Methods and devices to treat diseased or injured musculoskeletal tissue

Abstract

A knotless suture anchoring system includes an outer anchor having a central channel and a distal tip adapted to penetrate tissue. An inner anchor is positionable in the central channel of the outer anchor and a locking feature on one or both of the inner and outer anchors retains the inner anchor within the central channel. A continuous length of suture is coupled with the inner and outer suture anchors and has a free end. At least one of the inner and the outer anchors also has a cinching mechanism that allows the suture to be tensioned by passage of the suture through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained.

1 . A knotless suture anchoring system comprising:
 an outer anchor having a central channel and a distal tip adapted to penetrate tissue;   an inner anchor positionable in the central channel of the outer anchor;   a locking feature on one or both of the inner and outer anchors configured to retain the inner anchor within the central channel; and   a continuous length of suture coupled with the inner and outer anchors, the suture having a free end,   wherein at least one of the inner and outer anchors further comprises a cinching mechanism adapted to allow the suture to be tensioned by passage of the suture through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained.   
     
     
         2 . The anchoring system of  claim 1 , wherein the central channel extends only partially through the outer anchor. 
     
     
         3 . The anchoring system of  claim 1 , wherein the locking feature comprises an annular recessed region in the central channel of the outer anchor. 
     
     
         4 . The anchoring system of  claim 1 , wherein the outer anchor comprises an outer surface having surface features adapted to anchor the outer anchor with the tissue or to promote tissue ingrowth. 
     
     
         5 . The anchoring system of  claim 1 , wherein the locking feature comprises a plurality of resilient fingers extending radially outward from the inner anchor. 
     
     
         6 . The anchoring system of  claim 1 , wherein the cinching mechanism comprises a deflectable arm coupled to either the inner or the outer anchor. 
     
     
         7 . The anchoring system of  claim 1 , wherein the cinching mechanism is operative regardless of the position of the inner anchor relative to the outer anchor. 
     
     
         8 . The anchoring system of  claim 1 , further comprising a delivery instrument having a longitudinal axis, wherein the delivery instrument is adapted to carry both the inner anchor and the outer anchor simultaneously. 
     
     
         9 . The anchoring system of  claim 8 , wherein the delivery instrument is configured to receive a drill, wherein the drill is adapted to create an aperture in the tissue sized to receive the inner or the outer anchor. 
     
     
         10 . The anchoring system of  claim 1 , wherein the central channel is disposed at an angle transverse to a longitudinal axis of the outer anchor such that the inner anchor is disposed at an angle transverse to the longitudinal axis of the outer anchor when received in the central channel. 
     
     
         11 . A knotless suture anchoring system comprising:
 an outer anchor having a central channel and a distal tip adapted to penetrate tissue;   an inner anchor positionable in the central channel of the outer anchor and having a distal tip adapted to penetrate and be retained in tissue outside the outer anchor whereby the inner anchor may be positioned either in the outer anchor or in tissue apart from the outer anchor;   a locking feature on one or both of the inner and outer anchors configured to retain the inner anchor within the central channel; and   a continuous length of suture coupled with the inner and outer anchors, the suture having a free end,   wherein at least one of the inner and outer anchors further comprises a clamping mechanism adapted to clamp the suture under tension without knotting the suture.   
     
     
         12 . The anchoring system of  claim 11 , wherein the central channel extends only partially through the outer anchor. 
     
     
         13 . The anchoring system of  claim 11 , wherein the locking feature comprises an annular recessed region in the central channel of the outer anchor. 
     
     
         14 . The anchoring system of  claim 11 , wherein the outer anchor comprises an outer surface having surface features adapted to anchor the outer anchor with the tissue or to promote tissue ingrowth. 
     
     
         15 . The anchoring system of  claim 11 , wherein the inner anchor locking feature comprises a plurality of resilient fingers extending radially outward from the inner anchor. 
     
     
         16 . The anchoring system of  claim 11 , wherein the clamping mechanism comprises a cinching mechanism adapted to allow the suture to be tensioned by passage of the suture through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained. 
     
     
         17 . The anchoring system of  claim 16 , wherein the cinching mechanism comprises a deflectable arm coupled to either the inner or the outer anchor. 
     
     
         18 . The anchoring system of  claim 16 , wherein the cinching mechanism is operative regardless of the position of the inner anchor relative to the outer anchor. 
     
     
         19 . The anchoring system of  claim 17 , wherein the deflectable arm is integral with either the inner or the outer anchor. 
     
     
         20 . The anchoring system of  claim 17 , wherein the deflectable arm is disposed in an aperture within either the inner or the outer anchor. 
     
     
         21 . The anchoring system of  claim 20 , wherein the aperture is in an axial channel extending at least partially through the inner anchor. 
     
     
         22 . The anchoring system of  claim 21 , wherein the arm moves in a first radial direction when the suture is pulled in the first direction and the arm moves in a second radial direction when the suture is pulled in the second direction. 
     
     
         23 . The anchoring system of  claim 22 , wherein the suture is clamped between the arm and a wall of the aperture when the suture is pulled in the second direction. 
     
     
         24 . The anchoring system of  claim 22 , wherein the arm is resilient so as to return to an unbiased position after moving in either the first or the second radial directions. 
     
     
         25 . The anchoring system of  claim 22 , wherein the arm deflects radially inward when the suture is pulled in the second direction to clamp the suture between the arm and an opposing wall of the aperture, thereby constraining movement of the suture in the second direction. 
     
     
         26 . The anchoring system of  claim 11 , further comprising a delivery instrument having a longitudinal axis, wherein the delivery instrument is adapted to carry both the inner anchor and the outer anchor simultaneously. 
     
     
         27 . The anchoring system of  claim 26 , wherein the delivery instrument has an axial lumen, the inner and the outer anchors being releasably carried in the axial lumen. 
     
     
         28 . The anchoring system of  claim 26 , wherein the delivery instrument comprises a steering mechanism adapted to deflect a distal portion of the instrument. 
     
     
         29 . The anchoring system of  claim 26 , wherein the delivery instrument comprises a suture management feature, said feature adapted to releasably hold the length of suture and prevent tangling thereof. 
     
     
         30 . The anchoring system of  claim 11 , wherein the delivery instrument is configured to receive a drill, wherein the drill is adapted to create an aperture in the tissue sized to receive the inner or the outer anchor. 
     
     
         31 . The anchoring system of  claim 26 , wherein the delivery instrument is adapted to deliver the inner anchor and the outer anchor at an angle transverse to the longitudinal axis of the delivery instrument. 
     
     
         32 . The anchoring system of  claim 31 , wherein the delivery instrument comprises a hammer element coupled with the delivery instrument and adapted to convert axial movement along the longitudinal axis of the delivery instrument into an impacting force transverse to the longitudinal axis of the delivery instrument. 
     
     
         33 . The anchoring system of  claim 26 , wherein each of the inner and the outer anchors have a longitudinal axis and the delivery instrument carries the inner and the outer anchors such that the longitudinal axis of both anchors is transverse to the longitudinal axis of the delivery instrument. 
     
     
         34 . The anchoring system of  claim 11 , wherein the central channel is disposed at an angle transverse to a longitudinal axis of the outer anchor such that the inner anchor is disposed at an angle transverse to the longitudinal axis of the outer anchor when received in the central channel. 
     
     
         35 . The anchoring system of  claim 26 , wherein the delivery instrument comprises a jaw having first opposable member pivotably coupled with a second opposable member, wherein the first opposable member carries the inner anchor and the second opposable member carries the outer anchor, and
 wherein actuation of the jaw inserts the inner anchor into the outer anchor.   
     
     
         36 . The anchoring system of  claim 35 , wherein the inner and the outer anchors each have a longitudinal axis and wherein the anchors are carried by the opposable members such that the longitudinal axis of the anchors are transverse to a longitudinal axis of the opposable members. 
     
     
         37 . A knotless suture anchoring system comprising:
 a first anchor having a housing with a central channel sized to receive a suture therein; and   a cinching mechanism having a radially deflectable arm integral with the housing and disposed at least partially in the central channel, the suture passing through an opening in the arm and passing between a free end of the arm and the housing, wherein the cinching mechanism is adapted to allow the suture to pass through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained.   
     
     
         38 . The anchoring system of  claim 37 , wherein the cinching mechanism comprises a deflectable arm coupled to the first anchor. 
     
     
         39 . The anchoring system of  claim 38 , wherein the deflectable arm is integral with the first anchor. 
     
     
         40 . The anchoring system of  claim 38 , wherein the deflectable arm is disposed in an aperture within the first anchor. 
     
     
         41 . The anchoring system of  claim 40 , wherein the aperture is in an axial channel extending at least partially through the first anchor. 
     
     
         42 . The anchoring system of  claim 41 , wherein the arm moves in a first radial direction when the suture is pulled in the first direction and the arm moves in a second radial direction when the suture is pulled in the second direction. 
     
     
         43 . The anchoring system of  claim 42 , wherein the suture is clamped between the arm and a wall of the aperture when the suture is pulled in the second direction. 
     
     
         44 . The anchoring system of  claim 42 , wherein the arm is resilient so as to return to an unbiased position after moving in either the first or the second radial directions. 
     
     
         45 . The anchoring system of  claim 42 , wherein the arm deflects radially inward when the suture is pulled in the second direction to clamp the suture between the arm and an opposing wall of the aperture, thereby constraining movement of the suture in the second direction. 
     
     
         46 . The anchoring system of  claim 37 , wherein the housing comprises a distal tip adapted to penetrate tissue. 
     
     
         47 . The anchoring system of  claim 46 , wherein the housing comprises an outer surface having surface features adapted to anchor the first anchor in the tissue or to promote tissue ingrowth. 
     
     
         48 . The anchoring system of  claim 37 , further comprising a second anchor having an inner channel configured to receive the first anchor, wherein the inner channel comprises a locking feature adapted to engage with the first anchor to retain the first anchor in the second anchor. 
     
     
         49 . A knotless suture anchoring system comprising:
 a pin having a distal tip adapted to penetrate tissue;   an anchoring bracket; and   a length of suture,   wherein the suture is adapted to be coupled to the pin and the bracket.   
     
     
         50 . The anchoring system of  claim 49 , wherein the bracket is L-shaped. 
     
     
         51 . The anchoring system of  claim 49 , wherein the bracket comprises a suture management feature adapted to receive and hold the suture. 
     
     
         52 . The anchoring system of  claim 51 , wherein the suture management feature comprises a slit in the bracket. 
     
     
         53 . The anchoring system of  claim 49 , wherein the bracket comprises an anchoring pin adapted to penetrate the tissue thereby fixing the bracket to the tissue. 
     
     
         54 . The anchoring system of  claim 49 , wherein the suture is formed into a loop sized to capture tissue to be repaired. 
     
     
         55 . The anchoring system of  claim 54 , wherein the tissue to be repaired comprises a torn labrum. 
     
     
         56 . The anchoring system of  claim 49 , wherein the anchoring bracket or the pin further comprise a cinching mechanism adapted to allow the suture to be tensioned by passage of the suture through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained. 
     
     
         57 . A knotless suture anchoring system comprising:
 a delivery instrument having a longitudinal axis, a shaft axially movable along the longitudinal axis, and a hammer adapted to convert axial movement along the longitudinal axis into movement transverse thereto; and   a first anchor carried by the delivery instrument and having a distal tip adapted to penetrate tissue, wherein axial movement of the slidable shaft along the longitudinal axis moves the hammer in a motion transverse thereto, thereby impacting the anchor, whereby the first anchor is driven into the tissue at an angle transverse to the longitudinal axis of the delivery instrument.   
     
     
         58 . A method of knotless suturing comprising:
 providing a delivery instrument carrying a first anchor and a second anchor, wherein a continuous length of suture is coupled with the first and the second anchors;   advancing the delivery instrument to a treatment region comprising treatment tissue;   placing the first anchor into a first region of the tissue;   coupling the suture to a portion of the treatment tissue;   attaching the second anchor to the first anchor;   tensioning the suture; and   securing the suture without knotting the suture by moving the suture through a cinching mechanism in the first or the second anchor, wherein the cinching mechanism is adapted to allow the suture to move through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained independently of the position of the second anchor relative to the first anchor.   
     
     
         59 . The method of  claim 58 , wherein the second anchor is stationary relative to the first anchor during the entire step of securing the suture. 
     
     
         60 . The method of  claim 58 , wherein the tissue comprises bone and the step of placing the first anchor or the step of placing the second anchor comprises drilling a pilot hole into the bone, the pilot hole sized to receive the first or the second anchor. 
     
     
         61 . The method of  claim 58 , further comprising deflecting a distal portion of the delivery instrument. 
     
     
         62 . The method of  claim 58 , wherein the first region of tissue comprises the acetabulum and the treatment tissue comprises an acetabular labrum. 
     
     
         63 . The method of  claim 58 , wherein the step of attaching the second anchor to the first anchor comprises inserting the second anchor into a central channel of the first anchor and locking the two anchors together to prevent axial movement of the first anchor relative to the second anchor. 
     
     
         64 . The method of  claim 58 , wherein the delivery instrument further comprises an actuator mechanism near a proximal end of the instrument and the step of placing the first anchor or the step of placing the second anchor comprises actuating the actuator mechanism to expose the first or the second anchor from the delivery instrument. 
     
     
         65 . The method of  claim 58 , wherein the step of securing comprises clamping the suture between a deflectable arm and an inner wall of the first or the second anchor. 
     
     
         66 . The method of  claim 65 , wherein the arm is integral with either the first or the second anchor. 
     
     
         67 . The method of  claim 58 , wherein the step of attaching comprises placing the second anchor in a central channel within the first anchor. 
     
     
         68 . The method of  claim 67 , wherein the cinching mechanism is disposed in an inner channel of the second anchor. 
     
     
         69 . The method of  claim 58 , wherein the delivery instrument has a longitudinal axis, and wherein the step of placing the first anchor comprises placing the first anchor into the first region at an angle transverse to the longitudinal axis of the delivery instrument. 
     
     
         70 . The method of  claim 58 , wherein the step of attaching the second anchor to the first anchor comprises actuating a jaw disposed on the delivery instrument. 
     
     
         71 . A method of knotless suturing comprising:
 providing an anchoring device having an anchoring bracket, a length of suture and a pin, wherein the suture is coupled to the bracket and the pin;   anchoring the bracket to a first tissue region;   capturing tissue to be treated with the suture;   securing the pin to a structure selected from the bracket and a second tissue region; and   tensioning the suture.   
     
     
         72 . The method of  claim 71 , wherein the step of anchoring the anchoring bracket comprises inserting a pin coupled to the anchoring bracket into the first region. 
     
     
         73 . The method of  claim 71 , wherein the step of capturing the tissue to be treated comprises looping the suture around said tissue. 
     
     
         74 . The method of  claim 71 , wherein the step of tensioning the suture comprises passing the suture through a cinching mechanism in the pin or in the anchoring bracket, wherein the cinching mechanism is adapted to allow the suture to pass through the cinching mechanism in a first direction while movement of the suture through the cinching mechanism in a second direction opposite the first direction is constrained. 
     
     
         75 . The method of  claim 71 , wherein tensioning the suture comprises securing the suture without knotting the suture.