One-way adjustable collar suture construct and methods of forming and using same

Abstract

Surgical constructs and methods for a unidirectional adjustable fixed loop formed by tying two knots in a surgical filament, each knot defining a separate adjustable loop and the separate adjustable loops interconnected to form the unidirectional adjustable fixed loop. The knots enable non-joinable sutures to be used in the formation of the unidirectional adjustable fixed loop. Embodiments can include fixation devices, such as cortical buttons or plates for bone tunnels, and enable the knots to function independently of the fixation device and to be suspended below the fixation device. Embodiments can increase the compatibility of the adjustable fixed loop with existing fixation devices and can isolate and protect the knots from damage during use and after implantation.

Description

TECHNICAL FIELD

[0001] The present application relates generally to devices and methods for securing soft tissue (e.g., ligaments, tendons, grafts) to bone, and more particularly to suture constructs employing specific loop configurations that are adjustable in one direction. BACKGROUND

[0002] Ligaments are fibrous tissues that connect bones to other bones within the body. Disruption of the tissue can occur in a variety of ways, for example, in work-related activities, during sports events, or in any of a number of other situations and / or activities due to accidents such as falls or overexertion. These types of injuries are often caused by excessive stress or a particular force exerted on the tissue. When a ligament is damaged, surgical reconstruction can be necessary because ligaments can not regenerate on their own. In the case of a partial disruption, often referred to by the general term "sprain," the injury often heals without medical intervention, the patient rests, and care is taken not to subject the injury to overly strenuous activity during the healing process. However, if a ligament or tendon is detached from its attachment site on one or more connected bones, or if a ligament or tendon is ruptured due to a traumatic injury, it can be necessary to perform a surgical intervention to restore full function to the injured joint.

[0003] There are a variety of surgical procedures for reattaching ligaments or other soft tissue to bone. One example is the anterior cruciate ligament reconstruction procedure. Figure 1 A knee 100 is shown that includes an anterior cruciate ligament 102 and a posterior cruciate ligament 104 that extend from the head of the tibia 106 to the intercondylar notch of the femur 108. These ligaments operate to prevent forward and backward relative motion between the two bones. When ruptured, for example, as can occur in a strenuous athletic activity, surgical reconstruction can be necessary.

[0004] A ligament graft taken from a cadaver (i.e., an allograft) or from the patient's own tissue (i.e., an autograft) can be used to repair a tear in the cruciate ligaments of the knee. The reconstruction procedure typically involves creating a hole in both the femur and the tibia, and then securing opposite ends of the ligament graft in these holes. In one cruciate ligament repair procedure, the ligament graft is associated with a surgical implant and secured to the femur. A common femoral fixation device includes an elongated "button," sometimes referred to as a cortical button. The cortical button is attached to a suture loop that is sized to allow a soft tissue graft of sufficient length to be located within the femoral tunnel, while providing a secure extra-cortical fixation.

[0005] Existing devices and methods can be limited because they do not always provide the desired strength or adjustability. In some cases, for example, one or more knots that are tied to help maintain the position of a suture loop relative to a cortical button, and thus the position of a graft associated therewith, can loosen or slide. Thus, even if a ligament graft is placed at a desired location during surgery, the circumference of the loop can increase postoperatively, causing the graft to move away from the desired location. Further, it can be desirable to limit the number of knots used in conjunction with such devices because knots have the potential to loosen, and because additional surface area of knots can increase the risk of trauma to surrounding tissue. Further, existing devices and methods also lack adjustability in many cases. For example, in surgeries in which multiple ligament grafts are associated with a cortical button, it can be difficult to control the placement of one ligament graft without moving another.

[0006] Current adjustable cortical buttons used in orthopedic surgery employing knots rely on button geometry and / or multiple loops to achieve security. These are limiting factors in device flexibility and add potential difficulty in usability. Joints have been used as one-way fixation elements to attempt to solve these problems, however, such configurations are limited at least because they are not suitable for suture with adhesive, have a sheath and / or core that tightens, and often require a loop with a longer length to achieve security, increasing the minimum adjustable length. Further, when used with a pure suspension fixation device (e.g., a cortical button without positioning / retaining features), migration of the button relative to the bone tunnel (which can be caused by device unloading due to non-isometric repair) can cause a reduction in the interference area on one side of the device, reducing fixation strength.

[0007] Accordingly, there is a need for improved graft fixation devices and methods for repair and reconstruction surgery, including, for example, the cruciate ligaments of the knee. In particular, there is a need for devices and methods for positioning and securing ligament grafts that provide increased strength and adjustability without engaging suture or using suture that cannot be engaged. SUMMARY

[0008] The present invention relates to suture constructs having a unidirectionally adjustable loop. The suture constructs can be formed from a single suture filament and, in at least some embodiments, can be coupled to one or more fixation bodies (e.g., cortical buttons) for use in various soft tissue repair procedures. The single suture filament includes at least two knots and at least two loop portions formed therein. Each loop portion extends from a respective knot, and the two loop portions are interconnected to form a unidirectionally adjustable loop. The two loop portions can be interconnected, for example, by passing one loop portion through an opening defined by the other loop portion. A sliding tail formed from the suture filament and extending from a knot can be operable to constrict the loop portions or otherwise reduce the size of the loop portions, which in turn constricts or otherwise reduces the size of the adjustable loop. Further, a constriction tail formed from the suture filament and extending from a knot can be operable to constrict the knot, thereby preventing the sliding tail from sliding relative to the knot. When the constriction line tail constricts the knot, the loop portions, and thus the adjustable loop, cannot expand. In at least some embodiments, the constriction tail forms a bridge portion that extends between the two knots, where the bridge portion holds the construct in a locked configuration such that the unidirectionally adjustable loop can be constricted but not expanded.

[0009] The constructs disclosed herein can be used in various surgical repair procedures in which soft tissue is to be disposed at a desired location relative to a bone. Procedures in which ligaments or grafts are designed to be disposed in a bone tunnel, such as ACL and MCL repairs, can benefit from the constructs and implant devices disclosed herein. The present disclosure also allows for advantageous use in other types of repairs, including but not limited to AC joint repairs, bunion repairs, and ankle syndesmosis repairs.

[0010] In one exemplary embodiment, a suture construct formed from a suture filament includes a first knot formed in the suture filament, a first tail of the suture filament extending from the first knot, a bridge portion of the suture filament, a second knot formed in the suture filament, and a second tail of the suture filament extending from the second knot. The first knot forms a first loop extending from the first knot, where the first loop defines a first loop opening. The bridge portion extends from the first knot, connecting the first knot to the second knot. The second knot forms a second loop extending from the second knot, where the second loop defines a second loop opening, and a portion of the second loop passes through the first loop opening to define an adjustable loop of the suture construct. The adjustable loop defines an adjustable loop opening. The first tail is configured to slide relative to the first knot to reduce a size of the first loop opening, and thus a size of the adjustable loop opening. Similarly, the second tail is configured to slide relative to the second knot to reduce a size of the second loop opening, and thus a size of the adjustable loop opening. The bridge portion is configured to prevent the adjustable loop opening from expanding when the suture is manipulated into a locked configuration.

[0011] At least one of the first knot or the second knot can be a self-locking knot. Non-limiting examples of such knots include a figure-8 slip knot, an extended figure-8 slip knot, and a Prusik knot. The suture filament can not be joined at the location of the first knot and the second knot. In some embodiments, the second suture filament can be configured to capture a portion of the knot and / or the knot to allow release of the constriction of the knot upon application of a pulling force to the second filament. In one exemplary embodiment of this configuration, the second filament passes through the first knot and the second knot, with a first branch of the second suture filament extending through the first knot and a second branch of the second suture filament extending through the second knot, such that tension on the branches loosens the respective first knot and / or the respective second knot.

[0012] The fixed body can be coupled to the bridging portion of the suture filament. For example, the bridging portion can pass through a plurality of through-holes disposed in the fixed body. In some embodiments, a second fixed body can be coupled to the adjustable collar.

[0013] The suture can also include an unlocked configuration. In some such embodiments, the suture can be configured to move between the locked configuration and the unlocked configuration by adjusting the relative loading of the bridging portion and / or the tail portions (i.e., the first tail and the second tail). In one exemplary embodiment of a surgical implant, the implant includes a fixed body and a suture filament coupled to the fixed body. The fixed body has a longitudinal axis extending therealong, a first side and a second side, and a first through-hole and a second through-hole. The suture filament includes a first portion having a first tail, a first knot formed on the first portion, and a first collar portion. The first tail extends through the first through-hole, the first knot is disposed on the first side of the body, and the first collar portion extends away from the body from the first knot. The suture filament also includes a second portion having a second tail, a second knot formed on the second portion, and a second collar portion. The second tail extends through the second through-hole, the second knot is disposed on the first side of the body, and the second collar portion extends away from the body from the second knot. The second collar portion is coupled to the first collar portion to define an adjustable collar of the surgical implant. The suture filament also includes a bridging portion extending from the first knot to the second knot. The first knot and the second knot are configured such that tension on the first tail constricts the adjustable collar by constricting the first collar portion, and tension on the second tail constricts the adjustable collar by constricting the second collar portion. The first knot and the second knot are further configured such that tension on the bridging portion prevents expansion of the adjustable collar.

[0014] At least one of the first knot or the second knot can be a self-locking knot. Non-limiting examples of such knots include a figure-8 slip knot, an extended figure-8 slip knot, and a Prusik knot. The suture filament can not be joined at the location of the first knot and the second knot.

[0015] In some embodiments, the bridging portion can extend from the first knot through the first through-hole, across the body, and through the second through-hole to the second knot. The implant can include a second fixation body, in which case the second fixation body can be coupled to the adjustable collar. The one or more fixation bodies can include a cortical button. In some embodiments, the fixation body can include a third through-hole. In some such embodiments, and in embodiments that include a second fixation body but do not necessarily include a third through-hole, the surgical implant can include a second suture filament that captures a portion of the first knot and the second knot, a first branch of the second suture filament extending through the first knot, and a second branch of the second suture filament extending to the second knot. The second suture filament can be configured such that tension on at least one of the first branch or the second branch loosens the respective first knot or the respective second knot.

[0016] One example method for making a surgical implant includes forming a first knot in a first portion of a suture segment to form a first tail extending from one side of the first knot and a second portion of the suture segment extending from an opposite side of the first knot. The method also includes forming a first collar from the second portion, with the first collar being closed by the first knot. Further, a second knot is formed in the second portion of the suture segment to form a second tail extending from one side of the second knot and a third portion of the suture segment extending from an opposite side of the second knot. The method also includes forming a second collar from the third portion, the second collar being closed by the second knot, and the second collar being interconnected with the first collar to define an adjustable fixation collar of a suture construct.

[0017] The second portion of the suture segment can include a bridging portion extending between the first knot and the second knot. In some embodiments, at least one of the first tail or the second tail can be configured to shrink a size of an opening defined by the adjustable fixation collar when tension is applied to the tail to shrink a size of the first opening or the second opening defined by the respective first collar or the respective second collar.

[0018] The method can also include passing the first tail through a first through-hole of the fixation body, passing the second tail through a second through-hole of the fixation body, and passing the second portion of the suture segment through at least two of: (1) the first through-hole of the fixation body; (2) the second through-hole of the fixation body; (3) another through-hole of the fixation body; or (4) another through-hole of the fixation body. Additionally, the method can include coupling the adjustable fixation collar to the second fixation body. BRIEF DESCRIPTION OF DRAWINGS

[0019] The present disclosure will be more fully understood from the following detailed description, taken in conjunction with the accompanying drawings, in which:

[0020] Figure 1 Schematic side view of the anatomy of a human knee;

[0021] Figure 2 Side view of an adjustable fixation implant;

[0022] Figure 3 Perspective view of a fixation body of an adjustable fixation implant of Figure 2

[0023] Figure 4A Perspective view of a suture construct of an adjustable fixation implant of Figure 2

[0024] Figure 4B Detail side view of a portion of a suture construct including two figure-8 nooses of Figure 4A

[0025] Figure 5 Side view of an adjustable fixation implant of Figure 2 having a second fixation body coupled to a suture construct that is further illustrated in Figure 4A

[0026] Figure 6 Schematic side view of one exemplary embodiment forming a figure-8 noose;

[0027] Figure 7A Detail side view of a portion of a suture construct similar to that of Figure 4A the suture construct of Figure 7A includes a figure-8 noose in an adjustment orientation disposed along Figure 6

[0028] Figure 7B Detail side view of the portion of the suture construct of Figure 7A disposed along a locked orientation;

[0029] Figure 8A Detail side view of a portion of a suture construct similar to that of Figure 4A the suture construct of Figure 8A includes an extended figure-8 noose in an adjustment orientation;

[0030] Figure 8B Detail side view of the portion of the suture construct of Figure 8A disposed along a locked orientation;

[0031] Figure 9A Detail side view of a portion of a suture construct similar to that of Figure 4A the suture construct of Figure 9A ​​​​​The suture construct of FIG. 1 includes a single Prussik knot;

[0032] Figure 9B The suture construct of FIG. 1 includes a single Prussik knot; Figure 4A The suture construct of FIG. 1 includes a single Prussik knot; Figure 9B The suture construct of FIG. 1 includes a single Prussik knot;

[0033] Figures 10A-10C The suture construct of FIG. 1 includes a single Prussik knot;

[0034] Figure 11 The suture construct of FIG. 1 includes a single Prussik knot;

[0035] Figure 12A The suture construct of FIG. 1 includes a single Prussik knot; Figure 4A The suture construct of FIG. 1 includes a single Prussik knot;

[0036] Figure 12B The suture construct of FIG. 1 includes a single Prussik knot; Figure 4A The suture construct of FIG. 1 includes a single Prussik knot;

[0037] Figure 12C The suture construct of FIG. 1 includes a single Prussik knot; Figure 4A The suture construct of FIG. 1 includes a single Prussik knot;

[0038] Figure 13 The suture construct of FIG. 1 includes a single Prussik knot; Figure 3 The suture construct of FIG. 1 includes a single Prussik knot; Figure 4A The suture construct of FIG. 1 includes a single Prussik knot;

[0039] Figures 14A-14C The suture construct of FIG. 1 includes a single Prussik knot; Figure 13 The suture construct of FIG. 1 includes a single Prussik knot; DETAILED DESCRIPTION

[0040] Certain exemplary embodiments will now be described to provide a comprehensive understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of this disclosure is defined only by the claims. Features shown or described in conjunction with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of this disclosure. Additionally, in this disclosure, components with similar numbers in the embodiments generally have similar features. Furthermore, the extent to which linear or circular dimensions are used in the description of the disclosed systems, devices, and methods is not intended to limit the types of shapes that may be used in conjunction with such systems, devices, and methods. Those skilled in the art will recognize that equivalent dimensions of such linear and circular dimensions can be readily determined for any geometry. The size and shape of systems and devices and their components may depend at least on the anatomy of the patient in whom the system and device will be used, the size and shape of the components with which the system and device will be used, and the methods and procedures in which the system and device will be used.

[0041] The accompanying drawings provided herein are not necessarily drawn to scale. Furthermore, the arrows used to describe the direction of tensionable or pulling components are exemplary and in no way limit the direction in which individual components can be tensioned or pulled. Those skilled in the art will recognize other manner and directions used to generate the desired tension or movement. Similarly, although in some embodiments the movement of a component is described relative to another component, those skilled in the art will recognize that other movements are possible. Additionally, many terms may be used interchangeably in this disclosure, but those skilled in the art will understand. By way of non-limiting example, the terms "suture," "filament," and "suture filament" may be used interchangeably.

[0042] This disclosure relates throughout to methods and apparatus for securing soft tissue (including, but not limited to, ligaments, tendons, and grafts) to bone or other desired locations within a patient (e.g., a human, animal). Surgical implants described herein typically include a body or fixation body, such as a “cortical button,” and a suture structure formed by a suture (also referred to as a filament or suture thread) that passes through the body in a manner providing a one-way adjustable loop or is otherwise associated with the body. The one-way adjustable loop may consist of two interconnected loops of the suture (see, for example...) Figure 2 and Figure 4A and Figure 4BThe one-way adjustable loop forms a loop portion 501, 503. The size of the one-way adjustable loop can be adjusted by manipulating one or both of the interconnected loops of suture using the ends of the suture. In use, a graft and / or other tissue (e.g., ligament, tendon) can be coupled to or otherwise associated with the one-way adjustable loop, such as by placing the tissue through an opening defined by the one-way adjustable loop with the one-way adjustable loop extending from a fixed body of the implant. By placing and securing the fixed body outside of a bone tunnel and securing the position of the one-way adjustable loop after it has been adjusted to a desired size and thus a desired position, the tissue can be securely positioned within the bone tunnel to maintain the position of the graft relative to the bone tunnel.

[0043] Figure 2 For one example repair implant 600, the example repair implant includes a surgical construct 400 coupled to or otherwise associated with a fixed body, such as a cortical button 200. The surgical construct includes a one-way adjustable loop 550 that can be formed from two loop portions 501, 503 that are interconnected to one another. The implant 600 is arranged with a first tail 502 of the surgical construct 400 (see Figure 3 for a better view of the second through hole 212) and a second tail 504 (see Figure 3 for a better view of the first through hole 210) that pass through the first through hole 210 of the body 200. The tails 502, 504 extend from knots 520, 540 formed on the surgical construct 400, with the knots 520, 540 disposed on the same side of the body 200 as the one-way adjustable fixation loop 550. The knots 520, 540 and / or the through holes 212, 210 can be sized such that the knots 520, 540 cannot easily pass through the through holes 212, 210. Additionally, a bridging portion 505 (see Figure 4A and Figure 4B ) can extend between the first knot 520 and the second knot 540. For example, in connection with the implant as shown in Figure 2 , the bridging portion 505 can extend from the first knot 520 through the second through hole 212, across an opposite face of the body 200 (as compared to the one-way adjustable fixation loop 550), through the first through hole 210, and to the second knot 540. Alternatively, more similar to Figure 4A and 4BThe bridge portion 505 can extend directly between the two knots 520, 540 without passing through, over, across, and / or contacting the body 200, as provided in the illustration of the suture construct 400. The fixed collar 550 is considered a one-way collar in that force applied to the collar 550, such as by applying it to the body 200, to expand the one-way adjustable fixed collar 550 is impeded by the bridge 550, thereby constricting the knots 520, 540 and preventing the tail portions 502, 504 from sliding.

[0044] In Figure 2 In the illustrated configuration, tension on either the first tail portion 502 or the second tail portion 504, such as tension on either or both of the tail portions 502, 504 by a force applied in the direction D, can reduce the size of the opening 507, 509 defined by the collar portion 501, 503 associated with the respective tail portion 502, 504 and knot 520, 540. As the size of the opening 507 and / or 509 is reduced, the size of the opening 552 defined by the one-way adjustable fixed collar 550 is also reduced. More specifically, as one or both of the openings 507, 509 constrict, the end 550t of the collar 550 moves toward the body 200, with the end 550t generally at the location where the two collar portions 501, 503 of the filament are joined to one another. Those skilled in the art will recognize that the filament can be moved such that the end 550t is not necessarily at the location where the two collars 501, 503 of the filament are joined. For example, if one of the collar portions 507, 509 is significantly larger than the other, the end 550t can not be at the location where the collar portions 507, 509 are joined to one another. Thus, the end 550t of the collar 550 can more generally be the portion of the collar 550 that is generally farthest from the body 200, and in at least some cases, this end can be at the location where the collar portions 507, 509 are interconnected.

[0045] Additionally, Figure 2 The illustrated configuration is configured such that tension or force applied to the body 200 and / or the adjustable fixed collar 550 to attempt to expand the adjustable fixed collar 550 can be impeded because such applied tension or force can cause tension on the bridge portion 505, which in turn can constrict or lock the two knots 520, 540. Nonetheless, the present disclosure contemplates the ability to“unlock” the knots 520, 540 such that the constriction of the collar 550 can optionally be reversed, as described in more detail below.

[0046] In operation, the tails 502, 504 of the suture 500 can be pulled together or in an alternating fashion to reduce the length of the adjustable securement collar 550 as desired. After the desired position of the adjustable securement collar 550 is achieved, a force can be applied to the adjustable securement collar 550 to create tension and cause the knots 520, 540 to contract against the slidable portion of the suture 500 (e.g., such that the suture tails 502, 504 pass through their respective knots 520, 540), thereby maintaining the length of the adjustable securement collar 550.

[0047] The knots 520, 540 in the construction of the collar 550 allow for the use of non-joinable sutures 500 in the formation of the one-way adjustable securement collar 550. Even if the suture 500 is joinable, the construct 400 configuration can be such that no joint is used at least at the location where the knots 520, 540 are located. In contrast to a joint, the use of knots provides enhanced safety and greater flexibility in manufacturing a one-way contractive collar, as this allows for the use of sutures that are not compatible with alternative locking mechanisms, such as a joint, and has other beneficial effects. Thus, the knots 520, 540 provided herein can be described as non-joining, as these knots do not incorporate a joint as has been used previously in medical applications. The implant 600 and other configurations disclosed herein, as well as components thereof (e.g., various configurations of suture constructs), allow the knots 520, 540 to function independently of the body 200 (e.g., a primary fixation device, a cortical button, an anchor, or a plate). This arrangement increases the compatibility of the adjustable securement collar 550 for use in conjunction with many different types of fixation devices, and this arrangement, at least in part due to the knots 520 being disposed on one side of the body 200 and the tails 502, 504 being disposed on the other side of the body 200, facilitates isolation and / or protection of the knots 520, 540 when the user trims the tails 502, 504. Further, in contrast to a joint, the use of the knots 520, 540 provides a construct 400 with a shorter locking mechanism. In contrast to the knots 520, 540, which are in the range of about 2 millimeters per knot to about 3 millimeters per knot, a typical joint is about 17 millimeters in length. The shorter length of the knots takes up less collar length, and thus provides greater adjustability in use.

[0048] In the illustrated embodiments, the surgical construct 400 is formed from a single filament. However, those skilled in the art will appreciate that the disclosure provided herein can be adapted for use in forming from multiple filaments. For example, in some cases, a bridging portion similar to the bridging portion 505 can be formed by tying or otherwise connecting two separate filaments together, each filament having one knot, one looped portion, and one sliding tail, similar to the knots 520, 540, looped portions 501, 503, and sliding tails 502, 504 formed therein. Use of a single filament can provide benefits in terms of ease of manufacture and / or formation, strength, reliability, and the like. Notably, with respect to any of the illustrations herein that appear to show filaments of different colors or shading, such differences exist to emphasize the differences between the portions of the filament used for various features (e.g., tails, looped portions, etc.); the illustrated embodiments are each formed from a single filament.

[0049] Figure 3 One embodiment of a body 200 for use in conjunction with the suture constructs provided in the present disclosure is shown. The body, also referred to as a “cortical button,” 200 can be elongate and slightly rectangular in shape with rounded or curved ends 202, 204. A plurality of through-holes extending between a first side 206 and an opposite second side 208 can be formed in the body. A first through-hole 210 and a second through-hole 212 can be adjacent to one another and positioned such that their centers are disposed along a longitudinal axis 214 of the body 200. A third through-hole 216 can be positioned between the first and second through-holes 210, 212, and the center of this third through-hole can be offset from the longitudinal axis 214, as shown. The body 200 can also include a fourth through-hole 218 and a fifth through-hole 220 positioned outside of the first and second through-holes 210, 212 and proximate to the ends 202, 204 of the body. These through-holes can also be centered along the longitudinal axis 214.

[0050] As shown, the first through fourth through-holes 210, 212, 218, 220 can have substantially the same diameter, and for each adjacent pair, the spacing separating the adjacent through-holes can be substantially the same. The length L of the body 200 can be defined by the distance between the ends 202, 204, and the width W can be defined by the distance between the first and second side walls of the body 200 extending along the first or second surfaces 206, 208. The body 200 can also have a thickness T defined by the distance between the first and second surfaces 206, 208, as shown. Figure 3

[0051] ​In some embodiments, the length L of the body 200 can be in a range of about 5 mm to about 20 mm, the width W can be in a range of about 2 mm to about 6 mm, and the thickness T can be in a range of about 1 mm to about 3 mm. In one exemplary embodiment, the length L can be about 12 mm, the width W can be about 4.25 mm, and the thickness T can be about 2 mm.

[0052] The diameter of the through holes 210, 212, 216, 218, 220 can be in a range of about 1 mm to about 2 mm. The diameter of the first through hole 210 and the second through hole 212 can be selected such that a knot formed by a suture segment cannot pass through the hole. Additionally, in some embodiments, the third through hole 216 can be smaller than the first through hole 210 and the second through hole 212. For example, in one embodiment, the diameter of the first through hole 210, the second through hole 212, the fourth through hole 218, and the fifth through hole 220 can be about 1.6 mm, and the diameter of the third through hole 216 can be about 1.2 mm.

[0053] The body 200 can include one or more features that allow for easier manipulation of a length of suture passing therethrough. For example, the top edge 222 or the bottom edge 224 of any of the through holes 210, 212, 216, 218, 220 can be chamfered or rounded so as to ease passage of a suture segment therethrough and reduce the likelihood of damaging the suture segment by contact with a corner having a sharp edge. Additionally, one or more cutouts can be provided on the second surface 208 of the body 200 to facilitate pulling a suture segment through one of the plurality of through holes when the second surface 208 is, for example, pressed against the outer surface of a bone.

[0054] In some embodiments, the body 200 can include a recess on the second surface 208 to receive a knot 520, 540 of the construct 400 when the body 200 is pressed against a surface, such as a bone. Such a configuration can prevent the knot 520, 540 from interfering with contact between the second surface 208 and the surface of the bone, or at least minimize the impact of the knot 520, 540 on such contact.

[0055] Figure 3The illustrated body 200 is merely one example of a body in accordance with the teachings provided herein. Bodies configured to be associated with suture segments to form surgical implants as described herein can have a variety of different shapes, sizes, and features, and can be made from a variety of different materials. These various shapes, sizes, and materials can depend at least in part on the characteristics of other components used with the body, such as suture lengths, soft tissue graft types, and the like. The shapes, sizes, and materials can also depend on the particular type of surgery for which the body is used for implantation. Thus, while in the illustrated embodiment the body 200 is somewhat rectangular with curved ends 202, 204, in other embodiments the body can be substantially tubular or have any of a variety of other shapes. Configurations other than cortical buttons are possible as well, and thus the term “body” is in no way limited to include only cortical buttons. Various anchors, plates, and other fixation devices known to those of skill in the art can be used in conjunction with the suture constructs provided herein (e.g., the construct 400) or otherwise derived from the present disclosure to form adjustable fixation implants, such as the implant 600.

[0056] Additionally, the arrangement of the plurality of through holes formed through the body 200 can also be varied. For example, in the illustrated embodiment the longitudinal axis 214 is shown as a central longitudinal axis of the body. However, in other embodiments the axis 214 can be offset toward one side of the body. The plurality of through holes can similarly be offset, or can be angled with respect to the body 200. Additionally, the first through hole 210 and the second through hole 212 are not necessarily centered along the same axis as the fourth through hole 218 and the fifth through hole 220. In some cases, fewer or more through holes can be used. For example, in some cases the third through hole 216 can be omitted. However, where the third through hole 216 is used, generally the center of the third through hole 216 should be offset from any axis defined by the centers of the first through hole 210 and the second through hole 212.

[0057] In conjunction with Figure 3 The description and illustration of the implantable bodies provided is merely an example of a surgical implant for securing soft tissue to bone that can be used in conjunction with the suture constructs provided herein (e.g., the suture construct 400). Non-limiting examples of surgical implants and methods for securing soft tissue to bone are further provided below and in U.S. Patent Nos. 9,974,643 and 9,757,113, the contents of each of which are hereby incorporated by reference in their entirety. More specifically, techniques for performing surgery and implant bodies of the types disclosed therein can be used in conjunction with the suture constructs and related techniques disclosed herein.

[0058] Figure 4A and 4BA surgical construct 400 of implant 600 is shown, the construct 400 including a unidirectional adjustable loop 550 constructed using two 8-shaped lasso knots 520, 540. As shown, the surgical construct 400 can be made from a single suture segment 500 having a first tail 502 extending from a first knot 520 and a second tail 540 extending from a second knot 540. The knots 520, 540 can be tied in two segments of suture 500 such that extending from opposite or opposing sides of the knots are the tails 502, 504 and adjustable loop portions or loops 501, 503, which define openings 507, 509. The loops 501, 503 can be closed loops defined by the respective knots 520, 540. As shown, the ends of the loop portions 501, 503 (shown at terminal ends 550t) can be coupled to form a unidirectional adjustable securement loop 550, which itself defines an opening 552. In the illustrated embodiment, the loop portions 501, 503 are coupled by passing the filament 500 from one loop portion (e.g., loop portion 503) through an opening (e.g., opening 507) defined by the filament 500 from the other loop portion (e.g., loop portion 501). Thus, each loop portion 501, 503 passes through a respective opening 507, 509 defined by the filament 500 of the other loop portion 501, 503. Other ways of coupling one loop portion to the other loop portion are possible if such a configuration allows the filament 500 of the loop portion 501 and / or 503 to be advanced toward the knots 520, 540 (and / or toward a securement body when the construct 400 is used in conjunction with a securement body) to reduce the size of the opening 552 defined by the unidirectional adjustable securement loop 550. In operation, tension on either of the first tail 502 and the second tail 504 can cause the corresponding openings 507, 509 of the first adjustable loop portion 501 and the second adjustable loop portion 503 to decrease, which in turn can decrease the size of the opening 552 defined by the unidirectional adjustable securement loop 550.

[0059] The knots 520, 540 can be formed on the filament 500 in many different ways. In the illustrated embodiment shown in greater detail in Figure 4B , the knots 520, 540 are formed as 8-shaped lasso knots. More generally, the knots 520, 540 can be most appropriately classified as being of the type of slip knots and / or single-strand single-loop slipknots. In contrast to the tails 502, 504 on which the knots 520, 540 are sliding, these knots can exhibit self-locking behavior when arranged in the unidirectional surgical construct 400 due to, for example, the majority of tension applied to 552 being directed to the knots 520, 540. The illustrated embodiment provides some exemplary self-locking knots, including 8-shaped lasso knots (see Figures 4A-7B ), extended 8-shaped lasso knots (see Figure 8A , andFigure 8B ) and Prussik knots (see Figure 9A and Figure 9B ), which exemplary self-locking knots allow the knots to be used in a one-way configuration while still having the ability to reverse if desired. The illustrated embodiments in no way limit the type and / or number of knots (e.g., knots 520, 540) that can be used in conjunction with the suture constructs (e.g., construct 400) provided herein to achieve the desired functionality of the construct. Those skilled in the art will recognize other knots suitable for use in conjunction with the constructs and implants of the present disclosure in light of the present disclosure. Additionally, the bridging portion 505 connects the first knot 520 to the second knot 540, and tension on the bridging portion 505 can cause the knots 520, 540 to contract and prevent the one-way adjustable securement loop 550 from expanding.

[0060] Manipulating the single filament 500 to form each of the tail portions 502, 504, the loop portions 501, 503, the knots 520, 540, and the bridging portion 505 can be accomplished in a variety of ways. The order in which the various features of the construct 400 (e.g., tail portions, loop portions, knots, bridging portions, etc.) are formed is generally not critical. As generally shown, the single filament 500 includes two ends that ultimately become the tail portions 502, 504. In one exemplary embodiment, the filament 500 is extended from the tail portion 502, forms the first loop 501, and is tied around the tail portion 502 to form the knot 520 and the opening 507. The filament 500 can exit the first knot 520 and can be tied into the knot 540, thereby forming the bridging portion 505. The working end of the filament 500 can be passed through the opening 507 and can be formed into a loop around the loop 501 to form the loop 503. The working end can be returned and passed through the knot 540 to form the opening 509 and the tail portion 504.

[0061] In some embodiments, and as shown in Figures 10A-10C and Figure 11 , soft tissue can be suspended through the one-way adjustable securement loop 550, thereby coupling the soft tissue to the loop 550, and more generally to the repair implant (e.g., implant 600). Any number of techniques can be used to associate the soft tissue with the loop 550, thereby forming a coupled configuration in which movement of the loop 550 causes movement of the soft tissue. In some embodiments, the one-way adjustable securement loop 550 can be suspended on a primary securement device (such as a cortical button 200 or plate) by the bridging portion 505 of the suture 500 between the two knots 520, 540. In other embodiments, as described in greater detail below, the construct 400 can operate on its own without any securement device coupled to it. In other embodiments, as also described in greater detail below, the construct 400 can operate with multiple (i.e., two or more) securement devices. Figure 5One example of this configuration is provided.

[0062] Figure 5 For an illustration of one embodiment of a surgical implant 700 including a suture 500 having a unidirectionally adjustable loop 550 formed by two loop portions 501, 503 and knots 520, 540, and two cortical buttons 200, 200'. The second body 200' can be threaded onto or otherwise associated with the adjustable fixation loop 550 using techniques known to those of skill in the art for associating a fixation body with a suture. In the illustrated embodiment, the loop portion 503 is threaded through one through-hole 210' of the body 200', and back through a second through-hole 212' of the body 200'. The second body 200' can be used in a variety of situations, including but not limited to pulling two sides of a bone or two separate bones together by selectively applying tension to one or both of the tail portions 502, 504. Further, the following discussion with respect to Figures 12A-12C Additional non-limiting examples of implant configurations utilizing multiple fixation bodies are described.

[0063] The construct 400 itself can be used to achieve similar functionality without a fixation body, such as pulling two bones together. More generally, the construct 400 can be used with other components of the body other than bone (e.g., tissue), and even in situations outside of surgery, and thus with one or more objects. Some non-limiting examples of types of procedures that can benefit from the use of multiple fixation bodies in conjunction with the constructs disclosed herein (e.g., the construct 400) can include AC joint repair, bunion repair, and syndesmosis repair of the ankle joint. While the discussion herein focuses primarily on use in the medical field, those of skill will appreciate that the suture constructs provided herein can be applied in many fields and industries, as the suture constructs generally can be used to advance one or more objects toward a fixed position and / or to advance one or more objects toward another object.

[0064] Figure 6 One exemplary embodiment for forming a figure-8 lasso knot using a suture 700 is shown. As shown, the suture 700 includes a terminal end 701t. The suture 700 forms a figure-8 configuration 708, with the terminal end 701t extending through the upper half 720a of the figure-8 as it completes the shape of the figure-8, as shown at location E. The suture 700 can pass through the upper half 720a of the figure-8 at least once, as shown at location F, and through the lower half at least twice, as shown at locations G and H. In the case of the constructs provided herein, the portion of the suture 700 on the end of the suture opposite the terminal end 702t (at the knot 520) can be used to form a loop 550, as shown at location I. The loop 550 can be used to secure the suture 700 to a fixation body, such as the body 200, as shown at location J. The suture 700 can be used to form a figure-8 lasso knot in a variety of ways, and the above-described embodiment is merely one example of a figure-8 lasso knot that can be formed using the suture 700. Figure 6The portion 701t is used to form the remaining portion of a suture structure (e.g., structure 400) according to this disclosure, and therefore does not generally indicate the relative ends of the suture 700. Furthermore, in the case of the structure provided herein, the portion 703 of the filament 700 may be a loop portion, and the end 702t may be a tail portion.

[0065] Figure 7A The system is shown Figure 6 The figure-eight lasso knot 720 forms the lasso portion 703, the sliding tail or rear portion 702 (with... Figure 6 (associated with part 702t) and contraction tail 701 (with Figure 6 The suture 700 is associated with the end 701t. In operation, the sliding tail 702 is freely pulled through the figure-eight knot 720 to cause the loop portion 703 to contract, that is, to reduce the size of the opening 709 defined by the loop portion 703. As described above, such movement can also reduce the size of the opening defined by the loop portion 703 and the interconnecting loop portions (not shown). Figure 7B As shown, the suture 700 can be placed in a locking configuration by applying tension to the contraction tail 701. More specifically, by applying tension in directions P and P′ respectively, opposing tensions can be applied to the contraction tail 701 and the loop 703, causing the knot 720 to contract such that the tail 702 is substantially perpendicular to the direction in which the tail 702 naturally exits the knot 720 and / or substantially perpendicular to the force applied to the loop portion, causing the knot to contract or lock, thereby preventing the sliding tail 702 from moving further through the figure-eight lasso knot 720. Those skilled in the art will recognize that the force applied to the contraction tail 701 to place the knot 720, or more generally the suture structure including the knot 720, in a locking configuration does not necessarily have to be in a direction substantially perpendicular to the direction in which the tail 701 naturally exits the knot 720 and / or substantially perpendicular to the direction in which the sliding tail 702 is substantially perpendicular, and there are other ways in which the knot 720 can be placed in a locking configuration.

[0066] Figure 8A A suture 800 is shown, forming an extended figure-eight lasso knot 820 to create a loop portion 803, a contracted tail or rear portion 801, and a sliding tail or rear portion 802. In operation, the sliding tail 802 is freely pulled through the figure-eight lasso knot 820 to contract the loop portion 803, i.e., to reduce the opening 809 defined by the loop portion 803. Figure 8B The opening becomes smaller. As mentioned above, this type of movement can also reduce the size of the opening defined by the collar portion 803 and the interconnecting collar portions (not shown). Figure 8BAs shown, the suture 800 can be placed in a locking configuration by applying tension to the contraction tail 801. More specifically, tension can be applied to the contraction tail 801 and the loop 803 by applying opposite tensions in directions R and R′, respectively, to cause the knot 820 to contract or lock, thereby preventing the sliding tail 802 from moving further through the extended figure-eight lasso knot 820. Those skilled in the art will recognize that the force applied to the contraction tail 801 to place the knot 820, or more generally the suture structure including the knot 820, in the locking configuration does not necessarily have to be in directions R and R′, and there are other ways to place the knot 820 in the locking configuration. Compared to the figure-eight lasso knot 720, the extended figure-eight lasso knot 820 reduces the bending of the sliding tail 802. Similar to the figure-eight lasso knot 720, the contraction tail 801 can be part of a bridging portion, and the knot 820 can also be reversible, allowing the sliding tail 801 to move again.

[0067] Figure 9A A suture 900 is shown forming a Prussian knot 920 to create a loop portion 903, a contracting tail 902, and a sliding tail or rear portion 901. For example, a Prussian knot 920 can be formed by piercing the central portion of the suture 900 with the end of the suture 900. In operation, the sliding tail 901 is freely pulled through the Prussian knot 920 to contract the loop portion 903, i.e., to reduce the size of the opening 909 defined by the loop portion 903. As described above, such movement also causes the loop portion 903 and the interconnecting loop portions ( Figure 9A The opening defined (not shown) becomes smaller. The suture 900 can be placed in a locking configuration by applying tension to the contraction tail 902 and the collar 903. More specifically, by applying forces in directions K and K′, relative tensions can be applied to the contraction tail 902 and the collar 903 to cause the knot 920 to contract or lock, thereby preventing the sliding tail 901 from moving further through the Prussian knot 920. Those skilled in the art will recognize that the force applied to the contraction tail 902 to place the knot 920, or more generally the suture structure including the knot 920, in a locking configuration does not necessarily have to be in the illustrated directions, but generally only requires tension to be generated in the contraction portion of the knot 920. Those skilled in the art will also recognize that other ways exist to place the knot 920 in a locking configuration. Similar to knots 720 and 820, the tail 902 can be part of a bridging portion, and the knot 920 can also be reversible, allowing the sliding tail 901 to move again and / or the collar portion 903 to expand.

[0068] Prussian knot 920 can be stacked in series as needed to increase security, and Figure 9BA surgical construct 400' is shown that includes two Prussik knots 921, 922 forming a first loop portion 501' of an adjustable fixed loop 550' that defines an opening 552', and two Prussik knots 941, 942 forming a second loop portion 503' of the adjustable fixed loop 550'. The Figure 9A In comparison to Figure 9B , the equivalent of the shrink tail 902 can form the bridge portion 505', the equivalent of the slide tail 901 can form the first tail 502' and the second tail 504', and the equivalent of the loop portion 902 can form the first loop portion 501' and the second loop portion 503'. When used with a cortical button (not shown) such as a free-floating cortical button, the increased cross-sectional area created by the knots 921, 922, 941, 942 suspended beneath the button can act as a positioning mechanism within the bone tunnel, thereby more tightly constraining the position of the button relative to the tunnel hole of the tunnel. This can help center the body around the tunnel and reduce the likelihood of fixation failure of the initial fixation compared to solutions in which the suture beneath the button is straight. Indeed, any of the configurations provided herein can allow the knots (e.g., knots 520, 540, 720, 820) to act as a positioning mechanism.

[0069] As shown in Figure 9B , where the equivalent of the tails 901, 902 of the Prussik knot 920 can be used to form the first tail 502', the second tail 504', and the bridge portion 505', respectively, and the equivalent of the loop portion 903 can be used to form the first loop portion 501' and the second loop portion 503', when the figure-eight noose knot 720 or the extended figure-eight noose knot 820 is used for the surgical construct 400, the tails 502, 504 of the surgical construct 400 can be the slide tails 702, 802, the loop portions 501, 503 of the surgical construct 400 can be the loop portions 703, 803, and the bridge portion 505 of the surgical construct 400 can be the shrink tail 701, 801.

[0070] Furthermore, the present disclosure allows the tails 702, 802, 901 to move back to a configuration more similar to that shown in Figure 7A , Figure 8A and Figure 9A to remove the knot 720, 820, 920 from the locked configuration, thereby allowing the slide tails 702, 802, 901 to move again. When the shrink tail 701, 801, 902 is in the unlocked configuration, tension can be applied to the loop portion 703, 803, 903 to allow the opening 709, 809, 909 defined by the loop portion 703, 803, 903 to expand.

[0071] Figures 10A-10C is an illustration of the steps of a collar for tightening a one-way adjustable collar. Figure 10A An implant 600 is shown that includes a surgical construct 400 and a body 200, with soft tissue 110 coupled to an adjustable securement collar 550. The adjustable securement collar is formed from collar portions 501 and 503. Figure 10B A tightening or contraction operation is shown in which a force applied in direction S to either or both of the first tail 502 and the second tail 504 of the surgical construct 400 causes the adjustable securement collar 550 to contract, thereby reducing the size of the opening 552 and pulling the soft tissue 110 toward the body 200 to the Figure 10C position shown. More specifically, a tensile force applied to the tail 502 can cause the collar portion 501 to contract, and a tensile force applied to the tail 504 can cause the collar portion 503 to contract. In Figure 10C the event, a force applied in direction T to the soft tissue 110 does not cause the adjustable securement collar 550 to expand, as the resulting tensile force causes the bridging portion 505 of the surgical construct 400 to contract the knots 520, 540, which means that the knots 520, 540 are in a locked configuration. As described elsewhere herein, the knots 520, 540 are movable to an unlocked configuration, in which case a force applied in direction T, as well as other forces applied to the collar 550, can cause such expansion.

[0072] The ability to use the knots 520, 540 using sutures 500 that are incompatible with alternative locking mechanisms (e.g., a joint) allows for greater flexibility in the manufacturability of the one-way contraction collar construct 400. One such example is a suture having a solid core, such as DePuy Synthes Dynacord TM suture, available from DePuy Synthes Sports Medicine (Mitek) of Raynham, MA. The Dynacord TM suture is configured to have a solid core, which is critical to the contraction ability of the suture when wet. Additional information regarding such suture configurations is provided in at least U.S. Patent No. 8,870,915 to Mayer et al., the contents of which are incorporated by reference herein in their entirety. The contraction behavior of the constructs provided herein (e.g., the construct 400) can be used in conjunction with Dynaccord technology to resist loss of repair due to creep, reapproximation of tissue between which a gap has formed, or maintenance of compression forces on approximated tissue. The presence of a solid core and the need for a locking mechanism (such as a knot outside of the suture core) due to the need for a close relationship with the suture braid.

[0073] The foregoing, for example, in connection with Figures 10A-10CThe cinching steps described can also be used in conjunction with surgical procedures. The surgical constructs and implants provided herein can be used in a variety of procedures to secure soft tissue grafts to bone. One common procedure is to repair a torn or ruptured ACL in a patient's knee. An exemplary repair procedure can include forming bone tunnels through the patient's tibia 106 and femur 108 (see Figure 1 ) in a manner known in the art. This can result in bone tunnels 130 as shown, for example, Figure 11 .

[0074] Figure 11 The implant 600 provided in FIG. 6 includes the suture construct 400 and the fixation body 200. The bridging portion 505 extending between the two knots 520, 540 can be suspended across the body 200, which is seated on the distal side of the bone 108 once implanted. Each knot 520, 540 has a suture tail 502, 504, respectively, extending from one side of the knot, a tail extending through the button 200, and a filament forming a loop 501, 503, respectively, extending from the opposite side of the knot 520, 540. The loops 501, 503 form an interlocking loop portion, shown at terminal end 550t Figure 2 ), forming a one-way adjustable fixation loop 550.

[0075] The implant 600 can be prepared by coupling a ligament graft taken from a cadaver or the patient's own tissue (e.g., soft tissue 110) to the body 200 through the one-way adjustable fixation loop 550. The soft tissue 110 is suspended on or otherwise associated with the one-way adjustable fixation loop 550, and tension can be applied to the suture tails 502, 504 to reduce the size of the opening of the loop 550 until the soft tissue 110 is in a desired position relative to the bone tunnel 130.

[0076] More particularly, after the tunnel 130 is drilled through the bone 108 at the repair site, the implant 600 can be introduced. In some cases, the suture construct 400 and the body 200 can already be coupled together to form the implant 600. In other cases, the suture construct 400 can be associated with one or more bodies 200 to collectively perform the repair.

[0077] The body 200 can be introduced into a bone tunnel of the patient's tibia 106 and pulled through the tibia and femur 108 until the body 200 emerges on the exterior portion of the patient's femur. To pull the body 200 through the bone tunnel, a shuttle suture (not shown) can be threaded through the fourth through-hole 218 (see Figure 3). The shuttle suture can be used to pull the body generally along its longitudinal axis 214 through the bone tunnel 130 to minimize the cross-sectional area of the body. Pulling the body 200 in this manner can also pull the fixation loop 550 and the graft 110 into the patient's body.

[0078] After the body 200 emerges from the bone tunnel 130 at the outer surface of the femur 108, the body 200 can be flipped to an orientation in which the second side 208 is placed flush against the outer surface of the femur, such that the body 200 cannot re-enter the bone tunnel 130. Flipping the orientation of the body 200 can be accomplished by pulling a rotation suture (not shown) that can pass through a fifth through-hole 220 (see Figure 3 ) proximate the second (rear) end 204 of the body 200. It should be noted that both the shuttle suture and the rotation suture can be passed through the fourth through-hole 218 and the fifth through-hole 220 or other through-holes, if desired, prior to introducing the body 200 into the bone tunnel. After the body 200 has been pulled through the bone tunnel and flipped to be placed flush against the outer surface 302 of the femur 108 (as shown in Figure 11 ), the shuttle suture and the rotation suture can be removed by pulling only their free ends.

[0079] As shown in Figure 11 , and similar to that described above with respect to Figures 10A-10C , the ends 502, 504 can be tensioned in the direction of the arrow 304 to reduce the size of the unidirectional fixation loop 550 and pull the ligament graft 110 into the bone tunnel 130 formed in the femur 108. The size of the fixation loop 550 can be reduced until a desired amount of the graft 110 resides within the bone tunnel 130. Tensioning the ends 502, 504 of the suture segment 500 pulls the suture through the corresponding knots 520, 540 positioned below the body 200. The bridging portion 505 of the suture 500 connects the first knot 520 to the second knot 540 such that locking and securing the body by tensioning the bridging portion 505 so that the two knots 520, 540 abut against the femur 108 prevents the body 200 from moving away from the femur 108. If desired, additional supplemental fixation (e.g., by way of one or more half-knots) can be applied to the tails 502, 504.

[0080] To complete the procedure, the ends of the ligament graft 110 can be secured within the bone tunnels 130 formed in the patient's tibia 106 in any of a variety of ways known in the art. In certain embodiments, the ends 502, 504 can be joined together to provide the user with a single suture bundle for tensioning. This can be accomplished in a variety of ways known in the art. In some embodiments, for example, the ends 502, 504 can be associated together, such as by threading one end into the other end in vivo, to form a single end. When the desired depth / repair tension is achieved, the suture tails 502, 504 can be trimmed to a length. Additional details related to implantation techniques that can be used in conjunction with the present disclosure are provided in U.S. Patent Nos. 9,974,643 and 9,757,113 (the contents of each of which are incorporated by reference above), including but not limited to details that further extend the disclosed techniques and provide alternatives to the described techniques.

[0081] As noted above, embodiments of the present disclosure include the use of two or more fixation bodies. The bodies can be closed geometries, where the collar passes through the button when assembled (as shown in Figure 5 or open geometries, where the collar hangs over a portion of the button, as shown in Figures 12A-12C One skilled in the art will also recognize other techniques that can be used to associate the constructs provided herein with the fixation bodies.

[0082] Figure 12A An implant 1110 is shown that includes two open-geometry fixation bodies or buttons 1111, 1111' and suture 500 arranged to have unidirectionally adjustable fixation collars 550 to form a surgical repair construct 400. The open-geometry buttons 1111, 1111' include gaps 1112 in their through-holes to facilitate the construction of the implant 1110 without the need to thread the suture 500 through closed through-holes. This enables the suture 500 to be tied to form the surgical construct 400 with unidirectionally adjustable fixation collars 550 prior to assembling the buttons 1111, 1111' to the suture 500 and / or more easily associating and disassociating the construct 400 with the fixation bodies 1111, 1111'.

[0083] Figure 12BFor another embodiment of implant 1120, in this case suture 500 of surgical construct 400 with unidirectionally adjustable fixation loop 550 is coupled to each of the closed geometrically shaped fixation body or button 200 and another exemplary open geometrically shaped fixation body or plate 1121. Plate 1121 includes lateral gaps 1120 for coupling open geometrically shaped plate 1121 to suture 500 after suture has been passed through closed geometrically shaped button 200, as described herein. Again, the open geometry can allow construct 400 to more easily associate and disassociate with fixation body 1121.

[0084] Figure 12C For another embodiment of implant 1130, in this case suture 500 of surgical construct 400 with unidirectionally adjustable fixation loop 550 is coupled to each of the closed geometrically shaped fixation body or button 200 and another exemplary closed geometrically shaped fixation body or button 1131. Button 1131 includes an internal passage 1132 for passing suture 500 through closed geometrically shaped button 1131. Internal passage 1132 can better protect suture 500 from abrasion or other damage during the surgical procedure and / or once the implant is implanted within the body.

[0085] Figure 13 For an illustration of implant 1200, which includes suture 500 forming unidirectionally adjustable fixation loop 550, a single cortical button 200, and a utility stitch 1201. For applications where over-tensioning is a concern and it is advantageous to reverse the tension (e.g., a procedure involving the medial patellofemoral ligament), utility stitch 1201 can be added to knots 520, 540, e.g., by passing or extending a branch of utility stitch 1201 through knots 520, 540, such that when tension is applied to utility stitch 1201, knots 520, 540 can be opened to allow button 200 to slide, thereby expanding adjustable fixation loop 550. Utility stitch 1201 can pass through one of the through-holes of body 200, as shown by third through-hole 216, which enables tension applied to utility stitch 1201 to pull body 200 to expand adjustable fixation loop 550. As shown, toggle techniques such as Figures 14A-14C may be used to prevent the junction from migrating into the compression region (i.e., the location where the soft tissue suspension passes through loop 550) due to interference in the loop by the compressive force at the loop junction.

[0086] Figure 14AThe soft tissue 110 is shown suspended on the adjustable securement collar 550, and a force (indicated by arrow 1301) applied to the utility stitch 1201 to loosen the knots 520, 540 and expand the adjustable securement collar 550 by pulling the button 200 away from the soft tissue 110 (indicated by arrow 1302). Thereafter, and as shown, Figure 14B the force (indicated by arrow 1303) applied to the first and second tails 502, 504 can contract the adjustable securement collar 550 by pulling the button 200 toward the soft tissue 110 (as indicated by arrow 1304). Finally, as shown, Figure 14C even after the adjustable securement collar 550 has been contracted and the knots 520, 540 locked, a force (e.g., as indicated by arrow 1301) applied to the utility stitch 1201 can loosen the knots 520, 540 and expand the adjustable securement collar 550 by pulling the button 200 away from the soft tissue 110.

[0087] Additional features and advantages of the disclosure will be apparent based on the above description of the embodiments. Therefore, the application should not be limited by what has been particularly shown and described, except as may be defined in the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entireties.

Claims

1. A suture structure formed of suture filaments, comprising: A first knot is formed in the suture filament to form a first loop extending from the first knot, the first loop defining a first loop opening; The first tail of the suture filament extends from the first knot; The bridging portion of the suture filament extends from the first knot; A second knot is formed in the suture filament to form a second loop extending from the second knot, the second loop defining a second loop opening, and a portion of the second loop passing through the first loop opening to define an adjustable loop of the suture structure, the adjustable loop defining an adjustable loop opening; as well as The second tail of the suture filament extends from the second knot. The first tail portion is configured to slide relative to the first knot to reduce the size of the first collar opening, and thus reduce the size of the adjustable collar opening. The second tail portion is configured to slide relative to the second knot to reduce the size of the second collar opening, and thus reduce the size of the adjustable collar opening. The first knot is a self-locking knot with both an unlocking and a locking configuration; The second knot is a self-locking knot with both an unlocking and a locking configuration; and The bridging portion of the stitching filament connects the first knot to the second knot, and the tension on the bridging portion is configured to move the first knot from its unlocked configuration to its locked configuration and the second knot from its unlocked configuration to its locked configuration, thereby preventing the adjustable collar opening from expanding.

2. The suture structure according to claim 1, characterized in that, At least one of the self-locking knots includes at least one of a figure-eight lasso knot or an extended figure-eight lasso knot.

3. The suture structure according to claim 1, characterized in that, At least one of the self-locking knots includes at least one Prussian knot.

4. The suture structure according to claim 1, characterized in that, The suture filaments do not join at the positions of the first knot and the second knot.

5. The suture structure according to claim 1, characterized in that, It also includes a second suture filament configured to capture a portion of the first knot and the second knot, wherein a first branch of the second suture filament extends to the first knot and a second branch of the second suture filament extends to the second knot, such that tension on at least one of the first branch or the second branch is released from the corresponding first knot or the corresponding second knot.

6. The suture structure according to claim 1, characterized in that, It also includes a fixing body that is connected to the bridging portion of the suture filament.

7. The suture structure according to claim 6, characterized in that, It also includes a second fixing body, which is connected to the adjustable collar.

8. The suture structure according to claim 1, characterized in that, The suture also includes an unlocking configuration, wherein the suture is configured to move between the locking configuration and the unlocking configuration by adjusting the relative load of at least one of the bridging portion, the first tail, or the second tail.

9. A surgical implant comprising: A fixing body having a longitudinal axis extending therefrom, a first side and a second side, and a first through hole and a second through hole; as well as The suture filament according to any one of claims 1 to 8.

10. The surgical implant according to claim 9, characterized in that, The fixed body includes a leather button.

11. The surgical implant according to claim 9, characterized in that, The bridging portion extends from the first knot through the first through hole, across the body, and through the second through hole to reach the second knot.

12. The surgical implant according to claim 11, characterized in that, It also includes a second fixing body, which is connected to the adjustable collar.

13. The surgical implant according to claim 9, characterized in that, The surgical implant also includes a second suture filament that captures a portion of the first knot and the second knot, wherein a first branch of the second suture filament extends to the first knot, and a second branch of the second suture filament extends to the second knot. The second suture filament is configured such that the tension on at least one of the first branch or the second branch is released from the corresponding first knot or the corresponding second knot.

14. A method for preparing a surgical implant, comprising: A first knot is formed in the first portion of the suture segment to form a first tail extending from one side of the first knot and a second portion of the suture segment extending from the opposite side of the first knot. The second part forms a first loop, which is closed by the first knot; A second knot is formed in the second portion of the suture segment to form a second tail extending from one side of the second knot and a third portion of the suture segment extending from the opposite side of the second knot; as well as The third portion forms a second loop, which is closed by the second knot. The second loop is interconnected with the first loop to define an adjustable retaining loop for the suture structure. The first knot is a self-locking knot with both an unlocking and a locking configuration; The second knot is a self-locking knot with both an unlocking and a locking configuration.

15. The method according to claim 14, characterized in that, The second portion of the suture segment includes a bridging portion extending between the first knot and the second knot.

16. The method according to claim 14, characterized in that, At least one of the first tail portion or the second tail portion is configured to reduce the size of the opening defined by the adjustable retaining collar when tension is applied to the first tail portion or the second tail portion to reduce the size of the first opening or the second opening defined by the corresponding first collar or the corresponding second collar.

17. The method according to claim 14, characterized in that, Also includes: The first tail portion passes through the first through hole of the fixed body; The second tail portion passes through the second through hole of the fixing body; and The second portion of the suture segment passes through at least two of the first through hole of the fixation body, the second through hole of the fixation body, or at least another through hole of the fixation body.

18. The method according to claim 17, characterized in that, It also includes connecting the adjustable retaining collar to the second retaining body.

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