Devices, systems, and methods for attaching soft tissue to bone tissue

Abstract

A suture anchoring device for fixing a soft tissue to a bone tissue is disclosed that enables the exchange of sutures between anchors after implantation. The suture anchoring device may include a body that is inserted into the bone tissue, a suture exchange fitting situation within a passage formed within the body, and one or more pre-loaded sutures looped through the suture exchange fitting and projecting proximally from a proximal opening formed in the body. Surgical kits and surgical methods for performing various repair procedures using one or more suture anchoring device are also disclosed.

What is claimed is: 
     
         1 . A tissue anchor comprising:
 a body comprising a proximal end, a distal end opposite the proximal end, a proximal opening at the proximal end, a distal opening at the distal end, and a passage extending longitudinally through the body between the proximal and distal openings; and   a flexible elongated element at least contributing to the defining of an aperture that opens in a direction substantially perpendicular to a longitudinal axis of the passage, the flexible elongated element being secured to the body at first and second spaced-apart locations facilitating the aperture being maintained in an open condition.   
     
     
         2 . The tissue anchor of  claim 1 , wherein the first and second spaced-apart locations includes a first side of the passage and a second side of the passage opposite the first side of the passage. 
     
     
         3 . The tissue anchor of  claim 2 , wherein the flexible elongated element is secured to the each side of the passage via a ring, hook or loop. 
     
     
         4 . The tissue anchor of  claim 2 , wherein the body further comprises a distal tip that is at least one of received or configured to be received in the distal opening, and the first and second spaced-apart locations include a first side of the distal tip and a second side of the distal tip opposite the first side of the distal tip. 
     
     
         5 . The tissue anchor of  claim 1 , wherein the body further comprises a distal tip that is at least one of received or configured to be received in the distal opening, the flexible elongated element comprising a first tail and a second tail spaced-apart from the first tail by the first tail and the second tail respectively intersecting the distal tip at the first and second spaced-apart locations thereby facilitating the aperture being maintained in the open condition. 
     
     
         6 . The tissue anchor of  claim 5 , wherein, when the distal tip is received in the distal opening, the aperture is located in the passage proximal the distal tip. 
     
     
         7 . The tissue anchor of  claim 5 , wherein the distal tip comprises a molded material and a distal region of the first tail and a distal region of the second tail are molded into the molded material at the first and second spaced-apart locations. 
     
     
         8 . The tissue anchor of  claim 5 , wherein the distal tip is configured such that implantation forces exerted on the distal tip enhance the extent to which the distal tip is received in the distal opening. 
     
     
         9 . The tissue anchor of  claim 5 , wherein the first and second spaced-apart locations respectively comprise first and second spaced-apart channels in the distal tip, and a distal region of the first tail and a distal region of the second tail are respectively located in the first and second spaced-apart channels. 
     
     
         10 . The tissue anchor of  claim 9 , wherein the first spaced-apart channel comprises a groove defined in an outer surface of the distal tip and the distal region of the first tail extends through the groove, which opens against an inner wall surface defining the passage when the distal tip is received in the distal opening. 
     
     
         11 . The tissue anchor of  claim 9 , wherein the first spaced-apart channel comprises a lumen defined in the distal tip and the distal region of the first tail extends through the lumen. 
     
     
         12 . The tissue anchor of  claim 9 , wherein the first and second tails are distally joined together via a knot. 
     
     
         13 . The tissue anchor of  claim 11 , wherein the knot is coated or impregnated with a polymer, epoxy or adhesive. 
     
     
         14 . The tissue anchor of  claim 9 , wherein the first and second tails are part of a continuous loop of the flexible elongated element, the first and second tails extending into each other in a continuous manner. 
     
     
         15 . The tissue anchor of  claim 9 , wherein the first and second tails are distally joined together via a joining member extending about the at least portions of the first and second tails. 
     
     
         16 . The tissue anchor of  claim 15 , wherein the joining member is at least one of crimped or molded onto the first and second tails. 
     
     
         17 . The tissue anchor of  claim 16 , wherein the distal tip comprises a distal recess in which the joining member is seated. 
     
     
         18 . The tissue anchor of  claim 17 , wherein the distal tip comprises a proximal shaft opposite the distal recess, the distal tip being received in the distal opening on account of the proximal shaft being received in the distal opening and residing in the passage. 
     
     
         19 . The tissue anchor of  claim 18 , wherein the proximal shaft forms an interference fit with at least one of the distal opening or the passage. 
     
     
         20 . The tissue anchor of  claim 18 , wherein the first and second spaced-apart channels extend longitudinally along the proximal shaft. 
     
     
         21 . The tissue anchor of  claim 18 , wherein the aperture is defined between the flexible elongated element and a proximal end of the proximal shaft of the distal tip. 
     
     
         22 . The tissue anchor of  claim 5 , wherein a maximum height of the aperture in a non-deflected state and extending parallel to the longitudinal axis of the passage is defined between the flexible elongated element and a proximal end of the distal tip, and the maximum height of the aperture is between a height of the proximal end of the tissue anchor and a height of the proximal end of the body plus a thickness of a soft tissue, the soft tissue proximal to the proximal end of the body. 
     
     
         23 . The tissue anchor as in any of  claim 2  or  5 , in which a maximum width of the aperture in a non-deflected state is defined between the first and second spaced-apart locations, and the maximum width of the aperture is approximately the maximum width of the passage, the maximum width of the aperture extending perpendicular to the longitudinal axis of the passage. 
     
     
         24 . The tissue anchor as in any of  claim 2  or  5 , in which a most proximal extent of the flexible elongated element in a non-deflected state is recessed distally within the passage from the proximal opening up to approximately a thickness of a suture mass to be passed through the aperture. 
     
     
         25 . The tissue anchor as in any of  claim 2  or  5 , in which the proximal opening is configured to interface with an insertion tool. 
     
     
         26 . The tissue anchor as in any of  claim 2  or  5 , in which the flexible elongated element comprises a suture. 
     
     
         27 . The tissue anchor of  claim 26 , wherein the suture is a braided suture formed of a material comprising polyethylene, the material further comprising a thickness of between approximately 0.008″ and approximately 0.045″. 
     
     
         28 . The tissue anchor of  claim 26 , wherein the suture is at least one of heat treated, coated or impregnated to at least one of stiffen or shape the suture. 
     
     
         29 . The tissue anchor as in any of  claim 2  or  5 , in which the flexible elongated element comprises a wire or monofilament. 
     
     
         30 . The tissue anchor as in any of  claim 2  or  5 , in which the flexible elongated element extends through a sheath. 
     
     
         31 . The tissue anchor as in any of  claim 2  or  5 , in which the flexible elongated element extends along a U-shaped channel member. 
     
     
         32 . The tissue anchor as in any of  claim 2  or  5 , in which a segment of polymer or metal extends through a lumen of the flexible elongated element. 
     
     
         33 . The tissue anchor of  claim 5 , wherein a loop encircles a portion of the distal tip, the loop comprising the flexible elongated element, the aperture being defined between the flexible elongated element and a proximal end of the distal tip. 
     
     
         34 . The tissue anchor of  claim 33 , wherein the loop further comprises a joining member joining together the first and second tails of the flexible elongated element, and the joining member is received in a distal recess of the distal tip. 
     
     
         35 . The tissue anchor of  claim 5 , wherein the tissue anchor is a result of an assembly process comprising: a) assembling a tip assembly by causing a loop to encircle a portion of the distal tip, the loop comprising the flexible elongated element; and b) causing the tip assembly to be received in the distal opening of the body. 
     
     
         36 . The tissue anchor of  claim 35 , wherein the loop further comprises a joining member joining together the first and second tails of the flexible elongated element, and the joining member is received in a distal recess of the distal tip as part of assembling the tip assembly. 
     
     
         37 . The tissue anchor of  claim 1 , wherein the body further comprises a thread helically extending about an exterior of the body. 
     
     
         38 . The tissue anchor of  claim 37 , wherein the thread comprises a double helix thread comprising two distinct threads offset approximately 180 degrees from each other. 
     
     
         39 . The tissue anchor of  claim 1 , wherein the aperture has a minimum width to height ratio of three to one and a maximum width to height ratio of one to ten. 
     
     
         40 . The tissue anchor of  claim 1 , wherein the flexible elongated element is configured to flex in a twisting rotation manner such that the aperture can accommodate different suture exchange attack angles. 
     
     
         41 . The tissue anchor of  claim 1 , wherein the flexible elongated element is configured to flex in a twisting rotation manner such that a direction in which the aperture opens when the flexible elongated element is at maximum twisted rotation is between approximately 90 degrees and approximately 360 degrees from the direction in which the aperture opens when the flexible elongated element is in a non-deflected state. 
     
     
         42 . The tissue anchor of  claim 41 , wherein the flexible elongated element is configured to maintain the aperture sufficiently open to accommodate suture exchange despite being at the maximum twisted rotation. 
     
     
         43 . The tissue anchor of  claim 1 , wherein the flexible elongated element is configured to flex in a twisting rotation manner such that the aperture has no angles that are tighter than approximately 90 degrees when the flexible elongated element is at a twisted rotation of up to approximately 90 degrees from the direction in which the aperture opens when the flexible elongated element is in a non-deflected state. 
     
     
         44 . The tissue anchor of  claim 1 , wherein the aperture is configured to accommodate a minimum mass throughput of 4 sutures.