Devices and Methods for Advancing Knots

Abstract

Embodiments of a knot pusher and methods of use thereof are disclosed, that are usable for pushing a knot formed from a suture, two limbs of the suture extending from the knot. The knot pusher comprises a distal head defining top and bottom walls terminating in a distal knot pushing surface. The distal head includes at least two side grooves defined between the top and bottom walls that extend proximally from the knot pushing surface. Each of these side grooves is operable to receive one of the limbs of suture. The distal head additionally comprises a top wall suture receiving element for receiving one of the two limbs of the suture during advancement of the distal head to facilitate advancement of a sliding knot

We claim: 
     
         1 . A knot pusher usable for pushing a knot formed from a suture, two limbs of the suture extending from the knot, the knot pusher comprising:
 a distal head defining top and bottom walls terminating in a distal knot pushing surface;   at least two side grooves defined between said top and bottom walls and extending proximally from said knot pushing surface, each of said side grooves operable to receive one of the limbs of suture; and   a top wall suture receiving element associated with said top wall for receiving one of the two limbs of the suture during advancement of said distal head to facilitate advancement of a sliding knot.   
     
     
         2 . The knot pusher of  claim 1 , wherein the top wall suture receiving element comprises an intermediate groove formed within said top wall between said side grooves. 
     
     
         3 . The knot pusher of  claim 2 , wherein said intermediate groove extends proximally from said knot pushing surface longitudinally along the full length of said distal head. 
     
     
         4 . The knot pusher of  claim 2 , wherein said intermediate groove comprises a central groove. 
     
     
         5 . The knot pusher of  claim 1 , further comprising a handle coupled to said distal head for advancing said distal head, said handle being coupled to said distal head via an elongated shaft. 
     
     
         6 . The knot pusher of  claim 1 , wherein the knot pusher comprises at least one side groove suture retaining element for retaining one of the limbs of suture within said one of said side grooves. 
     
     
         7 . The knot pusher of  claim 6 , further comprising at least one suture guide coupled to said top and bottom walls for guiding the one of the limbs of suture into one of the side grooves. 
     
     
         8 . The knot pusher of  claim 7 , wherein said at least one suture guide comprises a suture containment element that defines a barrier for co-operating with the at least one side groove suture retaining element to retain said one of the limbs of the suture within said one of the side grooves. 
     
     
         9 . The knot pusher of  claim 7 , wherein the at least one suture guide comprises a pair of flanges that extend at an angle from said top and bottom walls. 
     
     
         10 . The knot pusher of  claim 9 , wherein the pair of flanges comprise a tapered configuration. 
     
     
         11 . The knot pusher of  claim 6 , wherein the at least one side groove suture retaining element comprises a resilient snap arm, said snap arm forming a portion of one of said top and bottom walls. 
     
     
         12 . The knot pusher of  claim 6 , wherein the at least one side groove suture retaining element comprises a resilient material that grips the suture in order to retain said one of the limbs of suture within said one of the side grooves. 
     
     
         13 . The knot pusher of  claim 11 , wherein the snap arm forms a portion of said bottom wall. 
     
     
         14 . The knot pusher of  claim 1 , further comprising a guiding edge that extends away from said distal head along a plane that is perpendicular to said distal head to maintain a separation between the two limbs of suture to enable loading of said two limbs of suture into the side grooves while said two limbs of suture are held substantially parallel to one another during use. 
     
     
         15 . The knot pusher of  claim 1 , further comprising a knot tracking component associated with said knot pusher to enable tracking of a number of overhand knots advanced by said knot pusher. 
     
     
         16 . The knot pusher of  claim 15 , wherein the knot tracking component is associated with one of said side grooves. 
     
     
         17 . The knot pusher of  claim 15 , wherein the knot tracking component is associated with said top wall suture receiving element. 
     
     
         18 . The knot pusher of  claim 1 , further comprising a tension maintaining element associated with said knot pusher for frictionally engaging one of the limbs of suture along a portion of said knot pusher to enable said one of the limbs of suture along a portion of said knot pusher to enable said one of the limbs of suture to be held in tension after advancement of said sliding knot. 
     
     
         19 . The knot pusher of  claim 18 , wherein said tension maintaining element comprises at least one finger allowing said one of the limbs of suture to be wrapped thereon in tension. 
     
     
         20 . The knot pusher of  claim 1 , wherein said side grooves comprise two top facing side grooves extending at least partially along a top face of said top wall to receive the two limbs of suture to enable advancement of an overhand knot.