Device and method for securing body tissue

Description

FIELD OF THE INVENTION

The invention relates to an apparatus and method for the fixation and stabilization of body tissue. More specifically, the invention relates to a fastener and medical device for the fixation and stabilization of a suture with respect to a body tissue.

BACKGROUND OF THE INVENTION

In the surgical repair of soft tissue such as the surgical reattachment of ligaments to bone or the attachment of tendon to muscle, it is known to use devices that surgically fasten the soft tissues to be repaired to the bone so as to avoid the use of suture knots. Suture knots are disadvantageous because the knot weakens a portion of the suture and reduces the overall force transmitting capability of the suture. Additionally, suture knots can also exhibit the phenomenon of “creep,’ where the suture can slip though the knot, resulting in a loss of tension in the suture. Suture creep can cause a change in orientation or misalignment of the attached tissue resulting in an improper healing of the attached tissue and/or pressure on or trauma to surrounding tissue.

Additionally, as a number of procedures are performed with limited surgical access, it can be difficult to form an appropriate suture knot. Furthermore, such a knot may not be uniformly tensioned and thus may slip or bind and cause pressure on or trauma to surrounding tissue.

In contrast, a fastener can be used to maintain a suture in a desired position relative to body tissue as long as the suture can be appropriately tensioned prior to its fixation and held in this tensioned state. For example, the fastener may be affixed to the suture in a manner that maintains the suture under tension. For instance, the fastener may be heated until its material reaches its transition temperature range and then plastically deformed. As the material is heated, it changes from a solid condition, in which it has a fixed form, to a soft or viscous condition. The soft or viscous material can be molded around an outer side surface of a suture and bonded to the suture without significant deformation of the suture. The transition temperature of the fastener may vary according to the material used. Some examples of various polymers which are suitable for forming fasteners are disclosed in U.S. Pat. No. 5,735,875, which is incorporated herein in its entirety. The fixation of the fastener prevents suture creep, maintaining the attached tissue in the proper orientation.

The use of fasteners helps avoid some of the deficiencies that may result from using only suture knots. One primary benefit of using fasteners is that they help properly tension the suture prior to fixation, which in turn may substantially reduce the likelihood of tensioned slip or binding of the suture that can cause excessive pressure on or trauma to the surrounding tissue. Additionally, fasteners can be used in limited access procedures.

SUMMARY OF THE INVENTION

The present invention provides a surgical system for securing a suture against movement relative to a body tissue. The surgical system includes a fastener and medical device for positioning and securing the fastener onto a suture. The surgical system can be utilized for the fixation and stabilization of body tissue, including soft tissue to soft tissue, soft tissue to bone, and bone to bone. The surgical system can additionally be used to affix implants or grafts to body tissue.

The fastener may have a first (“outer”) member and a second (“inner”) member, where the second member is slidably and rotatably positionable within the first member. The first member has first and second ends and an outer shell defining a longitudinal receptacle or passage along a central longitudinal axis. The second member is configured for insertion into the longitudinal passage and rotation about the central longitudinal axis. The second member includes first and second ends and a center portion interposed between the first and second ends. The first and second ends have cross sectional areas that are greater than the cross sectional area of the central portion. For instance, the second member may resemble a spool or an hourglass where the central region is smaller than the ends. The first and second members of the fastener may be bonded together in a manner that secures the suture against relative movement with respect to the body tissue. In one embodiment, for example, bonding the first and second members together involves plastically deforming at least one of the members.

The first member of the fastener may be an outer shell defining a longitudinal passage along a central longitudinal axis in which all or part of the second member may be placed or reside. The outer shell may have a pair of open ended slots at a first end and a key element positioned about a second end. The second member of the fastener may be configured for at least partial insertion into the longitudinal passage and rotatable about the central longitudinal axis. The second member may include one or more gear teeth radially positioned on or near either a first end, a second end, or both ends of the second member. A hook may be disposed on a center portion of the second member to receive or capture the suture. In addition, the first and second ends of the second member may have cross sectional areas that are larger than the cross sectional area of the center portion. It may be desirable for the first and second ends of the second member to be substantially similar in construction and/or size so that insertion of the second member into the first member does not require a particular orientation. When all or part of the second member is positioned within the first member, the key element of the first member may engage the gear teeth of the second member to prevent rotation of the second member with respect to the first member in a first direction while allowing rotation in a second, opposite direction.

In use, a suture may be positioned relative to body tissue, with at least one section of the suture extending from the body tissue. The at least one section of the suture extending from the body tissue may be captured or associated with the second member of the fastener in a manner such that axial rotation of the second member will cause the suture to wind or wrap around the second member.

The second fastener member may be moved into the longitudinal passage or receptacle of the first fastener member such that the suture extends through the first and second members of the fastener. The suture can be twisted or spiraled in the receptacle to aid in locking the suture therein. In one embodiment, the suture travels in a direction that is not parallel to the longitudinal axis of the passage or receptacle of the first member. For example, the direction of the longitudinal axis of the passage or receptacle may differ from the direction that the suture travels by about 45 to 90 degrees.

Once the fastener is assembled with the suture, the second member may be rotated with respect to the first member so that the suture starts to wind or wrap around the second member. Once the suture has reached a desired tension, energy may then be transmitted to the fastener in order to plastically deform a portion of the fastener about the suture, thereby securing the fastener to the suture.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein:

FIG. 1 depicts an exploded isometric view of a fastener of the present invention;

FIG. 2 depicts an isometric view of the fastener of FIG. 1;

FIG. 3 depicts a sectional view of the fastener of FIG. 1, including a suture therethrough;

FIG. 4 depicts a sectional view of the fastener of FIG. 1, including a wrapped suture thereon;

FIGS. 5A-5G depict alternative aperture and slot configurations for the shell of the fastener of FIG. 1;

FIG. 6 depicts an angular aperture configuration for the shell of the fastener of FIG. 1;

FIG. 7 depicts a ratcheting system for a fastener of the present invention;

FIG. 8 depicts a key element of the ratchet system of FIG. 7;

FIG. 9 depicts a gear element of the ratcheting system of FIG. 7;

FIG. 10 depicts an exploded isometric view of an alternative fastener of the present invention;

FIG. 11 depicts an isometric view of the fastener of FIG. 10;

FIG. 12 depicts a medical device of the present invention;

FIG. 13 depicts a sectional view of the medical device of FIG. 12;

FIG. 14 depicts a sectional view of the medical device of FIG. 12 showing the tip portion of the transfer mechanism;

FIG. 15 depicts a sectional view of the medical device of FIG. 12 showing the handle portion of the ratcheting mechanism;

FIG. 16 depicts a sectional view of the medical device of FIG. 12 showing the tip portion of the ratcheting mechanism;

FIG. 17 depicts a front view of the medical device of FIG. 12 showing the tip portion of the ratcheting mechanism;

FIG. 18 depicts a sectional view of the medical device of FIG. 12 showing the handle portion of the fixation mechanism;

FIG. 19 depicts a sectional view of the medical device of FIG. 12 showing the tip portion of the fixation mechanism;

FIG. 20 depicts a schematic diagram of an energy system of the present invention;

FIG. 21 depicts an isometric view of the medical device of FIG. 12 including an attached energy source;

FIG. 22 depicts a sectional view of the medical device of FIG. 12 showing the handle portion of the ejector mechanism;

FIG. 23 depicts a sectional view of the medical device of FIG. 12 showing the tip portion of the ejector mechanism;

FIG. 24 depicts a front isometric sectional view of the medical device of FIG. 12 of the ejector mechanism of FIG. 22;

FIG. 25 depicts a sectional view of the medical device of FIG. 12 showing the handle portion of a multi-fastener ejector mechanism;

FIG. 26 depicts a sectional view of the medical device of FIG. 12 showing the tip portion of the multi-fastener ejector mechanism;

FIG. 27 depicts a first isometric view of a first member of a fastener for use with the ejector mechanisms of FIGS. 12 and 26;

FIG. 28 depicts a second isometric view of a first member of a fastener for use with the multi-fastener ejector mechanism of FIGS. 12 and 26;

FIG. 29 depicts a first isometric view of a second member of a fastener for use with the first member of FIGS. 27 and 28;

FIG. 30 depicts a second isometric view of a second member of a fastener for use with the first member of FIGS. 27 and 28;

FIG. 31 depicts a first isometric view of an alternative second member of a fastener; and

FIG. 32 depicts a second isometric view of the alternative second member of a fastener.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a surgical system and fastener that help secure a suture against movement relative to body tissue. The surgical system includes a medical device or instrument that helps position and secure a fastener onto a suture. The medical device systematically moves the fastener into position against the body tissue while tensioning the suture with respect to the fastener. An actuation of the medical device attaches the fastener to the suture, securing the fastener against the body tissue to prevent relative movement of the suture with respect to the body tissue.

Referring now to the drawing figures in which like reference designators refer to like elements, there is shown in FIGS. 1 and 2 a fastener 10 of the present invention including a first (“outer”) member 12 and a second (“inner”) member 14, wherein the second member 14 is slidably and rotatably positionable within the first member 12. The first member 12 includes an outer shell 16 defining an axial passage or receptacle 18 along a longitudinal axis “A” of the fastener 10. The axial passage may extend completely from one end of the first member to the other end, but it also may extend only partially though the first member to form a receptacle or recess where all or part of the second member may be placed. Preferably, the longitudinal axis “A” corresponds to a central longitudinal axis of the first member. One or more pairs of apertures 20 and 22 may be opposingly positioned about the circumference of the outer shell 16 of the first member 12 and are dimensioned for receiving a suture therethrough.

The second member 14 includes first and second end portions 24 and 26 disposed on opposite sides of a center portion 28. The cross sectional areas of the first and second end portions 24 and 26 may be dimensioned such that either end of the second member 14 may be slidably and rotatably positionable inside the axial passage or receptacle 18 of the first member 12. The cross sectional area of the center portion 28 is less than the cross section areas of first and second end portions 24 and 26, thereby providing clearance space between the interior surface of the outer shell 16 and the outer surface of the center portion 28.

A suture passage 30 may be provided through the center portion 28. This suture passage may be orthogonal to the central longitudinal axis “A” of the fastener 10, or alternatively may be angled or offset as described above. Slots or cutouts as described above for the first member also may be used for the suture passage 30 of the second member. Skilled artisans would appreciate, however, that consideration should be given to providing sufficient torsional strength or rigidity to the second member since its center portion 28 where the suture passage is located has a smaller cross section.

Referring to FIGS. 3 and 4, when the second member 14 is positioned at least partially inside first member 12, the second member 14 may be rotated about longitudinal axis “A” so that the suture is wound or wrapped around its center portion 28. In a method of use, the second member 14 may be positioned within the first member 12 so that apertures 20 and 22 are aligned with the suture passage 30. A suture 32 may then be threaded through the apertures 20 and 22 and suture passage 30. Once the suture is threaded, the fastener 10 may be interposed between a first suture portion 34 having a free end and a second suture portion 36 that is connected to body tissue. The free end portion 34 may be tensioned as the second member 14 is rotated about the longitudinal axis “A”. In general, the first member is maintained in a position that prevents the suture from winding or wrapping around the outside of the outer shell 16. The rotation of the second member 14 wraps or winds part of the suture 32 about the center portion 28 of the second member 14, thereby drawing the fastener 10 toward the body tissue. Rotation of the second member 14 may continue until the first member 12 is positioned adjacent to the body tissue and the suture is under a desired tension. In this manner, the fastener may apply a force to the suture 32 and body tissue that helps prevent relative movement of the suture 32 with respect to the body tissue.

The shell may have other configurations for receiving a suture instead of apertures. For example, as shown in FIGS. 5A-5G, the outer shell 16 may have a pair of slots that extend from a central location of the shell 16 toward one or more ends of the first member. For instance, a pair of slots may extend from a central portion of the shell 16 toward the same end of the first member, or alternatively may extend toward opposite ends. The slots may be generally linear so that they travel generally in a direction parallel to longitudinal axis A, such as illustrated in FIG. 10. Alternatively, one or more slots may curve around a portion of the shell and form a curved or arced opening.

In addition, one or more slots also may not extend fully to an end of the first member 12. Instead, they may be disposed generally in the central region of the shell 16. This enclosed slot configuration may allow for some linear adjustability of the first and second members as well as the ability for the suture to wrap over a greater area of the second member 14. In yet another embodiment, a lateral slot may extend generally in a circumferential direction around a portion of the shell so that it is generally perpendicular to longitudinal axis A. A suture may be placed inside the lateral slot and be positioned to cooperate with the second member. One potential advantage of this configuration is that the ends of the first member may be free of notches, slots or cutouts that can cause them to more easily splay or bend open when subjected to hoop stress.

In addition to using different types of configurations in the shell (e.g., apertures, linear slots, arced or curved slots, lateral slots, etc.) for receiving a suture, the location of the apertures or slots may be configured so that a portion of the suture disposed on one side of the shell is offset from a portion of the suture on the opposing side of the shell. For example, as shown in FIG. 6, the offset of the two openings or apertures 20, 22 may differ by an angle 8 of from about 5 to 30 degrees from a perpendicular line to longitudinal axis A. Likewise, if a lateral slot is used, it too may be formed at an angle to provide a similar offset. This offset configuration may be useful in helping reduce entanglement of the suture portions as they are wound or wrapped around the second member.

After the fastener 10 has been moved into position against the body tissue, the first and second members 12 and 14 are interconnected or secured in a manner that prevents further relative movement between them. For example, a mechanical locking device, such as a pin inserted through the first and second members 12 and 14, may be applied to the fastener 10. Other mechanical locking devices, such as ratchets and the like, may also be used and are described more fully below.

Alternatively, a compressive force may be applied so that the fastener 10 plastically deforms the first and second members 12 and 14 and crimps them together. The plastic deformation may cause the first and second members 12 and 14 to bond together or simply may create an interference that cannot be overcome by tension forces of the suture.

In another embodiment, energy may be applied to the fastener 10 to bond or fuse the first and second members 12 and 14 together, preventing relative movement there between. For example, the applied energy may be heat, or may be converted into heat, so that portions of the material forming the first or second members, or both, reach a transition temperature range where the material flows more easily. The material may then be plastically deformed, fused, or otherwise bonded or held together.

Different types or intensities of energy can be combined or used individually to plastically deform, partly intermix, fuse, or bond the first and second fastener members together. Some examples of types of energy that may be used include, but are not limited to, ultrasound energy, ultrasonic energy, radio frequency (RF) energy, laser energy, infrared energy, microwave energy, electromagnetic energy, resistive heat energy, contact heating energy, and exothermic chemical reactions. The energy also may be used to activate an epoxy component, compound, or constituent part of one fastener member to chemically react with an epoxy component, compound, or constituent part of the other fastener member.

In one embodiment, the fastener 10 may include a ratcheting mechanism that allows rotation in one direction, but not in an opposite direction. Thus, a ratcheting mechanism may be used to help prevent an unwinding of the suture 32 from the second member 14. Referring to FIGS. 7-9, an exemplary ratcheting system of the present invention is provided. The first member 12 of the fastener 10 includes at least one key element 42 circumferentially positioned about an end portion 44 of the outer shell 16. The key element 42 may be formed from bending a portion of the end of the shell inwards toward the center of the first member, such as illustrated in FIG. 8. Alternatively, one or more key elements 42 may be formed on the interior surface of the axial passage 18. More than one key element may be provided as well. For instance, the interior surface of the axial passage 18 may have a plurality of inwardly projecting key teeth that are angled to allow gear teeth 48 on the second member 14 to slip over them in one direction, but not in the other.

The second member 14 of the fastener 10 includes an integrated gear portion 46 having a one or more angled gear teeth 48 radially positioned about one or both end portions 24 and 26. Upon insertion of the second member 14 into the axial passage 18 of the first member 12, the key element 42 engages the gear portion 46 of the second member 14. The angular positioning of the gear teeth 48, the key element 42, or both allow the second member 14 to be rotated in only one direction.

Preferably the key elements (or their teeth), the gear teeth, or both are present in sufficient number to provide discrete control mechanism against unwinding so that small intervals of rotation, such as less than about 10 degrees, and more preferably less than about 5 degrees, will cause the key element 42 and gear teeth 48 to shift from a first interlocking position to a second interlocking position. When in an interlocking position, rotation in an opposite or unwinding direction is prevented by the engagement of the key element 42 with the gear teeth 48.

In an exemplary method of use, upon positioning of the second member 14 within the first member 12, the key element 42 engages the gear portion 46 of the second member 14. The free end portion 34 of the suture 32 is tensioned and the second member 14 is rotated in a first direction, about the central longitudinal axis “A,” with respect to the first member 12. The rotation of the second member 14 wraps the connected end portion 36 of suture 32 about the center portion 28 of the second member 14, drawing the fastener 10 to the body tissue. The engagement of the key element 42 with the gear teeth 48 prevents the second member 14 from rotating in a second direction, opposite from the first direction, and unwrapping the connected end portion 36 of suture 32 from the center portion 28 of the second member 14. Rotation of the second member 14 may continue until the first member 12 is positioned adjacent to the body tissue. Further rotation of the second member causes the fastener 10 to apply a force to the suture 32 and body tissue, thereby preventing relative movement of the suture 32 with respect to the body tissue. The force tensions the suture 32 to a predetermined tension, where the tension in the suture can be measured with a sensor. Alternatively, the force applied to the tissue can be measured with a sensor, for example, a sensor can measure the change in resistance of the tissue as the force is applied to the tissue, decreasing the tissue thickness.

As previously disclosed, after the fastener 10 has been moved into position against the body tissue, the first and second members 12 and 14 may be interconnected to help prevent further relative movement between them. The ratchet configuration described above may be sufficiently capable of preventing undesired unwinding without modification. Thus, even though relative movement in winding direction may be possible, the configuration may be sufficient to prevent unwinding. Thus, in some cases prevention of relative movement in one direction (e.g., unwinding) may be sufficient.

As described above, mechanical fasteners also may be applied to the fastener 10 to prevent any relative movement or at least to prevent unwinding. Alternatively, a compressive force may be applied to the fastener 10, plastically deforming the first and second members 12 and 14. The plastic deformation may bond the first and second member 12 and 14 together or cause an interference that prevents relative movement. Once again, one alternative would be to expose the fastener 10 to an energy that bonds the first and second members 12 and 14 together.

Referring now to FIGS. 10 and 11 an alternative fastener 50 of the present invention is provided. Fastener 50 includes a first (“outer”) member 52 and a second (“inner”) member 54. The second member 54 is at least partly slidably and rotatably positionable within the first member 52. The first member 52 includes an outer shell 56 defining an axial passage 58 along a central longitudinal axis “A” of the fastener 50. A pair of slots 60 and 62 are positioned about the circumference of an end portion 64 of the outer shell 56 of the first member 52 and are dimensioned for receiving a suture there through.

The second member 54 includes first and second end portions 66 and 68 having a center portion 70 disposed there between. The center portion 70 includes a hook member 72 configured for capturing a suture. The cross sectional areas of the first and second end portions 66 and 68 are dimensioned such that the second member 54 is slidably and rotatably positionable through the axial passage 58 of the first member 52. The cross sectional area of the center portion 70 is less than the cross section areas of first and second end portions 66 and 68, providing spacing between the outer shell 56 of the first member 52 and the center portion 70 of the second member 54.

The second member 54 is positionable within the first member 52, wherein the second member 54 is rotatable about the central longitudinal axis “A” with respect to the first member 52. In a method of use, the second member 54 may be extended from (i.e., disposed at least partly outside of) the first member 52. The hook member 72 may be used to capture a suture 74. The second member 54 may be positioned within the first member 52, drawing the captured suture 74 into the slots 60 and 62 of the first member 52. As discussed above, any of the alternative embodiments discussed above for the first and second members shown in FIGS. 1-9 also may be utilized with this embodiment, and likewise the hook or other features of this embodiment may be used with other embodiments described herein.

Once the suture 74 is positioned through the hook member 72 and the slots 60 and 62, such that the fastener 50 is interposed between a first suture portion 76 having a free end and a second suture portion 78 that is connected to body tissue, the physician may begin the suture winding or wrapping process. The free end portion 76 of the suture 74 may be tensioned as the second member 54 is rotated about the central longitudinal axis “A”. The rotation of the second member 54 wraps the connected end portion 78 of suture 74 about the center portion 70 of the second member 54, drawing the fastener 50 to the body tissue. The second member 54 may continue to be rotated until the first member 52 is positioned adjacent the body tissue. Further rotation of the second member 54 once again causes the fastener to apply a force to the suture 74 and body tissue, thereby preventing relative movement of the suture 74 with respect to the body tissue.

After the fastener 50 has been moved into position against the body tissue, the first and second members 52 and 54 are interconnected, preventing relative movement there between. As previously disclosed, a variety of techniques and devices may be used to either prevent unwinding movement between the first and second fastener members, or to prevent any relative movement between them. Some examples include mechanical locking devices, ratchets, compressive forces, crimping, plastic deformation, bonding, exposure to one or more types or intensities of energy, or the like.

Referring to FIG. 12, a medical device 100 for applying a fastener 50 of the present invention is provided. The medical device 100 includes a tip 102 and a handle 104, wherein a tubular member 103 is interposed between and connected to the handle 102 and the tip 104. The fastener 50 is supported in the tip 102 such that an actuation of a transfer mechanism extends the second fastener member 54 from the first fastener member 52 to capture the suture 74. Upon capture, a ratcheting mechanism draws the fastener 50 to the body tissue, applying a tension to the suture 74 and the body tissue to prevent relative movement between the suture 74 and the body tissue. A fixation mechanism secures the fastener 50 to the suture by exposing the fastener 50 to one or more energy sources, thereby bonding the first and second members 52 and 54 of the fastener 50 together. An ejector mechanism ejects the bonded fastener 50 from the medical device 100.

Referring to FIGS. 13 and 14, a transfer mechanism 110 includes a transfer actuator 112 and a transfer rod 114. The transfer actuator 112 is slidably positionable within the handle 104 of the medical device 100, such that the transfer mechanism 110 is actuatable from a closed position to an open position. When the transfer mechanism is in a closed position, the second fastener member 54 is positioned substantially within, and perhaps fully within, the first fastener member 52, which is disposed in the tip 102 of the medical device 100.

To actuate the transfer mechanism 110 from the closed position to the open position, the transfer actuator 112 may be slid within the handle 104 to engage a first end 116 of the transfer rod 114. First and second tube supports 113 and 115 support the transfer rod 114 through tubular member 103 (not shown). During actuation of the transfer mechanism, the transfer rod 114 is moved through the tip 102 such that a second end 118 of the transfer rod 114 extends outward from the tip 102 away from the handle 104.

The second end 118 of the transfer rod 114 engages an end portion 120 of the second fastener member 54. For example, the second end 118 of the transfer rod 114 includes a swing arm 119 for engaging a radial channel about end portion 120 of the second fastener member 54.

As the second end 118 of the transfer rod 114 is extended from the tip 102, the second fastener member 54 is drawn out from the first fastener member 52, extending from the tip 102. In such a configuration, the medical device 100 is able to receive the suture 74 within hook 72.

Upon capture of the suture 74 in the hook 72, the transfer mechanism 110 is actuated from the open position to the closed position. The transfer actuator 112 may be slid within the handle 104 of the medical device 100 such that the transfer actuator 112 disengages the first end 116 of the transfer rod 114. A transfer biasing member 122 engages the first end 116 of the transfer rod 114 and moves the rod into the closed position. This movement of the transfer rod 114 causes the second fastener member 54 and the captured suture 74 to be moved at least partly, and possibly fully, into the first fastener member 52.

A ratcheting mechanism may be used to draw the fastener 50 to the body tissue and secure the suture 74 against relative movement with respect to the body tissue. Referring to FIG. 13, a ratcheting mechanism 130 includes a ratchet trigger 132 operably connected to a gear mechanism 134. The ratchet trigger 132 is illustrated as being pivotally connected to the handle 104 of the medical device 100, although skilled artisans would appreciate that the ratchet also may be operatively connected to the device in other ways. A ratchet trigger return 136 is provided so that the ratchet may be used repeatedly. With respect to FIG. 13, the ratchet return 136 is interposed between the ratchet trigger 132 and the handle 104. The trigger return 136 in this embodiment is illustrated as a coiled or helical spring, in view of the disclosure herein it should be understood that the trigger return 136 of this embodiment also may be a pressurized gas in a deformable chamber, a foamed material, a cantilever spring, or the like.

Turning to FIG. 15, the gear mechanism 134 or the ratchet 130 may have first and second gear systems 138 and 140 mounted in the handle 104 of the medical device 100. The first gear system 138 includes a first gear 142 and a second gear 144. The first gear 142 is operably connected to the ratchet trigger 132 with a ratchet member 146, such that as the ratchet trigger 132 is moved from a first position to a second position, the ratchet member 146 causes the first gear system 138 to rotate in a first direction R1. The second gear system 140 is engagingly connected to the second gear 144 of the first gear system 138, such that as the first gear system 138 is rotated in the first direction R1 the second gear system 140 is caused to rotate in a second direction R2, opposite from the first direction R1.

When the ratchet trigger 132 is released, the trigger return 136 moves the trigger from the second position to its original, first position. The operable connection between the ratchet member 146 and the first gear 142 is such that the ratchet member 146 does not cause the first gear 142 and first gear system 138 to rotate as the ratchet trigger 132 is moved from the second position to the first position. For example, the ratchet member 146 includes a plurality of angular key members which engage the teeth of the first gear 142 as the ratchet trigger 132 is moved from the first position to the second position. As the ratchet trigger 132 is moved from second position to the first position the angular key members of the ratchet member 146 disengage the teeth of the first gear 142, permitting the ratchet trigger 132 to be moved from second position to the first position without a rotating the first gear 142. A continuous, repetitive, movement of the ratchet trigger 132 from the first to the second positions results a ratcheting rotation of the second gear system 140.

The second gear system 140 is affixed to a center rod 150 of the medical device 100. As the second gear system 140 is rotated in the second direction R2 the center rod 150 is rotated in the second direction R2. The center rod 150 traverses the medical device 100, through the handle 104 and the tubular member 103 to the tip 102, and may be supported by the first and second tube supports 113 and 115.

Referring to FIG. 16, the center rod 150 engages the second fastener member 54, such that as the center rod 150 is rotated the second fastener member 54 also is rotated in a suture winding direction. The end 152 of the center rod 150 is shaped to slidingly engage an instrument passage 154 through the second member 54 of the fastener 50. Thus, the center rod end 152 and second member may interact similarly to a key in a keyway or as a tool such as a screwdriver, hex wrench, or the like fitting in a matched receptacle.

For example, the center rod end portion 152 and instrument passage 154 each have a substantially hemi-cylindrical cross sectional area. As mentioned above, other matched shapes for the center rod end portion 152 and instrument passage 154 may be used, such as a multi-sided geometric shapes (e.g., a rectangular, triangular, square, pentagonal, hexagonal, star, cross, hemi circular shapes, etc.). Thus, it is contemplated that the cross-sectional area of the center rod end portion 152 and instrument passage 154 can be any shape that allows the engagement and rotation of these two components.

The first fastener member 52 may be positioned within the tip 102 of the medical device 100 such that the second fastener member 54 is rotatable with respect to it. In the embodiment shown in FIG. 16, the first fastener member 52 includes a pair of longitudinal channels 156 that are slidingly engagable with the tip 102. Referring to FIG. 17, the tip 102 includes a pair of longitudinal extensions 158. The first fastener member 52 may be positioned in the tip 102 such that the longitudinal extensions 158 engage the longitudinal channels 156 and prevents rotation of the first member 52 as the second member 54 is rotated.

In use, ratchet trigger 132 is repeatedly moved from the first to the second to the first position, ratcheting (rotating) the center rod 150 in the second direction R2. The rotation of the center rod 150 rotates the second fastener member 54 in a winding direction with respect to the first fastener member 50. As the second fastener member 54 is rotated, the captured suture 74 is wound about the center portion 70 of the second member 54. The second member 54 may continue to be rotated, thereby drawing the tip 102 of the medical device 100 and the first fastener member 52 to the body tissue. Further rotation causes tension to be applied to the suture 74 and forces to be applied to the body tissue. Once a desired force is reached, rotation may be stopped and the suture 74 is restrained from movement relative to the body tissue.

The fixation mechanism may be used to bond the first and second fastener members 52 and 54 together, thereby securing the fastener 50 to the suture 74 and preventing relative movement between the suture 74 and the body tissue. Referring to FIG. 18, a fixation mechanism 170 includes a force application system and an energy system. The force application system includes a cam lock 174 biased to support a dual cam member 176 in a first position. The actuation of the second trigger 172 pivots the cam lock 174 to disengage the dual cam member 176. A cam biasing member 178 translates the dual cam member 176 from the first position in the first direction T1.

Referring to FIG. 19, the dual cam member 176 includes first and second cam members 180 and 182, each having angular tips 184 and 186. The angular tips 184 and 186 are positioned proximal to an energy element 188, which at least partially surrounds the fastener 50. An energy shroud 190 is interposed between the energy element 188 and fastener 50.

As noted above, an actuation of the second trigger 172 disengages the cam lock 174, allowing the cam biasing member 178 to translate the dual cam member 176 in a first direction T1. The translation of the dual cam member 176 translates the angular tips 184 and 186 of the first and second cam members 180 and 182 onto the energy element 188. The angular configuration of the tips 184 and 186 imparts a compressive force to the energy element 188 as the first and second cam members 180 and 182 are biased in the first direction T1, compressing the energy element 188 and the energy shroud 190 about the fastener 50.

Additionally, the translation of the dual cam member 176 activates the energy system to apply energy to the fastener 50, bonding the first and second fastener members 52 and 54. The translation of the dual cam member 176 in the first direction T1 activates a first switch SW1. The first switch SW1 closes a circuit, connecting the energy element 188 to an energy source. The energy element 188 provides energy, through energy shroud 190, to the fastener 50 to bond the first and second members 52 and 54 together. At least a portion of the applied energy is converted into heat, which causes the temperature of the fastener material to be elevated to a softening or transition temperature range. When in this range, one or all parts of the fastener may be subjected to plastic deformation.

The dual cam member 176 continues to translate in the first direction T1 as the first and/or second fastener members 52 and 54 are plastically deformed by the angular tips 184 and 186. The tips may be configured to impart an increasing compressive force onto the fastener 50. The combined application of the compressive force and energy to the fastener 50 results in the bonding or interlocking of the first and second member 52 and 54. The energy element 188 is disconnected from the energy source upon achieving a desired plastic deformation of the fastener 50.

The amount of plastic deformation may be preselected in some embodiments. For example, at the pre-selected plastic deformation of the fastener 50, the dual cam member 176 will have translated to a second position and engage with a second switch SW2. The engagement of the dual cam member 176 with the second switch SW2 opens the circuit and disconnects the energy source from the energy element 188. The fastener may then cool until its temperature falls below a transition state where the material is less likely or not expected to flow.

The fixation mechanism 170 is reset by actuating the reset button 192. The reset button 192 engages the dual cam member 174, translating the dual cam member 176 from the second position to the first position. The translation of the dual cam member 176 from the second position to the first position closes the second switch “SW2” and opens the first switch “SW1.” The biased cam lock 174 reengaged the dual cam member 176, supporting the dual cam member 176 in the first position. The fixation mechanism 170 can be reset, optionally, upon the completion of the bonding of the fastener or after the ejection of the fastener 50 from the tip portion 102 of the medical device 100.

Referring to FIG. 20, an exemplary energy system 173 of the presented invention is provided. The energy element 188 includes serially connected resistors R2 and R3 and heating elements R4 and R5. The resistors and heating elements are connected to the energy source 194, wherein switched SW1 and SW2 are in line with the energy source 194 and the resistors and heating elements. The switch SW1 is initially positioned in an open position and the switch SW2 is initially positioned in a closed position. As disclosed above, the translation of the dual cam member 176 in the first direction T1 activates switch SW1, closing the circuit and connecting the energy source 194 to the heating elements. The heating elements R4 and R5 generate heat, applying heat energy to the fastener 50, plastically deforming the first and second members 52 and 54.

At the pre-selected plastic deformation of the fastener 50, the dual cam member 176 will have translated to a second position, engaging switch SW2. The engagement of the dual cam member 176 with switch SW2 opens the circuit, disconnecting the energy source 194 from the resistors R2, R3, R4, and R5.

The electric system 173 can further include an activation indicator, providing a visual or audible indication the application of energy to the fastener 50. For example, the activation indicator 196 includes LED D1 and current limiting resistor R1. An activation of switch SW1 provides energy to the LED D1 to provide a visual indication of the application of energy to the fastener 50. The engagement of switch SW2 opens the circuit and disconnects the LED from the energy source 194.

The energy source 194 can be an external energy source connected to the handle 104 of the medical device 100. Alternatively, as shown in FIG. 21, the energy source 194 is a battery pack 194 connected to the handle 104 of the medical device 100. The battery 194 can include disposable batteries, or in the alternative, rechargeable batteries.

The ejection mechanism is used to eject the bonded fastener 50 from the tip 102 of the medical device 100. Referring to FIGS. 22 and 23, an ejection mechanism 200 includes an ejector 202 slidably mounted to the handle 104 of the medical device 100. The ejector 202 is maintained in a first position by an ejector biasing member 203. The ejector 202 includes an ejector pawl 204 for engaging a ratchet bushing 206, wherein the ratchet bushing 206 is slidably mounted about the center rod 150. The ejector 202 is slid, with respect to the handle 104, from the first position to a second position, such that the ejector pawl 204 engages and translates the ratchet bushing 206 along the center rod 150 in the first direction T1. The ratchet bushing 206 is positioned in abutting relations with a first end portion 210 of an ejector tube 208, wherein the ejector tube 208 is similarly slidingly mounted about the center rod 150, traversing the handle 104 and tubular member 103 to the tip 102. The ejector tube 208, and the center rod 150, is supported through the tubular member 103 by the first and second tube supports 113 and 115. The translation of the ratchet bushing 206 translates the ejector tube 208 in the first direction T1. The translation of the ejector tube 208 moves a second end portion 212 of the ejector tube 208 into an engagement with a trailing end portion 214 of the fastener 50, sliding the fastener 50 out of the tip portion 102 of the medical device 100.

Referring now to FIG. 24, simultaneously as the ejector 202 is moved from the first position to the second position, an angular leading end portion 216 of the ejector 202 engages the first end portion 116 of the transfer rod 114. The angular configuration of leading end portion 216 of the ejector 202 results in a rotation of the transfer rod 114 as the ejector 202 is moved from the first position to second position. As the transfer rod 114 is rotated, the second end portion 118 of the transfer rod 114 releases the leading end portion 120 of the second fastener member 54. As such, the fastener 50 is ejected from the medical device 100.

The above medical device 100 is disclosed as containing a single fastener 50 in the tip portion 102. However, it is contemplated the medical device 100 can include multiple fasteners 50. Referring to FIG. 25, the ejection mechanism 200 includes an ejector 202 slidably mounted to the handle portion 102 of the medical device 100. The ejector 202 is maintained in a first position by an ejector biasing member 203. The ejector 202 includes an ejector pawl 204 for engaging an ejector bushing 220, wherein the ejector bushing 220 is slidably mounted about the center rod 150. The ejector bushing 220 includes a plurality of ratchet members 222. The ejector 202 is slid, with respect to the handle 104, from the first position to the second position, such that the ejector pawl 204 engages a ratchet member 222, translating the ejector bushing 220 along the center rod 150 in the first direction T1. The ejector bushing 220 is prevented from translating along the center rod 150 in a direction opposite to the first direction T1 by the engagement of a locking member 224 with the at least one of the ratchet members 222 of the ejector bushing 220.

The ejector bushing 220 is positioned in an abutting relation with a first end portion 210 of an ejector tube 208, wherein the ejector tube 208 is similarly slidingly mounted about the center rod 150. The translation of the ejector bushing 220 translates the ejector tube 208 in the first direction T1.

Referring to FIG. 26, the tip 102 includes a plurality of fasteners 50 slidingly positioned onto an end portion 226 of the center rod 150. The end portion 226 of the center rod 150 is shaped to slidingly engage a passage 228 through the second fastener member 54, such that a plurality of fasteners 50 are serially positionable on the end portion 226 of the center rod 150.

The translation of the ejector tube 208 moves a second end portion 212 of the ejector tube 208 into an engagement with a first fastener 230, sliding the plurality of fasteners 50 along the end portion 226 of the center rod 150, such that a loaded fastener 232 is slid out of the tip 102 of the medical device 100. Upon ejection of the loaded fastener 232, the next adjacent fastener 234 is loaded into the tip 102 of the medical device 100.

Simultaneously, as shown in FIG. 24, as the ejector 202 is moved from the first position to the second position, an angular leading end portion 216 of the ejector 202 engages the first end portion 116 of the transfer rod 114. The angular configuration of leading end portion 216 of the ejector 202 resulted in a rotation of the transfer rod 114 as the ejector 202 is moved from the first position to second position. As the transfer rod 114 is rotated, the second end portion 118 of the transfer rod 114 releases the leading end portion 120 of the second fastener member 54 of the loaded fastener 232.

Upon ejection of the loaded fastener 232, the ejector 202 is moved from the second position to the first position. The angular configuration of leading end portion 216 of the ejector 202 results in a rotation of the transfer rod 114, such that the second end portion 118 of the transfer rod 114 engages the leading end portion 120 of the second member 54 of the next adjacent fastener 234 now loaded into the tip 102 of the medical device 100. The ejector mechanism 200 can be used to serially eject and load each fastener 50 onto the tip portion of the medical device 100.

In a method of use, the medical device 100 is used to secure a fastener 50 to a suture 74, thereby preventing relative movement of the suture 74 with respect to a body tissue. The fastener 50 may be supported in the tip 102 such that an actuation of a transfer mechanism 110 extends the second member 54 from the first member 52 to capture the suture 74. Upon capture, the ratcheting mechanism 103 draws the fastener 50 to the body tissue, applying a tension to the suture 74 and the body tissue to prevent relative movement between the suture 74 and the body tissue. The fixation mechanism 170 secures the fastener 50 to the suture with the application of an energy to the fastener 50, bonding the first and second fastener members 52 and 54 together. The ejector mechanism 200 ejects the bonded fastener 50 from the medical device 100. The medical device 100 can include a single fastener 50, or optionally, include multiple fasteners 50 serially loaded within the tip portion 102. The serially loaded fasteners 50 can be systematically bonded to individual sutures 74 to prevent a relative movement of the sutures 74 with respect to the body tissue.

Referring to FIGS. 27-30, there is provided and exemplary fastener 50 for uses with the devices of FIGS. 12-26. The first member 52 of the fastener 50 includes at least one key element 240 circumferentially positioned about an end portion 242 of the outer shell 244. The key element 240 may be formed from bending a portion of the end of the shell 244 inwards toward the center of the first member 52. Alternatively, one or more key elements 240 may be formed on the interior surface of the axial passage 248. More than one key 240 element may be provided as well. For instance, the interior surface of the axial passage 248 may have a plurality of inwardly projecting key elements 240 that are angled to allow gear teeth 262 on the second member 54 to slip over them in one direction, but not in the other. A pair of longitudinal channels 156 are positioned along the outer shell 244 to slidingly engage the tip 102 of the device.

The outer shell 244 of the first member includes a pair of suture slots 250 that extend from a central location of the shell 244 toward a second end portion 246. The suture slots 250 may be generally linear so that that they travel generally in a direction parallel to a central longitudinal axis. Alternatively, one or more slots 250 may curve around a portion of the shell 244 and form a curved or arced opening.

The second member 54 of the fastener 50 includes a first and second end portion 252 and 254 having a center portion 256 disposed there between. The center portion 256 includes a hook member 258 configured for capturing a suture. The cross sectional areas of the first and second end portions 252 and 254 are dimensioned such that the second member 54 is slideably and rotatably positionable through the axial passage 248 of the first member 52. The cross sectional area of the center portion 256 is less than the cross section areas of first and second end portions 252 and 254, providing spacing between the outer shell 244 of the first member 52 and the center portion 256 of the second member 54.

An integrated gear portion 260 having a one or more angled gear teeth 262 radially positioned about the second end portions 254. Upon insertion of the second member 54 into the axial passage 248 of the first member 52, the key element 240 engages the gear portion 260 of the second member 54. The angular positioning of the gear teeth 262, the key element 240, or both permits the second member 54 to be rotated in only one direction with respect to the first member 52.

The first end portion 252 of the second member includes a radial channel 264 there about. The radial channel 264 is configures such that the second end 118 of the transfer rod 114 engages the radial channel, where the swing arm 119 of the second end 118 of the transfer rod 114 is rotated into the radial channel 264.

The second end portion 254 includes a passage 228 therein, such that the second member 54 can be slideably positioned onto an end portion 226 of the center rod 150. The end portion 226 of the center rod 150 is shaped to slidingly engage a passage 228. The passage 228 can extend partially through the second member, such that only a single fastener 50 can be positioned on the end portion 226 of the center rod 150. Alternatively, the passage 228 can extend completely through the second member 54, such that a plurality of fasteners 50 are serially positionable on the end portion 226 of the center rod 150.

Referring to FIGS. 31 and 32 an alternative second member 270 of the fastener 50 includes a first and second end portion 272 and 274 having a center portion 276 disposed there between. The center portion 276 includes a hook member 278 configured for capturing a suture. The cross sectional areas of the first and second end portions 272 and 274 are dimensioned such that the second member 270 is slideably and rotatably positionable through the axial passage 248 of the first member 52. The cross sectional area of the center portion 276 is less than the cross section areas of first and second end portions 272 and 274, providing spacing between the outer shell 244 of the first member 52 and the center portion 276 of the second member 270.

An integrated gear portion 280 having a one or more angled gear teeth 282 radially positioned about the second end portions 274. Upon insertion of the second member 70 into the axial passage 248 of the first member 52, the key element 240 engages the gear portion 280 of the second member 270. The angular positioning of the gear teeth 282, the key element 240, or both permits the second member 270 to be rotated in only one direction with respect to the first member 52.

The first end portion 272 of the second member includes a radial channel 284 there about. The radial channel 284 is configure such that the second end 118 of the transfer rod 114 engages the radial channel, where the swing arm 119 of the second end 118 of the transfer rod 114 is rotated into the radial channel 284.

The second end portion 274 includes a passage 286 therein, such that the second member 74 can be slideably positioned onto an end portion 226 of the center rod 150. The passage 286 is aligned along the central longitudinal axis of the second member 270. The end portion 226 of the center rod 150 is shaped to slidingly engage a passage 286. The passage 286 can extend partially through the second member, such that only a single fastener 50 can be positioned on the end portion 226 of the center rod 150.

It is contemplated that the fasteners of the present invention may be formed of many different materials. The fasteners of the present invention may be made of, but are not limited to, a degradable, biodegradable, bioerodible, or bioabsorbable materials.

Alternatively, the fasteners may be formed of a material which is not degradable, biodegradable, bioerodible, or bioabsorbable. For example, the fastener may be formed of poly ether-ether-keton (PEEK), such as “PEEK-OPTIMA” (trademark). Alternatively, the fasteners may be formed of a para-dimethylamino-benzenediazo sodium sulfonate, such as “Dexon” (trademark). If desired, the fastener may be formed of nylon. Additionally, the fastener may be made of a heat shrink material.

Furthermore, the fasteners may include metallic material, polymeric material, ceramic material, composite material, body tissue, synthetic tissue, hydrophilic material, expandable material, compressible material, heat bondable material, and combinations thereof. Examples of body tissue include bone, collagen, cartilage, ligaments, or tissue graft material like xenograft, allograft, and autograft. The fastener may also be made from a porous matrix or mesh of biocompatible and bioresorbable fibers acting as a scaffold to regenerate tissue.

Moreover, the fasteners disclosed herein may include therapeutic substances to promote healing. These substances could include antibiotics, hydroxypatite, anti-inflammatory agents, steroids, antibiotics, analgesic agents, chemotherapeutic agents, bone morphogenetic protein (BMP), demineralized bone matrix, collagen, growth factors, autogenetic bone marrow, progenitor cells, calcium sulfate, immuno suppressants, fibrin, osteoinductive materials, apatite compositions, germicides, viable cells, fetal cells, stem cells, enzymes, proteins, hormones, cell therapy substances, gene therapy substances, and combinations thereof. These therapeutic substances may be combined with the materials used to make the fasteners to produce a composite fastener. Alternatively, the therapeutic substances may be impregnated or coated on the fastener. Time-released therapeutic substances and drugs may also be incorporated into or coated on the surface of the fastener. The therapeutic substances may also be placed in a bioabsorbable, degradable, or biodegradable polymer layer or layers.

It is contemplated that the viable cells may be incorporated or positioned on the fastener of the present invention. The viable cells may be any desired type of viable cells. It is contemplated that the viable cells may correspond to cells which were in a damaged organ or other portion of a patient's body. More than one type of viable cell may be positioned on the fastener.

When the fastener is to be positioned in an organ, it is contemplated that the viable cells on the fastener will have characteristics associated with the characteristics of normal cells in the organ in which the support structure is to be positioned. Many organs contain cells which have different characteristics and perform different functions within the organ. It is contemplated that the viable cells on the fastener may have different characteristics corresponding to the different characteristics of cells of an organ. When the fastener is to be positioned outside of an organ, the cells positioned on the support structure may have any desired characteristic or combination of characteristics.

It is also contemplated that the viable cells can be pluripotent cells that are directed to differentiate into the desired cell type or types. One example of such cells is stem cells. The differentiation can be controlled by applying or exposing the cells to certain environmental conditions such as mechanical forces (static or dynamic), chemical stimuli (e.g. pH), and/or electromagnetic stimuli.

More than one type of cell may be positioned on the fastener. The type of cell positioned at a particular location on the fastener will be determined by the orientation of the support structure in a patient's body and by the specific type of tissue desired at a particular location in a patient's body. For example, stromal cells may be positioned at a location where foundation tissue is desired and another type of cell may be positioned at locations where it is desired to have tissue perform a special function.

In order to promote the attachment of the viable cells to the fastener, the fastener can be pretreated with an agent that promotes cell adhesion. One such agent is an organic substance based on a biofilm. A biofilm is a slimy, glue-like substance that forms when bacteria attach to surfaces exposed to water. Typically, colonies of biofilm bacteria are unwanted as they carry out a variety of detrimental reactions. However, a sterile biofilm may be used to promote initial attachment of cells to the fastener.

The sterile biofilm could be engineered to isolate the glue-like substance while eliminating the adverse properties of the bacteria. The resulting sterile glue-like substance would be used to help the cells stick to the fastener. The engineered biofilm could be added to the fastener in the laboratory that produces the fastener or just prior to the addition of the cells by the user. Alternatively, the biofilm and fastener could be combined intra-corporally.

This biofilm also could be used as an independent polysaccharide based adhesive with mild to moderate adhesion forces. The biofilm could serve as a surgical adhesion or grouting for cells, for tissue fixation (soft tissue to soft tissue, soft tissue to bone, etc.) and as a sealant.

Additionally, it is contemplated that pharmaceutical agents such as tissue inductive growth factors, additives, and/or other therapeutic agents may be provided on or incorporated into the suture fastener or retainer of the present invention. Such additives may include materials such as plasticizers, citrate esters, hexametholsebacate, antibiotics (e.g., tetracyclines, penicillins, mefronidazole, clindamycin, etc.), to prevent infection, etc., or to accomplish other desired conditions or results, including for example, tissue inductive growth factors to promote a growth of tissue. Additional additives or therapeutic agents include osteoinductive, biocidal, or anti-infection substances. Suitable osteoinductive substances include, for example, growth factors. The growth factors may be selected from the group of IGF (insulin-like growth factors), TGF (transforming growth factors), FGB (fibroblast growth factors), EGF (epidermal growth factors), BMP (bone morphogenic proteins), and PDGF (platelet-derived growth factors).

The inductive growth factors, additives, and/or other therapeutic agents may be provided on or incorporated into the fastener prior to connection to the suture. Alternatively, the inductive growth factors, additives, and/or other therapeutic agents may be provided on or incorporated after connection to the suture.

The methods and devices of the present invention may be used in conjunction with any surgical procedure of the body. The repair, reconstruction, augmentation, and securing of tissue or an implant may be performed in connection with surgery of a joint, bone, muscle, ligament, tendon, cartilage, capsule, organ, skin, nerve, vessel, or other body part. For example, tissue may be repaired, reconstructed, augmented, and secured following intervertebral disc surgery, knee surgery, hip surgery, organ transplant surgery, bariatric surgery, spinal surgery, anterior cruciate ligament (ACL) surgery, tendon-ligament surgery, rotator cuff surgery, capsule repair surgery, fractured bone surgery, pelvic fracture surgery, avulsion fragment surgery, hernia repair surgery, and surgery of an intrasubstance ligament tear, annulus fibrosis, fascia lata, flexor tendons, etc. In one particular application, an anastomosis is performed over a balloon and the methods and devices of the present invention are used to repair the vessel.

Also, tissue may be repaired after an implant has been inserted within the body. Such implant insertion procedures include, but are not limited to, partial or total knee replacement surgery, hip replacement surgery, bone fixation surgery, etc. The implant may be an organ, partial organ grafts, tissue graft material (autogenic, allogenic, xenogenic, or synthetic), collagen, a malleable implant like a sponge, mesh, bag/sac/pouch, collagen, or gelatin, or a rigid implant made of metal, polymer, composite, or ceramic. Other implants include breast implants, biodegradable plates, porcine or bovine patches, metallic fasteners, compliant bearing for medial compartment of the knee, nucleus pulposus prosthetic, stent, tissue graft, tissue scaffold, biodegradable collagen scaffold, and polymeric or other biocompatible scaffold. The scaffold may include fetal cells, stem cells, embryonal cells, enzymes, and proteins.

The suture of the present invention may be made of metallic material, non-metallic material, composite material, polymeric material, co polymeric material, or combinations thereof. The members may be degradable, biodegradable, bioabsorbable, or nonbiodegradable. For example, suture materials that can be used include, but are not limited to, polyethylene, polyester, cat gut, silk, nylon, polypropylene, linen, cotton, and copolymers of glycolic and lactic acid. They suture materials may be threadlike, monofilament, multifilament, braided, or interlaced.

The present invention further provides flexible and rigid fixation of tissue. Both rigid and flexible fixation of tissue and/or an implant provides compression to enhance the healing process of the tissue. A fractured bone, for example, requires the bone to be realigned and rigidly stabilized over a period time for proper healing. Also, bones may be flexibly secured to provide flexible stabilization between two or more bones. Soft tissue, like muscles, ligaments, tendons, skin, etc., may be flexibly or rigidly fastened for proper healing. Flexible fixation and compression of tissue may function as a temporary strut to allow motion as the tissue heals. Furthermore, joints which include hard and soft tissue may require both rigid and flexible fixation to enhance healing and stabilize the range of motion of the joint. Flexible fixation and compression of tissue near a joint may provide motion in one or more desired planes. The fasteners described herein and incorporated by reference provide for both rigid and flexible fixation.

It is contemplated that the devices and methods of the present invention be applied using minimally invasive incisions and techniques to preserve muscles, tendons, ligaments, bones, nerves, and blood vessels. A small incision(s) may be made adjacent the damaged tissue area to be repaired, and a tube, delivery catheter, sheath, cannula, or expandable cannula may be used to perform the methods of the present invention. U.S. Pat. No. 5,320,611 entitled, Expandable Cannula Having Longitudinal Wire and Method of Use, discloses cannulas for surgical and medical use expandable along their entire lengths. The cannulas are inserted through tissue when in an unexpanded condition and with a small diameter. The cannulas are then expanded radially outwardly to give a full-size instrument passage. Expansion of the cannulas occurs against the viscoelastic resistance of the surrounding tissue. The expandable cannulas do not require a full depth incision, or at most require only a needle-size entrance opening.

Also, U.S. Pat. Nos. 5,674,240; 5,961,499; and 6,338,730 disclose cannulas for surgical and medical use expandable along their entire lengths. The cannula has a pointed end portion and includes wires having cores which are enclosed by jackets. The jackets are integrally formed as one piece with a sheath of the cannula. The cannula may be expanded by inserting members or by fluid pressure. The cannula is advantageously utilized to expand a vessel, such as a blood vessel. An expandable chamber may be provided at the distal end of the cannula. The above mentioned patents are hereby incorporated by reference.

In addition to using a cannula with the methods of the present invention, an introducer may be utilized to position fasteners at a specific location within the body. U.S. Pat. No. 5,948,002 entitled, Apparatus and Method for Use in Positioning a Suture Anchor, discloses devices for controlling the placement depth of a fastener. Also, U.S. patent application Ser. No. 10/102,413 discloses methods of securing body tissue with a robotic mechanism. The above-mentioned patent and application are hereby incorporated by reference. Another introducer or cannula which may be used with the present invention is the VersaStep® System by Tyco® Healthcare.

The present invention may also be utilized with minimally invasive surgery techniques disclosed in U.S. patent application Ser. No. 10/191,751 and U.S. Pat. Nos. 6,702,821 and 6,770,078. These patent documents disclose, inter alia, apparatus and methods for minimally invasive joint replacement. The femoral, tibial, and/or patellar components of a knee. replacement may be fastened or locked to each other and to adjacent tissue using fasteners disclosed herein and incorporated by reference. Furthermore, the methods and devices of the present invention may be utilized for repairing, reconstructing, augmenting, and securing tissue or implants during and “on the way out” of a knee replacement procedure. For example, the anterior cruciate ligament and other ligaments may be repaired or reconstructed; quadriceps mechanisms and other muscles may be repaired. The patent documents mentioned above are hereby incorporated by reference.

Moreover, the devices and methods of the present invention may by used to approximate a skin incision where there may be undue tension on the skin. Fasteners may be placed on opposite sides of the incision, and a suture or cable may be placed between the fasteners. When the suture is tensioned, the skin may be pulled together and held until the skin tissue relaxes. Then, the fasteners may be unlocked, and the suture may be tensioned again to further approximate the skin incision. The locking and unlocking of the fasteners along with the tensioning of the suture may be repeated until the incision is fully closed.

Furthermore, it is contemplated that the present invention may be used with bariatric surgery, colorectal surgery, plastic surgery, gastroesophageal reflex disease (GERO) surgery, or for repairing hernias. A band, mesh, or cage of synthetic material or body tissue may be placed around an intestine or other tubular body member. The band may seal the intestine. This method may be performed over a balloon or bladder so that anastomosis is maintained. The inner diameter of the tubular body part is maintained by the balloon. The outer diameter of the body part is then closed or wrapped with a band, mesh, or patch. The inner diameter of the tubular body member may be narrowed or restricted by the band. The band may be secured to the tubular body part or surrounding tissue with the devices and methods described herein and incorporated by reference.

In addition, intramedullary fracture fixation and comminuted fracture fixation may be achieved with the devices and methods of the present invention. For example, a plate or rod may be positioned within or against the fractured bone. A fastener may be driven across the bone and locked onto the plate, rod, or another fastener.

It is further contemplated that the present invention may be used in conjunction with the devices and methods disclosed in U.S. Pat. No. 5,329,846 entitled, Tissue Press and System, and U.S. Pat. No. 5,269,785 entitled, Apparatus and Method for Tissue Removal. For example, an implant secured within the body using the present invention may include tissue harvested, configured, and implanted as described in the patents. The above-mentioned patents are hereby incorporated by reference.

Additionally, it is contemplated that the devices and methods of the present invention may be used with heat bondable materials as disclosed in U.S. Pat. No. 5,593,425 entitled, Surgical Devices Assembled Using Heat Bondable Materials. For example, the fasteners of the present invention may include heat bondable material. The material may be deformed to secure tissue or hold a suture or cable. The fasteners made of heat bondable material may be mechanically crimped, plastically crimped, or may be welded to a suture or cable with RF (Bovie devices), laser, ultrasound, electromagnet, ultraviolet, infrared, electro-shockwave, or other known energy. The welding may be performed in an aqueous, dry, or moist environment. The welding device may be disposable, sterilizable, single-use, and/or battery-operated. The above-mentioned patent is hereby incorporated by reference.

Furthermore, it is contemplated that the methods of the present invention may be performed under indirect visualization, such as endoscopic guidance, computer assisted navigation, magnetic resonance imaging, CT scan, ultrasound, fluoroscopy, X-ray, or other suitable visualization technique. The implants, fasteners, fastener assemblies, and sutures of the present invention may include a radiopaque material for enhancing indirect visualization. The use of these visualization means along with minimally invasive surgery techniques permits physicians to accurately and rapidly repair, reconstruct, augment, and secure tissue or an implant within the body. U.S. Pat. Nos. 5,329,924; 5,349,956; and 5,542,423 disclose apparatus and methods for use in medical imaging. Also, the present invention may be performed using robotics, such as haptic arms or similar apparatus. The above-mentioned patents are hereby incorporated by reference.

Moreover, the fasteners and methods of the present invention may be used for the repair and reconstruction of a tubular pathway like a blood vessel, intestine, urinary tract, esophagus, or other similar body parts. For example, a blood vessel may be intentionally severed during a surgical operation, or the blood vessel may be damaged or tom as a result of an injury. Flexible fixation of the vessel would permit the vessel to function properly and also compress and stabilize the vessel for enhanced healing. To facilitate the repair or reconstruction of a body lumen, a balloon may be inserted into the lumen and expanded so the damaged, severed, or tom portion of the vessel is positioned against the outer surface of the inflated balloon. In this configuration, the fasteners and methods described and incorporated herein may be used to approximate the damaged portion of the vessel.

Although the invention has been described primarily on a macroscopic level, it is also envisioned that the present invention can be used for microscopic applications. For example, in the repair of nerve tissue, individual cells or fibers may need to be repaired. Similarly, muscle repair may require tightening of individual muscle fibers.

All references cited herein are expressly incorporated by reference in their entirety.

It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described herein above. In addition, unless mention was made above to the contrary, it should be noted that all of the accompanying drawings are not to scale. A variety of modifications and variations are possible in light of the above teachings without departing from the scope and spirit of the invention, which is embodied by the following claims.

Claims

1. A fastener for securing a suture relative to a body tissue, comprising: a first member comprised of an outer shell defining a circumferential longitudinal passage along a central longitudinal axis having a pair of slots through the outer shell of the first member and at least two key elements positioned about the interior surface of the circumferential longitudinal passage of the first member; anda second member configured for insertion along the central longitudinal axis into the circumferential longitudinal passage of the first member and rotatable about the central longitudinal axis in a first direction with respect to the first member, the second member comprising a first end, a second end, and a center portion, the center portion having a passage transverse to the central longitudinal axis, wherein at least one of the first and second ends of the second member have a cross sectional area larger than the cross sectional area of the center portion, and the second member having a plurality of engagement members radially positioned thereon,wherein the slots of the first member are configured to align with the passage transverse to the central longitudinal axis of the second member to enable passage of a suture through the first member and the second member,wherein rotation of the second member about the longitudinal axis in the first direction causes a portion of suture to wrap around a portion of the second member between the first and second members,wherein the key elements engage the engagement members to prevent rotation of the second member with respect to the first member in a second direction opposite to the first direction, andwherein the fastener is configured to secure soft tissue to bone.
2. The fastener of claim 1, wherein the second end of the second member further comprises an instrument recess passage along the central longitudinal axis extending at least partially through the second member for engagement by a medical device.
3. The fastener according to claim 2, wherein the axial longitudinal instrument recess for engagement by the medical device extends at least partially through at least one of the center portion and first end of the second member.
4. The fastener of claim 1, wherein the outer shell of the first member includes a pair of parallel channels for engagement by the medical device to restrict rotation of the first member.
5. The fastener of claim 1, wherein the first member of the fastener is configured to expand when the portion of suture wraps around the second member between the first and second members.
6. The fastener of claim 1, wherein the plurality of engagement members radially positioned on the second member are a plurality of gear teeth.
7. A fastener for securing a suture relative to a body tissue, comprising: a first member made of a first material, wherein the material is poly ether-ether-ketone, and including first and second ends and a circumferential outer shell defining a longitudinal passage along a central longitudinal axis, the first member having a pair of slots through the outer shell, and the first member having at least two key elements positioned around the interior surface of the circumferential longitudinal passage; anda second member made of a second material, wherein the second material is different from the first material, the second member configured for insertion along the central longitudinal axis into the longitudinal passage and rotatable about the central longitudinal axis with respect to the first member, the second member including first and second ends and a center portion interposed between the first and second ends, wherein the center portion is substantially cylindrical, has a smaller cross sectional area than the cross sectional area of the second end of the second member, and has a passage transverse to the central longitudinal axis, wherein the second member has a passage along the central longitudinal axis extending at least partially through the second member, and wherein the second member has a plurality of engagement members radially positioned about the second member; anda ratchet formed from the key elements of the first member and the engagement members of the second member that permits rotation of the second member in a first direction relative to the first member but restricts rotation in a second, opposite direction,wherein the slots of the first member are configured to align with the passage transverse to the central longitudinal axis of the second member to enable passage of a suture through the first member and the second member,wherein rotation of the second member about the longitudinal axis in the first direction causes a portion of suture to wrap around a portion of the second member between the first and second members,wherein the first member of the fastener is configured to expand, andwherein the fastener is configured to secure soft tissue to bone.
8. The fastener of claim 7, wherein the passage along the central longitudinal axis extending at least partially through the second member is configured for engagement by a medical device.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Patent Application No. 60/655,141, filed Feb. 22, 2005, entitled DEVICE AND METHOD FOR SECURING BODY TISSUE, the content of which is incorporated by reference in its entirety.

US Referenced Citations (816)

Number	Name	Date	Kind
319296	Molesworth	Jun 1885	A
668878	Jensen	Feb 1901	A
668879	Miller	Feb 1901	A
702789	Gibson	Jun 1902	A
862712	Collins	Aug 1907	A
2121193	Hanicke	Dec 1932	A
2187852	Friddle	Aug 1936	A
2178840	Lorenian	Nov 1936	A
2199025	Conn	Apr 1940	A
2235419	Callahan	Mar 1941	A
2248054	Becker	Jul 1941	A
2270188	Longfellow	Jan 1942	A
2518276	Braward	Aug 1950	A
2557669	Lloyd	Jun 1951	A
2566499	Richter	Sep 1951	A
2621653	Briggs	Dec 1952	A
2725053	Bambara	Nov 1955	A
2830587	Everett	Apr 1958	A
3367809	Soloff	May 1964	A
3204635	Voss	Sep 1965	A
3347234	Voss	Oct 1967	A
3391690	Armao	Jul 1968	A
3477429	Sampson	Nov 1969	A
3513848	Winston	May 1970	A
3518993	Blake	Jul 1970	A
3577991	Wilkinson	May 1971	A
3596292	Erb	Aug 1971	A
3608539	Miller	Sep 1971	A
3625220	Engelsher	Dec 1971	A
3648705	Lary	Mar 1972	A
3653388	Tenckhoff	Apr 1972	A
3656476	Swinney	Apr 1972	A
3657056	Winston	Apr 1972	A
3678980	Gutshall	Jul 1972	A
3709218	Halloran	Jan 1973	A
3711347	Wagner	Jan 1973	A
3760808	Bleuer	Sep 1973	A
3788318	Kim	Jan 1974	A
3789852	Kim	Feb 1974	A
3802438	Wolvek	Apr 1974	A
3807394	Attenborough	Apr 1974	A
3809075	Matles	May 1974	A
3811449	Gravlee	May 1974	A
3825010	McDonald	Jul 1974	A
3833003	Taricco	Sep 1974	A
3835849	McGuire	Sep 1974	A
3842824	Neufeld	Oct 1974	A
3857396	Hardwick	Dec 1974	A
3867932	Huene	Feb 1975	A
3875652	Arnold	Apr 1975	A
3898992	Balamuth	Aug 1975	A
3918442	Nikolaev	Nov 1975	A
3968800	Vilasi	Jul 1976	A
4023559	Gaskell	May 1977	A
4064566	Fketcher	Dec 1977	A
4089071	Kalnberz et al.	May 1978	A
4156574	Boben	May 1979	A
4164794	Spector	Aug 1979	A
4171544	Hench	Oct 1979	A
4183102	Guiset	Jan 1980	A
4199864	Ashman	Apr 1980	A
4200939	Oser	May 1980	A
4210148	Stivala	Jul 1980	A
4213816	Morris	Jul 1980	A
4235233	Mouwen	Nov 1980	A
4235238	Ogiu	Nov 1980	A
4257411	Cho	Mar 1981	A
4265231	Scheller	May 1981	A
4281649	Derweduwen	Aug 1981	A
4291698	Fuchs	Sep 1981	A
4309488	Heide	Jan 1982	A
4320762	Bentov	Mar 1982	A
4351069	Ballintyn	Sep 1982	A
4364381	Sher	Dec 1982	A
4365356	Broemer	Dec 1982	A
4388921	Sutter	Jun 1983	A
4395798	McVey	Aug 1983	A
4409974	Freedland	Oct 1983	A
4414166	Charlson	Nov 1983	A
4437191	Van der Zat	Mar 1984	A
4437362	Hurst	Mar 1984	A
4444180	Schneider	Apr 1984	A
4448194	DiGiovanni	May 1984	A
4456005	Lichty	Jun 1984	A
4461281	Carson	Jul 1984	A
4493317	Klaue	Jan 1985	A
4495664	Bianquaert	Jan 1985	A
4501031	McDaniel	Feb 1985	A
4504268	Herlitze	Mar 1985	A
4506681	Mundell	Mar 1985	A
4514125	Stol	Apr 1985	A
4526173	Sheehan	Jul 1985	A
4532926	O'Holla	Aug 1985	A
4535772	Sheehan	Aug 1985	A
4547327	Bruins	Oct 1985	A
4556350	Bernhardt	Dec 1985	A
4566138	Lewis	Jan 1986	A
4589868	Dretler	May 1986	A
4597379	Kihn	Jul 1986	A
4599085	Riess	Jul 1986	A
4601893	Cardinal	Jul 1986	A
4606335	Wedeen	Aug 1986	A
4621640	Mulhollan	Nov 1986	A
4630609	Chin	Dec 1986	A
4632101	Freedland	Dec 1986	A
4645503	Lin	Feb 1987	A
4657460	Bien	Apr 1987	A
4659268	Del Mundo	Apr 1987	A
4662063	Collins	May 1987	A
4662068	Polonsky	May 1987	A
4662887	Turner	May 1987	A
4669473	Richards	Jun 1987	A
4685458	Leckrone	Aug 1987	A
4691741	Affa et al.	Sep 1987	A
4705040	Mueller	Nov 1987	A
4706670	Andersen	Nov 1987	A
4708139	Dunbar	Nov 1987	A
4713077	Small	Dec 1987	A
4716901	Jackson	Jan 1988	A
4718909	Brown	Jan 1988	A
4722948	Sanderson	Feb 1988	A
4724584	Kasai	Feb 1988	A
4738255	Goble	Apr 1988	A
4739751	Sapega	Apr 1988	A
4741330	Hayhurst	May 1988	A
4749585	Greco	Jun 1988	A
4750492	Jacobs	Jun 1988	A
4768507	Fischell	Sep 1988	A
4772286	Goble	Sep 1988	A
4776328	Frey	Oct 1988	A
4776738	Winston	Oct 1988	A
4776851	Bruchman	Oct 1988	A
4781182	Purnell	Nov 1988	A
4790303	Steffee	Dec 1988	A
4792336	Hiavacek	Dec 1988	A
4817591	Klause	Apr 1989	A
4822224	Carl	Apr 1989	A
4823794	Pierce	Apr 1989	A
4832025	Coates	May 1989	A
4832026	Jones	May 1989	A
4834752	Van Kampen	May 1989	A
4841960	Garner	Jun 1989	A
4843112	Gerhart	Jun 1989	A
4846812	Walker	Jul 1989	A
4862882	Venturi	Sep 1989	A
4869242	Galluzzo	Sep 1989	A
4870957	Goble	Oct 1989	A
4883048	Purnell	Nov 1989	A
4890612	Kensey	Jan 1990	A
4895148	Bays	Jan 1990	A
4898156	Gattuma	Feb 1990	A
4899729	Gill	Feb 1990	A
4899744	Fujitsuka	Feb 1990	A
4901721	Hakki	Feb 1990	A
4921479	Grayzel	May 1990	A
4922897	Sapega	May 1990	A
4924866	Yoon	May 1990	A
4932960	Green	Jun 1990	A
4935026	Drews	Jun 1990	A
4935028	Drews	Jun 1990	A
4945625	Winston	Aug 1990	A
4946468	Libarid	Aug 1990	A
4954126	Wallsten	Sep 1990	A
4955910	Bolesky	Sep 1990	A
4957498	Caspari	Sep 1990	A
4963151	Ducheyne	Oct 1990	A
4966583	Debbas	Oct 1990	A
4968315	Gattuma	Nov 1990	A
4969888	Scholten	Nov 1990	A
4969892	Burton	Nov 1990	A
4990161	Kampner	Feb 1991	A
4992897	Deroux-Dauphin	Feb 1991	A
4994071	MacGregtor	Feb 1991	A
4997445	Hodorek	Mar 1991	A
4998539	Delanti	Mar 1991	A
5002550	Li	Mar 1991	A
5002563	Pyka	Mar 1991	A
5009652	Morgan	Apr 1991	A
5009663	Broome	Apr 1991	A
5009664	Sievers	Apr 1991	A
5013316	Goble	May 1991	A
5019090	Pinchuk	May 1991	A
5021059	Kensey	Jun 1991	A
5035713	Friis	Jul 1991	A
5037404	Golds	Aug 1991	A
5037422	Hayhurst	Aug 1991	A
5041093	Chu	Aug 1991	A
5041114	Chapman	Aug 1991	A
5041129	Hayhurst	Aug 1991	A
5046513	Gattuma	Sep 1991	A
5047055	Bao	Sep 1991	A
5051049	Wills	Sep 1991	A
5053046	Janese	Oct 1991	A
5053047	Kuslich	Oct 1991	A
5059193	Kuslich	Oct 1991	A
5059206	Winters	Oct 1991	A
5061274	Kensey	Oct 1991	A
5061286	Lyle	Oct 1991	A
5069674	Fearnot	Dec 1991	A
5078731	Hayhurst	Jan 1992	A
5078744	Chvapil	Jan 1992	A
5078745	Rhenter	Jan 1992	A
5084050	Draenert	Jan 1992	A
5084051	Tormala	Jan 1992	A
5085660	Lin	Feb 1992	A
5085661	Moss	Feb 1992	A
5098433	Freedland	Mar 1992	A
5098434	Serbousek	Mar 1992	A
5098436	Ferrante	Mar 1992	A
5100405	McLaren	Mar 1992	A
5100417	Cerier	Mar 1992	A
5102417	Palmaz	Apr 1992	A
5102421	Anspach	Apr 1992	A
5108399	Eitenmuller	Apr 1992	A
5120175	Arbegast	Jun 1992	A
5123520	Schmid	Jun 1992	A
5123914	Cope	Jun 1992	A
5123941	Lauren	Jun 1992	A
5127412	Cosmetto	Jul 1992	A
5133732	Wiktor	Jul 1992	A
RE34021	Mueller	Aug 1992	E
5141520	Goble	Aug 1992	A
5147362	Goble	Sep 1992	A
5154720	Trott	Oct 1992	A
5156613	Sawyer	Oct 1992	A
5156616	Meadows	Oct 1992	A
5158566	Pianetti	Oct 1992	A
5158934	Ammann	Oct 1992	A
5163960	Bonutti	Nov 1992	A
5171251	Bregen	Dec 1992	A
5176682	Chow	Jan 1993	A
5179964	Cook	Jan 1993	A
5180388	DiCarlo	Jan 1993	A
5183464	Dubrul	Feb 1993	A
5192287	Fournier	Mar 1993	A
5192326	Bao	Mar 1993	A
5197166	Meier	Mar 1993	A
5197971	Bonutti	Mar 1993	A
5203784	Ross	Apr 1993	A
5203787	Noblitt	Apr 1993	A
5208950	Merritt	May 1993	A
5209776	Bass	May 1993	A
5217493	Raad	Jun 1993	A
5219359	McQuilkin	Jun 1993	A
5226899	Lee	Jul 1993	A
5234006	Eaton	Aug 1993	A
5234425	Fogarty	Aug 1993	A
5236438	Wilk	Aug 1993	A
5236445	Hayhurst	Aug 1993	A
5242902	Murphy	Sep 1993	A
5254113	Wilk	Oct 1993	A
5258007	Spetzler	Nov 1993	A
5258015	Li	Nov 1993	A
5258016	DiPoto	Nov 1993	A
5266325	Kuzma	Nov 1993	A
5269783	Sander	Dec 1993	A
5269785	Bonutti	Dec 1993	A
5269809	Hayhurst	Dec 1993	A
5281235	Habermeyer	Jan 1994	A
5282832	Toso	Feb 1994	A
5290281	Tschakaloff	Mar 1994	A
5304119	Balaban	Apr 1994	A
5306280	Bregen	Apr 1994	A
5306301	Graf	Apr 1994	A
5315741	Dubberke	May 1994	A
5318570	Hood	Jun 1994	A
5318588	Horzewski	Jun 1994	A
5320611	Bonutti	Jun 1994	A
5324308	Pierce	Jun 1994	A
5328480	Melker	Jul 1994	A
5329846	Bonutti	Jul 1994	A
5329924	Bonutti	Jul 1994	A
5330468	Burkhart	Jul 1994	A
5330476	Hiot	Jul 1994	A
5330486	Wilkinson	Jul 1994	A
5336231	Adair	Aug 1994	A
5336240	Metzler	Aug 1994	A
5339799	Kami	Aug 1994	A
5349956	Bonutti	Sep 1994	A
5352229	Goble	Oct 1994	A
5354298	Lee	Oct 1994	A
5354302	Ko	Oct 1994	A
5366480	Corriveaau	Nov 1994	A
5370646	Reese	Dec 1994	A
5370660	Weinstein	Dec 1994	A
5372146	Branch	Dec 1994	A
5374235	Ahrens	Dec 1994	A
5376126	Lin	Dec 1994	A
5382254	McGarry	Jan 1995	A
5383883	Wilk	Jan 1995	A
5383905	Golds	Jan 1995	A
5391173	Wilk	Feb 1995	A
5395308	Fox	Mar 1995	A
5397311	Walker	Mar 1995	A
5400805	Warren	Mar 1995	A
5403312	Yates	Apr 1995	A
5403348	Bonutti	Apr 1995	A
5405359	Pierce	Apr 1995	A
5411523	Goble	May 1995	A
5413585	Pagedas	May 1995	A
5417691	Hayhurst	May 1995	A
5417701	Holmes	May 1995	A
5417712	Whittaker	May 1995	A
5423796	Skikhman	Jun 1995	A
5431670	Holmes	Jul 1995	A
5439470	Li	Aug 1995	A
5441538	Bonutti	Aug 1995	A
5443512	Parr	Aug 1995	A
5447503	Miller	Sep 1995	A
5449372	Schmaltz	Sep 1995	A
5449382	Dayton	Sep 1995	A
5451235	Lock	Sep 1995	A
5453090	Martinez	Sep 1995	A
5456722	McLeod	Oct 1995	A
5458653	Davison	Oct 1995	A
5462561	Voda	Oct 1995	A
5464424	O'Donnell	Nov 1995	A
5464426	Bonutti	Nov 1995	A
5464427	Curtis	Nov 1995	A
5470337	Moss	Nov 1995	A
5472444	Huebner	Dec 1995	A
5474554	Ku	Dec 1995	A
5478351	Meade	Dec 1995	A
5478353	Yoon	Dec 1995	A
5480403	Lee	Jan 1996	A
5486197	Le	Jan 1996	A
5487844	Fujita	Jan 1996	A
5488958	Topel	Feb 1996	A
RE36974	Bonutti	Mar 1996	E
5496292	Burnham	Mar 1996	A
5496335	Thomason	Mar 1996	A
5496348	Bonutti	Mar 1996	A
5499382	Nusinov et al.	Mar 1996	A
5500000	Feagin	Mar 1996	A
5501700	Hirata	Mar 1996	A
5504977	Weppner	Apr 1996	A
5505735	Li	Apr 1996	A
5507754	Green	Apr 1996	A
5522844	Johnson	Jun 1996	A
5522845	Wenstrom	Jun 1996	A
5522846	Bonutti	Jun 1996	A
5527341	Gogolewski	Jun 1996	A
5527342	Pietrzak	Jun 1996	A
5527343	Bonutti	Jun 1996	A
5529075	Clark	Jun 1996	A
5531759	Kensey	Jul 1996	A
5534012	Bonutti	Jul 1996	A
5534028	Bao	Jul 1996	A
5540718	Bartlett	Jul 1996	A
5542423	Bonutti	Aug 1996	A
5545178	Kensey	Aug 1996	A
5545180	Le	Aug 1996	A
5545206	Carson	Aug 1996	A
5549630	Bonutti	Aug 1996	A
5549631	Bonutti	Aug 1996	A
5556402	Xu	Sep 1996	A
5569252	Justin	Oct 1996	A
5569305	Bonutti	Oct 1996	A
5569306	Thal	Oct 1996	A
5573517	Bonutti	Nov 1996	A
5573538	Laboureau	Nov 1996	A
5573542	Stevens	Nov 1996	A
5575801	Habermeyer	Nov 1996	A
5580344	Hasson	Dec 1996	A
5584835	Greenfield	Dec 1996	A
5584860	Goble	Dec 1996	A
5584862	Bonutti	Dec 1996	A
5591206	Moufarrege	Jan 1997	A
5593422	Muijs Van De Moer	Jan 1997	A
5593425	Bonutti	Jan 1997	A
5593625	Riebel	Jan 1997	A
5601557	Hayhurst	Feb 1997	A
5601558	Torrie	Feb 1997	A
5601595	Schwartz	Feb 1997	A
5607427	Tschakaloff	Mar 1997	A
5609595	Pennig	Mar 1997	A
5618314	Harwin	Apr 1997	A
5620461	Muijs Van De Moer	Apr 1997	A
5626612	Bartlett	May 1997	A
5626614	Hart	May 1997	A
5626718	Philippe	May 1997	A
5630824	Hart	May 1997	A
5634926	Jobe	Jun 1997	A
5628751	Sander	Jul 1997	A
5643274	Sander	Jul 1997	A
5643293	Kogasaka	Jul 1997	A
5643295	Yoon	Jul 1997	A
5643321	McDevitt	Jul 1997	A
5645553	Kolesa	Jul 1997	A
5645597	Krapiva	Jul 1997	A
5645599	Samani	Jul 1997	A
5649955	Hashimoto	Jul 1997	A
5649963	McDevitt	Jul 1997	A
5651377	O'Donnell	Jul 1997	A
5658313	Thal	Aug 1997	A
5660225	Saffran	Aug 1997	A
5662658	Wenstrom	Sep 1997	A
5665089	Dall	Sep 1997	A
5665109	Yoon	Sep 1997	A
5667513	Torrie	Sep 1997	A
5669917	Saier	Sep 1997	A
5674240	Bonutti	Oct 1997	A
5681310	Yuan	Oct 1997	A
5681333	Burkhart	Oct 1997	A
5681351	Jamiolkowski	Oct 1997	A
5681352	Clancy	Oct 1997	A
5685820	Riek	Nov 1997	A
5688283	Knapp	Nov 1997	A
5690654	Ovil	Nov 1997	A
5690655	Hart	Nov 1997	A
5690676	DiPoto	Nov 1997	A
5691741	Kerigan et al.	Nov 1997	A
5693055	Zahiri	Dec 1997	A
5697950	Fucci	Dec 1997	A
5702397	Gonie	Dec 1997	A
5702462	Oberlander	Dec 1997	A
5707395	Li	Jan 1998	A
5713903	Sander	Feb 1998	A
5713921	Bonutti	Feb 1998	A
5718717	Bonutti	Feb 1998	A
5720747	Burke	Feb 1998	A
5725541	Anspach	Mar 1998	A
5725556	Moser	Mar 1998	A
5725582	Bevan	Mar 1998	A
5730747	Ek	Mar 1998	A
5733306	Bonutti	Mar 1998	A
5720753	Sander	Apr 1998	A
5735875	Bonutti	Apr 1998	A
5735877	Pagedas	Apr 1998	A
5735899	Schwartz	Apr 1998	A
5741282	Anspach	Apr 1998	A
5752952	Adamson	May 1998	A
5752974	Rhee	May 1998	A
5755809	Cohen	May 1998	A
5762458	Wang	Jun 1998	A
5766221	Benderev	Jun 1998	A
5769894	Ferragamo	Jun 1998	A
5772672	Toy	Jun 1998	A
5776151	Chan	Jul 1998	A
5779706	Tschakaloff	Jul 1998	A
5782862	Bonutti	Jul 1998	A
5785713	Jobe	Jul 1998	A
5792096	Rentmeester	Aug 1998	A
5797931	Bito	Aug 1998	A
5800537	Bell	Sep 1998	A
5807403	Beyar	Sep 1998	A
5810849	Kontos	Sep 1998	A
5810853	Yoon	Sep 1998	A
5810884	Kim	Sep 1998	A
5814072	Bonutti	Sep 1998	A
5814073	Bonutti	Sep 1998	A
5817107	Schaller	Oct 1998	A
5823994	Sharkey	Oct 1998	A
5824009	Fukuda	Oct 1998	A
5830125	Scribner	Nov 1998	A
5836897	Sakural	Nov 1998	A
5839899	Robinson	Nov 1998	A
5843178	Vanney	Dec 1998	A
5845645	Bonutti	Dec 1998	A
5851185	Berns	Dec 1998	A
5865834	McGuire	Feb 1999	A
5866634	Tokushige	Feb 1999	A
5868749	Reed	Feb 1999	A
5874235	Chan	Feb 1999	A
5879372	Bartlett	Mar 1999	A
5890928	Fuchs et al.	Apr 1999	A
5891166	Schervinsky	Apr 1999	A
5891168	Thal	Apr 1999	A
5893880	Egan	Apr 1999	A
5897574	Bonutti	Apr 1999	A
5899911	Carter	May 1999	A
5899921	Caspari	May 1999	A
5906579	Vander Salm	May 1999	A
5906625	Bito	May 1999	A
5908429	Yoon	Jun 1999	A
5911721	Nicholson	Jun 1999	A
5918604	Whelan	Jul 1999	A
5919193	Slavitt	Jul 1999	A
5919194	Anderson	Jul 1999	A
5919208	Valenti	Jul 1999	A
5919215	Wiklund	Jul 1999	A
5921986	Bonutti	Jul 1999	A
5925064	Meyers	Jul 1999	A
5928244	Tovey	Jul 1999	A
5928267	Bonutti	Jul 1999	A
5931838	Vito	Aug 1999	A
5931869	Boucher	Aug 1999	A
5940942	Fong	Aug 1999	A
5941900	Bonutti	Aug 1999	A
5941901	Egan	Aug 1999	A
5945002	Bonutti	Sep 1999	A
5947982	Duran	Sep 1999	A
5948000	Larsen	Sep 1999	A
5948001	Larsen	Sep 1999	A
5948002	Bonutti	Sep 1999	A
5951590	Goldfarb	Sep 1999	A
5957953	DiPoto	Sep 1999	A
5961499	Bonutti	Oct 1999	A
5961521	Roger	Oct 1999	A
5961554	Janson	Oct 1999	A
5964765	Fenton	Oct 1999	A
5964769	Wagner	Oct 1999	A
5968046	Castleman	Oct 1999	A
5968047	Reed	Oct 1999	A
5980520	Vancaillie	Nov 1999	A
5980559	Bonutti	Nov 1999	A
5984929	Bashiri	Nov 1999	A
5989282	Bonutti	Nov 1999	A
5993458	Vaitekunas	Nov 1999	A
5993477	Vaitekunas	Nov 1999	A
6007567	Bonutti	Dec 1999	A
6007580	Lehto	Dec 1999	A
6010525	Bonutti	Jan 2000	A
6010526	Sandstrom	Jan 2000	A
6017321	Boone	Jan 2000	A
6033429	Magovern	Mar 2000	A
6033430	Bonutti	Mar 2000	A
6045551	Bonutti	Apr 2000	A
6050998	Fletcher	Apr 2000	A
6056751	Fenton	May 2000	A
6056772	Bonutti	May 2000	A
6056773	Bonutti	May 2000	A
6059797	Mears	May 2000	A
6059817	Bonutti	May 2000	A
6059827	Fenton	May 2000	A
6063095	Wang	May 2000	A
6066151	Miyawaki	May 2000	A
6066160	Colvin	May 2000	A
6066166	Bischoff	May 2000	A
6068637	Popov	May 2000	A
6077277	Mollenauer	Jun 2000	A
6077292	Bonutti	Jun 2000	A
6080161	Eaves	Jun 2000	A
6083522	Chu	Jul 2000	A
6086593	Bonutti	Jul 2000	A
6086608	Ek	Jul 2000	A
6090072	Kratoska	Jul 2000	A
6099531	Bonutti	Aug 2000	A
6099537	Sugai	Aug 2000	A
6099550	Yoon	Aug 2000	A
6099552	Adams	Aug 2000	A
6102850	Wang	Aug 2000	A
6106545	Egan	Aug 2000	A
6117160	Bonutti	Sep 2000	A
6120525	Westcott	Sep 2000	A
6120536	Ding	Sep 2000	A
6125574	Ganaja	Oct 2000	A
6126677	Ganaja	Oct 2000	A
6139320	Hahn	Oct 2000	A
6149669	Li	Nov 2000	A
6152949	Bonutti	Nov 2000	A
6155756	Mericle	Dec 2000	A
6159224	Yoon	Dec 2000	A
6159234	Bonutti	Dec 2000	A
6171307	Orlich	Jan 2001	B1
6174324	Egan	Jan 2001	B1
6179840	Bowman	Jan 2001	B1
6179850	Goradia	Jan 2001	B1
6187008	Hamman	Feb 2001	B1
6190400	Van De Moer	Feb 2001	B1
6190401	Green	Feb 2001	B1
6200322	Branch	Mar 2001	B1
6217591	Egan	Apr 2001	B1
6224593	Ryan	May 2001	B1
6224630	Bao	May 2001	B1
6228086	Wahl	May 2001	B1
6231592	Bonutti	May 2001	B1
6238395	Bonutti	May 2001	B1
6238396	Bonutti	May 2001	B1
6258091	Sevrain	Jul 2001	B1
6264675	Brotz	Jul 2001	B1
6267761	Ryan	Jul 2001	B1
6273717	Hahn	Aug 2001	B1
6280474	Cassidy	Aug 2001	B1
6286746	Egan	Sep 2001	B1
6287325	Bonutti	Sep 2001	B1
6293961	Schwartz	Sep 2001	B2
6306159	Schwartz	Oct 2001	B1
6309405	Bonutti	Oct 2001	B1
6312448	Bonutti	Nov 2001	B1
6338730	Bonutti	Jan 2002	B1
6340365	Dittrich	Jan 2002	B2
6348056	Bates	Feb 2002	B1
6358271	Egan	Mar 2002	B1
6364897	Bonutti	Apr 2002	B1
6368325	McKinley	Apr 2002	B1
6368343	Bonutti	Apr 2002	B1
6371957	Amrein	Apr 2002	B1
6409742	Fulton	Jun 2002	B1
6409743	Fenton	Jun 2002	B1
6425919	Lambrecht	Jul 2002	B1
6428562	Bonutti	Aug 2002	B2
6432115	Mollenauer	Aug 2002	B1
6447516	Bonutti	Sep 2002	B1
6450985	Schoelling	Sep 2002	B1
6461360	Adam	Oct 2002	B1
6468293	Bonutti	Oct 2002	B2
6475230	Bonutti	Nov 2002	B1
6488196	Fenton	Dec 2002	B1
6500195	Bonutti	Dec 2002	B2
6503259	Huxel	Jan 2003	B2
6530933	Yeung	Mar 2003	B1
6535764	Imran	Mar 2003	B2
6544267	Cole	Apr 2003	B1
6544852	Oberlander	Apr 2003	B1
6545390	Hahn	Apr 2003	B1
6547792	Tsuji	Apr 2003	B1
6551304	Whalen	Apr 2003	B1
6527774	Lieberman	May 2003	B2
6558390	Cragg	May 2003	B2
6568313	Fukui	May 2003	B2
6569187	Bonutti	May 2003	B1
6572635	Bonutti	Jun 2003	B1
D477776	Pontaoe	Jul 2003	S
6557426	Reinermann	Jul 2003	B2
6585750	Bonutti	Jul 2003	B2
6592609	Bonutti	Jul 2003	B1
6594517	Nevo	Jul 2003	B1
6585764	Wright	Aug 2003	B2
6605090	Trieu	Aug 2003	B1
6610080	Morgan	Aug 2003	B2
6618910	Pontaoe	Sep 2003	B1
6623487	Goshert	Sep 2003	B1
6626944	Taylor	Sep 2003	B1
6623486	Weaver	Oct 2003	B1
6632245	Kim	Oct 2003	B2
6635073	Bonutti	Oct 2003	B2
6638279	Bonutti	Oct 2003	B2
6641592	Sauer	Nov 2003	B1
6645227	Fallin	Nov 2003	B2
6666877	Morgan	Dec 2003	B2
6669705	Westhaver	Dec 2003	B2
6679888	Green	Jan 2004	B2
6685750	Plos	Feb 2004	B1
6699240	Fracischelli	Mar 2004	B2
6702821	Bonutti	Mar 2004	B2
6705179	Mohtasham	Mar 2004	B1
6709457	Otte	Mar 2004	B1
6719765	Bonutti	Apr 2004	B2
6719797	Ferree	Apr 2004	B1
6722552	Fenton	Apr 2004	B2
6733531	Trieu	May 2004	B1
6764514	Li	Jul 2004	B1
6770078	Bonutti	Aug 2004	B2
6780198	Gregoire	Aug 2004	B1
6786989	Torriani	Sep 2004	B2
6796003	Marvel	Sep 2004	B1
6818010	Eichhorn	Nov 2004	B2
6823871	Schmieding	Nov 2004	B2
6860885	Bonutti	Mar 2005	B2
6878167	Ferree	Apr 2005	B2
6893434	Fenton	May 2005	B2
6899722	Bonutti	May 2005	B2
6890334	Brace	Jul 2005	B2
6913666	Aeschlimann	Jul 2005	B1
6916321	TenHuisen	Jul 2005	B2
6921264	Mayer	Jul 2005	B2
6923824	Morgan	Aug 2005	B2
6932835	Bonutti	Aug 2005	B2
6942684	Bonutti	Sep 2005	B2
6944111	Nakamura	Sep 2005	B2
6955540	Mayer	Oct 2005	B2
6955683	Bonutti	Oct 2005	B2
6958077	Suddaby	Oct 2005	B2
6981983	Rosenblatt	Jan 2006	B1
6997940	Bonutti	Feb 2006	B2
7001411	Dean	Feb 2006	B1
7004959	Bonutti	Feb 2006	B2
7008226	Mayer	Mar 2006	B2
7018380	Cole	Mar 2006	B2
7033379	Peterson	Apr 2006	B2
7048755	Bonutti	May 2006	B2
7066960	Dickman	Jun 2006	B1
7087073	Bonutti	Aug 2006	B2
7090111	Egan	Aug 2006	B2
7094251	Bonutti	Aug 2006	B2
7104996	Bonutti	Sep 2006	B2
7128763	Blatt	Oct 2006	B1
7147652	Bonutti	Dec 2006	B2
7160405	Aesclimann	Jan 2007	B2
7179259	Gibbs	Feb 2007	B1
7192448	Ferree	Mar 2007	B2
7217279	Reese	May 2007	B2
7217290	Bonutti	May 2007	B2
7241297	Shaolian	Jul 2007	B2
7250051	Francischelli	Jul 2007	B2
7252685	Bindseil	Aug 2007	B2
7273497	Ferree	Sep 2007	B2
7329263	Bonutti	Feb 2008	B2
7335205	Aeschlimann	Feb 2008	B2
7429266	Bonutti	Sep 2008	B2
7445634	Trieu	Nov 2008	B2
7481825	Bonutti	Jan 2009	B2
7481831	Bonutti	Jan 2009	B2
7510895	Rateman	Mar 2009	B2
7854750	Bonutti	Dec 2010	B2
7879072	Bonutti	Feb 2011	B2
7891691	Bearey	Feb 2011	B2
20010002440	Bonutti	May 2001	A1
20010009250	Herman	Jul 2001	A1
20010041916	Bonutti	Nov 2001	A1
20020016593	Hearn	Feb 2002	A1
20020016633	Lin	Feb 2002	A1
20020019649	Sikora	Feb 2002	A1
20020026244	Trieu	Feb 2002	A1
20020029083	Zucherman	Mar 2002	A1
20020029084	Paul	Mar 2002	A1
20020045902	Bonutti	Apr 2002	A1
20020062153	Paul	May 2002	A1
20020103495	Cole	Aug 2002	A1
20020123750	Eisermann	Sep 2002	A1
20020183762	Anderson	Dec 2002	A1
20020188301	Dallara	Dec 2002	A1
20030039196	Nakamura	Feb 2003	A1
20030040758	Wang	Feb 2003	A1
20030065361	Dreyfuss	Apr 2003	A1
20030105474	Bonutti	Jun 2003	A1
20030118518	Hahn	Jun 2003	A1
20030158582	Bonutti	Aug 2003	A1
20030167072	Oberlander	Aug 2003	A1
20030181800	Bonutti	Sep 2003	A1
20030195530	Thill	Oct 2003	A1
20030195565	Bonutti	Oct 2003	A1
20030204204	Bonutti	Oct 2003	A1
20030216742	Wetzler	Nov 2003	A1
20030225438	Bonutti	Dec 2003	A1
20030229361	Jackson	Dec 2003	A1
20040010287	Bonutti	Jan 2004	A1
20040030341	Aeschlimann	Feb 2004	A1
20040034357	Beane	Feb 2004	A1
20040044366	Bonutti	Mar 2004	A1
20040097939	Bonutti	May 2004	A1
20040098050	Foerster	May 2004	A1
20040138703	Alleyne	Jul 2004	A1
20040143334	Ferree	Jul 2004	A1
20040147958	Lam	Jul 2004	A1
20040167548	Bonutti	Aug 2004	A1
20040193187	Boehringer	Sep 2004	A1
20040220616	Bonutti	Nov 2004	A1
20040225325	Bonutti	Nov 2004	A1
20040230223	Bonutti	Nov 2004	A1
20040236374	Bonutti	Nov 2004	A1
20050033366	Cole	Feb 2005	A1
20050038514	Helm	Feb 2005	A1
20050043796	Grant	Feb 2005	A1
20050071012	Serhan	Mar 2005	A1
20050090827	Gedebou	Apr 2005	A1
20050096699	Wixey	May 2005	A1
20050113928	Cragg	May 2005	A1
20050126680	Aeschlimann	Jun 2005	A1
20050143826	Zucherman	Jun 2005	A1
20050149024	Ferrante	Jul 2005	A1
20050149029	Bonutti	Jul 2005	A1
20050203521	Bonutti	Sep 2005	A1
20050216059	Bonutti	Sep 2005	A1
20050216087	Zaucherman	Sep 2005	A1
20050222620	Bonutti	Oct 2005	A1
20050240190	Gall	Oct 2005	A1
20050240227	Bonutti	Oct 2005	A1
20050246021	Ringeisen	Nov 2005	A1
20050261684	Shaolian	Nov 2005	A1
20050267481	Carl	Dec 2005	A1
20050267533	Gertner	Dec 2005	A1
20050267534	Bonutti	Dec 2005	A1
20060009855	Goble	Jan 2006	A1
20060015101	Warburton	Jan 2006	A1
20060015108	Bonutti	Jan 2006	A1
20060024357	Carpenter	Feb 2006	A1
20060026244	Watson	Feb 2006	A1
20060064095	Senn	Mar 2006	A1
20060089646	Bonutti	Apr 2006	A1
20060122600	Cole	Jun 2006	A1
20060122704	Vresilovic	Jun 2006	A1
20060142799	Bonutti	Jun 2006	A1
20060167495	Bonutti	Jul 2006	A1
20060265009	Bonutti	Jul 2006	A1
20060265011	Bonutti	Jul 2006	A1
20060200199	Bonutti	Sep 2006	A1
20060212073	Bonutti	Sep 2006	A1
20060217765	Bonutti	Sep 2006	A1
20060229623	Bonutti	Oct 2006	A1
20060235470	Bonutti	Oct 2006	A1
20060241695	Bonutti	Oct 2006	A1
20060264950	Nelson	Nov 2006	A1
20070032825	Bonutti	Feb 2007	A1
20070088362	Bonutti	Apr 2007	A1
20070118129	Fraser	May 2007	A1
20070123878	Shaver	May 2007	A1
20070198555	Friedman	Aug 2007	A1
20070265561	Yeung	Nov 2007	A1
20070270833	Bonutti	Nov 2007	A1
20080021474	Bonutti	Jan 2008	A1
20080039845	Bonutti	Feb 2008	A1
20080039873	Bonutti	Feb 2008	A1
20080046090	Paul	Feb 2008	A1
20080195145	Bonutti	Feb 2008	A1
20080097448	Binder	Apr 2008	A1
20080108897	Bonutti	May 2008	A1
20080108916	Bonutti	May 2008	A1
20080114399	Bonutti	May 2008	A1
20080132950	Lange	Jun 2008	A1
20080140116	Bonutti	Jun 2008	A1
20080140117	Bonutti	Jun 2008	A1
20080269753	Cannestra	Oct 2008	A1
20080269808	Gall	Oct 2008	A1
20090024161	Bonutti	Jan 2009	A1
20090138014	Bonutti	Jan 2009	A1
20090093684	Schorer	Apr 2009	A1
20090194969	Bearey	Jun 2009	A1
20100211120	Bonutti	Feb 2010	A1
20110060375	Bonutti	Mar 2011	A1
20110295253	Bonutti	Dec 2011	A1
20120165841	Bonutti	Jun 2012	A1
20120191140	Bonutti	Jul 2012	A1
20120197316	Mayer	Aug 2012	A1
20120215233	Bonutti	Aug 2012	A1

Foreign Referenced Citations (40)

Number	Date	Country
2641580	Aug 2007	CA
2680827	Sep 2008	CA
2698057	Mar 2009	CA
1903316	Oct 1964	DE
1903016	Aug 1970	DE
3517204	Nov 1986	DE
3722538	Jan 1989	DE
9002844	Jan 1991	DE
784454	May 1996	EP
773004	May 1997	EP
1614525	Jan 2006	EP
1988837	Aug 2007	EP
2134294	Dec 2009	EP
2197371	Jun 2010	EP
2717368	Mar 1994	FR
2696338	Apr 1994	FR
2728779	Jan 1995	FR
2736257	Jul 1995	FR
2750031	Jun 1996	FR
2771621	Nov 1997	FR
2785171	Oct 1998	FR
2093701	Sep 1982	GB
2306110	Apr 1997	GB
8140982	Jun 1996	JP
184396	Jul 1966	SU
199112779	Sep 1991	WO
199323094	Nov 1993	WO
1994008642	Apr 1994	WO
199516398	Jun 1995	WO
199531941	Nov 1995	WO
1996014802	May 1996	WO
1997012779	Apr 1997	WO
199749347	Dec 1997	WO
1998011838	Mar 1998	WO
1998026720	Jun 1998	WO
2002053011	Jul 2002	WO
2007092869	Aug 2007	WO
2008116203	Sep 2008	WO
2009029908	Mar 2009	WO
2010099222	Feb 2010	WO

Non-Patent Literature Citations (72)

Entry
The Search for the Holy Grail: A Centrury of Anterior Cruciate Ligament Reconstruction, R. John Naranja, American Journal of Orthopedics, Nov. 1997.
Femoral Bone Plug Recession in Endoscope Anterior Cruciate Ligament Reconstruction, David E. Taylor, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Aug. 1996.
Meniscus Replacement with Bone Anchors: A Surgical Technique, Arthroscopy: Walter R. Shelton, The Journal of Arthroscopic and Related Surgery, 1994.
Problem Solving Report Question No. 1014984.066, Ultrasonic Welding, (c) 1999.
Dukane, Guide to Ultrasound Plastic Assembly, Ultrasonic Division Publication, (c) 1995.
Branson, Polymers: Characteristics and Compatibility for Ultrasonic Assembly, Applied Technologies Group, Publication unknown.
Enabling Local Drug Delivery-Implant Device Combination Therapies, Surmodics, Inc., (c) 2003.
Stent Based Delivery of Sirolimus Reduces Neointimal Formation in a Porcine Coronary Model, Takeshi Suzuki, American Heart Association, Inc. (c) 2001.
Why Tie a Knot When You Can Use Y-Knot?, Innovasive Devices Inc., (c) 1998.
Ask Oxford, compact Oxford English dictionary: projection, Mar. 30, 2009.
Ask Oxford, compact Oxford English dictionary: slit, Mar. 30, 2009.
Textured Surface Technology, Branson Technolog, Branson Ultrasonics Copr., (c) 1992.
Arthrex, Protect your graft, Am J Sports Med, vol. 22, No. 4, Jul.-Aug. 1994.
Barrett et al, T-Fix endoscopic meniscal repair: technique and approach to different types of tears, Apr. 1995, Arthroscopy vol. 11 No. 2 p. 245-51.
Cope, Suture Anchor for Visceral Drainage, AJR, vol. 148 p. 160-162, Jan. 1986.
Gabriel, Arthroscopic Fixation Devices, Wiley Enc. of Biomed Eng., 2006.
Innovasive, We've got you covered, Am J Sports Med, vol. 26, No. 1, Jan.-Feb. 1998.
510k—TranSet Fracture Fixation System, Feb. 24, 2004, k033717.
510k—Linvatec Biomaterials modification of Duet and impact Suture Anchor, Nov. 19, 2004, k042966.
510k, Arthrex pushlock, Jun. 29, 2005, K051219.
510k, Mitek micro anchor, Nov. 6, 1996, K962511.
510k, Multitak Suture System, Jan. 10, 1997, K964324.
510k, Modified Mitek 3.5mm Absorbable Suture Anchor System, Jun. 9, 1997, K970896.
510K, Summary for Arthrex Inc.'s Bio-Interference Screw, Jul. 9, 1997, K971358.
510k, Surgicraft Bone Tie, Sep. 25, 1998, K982719.
Karlsson et al, Repair of Bankart lesions with a suture anchor in recurrent dislocation of the shoulder, Scand. j. of Med & Science in Sports, 1995, 5:170-174.
Madjar et al, Minimally Invasive Pervaginam Procedures, for the Treatment of Female Stress Incontinence . . . , Artificial Organs, 22 (10) 879-885, 1998.
Nowak et al, Comparative Study of Fixation Techniques in the Open Bankart Operation Using Either a Cannulated Screw or Suture-Anchors, Acta Orthopcedica Belgica, vol. 64-2—1998.
Packer et al, Repair of Acute Scapho-Lunate Dissociation Facilitated by the “TAG”* Suture Anchor, Journal of Hand Surgery (British and European Volume, 1994) 19B: 5: 563-564.
Richmond, Modificatio of the Bankart reconstruction with a suture anchor, Am J Sports Med, vol. 19, No. 4, p. 343-346, 1991.
Shea et al, Technical Note: Arthroscopic Rotator Cuff Repair Using a Transhumeral Approach to Fixation, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 14, No. 1 Jan.-Feb. 1998: pp. 118-122.
Tfix, Acufex just tied the knot . . . , Am. J. Sports Med., vol. 22, No. 3, May-Jun. 1994.
Wong et al, Case Report: Proper Insertion Angle is Essential to Prevent Intra-Articular Protrusion of a Knotless Suture Anchor in Shoulder Rotator Cuff Repair, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 26, No. 2 Feb. 2010: pp. 286-290.
Cobb et al, Late Correction of Malunited Intercondylar Humeral Fractures Intra-Articular Osteotomy and Tricortical Bone Grafting, J BoneJointSurg [Br] 1994; 76-B:622-6.
Fellinger, et al, Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair, Jun. 1997, Arthroscopy vol. 13 No. 3 p. 370-4.
Hecker et al , Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs, Nov.-Dec. 1993 , The American Journal of Sports Medicine, vol. 21 No. 6 p. 874-9.
Hernigou et al, Proximal Tibial Osteotomy for Osteoarthritis with Varus Deformity a Ten to Thirteen-Year Follow-Up Study, J Bone Joint Surg, vol. 69-A, No. 3. Mar. 1987, p. 332-354.
Ibarra et al, Glenoid Replacement in Total Shoulder Arthroplasty, The Orthopedic Clinics of NorthAmerica: Total Shoulder Arthroplasty, vol. 29 No. 3, Jul. 1998 p. 403-413.
Mosca et al, Calcaneal Lengthening for Valgus Deformity of the Hindfoot: Results in Children Who Had Severe, Symptomatic Flatfoot and Skewfoot, J Bone Joint Surg,, 1195-p. 499-512.
Murphy et al , Radial Opening Wedge Osteotomy in Madelung's Deformity, J. Hand Surg, vol. 21 A No. 6 Nov. 1996, p. 1035-44.
Biomet, Stanmore Modular Hip, J. Bone Joint Surg., vol. 76-B : No. Two, Mar. 1994.
Petition for Inter Partes Review of U.S. Pat. No. 5,980,559, IPR 2013-00603, Filing Date Sep. 24, 2013.
Declaration of David Kaplan, Ph.D. Regarding U.S. Pat. No. 5,980,559, IPR 2013-00603, dated Sep. 24, 2013.
Petition for Inter Partes Review of U.S. Pat. No. 7,087,073, IPR 2013-00604, Filing Date Sep. 24, 2013.
Declaration of Wayne J. Sebastianelli, MD Regarding U.S. Pat. No. 7,087,073, Sep. 24, 2013, IPR 2013-00604.
Petition for Inter Partes Review of U.S. Pat. No. 6,500,195, IPR 2013-00624, Filing Date Oct. 2, 2013.
Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Pat. No. 6,500,195, IPR 2013-00624, dated Sep. 25, 2013.
Petition for Inter Partes Review of U.S. Pat. No. 5,527,343, IPR 2013-00628, Filing Date Sep. 26, 2013,dated Sep. 25, 2013.
Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Pat. No. 5,527,343, IPR 2013-00628, dated Sep. 25, 2013.
Corrected Petition for Inter Partes Review of U.S. Pat. No. 5,921,986, IPR 2013-00631, Filing Date Sep. 27, 2013.
Expert Declaration of Steve E. Jordan, MD, for Inter Partes Review of U.S. Pat. No. 5,921,986, IPR 2013-00631, dated Sep. 24, 2013.
Corrected Petition for Inter Partes Review of U.S. Pat. No. 8,147,514, IPR 2013-00632, Filing Date Sep. 27, 2013.
Declaration of Steve Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00632, dated Sep. 23, 2013 (exhibit 1009).
Corrected Petition Finter Partes Review of U.S. Pat. No. 8,147,514, IPR 2013-00633, Filing Date Sep. 27, 2013.
Declaration of Steve Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00633, dated Sep. 23, 2013 (exhibit 1006).
Flory, Principles of Polymer Chemistry, 1953, selected pages (cited in IPR 2013-00603, exhibit 1012).
Grizzi, Hydrolytic degradation of devices based on poly(DL-lactic acid) size-dependence, Biomaterials, 1995, vol. 16, No. 4, p. 305-11 (cited in IPR 2013-00603, exhibit 1006).
Gopferich, Mechanisms of polymer degradation and erosion, Biomaterials, 1996, vol. 17, No. 2, p. 103-114 (cited in IPR 2013-00603, exhibit 1013).
Gao et el, Swelling of Hydroxypropyl Methylcellulose Matrix Tablets . . . , J. of Pharmaceutical Sciences, vol. 85, No. 7, Jul. 1996, p. 732-740 (cited in IPR 2013-00603, exhibit 1014).
Linvatec, Impact Suture Anchor brochure, 2004 (cited in IPR 2013-00628, exhibit 1010).
Seitz et al, Repair of the Tibiofibular Syndesmosis with a Flexible Implant, J. of Orthopaedic Trauma, vol. 5, No. 1, p. 78-82, 1991 (cited in IPR 2013-00631, exhibit 1007) (cited in 2013-00632).
Translation of FR2696338 with translator's certificate dated Sep. 17, 2013 (cited in IPR 2013-00631, 2013-00632).
Translation of DE9002844.9 with translator's certificate dated Sep. 26, 2013 (cited in IPR 2013-00631, 2013-00632).
Declaration of Steve Jordan for U.S. Pat. No. 5,921,986, from IPR 2013-00632, dated Sep. 24, 2013 (exhibit 1010).
Declaration of Steve Jordan for U.S. Pat. No. 5,921,986, from IPR 2013-00633, dated Sep. 24, 2013 (exhibit 1007).
Declaration of Dr. Steve E. Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00631, dated Sep. 23, 2013 (exhibit 1012).
Final Office Action dated Oct. 8, 2014 relating to U.S. Appl. No. 11/358,399, 12 pages.
Final Office Action dated Sep. 22, 2011 relating to U.S. Appl. No. 11/358,399, 11 pages.
Final Office Action dated Dec. 18, 2009 relating to U.S. Appl. No. 11/358,399, 10 pages.
Non-Final Office Action dated Feb. 18, 2014 relating to U.S. Appl. No. 11/358,399, 16 pages.
Non-Final Office Action dated Jan. 3, 2011 relating to U.S. Appl. No. 11/358,399, 10 pages.
Non-Final Office Action dated Apr. 10, 2009 relating to U.S. Appl. No. 11/358,399, 8 pages.

Related Publications (1)

	Number	Date	Country
	20150282804 A1	Oct 2015	US

Provisional Applications (1)

	Number	Date	Country
	60655141	Feb 2005	US

Continuations (1)

	Number	Date	Country
Parent	11358399	Feb 2006	US
Child	14743189		US

Device and method for securing body tissue

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