# Patent

## Title
Visual aid for identifying suture limbs arthroscopically

## Abstract

A flexible suture for coupling tissue includes a first suture portion extending to a first end and a second suture portion extending to a second end. A plurality of braided strands form the first and second suture portions. An identifier characteristic is formed into the plurality of braided strands. The identifier characteristic extends from the first end of the first suture portion to the second end of the second suture portion, and the identifier characteristic distinguishes the first suture portion from the second suture portion.

## Background
FIELD
The present disclosure relates to suture constructions and, more particularly, to suture loop constructions containing visual aids for identifying suture limbs arthroscopically.
BACKGROUND
This section provides background information related to the present disclosure which is not necessarily prior art.
Arthroscopic surgery is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. The surgery is performed through portals (or cannulas) in the body through which the endoscope and tools are inserted. Often the surgeon is working in small, tight areas.
It is common for surgeons to use sutures to secure soft tissues to bone, bone to bone, and tissue to tissue. Often when working in the small tight area, the surgeon may have difficulty distinguishing the suture limbs or tying the suture limbs without moving the tissue or bone.
SUMMARY
This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.
The present teachings provide for a flexible suture for coupling tissue. The flexible suture includes a first suture portion extending to a first end and a second suture portion extending to a second end. A plurality of braided strands that form the first and second suture portions. An identifier characteristic is formed into the plurality of braided strands. The identifier characteristic extends from the first end of the first suture portion to the second end of the second suture portion, and the identifier characteristic distinguishes the first suture portion from the second suture portion.
The present teachings also provide for a flexible suture for coupling tissue that includes a first suture limb extending to a first end and a second suture limb extending to a second end. A plurality of braided strands that form the first and second suture limbs. A first structural identifier characteristic is formed into the plurality of braided strands of the first suture limb. A second structural identifier characteristic is formed into the plurality of braided strands of the second suture limb. The first and second structural identifiers differentiate the structure of the first suture limb from the structure of the second suture limb.
The present teachings also provide for a flexible suture for coupling tissue that includes a first suture limb extending to a first end and a second suture limb extending to a second end. A plurality of braided strands that form the first and second suture limbs. One of the first and second suture limbs includes a dyed portion.
The present teachings also provide for flexible suture for coupling tissue that includes a first suture limb extending to a first end and a second suture limb extending to a second end. A plurality of braided strands that form the first and second suture limbs. The first suture limb forms a braided cylinder, and the second suture limb forms a braided flat ribbon.
A flexible suture for coupling tissue that includes a first suture section that extends from a first end to a second end. A second suture section that extends from a third end to a fourth end. A plurality of braided strands that form the first and second suture sections. An identifier characteristic that is formed into the plurality of braided strands. The identifier characteristic extends from the first end to the second end of the first suture section and from the third end to the fourth end of the second suture section, and the identifier characteristic distinguishes the first suture limb from the second suture limb. A coupler attaches the first suture section to the second suture section.
Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.



DRAWINGS
The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.
FIG. 1A is a side view of a suture construct according to the present disclosure;
FIG. 1B is a perspective view of the suture construct of FIG. 1A arranged in an anchor device;
FIG. 2 is a cross-sectional view taken along line 2-2 of FIG. 1A;
FIG. 3 is an environmental view of the suture securing a portion of soft tissue to a portion of bone according to the present disclosure;
FIGS. 4A-C are environmental views of the suture repairing a tear in soft tissue according to the present disclosure;
FIG. 5A is a side view of a second embodiment of a suture construct according to the present disclosure;
FIG. 5B is a perspective view of the suture construct of FIG. 5A arranged in the anchor device;
FIG. 5C is a second side view of the suture construct of FIG. 5A;
FIG. 5D is a perspective view of the suture construct of FIG. 5C arranged in the anchor device;
FIGS. 6A-B are side views of a third embodiment of a suture construct according to the present disclosure;
FIG. 7 is a side view of a fourth embodiment of a suture construct according to the present disclosure;
FIG. 8 is a side view of a fifth embodiment of a suture construct according to the present disclosure;
FIG. 9 is a perspective view of a sixth embodiment of a suture construct arranged in the anchor device according to the present disclosure;
FIGS. 10A-B are side views of a seventh embodiment of a suture construct according to the present disclosure;
FIG. 11 is a side view of an eighth embodiment of a suture construct according to the present disclosure;
FIGS. 12A-C are side views of a ninth embodiment of a suture construct arranged in the anchor device according to the present disclosure;
FIG. 13 is a perspective view of a tenth embodiment of a suture construct according to the present disclosure; and
FIGS. 14-22 illustrate formation of a tail of a knotless suture anchor device according to the present teachings.



Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.
DETAILED DESCRIPTION
Example embodiments will now be described more fully with reference to the accompanying drawings.
With initial reference to FIG. 1A, a suture construct is generally illustrated at reference numeral 10. The suture construct 10 generally includes a first terminal end 14 and a second terminal end 18 and may include an identification characteristic such as a tracer 22 to identify the suture 10. The tracer 22 may extend from the first terminal end 14 to the second terminal end 18 of the suture construct 10. As shown in more detail in FIG. 2, the suture construct 10 may include an outer wall 26 formed from a plurality of strands 30 braided together. Each strand 30 may further include a plurality of fibers 34 braided together to form the strand 30. The tracer 22 may be one or more of the plurality of strands 30 or fibers 34.
When the tracer 22 extends from the first terminal end 14 to the second terminal end 18 of the suture construct 10, the suture construct 10 is easier to form because it can be manufactured in a single continuous step. There is no need to stop the machine during manufacturing to add or subtract any of the strands that are braided into the suture.
The suture construct 10 and tracer 22 may be made of any suitable flexible material or member, and need not be made of a suture. The suture construct 10 may also be made of a variety of different materials. When the suture construct 10 and tracer 22 are made of sutures, any suitable suture can be used.
For example, the braided suture may be a 16-strand hollow-core suture (see FIG. 2). In this example, 16 strands are braided together to form the outer wall 26, leaving a hollow passage 28 through the center extending from the first terminal end 14 to the second terminal end 18. Each strand 30 is formed from the plurality of fibers 34 that are braided together. The tracer 22 may be at least one strand or a plurality of strands in the suture construct 10. Any suitable braided suture can be used.
The suture construct 10 and tracer 22 may be of a variety of different materials. For example, the strands 30 of suture construct 10 may be of a polyethylene material that is substantially translucent or colorless. The tracer 22 may be of a polyester or nylon material that is either white or dyed a contrasting color to identify the tracer 22 in the suture construct 10. The tracer 22 assists the surgeon in differentiating between suture strands with the trace and suture strands without the trace. The tracer 22 may be modified from the first terminal end 14 to the second terminal end 18 of the suture construct 10 to assist the surgeon in distinguishing the first end 14 from the second 18.
With additional reference to FIG. 1B, sutures generally are manufactured in a spool and then cut to a specific length (for example only, 38 inches) to form the suture construct 10. Once cut to length, the suture construct 10 may be attached to an exemplary anchor 38. While a rigid anchor is illustrated, the surgeon can use any known anchor including a flexible anchor. The suture construct 10 may further include a first suture limb 42 adjacent to the first terminal end 14 and a second suture limb 46 adjacent to the second terminal end 18. The length of the first suture limb 42 may be equivalent to half the length of the suture construct 10 (for example only, 19 inches), equivalent to a portion that is less than half the length of the suture construct 10, or equivalent to a portion that is more than half the length of the suture construct 10. To help distinguish between the first suture limb 42 and the second suture limb 46, which can be particularly helpful for a surgeon during surgery, the first suture limb 42 and the second suture limb 46 can be provided with different colors, patterns, or designs, for example. Accordingly, when the suture is threaded through the eyelet of the anchor 38, the two limbs 42 and 46 may be distinguished, helping to identify their direction of travel.
In the embodiment of FIGS. 1A and B, the first suture limb 42 is distinguished from the second suture limb 46 in the number of picks per inch (PPI), or tightness, of the tracer 22 braided into the suture. The PPI is the number of traces visible per inch along the suture. For example, the PPI of the tracer 22 in the first suture limb 42 may be 30 PPI; whereas, the PPI of the tracer 22 in the second suture limb 46 may be 60 PPI, or twice as tight as the first suture limb 42. This difference is apparent by visual inspection because the colored tracer 22 will appear twice as often on the second suture limb 46 as it does on the first suture limb 42.
Now referring to FIG. 3, the suture construct 10 can be used to attach a portion of soft tissue 50 to bone 54. The suture construct 10 is threaded through the anchor 38. The anchor 38 is secured to the bone 54 by engaging a plurality of threads 58 on the anchor 38 into the bone 54 using an anchor implant or driving tool (not pictured). The first suture limb 42 may be passed through the soft tissue 50, becoming a post. The second suture limb 46 is passed around the outside of the soft tissue 50 and is knotted to the post 42. The suture limb 42 passing through the soft tissue 50 is used as the post when securing the first and second suture limbs 42, 46, because it is desirable for there to be minimal movement of the suture limb in the soft tissue 50. By knowing which end of the suture is the post and which end is to be knotted to the post, via the tracer 22, the surgeon can perform the procedure more quickly and efficiently during arthroscopic surgery.
Now referring to FIGS. 4A-C, the suture construct 10 may be used to repair a tear 62 in soft tissue 66. The suture construct 10 is threaded through the soft tissue, the first suture limb 42 on a first side of the tear 62 and the second suture limb 46 on an opposite, second side of the tear 62 (FIG. 4A). One of the suture limbs, for example only, the first suture limb 42, is determined to function as the post. The other suture limb, for example only, the second suture limb 46, is knotted around the post 42 (FIG. 4B). The knot is then pulled tight closing the tear 62 in the soft tissue 66 (FIG. 4C). Again, by knowing which end of the suture is the post and which end is to be knotted to the post, via the tracer 22, the surgeon can perform the procedure more quickly and efficiently during arthroscopic surgery.
Now referring to FIGS. 5A-D, a second embodiment of a suture construct 100 is illustrated. The suture construct 100 generally includes a first terminal end 104 and a second terminal end 108 and may include an identifier characteristic such as a color coating 112 on only a portion of the suture 100. The suture construct 100 may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30. Further, the suture construct 100 may also be of a monofilament construct (not shown). The suture construct 100 may be divided into two portions, a first suture limb 116 adjacent to the first terminal end 104 and a second suture limb 120 adjacent to the second terminal end 108, that may be distinguished by the color coating 112.
The plurality of fibers 34 may be of an all-white polyethylene material that is braided to form the plurality of strands 30. The second suture limb 120 may be coated with a dye or other material that is known to adhere to the polyethylene material. The dye or other material may be of a contrasting color to the all-white polyethylene and therefore may provide the color coating 112 on a portion of the suture construct 100. The color coating 112 may be applied to the entire second suture limb 120 (FIG. 5A) or may be applied in specific locations of the second suture limb 120 (FIG. 5C), distinguishing the second suture limb 120 from the first suture limb 116. The differences between the first suture limb 116 and the second suture limb 120 become more apparent when the suture construct 100 is threaded through the anchor 38. The differences in appearance help to identify the direction of travel and corresponding ends of each suture limb 116, 120.
The plurality of fibers 34 may also contain a material known to be radiopaque, for example barium sulfate, that is braided to form the plurality of strands 30. A radiopaque material is known in the art to be visible in x-ray images and to the naked eye. The second suture limb 120 may be coated with a radiopaque material such as barium sulfate. The radiopaque material may be of a contrasting color to the plurality of strands 30 and therefore may provide the color coating 112 on a portion of the suture construct 100. The color coating 112 may be applied to the entire second suture limb 120 (FIG. 5A) or may be applied in specific locations of the second suture limb 120 (FIG. 5C), distinguishing the second suture limb 120 from the first suture limb 116.
Now referring to FIGS. 6A-B, a third embodiment of a suture construct 200 is illustrated. The suture construct 200 generally includes a first suture limb 204 and a second suture limb 208 and may include an identifier characteristic such as a tracer 210 on a portion of the suture 200. The tracer 210 may extend the entire length of the suture limb 204. The suture construct 200 may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30.
The first suture limb 204 may be connected to the second suture limb 208 to form a continuous suture construct 200. The first suture limb 204 may include a first terminal end 212 and a second terminal end 216, and the second suture limb 208 may include a first terminal end 220 and a second terminal end 224. The first and second suture limbs 204, 208 may be tied together with a knot, adhered or epoxied together, locked together by passing each strand through the opposite strand, or fixed together by any means known in the art. When passing the strands through opposite ends, the suture from one end is passed between the braided strands, along the hollow core, and out through the braided strand or retained in the hollow core.
The second end 216 of the first suture limb 204 may be locked within the second suture limb 208, and the second end 224 of the second suture limb 208 may be locked within the first suture limb 204 (FIG. 6B). The first suture limb 204 may include a first aperture 228, and the second suture limb 208 may include a second aperture 232. The first and second apertures 228, 232 are formed during the braiding process as loose portions between pairs of strands defining the suture. The second terminal end 216 is passed through the second aperture 232 and into the hollow passage 28 of the 16-strand hollow-core suture. The second terminal end 224 is passed through the first aperture 228 and into the hollow passage 28 of the 16-strand hollow-core suture. When tightened, the second terminal end 216 of the first suture limb 204 and the second terminal end 224 of the second suture limb 208 resist the reverse movement. It is envisioned that the second terminal end 216 of the first suture limb 204 and the second terminal end 224 of the second suture limb 208 may be passed through the hollow passage 28 several times through multiple apertures in the first and second suture limbs 204, 208. Further, the second terminal end 216 of the first suture limb 204 and the second terminal end 224 of the second suture limb 208 may be retained in the hollow passage 28 or passed out through the braided strand.
The first and second suture limbs 204, 208 may be of different colors or sizes to assist the surgeon in differentiating between the different limbs 204, 208. For example, the first suture limb 204 may include the tracer 22 extending from the first end 212 to the second end 216 and being of a polyethylene or nylon material that has been dyed black. The second suture limb 208 may not include the tracer 22 or may include the tracer 22 being of a contrasting color such as red. The first and second suture limbs 204, 208 may also be of different sizes or diameters. For example, the first suture limb 204 may be braided tighter than the second suture limb 208, or vice versa. The second suture limb 208 may have a larger diameter than the first suture limb 204, and the first suture limb 204 may have a higher stiffness than the second suture limb 208, or vice versa.
Now referring to FIG. 7, a fourth embodiment of a suture construct 300 is illustrated. The suture construct 300 generally includes a first suture limb 304 adjacent to a first terminal end 308 and a second suture limb 312 adjacent to a second terminal end 316. The suture construct 300 may further include an identifier characteristic such as a tracer 320 on a portion of the suture 300. The tracer 320 may extend from the first terminal end 308 to the second terminal end 316. The suture construct 300 may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30.
The tracer 320 may be one or more of the plurality of strands 30 or fibers 34 braided into the suture construct 300 similar to that of the embodiment illustrated in FIGS. 1a-b. The suture construct 300 and tracer 320 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 300 and tracer 320 are made of sutures, any suitable suture can be used.
The suture construct 300 and tracer 320 may be of a variety of different materials. For example, the strands 30 of suture construct 300 may be of a polyethylene material that is substantially translucent or colorless and may also include a polyester or nylon material that is white in color. The tracer 320 may be of a polyester or nylon material that is either white or dyed a contrasting color to identify the tracer 320 in the suture construct 300. The tracer 320 assists the surgeon in differentiating between suture strands with the trace and suture strands without the trace.
The tracer 320 may be braided so that it is visual to an observer for a first portion 324 of the suture construct 300. The first portion 324 may be the same length as, and correspond to, the first suture limb 304. The tracer 320 then may be braided in the hollow passage 28 so that it is not visible to the observer for a second portion 328 of the suture construct 300. The second portion 328 may be the same length as, and correspond to, the second suture limb 312. After the second portion 328 the tracer 320 may be braided so that it is visual to the observer again. This pattern may be followed for the length of several suture constructs 300 during manufacturing and then cut to specified suture construct 300 lengths (for example only, 38 inches) at a later time.
Now referring to FIG. 8, a fifth embodiment of a suture construct 400 is illustrated. The suture construct 400 generally includes a first suture limb 404 adjacent to a first terminal end 408 and a second suture limb 412 adjacent to a second terminal end 416. The suture construct may further include an identifier characteristic such as a tracer 420 on a portion of the suture 400. The tracer 420 may extend from the first terminal end 408 to the second terminal end 416 of the suture construct 400. The suture construct 400 may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30.
The tracer 420 may be one or more of the plurality of strands 30 or fibers 34 braided into the suture construct 400 similar to that of the embodiment illustrated in FIGS. 1A-B. The suture construct 400 and tracer 420 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 400 and tracer 420 are made of sutures, any suitable suture can be used.
The suture construct 400 and tracer 420 may be of a variety of different materials. For example, the strands 30 of suture construct 400 may be of a polyethylene material that is substantially translucent or colorless or white in color. The tracer 420 may be of a polyester or nylon material that is white in color. The tracer 420 assists the surgeon in differentiating between suture strands with the trace and suture strands without the trace.
The tracer 420 may be braided into the suture construct 400 such that it is visible to the observer. After manufacturing of the suture construct 400 is complete, a first portion 424 of the suture construct 400 may be dipped in a dye solution of a contrasting color to dye the tracer 420 braided into the first portion 424. The first portion 424 may be the same length as the first suture limb 404. The dye adheres to the polyester or nylon material of the tracer 420 and does not adhere to the polyethylene fibers in the suture construct 420. Only the first portion 424 of the suture construct 400 is dyed a contrasting color so that the first suture limb 404 is differentiated from the second suture limb 412. By braiding a white tracer 420 into the suture construct 400 during manufacturing and dying the tracer 420 at a later time, a plurality of suture constructs 400 can be manufactured at one time and later be dyed different colors.
Now referring to FIG. 9, a sixth embodiment of a suture construct 500 is illustrated. The suture construct 500 generally includes a first suture limb 504 and a second suture limb 508. The suture construct 500 may include an identifier characteristic such as a tracer (not pictured) extending the entire length of the suture construct 500 as discussed in previous embodiments, but inclusion of the tracer in the suture construct 500 is not necessary for the sixth embodiment. The suture construct 500 may be the 16-strand hollow-core suture and may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30. The suture construct 500 may further be threaded through an eyelet of an anchor 512.
The suture construct 500 may be braided similar to that of the embodiment illustrated in FIGS. 1A-B. The suture construct 500 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 500 is made of sutures, any suitable suture can be used. For example, the fibers 34 forming the strands 30 of suture construct 500 may be of a polyethylene material that is substantially translucent or colorless or white in color.
The suture construct 500 may include a structural identifier characteristic, such as knots, extending the entire length of the suture construct 500. One of the first and second suture limbs 504, 508 may include knots 516 in specific locations along the suture limb, for example the second suture limb 508, as illustrated. The knots 516 along the second suture limb 508 may assist the surgeon in differentiating between the first suture limb 504 and the second suture limb 508 and may help to identify the direction of travel of each suture limb 504, 508.
Once the suture construct 500 is braided as discussed in previous embodiments, the suture construct 500 may be cut to length. The suture construct 500 may be threaded through the eyelet of the anchor 512. Preformed knots 516 may be placed in specific locations along either the first suture limb 504 or the second suture limb 508 (for example only, the second suture limb 508). The anchor 512 is secured in the bone 54, and the first suture limb 504 without the knots 516 is threaded through the soft tissue 50 (see also FIG. 3). The first suture limb 504 becomes the post. The second suture limb 508 is passed around the outside of the soft tissue 50 and is knotted to the post 504. The first suture limb 504 passing through the soft tissue 50 is used as the post when securing the first and second suture limbs 504,508, because it is desirable for there to be minimal movement of the suture limb in the soft tissue 50. Further, the first suture limb 504 is desirable to pass through the soft tissue 50 because the first suture limb 504 does not contain knots 516 that may become caught or do more damage or tearing to the soft tissue 50.
Now referring to FIGS. 10A-B, a seventh embodiment of a suture construct 600 is illustrated. The suture construct 600 generally includes a first suture limb 604 adjacent to a first terminal end 608 and a second suture limb 612 adjacent to a second terminal end 616. The suture construct 600 may further include an identifier characteristic such as a tracer 620 on a portion of the suture 600. The tracer 620 may extend from the first terminal end 608 to the second terminal end 616. The suture construct 600 may be the 16-strand hollow-core suture and may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30.
The tracer 620 may be one or more of the plurality of strands 30 or fibers 34 braided into the suture construct 600. The suture construct 600 and tracer 620 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 600 and tracer 620 are made of sutures, any suitable suture can be used.
The suture construct 600 and tracer 620 may be of a variety of different materials. For example, the strands 30 of suture construct 600 may be of a polyethylene material that is substantially translucent or colorless or white in color. The tracer 620 may be of a polyester or nylon material that is a contrasting color. The tracer 620 assists the surgeon in differentiating between suture strands with the trace and suture strands without the trace.
Each suture construct 600 may be cut from a suture group 624. The suture group 624 may be manufactured by braiding 16 strands 30 (of the plurality of fibers 34) together for a specific length (for example only, 1 inch) and then splitting the strands 30 into a first group 628 and a second group 632 of 8 strands each. One of the first group 628 and the second group 632 contains the plurality of strands 30 of the tracer 620. Each group of strands 628, 632 is individually braided for a specific length (for example only, 38 inches). The 16 strands 30 are then braided together. This pattern is repeated several times to form the suture group 624. The resulting suture group 624 is cut at a first portion 636 where the 16 strands 30 are braided together and at a second portion 640 along the first group 628 and the second group 632 a specific length (for example only, 19 inches) from where the 16 strands split into two groups of 8 strands each. Once cut, each suture construct 600 is in a condition ready for use.
Now referring to FIG. 11, an eighth embodiment of a suture construct 700 is illustrated. The suture construct 700 generally includes a first suture limb 704 adjacent to a first terminal end 708 and a second suture limb 712 adjacent to a second terminal end 716. The suture construct 700 may further include an identification characteristic such as a tracer 720 on a portion of the suture 700. The tracer 720 may extend from the first terminal end 708 to the second terminal end 716. The suture construct 700 may be the 16-strand hollow-core suture and may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30.
The suture construct 700 and tracer 720 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 700 and tracer 720 are made of sutures, any suitable suture can be used. For example, the strands 30 of suture construct 700 may be of a polyethylene material that is substantially translucent or colorless or white in color. The tracer 720 may be of a polyester or nylon material that is a contrasting color. The tracer 720 assists the surgeon in differentiating between suture strands with the trace and suture strands without the trace.
The tracer 720 may be sewn in to the suture construct 700 after the suture construct 700 has been braided into the 16-strand hollow-core suture as described above. The tracer 720 may only be sewn into a portion of the suture construct 700 corresponding to the second suture limb 712 to differentiate the second suture limb 712 from the first suture limb 704. The tracer may also be sewn into the portion of the suture construct 700 corresponding to the second suture limb 712 so that it is visible on the second suture limb 712 and may be sewn into the hollow passage 28 of the suture construct 700 over a portion corresponding to the first suture limb 704 so that it is not visible but extends the entire length of the suture construct 10.
Now referring to FIGS. 12A-C, a ninth embodiment of a suture construct 800 is illustrated. The suture construct 800 generally includes a first suture limb 804 and a second suture limb 808. The suture construct 800 may include an identifier characteristic such as a tracer (not pictured) extending the entire length of the suture construct 800 as discussed in previous embodiments, but inclusion of the tracer in the suture construct 800 is not necessary for the ninth embodiment. The suture construct 800 may be the 16-strand hollow-core suture and may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30. One of the first suture limb 804 and the second suture limb 808 may include a structural identifier, such as a loop or a bifurcation, to assist the surgeon in differentiating between the first and second suture limbs 804, 808. Further, the suture construct 800 may include a structural identification characteristic extending the entire length of the suture 800 that differentiates a first suture limb 804 from a second suture limb 808.
Referring specifically to FIG. 12A, once the suture construct 800 is braided according to previous embodiments, the suture construct 800 may be cut to length. The suture construct 800 may then be threaded through the eyelet of an anchor 812. The second suture limb 808 may be looped back to the eyelet of the anchor 812 and secured in order to form a loop for identification and ability to manipulate. The anchor 812 is secured in the bone 54, and the second suture limb 808 with the loop is passed through the soft tissue 50 (see also FIG. 3). The second suture limb 808 becomes the post. The first suture limb 804 is passed around the outside of the soft tissue 50 and is knotted to the post 808. The second suture limb 808 passing through the soft tissue 50 is used as the post when securing the first and second suture limbs 804, 808, because it is desirable for there to be minimal movement of the suture limb in the soft tissue 50 and the loop in the second suture limb 808 is easy to grab with a tool arthroscopically.
Referring specifically to FIG. 12B, once the suture construct 800 is braided according to previous embodiments, the suture construct 800 may be cut to length. The suture construct 800 may be threaded through the eyelet of the anchor 812. A loop 816 may be secured along the length of the second suture limb 808 for identification and manipulation. The loop 816 may be secured to the suture limb 808 similarly to the locking method discussed in the third embodiment 200. The second suture limb 808 may include a first aperture 820 and a second aperture 824. The first and second apertures 820, 824 are formed during the braiding process as loose portions between pairs of fibers defining the suture. A first end 828 of the loop 816 is passed through the first aperture 820 and into the hollow passage 28 of the 16-strand hollow-core suture. A second end 832 is passed through the second aperture 824 and into the hollow passage 28 of the 16-strand hollow-core suture. When tightened, the first end 828 and the second end 832 resist reverse movement and the loop 816 remains secured to the second suture limb 808.
The anchor 812 is secured in the bone 54, and the second suture limb 808 with the loop 816 is passed through the soft tissue 50 arthroscopically (see also FIG. 3). The second suture limb 808 becomes the post. The first suture limb 804 is passed around the outside of the soft tissue 50 and is knotted to the loop 816 on the post 808. The second suture limb 808 passing through the soft tissue 50 is used as the post when securing the first and second suture limbs 804, 808, because it is desirable for there to be minimal movement of the suture limb in the soft tissue 50 and the loop in the second suture limb 808 is easy to grab with a tool arthroscopically.
Referring specifically to FIG. 12C, once the suture construct 800 is braided according to previous embodiments, the suture construct 800 may be cut to length. The suture construct 800 may be threaded through the eyelet of the anchor 812. A bifurcation 836 may be formed along the length of the second suture limb 808 for identification and manipulation. The bifurcation 836 may be formed during the braiding process as a loose portion between pairs of fibers defining the suture.
The anchor 812 is secured in the bone 54, and the second suture limb 808 with the bifurcation 836 is passed through the soft tissue 50 arthroscopically (see also FIG. 3). The second suture limb 808 becomes the post. The first suture limb 804 is passed around the outside of the soft tissue 50 and is knotted to the bifurcation 836 on the post 808. The second suture limb 808 passing through the soft tissue 50 is used as the post when securing the first and second suture limbs 804, 808, because it is desirable for there to be minimal movement of the suture limb in the soft tissue 50, and the bifurcation 836 in the second suture limb 808 is easy to grab with a tool arthroscopically.
During the process to secure the first suture limb 804 to the second suture limb 808, the first suture limb 804 is passed through the bifurcation 836 in the second suture limb 808. The strands 30 of fibers 34 in the second suture limb 808 may be tightened applying pressure to the first suture limb 804. When tightened, the first suture limb 804 resists reverse movement and may be knotted around the second suture limb 808.
Now referring to FIG. 13, a tenth embodiment of a suture construct 900 is illustrated. The suture construct 900 generally includes a first suture limb 904 adjacent to a first terminal end 908 and a second suture limb 912 adjacent to a second terminal end 916. The suture construct 900 may include an identifier characteristic such as a tracer (not pictured) extending the entire length of the suture construct 900 as discussed in previous embodiments, but inclusion of the tracer in the suture construct 900 is not necessary for the tenth embodiment. The suture construct 900 can be made of any suitable flexible material or member, and need not be made of a suture. When the suture construct 900 is made of sutures, any suitable suture can be used. For example, the strands 30 of suture construct 900 may be of a polyethylene material that is substantially translucent, colorless, or white in color.
The suture construct 900 may include an identification characteristic on a plurality of portions to assist the surgeon in identifying the first terminal end 908 and the second terminal end 916. A first portion 920 that may correspond to the first suture limb 904 may be the 16-strand hollow-core suture discussed previously and may include the outer wall 26 formed from the plurality of strands 30 braided together (FIG. 2). Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30. A second portion 924 that may correspond to the second suture limb 912 may be a 16-strand flat braided ribbon construct formed from the plurality of strands 30 braided together. Each strand 30 may further include the plurality of fibers 34 braided together to form the strand 30. The round or cylindrical shape of the first portion 920 is distinguished from the flat shape of the second portion 924 both by touch and sight to assist the surgeon in distinguishing the first suture limb 904 from the second suture limb 912.
During manufacture of the first portion 920 of the suture construct 900, each of the 16 strands 30 is braided around the remainder of the strands 30 to form the cylindrical shape. During manufacture of the second portion 924 of the suture construct 900, the strands 30 are braided horizontally back and forth to create a flat braid. While manufacturing the suture construct 900, the different braid patterns are alternated to form a single long suture group that can then be cut to appropriate suture lengths (for example only, 38 inches).
With additional reference to FIGS. 14-22, a method for forming a suture tail 12′, or any other suture strand in which it would be advantageous to distinguish between two different suture portions, will now be described. With initial reference to FIG. 14, a second portion 68′ of the suture tail 12′ is illustrated. The second portion 68′ includes a first end 68A′ and a second end 68B′. Second end 18′ of the suture tail 12′ is at the second end 68B′ of the second portion 68′. As illustrated in FIG. 15, a threader, such as the threader 92′ or any suitable threading device, is inserted through a first area of the second portion 68′ of the suture tail 12′ to define a first tail sleeve 68C′. The threader 92′ is also inserted through a second area to define a second tail sleeve 68D′. The second tail sleeve 68D′ is closer to the first end 68A′ than the first tail sleeve 68C′.
With the threader 92′ extending through each of the first tail sleeve 68C′ and the second tail sleeve 68D′, the first end 68A′ is inserted into the threader 92′ and grasped by the threader 92′. The threader 92′ is then withdrawn through the second tail sleeve 68D′ and the first tail sleeve 68C′ in order to draw the first end 68A′ through the second tail sleeve 68D′ and into the first tail sleeve 68C′, as illustrated in FIG. 16. Therefore, the second portion 68′ defines a loop 68E′. Again, since the tail 16′ is made from braided fibers, the first tail sleeve 68C′ and the second tail sleeve 68D′ are formed by a passage formed by the braided fibers that extends from the first end 66A′ to the second end 66B′. Ends of each of the first tail sleeve 68C′ and the second tail sleeve 68D′ are formed by openings in the braided fibers.
With additional reference to FIG. 17, the first portion 66′ of the suture tail 12′ includes a first end 66A′ that is opposite to a second end 66B′. The threader 92′ is inserted through the first portion 66′ at or proximate to the second end 66B′ to define a third tail sleeve 66C′ in the first portion 66′. The second end 68B′ of the second portion 68′ is inserted through the threader 92′, and the threader 92′ is withdrawn through the third tail sleeve 66C′ in order to draw the second portion 68′ into the third tail sleeve 66C′, as illustrated in FIG. 18.
With additional reference to FIG. 19, the first end 66A′ of the first portion 66′ is inserted through the loop 68E′ of the second portion 68′, and the first end 66A′ is pulled, which pulls the third tail sleeve 66C′ over and past the first tail sleeve 68C′ and onto the second tail sleeve 68D′, as illustrated in FIG. 20. With additional reference to FIG. 21, an excess area of the second portion 68′ proximate to the first end 68A′ is cut from a remainder of the second portion 68′. As illustrated in FIG. 22, the first portion 66′ and the second portion 68′ are then pulled apart to strengthen the connection between the first portion 66′ and the second portion 68′, and thereby form the suture tail 12′ of the knotless suture anchor device 10′.
To make it easier for a surgeon to distinguish between the first portion 66′ and the second portion 68′ of the suture tail 12′, the first portion 66′ and the second portion 68′ can be configured in any suitable manner to facilitate distinction therebetween, such as visual distinction therebetween. For example, the first portion 66′ and the second portion 68′ can include or consist of different colors, and/or different design patterns, and/or any of the tracers 22, 210, 320, 420, 620, 720 described herein configured in any suitable manner to distinguish the first and second portions 66′ and 68′ from one another. The first and second portions 66′ and 68′ can also have different thicknesses or weights. The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.

## Claims

1. A flexible suture, comprising:
an elongate member comprising a plurality of braided strands, wherein the elongate member comprises a first suture portion extending from a midpoint to a first end and a second suture portion extending from the midpoint to an opposed second end, and wherein the plurality of braided strands comprises:
a plurality of suture strands, wherein each of the plurality of suture strands comprises a first material having a first appearance, and
a tracer strand comprising a second material having a second appearance comprising at least one identifier characteristic, wherein the tracer strand extends continuously from the first end to the second end of the elongate member, wherein the identifier characteristic contrasts the tracer strand from the plurality of suture strands; and
wherein the plurality of braided strands have a first braid configuration over the first suture portion where the tracer strand has a first number of picks per inch over the first suture portion, wherein the plurality of braided strands have a second braid configuration over the second suture portion where the tracer strand has a second number of picks per inch over the second suture portion that is different from the first number of picks per inch, and wherein the first suture portion and the second suture portion are visually distinct.

2. The flexible suture of claim 1, wherein the identifier characteristic of the tracer strand comprises a contrast color that is visually distinct from the first appearance of the plurality of suture strands.

3. The flexible suture of claim 1, wherein at least one of the first braid configuration and the second braid configuration comprise a hollow core braid.

4. The flexible suture of claim 3, wherein the hollow-core braid comprises 16 strands.

5. The flexible suture of claim 1, wherein the tracer strand comprises a plurality of tracer strands.

6. A flexible suture, comprising:
a first suture section extending from a first end to a second end thereof, wherein the first suture section comprises a first plurality of braided strands, wherein the first plurality of braided strands comprises a first plurality of suture strands and a first tracer strand, wherein the first tracer strand extends continuously from the first end to the second end, wherein each of the first plurality of suture strands comprises a first material having a first appearance, wherein the first tracer strand comprises a second material having an identifier characteristic that contrasts the first tracer strand from the first plurality of suture strands, and wherein the first plurality of braided strands has a first braided configuration where the first tracer strand has a first number of picks per inch;
a second suture section extending from a third end to a fourth end thereof, wherein the second suture section comprises a second plurality of braided strands, wherein the second plurality of braided strands comprises a second plurality of suture strands and a second tracer strand, wherein the second tracer strand extends continuously from the third end to the fourth end, wherein each of the second plurality of suture strands comprises the first material, wherein the second tracer strand comprises the second material, and wherein the second plurality of braided strands has a second braided configuration where the second tracer strand has a second number of picks per inch that is different from the first number of picks per inch of the first tracer strand of the first plurality of braided strands; and
a coupler coupling the first suture section to the second suture section;
wherein the first suture section and the second suture section are visually distinct.

7. A flexible suture, comprising:
an elongate member comprising a plurality of braided strands, wherein the elongate member comprises a first suture portion extending from a midpoint to a first end and a second suture portion extending from the midpoint to an opposed second end, and wherein the plurality of braided strands comprises:
a plurality of suture strands, wherein each of the plurality of suture strands comprises a first material having a first appearance, and
a tracer strand comprising a second material having a second appearance comprising at least one identifier characteristic, wherein the tracer strand extends continuously from the first end to the second end of the elongate member, wherein the identifier characteristic contrasts the tracer strand from the plurality of suture strands; and
wherein the plurality of braided strands have a first braid configuration over the first suture portion where the tracer strand has a first number of picks per inch over the first suture portion, wherein the plurality of braided strands have a second braid configuration over the second suture portion where the tracer strand has a second number of picks per inch over the second suture portion that is different from the first number of picker per inch, and wherein the first suture portion and the second suture portion are visually distinct; and

an anchor comprising a thread on a distal portion thereof;
wherein the elongate member is coupleable to the anchor.

8. The flexible suture of claim 7, wherein the identifier characteristic of the tracer strand comprises a contrast color that is visually distinct from the first appearance of the plurality of suture strands.

9. The flexible suture of claim 7, wherein at least one of the first braid configuration and the second braid configuration comprise a hollow-core braid.

10. The flexible suture of claim 9, wherein the hollow-core braid comprises 16 strands.

11. The flexible suture of claim 7, wherein the tracer strand comprises a plurality of tracer strands.