System and method for meniscal repair through a meniscal capsular tunnel

Abstract

A system for open or arthroscopic surgical repair of torn or damaged meniscal tissue has a repair member and an instrument. The repair member is a suture, flexible or rigid implant. The instrument has at a portion that is shaped to slide within a meniscal capsular tunnel. The meniscal capsular tunnel is an opening in the knee soft tissue passing from the anterior side of the knee adjacent to the mensical tissue to the posterior side of the knee in both the medial and lateral directions. The instrument interacts with the repair member to either insert it into the meniscus from the posterior side, or to facilitate securing of the repair member so that the repair member holds the meniscal tissue together on either side of a meniscal tear to foster healing of the damaged tissue.

1 . A system for surgical repair of a meniscus of a knee, the system comprising:
 a repair member; and   an instrument, at least a distal end of which is configured to slide adjacent to the meniscus through an anterior portion of a meniscal capsular tunnel to facilitate implantation of the repair member in the meniscus.   
     
     
         2 . The system of  claim 1 , wherein the instrument comprises a delivery interface configured to pass a first end of the repair member from the meniscal capsular tunnel through at least a portion of the meniscus. 
     
     
         3 . The system of  claim 2 , wherein the repair member comprises a first end having a barbed shape selected to secure the first end with respect to the meniscus in response to insertion of the first end through at least a portion of the meniscus. 
     
     
         4 . The system of  claim 3 , wherein the repair member further comprises a second end having a barbed shape selected to secure the second end with respect to the meniscus in response to insertion of the second end through at least a portion of the meniscus. 
     
     
         5 . The system of  claim 1 , wherein the instrument comprises a retention interface configured to facilitate securement of the repair member to the meniscus. 
     
     
         6 . The system of  claim 5 , wherein the retention interface is configured to retain first and second ends of the repair member to facilitate withdrawal of the first and second ends from the knee through the meniscal capsular tunnel. 
     
     
         7 . The system of  claim 5 , wherein the retention interface is configured to secure first and second ends of the repair member together. 
     
     
         8 . The system of  claim 5 , wherein the retention interface is configured to secure a coupling member to the repair member to secure the repair member to the meniscus. 
     
     
         9 . The system of  claim 5 , wherein the retention interface is configured to manipulate at least one end of the repair member protruding from the meniscus to prevent withdrawal of the end into the meniscus. 
     
     
         10 . The system of  claim 5 , further comprising a second instrument configured to insert the repair member into the meniscus from a location anteriorly of a tear to be repaired by the system. 
     
     
         11 . The system of  claim 1 , wherein the repair member comprises a length of suture comprising first and second ends configured to be secured together to retain the length of suture with respect to the meniscus. 
     
     
         12 . The system of  claim 1 , wherein the repair member comprises a length of suture comprising first and second ends configured to be secured with respect to the meniscus independently of each other. 
     
     
         13 . The system of  claim 1 , wherein the repair member comprises a staple comprising first and second ends configured to be secured with respect to the meniscus independently of each other. 
     
     
         14 . The system of  claim 1 , wherein the repair member comprises a staple comprising first and second ends, the system further comprising a retainer attachable to the first end and the second end to secure the staple with respect to the meniscus. 
     
     
         15 . The system of  claim 1 , wherein the repair member comprises a clip comprising first and second ends configured to be secured together to retain the clip with respect to the meniscus. 
     
     
         16 . The system of  claim 1 , wherein the repair member comprises a post comprising a barbed end shaped to be secured with respect to the meniscus in response to insertion of the barbed end at least partially through the meniscus. 
     
     
         17 . The system of  claim 1 , wherein the distal end is shaped to dilate a potential space between tissues within the knee to form the meniscal capsular tunnel in response to pressure of the distal end against the tissues. 
     
     
         18 . The system of  claim 17 , wherein the instrument further comprises a proximal end shaped to be grasped by a surgeon and an intermediate portion extending between the proximal and distal ends, wherein the intermediate portion is flexible to permit passage of the distal end from the anterior portion of the meniscal capsular tunnel to a posterior portion of the meniscal capsular tunnel, wherein the posterior portion is positioned posteriorly of the meniscus. 
     
     
         19 . A system for surgical repair of a meniscus of a knee, the system comprising:
 a repair member; and   an instrument, at least a distal end of which is configured to slide adjacent to the meniscus through an adjacent meniscal capsular tunnel extending between a first tissue immediately adjacent to the meniscus and a second tissue immediately exterior to the first tissue to facilitate implantation of the repair member in the meniscus.   
     
     
         20 . The system of  claim 19 , wherein the instrument comprises a delivery interface configured to pass a first end of the repair member from the meniscal capsular tunnel through at least a portion of the meniscus. 
     
     
         21 . The system of  claim 19 , wherein the instrument comprises a retention interface configured to facilitate securement of the repair member to the meniscus. 
     
     
         22 . The system of  claim 19 , wherein the distal end is shaped to dilate a potential space between tissues within the knee to form the adjacent meniscal capsular tunnel in response to pressure of the distal end against the tissues. 
     
     
         23 . The system of  claim 22 , wherein the instrument further comprises a proximal end shaped to be grasped by a surgeon and an intermediate portion extending between the proximal and distal ends, wherein the intermediate portion is flexible to permit passage of the distal end from the anterior portion of the meniscal capsular tunnel to a posterior portion of the meniscal capsular tunnel, wherein the posterior portion is positioned posteriorly of the meniscus. 
     
     
         24 . A system for surgical repair of a meniscus of a knee, the system comprising:
 a repair member comprising a first end, a central portion, and a second end; and   an instrument, at least a distal end of which is configured to be inserted into the knee and positioned exteriorly of a tear positioned posteriorly, medially, or laterally on the meniscus to facilitate implantation of the repair member;   wherein the repair member and the instrument are further configured to facilitate implantation of the repair member to repair the tear without requiring retraction of ligamentomuscular structures positioned exteriorly of the tear to complete implantation of the repair member.   
     
     
         25 . The system of  claim 24 , wherein the instrument comprises a delivery interface configured to pass a first end of the repair member through at least a portion of the meniscus from a position posteriorly of the meniscus. 
     
     
         26 . The system of  claim 24 , wherein the instrument comprises a retention interface configured to facilitate securement of the repair member to the meniscus from a position posteriorly of the meniscus. 
     
     
         27 . The system of  claim 24 , wherein the distal end is shaped to dilate a potential space between tissues within the knee in response to pressure of the distal end against the tissues to permit passage of the distal end posterior to the meniscus. 
     
     
         28 . The system of  claim 27 , wherein the instrument further comprises a proximal end shaped to be grasped by a surgeon and an intermediate portion extending between the proximal and distal ends, wherein the intermediate portion is flexible to permit passage of the distal end within the knee from a position anterior to the meniscus to a position posterior to the meniscus. 
     
     
         29 . A method of repairing a damaged meniscus of a knee, the method comprising:
 inserting a repair member into a meniscal capsular tunnel of the knee;   actuating the repair member around at least a portion of the meniscus to position at least a first end of the repair member posteriorly of the meniscus, within the meniscal capsular tunnel; and   passing the first end from the meniscal capsular tunnel through at least a portion of the meniscus.   
     
     
         30 . The method of  claim 29 , wherein the repair member comprises a first end having a barbed shape, the method further comprising securing the first end with the barbed shape in response to passage of the first end through at least a portion of the meniscus. 
     
     
         31 . The method of  claim 30 , wherein the repair member further comprises a second end having a barbed shape, the method further comprising securing the second end with the barbed shape of the second end in response to passage of the second end through at least a portion of the meniscus. 
     
     
         32 . The method of  claim 29 , further comprising coupling the repair member to a delivery interface of an instrument, wherein actuating the repair member around at least a portion of the meniscus comprises urging a distal end of the instrument around at least a portion of the meniscus, wherein passing the first end from the meniscal capsular tunnel through at least a portion of the meniscus comprises actuating the delivery interface to urge the first end into the meniscus. 
     
     
         33 . The method of  claim 32 , wherein actuating the repair member around at least a portion of the meniscus comprises pressing the distal end against tissues within the knee to dilate a potential space between tissues to form the meniscal capsular tunnel. 
     
     
         34 . The method of  claim 33 , wherein inserting the repair member into the meniscal capsular tunnel comprises inserting the repair member into an anterior portion of the meniscal capsular tunnel. 
     
     
         35 . A method of repairing a damaged meniscus of a knee, the method comprising:
 passing a first end of a repair member through at least a portion of the meniscus;   manipulating the first end within a meniscal capsular tunnel of the knee; and   securing the repair member to the meniscus in response to manipulation of the first end.   
     
     
         36 . The method of  claim 35 , further comprising withdrawing the first end from the knee through the meniscal capsular tunnel to facilitate securement of the repair member to the meniscus. 
     
     
         37 . The method of  claim 35 , wherein the repair member comprises a second end, wherein securing the repair member to the meniscus comprises securing the first and second ends together. 
     
     
         38 . The method of  claim 35 , wherein securing the repair member to the meniscus comprises securing a coupling member to the repair member. 
     
     
         39 . The method of  claim 35 , wherein, after passage of the first end through at least a portion of the meniscus, the first end protrudes from the meniscus, wherein securing the repair member comprises preventing withdrawal of the end into the meniscus. 
     
     
         40 . The method of  claim 35 , wherein passing the first end through at least a portion of the meniscus comprises inserting the first end from a location anteriorly of a tear to be repaired. 
     
     
         41 . The method of  claim 35 , wherein the repair member comprises a length of suture further comprising a second end, wherein securing the repair member to the meniscus comprises securing the first and second ends together to retain the length of suture with respect to the meniscus. 
     
     
         42 . The method of  claim 35 , wherein the repair member comprises a length of suture further comprising a second end, wherein securing the repair member comprises securing the first end and the second end with respect to the meniscus independently of each other. 
     
     
         43 . The method of  claim 35 , wherein the repair member comprises a staple comprising first and second ends, wherein securing the repair member to the meniscus comprises attaching a retainer to the first end and the second end. 
     
     
         44 . The method of  claim 35 , wherein the repair member comprises a clip comprising first and second ends, wherein securing the repair member comprises securing the first end to the second end. 
     
     
         45 . The method of  claim 35 , further comprising inserting at least a distal end of an instrument into the meniscal capsular tunnel, wherein manipulating the first end comprises manipulating the first end with the distal end. 
     
     
         46 . The method of  claim 45 , wherein inserting the distal end into the meniscal capsular tunnel comprises pressing the distal end against tissues within the knee to dilate a potential space between the tissues to form the meniscal capsular tunnel. 
     
     
         47 . The method of  claim 46 , further comprising actuating the distal end from an anterior portion of the meniscal capsular tunnel to a posterior portion of the meniscal capsular tunnel, wherein manipulating the first end comprises manipulating the first end within the posterior portion. 
     
     
         48 . A method of repairing a damaged meniscus of a knee, the method comprising:
 inserting a first end of a repair member through at least a portion of the meniscus from a position exteriorly of a tear positioned posteriorly, medially, or laterally on the meniscus; and   securing the first end to substantially prevent withdrawal of the repair member from the meniscus during normal operation of the knee to expedite reparation of the tear;   wherein the steps of inserting the first end of the repair member through at least a portion of the meniscus and securing the repair member are carried out without requiring retraction of ligamentomuscular structures positioned exteriorly of the tear.   
     
     
         49 . The method of  claim 48 , wherein inserting the first end through at least a portion of the meniscus comprises:
 coupling the repair member to a delivery interface of an instrument; and   actuating the delivery interface to urge the first end through at least a portion of the meniscus from a position posteriorly of the meniscus.   
     
     
         50 . The method of  claim 48 , wherein securing the first end comprises manipulating the first end with a retention interface of an instrument from a position posteriorly of the meniscus. 
     
     
         51 . The method of  claim 48 , further comprising pressing a distal end of an instrument against tissues within the knee to dilate a potential space between the tissues to permit passage of the distal end posterior to the meniscus. 
     
     
         52 . The method of  claim 51 , wherein bifurcating the one or more layers of tissue comprises inserting the distal end into the knee anteriorly of the meniscus, the method further comprising actuating the distal end from a position anterior to the meniscus to a position posterior to the meniscus.