 104 ′ and top outside corner 76 creates a high degree of friction which forms a secondary locking mechanism between line 100 and line lock 10 .
- the engagement between capture working ends 104 and 104 ′ and top outside corner 76 prevents backward movement of line lock 10 relative to line 100 .
- compression portion 110 is disposed above a portion of top outside corner 76 so as to directly bias working ends 104 against top outside corner 76 .
- Compression portion 110 is also shown disposed directly above a portion of working end 104 that is biasing against top outside corner 76 .
- compression portion 110 when tensioned can extend between central passageway 22 and secondary passageways 24 without passing over working passageway 28 . That is, compression portion 110 can pass at a location toward second side 21 of line lock 10 that is spaced apart from working passageway 28 . In this embodiment, compression portion 110 still passes over working end 104 , thereby remotely causing working end 104 to fold over and bias against top outside corner 76 .
- One of the unique features of the present embodiment is that as line lock 10 is advanced toward standing end 102 when standing end 102 is not under tension, i.e., when slack is being removed from standing end 102 , working ends 104 and 104 ′ tend to push away compression portions 110 and 110 ′, as discussed above, thereby minimizing frictional engagement between working ends 104 , 104 ′, compression portions 110 , 110 ′ and line lock 10 . As a result, line lock 10 can be easily advanced on line 100 .
- compression portions 110 and 110 ′ traverse a substantially straight path because they are constrained by secondary passageways 24 and 24 ′ and primary passageway 22 . This substantially straight path translates to a lower frictional resistance to sliding not possible with other adjustable line locks known in the art.
- line 100 is routed through passageways 22 , 24 , and 28 so as to pass over the outside corners of the passageways.
- a tensioned section of line 100 passes around a first outside corner of line lock 10
- friction produced between line 100 and the corresponding outside corner cause a decrease in tension on the portion of line 100 extending away from the outside corner on the side opposite the tensioned section.
- the friction produced at the outside corner must be overcome in order to cause line 100 to slide.
- each subsequent corner produces an incremental decrease in line tension and a corresponding incremental increase in friction that must be overcome to cause line 100 to slide.
- the loss in tension and increase in friction diminishes for each subsequent corner.
- the first corners are the most significant.
- each outside corner that bounds a corresponding opening has to have the same radius of curvature.
- the portion of each outside corner that directly engages line 100 can have a radius of curvature that is different from the remainder of the corresponding outside corner.
- line lock 10 is shown having an alternative routing of line 100 .
- working ends 104 and 104 ′ are passed up through secondary passageways 24 and 24 ′, respectively, down through primary passageway 22 , and then back up through working passageways 28 and 28 ′, respectively.
- compression portions 110 and 110 ′ are formed that selectively force working ends 104 and 104 ′ toward capture slots 34 as discussed above.
- one end of line 100 can be routed as shown in FIG. 4A while the opposing end of line 100 is routed as shown in FIG. 7 .
- Line lock 120 comprises body 12 having primary passageway 22 and secondary passageways 24 and 24 ′ extending therethrough as discussed above with regard to FIG. 1 .
- line lock 120 comprises working passageways 122 and 122 ′ that are circumferentially open. That is, each working passageway 122 and 122 ′ comprises an elongated tapered slot having a first end 124 and an opposing second end 126 .
- First end 124 is open along first side 19 of body 12 to facilitate convenient loading of line 100 therein.
- First end 124 also typically has a width greater than the diameter of line 100 .
- Second end 126 extends to a location between primary passageway 22 and a corresponding one of secondary passageway 24 , 24 ′.
- each working passageway 122 , 122 ′ typically has a width substantially equal to or smaller than the diameter of line 100 .
- FIG. 9 Depicted in FIG. 9 is another alternative embodiment of a line lock 136 having substantially the same configuration as line lock 120 .
- line lock 136 comprises a partially bounded primary passageway 138 which is open at second side 21 of body 12 and partially bounded secondary passageways 140 and 140 ′ that are also each open at or adjacent to second side 21 of body 12 .
- line 100 is secured by being wedged into capture slots 34 and 34 ′ and by biasing working portions 104 and 104 ′ against the top outside corner 76 of each working passageway 28 , 28 ′.
- the locking features can be used independently.
- FIG. 10 depicted in FIG. 10 is a line lock 144 having body 12 with secondary passageways 24 and 24 ′.
- line lock 144 comprises working passageways 146 and 146 ′ wherein capture slots 34 have been eliminated.
- Working passageways 146 and 146 ′ merely comprise elongated channels having a width substantially the same size or larger than the diameter of the line 100 to be passed therethrough.
- Line 100 is thus primarily secured to line lock 144 as a result of compression portions 110 , 110 ′ biasing line 100 against top outside corner 76 of each working passageways 146 and 146 ′ as previously discussed.
- Line lock 144 is also distinguished over line lock 10 in that primary passageway 22 has been replaced with a first primary passageway 148 and a spaced apart second primary passageway 148 ′.
- Primary passageways 148 and 148 ′ operate with opposing ends of line 100 . It is also noted that in alternative embodiments primary passageway(s) and/or the secondary passageways need not be elongated to allow the line passing therethrough to slide toward opposing sides 19 and 21 of body 12 as previously discussed with regard to line lock 10 .
- Line lock 150 Depicted in FIG. 11 is an alternative embodiment of a line lock 150 that is designed to slide along a single strand of line 100 .
- Line lock 150 comprises a substantially disk shaped body 152 having a top surface 154 and an opposing bottom surface 156 . Extending through body 152 between surfaces 154 and 156 is a primary passageway 158 and a spaced apart secondary passageway 160 . Disposed between passageways 158 and 160 is a working passageway 162 . Similar to line lock 10 , working passageway 162 of line lock 150 has a first end with enlarged access region 32 and an opposing second end with constricted capture slot 34 thereat.
- Primary passageway 158 and secondary passageway 160 have substantially the same elongated circular configuration which is similar to previously discussed secondary passageway 24 .
- Each of passageways 158 and 160 has an inside face 162 and 164 , respectively, that is disposed toward working passageway 162 .
- Each inside face 162 and 164 is substantially disposed in or is tangent to a corresponding plane 168 and 170 , respectively. Planes 168 and 170 converge toward capture slot 34 of working passageway 162 and diverge away from access region 32 .
- end passageway 172 Also extending through body 152 between top surface 154 and bottom surface 156 is an end passageway 172 .
- end passageway 172 can be positioned at a variety of different locations, end passageway 172 is shown aligned with working passageway 162 such that a plane extending between working passageway 162 and end passageway 172 separates primary passageway 158 from secondary passageway 160 .
- line 100 is routed through line lock 150 by passing working portion 104 from top surface 154 to bottom surface 156 through end passageway 172 , up through primary passageway 158 , down through secondary passageway 160 , and finally up through working passageway 162 .
- Compression portion 110 of line 100 extends between primary passageway 158 and secondary passageway 160 and is positioned to act upon working portion 104 .
- Line lock 150 can be selectively advanced by pulling working portion 104 away from top surface 154 so that line 100 travels through line lock 150 .
- line lock 150 can be manually slid toward standing portion 102 . In either event, the length of standing portion 102 is decreased.
- line 100 locks on line lock 150 in substantially the same manner that line 100 locks with working passageway 28 as previously discussed with regard to line lock 10 . That is, compression portion 110 forces working end 104 toward capture slot 34 so that the portion of line 100 within working passageway 162 is captured by wedged frictional engagement within capture slot 34 . Furthermore, compression portion 110 either directly or indirectly biases working portion 104 against the top outside corner 76 of working passageway 162 at the second end thereof so as to increase the frictional engagement between line 100 and line lock 150 .
- Line lock 150 thus provides a continuously adjustable line lock or a one way sliding stop. In alternative embodiments, it is appreciated that line lock 150 can be modified in at least the same ways as discussed with the other line locks disclosed herein.
- FIGS. 12A-12C The embodiment shown in FIGS. 12A-12C is advantageous in certain applications where line lock 150 is positioned behind a first object and working portion 104 and standing portion 102 pass through the first object.
- standing portion 102 is fixed to a second object.
- line lock 150 By pulling on working portion 104 , the first object is drawn irreversibly toward the second object.
- This is an advantage with surgical sutures where standing end 102 of a suture is attached to normal tissues and line lock 150 is placed behind tissue that has torn away.
- Standing portion 102 and working portion 104 pass through the torn tissue toward the normal tissue.
- the torn tissue is pulled into apposition with the normal tissues and line lock 150 maintains the torn tissue adjacent to the normal tissue to facilitate healing of the tissue.
- Line lock 180 Depicted in FIGS. 13A and 13B is another embodiment of a line lock 180 incorporating features of the present invention.
- Line lock 180 also comprises a substantially disk shaped body 182 having a top surface 184 and an opposing bottom surface 186 .
- line lock 180 includes primary passageway 158 , secondary passageway 160 , and working passageway 162 .
- working passageway 162 is disposed such that a geometric line segment can be extended between primary passageway 158 and secondary passageway 160 so that the line segment intersects with working passageway 162 .
- line lock 180 does not include end passageway 172 .
- Each of passageways 158 , 160 , and 162 is configured to receive a double strand of line 100 . Specifically, during use both working end 104 and 104 ′ are passed up through primary passageway 158 , down through secondary passageway 160 and then back up through working passageway 162 . As a result, standing portion 102 is again formed in a loop that can be looped around, passed through, or otherwise secured to tissue or other structure. Unwanted slack is removed from standing portion 102 by again sliding line lock 180 on line 100 toward standing portion 102 and/or by pulling on one or both of working portions 104 and 104 ′ so that line 100 passes through line lock 180 .
- compression portions 110 and 110 ′ force working portions 104 , 104 ′ toward capture slot 34 so that a portion of each line section passing through working passageway 162 is captured by wedged frictional engagement within capture slot 34 .
- Compression portions 110 and 110 ′ also bias working portions 104 and 104 ′ toward and/or against top outsider corner 76 of working passageway 162 so as to increase the frictional engagement between line 100 and line lock 180 .
- each passageway 158 , 160 , and 162 can be set so as to further control the ability of line 100 to slide or not slide through the passageway.
- Other alternatives as discussed with the line locks herein are also applicable to line lock 180 .
- each of the passageways 158 , 160 , and 162 can also be configured to receive a single strand of line 100 .
- the single strand of line 100 is routed in a manner as described above for the double strand of line 100 .
- the standing portion 102 consists of a free end which can be attached to tissue or other structures.
- FIGS. 14A and 14B Depicted in FIGS. 14A and 14B is still another embodiment of a line lock 190 incorporating features of the present invention.
- Line lock 190 has substantially the same configuration as line lock 180 with like elements being referenced with like reference characters.
- the primary distinction between line locks 180 and 190 is that in line lock 190 , an end 192 of line 100 adjacent to standing portion 102 is secured to bottom surface 186 of body 182 .
- End 192 can be secured to body 182 by being integrally molded into body 182 or can be otherwise secured such as by welding or mechanical attachment.
- Line lock 190 is also distinguished from line lock 180 in that passageways 158 , 160 , and 162 need only be configured to receive a single strand of line 100 . That is, working end 104 passes up through primary passageway 158 , down through secondary passageway 160 , and then back up through working passageway 162 . Standing portion 102 is again substantially formed into a loop extending from end 192 of line 100 to primary passageway 158 . Because end 192 of line 100 is secured to body 182 , unwanted slack can be removed from standing portion 102 by pulling line 100 through line lock 190 and/or sliding line lock 190 down line 100 . Line 100 is locked to line lock 190 in substantially the same manner as discussed above with regard to the other line locks when line 100 is tensioned on line lock 190 .
- Line lock 200 comprises an elongated substantially box shaped body 202 comprising a top wall 204 and an opposing bottom wall 206 each extending between a first side wall 208 and a first end 210 and an opposing second side wall 212 and an opposing second end 214 . Also extending between top wall 204 and bottom wall 206 is a front wall 216 and an opposing back wall 218 .
- Partially bounded within body 202 is a hollow chamber 220 .
- An access channel 222 is formed on front wall 216 so as to communicate with chamber 220 .
- a primary passageway 224 is also communicating with chamber 220 .
- Primary passageway centrally extends through bottom wall 206 to chamber 220 .
- a first secondary passageway 226 extends through first side wall 208 so as to communicate with chamber 220 while a second secondary passageway 226 ′ extends through second side wall 212 so as to communicate with chamber 220 .
- a pair of first working passageways 228 and 228 ′ extend through bottom wall 206 and top wall 204 , respectively, in vertical alignment between primary passageway 224 and first secondary passageway 226 .
- each of working passageways 228 , 228 ′ and 230 , 230 ′ has a first end towards front wall 226 with an enlarged axis region 32 and an opposing second end toward back wall 218 with a capture slot 34 formed thereat.
- working portions 104 of line 100 are passed up through primary passageway 224 into chamber 220 .
- Working portion 104 then passes out of chamber 220 through first secondary passageway 226 .
- working portion 104 passes up through first working passageway 228 , through chamber 220 , and then out through first working passageway 228 ′.
- Compression portion 110 of line 100 extends from primary passageway 224 to first secondary passageway 226 .
- Working portion 104 is routed such that line 100 passes between compression portion 110 and back wall 218 .
- working portion 104 ′ extends from chamber 220 out through second secondary passageway 226 ′.
- Working portion 104 ′ then extends up through second working passageway 230 , through chamber 220 , and then out through second working passageway 230 ′.
- line 100 extends between compression portion 110 ′ and back wall 218 .
- line lock 200 can be slid along line 100 and/or line 100 can be pulled therethrough so as to remove all unwanted slack from standing portion 102 .
- compression portions 110 and 110 ′ force the portion of line 100 extending between first working passageways 228 and 228 ′ and between second working passageways 230 and 230 ′, respectively, toward corresponding capture slots 34 .
- at least a portion of line 100 extending through each of the working passageways is captured by frictional wedge engagement within each of the corresponding capture slots 34 .
- Line 100 is thus locked with line lock 200 .
- Line lock 200 offers several advantages. When standing end 102 is slack and working ends 104 and 104 ′ are tensioned, the sections of line 100 extending between working passageways 228 and 228 ′ and between working passageways 230 and 230 ′ force compression portions 110 and 110 ′, respectively, back toward front wall 216 so as to allow the free travel of line 100 through line lock 200 . In contrast, as discussed above, when tension is created in standing end 102 and slack is created in working ends 104 and 104 ′, compression portions 110 and 110 ′ force the sections of line 100 extending between working passageways 228 and 228 ′ and between working passageways 230 and 230 ′ toward back wall 218 so as to secure line 100 within the capture slots 34 . This back and forth movement of compression portions 110 and 110 ′ creates “backlash,” or a finite distance that line lock 200 can move away from standing end 102 until locking of line 100 is achieved.
- Top wall 204 of line lock 200 provides a physical constraint to the amount of movement seen in compression portions 110 and 110 ′, thereby minimizing the amount of backlash. Furthermore, top wall 204 provides an additional friction point when compression portions 110 and 110 ′ compress against line 100 , thereby increasing the strength of the locking of line 100 . That is, one friction point is located at working passageways 228 and 230 on bottom wall 206 and the second friction point is located at working passageways 228 ′ and 230 ′ on top wall 204 .
- line lock 200 can be routed through line lock 200 in a manner analogous to the routing in FIG. 7 .
- the various passageways can be open or closed as depicted in FIGS. 8 and 9 .
- line lock 200 can be divided in half and modified to function similar to the line locks shown in FIGS. 11-14 .
- Line lock 240 has a configuration similar to line lock 200 and thus like elements are identified by like reference characters.
- Line lock 240 comprises an elongated substantially box shaped body 242 . Similar to line lock 200 , body 242 comprises top wall 204 and bottom wall 206 extending between side wall 208 and side wall 212 . Body 242 also includes front wall 216 and back wall 218 which partially bound chamber 220 .
- a first primary passageway 241 extends through first side wall 208 while second primary passageway 241 ′ extends through second side wall 212 .
- Primary passageways 241 and 241 ′ each communicate with chamber 220 .
- Body 242 of line lock 240 further comprises a first secondary passageway 244 extending through back wall 218 in communication with chamber 220 and a spaced apart second secondary passageway 244 ′ in communication with chamber 220 .
- a first access port 246 extends through front wall 216 in alignment with first secondary passageway 244 ′ so as to communicate with chamber 220 .
- a second access port 246 ′ extends through front wall 216 in alignment with second secondary passageway 244 so as to also communicate with chamber 220 .
- line lock 240 comprises a pair of first working passageways 248 and 248 ′.
- Working passageway 248 comprises a constricting slot that is formed on bottom wall 206 and is open along intersecting front wall 216 .
- First working passageway 248 ′ is aligned with first working passageway 248 and is formed on top wall 204 so as to also be open along intersecting front wall 216 .
- a pair of second working passageways 250 and 250 ′ are similarly formed on bottom wall 206 and top wall 204 so as to be aligned with second secondary passageway 244 ′.
- Each of the working passageways terminates at capture slot having a width substantially equal to or smaller than the diameter of line 100 .
- working end 104 of line 100 is passed through first primary passageway 242 into chamber 220 and then out through first secondary passageway 244 .
- Working end 104 then passes down around bottom wall 206 and is then fed up through first working passageways 248 and 248 ′.
- a compression portion 110 of line 100 extends between primary passageway 241 and secondary passageway 244 .
- Working portion 104 is passed between working passageways 248 , 248 ′ so that line 100 passes between compression portion 110 and first secondary passageway 244 .
- Working portion 104 ′ is similarly passed through the passageways on the opposing side of line lock 240 . That is, working portion 104 ′ passes through primary passageway 241 ′ and into chamber 220 . Working portion 104 ′ then travels out through secondary passageway 244 ′, bends around bottom wall 206 , and then travels up through working passageways 250 and 250 ′.
- slack can be removed from standing portion 102 by pulling line 100 through line lock 240 and/or sliding line lock 240 toward standing portion 102 .
- compression portions 110 and 110 ′ again force portions of line 100 into capture slots 34 of the working passageways so as to secure line 100 to line lock 240 by wedged frictional engagement.
- line lock 240 provides containment of compression portions 110 and 110 ′ to minimize backlash.
- line 100 is routed through line lock 240 such that at least one line turn exceeds 90 degrees.
- the transition between compression portions 110 and 110 ′ and looping portions, designated as 252 and 252 ′, respectively, create 180 degree turns in line 100 .
- These sharp bends in line 100 increase the friction that must be overcome in order to advance line lock 240 toward standing end 102 .
- the sharp bends also contribute to greater locking strength of line lock 240 to line 100 .
- This embodiment is beneficial when line 100 is monofilament or single strand line, due to the commonly lower line on line friction and greater flexural stiffness of monofilament line when compared to braided or twisted strand line.
- a perspective view illustrates a line lock 310 according to one alternative embodiment of the invention.
- the line lock 310 has a body 312 that is generally disc-shaped.
- the body 312 has a top surface 314 , a bottom surface 316 , and a periphery 318 that extends between the top surface 314 and the bottom surface 314 to define a generally circular profile.
- a shape having a “generally circular profile” is any shape in which the outside boundary of any cross section passing through the main portion of the shape is substantially circular.
- the body 312 bounds a plurality of passageways designed to cooperate receive a line such as a suture.
- passageways that “cooperate to receive” a line such as a suture receive the line such that the line passes through all of the cooperating passageways.
- the passageways of the body 312 include a first primary passageway 322 and a second primary passageway 323 , each of which may be positioned adjacent to the periphery 318 .
- the primary passageways 322 , 323 are positioned on opposite sides of the body 312 .
- the passageways include a first secondary passageway 324 and a second secondary passageway 325 , which are also positioned on opposite sides of the body 312 , adjacent to the periphery 318 .
- the secondary passageways 324 , 325 may be positioned slightly closer to the periphery 318 than the primary passageways 322 , 323 .
- the passageways also include a first working passageway 328 and a second working passageway 329 .
- the working passageways 328 , 329 are relatively centrally located with respect to the body 312 .
- Each of the primary and secondary passageways 322 , 323 , 324 , 325 may be generally rounded, and may optionally be somewhat elongated to provide an oval cross-section capable of receiving a doubled-over suture end, as when a suture end (not shown) is inserted through a loop (not shown) and drawn through the primary and secondary passageways 322 , 323 , 324 , 325 via the loop.
- Each of the working passageways 328 , 329 may also have a cross-section broad enough to receive a doubled-over suture end.
- the passageways 322 , 323 , 324 , 325 , 328 , 329 intersect the top surface 314 to form corresponding openings, each of which is bounded by one of a plurality of top outside corners 336 .
- the passageways 322 , 323 , 324 , 324 , 328 , 329 also intersect the bottom surface 316 to form corresponding openings, each of which is bounded by one of a plurality of bottom outside corners (not shown).
- the top outside corners 336 may have a smaller (i.e., sharper) radius than the corresponding bottom outside corners. More particularly, the top outside corners 336 of the working passageways 328 , 329 may have comparatively small radii when compared to the bottom outside corners. In fact, in the embodiment of FIG. 19 , the radii of the top outside corners 336 of the working passageways 328 , 329 are considerably sharper than those of the top outside corners 336 of the primary and secondary passageways 322 , 323 , 324 , 325 . The sharp radii of the top outside corners 336 of the working passageways 328 , 329 enhances locking of the suture by the line lock 310 .
- Each of the working passageways 328 , 329 may have a shape that also facilitates locking of the suture, such as the teardrop-shaped cross-section illustrated in FIG. 19 . More precisely, each of the working passageways 328 may have an access region 332 and a capture slot 334 .
- the access region 332 is large enough to permit the suture to pass therethrough with clearance.
- the capture slot 334 may be somewhat narrower such that, when the suture is drawn into the capture slot 334 , the walls of the capture slot 334 press against the suture to restrict further motion of the suture through the slot 334 .
- the operation of the capture slot 334 will be further shown and described in connection with FIGS. 20 and 21 .
- the first primary, secondary, and working passageways 322 , 324 , 328 are symmetrically arranged about the center of the body 312 with respect to the second primary, secondary, and working passageways 323 , 325 , 329 .
- the first primary, secondary, and working passageways 322 , 324 , 328 possess radial symmetry with respect to the second primary, secondary, and working passageways 323 , 325 , 329 .
- first primary, secondary, and working passageways 322 , 324 , 328 were rotated 180° about a central axis 338 of the body 1212 , they would be substantially superimposed on the second primary, secondary, and working passageways 323 , 325 , 329 .
- the capture slots 334 may extend at angles with respect to the access regions 332 so that the working passageways 328 , 329 may be more compactly arranged, while keeping the capture slots 334 at the desired position and orientation with respect to the first primary and secondary passageways 322 , 324 and with respect to the second primary and secondary passageways 323 , 325 .
- Such a configuration may potentially provide a more compact line lock (not shown) without losing suture locking capability.
- FIG. 19 also illustrates an insertion tool 340 that may be used to insert a line lock such as the line lock 310 of FIG. 19 into a relatively constricted space, such as a space within the body accessed via a cannula or the like.
- the insertion tool 340 has a proximal end (not shown), which may have handle or other structure to facilitate grasping by hand.
- the insertion tool 340 also has a distal end 342 and a hollow bore 344 that may extend along the entire displacement between the proximal end and the distal end 342 so that sutures or other items can be inserted into one end of the hollow bore 344 and retrieved from the opposite end.
- the distal end 342 has a rim 346 , which may have an annular shape, a frustoconical shape, or the like, such that the body 312 is able to seat against the rim 346 .
- the insertion tool 340 can thus be used to advance the line lock 310 in a manner that will be more fully set forth in the description of FIG. 20 .
- a perspective view illustrates a system 348 including the line lock 310 of FIG. 19 and a suture 350 relatively loosely passing through the passageways 322 , 323 , 324 , 325 , 328 , 329 of the body 312 .
- the suture 350 may be similar or identical to that described previously. Accordingly, the suture 350 may have a standing portion 352 , which is the portion of the suture 350 that is placed under tension and constrained by advancement of the line lock 310 , first and second working portions 354 , 355 , which are handled by a user, and first and second locking portions 356 , 357 that are positioned between the standing portion 352 and the first and second working portions 354 , 355 , respectively.
- the suture 350 may be inserted through the passageways 322 , 323 , 324 , 325 , 328 , 329 according to a wide variety of methods.
- the suture 350 may be inserted by hand.
- the suture 350 may be inserted through the use of threaders (not shown) that are initially routed through the passageways 322 , 323 , 324 , 325 , 328 , 329 along the proper pathways.
- the threaders may have leading ends designed to be drawn by hand, and trailing ends with loops or other features capable of capturing and drawing the suture ends, as will be shown and described in connection with FIGS. 22-26 .
- a cartridge (not shown) may be used to retain the line lock 310 and guide the suture 350 through the passageways 322 , 323 , 324 , 325 , 328 , 329 along the desired pathways, as will also be shown and described subsequently.
- the first locking portion 356 extends from the standing portion 352 through the first primary passageway 322 , then through the first secondary passageway 324 , and then through the first working passageway 328 . From the first working passageway 328 , the first working portion 354 extends between the top surface 314 and the section of the first locking portion 356 that passes from the first primary passageway 322 to the first secondary passageway 324 . This section of the first locking portion 356 is a first compression section 360 of the suture 350 .
- the second locking portion 357 extends from the standing portion 352 through the second primary passageway 323 , then through the second secondary passageway 325 , and then through the second working passageway 329 . From the second working passageway 329 , the second working portion 355 extends between the top surface 314 and the section of the second locking portion 357 that passes from the second primary passageway 323 to the second secondary passageway 325 . This section of the second locking portion 357 is a second compression section 361 of the suture 350 .
- the standing portion 352 may be inserted through and/or around some feature (not shown), such as bodily tissue, that is to be retained by the system 348 .
- the standing portion 352 may additionally or alternatively pass through an opening of a bone anchor or the like to enable tissues to be anchored to the bone, as in rotator cuff repair.
- the suture 350 may be tightened by advancing the line lock 310 along the standing portion 352 .
- the line lock 310 may be advanced by holding the working portions 354 , 355 and pressing the body 312 toward the standing portion 352 .
- the line lock 310 may be advanced along the standing portion 352 through the use of a tool such as the insertion tool 340 of FIG. 19 . More precisely, the working portions 354 , 355 may first be inserted into the hollow bore 344 at the distal end 342 . The working portions 354 , 355 are inserted through the hollow bore 344 such that they protrude from the hollow bore 344 at the proximal end. A user may then grasp the working portions 354 , 355 and draw them proximally, while holding the insertion tool stationary or advancing it distally, until there remains no slack in the working portions 354 , 355 , and the body 312 is seated against the rim 346 of the distal end 342 . The shape of the rim 346 may tend to draw the body 312 into a position and orientation coaxial with the insertion tool 340 to facilitate insertion of the line lock 310 into a relatively narrow space.
- the line lock 310 may be advanced along the standing portion 352 without any tooling.
- the line lock 310 may be pressed and moved along the standing portion 352 by direct pressure from a finger.
- grasping the working portions 354 , 355 and pulling them in substantially opposite and/or co-linear directions may cause the line lock 310 to advance along the standing portion 352 .
- Each of the working portions 354 , 355 may then lie along the top surface 314 , but may not pass through the corresponding capture slot 334 until locking is performed.
- Such a technique may be particularly useful for retaining tissues in more readily accessible areas, where the working portions 354 , 355 can be oriented and drawn in opposite directions.
- Use of insertion tooling may be more appropriate for more confined spaces.
- FIG. 21 a perspective view illustrates the system 348 of FIG. 20 , with the suture 350 routed relatively tightly through the passageways 322 , 323 , 324 , 325 , 328 , 329 .
- tension in the standing portion 352 causes the compression sections 360 , 361 to become taught.
- the compression sections 360 , 361 straighten, thereby drawing the portions of the suture 350 within the working passageways 328 , 329 outward, into the capture slots 334 .
- the sections of the working portions 354 , 355 adjacent to the working passageways 328 , 329 are pinned against the top surface 314 by the compression sections 360 , 361 .
- each of the working portions 354 , 355 is bent twice, with each bend having an angle of about ninety degrees.
- a first bend 370 is about the top outside corner 336 of each corresponding working passageway 328 , 329
- a second bend 372 is about the corresponding compression section 360 , 361 .
- the top outside corners 336 of the working passageways 328 , 329 have tight radii. Accordingly, the top outside corners 336 of the working passageways 328 , 329 provide relatively high friction surfaces, particularly when the working portions 354 , 355 are pressed against them via tension, like that applied by the compression sections 360 , 361 .
- the compression sections 360 , 361 may also provide considerable friction, depending on the structure and material of the suture 350 .
- the working portions 354 , 355 Due to the friction applied to the bends 370 , 372 of each of the working portions 354 , 355 by the tensioned standing portion 352 , the working portions 354 , 355 are generally unable to retract back into the working passageways 328 , 329 . However, the standing portion 352 may still be tightened by further drawing on the working portions 354 , 355 . Tension in the working portions 354 , 355 tends to pull the compression sections 360 , 361 inward, thereby removing the bends 370 , 372 and relieving the associated sources of friction. Further advancement of the body 312 along the standing portion 352 only increases the level of tension in the standing portion 352 so that, when tension on the working portions 328 , 329 is relieved, the working portions 328 , 329 are again drawn to the locked configuration.
- the working portions 354 , 355 may be cut short, for example, just outside the second bends 372 .
- the friction on the bends 370 , 372 keeps slippage to a level low enough that cutting the working portions 354 , 355 in such a manner does not impair the operation of the line lock 310 .
- the second bends 372 may disappear because there is no longer tension drawing the working portions 354 , 355 to the orientation illustrated in FIG. 21 .
- the second bends 372 are not required for locking; rather, the compression sections 360 , 361 continue to press the suture 352 against the top surface 314 , adjacent to the first bends 370 .
- the friction of this compression interface in addition to that of the first bends 370 , is sufficient to keep the suture 350 from slipping back through the passageways 322 , 323 , 324 , 325 , 328 , 329 .
- the line lock 310 and/or the suture 352 may be formed of biodegradable or bioabsorbable materials.
- the line lock 310 and the suture 352 may be small and compact enough that they can remain in the body indefinitely without causing any discomfort or significant health risks.
- FIG. 22 a perspective view illustrates one embodiment of a system 400 including the line lock 310 of the previous embodiment (not visible in FIG. 22 ), and various implements to help insert, or “thread,” the suture 350 through the passageways 322 , 323 , 324 , 325 , 328 , 329 of the line lock 310 .
- a longitudinal direction 402 , a lateral direction 404 , and a transverse direction 406 cooperate to form a system of orthogonal axes that will be used for reference in the following description.
- the system 400 includes a cartridge 410 , a first threader 412 , and a second threader 414 .
- the cartridge 410 contains the line lock 310 and, when in the closed configuration shown in FIG. 22 , substantially encloses the line lock 310 to facilitate insertion of the suture 350 through the passageways 322 , 323 , 324 , 325 , 328 , 329 , and possibly, to help isolate the line lock 310 from contaminants.
- the phrase “substantially enclose” does not require full enclosure; rather, some portion(s) of the substantially enclosed part may protrude from the enclosure.
- the cartridge 410 may be formed of a plastic such as polypropylene, PEEK, or the like.
- the threaders 412 , 414 pass through the cartridge 410 along first and second pathways, respectively, to enable a user to draw the suture 350 through the passageways 322 , 323 , 324 , 325 , 328 , 329 along the correct pattern, as will be described in greater detail subsequently.
- the threaders 412 , 414 may be formed substantially of a fibrous material or a plastic, such as nylon.
- the cartridge 410 has a first longitudinal end 420 , a second longitudinal end 422 , a first lateral end 424 , and a second lateral end 426 .
- the threaders 412 , 414 pass through the longitudinal ends 420 , 422 .
- the cartridge 410 has a lid 430 designed to move with respect to the remainder of the cartridge 410 , which will be referred to as a containment portion 432 .
- a living hinge 434 extends generally along the first lateral end 424 , between the adjacent edges of the lid 430 and the containment portion 432 .
- the living hinge 434 is integrally formed with the lid 430 and the containment portion 432 and flexes to enable pivotal motion of the lid 430 with respect to the containment portion 432 .
- a conventional hinge may be used, or a lid may be slidable with respect to and/or fully removable from the remainder of the cartridge, thereby obviating the need for a hinging mechanism.
- a first tab 436 integrally formed with the lid 430 and a second tab 438 integrally formed with the containment portion 432 may easily be pushed in opposite directions, for example, by a user's thumbs, to open the cartridge 410 .
- the lid 430 and the containment portion 432 may be designed to adhere to each other at the second lateral end 426 so that the cartridge 410 only opens when a threshold force is applied. Thus, the cartridge 410 may not open if dropped or jostled.
- the first longitudinal end 420 has a first set of slots 440 through which the threaders 412 , 414 pass.
- the second longitudinal end 422 has a second set of slots 442 through which the threaders 412 , 414 pass.
- the threaders 412 , 414 extend into the cartridge 410 through the first longitudinal end 420 and out again through the second longitudinal end 422 .
- Each of the threaders 412 , 414 has a leading end 450 adjacent to the second set of slots 442 and a trailing end 452 adjacent to the first set of slots 440 .
- Each of the leading ends 450 has a pull feature designed to facilitate grasping and drawing of the leading ends 450 by hand.
- the pull features take the form of grips 454 that may be easily grasped, for example, between a thumb and an index finger.
- the grips 454 may be plastic rods crimped, insert molded, adhesive bonded, or otherwise attached to the remainder of the threaders 412 , 414 .
- differently configured pull features may be used, including rigid rings, flexible loops, spherical beads, squared beads, and the like.
- each of the trailing ends 452 has a suture retention feature designed to retain a portion of a suture to enable the threaders 412 , 414 to draw the suture through the passageways 322 , 323 , 324 , 325 , 328 , 329 of the line lock 310 .
- the suture retention features take the form of eyelets 456 , each of which is able to receive an end of the suture such that the suture end can double back on itself to be drawn through the cartridge 410 .
- the eyelets 456 may be crimped, adhesive bonded, insert molded, or otherwise attached to the remainder of the threaders 412 , 414 .
- differently configured suture retention features may be used, including adhesive-coated surfaces, collets, clips, flexible loops, and the like.
- the eyelets 456 may be retained to ensure that they are not drawn into the cartridge 410 prior to attachment to the suture to be threaded through the line lock 310 .
- the containment portion 432 may have retention posts 458 that extend in the longitudinal direction 402 on either side of each of the slots of the first set of slots 440 .
- Each of the eyelets 456 may optionally be looped around a pair of the retention posts 458 so that each eyelet 456 is unable to enter the corresponding slot of the first set of slots 440 until the eyelet 456 is removed from around the retention posts 458 .
- Each of the eyelets 456 may need to be slightly larger than shown in FIG. 22 to enable them to encircle a pair of the retention posts 458 .
- the retention posts 458 may also serve a similar function if loops or other flexible suture retention features are used in place of the eyelets 456 .
- FIG. 23 a perspective view illustrates the system 400 of FIG. 22 , with the cartridge 410 in the open configuration to expose the line lock 310 .
- the suture 350 has also been inserted into engagement with the trailing ends 452 of the threaders 412 , 414 . More precisely, a first suture portion 460 of the suture 350 has been inserted through the eyelet 456 of the first threader 412 , and a second suture portion 462 of the suture 350 has been inserted through the eyelet 456 of the second threader 414 .
- the first and second suture portions 460 , 462 are doubled back on themselves to permit the eyelets 456 to draw them through the cartridge 410 and through the passageways 322 , 323 , 324 , 325 , 328 , 329 (not visible in FIG. 23 ) of the line lock 310 .
- Each of the suture portions 460 , 462 may correspond to one or more of the various portions 352 , 354 , 355 , 356 , 357 of the suture 350 . However, no direct correlation is necessary because any portion(s) of the suture 350 may be drawn through the line lock 310 via the cartridge 410 and the threaders 412 , 414 . In the alternative to threading two portions of a suture through the line lock 310 , the system 400 may be used to thread two separate sutures through the line lock 310 .
- the containment portion 432 has a pair of sockets 464 formed therein.
- Each of the sockets 464 may provide a generally rectangular cavity surrounded by a wall that is slotted to permit expansion of the socket 464 .
- the lid 430 has a pair of posts 466 that are generally rectangular in shape, and are sized and positioned to slide into the sockets 464 when the cartridge 410 is in the closed configuration.
- the posts 466 may be sized to fit relatively tightly into the sockets 464 so that the cartridge 410 does not open until the threshold force is applied to remove the posts 466 from the sockets 464 .
- the containment portion 432 also has a central divider 470 that extends generally along the lateral direction 404 to effectively separate the containment portion 432 into two separate compartments.
- the containment portion 432 defines a retention feature designed to retain the line lock 310 .
- retention feature and “threading feature” are to be broadly interpreted to include, not just single structural elements, but also groups of elements that cooperate to carry out line lock retention or suture threading.
- the retention feature takes the form of a pair of troughs 472 positioned on either side of a space in which the line lock 310 rests within the containment portion 432 .
- the troughs 472 face each other such that they retain the periphery 318 of the body 312 of the line lock 310 to resist motion of the line lock 310 along the longitudinal and lateral directions 402 , 404 .
- the troughs 472 are exposed on the open side of the containment portion 432 so that the line lock 310 can be inserted into the space between the troughs 472 , or removed therefrom, by moving the line lock 310 along the transverse direction 406 .
- the containment portion 432 has a threading feature designed to help guide the suture 350 through the passageways 322 , 323 , 324 , 325 , 328 , 329 along the desired pattern.
- the threading feature takes the form of a pair of posts 474 positioned on either side of the central divider 470 , and thus on either side of the space in which the line lock 310 rests.
- Each of the posts 474 may have a generally teardrop-shaped cross section, as taken through a plane parallel to the longitudinal and lateral directions 402 , 404 .
- Each of the posts 474 also has a slot 476 facing the adjacent one of the first and second longitudinal ends 420 , 422 .
- the threaders 412 , 414 are wrapped around the posts 474 along a configuration similar to that provided by the suture 350 illustrated in FIGS. 20 and 21 . More precisely, from its trailing end 452 , the first threader 412 passes through one of the first set of slots 440 , then through the first primary passageway 322 (not visible in FIG. 23 ) and then through the first secondary passageway 323 (not visible) to define a first loop 480 of the first threader 412 . From the first secondary passageway 323 , the first threader 412 passes through the first working passageway 328 (not visible) to define a second loop 482 of the first threader 412 . From the first working passageway 328 , the first threader 412 extends through the first loop 480 and then passes through the corresponding one of the second set of slots 442 , to the leading end 450 .
- the second threader 414 passes through one of the first set of slots 440 , then through the second primary passageway 324 (not visible in FIG. 23 ) and then through the second secondary passageway 325 (not visible) to define a first loop 484 of the second threader 414 .
- the second threader 414 passes through the second working passageway 329 (not visible) to define a second loop 486 of the second threader 414 .
- the second threader 414 extends through the first loop 484 and then passes through the corresponding one of the second set of slots 442 , to the leading end 450 .
- the various portions of the threaders 412 , 414 may be positioned to correspond to portions of the suture 350 , as labeled in FIGS. 20 and 21 .
- the trailing ends 452 may correspond to the standing portion 352 of the suture 350
- the leading ends 450 may correspond to the working portions 354 , 355
- the loops 480 , 482 , 484 , 486 may correspond to the locking portions 356 , 357 .
- the first loops 480 , 484 of the threaders 412 , 414 respectively, may more precisely correspond to the compression sections 360 , 361 of the locking portions 356 , 357 .
- the suture 350 assumes a configuration having the various portions 352 , 354 , 355 , 356 , 357 and sections 360 , 361 , as illustrated in FIGS. 20 and 21 .
- the lid 430 has a pair of blocking members 490 that engage the posts 474 when the cartridge 410 is closed to keep the various loops 480 , 482 , 484 , 486 in place. More precisely, each of the blocking members 490 has a longitudinal portion 492 extending along the longitudinal direction 402 , and a lateral portion 494 extending along the lateral direction 404 . The longitudinal portions 492 may be positioned to seat in the slots 476 of the posts 474 to ensure that the loops 480 , 482 , 484 , 486 cannot slip from the posts 474 by moving transversely toward the lid 430 , into a gap that may exist between the posts 474 and the lid 430 .
- the lateral portions 494 may be positioned inward of and adjacent to the first and second sets of slots 440 , 442 to ensure that the leading and trailing ends 450 , 452 of the threaders 412 , 414 are unable to slide out of the slots 440 , 442 by moving transversely toward the lid 430 , into a gap that may exist between the slots 440 , 442 and the lid 430 .
- FIG. 24 a perspective view illustrates the system 400 of FIG. 22 , with the cartridge 410 open to expose the line lock 310 .
- the first threader 412 is drawn partially through the cartridge 410 so that the corresponding first suture portion 460 of the suture 350 is partially drawn through the corresponding passageways 322 , 324 , 328 (not visible in FIG. 24 ) of the line lock 310 .
- first suture portion 460 has been drawn through the corresponding one of the first set of slots 420 and through the first primary passageway 322 (not visible in FIG. 24 ) of the line lock 310 . Further, the first suture portion 460 has been drawn along the first loop 480 of the first threader 412 so that the first suture portion 460 encircles the post 474 toward the second longitudinal side 422 , in place of the first loop 480 .
- the leading, doubled-over portion of the first suture portion 460 is thus poised to enter the first secondary passageway 324 (not visible). From the first secondary passageway 324 , the first suture portion 460 will then be drawn along the second loop 482 of the first threader 412 , through the first working passageway 328 (not visible), and then through the corresponding one of the second set of slots 442 in the second longitudinal end 422 . The leading, doubled-over portion of the first suture portion 460 will then protrude from the cartridge 410 and may easily be grasped and drawn by hand until the line lock 310 is positioned at the desired location along the length of the first suture portion 460 .
- the second suture portion 462 may be drawn through the cartridge 410 in a similar manner, as described previously in connection with the discussion of FIG. 23 .
- both suture portions 460 , 462 may be drawn fully through the cartridge 410 and through the passageways 322 , 323 , 324 , 325 , 328 , 329 of the line lock 310 .
- the suture portions 460 , 462 may be drawn through the cartridge 410 with the cartridge in the open configuration, as illustrated in FIG. 24 , or with the cartridge 410 in the closed configuration. If desired, part or all of the cartridge 410 may be made translucent or transparent so that a user can easily verify proper threading without opening the cartridge 410 .
- FIG. 25 a perspective view illustrates the system 400 of FIG. 22 , with the cartridge 410 in the open configuration to expose the line lock 310 .
- the suture 350 has been fully threaded through the passageways 322 , 323 , 324 , 325 , 328 , 329 of the line lock 310 in the manner illustrated in FIGS. 20 and 21 . Accordingly, the line lock 310 need only be removed from the cartridge 410 prior to use to retain tissue.
- FIG. 26 a perspective view illustrates the system 400 of FIG. 22 , with the cartridge 410 in the open configuration, and with the line lock 310 and the suture 350 removed from the cartridge 410 for use.
- the line lock 310 has been drawn from the space between the troughs 472 by drawing the line lock 310 along the transverse direction 406 , toward the space the lid 430 would occupy if the cartridge 410 were closed.
- the first and second suture portions 460 , 462 are also drawn along the same direction to slide free of the posts 474 and the first and second sets of slots 440 , 442 .
- the standing portion 352 may connect the first and second suture portions 460 , 461 together at a location not illustrated in FIG. 26 .
- the standing portion 352 may be inserted through an anchor embedded in tissue, or otherwise positioned behind tissues to be retained by the system 400 , prior to performance of the threading process set forth above. If the standing portion 352 is not required to pass through an enclosed aperture, the standing portion 352 may be positioned with respect to the tissue to be retained after the suture 350 has been threaded through the line lock 310 .
- first and second suture portions 460 , 462 may be two separate lengths of suture.
- the first and second suture portions 460 , 462 may then be attached to their respective anchor points, or to each other, before or after they are threaded through the line lock 310 .
- the first and second suture portions 460 , 462 as separate sutures, may be attached to two different anchor points and the line lock 310 may be applied to draw the anchor points, and thereby the connected tissues, together.
- the line lock 310 may only receive a single suture portion via the cartridge 410 and one of the threaders 412 , 414 . Such a single suture portion may be attached to an anchor at one end and tightened via the line lock 310 to retain tissue. As yet another alternative, a differently configured line lock (not shown) may be retained within the cartridge 410 to receive a single suture portion. Such a line lock may operate as the functional equivalent of the line lock 310 , and may thus have only the first passageways 322 , 324 , 328 .
- the line lock 310 may then be used to retain the tissue as desired. This may be accomplished by following the procedures outlined previously, i.e., holding the working portions 354 , 355 and advancing the line lock 310 along the suture 350 to constrict the standing portion 352 , either with or without an insertion tool, and then trimming the suture 350 .
- the suture 350 may easily be threaded through the line lock 310 in the proper pattern to ensure that the line lock 310 is able to perform as desired. Threading may be performed without significantly compromising the sterility of the line lock 310 , the suture 350 , or the operating environment. Thus, the convenience, reliability, and safety of tissue retention operations may be enhanced through the present invention.
- the present invention has particular relevance to surgery, and more particularly to tissue retention through the use of sutures.
- the principles, structures, and methods of the present invention may also be extended to other fields, including the use of larger line locks for locking ropes or cables in a wide variety of applications.
Abstract
A line lock includes a body at least partially bounding a plurality of passageways such that a suture can only be drawn through the passageways along one direction. The suture may be inserted through the passageways through the use of a cartridge designed to contain the line lock. Threaders may pass through the line lock within the cartridge. Each threader may have a leading end and a trailing end that can be coupled to a suture end. Thus, two suture ends may be drawn through the passageways by coupling them to the threaders and drawing the leading ends of the threaders to cause the suture ends to pass through the passageways according to the desired pattern. The cartridge may then be opened to permit easy removal of the suture and the line lock.
Description
- This application is a continuation of the following; which is herein incorporated by reference:
- Pending U.S. application Ser. No. 10/942,275, filed Sep. 15, 2004, which carries Applicants docket no. MLI-16, and is entitled LINE LOCK THREADING SYSTEMS AND METHODS, which is a continuation-in-part of the following which is incorporated herein by reference:
- U.S. patent application Ser. No. 10/459,375, now U.S. Pat. No. 7,150,757, filed on Jun. 11, 2003, which carries Applicants docket no. 13447.35, and is entitled ADJUSTABLE LINE LOCKS AND METHODS, which is a continuation-in-part of the following which is incorporated herein by reference:
- U.S. patent application Ser. No. 10/936,376, now U.S. Pat. No. 7,566,339, filed on Sep. 7, 2004, which carries Applicants docket no. MLI-15, and is entitled ADJUSTABLE LINE LOCKS AND METHODS.
- 1. The Field of the Invention
- The present invention relates generally to devices to replace knots and more specifically to devices to replace surgical knots tied in open, arthroscopic, and endoscopic procedures.
- 2. The Relevant Technology
- Numerous devices have been developed to eliminate the need to tie knots as a way of securing a line. The devices that accomplish the same function as a knot, which is in part to secure a line to retain tension in a portion of the line, are typically referred to as line locks.
- Line locks generally operate in one of two ways. Some line locks are manually actuated to secure one or more lines so that tension is maintained in a portion of the line(s). Once actuated, the line lock resists sliding along the line(s) either toward or away from the tensioned portion of the line. Other line locks are continuously adjustable in one direction so that tension is increased in the portion of the line upon which the line lock is advanced. The continuously adjustable line locks resist movement away from the tensioned portion of the line, but can be further advanced toward the tensioned portion of the line with an appropriately applied force.
- The portion of a line that is put under tension, typically to secure some object, is commonly referred to as the standing end. The portion of the line that extends toward the line handler is commonly referred to as the working end. A knot in a line, or a line lock attached to a line, is the demarcation between the standing end and the working end.
- Continuously adjustable line locks offer several advantages. They are passive locking devices, meaning that no other operation is required to secure the line lock once it is moved along the line to its desired position. Furthermore, these line locks can be used to continuously increase the tension in the standing end until it reaches a desired level of tension.
- The advantages of line locks over tied knots are very attractive in many varied applications, including the use of surgical sutures. However, the line locks developed to date have many deficiencies when considered for surgical suture applications. For example, many known line locks for surgical applications are somewhat small, and as a result, they have small passageways that are positioned quite close to each other. This makes threading the suture through the line lock somewhat difficult. Furthermore, the user must often take special care to thread the suture through the line lock in the proper pattern. Use of an improper threading pattern may cause the line lock to operate improperly, and possibly, to fail to retain the tissue it is applied to.
- Various embodiments of the present invention will now be discussed with reference to the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope.
-
FIG. 1 is a perspective view of an adjustable line lock. -
FIG. 2 is a top plan view of line lock shown inFIG. 1 . -
FIG. 3 is an elevated cross sectional side view of the line lock shown inFIG. 1 . -
FIG. 4A is a perspective view of the line lock shown inFIG. 1 with a line routed therethrough in a slack unlocked position. -
FIG. 4B is a perspective view of the line lock shown inFIG. 4A with the line in a tensioned locked position. -
FIG. 5 is a top plan view of the line lock shown inFIG. 4B . -
FIG. 6 is a bottom plan view of the line lock shown inFIG. 4B . -
FIG. 7 is a perspective view of the line lock shown inFIG. 4A with the line routed in a different path. -
FIG. 8 is a perspective view of an alternative embodiment of the line lock shown inFIG. 1 with open working passageways. -
FIG. 9 is a perspective view of another alternative embodiment of the line lock shown inFIG. 1 with open passageways. -
FIG. 10 is a perspective view of another alternative embodiment of the line lock shown inFIG. 1 with dual primary passageways and uniform working passageways. -
FIG. 11 is a perspective view of a line lock for use with a single strand of line. -
FIG. 12A is a perspective view of the line lock shown inFIG. 11 with a line routed therethrough. -
FIG. 12B is a top plan view of the line lock shown inFIG. 12A . -
FIG. 12C is a bottom plan view of the line lock shown inFIG. 12A . -
FIG. 13A is a top perspective view of a line lock having dual strands of line routed therethrough. -
FIG. 13B is a bottom perspective view of the line lock shown inFIG. 13A . -
FIG. 14A is a top perspective view of a line lock having a line secured thereto. -
FIG. 14B is a bottom perspective view of the line lock shown inFIG. 14A . -
FIG. 15 is a perspective view of an alternative embodiment of a line lock. -
FIG. 16A is a perspective view of the line lock shown inFIG. 15 with a line routed therethrough. -
FIG. 16B is a top plan view of the line lock shown inFIG. 16A . -
FIG. 16C is a bottom plan view of the line lock shown inFIG. 16A . -
FIG. 17 is a perspective view of another alternative embodiment of a line lock. -
FIG. 18A is a perspective view of the line lock shown inFIG. 17 with a line routed therethrough. -
FIG. 18B is a top plan view of the line lock shown inFIG. 18A . -
FIG. 18C is a bottom plan view of the line lock shown inFIG. 18A . -
FIG. 19 is a perspective view of a line lock according to another alternative embodiment of the invention, with an associated insertion tool. -
FIG. 20 is a perspective view of the line lock ofFIG. 19 , with a suture passing loosely through the passageways of the line lock. -
FIG. 21 is a perspective view of the line lock ofFIG. 19 , with suture passing tightly through the passageways of the line lock. -
FIG. 22 is a perspective view of a system including a cartridge with threaders that facilitate the insertion of suture through the passageways of the line lock ofFIG. 19 . -
FIG. 23 is a perspective view of the system ofFIG. 22 , with the lid of the cartridge open and sutures coupled to the trailing ends of the threaders. -
FIG. 24 is a perspective view of the system ofFIG. 22 , with the cartridge open and one of the sutures drawn part-way through the cartridge. -
FIG. 25 is a perspective view of the system ofFIG. 22 , with the cartridge open and the sutures fully drawn through the cartridge to pass through the passageways of the line lock. -
FIG. 26 is a perspective view of the system ofFIG. 22 , with the cartridge open and the sutures and line lock removed from the cartridge for use. - The present invention relates to line locks that can be used in part to replace surgical knots tied in sutures in open, arthroscopic, and endoscopic procedures. By increasing the size of the line locks, it is also appreciated that the line locks can be used outside of surgical procedures for any use where it is desired to selectively adjust and/or tie off a line such as a rope, cord, string, or other conventional type of line.
- Depicted in
FIG. 1 is one embodiment of aline lock 10 incorporating features of the present invention.Line lock 10 comprises anelongated body 12 having atop surface 14 and an opposingbottom surface 16 that each extend between afirst end 18 and an opposingsecond end 20.Body 12 also has afirst side 19 and an opposingsecond side 21 extending betweenfirst end 18 andsecond end 20. In the embodiment depicted,body 12 has a substantially rectangular configuration with rounded ends. As will be apparent from the following disclosure, however,body 12 can be any desired configuration such as triangular, circular, square or any other polygonal or irregular configuration. - In typical surgical applications,
body 12 has a maximum dimension D along its length (FIG. 2 ) which is typically less than about 2 cm, more commonly less than about 1.5 cm, and even more commonly less than about 1 cm. Other dimensions can also be used. By way of example and not by limitation, in oneembodiment body 12 has a height in a range between about 1 mm to about 1.5 mm, a width in a range between about 2 mm to about 3 mm, and length D in a range between about 5 mm to about 8 mm. In non-surgical applications,body 12 can be any desired dimension. For example, maximum dimension D can be in a range from about 5 cm to about 0.5 m. Again, other dimensions can also be used. - For use in surgical applications,
body 12 can be comprised of any biocompatible material. The biocompatible material can be bioabsorbable or non-bioabsorbable. Examples of typical materials include non-bioabsorbable plastic, bioabsorbable plastic, synthetic tissue, and allograft tissue. In non-surgical applications,body 12 can be made of any desired material such as metal, plastic, wood, fiberglass, composite, or the like. - As depicted in
FIG. 1 , centrally extending throughbody 10 betweentop surface 14 andbottom surface 16 is aprimary passageway 22. As used in the specification and appended claims, the term “passageway” is broadly intended to include closed apertures, such as depicted byprimary passageway 22, partially bound apertures, open channels, recesses, grooves, slots, and the like, that are capable of receiving a line and at least partially retaining the line therein. The term “line” as used in the specification and appended claims is broadly intended to include suture, cord, rope, filament, wire, cable, and any other form of line. - Extending between
surfaces first end 18 ofbody 12 is a firstsecondary passageway 24. A secondsecondary passageway 24′ extends betweensurfaces second end 20. Extending throughbody 12 at a location betweenprimary passageway 22 and firstsecondary passageway 24 is a first workingpassageway 28. In one embodiment, although not necessarily required, first workingpassageway 28 is disposed betweenprimary passageway 22 and firstsecondary passageway 24 such that a geometric line segment 36 (FIG. 2 ) can be extended betweenprimary passageway 22 and firstsecondary passageway 24 so thatline segment 36 intersects with first workingpassageway 28. Similar to first workingpassageway 28, a second workingpassageway 28′ extends throughbody 12 at a location betweenprimary passageway 22 and secondsecondary passageway 24′. - Each working
passageway first end 38 and an opposingsecond end 40. Each workingpassageway enlarged access region 32 atfirst end 38 which communicates with aconstricted capture slot 34 atsecond end 40.Access region 32 is sized to enable easy feeding of a line into and through the corresponding workingpassageways access region 32 can be slightly smaller than the transverse cross sectional area of the line which is to be passed therethrough,access region 32 typically has a transverse cross sectional area that is equal to or slightly larger than the transverse cross sectional area of the line that is to be passed therethrough. - In contrast,
capture slot 34 has a width W that is substantially equal to or less than the diameter of the line that is to be passed through workingpassageways passageways capture slot 34 can come in a variety of different constricted, tapered, or notched shaped configurations that are capable of securely retaining a line through wedged engagement. For line made of less compressible material, such as metal, the required difference between the width W and the diameter of the line may be less than the examples given above. - As depicted in
FIG. 2 ,central passageway 22 is bounded by aninterior surface 42 ofbody 12 having a substantially triangular transverse cross section.Interior surface 42 comprises afirst side face 44 disposed toward first workingpassageway 28, asecond side face 46 disposed toward second workingpassageway 28′ and which intersects withfirst side face 44, a third side face 48 extending betweenfirst side face 44 andsecond side face 46. Although side faces 44 and 46 are shown as being substantially flat, in alternative embodiments side faces 44 and 46 can be curved or irregular. In one embodiment, however,first side face 44 is substantially disposed in or tangent to a first plane illustrated by dashedline 50. With reference toFIG. 2 ,plane 50 slopes towardsecond end 40 of first workingpassageway 28 asplane 50 extends fromfirst side 19 ofbody 12 tosecond side 21. - First
secondary passageway 24 is bounded by aninterior surface 54 ofbody 12 having an elongated transverse cross section.Interior surface 54 comprises afirst side face 56 disposed toward first workingpassageway 28 and an opposingsecond side face 58. Although side faces 56 and 58 are shown as being substantially flat, in alternative embodiments side faces 56 and 58 can also be curved or irregular. Again, in one embodimentfirst side face 56 is substantially disposed in or tangent to a second plane illustrated by dashedline 60. With reference toFIG. 2 ,second plane 60 slopes towardsecond end 40 of first workingpassageway 28 assecond plane 60 extends fromfirst side 19 ofbody 12 tosecond side 21. - In the above discussed configuration,
first plane 50 andsecond plane 60 are disposed so as to be converging as they extend fromfirst side 19 ofbody 12 tosecond side 21. In the embodiment depicted, planes 50 and 60 intersect at alocation 62 onbody 12 that is at least substantially aligned with a central longitudinal axis ofcapture slot 34. In other embodiments,location 62 can be directly adjacent tobody 12 or at a distance frombody 12 Likewise,location 62 need not be aligned with the central longitudinal axis ofcapture slot 34. Although not required, in one embodiment planes 50 and 60 are disposed at equally opposing angles relative to the central longitudinal axis ofcapture slot 34. Furthermore, planes 50 and 60 can intersect so as to form an inside angle therebetween in a range between about 5° to about 85°. - Second
secondary passageway 24′ has substantially the same configuration as firstsecondary passageway 24. Likewise, secondsecondary passageway 24′ has substantially the same relative position to second workingpassageway 28′ andsecond side face 46 ofprimary passageway 22 as first secondary passageway 26 has to first workingpassageway 28 andfirst side face 44 ofprimary passageway 22. As such, the discussion with regard toplanes primary passageway 22 and secondsecondary passageway 24′. - By way of example of the passageways and not by limitation, for use with a size USP #2 braided suture, which has a diameter in a range between about 0.5 mm to about 0.6 mm,
primary passageway 22 has a length in a range between about 1.3 mm to about 1.5 mm and a width in a range between about 1 mm to about 1.3 mm.Secondary passageways Access region 32 of workingpassageways - Depicted in
FIG. 3 ,interior surface 42 ofprimary passageway 22 extends to a topoutside corner 66 and an opposing bottom outsidecorner 68. Topoutside corner 66 bounds a topprimary opening 70 while bottom outsidecorner 66 bounds a bottomprimary opening 72. Similarly, first workingpassageway 28 has aninterior surface 74 that extends to a topoutside corner 76 and an opposing bottom outsidecorner 78. Topoutside corner 76 bounds a top workingopening 80 while bottom outsidecorner 76 bounds abottom working opening 82. Likewise,interior surface 54 of firstsecondary passageway 24 extends to a topoutside corner 86 and an opposing bottom outsidecorner 88. Topoutside corner 86 bounds a topsecondary opening 90 while bottom outsidecorner 86 bounds a bottomsecondary opening 92. - For reasons as will be discussed below in greater detail, each of top
outside corners corners corners outside corners - It is again noted that second
secondary passageway 24′ and second workingpassageway 28′ having substantially the same configuration as firstsecondary passageway 24 and first workingpassageway 28, respectively. As such, the same discussion with regard to the outside corners are also applicable thereto. Likewise, like elements are identified by like reference characters. - Depicted in
FIG. 4A is aline 100 adjustably mounted online lock 12.Line 100 comprises a standingportion 102 in the form of a loop which extends belowprimary passageway 22, a first workingportion 104 which extends out of first workingpassageway 28, and afirst locking portion 106 extending therebetween. It is appreciated that each of thesections line 100 are relative to each other in that they change asline 100 is adjusted online lock 10.Line 100 further includes a second workingportion 104′ which extends out of second workingpassageway 28′ and asecond locking portion 106′ that extends between standingportion 102 and second workingportion 104′. - First locking
portion 106 extends up throughprimary passageway 22, down through firstsecondary passageway 24, and then up through first workingpassageway 28. The section of lockingportion 106 extending betweenprimary passageway 22 and firstsecondary passageway 24 is referred to ascompression section 110.Line 100 passes up through first workingpassageway 28 so that first workingportion 104 is disposed betweencompression section 110 andcapture slot 34.Second locking portion 106′ is similarly passed throughpassageways - During use, standing
portion 102 ofline 100 is typically looped around, embedded within, or passed through tissue, or some other structure. To secure standingportion 102 to the structure, unwanted slack is removed from standingportion 102. This is accomplished by slidingline lock 10 over standingportion 102 and/or pulling on workingportion 104 and/or 104′ so that the unwanted slack is pulled throughline lock 10. In either event, at least one of workingportions portion 102 shortens. - In the configuration depicted in
FIG. 4A ,line 100 is passing throughenlarged access regions 32 of workingpassageways relative locking portions line lock 10 as the unwanted slack from standingportion 102 is removed. A mild tension force is typically applied to workingportions compression section first side 19 ofbody 12 and thus away fromcapture slots line 100 passing throughprimary passageway 22 andsecondary passageways first side 19 ofbody 12. This movement ofline 100 helps to decrease frictional resistance online 100. - Once the slack is removed from standing
portion 102, further force is applied to workingportions line lock 10 so as totension locking portions line lock 10. As depicted inFIG. 4B , asline 100 is tensioned, the diverging side face 44 ofprimary passageway 22 and side face 56 of firstsecondary passageway 24 cause the portions ofline 100 passing therethrough, and thuscompression portion 110 extending therebetween, to slide towardfirst side 21 ofbody 12. - Furthermore, as
line 100 is tensioned,compression portions line 100 causescompression portions portions corresponding capture slots line 100 within workingpassageways corresponding capture slots line 100 is secured therein by wedged frictional engagement. That is,line 100 is secured by compression withincapture slots line 100 has a diameter larger than the width ofcapture slots line 100 is captured under compression incapture slots line 100 will remain captured even if there is a complete loss of tension in standingend 102. Thus, “locking” ofline lock 10 toline 100 ensures thatline lock 10 will not become separated fromline 100, even under cyclic changes in line tension in standingend 102. Furthermore,line lock 10 is continuously adjustable in that further tension can be applied to standingportions 104 and/or 104′ at any time to remove additional slack from standingportion 102 while retainingline 100 locked toline lock 10. - The passageways extending through
line lock 10 are also configured such that ascompression portions force line 100 intocapture slots compression portions outside corner 76 ofcapture slots outside corner 76, the engagement between the captured working ends 104 and 104′ and topoutside corner 76 creates a high degree of friction which forms a secondary locking mechanism betweenline 100 andline lock 10. As such, the engagement betweencapture working ends outside corner 76 prevents backward movement ofline lock 10 relative toline 100. - In the embodiment depicted in
FIG. 4B ,compression portion 110 is disposed above a portion of topoutside corner 76 so as to directly bias workingends 104 against topoutside corner 76.Compression portion 110 is also shown disposed directly above a portion of workingend 104 that is biasing against topoutside corner 76. In alternative embodiments,compression portion 110 when tensioned can extend betweencentral passageway 22 andsecondary passageways 24 without passing over workingpassageway 28. That is,compression portion 110 can pass at a location towardsecond side 21 ofline lock 10 that is spaced apart from workingpassageway 28. In this embodiment,compression portion 110 still passes over workingend 104, thereby remotely causing workingend 104 to fold over and bias against topoutside corner 76. - One of the unique features of the present embodiment is that as
line lock 10 is advanced toward standingend 102 when standingend 102 is not under tension, i.e., when slack is being removed from standingend 102, working ends 104 and 104′ tend to push awaycompression portions compression portions line lock 10. As a result,line lock 10 can be easily advanced online 100. - Furthermore, unlike some other continuously adjustable line locks known in the art that use a loop portion to draw in and wedge a portion of a line within a bore hole,
compression portions secondary passageways primary passageway 22. This substantially straight path translates to a lower frictional resistance to sliding not possible with other adjustable line locks known in the art. - As previously discussed,
line 100 is routed throughpassageways line 100 passes around a first outside corner ofline lock 10, friction produced betweenline 100 and the corresponding outside corner cause a decrease in tension on the portion ofline 100 extending away from the outside corner on the side opposite the tensioned section. The friction produced at the outside corner must be overcome in order to causeline 100 to slide. Similarly, as the line passes around subsequent outside corners away from the tensioned section, each subsequent corner produces an incremental decrease in line tension and a corresponding incremental increase in friction that must be overcome to causeline 100 to slide. The loss in tension and increase in friction diminishes for each subsequent corner. Thus, the first corners are the most significant. - As depicted in
FIG. 6 , in view of the above discussion, when workingend 104 is tensioned and standingend 102 is slack,line 100 extending from workingend 104 towardline lock 10 first turns on bottom outsidecorner 78 of workingpassageway 28 and bottom outsidecorner 88 ofsecondary passageway 24. As a result of the fact that these are the closest outside corners to tensioned workingend 104,outside corners outside corners line lock 10 toward standingend 102,outside corners - In contrast, as depicted in
FIG. 5 , when standingend 102 is tensioned and workingend 104 is slack,line 100 extending from standingend 102 towardline lock 10 first turns on topoutside corner 66 ofprimary passageway 22 and topoutside corner 86 ofsecondary passageway 24. In view of the fact that these are the closest outside corners to tensioned standingend 102,outside corners outside corners line 100 once tensioned,outside corners outside corners outside corners line 100 can have a radius of curvature that is different from the remainder of the corresponding outside corner. - Depicted in
FIG. 7 ,line lock 10 is shown having an alternative routing ofline 100. To achieve this routing, working ends 104 and 104′ are passed up throughsecondary passageways primary passageway 22, and then back up through workingpassageways compression portions capture slots 34 as discussed above. In yet another alternative, it is appreciated that one end ofline 100 can be routed as shown inFIG. 4A while the opposing end ofline 100 is routed as shown inFIG. 7 . - Depicted in
FIG. 8 is an alternative embodiment of aline lock 120. It is noted that all common elements of alternative embodiments of line locks disclosed herein are identified by like reference characters.Line lock 120 comprisesbody 12 havingprimary passageway 22 andsecondary passageways FIG. 1 . In contrast to the circumferentially closed workingpassageways line lock 120 comprises workingpassageways passageway first end 124 and an opposingsecond end 126.First end 124 is open alongfirst side 19 ofbody 12 to facilitate convenient loading ofline 100 therein.First end 124 also typically has a width greater than the diameter ofline 100.Second end 126 extends to a location betweenprimary passageway 22 and a corresponding one ofsecondary passageway - In this embodiment it is noted that the passageways are positioned such that a
geometric line segment 130 can be extended betweenprimary passageway 22 andsecondary passageway 24′ such thatline segment 130 does not intersect with workingpassageway 122′. However, ageometric line segment 132 can also be extended betweenprimary passageway 22 andsecondary passageway 24′ such thatline segment 132 intersects with workingpassageway 122′.Second end 126 of each workingpassageway line 100. - Depicted in
FIG. 9 is another alternative embodiment of aline lock 136 having substantially the same configuration asline lock 120. In contrast to the circumferentially boundedprimary passageway 22 andsecondary passageways line lock 120 inFIG. 8 , however,line lock 136 comprises a partially boundedprimary passageway 138 which is open atsecond side 21 ofbody 12 and partially boundedsecondary passageways second side 21 ofbody 12. - Two separate locking features were previously discussed with regard to securing
line 100 toline lock 10. Specifically,line 100 is secured by being wedged intocapture slots portions corner 76 of each workingpassageway FIG. 10 is aline lock 144 havingbody 12 withsecondary passageways line lock 10, however,line lock 144 comprises workingpassageways capture slots 34 have been eliminated. Workingpassageways line 100 to be passed therethrough.Line 100 is thus primarily secured toline lock 144 as a result ofcompression portions line 100 against topoutside corner 76 of each workingpassageways -
Line lock 144 is also distinguished overline lock 10 in thatprimary passageway 22 has been replaced with a firstprimary passageway 148 and a spaced apart secondprimary passageway 148′.Primary passageways line 100. It is also noted that in alternative embodiments primary passageway(s) and/or the secondary passageways need not be elongated to allow the line passing therethrough to slide toward opposingsides body 12 as previously discussed with regard toline lock 10. - Depicted in
FIG. 11 is an alternative embodiment of aline lock 150 that is designed to slide along a single strand ofline 100.Line lock 150 comprises a substantially disk shapedbody 152 having atop surface 154 and an opposingbottom surface 156. Extending throughbody 152 betweensurfaces primary passageway 158 and a spaced apartsecondary passageway 160. Disposed betweenpassageways passageway 162. Similar toline lock 10, workingpassageway 162 ofline lock 150 has a first end withenlarged access region 32 and an opposing second end withconstricted capture slot 34 thereat. -
Primary passageway 158 andsecondary passageway 160 have substantially the same elongated circular configuration which is similar to previously discussedsecondary passageway 24. Each ofpassageways inside face passageway 162. Eachinside face corresponding plane Planes capture slot 34 of workingpassageway 162 and diverge away fromaccess region 32. - Also extending through
body 152 betweentop surface 154 andbottom surface 156 is anend passageway 172. Althoughend passageway 172 can be positioned at a variety of different locations,end passageway 172 is shown aligned with workingpassageway 162 such that a plane extending between workingpassageway 162 andend passageway 172 separatesprimary passageway 158 fromsecondary passageway 160. - During use, as depicted in
FIGS. 12A-12C ,line 100 is routed throughline lock 150 by passing workingportion 104 fromtop surface 154 tobottom surface 156 throughend passageway 172, up throughprimary passageway 158, down throughsecondary passageway 160, and finally up through workingpassageway 162.Compression portion 110 ofline 100 extends betweenprimary passageway 158 andsecondary passageway 160 and is positioned to act upon workingportion 104.Line lock 150 can be selectively advanced by pulling workingportion 104 away fromtop surface 154 so thatline 100 travels throughline lock 150. Alternatively,line lock 150 can be manually slid toward standingportion 102. In either event, the length of standingportion 102 is decreased. - As
line 100 is tensioned online lock 150,line 100 locks online lock 150 in substantially the same manner that line 100 locks with workingpassageway 28 as previously discussed with regard toline lock 10. That is,compression portion 110forces working end 104 towardcapture slot 34 so that the portion ofline 100 within workingpassageway 162 is captured by wedged frictional engagement withincapture slot 34. Furthermore,compression portion 110 either directly or indirectlybiases working portion 104 against the top outsidecorner 76 of workingpassageway 162 at the second end thereof so as to increase the frictional engagement betweenline 100 andline lock 150.Line lock 150 thus provides a continuously adjustable line lock or a one way sliding stop. In alternative embodiments, it is appreciated thatline lock 150 can be modified in at least the same ways as discussed with the other line locks disclosed herein. - The embodiment shown in
FIGS. 12A-12C is advantageous in certain applications whereline lock 150 is positioned behind a first object and workingportion 104 and standingportion 102 pass through the first object. In this situation, standingportion 102 is fixed to a second object. By pulling on workingportion 104, the first object is drawn irreversibly toward the second object. This is an advantage with surgical sutures where standingend 102 of a suture is attached to normal tissues andline lock 150 is placed behind tissue that has torn away. Standingportion 102 and workingportion 104 pass through the torn tissue toward the normal tissue. By pulling on workingportion 104 of suture, the torn tissue is pulled into apposition with the normal tissues andline lock 150 maintains the torn tissue adjacent to the normal tissue to facilitate healing of the tissue. - Depicted in
FIGS. 13A and 13B is another embodiment of aline lock 180 incorporating features of the present invention.Line lock 180 also comprises a substantially disk shapedbody 182 having atop surface 184 and an opposingbottom surface 186. As withline lock 150,line lock 180 includesprimary passageway 158,secondary passageway 160, and workingpassageway 162. Again, although not required, workingpassageway 162 is disposed such that a geometric line segment can be extended betweenprimary passageway 158 andsecondary passageway 160 so that the line segment intersects with workingpassageway 162. In contrast toline lock 150,line lock 180 does not includeend passageway 172. - Each of
passageways line 100. Specifically, during use both workingend primary passageway 158, down throughsecondary passageway 160 and then back up through workingpassageway 162. As a result, standingportion 102 is again formed in a loop that can be looped around, passed through, or otherwise secured to tissue or other structure. Unwanted slack is removed from standingportion 102 by again slidingline lock 180 online 100 toward standingportion 102 and/or by pulling on one or both of workingportions line 100 passes throughline lock 180. - When
line 100 is tensioned online lock 180,compression portions force working portions capture slot 34 so that a portion of each line section passing through workingpassageway 162 is captured by wedged frictional engagement withincapture slot 34.Compression portions portions top outsider corner 76 of workingpassageway 162 so as to increase the frictional engagement betweenline 100 andline lock 180. As previously discussed withpassageways line lock 10 inFIGS. 1-6 , the radius of curvature of the top outside corner and bottom outside corner of eachpassageway line 100 to slide or not slide through the passageway. Other alternatives as discussed with the line locks herein are also applicable toline lock 180. In particular each of thepassageways line 100. In this configuration the single strand ofline 100 is routed in a manner as described above for the double strand ofline 100. Instead of the standingportion 102 forming a loop when a double strand ofline 100 is used, in this case the standingportion 102 consists of a free end which can be attached to tissue or other structures. - Depicted in
FIGS. 14A and 14B is still another embodiment of aline lock 190 incorporating features of the present invention.Line lock 190 has substantially the same configuration asline lock 180 with like elements being referenced with like reference characters. The primary distinction between line locks 180 and 190 is that inline lock 190, anend 192 ofline 100 adjacent to standingportion 102 is secured tobottom surface 186 ofbody 182.End 192 can be secured tobody 182 by being integrally molded intobody 182 or can be otherwise secured such as by welding or mechanical attachment. -
Line lock 190 is also distinguished fromline lock 180 in that passageways 158, 160, and 162 need only be configured to receive a single strand ofline 100. That is, workingend 104 passes up throughprimary passageway 158, down throughsecondary passageway 160, and then back up through workingpassageway 162. Standingportion 102 is again substantially formed into a loop extending fromend 192 ofline 100 toprimary passageway 158. Becauseend 192 ofline 100 is secured tobody 182, unwanted slack can be removed from standingportion 102 by pullingline 100 throughline lock 190 and/or slidingline lock 190down line 100.Line 100 is locked toline lock 190 in substantially the same manner as discussed above with regard to the other line locks whenline 100 is tensioned online lock 190. - Depicted in
FIG. 15 is still another embodiment of aline lock 200 incorporating features of the present invention.Line lock 200 comprises an elongated substantially box shapedbody 202 comprising atop wall 204 and an opposingbottom wall 206 each extending between afirst side wall 208 and afirst end 210 and an opposingsecond side wall 212 and an opposingsecond end 214. Also extending betweentop wall 204 andbottom wall 206 is afront wall 216 and an opposingback wall 218. - Partially bounded within
body 202 is ahollow chamber 220. Anaccess channel 222 is formed onfront wall 216 so as to communicate withchamber 220. Also communicating withchamber 220 is aprimary passageway 224. Primary passageway centrally extends throughbottom wall 206 tochamber 220. A firstsecondary passageway 226 extends throughfirst side wall 208 so as to communicate withchamber 220 while a secondsecondary passageway 226′ extends throughsecond side wall 212 so as to communicate withchamber 220. A pair of first workingpassageways bottom wall 206 andtop wall 204, respectively, in vertical alignment betweenprimary passageway 224 and firstsecondary passageway 226. - Similarly, a pair of second working
passageways bottom wall 206 andtop wall 204 in vertical alignment betweenprimary passageway 224 and secondsecondary passageway 226′. As with the prior working passageways, each of workingpassageways front wall 226 with anenlarged axis region 32 and an opposing second end towardback wall 218 with acapture slot 34 formed thereat. - During use, as depicted in
FIG. 16A-16C , workingportions 104 ofline 100 are passed up throughprimary passageway 224 intochamber 220. Workingportion 104 then passes out ofchamber 220 through firstsecondary passageway 226. Finally, workingportion 104 passes up through first workingpassageway 228, throughchamber 220, and then out through first workingpassageway 228′.Compression portion 110 ofline 100 extends fromprimary passageway 224 to firstsecondary passageway 226. Workingportion 104 is routed such thatline 100 passes betweencompression portion 110 andback wall 218. - In like manner, working
portion 104′ extends fromchamber 220 out through secondsecondary passageway 226′. Workingportion 104′ then extends up through second workingpassageway 230, throughchamber 220, and then out through second workingpassageway 230′. Again,line 100 extends betweencompression portion 110′ andback wall 218. - As with the other embodiments,
line lock 200 can be slid alongline 100 and/orline 100 can be pulled therethrough so as to remove all unwanted slack from standingportion 102. Asline 100 is tension online lock 200,compression portions line 100 extending between first workingpassageways passageways capture slots 34. As a result, at least a portion ofline 100 extending through each of the working passageways is captured by frictional wedge engagement within each of thecorresponding capture slots 34.Line 100 is thus locked withline lock 200. -
Line lock 200 offers several advantages. When standingend 102 is slack and workingends line 100 extending between workingpassageways passageways force compression portions front wall 216 so as to allow the free travel ofline 100 throughline lock 200. In contrast, as discussed above, when tension is created in standingend 102 and slack is created in workingends compression portions line 100 extending between workingpassageways passageways back wall 218 so as to secureline 100 within thecapture slots 34. This back and forth movement ofcompression portions lock 200 can move away from standingend 102 until locking ofline 100 is achieved. -
Top wall 204 ofline lock 200 provides a physical constraint to the amount of movement seen incompression portions top wall 204 provides an additional friction point whencompression portions line 100, thereby increasing the strength of the locking ofline 100. That is, one friction point is located at workingpassageways bottom wall 206 and the second friction point is located at workingpassageways 228′ and 230′ ontop wall 204. - It is again appreciated that the alternatives as discussed with the other embodiments are also applicable to
line lock 200. By way of example and not by limitation,line 100 can be routed throughline lock 200 in a manner analogous to the routing inFIG. 7 . The various passageways can be open or closed as depicted inFIGS. 8 and 9 . Similarly,line lock 200 can be divided in half and modified to function similar to the line locks shown inFIGS. 11-14 . - Depicted in
FIG. 17 is a final alternative embodiment of aline lock 240 incorporating features of the present invention.Line lock 240 has a configuration similar toline lock 200 and thus like elements are identified by like reference characters.Line lock 240 comprises an elongated substantially box shapedbody 242. Similar toline lock 200,body 242 comprisestop wall 204 andbottom wall 206 extending betweenside wall 208 andside wall 212.Body 242 also includesfront wall 216 andback wall 218 which partially boundchamber 220. - In contrast to
line lock 200, a firstprimary passageway 241 extends throughfirst side wall 208 while secondprimary passageway 241′ extends throughsecond side wall 212.Primary passageways chamber 220.Body 242 ofline lock 240 further comprises a firstsecondary passageway 244 extending throughback wall 218 in communication withchamber 220 and a spaced apart secondsecondary passageway 244′ in communication withchamber 220. Afirst access port 246 extends throughfront wall 216 in alignment with firstsecondary passageway 244′ so as to communicate withchamber 220. Similarly, asecond access port 246′ extends throughfront wall 216 in alignment with secondsecondary passageway 244 so as to also communicate withchamber 220. - Furthermore, in contrast to the bounded working passageways of
line lock 200,line lock 240 comprises a pair of first workingpassageways passageway 248 comprises a constricting slot that is formed onbottom wall 206 and is open along intersectingfront wall 216. First workingpassageway 248′ is aligned with first workingpassageway 248 and is formed ontop wall 204 so as to also be open along intersectingfront wall 216. A pair of second workingpassageways bottom wall 206 andtop wall 204 so as to be aligned with secondsecondary passageway 244′. Each of the working passageways terminates at capture slot having a width substantially equal to or smaller than the diameter ofline 100. - During use, as depicted in
FIGS. 18A-18C , workingend 104 ofline 100 is passed through firstprimary passageway 242 intochamber 220 and then out through firstsecondary passageway 244. Workingend 104 then passes down aroundbottom wall 206 and is then fed up through first workingpassageways compression portion 110 ofline 100 extends betweenprimary passageway 241 andsecondary passageway 244. Workingportion 104 is passed between workingpassageways line 100 passes betweencompression portion 110 and firstsecondary passageway 244. - Working
portion 104′ is similarly passed through the passageways on the opposing side ofline lock 240. That is, workingportion 104′ passes throughprimary passageway 241′ and intochamber 220. Workingportion 104′ then travels out throughsecondary passageway 244′, bends aroundbottom wall 206, and then travels up through workingpassageways - In the above configuration, slack can be removed from standing
portion 102 by pullingline 100 throughline lock 240 and/or slidingline lock 240 toward standingportion 102. Asline 100 tensions online lock 240,compression portions line 100 intocapture slots 34 of the working passageways so as to secureline 100 toline lock 240 by wedged frictional engagement. - Like
line lock 200,line lock 240 provides containment ofcompression portions line 100 is routed throughline lock 240 such that at least one line turn exceeds 90 degrees. For example, the transition betweencompression portions line 100. These sharp bends inline 100 increase the friction that must be overcome in order to advanceline lock 240 toward standingend 102. However, the sharp bends also contribute to greater locking strength ofline lock 240 toline 100. This embodiment is beneficial whenline 100 is monofilament or single strand line, due to the commonly lower line on line friction and greater flexural stiffness of monofilament line when compared to braided or twisted strand line. - Referring to
FIG. 19 , a perspective view illustrates aline lock 310 according to one alternative embodiment of the invention. As shown, theline lock 310 has abody 312 that is generally disc-shaped. Thebody 312 has atop surface 314, abottom surface 316, and aperiphery 318 that extends between thetop surface 314 and thebottom surface 314 to define a generally circular profile. In this application, a shape having a “generally circular profile” is any shape in which the outside boundary of any cross section passing through the main portion of the shape is substantially circular. - The
body 312 bounds a plurality of passageways designed to cooperate receive a line such as a suture. In this application, passageways that “cooperate to receive” a line such as a suture receive the line such that the line passes through all of the cooperating passageways. The passageways of thebody 312 include a firstprimary passageway 322 and a secondprimary passageway 323, each of which may be positioned adjacent to theperiphery 318. Theprimary passageways body 312. - Furthermore, in the
line lock 310 ofFIG. 19 , the passageways include a firstsecondary passageway 324 and a secondsecondary passageway 325, which are also positioned on opposite sides of thebody 312, adjacent to theperiphery 318. Thesecondary passageways periphery 318 than theprimary passageways passageway 328 and a second workingpassageway 329. The workingpassageways body 312. - Each of the primary and
secondary passageways secondary passageways passageways - The
passageways top surface 314 to form corresponding openings, each of which is bounded by one of a plurality of topoutside corners 336. Thepassageways bottom surface 316 to form corresponding openings, each of which is bounded by one of a plurality of bottom outside corners (not shown). - As in the description previously set forth, some or all of the top outside
corners 336 may have a smaller (i.e., sharper) radius than the corresponding bottom outside corners. More particularly, the top outsidecorners 336 of the workingpassageways FIG. 19 , the radii of the top outsidecorners 336 of the workingpassageways corners 336 of the primary andsecondary passageways corners 336 of the workingpassageways line lock 310. - Each of the working
passageways FIG. 19 . More precisely, each of the workingpassageways 328 may have anaccess region 332 and acapture slot 334. Theaccess region 332 is large enough to permit the suture to pass therethrough with clearance. However, thecapture slot 334 may be somewhat narrower such that, when the suture is drawn into thecapture slot 334, the walls of thecapture slot 334 press against the suture to restrict further motion of the suture through theslot 334. The operation of thecapture slot 334 will be further shown and described in connection withFIGS. 20 and 21 . - In the embodiment of
FIG. 19 , the first primary, secondary, and workingpassageways body 312 with respect to the second primary, secondary, and workingpassageways passageways passageways passageways central axis 338 of the body 1212, they would be substantially superimposed on the second primary, secondary, and workingpassageways - According to one alternative embodiment, the
capture slots 334 may extend at angles with respect to theaccess regions 332 so that the workingpassageways capture slots 334 at the desired position and orientation with respect to the first primary andsecondary passageways secondary passageways - In addition to the
line lock 310,FIG. 19 also illustrates aninsertion tool 340 that may be used to insert a line lock such as theline lock 310 ofFIG. 19 into a relatively constricted space, such as a space within the body accessed via a cannula or the like. Theinsertion tool 340 has a proximal end (not shown), which may have handle or other structure to facilitate grasping by hand. Theinsertion tool 340 also has adistal end 342 and ahollow bore 344 that may extend along the entire displacement between the proximal end and thedistal end 342 so that sutures or other items can be inserted into one end of thehollow bore 344 and retrieved from the opposite end. Thedistal end 342 has arim 346, which may have an annular shape, a frustoconical shape, or the like, such that thebody 312 is able to seat against therim 346. Theinsertion tool 340 can thus be used to advance theline lock 310 in a manner that will be more fully set forth in the description ofFIG. 20 . - Referring to
FIG. 20 , a perspective view illustrates asystem 348 including theline lock 310 ofFIG. 19 and asuture 350 relatively loosely passing through thepassageways body 312. Thesuture 350 may be similar or identical to that described previously. Accordingly, thesuture 350 may have a standingportion 352, which is the portion of thesuture 350 that is placed under tension and constrained by advancement of theline lock 310, first and second workingportions second locking portions portion 352 and the first and second workingportions - The
suture 350 may be inserted through thepassageways suture 350 may be inserted by hand. Alternatively, thesuture 350 may be inserted through the use of threaders (not shown) that are initially routed through thepassageways FIGS. 22-26 . In addition to or in the alternative to the use of threaders, a cartridge (not shown) may be used to retain theline lock 310 and guide thesuture 350 through thepassageways - As illustrated in
FIG. 20 , thefirst locking portion 356 extends from the standingportion 352 through the firstprimary passageway 322, then through the firstsecondary passageway 324, and then through the first workingpassageway 328. From the first workingpassageway 328, the first workingportion 354 extends between thetop surface 314 and the section of thefirst locking portion 356 that passes from the firstprimary passageway 322 to the firstsecondary passageway 324. This section of thefirst locking portion 356 is afirst compression section 360 of thesuture 350. - Similarly, the
second locking portion 357 extends from the standingportion 352 through the secondprimary passageway 323, then through the secondsecondary passageway 325, and then through the second workingpassageway 329. From the second workingpassageway 329, the second workingportion 355 extends between thetop surface 314 and the section of thesecond locking portion 357 that passes from the secondprimary passageway 323 to the secondsecondary passageway 325. This section of thesecond locking portion 357 is asecond compression section 361 of thesuture 350. - The standing
portion 352 may be inserted through and/or around some feature (not shown), such as bodily tissue, that is to be retained by thesystem 348. The standingportion 352 may additionally or alternatively pass through an opening of a bone anchor or the like to enable tissues to be anchored to the bone, as in rotator cuff repair. From the configuration ofFIG. 20 , thesuture 350 may be tightened by advancing theline lock 310 along the standingportion 352. Theline lock 310 may be advanced by holding the workingportions body 312 toward the standingportion 352. - According to one method, the
line lock 310 may be advanced along the standingportion 352 through the use of a tool such as theinsertion tool 340 ofFIG. 19 . More precisely, the workingportions hollow bore 344 at thedistal end 342. The workingportions hollow bore 344 such that they protrude from thehollow bore 344 at the proximal end. A user may then grasp the workingportions portions body 312 is seated against therim 346 of thedistal end 342. The shape of therim 346 may tend to draw thebody 312 into a position and orientation coaxial with theinsertion tool 340 to facilitate insertion of theline lock 310 into a relatively narrow space. - Once the slack has been removed from the working
portions portions portions passageways primary passageways passageways portions compression sections portions access regions 332 of the workingpassageways line lock 310 is able to advance along the standingportion 352, thereby causing the standingportion 352 to tighten. - In alternative to use of a tool such as the
insertion tool 340 ofFIG. 19 , theline lock 310 may be advanced along the standingportion 352 without any tooling. For example, theline lock 310 may be pressed and moved along the standingportion 352 by direct pressure from a finger. Alternatively, grasping the workingportions line lock 310 to advance along the standingportion 352. Each of the workingportions top surface 314, but may not pass through thecorresponding capture slot 334 until locking is performed. Such a technique may be particularly useful for retaining tissues in more readily accessible areas, where the workingportions - Referring to
FIG. 21 , a perspective view illustrates thesystem 348 ofFIG. 20 , with thesuture 350 routed relatively tightly through thepassageways portion 352 tightens, tension in the standingportion 352 causes thecompression sections compression sections suture 350 within the workingpassageways capture slots 334. The sections of the workingportions passageways top surface 314 by thecompression sections - Accordingly, each of the working
portions first bend 370 is about the top outsidecorner 336 of each corresponding workingpassageway second bend 372 is about the correspondingcompression section corners 336 of the workingpassageways corners 336 of the workingpassageways portions compression sections compression sections suture 350. - Due to the friction applied to the
bends portions portion 352, the workingportions passageways portion 352 may still be tightened by further drawing on the workingportions portions compression sections bends body 312 along the standingportion 352 only increases the level of tension in the standingportion 352 so that, when tension on the workingportions portions - After the locking
portions portion 352, the workingportions bends portions line lock 310. The second bends 372 may disappear because there is no longer tension drawing the workingportions FIG. 21 . However, thesecond bends 372 are not required for locking; rather, thecompression sections suture 352 against thetop surface 314, adjacent to the first bends 370. The friction of this compression interface, in addition to that of thefirst bends 370, is sufficient to keep thesuture 350 from slipping back through thepassageways - If desired, the
line lock 310 and/or thesuture 352 may be formed of biodegradable or bioabsorbable materials. Alternatively, theline lock 310 and thesuture 352 may be small and compact enough that they can remain in the body indefinitely without causing any discomfort or significant health risks. - Referring to
FIG. 22 , a perspective view illustrates one embodiment of asystem 400 including theline lock 310 of the previous embodiment (not visible inFIG. 22 ), and various implements to help insert, or “thread,” thesuture 350 through thepassageways line lock 310. Alongitudinal direction 402, alateral direction 404, and atransverse direction 406 cooperate to form a system of orthogonal axes that will be used for reference in the following description. - In addition to the
line lock 310, thesystem 400 includes acartridge 410, afirst threader 412, and asecond threader 414. Thecartridge 410 contains theline lock 310 and, when in the closed configuration shown inFIG. 22 , substantially encloses theline lock 310 to facilitate insertion of thesuture 350 through thepassageways line lock 310 from contaminants. In this application, the phrase “substantially enclose” does not require full enclosure; rather, some portion(s) of the substantially enclosed part may protrude from the enclosure. - The
cartridge 410 may be formed of a plastic such as polypropylene, PEEK, or the like. Thethreaders cartridge 410 along first and second pathways, respectively, to enable a user to draw thesuture 350 through thepassageways threaders - As shown in
FIG. 22 , thecartridge 410 has a firstlongitudinal end 420, a secondlongitudinal end 422, a firstlateral end 424, and a secondlateral end 426. Thethreaders cartridge 410 has alid 430 designed to move with respect to the remainder of thecartridge 410, which will be referred to as acontainment portion 432. More specifically, aliving hinge 434 extends generally along the firstlateral end 424, between the adjacent edges of thelid 430 and thecontainment portion 432. The livinghinge 434 is integrally formed with thelid 430 and thecontainment portion 432 and flexes to enable pivotal motion of thelid 430 with respect to thecontainment portion 432. In alternative embodiments, a conventional hinge may be used, or a lid may be slidable with respect to and/or fully removable from the remainder of the cartridge, thereby obviating the need for a hinging mechanism. - A
first tab 436 integrally formed with thelid 430 and asecond tab 438 integrally formed with thecontainment portion 432 may easily be pushed in opposite directions, for example, by a user's thumbs, to open thecartridge 410. Thelid 430 and thecontainment portion 432 may be designed to adhere to each other at the secondlateral end 426 so that thecartridge 410 only opens when a threshold force is applied. Thus, thecartridge 410 may not open if dropped or jostled. - The first
longitudinal end 420 has a first set ofslots 440 through which thethreaders longitudinal end 422 has a second set ofslots 442 through which thethreaders threaders cartridge 410 through the firstlongitudinal end 420 and out again through the secondlongitudinal end 422. Each of thethreaders leading end 450 adjacent to the second set ofslots 442 and a trailingend 452 adjacent to the first set ofslots 440. - Each of the leading ends 450 has a pull feature designed to facilitate grasping and drawing of the leading ends 450 by hand. In the embodiment of
FIG. 22 , the pull features take the form ofgrips 454 that may be easily grasped, for example, between a thumb and an index finger. Thegrips 454 may be plastic rods crimped, insert molded, adhesive bonded, or otherwise attached to the remainder of thethreaders - Additionally, each of the trailing ends 452 has a suture retention feature designed to retain a portion of a suture to enable the
threaders passageways line lock 310. InFIG. 22 , the suture retention features take the form ofeyelets 456, each of which is able to receive an end of the suture such that the suture end can double back on itself to be drawn through thecartridge 410. Theeyelets 456 may be crimped, adhesive bonded, insert molded, or otherwise attached to the remainder of thethreaders - The
eyelets 456 may be retained to ensure that they are not drawn into thecartridge 410 prior to attachment to the suture to be threaded through theline lock 310. For example, thecontainment portion 432 may haveretention posts 458 that extend in thelongitudinal direction 402 on either side of each of the slots of the first set ofslots 440. Each of theeyelets 456 may optionally be looped around a pair of the retention posts 458 so that eacheyelet 456 is unable to enter the corresponding slot of the first set ofslots 440 until theeyelet 456 is removed from around the retention posts 458. Each of theeyelets 456 may need to be slightly larger than shown inFIG. 22 to enable them to encircle a pair of the retention posts 458. The retention posts 458 may also serve a similar function if loops or other flexible suture retention features are used in place of theeyelets 456. - Referring to
FIG. 23 , a perspective view illustrates thesystem 400 ofFIG. 22 , with thecartridge 410 in the open configuration to expose theline lock 310. Thesuture 350 has also been inserted into engagement with the trailing ends 452 of thethreaders first suture portion 460 of thesuture 350 has been inserted through theeyelet 456 of thefirst threader 412, and asecond suture portion 462 of thesuture 350 has been inserted through theeyelet 456 of thesecond threader 414. The first andsecond suture portions eyelets 456 to draw them through thecartridge 410 and through thepassageways FIG. 23 ) of theline lock 310. - Each of the
suture portions various portions suture 350. However, no direct correlation is necessary because any portion(s) of thesuture 350 may be drawn through theline lock 310 via thecartridge 410 and thethreaders line lock 310, thesystem 400 may be used to thread two separate sutures through theline lock 310. - As shown in
FIG. 23 , thecontainment portion 432 has a pair ofsockets 464 formed therein. Each of thesockets 464 may provide a generally rectangular cavity surrounded by a wall that is slotted to permit expansion of thesocket 464. Thelid 430 has a pair ofposts 466 that are generally rectangular in shape, and are sized and positioned to slide into thesockets 464 when thecartridge 410 is in the closed configuration. Theposts 466 may be sized to fit relatively tightly into thesockets 464 so that thecartridge 410 does not open until the threshold force is applied to remove theposts 466 from thesockets 464. - The
containment portion 432 also has acentral divider 470 that extends generally along thelateral direction 404 to effectively separate thecontainment portion 432 into two separate compartments. Thecontainment portion 432 defines a retention feature designed to retain theline lock 310. In this application, the terms “retention feature” and “threading feature” are to be broadly interpreted to include, not just single structural elements, but also groups of elements that cooperate to carry out line lock retention or suture threading. - In
FIG. 23 , the retention feature takes the form of a pair oftroughs 472 positioned on either side of a space in which theline lock 310 rests within thecontainment portion 432. Thetroughs 472 face each other such that they retain theperiphery 318 of thebody 312 of theline lock 310 to resist motion of theline lock 310 along the longitudinal andlateral directions troughs 472 are exposed on the open side of thecontainment portion 432 so that theline lock 310 can be inserted into the space between thetroughs 472, or removed therefrom, by moving theline lock 310 along thetransverse direction 406. - Additionally, the
containment portion 432 has a threading feature designed to help guide thesuture 350 through thepassageways FIG. 23 , the threading feature takes the form of a pair ofposts 474 positioned on either side of thecentral divider 470, and thus on either side of the space in which theline lock 310 rests. Each of theposts 474 may have a generally teardrop-shaped cross section, as taken through a plane parallel to the longitudinal andlateral directions posts 474 also has aslot 476 facing the adjacent one of the first and second longitudinal ends 420, 422. - The
threaders posts 474 along a configuration similar to that provided by thesuture 350 illustrated inFIGS. 20 and 21 . More precisely, from its trailingend 452, thefirst threader 412 passes through one of the first set ofslots 440, then through the first primary passageway 322 (not visible inFIG. 23 ) and then through the first secondary passageway 323 (not visible) to define afirst loop 480 of thefirst threader 412. From the firstsecondary passageway 323, thefirst threader 412 passes through the first working passageway 328 (not visible) to define asecond loop 482 of thefirst threader 412. From the first workingpassageway 328, thefirst threader 412 extends through thefirst loop 480 and then passes through the corresponding one of the second set ofslots 442, to theleading end 450. - Similarly, from its trailing
end 452, thesecond threader 414 passes through one of the first set ofslots 440, then through the second primary passageway 324 (not visible inFIG. 23 ) and then through the second secondary passageway 325 (not visible) to define afirst loop 484 of thesecond threader 414. From the secondsecondary passageway 325, thesecond threader 414 passes through the second working passageway 329 (not visible) to define asecond loop 486 of thesecond threader 414. From the second workingpassageway 329, thesecond threader 414 extends through thefirst loop 484 and then passes through the corresponding one of the second set ofslots 442, to theleading end 450. - The various portions of the
threaders suture 350, as labeled inFIGS. 20 and 21 . For example, the trailing ends 452 may correspond to the standingportion 352 of thesuture 350, the leading ends 450 may correspond to the workingportions loops portions first loops threaders compression sections portions suture 350 is drawn through thepassageways threaders 412, thesuture 350 assumes a configuration having thevarious portions sections FIGS. 20 and 21 . - As also shown in
FIG. 23 , thelid 430 has a pair of blockingmembers 490 that engage theposts 474 when thecartridge 410 is closed to keep thevarious loops members 490 has alongitudinal portion 492 extending along thelongitudinal direction 402, and alateral portion 494 extending along thelateral direction 404. Thelongitudinal portions 492 may be positioned to seat in theslots 476 of theposts 474 to ensure that theloops posts 474 by moving transversely toward thelid 430, into a gap that may exist between theposts 474 and thelid 430. Similarly, thelateral portions 494 may be positioned inward of and adjacent to the first and second sets ofslots threaders slots lid 430, into a gap that may exist between theslots lid 430. - Referring to
FIG. 24 , a perspective view illustrates thesystem 400 ofFIG. 22 , with thecartridge 410 open to expose theline lock 310. InFIG. 24 , thefirst threader 412 is drawn partially through thecartridge 410 so that the correspondingfirst suture portion 460 of thesuture 350 is partially drawn through the correspondingpassageways FIG. 24 ) of theline lock 310. - More precisely, the
first suture portion 460 has been drawn through the corresponding one of the first set ofslots 420 and through the first primary passageway 322 (not visible inFIG. 24 ) of theline lock 310. Further, thefirst suture portion 460 has been drawn along thefirst loop 480 of thefirst threader 412 so that thefirst suture portion 460 encircles thepost 474 toward the secondlongitudinal side 422, in place of thefirst loop 480. - The leading, doubled-over portion of the
first suture portion 460 is thus poised to enter the first secondary passageway 324 (not visible). From the firstsecondary passageway 324, thefirst suture portion 460 will then be drawn along thesecond loop 482 of thefirst threader 412, through the first working passageway 328 (not visible), and then through the corresponding one of the second set ofslots 442 in the secondlongitudinal end 422. The leading, doubled-over portion of thefirst suture portion 460 will then protrude from thecartridge 410 and may easily be grasped and drawn by hand until theline lock 310 is positioned at the desired location along the length of thefirst suture portion 460. - The
second suture portion 462 may be drawn through thecartridge 410 in a similar manner, as described previously in connection with the discussion ofFIG. 23 . Thus, bothsuture portions cartridge 410 and through thepassageways line lock 310. Thesuture portions cartridge 410 with the cartridge in the open configuration, as illustrated inFIG. 24 , or with thecartridge 410 in the closed configuration. If desired, part or all of thecartridge 410 may be made translucent or transparent so that a user can easily verify proper threading without opening thecartridge 410. - Referring to
FIG. 25 , a perspective view illustrates thesystem 400 ofFIG. 22 , with thecartridge 410 in the open configuration to expose theline lock 310. Thesuture 350 has been fully threaded through thepassageways line lock 310 in the manner illustrated inFIGS. 20 and 21 . Accordingly, theline lock 310 need only be removed from thecartridge 410 prior to use to retain tissue. - Referring to
FIG. 26 , a perspective view illustrates thesystem 400 ofFIG. 22 , with thecartridge 410 in the open configuration, and with theline lock 310 and thesuture 350 removed from thecartridge 410 for use. Theline lock 310 has been drawn from the space between thetroughs 472 by drawing theline lock 310 along thetransverse direction 406, toward the space thelid 430 would occupy if thecartridge 410 were closed. The first andsecond suture portions posts 474 and the first and second sets ofslots - As shown, the various portions and
sections suture 350 are arranged substantially as shown inFIGS. 20 and 21 . The standingportion 352 may connect the first andsecond suture portions 460, 461 together at a location not illustrated inFIG. 26 . The standingportion 352 may be inserted through an anchor embedded in tissue, or otherwise positioned behind tissues to be retained by thesystem 400, prior to performance of the threading process set forth above. If the standingportion 352 is not required to pass through an enclosed aperture, the standingportion 352 may be positioned with respect to the tissue to be retained after thesuture 350 has been threaded through theline lock 310. - In alternative embodiments, the first and
second suture portions second suture portions line lock 310. If desired, the first andsecond suture portions line lock 310 may be applied to draw the anchor points, and thereby the connected tissues, together. - As another alternative, the
line lock 310 may only receive a single suture portion via thecartridge 410 and one of thethreaders line lock 310 to retain tissue. As yet another alternative, a differently configured line lock (not shown) may be retained within thecartridge 410 to receive a single suture portion. Such a line lock may operate as the functional equivalent of theline lock 310, and may thus have only thefirst passageways - Returning to the configuration of
FIG. 26 , once thesuture 350 has been properly threaded through thepassageways FIG. 26 ), theline lock 310 may then be used to retain the tissue as desired. This may be accomplished by following the procedures outlined previously, i.e., holding the workingportions line lock 310 along thesuture 350 to constrict the standingportion 352, either with or without an insertion tool, and then trimming thesuture 350. - Thus, the
suture 350 may easily be threaded through theline lock 310 in the proper pattern to ensure that theline lock 310 is able to perform as desired. Threading may be performed without significantly compromising the sterility of theline lock 310, thesuture 350, or the operating environment. Thus, the convenience, reliability, and safety of tissue retention operations may be enhanced through the present invention. - The present invention has particular relevance to surgery, and more particularly to tissue retention through the use of sutures. However, the principles, structures, and methods of the present invention may also be extended to other fields, including the use of larger line locks for locking ropes or cables in a wide variety of applications.
- The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. For example, above are described various alternative examples of different adjustable line locks. It is appreciated that various features of the line locks can be mixed and matched to form a variety of other alternatives, each of which may have a different threading system according to the invention. As such the described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
Claims (40)
1. A system for inserting a suture through passageways of a line lock, the system comprising:
a cartridge comprising:
a retention feature shaped to retain a line lock comprising a body at least partially bounding a plurality of passageways; and
a threading feature shaped to facilitate insertion of the suture through the passageways.
2. The system of claim 1 , wherein the cartridge is shaped to substantially enclose the line lock.
3. The system of claim 2 , wherein the cartridge further comprises a lid that is movable with respect to a remainder of the cartridge to open the cartridge to permit removal of the line lock from the cartridge.
4. The system of claim 1 , wherein the retention feature comprises a pair of troughs positioned on either side of a space into which the line lock fits, wherein the troughs are shaped to restrict motion of the line lock along two perpendicular axes.
5. The system of claim 4 , wherein the threading feature comprises a pair of posts positioned on either side of the space, wherein the posts are displaced from each other along a first direction substantially perpendicular to a second direction along which the troughs are displaced from each other such that the suture can move around and between the posts to move through the passageways along a first pathway.
6. The system of claim 1 , further comprising a first threader routed through the passageways along a first pathway via at least partial encirclement of the threading feature such that the first threader is drawable to draw a first locking portion of the suture through the passageways along the first pathway.
7. The system of claim 6 , wherein the first threader comprises a leading end having a pull feature that facilitates grasping and pulling of the leading end by hand, and a trailing end having a suture retention feature that retains a portion of the suture to permit the trailing end to draw the suture.
8. The system of claim 6 , further comprising a second threader routed through the passageways along a second pathway via at least partial encirclement of the threading feature such that the second threader is drawable to draw a second locking portion of the suture through the passageways along the second pathway.
9. The system of claim 8 , wherein the first pathway extends through first primary, secondary, and locking passageways of the line lock, wherein the second pathway extends through second primary, secondary, and working passageways of the line lock.
10. The system of claim 6 , further comprising the line lock.
11. The system of claim 10 , wherein the passageways are arranged to receive the suture such that the suture is able to be drawn through the passageways along only one direction.
12. The system of claim 10 , wherein the line lock is generally disc-shaped.
13. A system for retaining tissue, the system comprising:
a line lock comprising a body at least partially bounding a plurality of passageways; and
a first threader passing through the passageways along a first pathway, the first threader comprising a suture retention feature shaped to retain a portion of a suture to draw the suture along the first pathway in response to motion of the first threader along the first pathway;
wherein the passageways are arranged to permit the suture to be drawn along the first pathway substantially only along one direction.
14. The system of claim 13 , wherein the first threader comprises a leading end having a pull feature that facilitates grasping and pulling of the leading end by hand, and a trailing end having the suture retention feature.
15. The system of claim 14 , wherein the suture retention feature comprises a loop sized to grasp the suture in response to tension on the first threader.
16. The system of claim 13 , wherein the portion of the suture comprises a first locking portion of the suture, the system further comprising a second threader passing through the passageways along a second pathway, the second threader comprising a suture retention portion shaped to retain a second locking portion of the suture to draw the second locking portion along a second pathway in response to motion of the second threader along the second pathway.
17. The system of claim 16 , wherein the passageways comprise first primary, secondary, and locking passageways and second primary, secondary, and locking passageways, wherein the first pathway extends through the first primary, secondary, and locking passageways and the second pathway extends through the second primary, secondary, and working passageways.
18. The system of claim 13 , wherein the passageways are arranged to receive the suture such that the suture is able to be drawn through the passageways along only one direction.
19. The system of claim 13 , further comprising a cartridge shaped to substantially enclose the line lock and the first threader.
20. The system of claim 19 , wherein the cartridge comprises a retention feature shaped to retain the line lock, and a threading feature shaped to guide the first threader along the first pathway.
21. A system for inserting a suture through passageways of a line lock, the line lock comprising a body at least partially bounding the passageways, the system comprising:
a cartridge comprising a threading feature; and
a first threader positioned at least partially within the cartridge such that the first threader can be drawn along the threading feature to move the first threader along a first pathway through the passageways to draw the suture along the first pathway.
22. The system of claim 21 , wherein the cartridge is shaped to substantially enclose the line lock, wherein the cartridge further comprises a lid that is movable with respect to a remainder of the cartridge to open the cartridge to permit removal of the line lock from the cartridge.
23. The system of claim 21 , wherein the retention feature comprises a pair of troughs positioned on either side of a space into which the line lock fits, wherein the troughs are shaped to restrict motion of the line lock along two perpendicular axes.
24. The system of claim 23 , wherein the threading feature comprises a pair of posts positioned on either side of the space, wherein the posts are displaced from each other along a first direction substantially perpendicular to a second direction along which the troughs are displaced from each other such that the suture can move around and between the posts to move through the passageways along a first pathway.
25. The system of claim 21 , wherein the first threader is routed through the passageways along a first pathway via at least partial encirclement of the threading feature such that the first threader is drawable to draw a first locking portion of the suture through the passageways along the first pathway.
26. The system of claim 25 , wherein the first threader comprises a leading end having a pull feature that facilitates grasping and pulling of the leading end by hand, and a trailing end having a suture retention feature that retains a portion of the suture to permit the trailing end to draw the suture.
27. The system of claim 25 , further comprising a second threader routed through the passageways along a second pathway via at least partial encirclement of the threading feature such that the second threader is drawable to draw a second locking portion of the suture through the passageways along the second pathway.
28. The system of claim 27 , wherein the first pathway extends through first primary, secondary, and locking passageways of the line lock, wherein the second pathway extends through second primary, secondary, and working passageways of the line lock.
29. The system of claim 21 , further comprising the line lock.
30. The system of claim 29 , wherein the passageways are arranged to receive the suture such that the suture is able to be drawn through the passageways along only one direction.
31. A system for retaining a line lock, the system comprising:
a cartridge comprising:
a retention feature shaped to retain a line lock, the line lock comprising a body at least partially bounding a plurality of passageways arranged to receive a suture; and
a lid movably attached to a remainder of the cartridge such that the lid and the remainder of the cartridge cooperate to substantially enclose the line lock, wherein the cartridge is openable via pressure against the lid to permit removal of the line lock from the cartridge.
32. The system of claim 31 , wherein the cartridge is formed substantially of rigid plastic, the cartridge further comprising a living hinge positioned to permit pivotal motion of the lid with respect to the remainder of the cartridge.
33. The system of claim 32 , wherein the cartridge further comprises a latch positioned to keep the lid from pivoting open with respect to the remainder of the cartridge until a threshold force is applied.
34. The system of claim 31 , wherein the retention feature comprises a pair of troughs positioned on either side of a space into which the line lock fits, wherein the troughs are shaped to restrict motion of the line lock along two perpendicular axes.
35. The system of claim 31 , wherein the cartridge further comprises a threading feature shaped to facilitate insertion of the suture through the passageways.
36. The system of claim 35 , wherein the threading feature comprises a pair of posts positioned on either side of a space into which the line lock fits such that the suture can move around and between the posts to move through the passageways along a first pathway.
37. The system of claim 35 , further comprising a first threader routed through the passageways along a first pathway via at least partial encirclement of the threading feature such that the first threader is drawable to draw a first locking portion of the suture through the passageways along the first pathway.
38. The system of claim 37 , further comprising a second threader routed through the passageways along a second pathway via at least partial encirclement of the threading feature such that the second threader is drawable to draw a second locking portion of the suture through the passageways along the second pathway.
39. The system of claim 38 , wherein the first pathway extends through first primary, secondary, and locking passageways of the line lock, wherein the second pathway extends through second primary, secondary, and working passageways of the line lock.
40. The system of claim 35 , further comprising the line lock, wherein the passageways are arranged to receive the suture such that the suture is able to be drawn through the passageways along only one direction.
Priority Applications (1)
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US12/851,197 US20100305585A1 (en) | 2003-06-11 | 2010-08-05 | Line lock threading systems and methods |
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US10/459,375 US7150757B2 (en) | 2003-06-11 | 2003-06-11 | Adjustable line locks and methods |
US10/936,376 US7566339B2 (en) | 2003-06-11 | 2004-09-07 | Adjustable line locks and methods |
US10/942,275 US7806909B2 (en) | 2003-06-11 | 2004-09-15 | Line lock threading systems and methods |
US12/851,197 US20100305585A1 (en) | 2003-06-11 | 2010-08-05 | Line lock threading systems and methods |
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US20100318126A1 (en) | 2010-12-16 |
US20050288710A1 (en) | 2005-12-29 |
US7806909B2 (en) | 2010-10-05 |
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