Tissue manipulation

Abstract

An apparatus and method for manipulating and anchoring tissue is provided. The invention is directed to solving the problem of manipulating and anchoring tissue within a joint when access to that tissue is limited, for example, during arthroscopic surgery.

1. An apparatus for insertion into and through tissue to provide a mechanism for manipulating and anchoring tissue within a patient, the apparatus comprising:
 an elongated anchor member having opposite ends that are tapered to be insertable into and through the tissue to be manipulated, the member being shaped to normally assume a substantially straight configuration; and 
 a suture irremovably attached to the anchor member between the opposite ends of the anchor member, the suture having an end free for manipulating the tissue into which the anchor member is inserted, the suture being flaccid in the vicinity of the anchor member so that the suture and anchor member do not assume a predetermined relative orientation. 
 
     
     
       2. The apparatus of  claim 1  wherein the suture is a flexible, non-stiffened member in the vicinity of the anchor member. 
     
     
       3. The apparatus of  claim 1  wherein the anchor member is resiliently deformable. 
     
     
       4. The apparatus of  claim 1  wherein the tapered ends of the anchor member define slanted end faces. 
     
     
       5. The apparatus of  claim 1  wherein the suture is attached to facilitate substantially perpendicular extension of the suture from the anchor member. 
     
     
       6. The apparatus of  claim 1  wherein the suture is attached to the anchor member medially thereof and extends laterally away from said elongated anchor member. 
     
     
       7. The apparatus of  claim 1  wherein the anchor member is insertable through the tissue to be manipulated by the suture to a position underneath the tissue and the suture extends therefrom to outside of the tissue. 
     
     
       8. The apparatus of  claim 1  wherein the suture and anchor member are configured such that the end of the suture is free for manipulating the anchor member to thereby manipulate the tissue. 
     
     
       9. The apparatus of  claim 1  wherein the free end of the suture is a first end and the suture also has a second end, which second end is fixed to the anchor member, and wherein the anchor member is insertable to a manipulation position underneath the tissue that is thereafter to be manipulated, and wherein in the manipulation position, the first end is outside the tissue and the second end is underneath the tissue. 
     
     
       10. The apparatus of  claim 1  wherein the suture and anchor member have a manipulation position in which the anchor member is substantially entirely underneath the tissue to be manipulated. 
     
     
       11. The apparatus of  claim 1  wherein the anchor member is attached to the suture near the longitudinal midpoint of the anchor member and the suture extends laterally therefrom. 
     
     
       12. The apparatus of claim 1 further comprising a second anchor member attached to the suture.  
     
     
       13. The apparatus of claim 12 wherein the second anchor member is slidingly attached to the suture.  
     
     
       14. The apparatus of claim 12 wherein the anchor members have different shapes.  
     
     
       15. The apparatus of claim 12 wherein the suture is flaccid in the vicinity of the second anchor member so that the suture and the second anchor member do not assume a predetermined orientation.  
     
     
       16. The apparatus of claim 12 wherein the suture is attached to facilitate substantially perpendicular extension of the suture from each anchor member.  
     
     
       17. A method, comprising:
 advancing an elongate member to place the elongate member relative to a first body structure of a patient,   placing a flat, circular member relative to a second body structure of the patient with a flat surface of the circular member against the second body structure, the two members being coupled by a flexible member, the circular member being slidable along the flexible member,   applying tension to the flexible member while sliding the circular member along the flexible member, the circular member acting to maintain tension on the flexible member, and   rotating the elongate member from a position substantially parallel to the flexible member during advancement of the elongate member to a position substantially perpendicular to the flexible member.    
     
     
       18. The method of claim 17 wherein the elongate member is rotated by pulling the flexible member.  
     
     
       19. The method of claim 17 wherein the two members are coupled by suture.  
     
     
       20. The method of claim 17 wherein the circular member is slid by urging the circular member along the flexible member.  
     
     
       21. The method of claim 17 wherein the flexible member is received through an opening in the circular member.  
     
     
       22. An apparatus for insertion into and through tissue to provide a mechanism for manipulating and anchoring tissue within a patient, the apparatus comprising:
 an elongated anchor member having a substantially cylindrical shape with opposite ends, the member having a first length along a first side and second length that is shorter than the first length along a second side that is opposite to the first side such that ends of the second side are axially spaced from ends of the first side, the member being shaped to normally assume a substantially straight configuration; and   a suture irremovably attached to the anchor member between the opposite ends of the anchor member, the suture having an end free for manipulating the tissue into which the anchor member is inserted, the suture being flaccid in the vicinity of the anchor member so that the suture and anchor member do not assume a predetermined relative orientation.    
     
     
       23. The apparatus of claim 22 wherein the suture is a flexible, non-stiffened member in the vicinity of the anchor member.  
     
     
       24. The apparatus of claim 22 wherein the anchor member is resiliently deformable.  
     
     
       25. The apparatus of claim 22 wherein the ends of the anchor member are tapered and define slanted end faces.  
     
     
       26. The apparatus of claim 22 wherein the suture is attached to facilitate substantially perpendicular extension of the suture from the anchor member.  
     
     
       27. The apparatus of claim 22 wherein the suture is attached to the anchor member medially thereof and extends laterally away from said elongated anchor member.  
     
     
       28. The apparatus of claim 22 wherein the anchor member is insertable through the tissue to be manipulated by the suture to a position underneath the tissue and the suture extends therefrom to outside of the tissue.  
     
     
       29. The apparatus of claim 22 wherein the suture and anchor member are configured such that the end of the suture is free for manipulating the anchor member to thereby manipulate the tissue.  
     
     
       30. The apparatus of claim 22 wherein the free end of the suture is a first end and the suture also has a second end, which second end is fixed to the anchor member, and wherein the anchor member is insertable to a manipulation position underneath the tissue that is thereafter to be manipulated, and wherein in the manipulation position, the first end is outside the tissue and the second end is underneath the tissue.  
     
     
       31. The apparatus of claim 22 wherein the suture and anchor member have a manipulation position in which the anchor member is substantially entirely underneath the tissue to be manipulated.  
     
     
       32. The apparatus of claim 22 wherein the anchor member is attached to the suture near the longitudinal midpoint of the anchor member and the suture extends laterally therefrom.  
     
     
       33. The apparatus of claim 22 further comprising a second anchor member attached to the suture.  
     
     
       34. The apparatus of claim 33 wherein the second anchor member is slidingly attached to the suture.  
     
     
       35. The apparatus of claim 33 wherein the anchor members have different shapes.  
     
     
       36. The apparatus of claim 33 wherein the suture is flaccid in the vicinity of the second anchor member so that the suture and the second anchor member do not assume a predetermined orientation.  
     
     
       37. The apparatus of claim 33 wherein the suture is attached to facilitate substantially perpendicular extension of the suture from each anchor member.  
     
     
       38. A method, comprising:
 advancing a first member into and through tissue in a patient, the first member being elongated and shaped to normally assume a substantially straight configuration and having a suture attached thereto between the opposite ends of the first member, the suture having an end free for manipulating the tissue into which the first member is inserted, the suture being flaccid in the vicinity of the first member so that the suture and member do not assume a predetermined relative orientation,   rotating the first member from a position substantially parallel to the suture during advancement of the first member to a position substantially perpendicular to the suture,   placing the first member at a first location within the patient,   placing a second member at a second location within the patient, the two members being coupled by the suture, the second member being slidable along the suture, and   applying tension to the free end of the suture, the length of the suture between the first and second members being shortened with the first and second members tending to be drawn together.    
     
     
       39. The method of claim 38 wherein the tissue comprises stable cartilage and torn cartilage, and further comprising:
 advancing the first member such that the suture extends from the stable cartilage to the torn cartilage, and   applying sufficient tension to the suture to retain the torn cartilage against the stable cartilage.    
     
     
       40. The method of claim 38 wherein the free end of the suture is a first end and the suture also has a second end, which second end is fixed to the first member, and further comprising inserting the first member to a manipulation position underneath the tissue that is thereafter to be manipulated.  
     
     
       41. The method of claim 38 wherein the first member is rotated by pulling the suture.  
     
     
       42. The method of claim 38 wherein the second member is placed after the first member.  
     
     
       43. A method, comprising:
 advancing an elongate member to place the elongate member relative to a first body structure of a patient,   placing a flat member relative to a second body structure of the patient, the two members being coupled by a flexible member, the flat member being slidable along the flexible member,   applying tension to the flexible member while sliding the flat member along the flexible member, the flat member acting to maintain tension on the flexible member, and   rotating the elongate member from a position substantially parallel to the flexible member during advancement of the elongate member to a position substantially perpendicular to the flexible member.    
     
     
       44. The method of claim 43 wherein the elongate member is rotated by pulling the flexible member.  
     
     
       45. The method of claim 43 wherein the two members are coupled by suture.  
     
     
       46. The method of claim 43 wherein the flat member is slid by urging the flat member along the flexible member.  
     
     
       47. The method of claim 43 wherein the flexible member is received through an opening in the flat member.