Abstract:
A suture construction and method for forming a suture construction is disclosed. The construction utilizes a suture having an enlarged central body portion defining a longitudinal passage. First and second ends of the suture are passed through first and second apertures associated with the longitudinal passage to form a pair of loops. Portions of the suture lay parallel to each other within the suture. Application of tension onto the suture construction causes constriction of the longitudinal passage, thus preventing relative motions of the captured portions of the suture.

Description:
FIELD 
       [0001]    The present disclosure relates to suture loop constructions and, more particularly, to a locking suture loop construction and a method of its construction. 
       BACKGROUND 
       [0002]    The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
         [0003]    It is commonplace in arthroscopic procedures to employ sutures and anchors to secure soft tissues to bone. Despite their widespread use, several improvements in the use of sutures and suture anchors can be made. For example, the procedure of tying knots can be very time consuming, thereby increasing the cost of the procedure and limiting the capacity of the surgeon. Furthermore, the strength of the repair may be limited by the strength of the knot. This latter drawback may be of particular significance if the knot is tied improperly as the strength of the knot in such situations can be significantly lower than the tensile strength of the suture material. 
         [0004]    To overcome this problem, sutures having a single preformed loop have been provided.  FIG. 1  represents a prior art suture construction. As shown, one end of the suture is passed through a passage defined in the suture itself. The application of tension to the ends of the suture pulls a portion of the suture through the passage, causing a loop formed in the suture to close. Unfortunately, relaxation of the system can allow a portion of the suture to translate back through the passage, thus relieving the desired tension. 
         [0005]    It is an object of the present teachings to provide an alternative device for anchoring sutures to bone and soft tissue. The device, which is relatively simple in design and structure, is highly effective for its intended purpose. 
       SUMMARY 
       [0006]    To overcome the aforementioned deficiencies, a method for configuring a braided tubular suture and a suture configuration are disclosed. The method includes passing a first end of the suture through a first aperture into a passage defined by the suture and out a second aperture defined by the suture so as to place the first end outside of the passage. A second end of the suture is passed through the second aperture into the passage and out the first aperture so as to place the second end outside of the passage. 
         [0007]    In another embodiment, a method for configuring a braided suture is disclosed. The method includes passing a first end of the suture through the first aperture defined between the pair of fibers defining the suture and into a longitudinal passage defined by the suture. The first end of the suture is then passed through a second aperture defined between a second pair of fibers so as to place the first end outside of the longitudinal passage. A second end of the suture is passed through a third aperture defined between a third pair of fibers and into the longitudinal passage. The second end is passed through an aperture defined by a fourth pair of fibers so as to place the second end outside of the longitudinal passage. 
         [0008]    In another embodiment, a suture anchor construction is provided comprising a suture and a suture anchor defining a bore. The suture has first and second ends and defines an interior longitudinal passage portion, and first and second depending apertures disposed between the first and second ends. The first end is placed through the first and second apertures so as to place a first portion within the longitudinal passage portion, and the second end is placed through the second and first aperture so as to place a second portion within a first portion of the longitudinal passage portion. The first portion is at least partially disposed with the bore. The suture anchor can be one of a screw, a plate, and a cannulated member. 
         [0009]    In another embodiment, a suture construction is provided having a suture with first and second ends and an enlarged central portion defining an interior longitudinal passage. First and second passage depending apertures are disposed between the first and second ends. The first end being placed through the first and second apertures so as to place a first portion of the suture within the longitudinal passage. The second end being placed through the second and first aperture so as to place a second portion of the suture within the longitudinal passage. 
         [0010]    Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     
       DRAWINGS 
         [0011]    The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way. 
           [0012]      FIG. 1  represents a prior art suture configuration; 
           [0013]      FIGS. 2A and 2B  represent suture constructions according to the teachings; 
           [0014]      FIG. 3  represents the formation of the suture configuration shown in  FIG. 2A ; 
           [0015]      FIGS. 4A and 4B  represent alternate suture configurations; 
           [0016]      FIGS. 5-7  represent further alternate suture configurations; 
           [0017]      FIG. 8  represents the suture construction according to  FIG. 5  coupled to a bone engaging fastener; 
           [0018]      FIGS. 9, 10, 11A, and 11B  represent the coupling of the suture construction according to  FIG. 5  to a bone screw; 
           [0019]      FIGS. 12A-12E  represent the coupling of a soft tissue to an ACL replacement in a femoral/humeral reconstruction; and 
           [0020]      FIGS. 13A-13D  represent a close-up view of the suture shown in  FIGS. 1-11C . 
       
    
    
     DETAILED DESCRIPTION 
       [0021]    The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features. 
         [0022]      FIG. 2A  represents a suture construction  20  according to the present teachings. Shown is a suture  22  having a first end  24  and a second end  26 . The suture  22  is formed of a braided body  28  that defines a longitudinally formed hollow passage  30  therein. First and second apertures  32  and  34  are defined in the braided body  28  at first and second locations of the longitudinally formed passage  30 . 
         [0023]    Briefly referring to  FIG. 3 , a first end  24  of the suture  22  is passed through the first aperture  32  and through longitudinal passage  30  formed by a passage portion, and out the second aperture  34 . The second end  26  is passed through the second aperture  34 , through the passage  30  and out the first aperture  32 . This forms two loops  46  and  46 ′. As seen in  FIG. 28 , the relationship of the first and second apertures  32  and  34  with respect to the first and second ends  24  and  26  can be modified so as to allow a bow-tie suture construction  36 . As described below, the longitudinal and parallel placement of first and second suture portions  38  and  40  of the suture  22  within the longitudinal passage  30  resists the reverse relative movement of the first and second portions  38  and  40  of the suture once it is tightened. 
         [0024]    The first and second apertures are formed during the braiding process as loose portions between pairs of fibers defining the suture. As further described below, the first and second ends  24  and  26  can be passed through the longitudinal passage  30  multiple times. It is envisioned that either a single or multiple apertures can be formed at the ends of the longitudinally formed passage. 
         [0025]    As best seen in  FIGS. 4A and 4B , a portion of the braided body  28  of the suture defining the longitudinal passage  30  can be braided so as to have a diameter larger than the diameter of the first and second ends  24  and  26 . Additionally shown are first through fourth apertures  32 ,  34 ,  42 , and  44 . These apertures can be formed in the braiding process or can be formed during the construction process. In this regard, the apertures  32 ,  34 ,  42 , and  44  are defined between adjacent fibers in the braided body  28 . As shown in  FIG. 4B , and described below, it is envisioned the sutures can be passed through other biomedically compatible structures. 
         [0026]      FIGS. 5-7  represent alternate constructions wherein a plurality of loops  46   a - d  are formed by passing the first and second ends  24  and  26  through the longitudinal passage  30  multiple times. The first and second ends  24  and  26  can be passed through multiple or single apertures defined at the ends of the longitudinal passage  30 . The tensioning of the ends  24  and  26  cause relative translation of the sides of the suture with respect to each other. 
         [0027]    Upon applying tension to the first and second ends  24  and  26  of the suture  22 , the size of the loops  46   a - d  is reduced to a desired size or load. At this point, additional tension causes the body of the suture defining the longitudinal passage  30  to constrict about the parallel portions of the suture within the longitudinal passage  30 . This constriction reduces the diameter of the longitudinal passage  30 , thus forming a mechanical interface between the exterior surfaces of the first and second parallel portions as well as the interior surface of the longitudinal passage  30 . 
         [0028]    As seen in  FIGS. 8-11 , the suture construction can be coupled to various biocompatible hardware. In this regard, the suture construction  20  can be coupled to an aperture  52  of the bone engaging fastener  54 . Additionally, it is envisioned that soft tissue or bone engaging members  56  can be fastened to one or two loops  46 . After fixing the bone engaging fastener  54 , the members  56  can be used to repair, for instance, a meniscal tear. The first and second ends  24 ,  26  are then pulled, setting the tension on the loops  46 , thus pulling the meniscus into place. Additionally, upon application of tension, the longitudinal passage  30  is constricted, thus preventing the relaxation of the tension caused by relative movement of the first and second parallel portions  38 ,  40 , within the longitudinal passage  30 . 
         [0029]    As seen in  FIGS. 9-11B , the loops  46  can be used to fasten the suture construction  20  to multiple types of prosthetic devices. As described further below, the suture  22  can further be used to repair and couple soft tissues in an anatomically desired position. Further, retraction of the first and second ends allows a physician to adjust the tension on the loops between the prosthetic devices. 
         [0030]      FIG. 11 b    represents the coupling of the suture construction according to  FIG. 28  with a bone fastening member. Coupled to a pair of loops  46  and  46 ′ are tissue fastening members  56 . The application of tension to either the first or second end  24  or  26  will tighten the loops  46  or  46 ′ separately. 
         [0031]      FIGS. 12A-12E  represent potential uses of the suture constructions  20  in  FIGS. 2A-7  in an ACL repair. As can be seen in  FIG. 12A , the longitudinal passage portion  30  of suture construction  20  can be first coupled to a fixation member  60 . The member  60  can have a first profile which allows insertion of the member  60  through the tunnel and a second profile which allows engagement with a positive locking surface upon rotation. The longitudinal passage portion  30  of the suture construction  20 , member  60 , loops  46  and ends  24 ,  26  can then be passed through a femoral and tibial tunnel  62 . The fixation member  60  is positioned or coupled to the femur. At this point, a natural or artificial ACL  64  can be passed through a loop or loops  46  formed in the suture construction  20 . Tensioning of the first and second ends  24  and  26  applies tension to the loops  46 , thus pulling the ACL  64  into the tunnel. In this regard, the first and second ends are pulled through the femoral and tibial tunnel, thus constricting the loops  46  about the ACL  64  (see  FIG. 12B ). 
         [0032]    As shown, the suture construction  20  allows for the application of force along an axis  61  defining the femoral tunnel. Specifically, the orientation of the suture construction  20  and, more specifically, the orientation of the longitudinal passage portion  30 , the loops  46 , and ends  24 ,  26  allow for tension to be applied to the construction  20  without applying non-seating forces to the fixation member  60 . As an example, should the loops  24 ,  26  be positioned at the member  60 , application of forces to the ends  24 ,  26  may reduce the seating force applied by the member  60  onto the bone. 
         [0033]    As best seen in  FIG. 12C , the body portion  28  and parallel portions  38 ,  40  of the suture construction  20  remain disposed within to the fixation member  60 . Further tension of the first ends draws the ACL  64  up through the tibial component into the femoral component. In this way, suture ends can be used to apply appropriate tension onto the ACL  64  component. The ACL  64  is then fixed to the tibial component using a plug or screw as is known. 
         [0034]    After feeding the ACL  64  through the loops  46 , tensioning of the ends allows engagement of the ACL with bearing surfaces defined on the loops. The tensioning pulls the ACL  64  through a femoral and tibial tunnel. The ACL  64  could be further coupled to the femur using a transverse pin or plug. As shown in  FIG. 12E , once the ACL is fastened to the tibia, further tensioning can be applied to the first and second ends  24 ,  26  placing a desired predetermined load on the ACL. This tension can be measured using a force gauge. This load is maintained by the suture configuration. It is equally envisioned that the fixation member  60  can be placed on the tibial component  66  and the ACL pulled into the tunnel through the femur. Further, it is envisioned that bone cement or biological materials may be inserted into the tunnel  62 . 
         [0035]      FIGS. 13A-13D  represent a close-up of a portion of the suture  20 . As can be seen, the portion of the suture defining the longitudinal passage  30  has a diameter d 1  which is larger than the diameter d 2  of the ends  24  and  26 . The first aperture  32  is formed between a pair of fiber members. As can be seen, the apertures  32 ,  34  can be formed between two adjacent fiber pairs  68 ,  70 . Further, various shapes can be braided onto a surface of the longitudinal passage  30 . 
         [0036]    The sutures are typically braided of from 8 to 16 fibers. These fibers are made of nylon or other biocompatible material. It is envisioned that the suture  22  can be formed of multiple type of biocompatible fibers having multiple coefficients of friction or size. Further, the braiding can be accomplished so that different portions of the exterior surface of the suture can have different coefficients of friction or mechanical properties. The placement of a carrier fiber having a particular surface property can be modified along the length of the suture so as to place it at varying locations within the braided constructions. 
         [0037]    The description of the invention is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. Such variations are not to be regarded as a departure from the spirit and scope of the invention.