Quick-buckling knot pusher: side-loading knot pusher

Abstract

A knot pusher for quickly loading suture lines 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 traversing the gate slot. A movable door crossbar is connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position. The door crossbar extends through at least a portion of the suture loading slot when the actuator is in the closed position. The knot pusher may also include an ergonomic ring handle that forces the knot pusher to be properly oriented for use.

Description

[0001] This application is a divisional application of Chinese Patent Application No. 202080061921.2 (International Application No. PCT / US2020 / 049124), filed on September 3, 2020, with the invention title of "Quickdraw Knot Pusher: Side Loading Knot Pusher".

[0002] Cross - reference to related applications

[0003] This application claims the priority and benefit of U.S. Provisional Patent Application No. 62 / 895,160, filed on September 3, 2019, and titled "Quickdraw Knot Pusher: Side Loading Knot Pusher", the entire content of which is incorporated herein by reference. Technical Field

[0004] 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

[0005] Many common surgical procedures involve the repair and reconstruction of torn or damaged soft tissue. For example, in common arthroscopic surgical procedures, a replacement graft ligament is fixed at the site of the now - damaged original ligament. Suspension graft fixation devices have been developed to fix the graft ligament in a bone tunnel. The suspension graft fixation device works by being placed transversely across the opening of the bone tunnel and typically takes the form of an elongated anchoring member that suspends a graft retaining loop from a fixed point on the surface of the bone to which the graft is attached. The graft retaining loop is formed of sutures and is fixed with a knot formed in the sutures.

[0006] In other arthroscopic procedures, expanded rigid anchors or soft all - suture anchors are used to attach soft tissue to bone. Typically, the anchor is attached to a suture and deployed by tensioning the suture. To fix the deployed anchor, a knot is formed in the suture. The knot in the suture for fixing the graft or anchor in an arthroscopic procedure is done manually or via a screwdriver / inserter device. The screwdriver / inserter mechanism is preferred over the manual deployment of arthroscopic anchors and the tying of graft - retaining suture loops because the screwdriver / inserter mechanism generally requires less visibility and fewer loading steps by the user. However, current screwdriver / inserter devices require the user to thread the suture onto the distal end of the device before use, which takes time and a small amount of careful movement.

[0007] Accordingly, there is a need for a device for pushing a knot into a surgical site where the suture is easily loaded onto the device.

[0008] As used herein, the term "suture" can be any type of filamentous material, such as a biocompatible or bioabsorbable filament, ribbon, strip, woven or non-woven material.

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

[0010] Embodiments of the present invention relate to a knot pusher. Embodiments of the knot pusher include an actuator housing having an actuator movable between an open position and a closed position, and an elongate tube extending from the actuator housing. The knot pusher includes at least two slots: a door slot extending through the elongate tube, and a suture loading slot extending through the elongate tube and traversing the door slot. A movable door crossbar is connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position. When the actuator is in the closed position, the door 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 elongate tube extending from the actuator housing. The knot pusher includes three slots: a door slot extending through the elongate tube, a suture exit slot extending through the elongate tube, and a suture loading slot extending through the elongate tube and traversing the door slot. A movable door crossbar is connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position. When the actuator is in the closed position, the door 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 at least partially within the actuator housing and movable between an open position and a closed position. An elongate tube extends from the actuator housing. The knot pusher includes at least two slots: a door slot extending through the elongate tube, and a suture loading slot extending through the elongate tube and transverse to the door slot. A movable door crossbar is connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position. When the actuator is in the closed position, the door crossbar extends through at least a portion of the suture loading slot.

[0013] These and other aspects of the invention will become apparent and be 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 drawings merely illustrate typical embodiments of the disclosed subject matter and are not to be considered limiting of its scope as the disclosed subject matter may admit to other equivalent embodiments. Now briefly referring to the drawings, wherein:

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

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

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

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

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

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

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

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

[0023] Figure 9 is a close-up top view schematic of the loading area of a knot pusher according to an embodiment;

[0024] Figure 10A close-up bottom view schematic of the loading area of the knot pusher according to an embodiment;

[0025] Figure 11A A bottom view of the loading area in the open position with a suture extending therethrough according to an embodiment;

[0026] Figure 11B A side view of the loading area in the open position with a suture extending therethrough according to an embodiment;

[0027] Figure 12 A close-up isometric view schematic of the loading area in the closed position according to an embodiment;

[0028] Figure 13 A close-up side view schematic of the loading area in the closed position according to an embodiment;

[0029] Figure 14 A close-up top view schematic of the loading area in the closed position according to an embodiment;

[0030] Figure 15 A close-up bottom view schematic of the loading area in the closed position according to an embodiment;

[0031] Figure 16 A side view of the loading area in the closed position with a suture extending therethrough according to an embodiment;

[0032] Figure 17 A close-up cross-sectional view schematic of the loading area in the closed position according to an embodiment; and

[0033] Figure 18 A close-up isometric view schematic of the loading area in the closed position according to an embodiment. DETAILED DESCRIPTION

[0034] Aspects of the present invention and certain of its features, advantages, and details are explained more fully below with reference to the non-limiting examples shown in the accompanying drawings. Descriptions of well-known structures are omitted so as not to unnecessarily obscure the present invention in detail. However, it should be understood that the detailed descriptions and specific non-limiting examples, while indicating aspects of the present invention, are given by way of illustration only and not by way of limitation. Various substitutions, modifications, additions, and / or arrangements within the spirit and / or scope of the basic concepts of the present disclosure will be apparent to those skilled in the art.

[0035] Reference is now made to the drawings, in which like reference numerals always refer to like parts, Figure 1An isometric schematic view 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 an annular end 110 (also referred to as a "loop end") through which an orifice 112 extends. The handle 106 also has a rectangular actuator housing 114 extending distally from the annular end 110. The actuator housing 114 has a movable actuator 108 configured to move proximally towards the annular end 110 and distally away from the annular end. The annular end 110 is provided to achieve ergonomic and orientation benefits, as will be described in detail below. Also as Figure 1 shown, an elongate tube 116 extends from the handle 106 (i.e., from the actuator housing 114) to the distal end 104 along a central longitudinal y-y axis. At the distal end 104 of the knot pusher 100, the elongate tube 116 includes a loading area 118 for attaching a suture (not shown) to the knot pusher 100.

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

[0037] The orifice 112 extending through the annular end 110 has a central x-x axis extending therethrough. The central x-x axis is angled relative to the central longitudinal y-y axis extending through the elongate tube 116. In Figure 3 , the central x-x axis is at an angle between 0 degrees and 90 degrees relative to the central longitudinal y-y axis. The angle of the annular end 110 provides a unidirectional function that forces the user to orient the knot pusher 100 in the correct position in order to place his or her thumb in the orifice 112, regardless of the hand (left or right) used. Thus, the angle of the annular 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 turning to Figure 4, showing an exploded schematic view of a knot pusher 100 according to an embodiment. In the depicted embodiment, the handle 106 consists of two parts: a first body part 120 and a second body part 122. The first body part 120 and the second body part 122 each include an annular end 110 through which an aperture 112 extends. Additionally, the first body part 120 and the second body part 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 Figure 1 shown in

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

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

[0041] Still referring 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 therein is biased towards the distal end 144 of the actuator housing 114. Accordingly, the door rod 130 is biased in the distal direction, i.e., biased to 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 the open position and the closed position. As Figure 5 shown, the actuator 108 has an outer surface 136 connected to the actuator button 134, and the outer surface extends at an angle with respect to the central longitudinal y-y axis. The angled outer surface 136 of the actuator 108 allows the actuator 108 to hold the spring 124 in its compressed form when the actuator button 134 is moved proximally to the open position. The user must maintain the 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 its uncompressed form, moving the actuator button 134 in the distal direction until the outer surface 136 of the actuator 108 abuts a snap 150 (e.g., a protrusion or other blocking feature) on the actuator housing 114. This prevents the actuator 108 from moving without engaging the actuator button 134 and also prevents the actuator 108 from moving when a force is applied to the door rod 130 during use.

[0043] Now referring to Figure 6 , a schematic exploded view of a close-up of the loading area 118 according to an embodiment is shown. The elongate tube 116 includes a door crossbar 132 connected to the door rod 130. The door rod 130 includes a feature 152 (e.g., a protrusion) extending through an aperture 126 in the door crossbar 132. The connection of the door rod 130 and the door crossbar 132 through the feature 152 extending through the aperture 126 facilitates the movement of the door crossbar 132 together with the door rod 130. Accordingly, when the actuator 108 moves the door rod 130 ( Figure 5 ) connected thereto, 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 elongate tube 116. The door rod 130 and the door crossbar 132 are assembled inside the pusher 100 (as shown in the drawing) and combined.

[0044] Still referring to Figure 6 , the loading area 118 of the elongate tube 116 further includes a door slot 140. The door slot 140 extends through the elongate tube 116 into the internal volume ( Figure 10 ). As Figure 6 shown, the door slot 140 is slightly spaced from the distal end 104 of the elongate tube 116. The door slot 140 extends along or parallel to the central longitudinal y-y axis. In Figure 6In the embodiment shown, the door slot 140 is rectangular and sized and configured to facilitate movement of the door crossbar 132 therein. As the door bar 130 moves upon engagement of the actuator 108, the door crossbar 132 moves proximally or distally within the door slot 140. Thus, the door slot 140 restricts proximal and distal movement of the door crossbar 132 and thus restricts proximal and distal movement of the door bar 130.

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

[0046] As shown in Figure 7 , the suture exit slot 138 is approximately 180 degrees (radially) with respect to the elongate channel 128 along the elongate tube 116. In other words, the suture exit slot 138 is substantially parallel to the elongate channel 128. Also as shown in Figure 7 , the suture exit slot 138 is slightly spaced from the distal end 104 of the elongate tube 116, while the elongate channel 128 extends through the distal end 104 of the elongate tube 116. The door slot 140 is approximately 90 degrees (radially) with respect to the suture exit slot 138 along the elongate tube 116, as depicted in Figure 7 .

[0047] In Figures 7 - 10 , the loading area 118 includes a suture loading slot 142 that extends 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 elongate tube 116. The suture loading slot 142 is substantially perpendicular to the door slot 140, the suture exit slot 138, and the central longitudinal y-y axis, as shown in Figure 8 .

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

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

[0050] Now turning to Figure 16 , a side view of the loading area 118 in the closed position with a suture 200 extending therethrough according to an embodiment is shown. As described above, when the actuator 108 is released and moves 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 elongate channel 128 and out of the distal end 104 of the elongate tube 116. The second branch 204 of the suture 200 extends out of the suture exit slot 138 and, in some cases, along the recess 154.

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

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

[0053] It should be understood that the values used above are only representative values and that other values may be consistent with the spirit and intent of the present disclosure.

[0054] Although several inventive embodiments have been described and illustrated herein with reference to certain exemplary embodiments, those of ordinary skill in the art will readily envision 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 details can be made therein without departing from the spirit and scope of the invention as defined by the claims that can be 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 are exemplary, and the actual parameters, dimensions, materials, and / or configurations will depend on one or more specific applications for which the teachings of the invention are used. Using only routine experimentation, those skilled in the art will recognize or be able to ascertain many equivalent forms of the specific inventive embodiments described herein. Accordingly, it should be understood that the foregoing embodiments are presented by way of example only and are within the scope of the appended claims and their equivalents, and that the inventive embodiments can be practiced in a manner different from that specifically described and claimed. In addition, in the case where exemplary embodiments are described with reference to a certain number of elements, it will be understood that exemplary embodiments can be practiced using fewer or greater than a certain number of elements.

[0055] All references cited herein (including publications, patent applications, and patents) are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and set forth in full herein.

[0056] All definitions defined and used herein shall be understood to be precedence over dictionary definitions, definitions in documents incorporated by reference, and / or ordinary meanings of the defined terms.

[0057] Unless otherwise stated herein or clearly contradicted by context, the terms “a” and “the” and similar referents used in the context of describing the invention (especially in the context of the appended claims) shall be understood to cover both the singular and the plural. Unless otherwise noted, the terms “comprising,” “having,” “including,” and “containing” shall be understood to be open-ended terms (i.e., meaning “including but not limited to”). The term “connected” shall be understood to be partially or fully incorporated, attached to, or joined together, even where there is some intervening therebetween.

[0058] 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 of the elements in the list of elements, but not necessarily including at least one element of each specifically listed element in the list of elements, and not excluding any combinations of elements in the list of elements. This definition also allows that elements other than those specifically recited in the list of elements to which the phrase "at least one" refers may optionally exist, whether related or unrelated to those specifically recited 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") can, in one embodiment, refer to at least one, optionally including more than one A, without B (and optionally including elements other than B); in another embodiment, refer to at least one, optionally including more than one B, without A (and optionally including elements other than A); in yet another embodiment, refer 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); and so on.

[0059] It should also be understood that, unless expressly stated to the contrary, in any method that includes more than one step or act as claimed herein, the order of the steps or acts of the method is not necessarily limited to the order in which the steps or acts of the method are recited.

[0060] As used herein throughout the specification and claims, approximating language may be used to modify any quantitative representation that admits of variation without resulting in a change in the basic function to which it is related. Accordingly, 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, the approximating language may correspond to the precision of the instrument used to measure the value. Herein and throughout the specification and claims, range limitations may be combined and / or interchanged; unless the context or language indicates otherwise, such ranges are identified and include all the subranges contained therein.

[0061] Unless otherwise stated herein, the recitation of a range of values herein is merely intended to be a shorthand method of referring individually to each separate value that falls within the range, and each separate value is incorporated into the specification as if it were individually recited herein.

[0062] Unless otherwise stated 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 merely intended to better illustrate embodiments of the invention and does not impose a limitation on the scope of the invention.

[0063] No language in the specification should be construed as indicating that any non-claimed element is essential to the practice of the invention.

[0064] In the claims, as well as in the specification above, all transitional phrases such as "comprising," "including," "carrying," "having," "containing," "involving," "holding," "consisting of," and the like, are to be understood to be open-ended, i.e., to mean including but not limited to. Only the transitional phrases "consisting of" and "consisting essentially of" shall be closed or semi-closed transitional phrases, respectively, as set forth in section 2111.03 of the Patent Examination Procedure Manual of the United States Patent and Trademark Office.

[0065] It will be apparent to those skilled in the art that various modifications and variations can be made to the invention without departing from the spirit and scope of the invention. It is not intended to limit the invention to the one or more specific forms disclosed, but on the contrary, it is intended to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention as defined by the appended claims. Thus, it is intended that the invention cover modifications and variations of the invention provided they fall within the scope of the appended claims and their equivalents.

Claims

1. A knot pusher, comprising: An actuator housing having an actuator movable between an open position and a closed position; An elongate tube extending from the actuator housing; A door slot extending through the elongate tube; A suture exit slot extending through the elongate tube; A suture loading slot extending through the elongate tube and crossing the door slot; A movable door crossbar connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position; Wherein when the actuator is in the closed position, the door crossbar extends through at least a portion of the suture loading slot.

2. The knot pusher according to claim 1, wherein the suture exit slot is at 90 degrees to the door slot.

3. The knot pusher according to claim 1, wherein the suture exit slot extends into a recess in the elongate tube.

4. The knot pusher according to claim 1, wherein the suture loading slot extends into the suture exit slot.

5. The knot pusher according to claim 1, further comprising an elongate channel extending along and through the elongate tube, wherein the elongate channel is substantially parallel to the suture exit slot.

6. The knot pusher according to claim 1, wherein when in the closed position, a suture extends through a distal end of the elongate tube and through the suture exit slot.

7. The knot pusher according to claim 1, further comprising one or more rounded edges within the actuator housing.

8. A knot pusher, comprising: A handle having an actuator housing extending from an annular end; An actuator at least partially within the actuator housing and movable between an open position and a closed position; An elongate tube extending from the actuator housing; A door slot extending through the elongate tube; A suture loading slot extending through the elongate tube and crossing the door slot; A movable door crossbar connected to the actuator such that the door crossbar moves with the actuator between the open position and the closed position; Wherein when the actuator is in the closed position, the door crossbar extends through at least a portion of the suture loading slot.

9. The knot pusher according to claim 8, wherein the annular end is angled relative to a central longitudinal axis extending through the elongate tube.

10. The knot pusher according to claim 9, wherein a central axis extending through an orifice in the annular end is at an acute angle relative to the central longitudinal axis extending through the elongate tube.

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