Quick-release knot pusher: Side-load knot pusher

Abstract

A knot pusher for quickly loading sutures without threading at the distal end. The knot pusher includes an actuator housing having an actuator movable between an open position and a closed position, and an elongated tube extending from the actuator housing. The knot pusher includes at least two slots: a gate slot extending through the elongated tube, and a suture loading slot extending through the elongated tube and across the gate slot. A movable gate crossbar is connected to the actuator so that the gate crossbar moves with the actuator between the open position and the closed position. When the actuator is in the closed position, the gate crossbar extends through at least a portion of the suture loading slot. The knot pusher may also include an ergonomic ring handle that forces the knot pusher to be correctly oriented for use.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to and the benefit of U.S. Provisional Patent Application No. 62 / 895,160, filed on September 3, 2019, and entitled “Quickdraw Knot Pusher: Side Loading Knot Pusher,” the entire contents of which are incorporated herein by reference. Technical Field

[0003] The present invention relates to arthroscopic knot tying, and more particularly to a knot pusher device for quickly and safely loading sutures to facilitate arthroscopic knot tying. Background Art

[0004] US2016 / 038141A1 discloses the prior art on which the preamble of claim 1 is based. Related technologies are disclosed in US2016 / 374749A1 and WO2018 / 049138A1.

[0005] Many common surgical procedures involve the repair and reconstruction of torn or damaged soft tissue. For example, in common arthroscopic surgery, a replacement graft ligament is fixed to the site of the now damaged original ligament. Suspension graft fixation devices have been developed to fix the graft ligament in the bone tunnel. The working principle of the suspension graft fixation device is to be placed laterally across the opening of the bone tunnel and is usually in the form of an elongated anchoring member that suspends a graft retaining ring from a fixed point on the surface of the bone to which the graft is attached. The graft retaining ring is composed of sutures and is fixed with knots formed in the sutures.

[0006] In other arthroscopic procedures, soft tissue is attached to bone using an expanded rigid anchor or a soft all-suture anchor. Typically, the anchor is attached to a suture and is deployed by tensioning the suture. In order to secure the deployed anchor, a knot is formed in the suture. The knot in the suture for securing the graft or anchor in the arthroscopic procedure is completed manually or via a screwdriver / inserter device. The screwdriver / inserter mechanism is preferred to the manual deployment of the arthroscopic anchor and the tying of the graft-holding suture loop because the user's visibility and loading steps required by the screwdriver / inserter mechanism are generally less. However, current screwdriver / inserter devices require the user to thread the suture on the distal end of the device before use, which requires time and a small amount of careful movement.

[0007] Therefore, there is a need for a device for advancing a knot into a surgical site wherein a suture can be easily loaded onto the device.

[0008] The term "suture" as used herein may be any type of filamentous material, such as biocompatible or bioabsorbable filaments, ribbons, strips, woven or nonwoven materials.

[0009] Related Art Section Disclaimer Description: With respect to specific patents / publications / products discussed above in the Related Art Section Description or elsewhere in this disclosure, these discussions should not be considered as an admission that the discussed patents / publications / products are prior art for patent law purposes. For example, some or all of the discussed patents / publications / products may not be sufficiently early in time, may not reflect subject matter that was developed early enough in time, and / or may not be sufficient to achieve prior art equivalents for patent law purposes. With respect to specific patents / publications / products discussed above in the Related Art Section Description and / or throughout the application, their descriptions / disclosures are incorporated herein by reference in their respective entireties. Summary of the invention

[0010] The above-mentioned object is achieved by a knot pusher as set forth in the attached claims. An embodiment of a knot pusher comprises an actuator housing having an actuator movable between an open position and a closed position, and an elongated tube extending from the actuator housing. The knot pusher comprises at least two slots: a gate slot extending through the elongated tube, and a suture loading slot extending through the elongated tube and across the gate slot. A movable gate crossbar is connected to the actuator so that the gate crossbar moves with the actuator between the open position and the closed position. When the actuator is in the closed position, the gate crossbar extends through at least a portion of the suture loading slot.

[0011] According to another aspect, the knot pusher includes an actuator housing having an actuator movable between an open position and a closed position, and an elongated tube extending from the actuator housing. The knot pusher includes three slots: a gate slot extending through the elongated tube, a suture outlet slot extending through the elongated tube, and a suture loading slot extending through the elongated tube and across the gate slot. A movable gate crossbar is connected to the actuator so that the gate crossbar moves between the open position and the closed position with the actuator. When the actuator is in the closed position, the gate crossbar extends through at least a portion of the suture loading slot.

[0012] According to another aspect, the knot pusher includes a handle having an actuator housing extending from an annular end. There is an actuator that is at least partially within the actuator housing and can move between an open position and a closed position. An elongated tube extends from the actuator housing. The knot pusher includes at least two slots: a gate slot extending through the elongated tube, and a suture loading slot extending through the elongated tube and across the gate slot. A movable gate crossbar is connected to the actuator so that the gate crossbar moves between the open position and the closed position with the actuator. When the actuator is in the closed position, the gate crossbar extends through at least a portion of the suture loading slot.

[0013] These and other aspects of the invention will be apparent from and elucidated with reference to the embodiments described hereinafter. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The present invention will be more fully understood and appreciated by reading the following detailed description in conjunction with the accompanying drawings. The accompanying drawings illustrate only typical embodiments of the disclosed subject matter and are therefore not to be considered limiting of its scope, as the disclosed subject matter may admit of other equally effective embodiments. Reference is now made briefly to the accompanying drawings, in which:

[0015] Figure 1 is an isometric schematic diagram of a knot pusher according to an embodiment;

[0016] Figure 2 is a close-up isometric schematic diagram of a handle of a knot pusher according to an embodiment;

[0017] Figure 3 is a close-up side view of a handle of a knot pusher according to an embodiment;

[0018] Figure 4 is a schematic diagram of an exploded view of a knot pusher according to an embodiment;

[0019] Figure 5 is a close-up and partial cross-sectional schematic diagram of a handle of a knot pusher according to an embodiment;

[0020] Figure 6 is a close-up exploded view schematic diagram of a loading area according to an embodiment;

[0021] Figure 7 is a close-up isometric schematic diagram of a loading area of ​​a knot pusher according to an embodiment;

[0022] Figure 8 is a close-up side schematic view of a loading area of ​​a knot pusher according to an embodiment;

[0023] Fig. 9 is a close-up top view of a loading area of ​​a knot pusher according to an embodiment;

[0024] Fig.10is a close-up bottom view of a loading area of ​​a knot pusher according to an embodiment;

[0025] Fig.11A is a bottom view of a loading area in an open position with sutures extending therethrough according to an embodiment;

[0026] Fig. 11B is a side view of a loading area in an open position with sutures extending therethrough according to an embodiment;

[0027] Fig.12 is a close-up isometric schematic diagram of a loading area in a closed position according to an embodiment;

[0028] Fig.13 is a close-up side schematic view of a loading area in a closed position according to an embodiment;

[0029] Fig.14 is a close-up top view schematic diagram of a loading area in a closed position according to an embodiment;

[0030] Fig.15 is a close-up bottom view of a loading area in a closed position according to an embodiment;

[0031] Fig.16 is a side view of a loading area in a closed position with sutures extending therethrough according to an embodiment;

[0032] Fig.17 is a schematic close-up cross-sectional view of a loading area in a closed position according to an embodiment; and

[0033] Fig.18 is a close-up isometric illustration of a loading area in a closed position according to an embodiment. DETAILED DESCRIPTION

[0034] Embodiments of the present invention are explained more fully below with reference to the accompanying drawings. Descriptions of known structures are omitted so as not to unnecessarily obscure the present invention in detail. However, it should be understood that the detailed description and specific non-limiting examples, while indicating aspects of the present invention, are given only in an illustrative manner, rather than in a limiting manner. Various substitutions, modifications, additions and / or arrangements within the spirit and / or scope of the basic concepts of the present invention will be apparent to those skilled in the art in light of this disclosure.

[0035] Referring now to the drawings, wherein like reference numerals refer to like parts throughout, Figure 1An isometric schematic diagram of a knot pusher 100 according to an embodiment is shown. The knot pusher 100 has a proximal end 102 and a distal end 104. At the proximal end 102, the knot pusher 100 has a handle 106. The handle 106 has a ring end 110 (also referred to as a "ring end") through which an orifice 112 extends. The handle 106 also has a rectangular actuator housing 114 extending from the ring end 110 to the distal end. The actuator housing 114 has a movable actuator 108, which is configured to move proximally toward the ring end 110 and move distally away from the ring end. The ring end 110 is provided to achieve ergonomic and directional benefits, as will be described in detail below. Also as Figure 1 As shown in FIG. 1 , the elongated tube 116 extends from the handle 106 (ie, from the actuator housing 114) along a central longitudinal yy axis to the distal end 104. At the distal end 104 of the knot pusher 100, the elongated tube 116 includes a loading area 118 for attaching a suture (not shown) to the knot pusher 100.

[0036] Reference now Figure 2 , a close-up isometric view schematic diagram of the handle 106 of the knot pusher 100 according to an embodiment is shown. As stated above, the handle 106 has an ergonomic ring end 110 at the proximal end 102 of the knot pusher 100. The geometry of the ring end 110 allows the user's thumb to naturally rest in the orifice 112 during use. Figure 2 As shown in Figure 3 As is more clearly shown in FIG. 1 , the annular end 110 is angled relative to the actuator housing 114 .

[0037] The aperture 112 extending through the annular end 110 has a central xx axis extending therethrough. The central xx axis is angled relative to a central longitudinal yy axis extending through the elongated tube 116. Figure 3 In the embodiment of the present invention, the central xx axis is at an angle between 0 and 90 degrees relative to the central longitudinal yy axis. The angle of the ring end 110 provides a one-way function that forces the user to orient the knot pusher 100 in the correct position to place his or her thumb in the aperture 112 regardless of the hand used (left or right). Therefore, the angle of the ring end 110 not only provides an ergonomic grip, but also forces the knot pusher 100 to be properly oriented when manipulated by the user.

[0038] Now go to Figure 4, shows a schematic exploded view of a knot pusher 100 according to an embodiment. In the depicted embodiment, the handle 106 is composed of two parts: a first body portion 120 and a second body portion 122. The first body portion 120 and the second body portion 122 each include an annular end 110 having an aperture 112 extending therethrough. In addition, the first body portion 120 and the second body portion 122 each include half of a rectangular actuator housing 114. The actuator housing 114 houses a movable actuator 108. In the depicted embodiment, the movable actuator 108 is spring-loaded, i.e., biased by a spring 124 within the actuator housing 114. The movable actuator 108 includes an actuator button 134 extending from the actuator housing 114, as shown. Figure 1 as shown in .

[0039] Return to reference Figure 4 , the elongated tube 116 is hollow so that it has an internal volume. An elongated channel 128 extends through the outside of the elongated tube 116 and into the internal volume. The elongated channel 128 extends along or parallel to the central longitudinal yy axis. The elongated tube 116 further includes a removable and / or removable door rod 130. The door rod 130 is a narrow flat rod that is sized and configured to fit within the elongated channel 128. The elongated tube 116 also includes a door crossbar 132. In the depicted embodiment, the door crossbar 132 is rectangular, with the orifice 126 extending therethrough. The door rod 130 and the door crossbar 132 are attached to the actuator 108 and move with the actuator to move the loading area 118 between the open position and the closed position.

[0040] Now go to Figure 5 , a schematic diagram of a close-up and partial cross-sectional view of the handle 106 of the knot pusher 100 according to an embodiment is shown. As shown, the elongated tube 116 is secured to the handle 106 at the distal end 144 of the actuator housing 114. In the depicted embodiment, the elongated tube 116 is secured within the actuator housing 114; however, it is contemplated that the elongated tube may be attached flush with the exterior of the distal end 144. A gate rod 130 is shown within the elongated channel 128 of the elongated tube 116. The gate rod 130 is connected to the actuator 108, as shown in FIG. Figure 5 Thus, the door rod 130 moves with the actuator 108 .

[0041] Still refer to Figure 5 , the actuator 108 is connected to the spring 124, and the spring 124 is connected to the proximal end 146 of the actuator housing 114. The spring 124 is connected to a pair of spring guides 148, one spring guide on the proximal end 146 of the actuator housing 114 and one spring guide on the actuator 108, which keeps the force vector of the spring 124 axial. Figure 5The spring 124 in the actuator housing 114 is biased toward the distal end 144. Therefore, the door rod 130 is biased in the distal direction, that is, biased in the closed position of the loading area 118.

[0042] As stated above, the purpose of the spring-biased actuator 108 is to move the loading area 118 between an open position and a closed position. Figure 5 As shown in , the actuator 108 has an outer surface 136 connected to the actuator button 134, which extends at an angle relative to the central longitudinal yy axis. The angled outer surface 136 of the actuator 108 allows the actuator 108 to maintain the spring 124 in its compressed state when the actuator button 134 moves proximally to the open position. The user must maintain a force on the actuator button 134 in the proximal direction to maintain the open position of the loading area 118. When the actuator button 134 is released, it automatically returns the loading area 118 to the closed position. When the actuator button 134 is released, the spring 124 relaxes to an uncompressed state, causing the actuator button 134 to move in the distal direction until the outer surface 136 of the actuator 108 is docked with a catch 150 (e.g., a protrusion or other blocking feature) on the actuator housing 114. This prevents the actuator 108 from moving without the actuator button 134 being engaged, and also prevents the actuator 108 from moving when force is applied to the door bar 130 during use.

[0043] Reference now Figure 6 , shows a close-up exploded view schematic diagram of the loading area 118 according to an embodiment. The elongated tube 116 includes a door rail 132 connected to the door rod 130. The door rod 130 includes a feature 152 (e.g., a protrusion) extending through the aperture 126 in the door rail 132. The connection between the door rod 130 and the door rail 132 via the feature 152 extending through the aperture 126 promotes the door rail 132 to move with the door rod 130. Therefore, when the actuator 108 causes the door rod 130 ( Figure 5 ) moves, the door crossbar 132 moves. The door crossbar 132 is also used to limit the movement of the door rod 130 to only along the elongated tube 116. The door rod 130 and the door crossbar 132 are assembled inside the knot pusher 100 (as shown in the figure) and combined.

[0044] Still refer to Figure 6 The loading area 118 of the elongated tube 116 also includes a door slot 140. The door slot 140 extends through the elongated tube 116 to the interior volume ( Fig.10 ).like Figure 6 As shown in FIG. 1 , the gate slot 140 is slightly spaced from the distal end 104 of the elongated tube 116. The gate slot 140 extends along or parallel to the central longitudinal axis yy. Figure 6In the embodiment shown in FIG. 1 , the door slot 140 is rectangular and is sized and configured to facilitate movement of the door rail 132 therein. When the door bar 130 moves in response to engagement of the actuator 108, the door rail 132 moves proximally or distally within the door slot 140. Thus, the door slot 140 limits proximal and distal movement of the door rail 132, and thus, the door bar 130.

[0045] Now go to Figure 7-10 , various close-up views of the loading area 118 of the knot pusher 100 according to an embodiment are shown. At the loading area 118 on the elongated tube 116, there is a suture outlet slot 138, such as Figure 6-7 9. The suture exit slot 138 extends through the elongated tube 116 and extends to a tapered or pointed recess 154 in the elongated tube 116. The suture exit slot 138 is substantially rectangular and extends along or parallel to the central longitudinal yy axis.

[0046] like Figure 7 As shown in FIG. 1 , the suture exit slot 138 is approximately 180 degrees (radially) along the elongated tube 116 from the elongated channel 128. In other words, the suture exit slot 138 is substantially parallel to the elongated channel 128. Figure 7 As shown in FIG. 1 , the suture exit slot 138 is slightly spaced from the distal end 104 of the elongated tube 116, while the elongated channel 128 extends through the distal end 104 of the elongated tube 116. The gate slot 140 is approximately 90 degrees (radially) along the elongated tube 116 to the suture exit slot 138, as shown in FIG. Figure 7 Described in.

[0047] exist Figure 7-10 1, the loading area 118 includes a suture loading slot 142 extending between the door slot 140 and the suture exit slot 138. The suture loading slot 142 is a gap, cutout, orifice, or other opening in the elongated tube 116. The suture loading slot 142 is substantially perpendicular to the door slot 140, the suture exit slot 138, and the central longitudinal axis yy. Figure 8 as shown in .

[0048] Reference now Fig.11A and 11B , respectively, show a bottom view and a side view of the loading area 118 in an open position with a suture 200 extending therethrough according to an embodiment. The suture 200 is loaded into the suture loading slot 142 via the door slot 140, as shown in FIG. Fig. 11B When loaded, the suture 200 extends through the elongated channel 128, as shown in FIG. Fig.11A When loading suture 200, loading area 118 is in the open position (via actuator 108, as described above).

[0049] Now go to Fig.12 , showing a close-up isometric view of the loading area 118 in a closed position according to an embodiment. From the open position, the actuator 108 ( Figure 1-5 ) is released and slides distally to the closed position. When the actuator 108 slides distally, the door rod 130 moves distally in the elongated channel 128 to the distal end 104 of the knot pusher 100, as shown in FIG. Fig.15 As shown in FIG. 1 , when the door rod 130 slides distally, the door crossbar 132 moves distally to a closed position. When in the closed position, the door crossbar 132 extends into the door slot 140, as shown in FIG. Figure 12-13 As shown in Figure 12-13 As shown in , when door rail 132 extends into door slot 140 , door rail 132 blocks suture loading slot 142 .

[0050] Now go to Fig.16 , shows a side view of the loading area 118 in a closed position with the suture 200 extending therethrough according to an embodiment. As described above, when the actuator 108 is released and moved distally to the closed position, the door rod 130 moves distally, thereby pushing the door crossbar 132 distally within the door slot 140. The door rod 130 pushes the first branch 202 of the suture 200 through the elongated channel 128 and out of the distal end 104 of the elongated tube 116. The second branch 204 of the suture 200 extends out of the suture exit slot 138 and, in some cases, extends along the recess 154.

[0051] Now go to Fig.17 , illustrates a close-up cross-sectional schematic view of the loading area 118 in a closed position according to an embodiment. Fig.17 14. The path of the suture 200 is shown in FIG. The path of the suture 200 is from the distal end 104 of the elongated tube 116, through the blocked gate slot 140, and out of the suture exit slot 138. In the depicted embodiment, the rounded corners 156 are on all edges within the elongated tube 116 at the loading area 118. The rounded corners 156 ensure that the edges are rounded so that the edges do not interfere with the suture 200, which may cause wear. Fig.18 A close-up isometric view of the loading area 118 in a closed position is shown in FIG. As shown, the door rail 132 is in a closed position within the door slot 140.

[0052] Advantages of the knot pusher 100 include the ability to quickly load suture 200 without threading the distal end 104. The ergonomic loop handle 106 of the knot pusher 100 disclosed herein forces the knot pusher 100 to be properly oriented for use.

[0053] Although several inventive embodiments have been described and illustrated herein with reference to certain exemplary embodiments, a person of ordinary skill in the art will readily conceive of various other devices and / or structures for performing the functions and / or obtaining the results and / or one or more of the advantages described herein, and each of such variations and / or modifications is considered to be within the scope of the inventive embodiments described herein (and those skilled in the art will understand that various changes in detail can be made therein without departing from the scope of the invention as defined by the claims supported by the written description and the drawings). More generally, those skilled in the art will readily understand that all parameters, dimensions, materials, and configurations described herein with reference to exemplary embodiments are exemplary, and that actual parameters, dimensions, materials, and / or configurations will depend on the teachings of the invention for one or more specific applications thereof. Using only routine experimentation, those skilled in the art will recognize or be able to determine many equivalents of the specific inventive embodiments described herein. Therefore, it should be understood that the foregoing embodiments are given by way of example only, and within the scope of the appended claims, and that embodiments of the invention may be practiced in a manner different from that specifically described and claimed. In addition, where exemplary embodiments are described with reference to a certain number of elements, it will be understood that the exemplary embodiments may be practiced with less than or greater than a certain number of elements.

[0054] All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and / or ordinary meanings of the defined terms.

[0055] Unless otherwise indicated herein or clearly contradicted by context, the use of the terms "a", "an", "the" and similar referents in the context of describing the present invention (especially in the context of the appended claims) should be understood to cover both the singular and the plural. Unless otherwise indicated, the terms "comprising", "having", "including" and "containing" should be understood as open-ended terms (i.e., meaning "including, but not limited to"), unless otherwise indicated. The term "connected" should be understood as being partially or completely contained within, attached to, or joined together, even if not directly attached to where there is some intervening place.

[0056] As used herein in the specification and claims, the phrase "at least one" with respect to a list of one or more elements should be understood to mean at least one element selected from any one or more elements in the list of elements, but does not necessarily include at least one element of each element specifically listed in the list of elements, and does not exclude any combination of elements in the list of elements. This definition also allows that elements other than the elements specifically indicated in the list of elements referred to by the phrase "at least one" may optionally be present, whether related or unrelated to those specifically indicated elements. Thus, as a non-limiting example, "at least one of A and B" (or equivalently "at least one of A or B", or equivalently "at least one of A and / or B") may refer to at least one, optionally including more than one A, without the presence of B (and optionally including elements other than B) in one embodiment; to at least one, optionally including more than one B, without the presence of A (and optionally including elements other than A) in another embodiment; to at least one, optionally including more than one A, and at least one, optionally including more than one B (and optionally including other elements) in yet another embodiment; etc.

[0057] It should also be understood that in any method claimed herein that includes more than one step or action, the order of the steps or actions of the method is not necessarily limited to the order in which the steps or actions of the method are listed unless explicitly indicated to the contrary.

[0058] Approximate language, as used herein throughout the specification and claims, may be used to modify any quantitative representation that is permissibly variable without resulting in a change in the basic function to which it is related. Thus, a value modified by one or more terms, such as "about" and "substantially," is not limited to the precise value specified. In at least some instances, approximate language may correspond to the precision of an instrument used to measure the value. Here and throughout the specification and claims, range limitations may be combined and / or interchanged; unless context or language indicates otherwise, such ranges are identified and include all subranges contained therein.

[0059] Recitation of ranges of values ​​herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein.

[0060] Unless otherwise specified herein or otherwise clearly contradicted by context, all methods described herein may be performed in any suitable order. Unless otherwise required, the use of any and all examples or exemplary language (e.g., "such as") provided herein is intended only to better illustrate embodiments of the present invention and does not impose limitations on the scope of the present invention.

[0061] No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

[0062] In the claims and in the foregoing description, all transitional phrases, such as "comprising," "including," "carrying," "having," "containing," "involving," "having," "consisting of," and the like, are to be construed as open-ended, i.e., meaning including but not limited to. Only the transitional phrases "consisting of" and "consisting essentially of" are to be closed or semi-closed transitional phrases, respectively, as set forth in Section 2111.03 of the United States Patent Office Manual of Patent Examining Procedures.

[0063] It will be apparent to those skilled in the art that various modifications and variations may be made to the present invention without departing from the scope of the present invention. It is not intended to limit the present invention to the specific form or forms disclosed, but rather, it is intended to cover all modifications, alternative constructions, and equivalents that fall within the scope of the present invention as defined by the appended claims. Therefore, it is intended that the present invention covers modifications and variations of the present invention, provided that they fall within the scope of the appended claims.

Claims

1. A knot pusher, include: an actuator housing (114) having an actuator (108) movable between an open position and a closed position; an elongated tube (116) extending from the actuator housing; a door slot (140) extending through the elongated tube; and a suture loading slot (142) extending through the elongated tube and across the gate slot; It is characterized in that a door rail (132) movable within the door slot (140) and connected to the actuator so that the door rail moves with the actuator between the open position and the closed position; an elongated channel (128) extending along and through the elongated tube (116), a movable door bar (130) connected to the actuator (108) and the door rail (132), wherein when the actuator (108) is in the closed position, the door crossbar (132) extends through at least a portion of the suture loading slot (142), and Therein, the movable gate rod (130) is configured to move distally to push the first branch (202) of the suture (200) through the elongated channel (128) and out of the distal end (104) of the elongated tube (116).

2. The knot pusher of claim 1, further comprising a handle (106) having a ring-shaped end (110) connected to the actuator housing (114).

3. The knot pusher according to claim 1, in, The movable door rod (130) is movable within the elongated channel (128) between the open position and the closed position.

4. The knot pusher of claim 1, wherein the suture loading slot (142) extends in a direction substantially perpendicular to a direction in which the gate slot (140) extends.

5. The knot pusher according to claim 1, further comprising a spring (124) connecting the actuator (108) to the actuator housing (114), The knot pusher further includes an actuator button (134) extending from an outer surface of the actuator (108) and passing through the actuator housing (114). in, The outer surface of the actuator (108) extends at an angle relative to a central longitudinal axis extending through the elongated tube (116), and The knot pusher further includes a catch (150) on the actuator housing (114), wherein the outer surface of the actuator (108) engages the catch when the actuator is in the closed position.

6. The knot pusher of claim 1 including a suture exit slot (138) extending through the elongated tube.

7. The knot pusher of claim 6, wherein the suture exit slot (138) is 90 degrees to the gate slot (140).

8. The knot pusher of claim 6, wherein the suture exit slot (138) extends to a recess (154) in the elongated tube (116).

9. The knot pusher of claim 6, wherein the suture loading slot (142) extends to the suture exit slot (138).

10. The knot pusher of claim 6, further comprising an elongated channel (128) extending along and through the elongated tube, wherein the elongated channel is substantially parallel to the suture exit slot (138).

11. The knot pusher of claim 6, wherein in the closed position, a suture extends through the distal end of the elongated tube (116) and through the suture exit slot (138).

12. The knot pusher of claim 6, further comprising one or more rounded edges within the actuator housing (114).

13. The knot pusher according to claim 1, include: a handle (106) having an actuator housing (114) extending from an annular end (110); The actuator (108) is at least partially within the actuator housing.

14. The knot pusher of claim 13, wherein the annular end (110) is angled relative to a central longitudinal axis extending through the elongated tube (116).

15. The knot pusher of claim 14, wherein a central axis extending through an aperture (112) in the annular end (110) is at an acute angle relative to the central longitudinal axis extending through the elongated tube (116).

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