Suture management and tensioning devices and methods for soft tissue reconstruction or bone-to-bone fixation

Abstract

An adjustable, stand-alone tensioning system requires no additional fixturing, weights, or bone surface modification, and allows a single practitioner to provide an adjustable and repeatable tension to a soft tissue graft, and to install the final fixation implant. Its design facilitates introduction of the suture component of the graft into the tensioning process by simplifying retention of the suture. An even, regulated and reproducible tension is easily achieved without requiring the practitioner to manually pull on the suture strands to maintain graft tension.

1 - 14 . (canceled) 
     
     
         15 . A method of tensioning a portion of soft tissue during an orthopedic procedure at an operative site in a patient's body, comprising:
 positioning a body of a suture management device at a desired location in proximity to the operative site;   attaching a first end of a length of suture to a portion of soft tissue to be tensioned, wherein the second end of said length of suture is attached to a suture retaining member disposed within said suture management device body;   
       actuating a suture tensioning control to retract the length of suture into the device body, thereby tensioning the portion of soft tissue; and
 limiting the tension applied to the portion of soft tissue to a desired level. 
 
     
     
         16 . The method as recited in  claim 15 , wherein the tension limiting step is performed by pre-setting a tension level using a tension adjusting control on said device. 
     
     
         17 . The method as recited in  claim 15 , wherein the tension limiting step is performed by actuating the suture tensioning control until a force gauge indicates that the desired tension level has been applied. 
     
     
         18 . The method as recited in  claim 15 , and further comprising a step of inserting a tool through a channel in said device body to deploy an implant. 
     
     
         19 . The method as recited in  claim 18 , and further comprising a step of removing the device from the patient's body. 
     
     
         20 . A method of tensioning a portion of soft tissue during an orthopedic procedure at an operative site in a patient's body, comprising:
 positioning a body of a suture management device at a desired location in proximity to the operative site;   attaching a first end of a length of suture to a portion of soft tissue to be tensioned, wherein a second end of said length of suture is attached to a suture retaining member disposed on or about said suture management device body;   retracting the length of suture into the device body, thereby tensioning the portion of soft tissue; and   limiting the tension applied to the portion of soft tissue to a desired level.   
     
     
         21 . The method as recited in  claim 20 , wherein the retracting is accomplished through manual actuation. 
     
     
         22 . The method as recited in  claim 20 , wherein the suture retaining member is a cleat. 
     
     
         23 . The method as recited in  claim 20 , wherein the suture retaining member is a slot. 
     
     
         24 . The method as recited in  claim 20 , wherein the suture retaining member is a slot of a cleat. 
     
     
         25 . The method as recited in  claim 20 , wherein the suture management device is a soft tissue tensioning system comprising:
 a manual suture tensioning device having a generally T-shape;   said device comprising a bar and a finger guard which is orthogonal to the bar;   said bar having opposed lateral ends;   a lateral suture cleat disposed on each lateral end of the bar; and   a primary suture cleat extending about a top and a bottom of each of said opposed lateral ends of said bar.   
     
     
         26 . The method as recited in  claim 20 , and further comprising a step of inserting a tool through a channel in said device body. 
     
     
         27 . The method as recited in  claim 26 , wherein the device body is cannulated. 
     
     
         28 . The method as recited in  claim 26 , wherein the tool deploys an implant. 
     
     
         29 . The method as recited in  claim 26 , and further comprising a step of removing the device from the patient's body. 
     
     
         30 . The method as recited in  claim 20 , wherein the step of retracting is accomplished by actuating a suture tensioning control. 
     
     
         31 . The method as recited in  claim 30 , wherein the tension limiting step is performed by pre-setting a tension level using a tension adjusting control on said device. 
     
     
         32 . The method as recited in  claim 30 , wherein the tension limiting step is performed by actuating the suture tensioning control until a force gauge indicates that the desired tension level has been applied. 
     
     
         33 . The method as recited in  claim 30 , wherein the step of actuating a suture tensioning control is accomplished manually. 
     
     
         34 . The method as recited in  claim 30 , wherein the suture tensioning control is manual.