Suture threader and method of tissue repair

Abstract

A method for tissue repair using a mattress stitch is disclosed. The mattress stitch is created using a suture threader and suture construct using only one portal and without a shuttling step. The suture threader is provided with two sharp teeth or tines that pierce the tissue (or tissue and associated graft) at two different locations. The suture construct can be a loop that terminates in a tail. The tail passes from one tooth to another and is then secured within the securing mechanism of one of the two sharp teeth. The tail passes through the loop to form a cinch loop around and through the tissue (or tissue and graft).

Description

[Background technology]

[0001] TECHNICAL FIELD The present disclosure relates to the field of surgery, and more particularly to instruments and methods for passing sutures. Summary of the Invention [Means for solving the problem]

[0002] Disclosed are instruments and methods for surgical repair. The suture threader is provided with a means for penetrating two distinct points in tissue, passing a suture through a region of tissue, and retrieving the suture. The means can include sharp teeth and / or pointed structures.

[0003] A method for threading a suture is also disclosed. The flexible strand can be threaded blindly through tissue using a suture threader. The flexible strand can be threaded horizontally underneath the tissue. The teeth of the suture threader can be pierced through the tissue at the desired locations for the flexible strand's entry and exit. A needle can be passed from one tooth to the other, and the flexible strand can be passed from one tooth to the other and up through the tissue. [Brief explanation of the drawings]

[0004] [Figure 1] 1 illustrates a suture passing instrument. [Figure 2] 2 illustrates a side view of the suture passing instrument of FIG. 1 (with the needle advanced); [Figure 3] 3 illustrates an enlarged view of the tip of the suture passing instrument of FIG. 2. [Figure 4] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 5] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 6] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 7]2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 8] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 9] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 10] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 11] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 12] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 13] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 14] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 15] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 16] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 17] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 18] 2 illustrates the schematic subsequent steps of tissue repair using the suture passing instrument of FIG. 1; [Figure 19] 3 illustrates an enlarged view of the tip of the suture passing instrument of FIG. 2. [Figure 20] 2 illustrates an enlarged top view of the tip of the suture passing instrument of FIG. 1; [Figure 21] 2 illustrates an enlarged side view of the tip of the suture passing instrument of FIG. 1; [Figure 22] 3 illustrates an enlarged perspective view of the tip of the suture passing instrument of FIG. 2; [Figure 23] 3 illustrates an enlarged side view of the tip of the suture passing instrument of FIG. 2. DETAILED DESCRIPTION OF THE INVENTION

[0005] The present disclosure provides surgical systems, assemblies, constructs, and methods for tissue repair and reconstruction.

[0006] The suture passing instrument is provided with a means for penetrating two distinct points within the tissue (or tissue and associated graft), passing the suture by feel through the tissue region, and retrieving the suture. The means can include pointed structures such as sharp teeth and / or tines.

[0007] A method for threading a suture is also disclosed. The flexible strand can be threaded blindly through the tissue (or tissue and associated graft) using a suture threader. The flexible strand can be threaded horizontally underneath the tissue (or tissue and graft). The teeth of the suture threader can pierce through the tissue (or tissue and graft) at desired locations for the flexible strand's entry and exit. A needle can be passed from one tooth to the other, and the flexible strand can be passed up through the tissue (or tissue and graft).

[0008] In embodiments, the suture passing instrument is employed in a shoulder repair, such as a shoulder mattress repair. The repair can include a cerclage loop. The repair can include a Weston loop. The repair can include one or more knots. The repair can be a knotless repair. The repair can be a knotted repair. The repair can be a soft tissue repair, such as repair of tendons, ligaments, muscles, etc. The repair can secure a graft to tissue. The repair can secure tissue to tissue.

[0009] Techniques for surgical repair, such as endoscopic surgical repair (e.g., arthroscopic surgery), are also disclosed. A first portion of a flexible construct is passed through two separate points or locations within the tissue (or tissue and associated graft), the suture threader is removed, and the first portion of the flexible construct is passed through a second portion of the same flexible construct to form a stitch. The second portion of the flexible construct can be a preformed loop. The flexible construct can be a suture loop terminating in a single tail. In embodiments, the tissue can be soft tissue, such as a tendon or ligament. In embodiments, the tissue can be a capsule. In embodiments, the repair can be performed with overlying tissue and graft. The suture threader can facilitate the placement of sutures within the soft tissue (or soft tissue and graft) and the formation of a mattress stitch through a single arthroscopic portal and without a shuttling step.

[0010] The suture threading instrument can include an elongated tubular member having a channel and a distal tip configured to penetrate and puncture tissue. The distal tip can include two sharp teeth or tines. The teeth or tines can have different sizes. The teeth or tines can have different lengths. The teeth or tines can penetrate tissue (or tissue and graft) at two different locations approximately simultaneously. The suture threading instrument is loaded with a flexible construct in the form of a preformed suture loop terminating in a single tail. The suture threading instrument can include a handle assembly located at the proximal end of the elongated tubular member. The tip is located at the distal end of the elongated tubular member. The handle assembly can house a mechanism for facilitating advancement and retraction of the needle and flexible construct.

[0011] In embodiments, the suture threader comprises a hollow shaft having a longitudinal axis, a distal end, and a proximal end; a tip at the distal end of the shaft having two sharp teeth of different lengths, each having an opening for the flexible construct to pass through and a pointed end for penetrating (e.g., piercing) tissue or tissue and graft; and a flexible construct in the form of a loop having one or more tails, one of the tails secured to one of the teeth. The tail of the flexible construct is configured to pass from one tooth to the other, exit the tissue, and pass through the loop of the flexible construct. In embodiments, the loop is a preformed loop secured to the shaft of the suture threader. The preformed loop can terminate in one or more tails. In embodiments, the loop is a continuous, flexible, uninterrupted loop terminating in a single tail.

[0012] Also disclosed is a method for suturing tissue. In embodiments, tissue can be sutured by securing tails of flexible strands to the tines of a suture passing instrument, passing the suture passing instrument through the tissue (or tissue and graft) so that the suture passing instrument punctures the tissue (or tissue and graft) at two different locations, subsequently advancing a needle to allow the tails to pass through the tissue (or tissue and graft) from the first location to the second location, removing the suture passing instrument to allow the tails to exit the tissue (or tissue and graft), and passing the tails through a loop of the flexible strand to form a cinch (a continuous, uninterrupted loop of the flexible strand) through and around the tissue. The steps can be repeated to form a mattress stitch.

[0013] An exemplary method of suturing tissue includes (i) securing a flexible construct formed from flexible strands having a loop terminating in a single tail to a suture threader, (ii) piercing the tissue (or tissue and graft) with the suture threader at two different locations within the tissue (or tissue and graft), (iii) advancing the tail of the flexible construct from one area of ​​its tip to another area of ​​its tip and withdrawing the suture threader from the tissue (or tissue and graft), (iv) passing the single tail through the loop of the flexible construct to form a suture-passing cinch loop, and (v) pulling the single tail to complete tension on the cinch loop. This method can be performed through a single portal without additional shuttling steps or instruments.

[0014] Referring now to the drawings, in which like elements are designated by like reference numerals, FIGS. 1-23 illustrate a suture passing instrument 100 and flexible construct 80 employed in an exemplary method of tissue repair 101, 102 (shoulder repair 101, 102) of the present disclosure.

[0015] 1 and 2, suture threader instrument 100 (suture threader 100, instrument 100, surgical instrument 100, assembly 100) comprises an elongated tubular member or shaft 12 having a longitudinal axis 12a, a proximal end 11, a distal end 13, and an axial throughbore therein. Shaft 12 may be a tube or narrow diameter rod sized to allow the tubular member to be introduced through an associated cannula (e.g., an 8.25 cannula) in a minimally invasive procedure such as an arthroscopic or other endoscopic procedure, or into a body cavity such as the abdominal cavity.

[0016] The elongated tubular member 12 connects and extends between the handle assembly 40 and a tip 50 designed to penetrate tissue (or tissue and associated grafts). The tip 50 (shown enlarged in FIG. 3 ) is provided with first and second tines 60, 70 (first and second jaws 60, 70, lower and upper jaws 60, 70, tines 60, 70, first and second jaw members 60, 70) integrally provided with the shaft 12. In an embodiment, the first tine 60 is a lower jaw provided with a sharpened distal tip 61, a passage 66 (not shown) for receiving the needle 30, and a distal opening 65 for allowing the needle to pass therethrough. The opening 65 also allows a first portion of a flexible construct 80 (flexible strand 80) to pass therethrough and extend, as described in more detail below. The opening 65 is provided at the distal-most end of the tip 50 and communicates with the needle passage 66. Distal opening 65 allows suture 80 to be positioned therein in an orientation non-parallel to the longitudinal axis of the instrument. In embodiments, suture 80 can be positioned within opening 65 so that it lies approximately perpendicular to the longitudinal axis of the instrument.

[0017] In embodiments, the second tooth 70 is an upper jaw provided with a sharp distal tip 71 and a distal opening 75 to allow the needle 30 and flexible construct 80 to pass therethrough. The opening 75 may be a through opening that allows the first portion of the flexible construct 80 to pass and extend therethrough, as described in more detail below. The second tooth 70 also includes a locking mechanism 77 (shown in more detail in FIG. 7 ) located approximately in the same plane as the distal opening 75 to allow the first portion 81 of the flexible construct 80 to be secured thereto when the device 100 is withdrawn from the tissue (or tissue and associated implant).

[0018] In an embodiment, the first tine 60 has a length L1 that is different from the length L2 of the second tine 70. In an embodiment, the length L1 may be less than the length L2, as shown in Figure 3. Additional details and various views of the tip 50 of the instrument 100 are shown in Figures 20-23.

[0019] The flexible construct 80 is provided with a first portion 81 that terminates with a second portion 85 in the form of a continuous, flexible, uninterrupted loop 85. In an exemplary embodiment, the flexible construct 80 is a FiberStick™ link 80 that is provided with a first portion 81 that forms a tail 81. The tail 81 may be reinforced to allow for convenient and easy advancement through the tissue and openings 65, 75 of the suture threader 100. The second portion 85 may be in the form of a loop, for example, a continuous, flexible, uninterrupted loop 85 that terminates in a single tail 81.

[0020] 4-18, the flexible strand 80 is loaded onto the instrument 100 as shown in FIG. 4. The single tail 81 is loaded onto the lower jaw 60 (short tine 60) of the suture threader 100. The loop 85 can be secured at a point M located approximately in the center of the instrument, i.e., approximately midway between the proximal end 11 and the distal end 13 of the instrument 100.

[0021] 4-18 illustrate schematic steps of a method of tissue repair (e.g., tendon or ligament repair, or attachment of a graft to tissue) using an instrument 100 loaded with an exemplary flexible strand 80 (suture construct 80, flexible construct 80, suture 80, flexible material 80). FIG. 17 illustrates an exemplary repair 101 of soft tissue 90. FIG. 18 illustrates an exemplary repair 102 for attaching a graft 91 to soft tissue 90.

[0022] 4-7: An instrument 100 loaded with a flexible strand 80 passes through tissue 90 (FIG. 7), or tissue 90 and associated graft 91 (FIG. 6). The instrument 100 pokes the tissue 90 (or graft 91 and tissue 90), for example, puncturing the tissue 90 (or graft 91 and tissue 90) at two different locations A and B. Alternatively, the instrument 100 can pass under the tissue 90 (e.g., tendon). The suture 80 is loaded onto the short tines 60 of the device 100. The suture 80 can be housed on a ring 88 toward the center M of the device, including a preformed loop 85 (cerclage 85) or a modified Weston loop 85. The distal end of the instrument 100 is inserted through a cannula and into the tissue 90 (or tissue 90 and associated graft 91). The device 100 can be used in open or arthroscopic procedures.

[0023] Figure 8: Once the appropriate depth is achieved in the tissue 90 and associated graft 91, the needle 30 is fired, moving the suture 81 through the window 75 of the longer tine 70. The needle 30 can be advanced by depressing the knob 41 of the handle 40 in the direction of arrow I. Figure 9 illustrates a close-up view of the tip 50 of the instrument 100.

[0024] FIG. 10: The needle 30 is retracted back into the short tines 60 (by pulling the knob 41 of the handle 40 in the direction of arrow R), leaving the suture 81 in the longer tine window.

[0025] Figure 11: The device 100 is pulled out of the tissue 90 and graft 91 in the direction of arrow P. The suture 81 folds over the distal wall of the longer tine window 75 and becomes caught in the suture capture spike 77 (anchoring mechanism 77). Figure 12 illustrates a close-up of the suture anchoring mechanism 77 of the upper tine 70.

[0026] FIG. 13: The device 100 is withdrawn from the cannula.

[0027] 14: The suture ring 88 is separated from the device 100 and slid over the distal end 13 of the device 100. With the suture 81 still attached to the longer tines 70 (at the securing mechanism 77), the ring 88 slides over the retained suture 81, thus converting the cerclage 85 or modified Weston loop 85 into a suture cinch 89.

[0028] FIG. 15: Suture 81 emerges from longer tine 70.

[0029] FIG. 16: A preformed loop 85 (cerclage loop 85) or modified Weston loop 85 is removed from a ring 88 as shown.

[0030] Figure 17: The ring 88 is removed and the cinch loop 89 is tensioned until sufficient tension is created in the repair 101. The suture ring 88 can be discarded.

[0031] Figure 18: The ring 88 is removed and the cinch loop 89 is tensioned until sufficient tension is created in the repair 102. The suture ring 88 can be discarded.

[0032] The flexible strand 80 (suture construct 80, flexible construct 80, suture 80, flexible material 80) can be formed from a single strand of material that is looped / joined to form a loop 85 and a single tail 81. In embodiments, the flexible strand 80 has a length and two ends that form a loop 85 that terminate in a single tail 81. In embodiments, the flexible strand 80 has one end that forms a loop 85 and the other end that forms a single tail 81 (flexible end 81). The loop 85 can be a continuous, uninterrupted flexible loop formed from a material such as a suture. The loop 85 can terminate in a single flexible end or tail 81. In one embodiment, the circumference of the loop 85 can be fixed. In one embodiment, the loop 85 and tail 81 can be formed from a suture having a round cross-section. The sutures can have the same or different diameters. The loop 85 may be formed by splicing a flexible strand through itself or by other methods known in the art such as fusing, gluing, bonding, joining, braiding, linking, and the like.

[0033] While the embodiment detailed above is described with reference to flexible strand 80 forming a continuous, uninterrupted flexible loop 85 around ring 88, it should be understood that the present disclosure is not limited to this exemplary embodiment only, and thus the present disclosure also contemplates flexible strands that can form any loop, such as a knotted loop or any similar structure, around any portion of device 100. Additionally, flexible strand 80 can also include two ends or tails in addition to one loop, such that a loop can be located between and adjacent to the two ends / tails.

[0034] The flexible strand 80 can include a single filament or fiber, or can include multiple continuous filaments, filament segments, or regions having different configurations (e.g., different dimensions and / or different compositions). The filament regions / segments can each be homogenous (i.e., formed from the same material) or a combination of homogenous and heterogeneous (i.e., formed from multiple materials). Exemplary materials can include suture, silk, cotton, nylon, polypropylene, polyethylene, ultra-high molecular weight polyethylene (UHMWPE), polyethylene terephthalate (PET), and polyester, as well as copolymers thereof, or combinations thereof.

[0035] In embodiments, flexible strands 80 are made from any known suture construction, such as multifilament, braided, knitted, woven suture, or comprise fibers of ultra-high molecular weight polyethylene (UHMWPE) or FiberWire® suture (disclosed in U.S. Pat. No. 6,716,234, the disclosure of which is incorporated herein by reference in its entirety). Flexible strands 80 can also be formed from suture tape, such as Arthrex FiberTape®, a braided, rectangular-like in cross section, high-strength suture tape disclosed in U.S. Pat. No. 7,892,256, the disclosure of which is incorporated herein by reference in its entirety.

[0036] The flexible strand 80 can also include and be made of any type of material (suture, nylon, silk, UHMWPE, metal, bioabsorbable, etc.) that can allow the flexible strand to form a loop that terminates in a single tail.

[0037] The instrument 100 and construct 80 may be employed in endoscopic surgery. The term "endoscopic surgery" refers to surgical procedures within a patient's body through small openings, as opposed to traditional open surgery through large incisions.

[0038] According to exemplary and illustrative embodiments only, the suture threader 100 comprises a shaft 12 having a longitudinal axis 12a, a distal end 13, and a proximal end 11; a first jaw member 60 integral with the distal end 13 of the shaft 12, the first jaw member 60 having a passageway 66 for receiving the needle 30 and a distal opening 61 for allowing the needle 30 to pass therethrough; a second jaw member 70 attached to the distal end 13 of the shaft 12 and integral with the distal end of the shaft, the second jaw member 70 including a through opening 71 and a locking mechanism 77 for securing a flexible strand 80 at its distal-most end, the locking mechanism 77 located generally in the same plane as the through opening 71; and a handle assembly 40 configured to move the needle 30 from the first jaw member 60 to the second jaw member 70. The flexible strand 80 includes a tail 81 and a loop. The loop may terminate in the tail. The loop can be a flexible, continuous, uninterrupted loop. The loop can be a knotted loop. Tail 81 is secured to first jaw member 60. Loop 85 can be secured to handle assembly 40. Loop 85 can be secured to ring 88 of handle assembly 40. Ring 88 is configured to be removed from the handle assembly and slid over distal tip 50 of suture threader 100 to allow tail 81 to pass through loop 85, thus forming suture stitches 89 around and through tissue 90 (or tissue 90 and graft 91) at repair sites 101, 102.

[0039] According to exemplary and illustrative embodiments only, a method of suturing tissue includes (i) loading suture 80 formed from suture loop 85 and tail 81 onto instrument 100; (ii) piercing tissue 90 (or graft 91 and tissue 90) at two different locations A, B within tissue 90 (or graft 91 and tissue 90) with the tip of instrument 100; and (iii) suturing tissue 90 (or graft 91 and tissue 90) from location A to location B and from lower jaw 60 to upper jaw 70 of instrument 100. ), (iv) withdrawing instrument 100 from tissue 90 (or graft 91 and tissue 90) allowing tail 81 to be secured within fixation mechanism 77 at the distal-most end of upper jaw 70 of instrument 100, and (v) passing tail 81 through suture loop 85 to form a cinch 89 (direct-through cinch stitch or mattress stitch) around and through tissue 90 (or graft 91 and tissue 90) of repair 101, 102. In embodiments, repairs 101, 102 are knotless repairs. In embodiments, repairs 101, 102 are knotted repairs.

[0040] The flexible strand 80 can be coated (partially or fully) with wax (beeswax, petroleum wax, polyethylene wax, or others), silicone (Dow Corning Silicone Fluid 202A, or others), silicone rubber (Nusil Med 2245, Nusil Med 2174 with a bonding catalyst, or others), PTFE (Teflon, Hostaflon, or others), PBA (polybutyrate acid), ethyl cellulose (Filodel), or other coatings to, for example, improve the lubricity, loop security, flexibility, ease of handling, or abrasion resistance of the suture. The flexible strand 80 can also be provided with a colored tracing strand or otherwise visually contrast with other areas / regions of the construct, which can, for example, remain a simple solid color or display a different tracing pattern. Various structural elements of the flexible strand 80, such as the loop 85 and / or tail 81, can be visually coded to simplify the identification and handling of the suture loops and ends. Easy identification of sutures in situ is advantageous in surgical procedures.

[0041] The term "high strength suture" is defined as any elongated flexible member, with the selection of material and size depending on the particular application. For purposes of illustration, and without limitation, the term "suture" as used herein may be a cable, filament, thread, wire, fabric, or any other flexible member suitable for tissue fixation within the body.

Claims

1. 1. A suture threader comprising: a shaft having a longitudinal axis, a distal end, and a proximal end; a first jaw member integral with the distal end of the shaft, the first jaw member having a passage for receiving a needle and a distal opening for allowing the needle to pass therethrough; a second jaw member attached to and integral with the distal end of the shaft, the second jaw member including a through opening and a securing mechanism for securing a flexible strand at its distal-most end, the securing mechanism being generally flush with the through opening; a handle assembly configured to move the needle from the first jaw member to the second jaw member.

2. The suture threader of claim 1 , wherein the first jaw member has a first length and the second jaw member has a second length, the first length being different from the second length.

3. The suture threader of claim 2 , wherein the first length is less than the second length.

4. The suture threader of claim 1 , wherein the first jaw member and the second jaw member each terminate in a sharp tip configured to pierce tissue, or tissue and an associated graft.

5. The suture threader of claim 1 , wherein the flexible strand includes a loop terminating in a tail, the loop being secured to the handle assembly and the tail being secured to the first jaw member.

6. 6. The suture threader of claim 5, wherein the loop is a continuous flexible loop secured to a ring of the handle assembly, the ring configured to separate from the suture threader and slide over the distal end and tail of the suture threader.

7. The suture threader of claim 5, wherein the loop is a preformed cerclage loop or a Weston loop.

8. 2. The suture threader of claim 1, wherein the flexible strand is formed from a loop terminating in a single tail, the loop being secured to the handle assembly and the single tail being secured to the first jaw member.

9. 2. The suture threader of claim 1, wherein the locking mechanism of the second jaw member is a suture capture spike that secures the flexible strand to the second jaw member as the suture threader is withdrawn from tissue or from tissue and an associated graft.

10. The suture threader of claim 1 , wherein the flexible strand is a suture.

11. 1. A method of suturing tissue, comprising: securing the flexible construct to a suture threader; advancing the suture threader through the arthroscopic portal and through the tissue to be sutured such that the suture threader pierces the tissue with a tip of the suture threader at two separate and distinct locations within the tissue; advancing a tail of the flexible construct from a lower jaw of the suture threader to an upper jaw of the suture threader; withdrawing the suture threader from the tissue to allow the tail of the flexible construct to be secured within a securing mechanism at the distal-most end of the upper jaw of the suture threader; and passing the tail through a loop of the flexible construct to form a cinch loop around and through the tissue.

12. 12. The method of claim 11, wherein the tail is a suture tail and the loop is a continuous, uninterrupted flexible suture loop that terminates in the suture tail.

13. The method of claim 11 , wherein the tissue is a tendon, ligament, graft, or muscle.

14. The method of claim 11 , wherein the tissue is a soft tissue or a graft.

15. The method of claim 11 , wherein the lower jaw has a length that is less than a length of the upper jaw.

16. passing the tail through the loop attaching the loop to a ring on a handle assembly of the suture threader; removing the ring from the handle assembly and sliding the ring over the distal end of the suture threader to allow the tail to pass through the loop and form the cinch loop; and pulling the tail to apply tension to the cinch loop.

17. 12. The method of claim 11, wherein all steps are performed using the same arthroscopic portal and without the use of a shuttling device.

18. The method of claim 11 , wherein the lower jaw and the upper jaw each terminate in a sharp tip to pierce the tissue at the two separate and distinct locations.

19. The method of claim 11 , wherein the method is knotless.

20. The method of claim 11 , wherein the method is knotted.

21. 1. A method of forming a mattress stitch on tissue, comprising: securing the tail of the suture construct to a suture threader; advancing the suture threader with the suture construct at the surgical site through an arthroscopic portal; puncturing tissue at the surgical site with two sharp tines at the distal end of the suture threader at two different locations simultaneously within the tissue; advancing a needle through the shaft of the suture threader and through one of the two sharp tines to allow the tail to advance from one of the two sharp tines to the other of the two sharp tines of the suture threader; retracting the needle from the two sharp tines; removing the suture threader from the surgical site to allow the tail of the suture construct to be securely attached to the locking mechanism of one of the two sharp tines; passing the tail of the suture construct through a loop of a flexible construct; and pulling the tail to form a cinch loop around and through the tissue.

22. 22. The method of claim 21, wherein all steps are performed using the same arthroscopic portal.

23. 22. The method of claim 21, wherein the suture construct is a single strand, the tail is a single tail, and the loop is a continuous, flexible, uninterrupted loop terminating in the single tail.

24. 22. The method of claim 21, wherein the suture construct is formed from suture, silk, cotton, nylon, polypropylene, polyethylene, ultra-high molecular weight polyethylene (UHMWPE), polyethylene terephthalate (PET), polyester, or a copolymer, or a combination thereof.

25. 22. The method of claim 21, wherein the loop is secured to a movable ring on a handle of the suture threader.

26. The method of claim 21 , wherein the loop is secured to a handle of the suture threader.

27. 22. The method of claim 21, wherein the tail is reinforced.

28. 22. The method of claim 21, wherein the tissue is a soft tissue.

29. 22. The method of claim 21, wherein the tissue is a rotator cuff tendon and graft.

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