A knot pushing device comprising: an elongated shaft portion having a distal end, a proximal end, a fixed outer shaft, and a movable inner shaft coupled to the fixed outer shaft; the proximal end comprising an actuator handle; the distal end comprising a fixed arm at a distal end of the fixed outer shaft, a generally u-shaped end extending from a distal end of the fixed arm, and a movable arm at a distal end of the movable inner shaft; wherein the movable arm is configured to pivot about a pivot center in relation to a fixed position of the fixed arm by a movement of the inner shaft inside the outer shaft, thereby moving the knot pushing device from an open configuration to a closed configuration; characterized in that the generally u-shaped end defines a proximally facing opening adapted to receive a portion of an elongate flexible suture material, wherein the generally u-shaped end comprising a first leg extending substantially distally from the fixed arm, a connection portion extending substantially radially away from the fixed arm in a direction away from the movable arm, and a second leg located opposite the first leg and extending substantially proximally away from the connecting portion, wherein the first leg of the u-shaped end comprises a pin guide opening, and wherein the second leg of the u-shaped end comprises a pin receiver opening; and wherein the movable arm comprises a closure pin which extends through the pin guide opening and across the proximally facing opening of the u-shaped end and into the pin receiver opening when the knot pushing device is in the closed configuration. an elongated shaft portion having a distal end, a proximal end, a fixed outer shaft, and a movable inner shaft coupled to the fixed outer shaft; the proximal end comprising an actuator handle; the distal end comprising a fixed arm at a distal end of the fixed outer shaft, a generally u-shaped end extending from a distal end of the fixed arm, and a movable arm at a distal end of the movable inner shaft; wherein the movable arm is configured to pivot about a pivot center in relation to a fixed position of the fixed arm by a movement of the inner shaft inside the outer shaft, thereby moving the knot pushing device from an open configuration to a closed configuration; characterized in that the generally u-shaped end defines a proximally facing opening adapted to receive a portion of an elongate flexible suture material, wherein the generally u-shaped end comprising a first leg extending substantially distally from the fixed arm, a connection portion extending substantially radially away from the fixed arm in a direction away from the movable arm, and a second leg located opposite the first leg and extending substantially proximally away from the connecting portion, wherein the first leg of the u-shaped end comprises a pin guide opening, and wherein the second leg of the u-shaped end comprises a pin receiver opening; and wherein the movable arm comprises a closure pin which extends through the pin guide opening and across the proximally facing opening of the u-shaped end and into the pin receiver opening when the knot pushing device is in the closed configuration.