Patent ID: 12251094

DETAILED DESCRIPTION

Exemplary embodiments of the disclosure will be best understood by reference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the disclosure, as generally described and illustrated in the Figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, system, and method, as represented inFIGS.1through36, is not intended to limit the scope of the claims, but is merely representative of exemplary embodiments of the present disclosure.

The phrases “connected to,” “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature.

The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.

Not every feature of each embodiment is labeled in every figure in which that embodiment appears, in order to keep the figures clear. Similar reference numbers (for example, those that are identical except for the first numeral) may be used to indicate similar features in different embodiments.

Standard medical planes of reference and descriptive terminology are employed in this specification. While these terms are commonly used to refer to the human body, certain terms are applicable to physical objects in general.

A standard system of three mutually perpendicular reference planes is employed. A sagittal plane divides a body into right and left portions. A coronal plane divides a body into anterior and posterior portions. A transverse plane divides a body into superior and inferior portions. A mid-sagittal, mid-coronal, or mid-transverse plane divides a body into equal portions, which may be bilaterally symmetric. The intersection of the sagittal and coronal planes defines a superior-inferior or cephalad-caudal axis. The intersection of the sagittal and transverse planes defines an anterior-posterior axis. The intersection of the coronal and transverse planes defines a medial-lateral axis. The superior-inferior or cephalad-caudal axis, the anterior-posterior axis, and the medial-lateral axis are mutually perpendicular.

Anterior means toward the front of a body. Posterior means toward the back of a body. Superior or cephalad means toward the head. Inferior or caudal means toward the feet or tail. Medial means toward the midline of a body, particularly toward a plane of bilateral symmetry of the body. Lateral means away from the midline of a body or away from a plane of bilateral symmetry of the body. Axial means toward a central axis of a body. Abaxial means away from a central axis of a body. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body. Proximal means toward the trunk of the body. Proximal may also mean toward a user or operator. Distal means away from the trunk. Distal may also mean away from a user or operator. Dorsal means toward the top of the foot. Plantar means toward the sole of the foot.

Any of the devices described herein may be fabricated from metals, alloys, polymers, plastics, ceramics, glasses, composite materials, or combinations thereof, including but not limited to stainless steel, ABS, polycarbonate, glass filled polycarbonate, PEEK (polyether ether ketone), titanium, and titanium alloys, among others. Different materials may be used within a single part.

FIG.1throughFIG.14are a perspective views of an instrument for surgical repair of an Achilles tendon or tendon repair instrument1000according to an embodiment. In some embodiments, tendon repair instrument1000may be configured for minimally invasive percutaneous Achilles tendon repair surgery. More specifically, the tendon repair instrument1000may be configured to engage an Achilles tendon in multiple planes.

The tendon repair instrument1000may have an interior portion configured to engaged the Achilles tendon within a body of a patient and an exterior portion that remains outside of the body of the patient. The interior portion may include a plurality of tendon guides. The exterior portion may include a handle and a posterior pin guide.

The tendon repair instrument1000may further be configured so that, when the interior portion of the device retains at least a portion of an Achilles tendon, the portion of the Achilles tendon has a generally fixed location with respect to the exterior portion of the device.

The tendon repair instrument1000may be configured for Achilles tendon repair of the Achilles tendon of a right leg and/or a left leg of a patient. The following descriptions of the tendon repair instrument1000and methods for surgical repair of an Achilles tendon may be directed towards repair of the Achilles tendon of the right leg of a patient.

For repair of an Achilles tendon of a left leg of a patient, the tendon repair instrument1000and methods for surgical repair of an Achilles tendon as described may be used, however, the descriptions of medial and lateral directions may be reversed. For example, for repair of the Achilles tendon of the right leg, lateral may indicate the right side of the patient and medial may indicate the left side of the patient. For repair of the Achilles tendon of the left leg, lateral may indicate the left side of the patient and medial may indicate the right side of the patient.

Alternatively, for repair of an Achilles tendon of a left leg of a patient, a mirror image of the tendon repair instrument1000as described may be used and the descriptions of medial and lateral directions may remain as described herein.

The tendon repair system may include similar instruments, and/or similar methods as described in U.S. Pat. No. 11,896,215 filed on 27 Jul. 2021, entitled “ACHILLES TENDON REPAIR DEVICE”, the disclosure of which is incorporated herein by reference in its entirety.

The tendon repair system may further include similar instruments, and/or similar methods as described in U.S. Pat. No. 7,615,062 filed on 23 Apr. 2007, entitled “SUTURE GUIDE AND RUPTURED TISSUE REPAIR”, the disclosure of which is incorporated herein by reference in its entirety.

The tendon repair instrument1000may include a handle1100and a plurality of tendon guides. The plurality of tendon guides may include a lateral tendon guide1200; a medial tendon guide1300; an anterior tendon guide1400; and a posterior tendon guide1500. The plurality of tendon guides may be configured to retain a tendon1050to facilitate passage of a plurality suture needles through the tendon1050.

The handle1100may further include an anterior adjustment feature1150configured to be moveably coupled to the handle1100and further configured to adjust the position of a posterior tendon guide1500in an anterior-posterior plane. The handle1100may further include one or more medial-lateral adjustment features1060configured to be moveably couple to the handle1100and further configured to adjust the position of a lateral tendon guide1200and/or a medial tendon guide1300in a medial-lateral plane. The handle1100may further include a posterior pin guide1600including a first sidewall1610; a second sidewall1620; and a top surface1650.

In an embodiment, a lateral tendon guide1200and a medial tendon guide1300may be configured and spaced apart such that a tendon1050may be retained between the lateral tendon guide1200and the medial tendon guide1300. The spacing between the lateral tendon guide1200and the medial tendon guide1300may be adjusted with a medial-lateral adjustment feature1060. The lateral tendon guide1200and the medial tendon guide1300may be configured so that the range of the distance the lateral tendon guide1200may be spaced apart from the medial tendon guide1300may be approximately 3 cm-12 cm. The distance the lateral tendon guide1200may be spaced apart from the medial tendon guide1300may be equal to or greater than the width of a posterior tendon guide1500and equal to or greater than the width of an anterior tendon guide1400.

In an embodiment, a posterior tendon guide1500and an anterior tendon guide1400may be configured and spaced apart such that a tendon1050may be retained between the posterior tendon guide1500and the anterior tendon guide1400. The anterior tendon guide1400may be movably coupled to the handle1100such that the anterior tendon guide1400may be actuated to grip the tendon1050between the anterior tendon guide1400and the posterior tendon guide1500.

The spacing between the posterior tendon guide1500and the anterior tendon guide1400may be adjusted with an anterior adjustment feature1150. The anterior tendon guide1400may be configured to be actuated to grip the tendon1050between the anterior tendon guide1400and the posterior tendon guide1500. The posterior tendon guide1500and the anterior tendon guide1400may be configured so that the range of the distance the posterior tendon guide1500may be spaced apart from the anterior tendon guide1400is approximately 2 cm-10 cm.

The spacing of a lateral tendon guide1200and a medial tendon guide1300may be configured to be equal to or larger than the size of a tendon1050, in a medial-lateral plane. Additionally, the spacing of the lateral tendon guide1200and the medial tendon guide1300may be configured to fit within a paratenon of a tendon1050. The spacing of a posterior tendon guide1500and an anterior tendon guide1400may be configured to be equal to or larger than the size of a tendon1050, in an anterior-posterior plane. Additionally, the spacing of the posterior tendon guide1500and the anterior tendon guide1400may be configured to fit within a paratenon of a tendon1050.

In an embodiment, a lateral tendon guide1200; a medial tendon guide1300; an anterior tendon guide1400; and a posterior tendon guide1500each may extend from a handle1100and may be configured to enter a paratenon of a tendon1050through a percutaneous incision to a depth of up to 25 cm.

FIG.15throughFIG.23show partial side, partial top and perspective views of the instrument for surgical repair of an Achilles tendon or tendon repair instrument1000according to an embodiment. In an embodiment, a posterior pin guide1600may include a top surface1650that may include a plurality of posterior pin holes1660. The posterior pin guide1600may further include a first sidewall1610and a second sidewall1620. The first sidewall1610may include a medial pin guide1635and the second sidewall1620may include a lateral pin guide1630. The lateral pin guide1630and medial pin guide1635may be configured to guide a first suture needle2050through the first sidewall1610and the second sidewall1620generally parallel to a coronal plane2600.

The posterior pin guide1600may further include one or more medial arm apertures1370through the second side wall1620and one or more lateral arm apertures1270through the first side wall1610. The handle1100may include one or more medial outer arms1360and one or more lateral outer arms1260. The one or more medial arm apertures1370may be configured to slidably receive the one or more medial outer arms1360. The one or more lateral arm apertures1270may be configured to slidably receive the one or more lateral outer arms1260.

The posterior pin guide1600may be positioned along the one or more medial outer arms1360and the one or more lateral outer arms1260based on the desired suture trajectories through the Achilles tendon.

The lateral pin guide1630and medial pin guide1635may be configured to guide a first suture needle2050through a tendon1050between a posterior tendon guide1500and an anterior tendon guide1400with the tendon1050retained between the posterior tendon guide1500and the anterior tendon guide1400. The lateral pin guide1630and medial pin guide1635may be located in a distal portion of a posterior pin guide1600. The posterior pin guide1600may be positioned posterior to the tendon1050such that the posterior pin holes1660may be configured to guide insertion of one or more suture needles through the tendon1050along at least partially anterior directions.

In an embodiment, a lateral tendon guide1200may include a lateral tendon guide eye1250and a medial tendon guide1300may include a medial tendon guide eye1350. The lateral tendon guide eye1250and the medial tendon guide eye1350may each be configured as a hook shape. The lateral tendon guide eye1250and the medial tendon guide eye1350may further be configured so the eye of the hook may be aligned with the spacing between a posterior tendon guide1500and an anterior tendon guide1400. Additionally, the opening of each hook may be located at a proximal end of the lateral tendon guide1200and the medial tendon guide1300.

In an embodiment, a top surface1650may include a plurality of posterior pin holes1660configured to guide a plurality of suture needles through a tendon1050between a posterior tendon guide1500and an anterior tendon guide1400with the tendon1050retained between the posterior tendon guide1500and the anterior tendon guide1400. Each of the posterior pin holes1660may be configured to guide a suture needle: through a top surface1650; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. In an embodiment, each of the posterior pin holes1660may be configured to have a suture needle trajectory angle2500that may be offset at least 10° from a coronal plane2600.

In an embodiment, each of the posterior pin holes1660may be configured to have a suture needle trajectory angle2500that may be offset at least 15° from a coronal plane2600. In an embodiment, each of the posterior pin holes1660may be configured to have a suture needle trajectory angle2500that may be offset at least 20° from a coronal plane2600.

In an embodiment, a top surface1650may include four or more posterior pin holes1660. The four or more posterior pin holes1660may be configured wherein half of the four or more posterior pin holes1660are mirrored about a central medial-lateral plane of the tendon repair instrument1000. The four or more posterior pin holes1660may be configured to receive: a second suture needle2150; a third suture needle2250; a fourth suture needle2350; and a fifth suture needle (not shown).

In an embodiment, a first suture needle2050may be configured to shuttle a first suture2000: through a first sidewall1610; through the skin and soft tissue of a patient; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through the other of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. The first suture needle2050may be configured to disengage from the first suture2000leaving the ends of the first suture2000exterior to a patient and a central portion of the first suture2000tracing a path through the tendon repair instrument1000.

In an embodiment, a second suture needle2150may be configured to shuttle a second suture2100: through an posterior pin hole1660, in a generally posterior to anterior direction; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. The second suture needle2150may be configured to disengage from the second suture2100leaving the ends of the second suture2100exterior to a patient and a central portion of the second suture2100tracing a path through the tendon repair instrument1000.

In an embodiment, a third suture needle2250may be configured to shuttle a third suture2200: through an posterior pin hole1660, in a generally posterior to anterior direction; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. The third suture needle2250may be configured to disengage from the third suture2200leaving the ends of the third suture2200exterior to a patient and a central portion of the third suture2200tracing a path through the tendon repair instrument1000.

In an embodiment, a fourth suture needle2350may be configured to shuttle a fourth suture (not shown): through an posterior pin hole1660, in a generally posterior to anterior direction; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. The fourth suture needle2350may be configured to disengage from the fourth suture (not shown) leaving the ends of the fourth suture (not shown) exterior to a patient and a central portion of the fourth suture (not shown) tracing a path through the tendon repair instrument1000.

In an embodiment, a fifth suture needle (not shown) may be configured to shuttle a fifth suture (not shown): through an posterior pin hole1660, in a generally posterior to anterior direction; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. The fifth suture needle (not shown) may be configured to disengage from the fifth suture (not shown) leaving the ends of the fifth suture (not shown) exterior to a patient and a central portion of the fifth suture (not shown) tracing a path through the tendon repair instrument1000.

In an embodiment, a tendon repair instrument1000may include a posterior pin guide1600including a first sidewall1610and a second sidewall1620. The first sidewall1610may include a plurality of posterior pin holes1660. The second sidewall may include a plurality of posterior pin holes1660. The plurality of posterior pin holes1660may be configured to guide a plurality of suture needles in a generally anterior to posterior trajectory. Each of the plurality of posterior pin holes1660may be configured to have a suture needle trajectory angle2500that may be offset at least 10° from a coronal plane2600.

The plurality of posterior pin holes1660may be configured to guide a plurality of suture needles: through a posterior pin hole1660, in a generally anterior to posterior direction; through the skin and soft tissue of a patient; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; through a tendon1050, retained between a posterior tendon guide1500and an anterior tendon guide1400, and retained between a lateral tendon guide1200and a medial tendon guide1300; through a gap between the posterior tendon guide1500and the other of the lateral tendon guide1200and the medial tendon guide1300; and exiting a patient through the soft tissue and skin.

The plurality of posterior pin holes1660may be configured to guide a plurality of suture needles: through a posterior pin hole1660, in an at least partially posterior direction; through the skin and soft tissue of a patient; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; through a tendon1050, retained between a posterior tendon guide1500and an anterior tendon guide1400, and retained between a lateral tendon guide1200and a medial tendon guide1300; through a gap between the posterior tendon guide1500and the other of the lateral tendon guide1200and the medial tendon guide1300; and exiting a patient through the soft tissue and skin.

The first sidewall1610and/or the second sidewall1620may be extended sufficiently anterior that one or more posterior pin holes1660can be anterior to the coronal plane2600, enabling insertion of the suture needle(s) along a direction offset by at least 10° from the coronal plane2600. The top surface1650may optionally be omitted, or may have corresponding holes that receive and further guide the suture needle(s). Additionally, or alternatively, the first sidewall1610and/or the second sidewall1620may have pin holes (not shown) that are positioned on the opposite side of the Achilles tendon from the posterior pin holes1660, and receive and further guide the suture needle(s) after passage of the suture needle(s) through the Achilles tendon.

In some embodiments, the first sidewall1610and/or the second sidewall1620may extend further anteriorly and posteriorly of the coronal plane2600than is shown in the drawings in order to position such pin holes with the necessary offsets anteriorly and posteriorly of the coronal plane2600. The top surface1650then may not be present, or may not have pin holes. In some embodiments, the suture needle(s) may be inserted posterior-to-anterior rather than anterior-to-posterior.

In an embodiment, each of the posterior pin holes1660, the lateral pin guide1630, and the medial pin guide1635may be configured so that the trajectories of any pair of guides do not intersect. Each of the posterior pin holes1660, the lateral pin guide1630, and the medial pin guide1635may be configured so that each of the first suture needle2050; second suture needle2150; third suture needle2250; fourth suture needle2350; and fifth suture needle (not shown) may be engaged with the tendon repair instrument1000without interference from a secondary suture needle.

FIG.24andFIG.25show perspective views of an instrument for surgical repair of an Achilles tendon, or tendon repair instrument1000′ according to an embodiment. The tendon repair instrument1000′ may include a posterior pin guide1600′. The posterior pin guide1600′ may include a first sidewall1610′, a second sidewall1620′, a plurality of lateral pin guides1630′, and a plurality of medial pin guides1635′. The lateral pin guides1630′ may be configured to guide a plurality of suture needles through the second sidewall1620′ generally parallel to a coronal plane2600. The medial pin guides1635′ may be configured to guide a plurality of suture needles through the first sidewall1610′ generally parallel to a coronal plane2600. The lateral pin guides1630′ and the medial pin guides1635′ may be configured to guide a plurality of suture needles through a tendon1050between a posterior tendon guide1500and an anterior tendon guide1400with the tendon1050retained between the posterior tendon guide1500and the anterior tendon guide1400.

The first sidewall1610′ and the second sidewall1620′ may include a plurality of lateral pin guides1630′ and medial pin guides1635′. The medial pin guides1635′ may be configured to guide a plurality of suture needles through the first sidewall1610′ generally parallel to a coronal plane2600. The lateral pin guides1630′ may be configured to guide a plurality of suture needles through the second sidewall1620′ generally parallel to a coronal plane2600. The lateral pin guides1630′ and the medial pin guides1635′ may be configured to guide a plurality of suture needles through a tendon1050between a posterior tendon guide1500and an anterior tendon guide1400with the tendon1050retained between the posterior tendon guide1500and the anterior tendon guide1400.

The posterior pin guide1600′ may further include a top surface1650′ including a top surface aperture1680. The top surface aperture1680may take the place of the posterior pin holes1660, and may be configured to allow a plurality of suture needles to pass: through the top surface aperture1680; through the skin and soft tissue of a patient; through a gap between a posterior tendon guide1500and one of a lateral tendon guide1200and a medial tendon guide1300; through a tendon1050, retained between the posterior tendon guide1500and the anterior tendon guide1400, and retained between the lateral tendon guide1200and the medial tendon guide1300; through one of a lateral tendon guide eye1250and a medial tendon guide eye1350; and exiting a patient through the soft tissue and skin. Each of the plurality of suture needles may have a trajectory that may be offset at least 15° from a coronal plane2600.

In an embodiment, a lateral tendon guide1200and a medial tendon guide1300may be configured to engage a plurality of sutures that may follow the trajectories of a plurality of posterior pin holes1660, a lateral pin guide1630and a medial pin guide1635, and whose suture ends are exterior to a patient, whereby, when the lateral tendon guide1200and the medial tendon guide1300may be withdrawn from a surgical site through a percutaneous incision, the plurality of sutures may be engaged and the ends of the plurality of sutures may be drawn into the patient and then drawn back out of the patient through the percutaneous incision while leaving a central portion of each of the plurality of sutures engaged with the tendon1050. The lateral tendon guide1200and the medial tendon guide1300may further be configured so that the lateral tendon guide1200and the medial tendon guide1300may disengage from the plurality of sutures through an opening in a lateral tendon guide eye1250and a medial tendon guide eye1350.

In an embodiment, a lateral tendon guide1200, a medial tendon guide1300, a posterior tendon guide1500, and an anterior tendon guide1400may be configured to permit routing of one or more suture needles through the tendon1050along trajectories that facilitate application of a Krackow suturing technique. The Krackow suturing technique is a continuous locking loop suture technique that may involve two or more locking loops placed along each side of a tendon and is well known in the art for open surgical tendon repair. The Krackow suturing technique may require suture needles to travel, at least partially, in a posterior to anterior direction.

Additionally, a plurality of posterior pin holes1660, a lateral pin guide1630, and a medial pin guide1635may be configured to permit insertion of one or more suture needles through the tendon1050along trajectories that facilitate application of the Krackow suturing technique. In an embodiment, a lateral tendon guide1200, a medial tendon guide1300, a posterior tendon guide1500, and an anterior tendon guide1400may be configured to permit insertion of one or more suture needles through the tendon1050along trajectories that facilitate application of other suturing techniques used in open Achilles tendon repair surgery, such as McKeon's Double Krackow, Wilson's Double Krackow, Ostrander's Modified Krackow, Giftbox-modified Krackow, Kessler, or Bunnell.

FIG.26thoughFIG.36illustrate one exemplary method for minimally invasive percutaneous Achilles tendon repair surgery using a tendon repair instrument1000according to an embodiment. The method for minimally invasive percutaneous Achilles tendon repair surgery using a tendon repair instrument1000may include the following steps:1. Make a percutaneous incision over the rupture site and enter the paratenon. Grab the free tendon with a snap or clamp.2. Adjust the distance between the medial tendon guide and the lateral tendon guide, and the distance between the anterior tendon guide and the posterior tendon guide, so that the tendon repair instrument may be fully inserted along the Achilles tendon using the snap or clamp to hold the tendon stable.3. Insert the arms of the tendon repair instrument into the paratenon of the Achilles tendon and maneuver the instrument to receive the Achilles tendon such that the Achilles tendon is retained between the medial tendon guide and the lateral tendon guide.4. Optional step: The anterior tendon guide may optionally be attached to the device prior to insertion into the paratenon. If the anterior tendon guide is not attached, after the device is inserted, insert the anterior tendon guide along the anterior side of the Achilles tendon and, once fully inserted, secure it to the handle of the tendon repair instrument.5. Actuate the anterior tendon guide to grip the tendon between the anterior tendon guide and the posterior tendon guide.6. Pass a first suture needle through a medial pin guide and/or a lateral pin guide.7. Leave the first suture needle in place while inserting subsequent suture needles to help hold the tendon in place.8. Pass additional suture needles through the posterior pin holes, that are offset at least 100 from a coronal plane2600, and into the tendon along directions that are at least partially anterior.9. Pull suture needles through leaving approximately equal ends of sutures on both sides, exterior to the patient.10. Adjust anterior tendon guide to release pressure on the tendon.11. Withdraw tendon repair instrument from surgical site pulling ends of sutures out through the percutaneous incision.12. Use suture ends and loops to perform Krackow suturing technique; Kessler suturing technique; Bunnell suturing technique; or other suturing technique commonly used in open Achilles tendon repair surgery.

The foregoing is just one of many possible methods in which an instrument according to the present disclosure may be employed. In one exemplary method for minimally invasive percutaneous Achilles tendon repair surgery using a tendon repair instrument1000, the above method may include the following additional steps:1. Perform steps 1-9 of the above method2. Partially withdraw the tendon repair instrument so that the posterior pin guide is located between the previously placed sutures and the percutaneous incision. Ensure the posterior pin guide is located above the tendon.3. Repeat steps 4-9 of the above method.4. Perform steps 10-11 of the above method.

Those of skill in the art will recognize that this is only one of many potential methods that may be used for minimally invasive percutaneous Achilles tendon repair surgery. In alternative embodiments, different methods may be used to surgically repair an Achilles using a tendon repair instrument1000or other systems described above. Further, the method set forth inFIG.26throughFIG.36may be employed to surgically repair an Achilles tendon using other tendon repair instruments besides those specifically disclosed herein.

Reference throughout this specification to “an embodiment” or “the embodiment” means that a particular feature, structure or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the quoted phrases, or variations thereof, as recited throughout this specification are not necessarily all referring to the same embodiment.

Similarly, it should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than those expressly recited in that claim. Rather, as the following claims reflect, inventive aspects lie in a combination of fewer than all features of any single foregoing disclosed embodiment. Thus, the claims following this Detailed Description are hereby expressly incorporated into this Detailed Description, with each claim standing on its own as a separate embodiment. This disclosure includes all permutations of the independent claims with their dependent claims.

The phrases “generally parallel” and “generally perpendicular” refer to structures that are within 30° parallelism or perpendicularity relative to each other, respectively. Recitation in the claims of the term “first” with respect to a feature or element does not necessarily imply the existence of a second or additional such feature or element. Elements recited in means-plus-function format are intended to be construed in accordance with 35 U.S.C. § 112 Para. 6. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles of the disclosure.

While specific embodiments and applications of the present disclosure have been illustrated and described, it is to be understood that the disclosure is not limited to the precise configuration and components disclosed herein. Various modifications, changes, and variations which will be apparent to those skilled in the art may be made in the arrangement, operation, and details of the methods and systems of the present disclosure without departing from its spirit and scope.