Arthroscopic graft insertion system and method

Abstract

A graft configured for arthroscopic insertion into a transplant site within a patient's body includes a substantially flat portion defined by at least a first margin, a second margin, and a third margin, a first guide lumen positioned along a portion of the first margin, a second guide lumen positioned along a portion of the second margin, and a leading lumen positioned along a portion of the third margin. Each of the first guide lumen, the second guide lumen, and the leading lumen is configured to receive sutures. The third margin is substantially perpendicular to the first and second margins, and therefore the leading lumen is substantially perpendicular to the first and second guide lumens.

Description

Technical Field

[0001] [Cross - Reference to Related Applications] This application claims the benefit of priority of U.S. Provisional Patent Application No. 63 / 515,775, filed on July 26, 2023, the content of which is incorporated herein by reference.

[0002] This application relates to a system and method for arthroscopic insertion of a graft. Specifically, this application relates to an arthroscopic insertion system and method for a graft that can be introduced into a patient using a suture and fixed to the implantation site using the same suture.

Background Art

[0003] In procedures involving the repair of tendons and ligaments, for example, a graft (a "transplant") that is delivered arthroscopically via a suture is used to encourage a severed tendon to grow onto the bone. Such a graft is introduced into the patient in a compressed state and is once deployed in vitro and attached to the implantation site.

[0004] During the introduction of the graft into the patient and during the implantation of the graft at the implantation site, the force exerted by the suture on the graft must be controlled in both cases. The graft must maintain a compressed state during introduction and be deployed across the entire implantation site. Further, the graft must be able to withstand the tension acting in multiple directions during implantation to ensure tendon repair and maintain durability throughout its lifespan.

[0005] In conventional graft shapes, additional components (e.g., introducers) are required to introduce the graft into the patient's body, which may make it difficult to introduce the graft into the patient. In such conventional graft shapes, the graft may not be able to withstand the tension during implantation, and thus there is also a risk of deterioration of patient outcomes.

Summary of the Invention

[0006] This application discloses various embodiments of a graft configured for arthroscopic insertion into a transplant site within a patient's body. Related methods of use and embodiments of a kit for arthroscopic insertion of the graft into the transplant site within a patient's body are also disclosed.

[0007] In aspects of this disclosure, the graft may include a substantially flat portion defined by at least a first edge, a second edge, and a third edge. The graft may further include a first guiding lumen positioned along a portion of the first edge, a second guiding lumen positioned along a portion of the second edge, and a leading lumen positioned along a portion of the third edge. Each of the first guiding lumen, the second guiding lumen, and the leading lumen may be configured to receive sutures. The third edge may be substantially perpendicular to the first and second edges, and therefore the leading lumen may be substantially perpendicular to the first and second guiding lumens.

[0008] In some implementations, the third margin is the distal margin of the graft, and therefore the leading lumen is positioned along a portion of the distal margin of the graft. In further implementations, the third margin may include the proximal margin of the graft, and therefore the leading lumen is positioned along a portion of the proximal margin of the graft.

[0009] In some implementations, the graft is configured to transition from a first flat configuration to a compressed configuration when the suture is pulled by a first amount, and to transition from the compressed configuration to a second flat configuration when the suture is pulled by a second amount.

[0010] In some implementations, the graft contains electrospun material. In further implementations, the lengths of the first and second edges can be approximately 20 millimeters, and the length of the third edge can be approximately 30 millimeters.

[0011] In some implementations, the graft in the compression configuration is sized to pass through the cannula and an incision approximately 5 to 8 millimeters in length.

[0012] In some implementations, the graft contains biocompatible material. In further implementations, the portion of the first edge is shorter than the length of the first edge, the portion of the second edge is shorter than the length of the second edge, and the portion of the third edge is shorter than the length of the third edge.

[0013] In some implementations, the graft further includes a fourth edge and a backout lumen positioned along a portion of the fourth edge. In some implementations, the length of the leading lumen is at least 80 percent of the length of the first and second guiding lumens. In further implementations, the leading lumen has a length of at least approximately 18 millimeters.

[0014] In some implementations, the suture may include a continuous suture attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture. In some implementations, the suture may include a first material piece and a second material piece, the first material piece being attached to the graft site at a first position and the second material piece being attached to the graft site at a second position. In further implementations, the first material piece and the second material piece are configured to be tied together. In some implementations, the graft is configured to be attached to the graft site at the first and second positions.

[0015] In some implementations, at least one of the first guide lumen and the second guide lumen includes a first lumen segment and a second lumen segment. In further implementations, the suture is a sliding suture.

[0016] In another embodiment, a method for arthroscopically inserting a graft into a transplant site within a patient's body is disclosed. In some embodiments, the graft may include a substantially flat portion defined by at least a first edge, a second edge, and a third edge, a first guide lumen positioned along the first edge, a second guide lumen positioned along the second edge, and a leading lumen positioned along the third edge, each of which is configured to receive a suture, the third edge being substantially perpendicular to the first and second edges, and therefore the leading lumen being substantially perpendicular to the first and second guide lumens. The method may further include passing a suture attached to the transplant site at least at a first position and a second position along the length of the suture through the first guide lumen, the second guide lumen, and the leading lumen of the graft. The method may further include pulling the suture to move the graft through the incision along the suture to the transplant site.

[0017] In some implementations, the third margin is the distal margin of the graft, and therefore the leading lumen is positioned along a portion of the distal margin of the graft. In yet another implementation, the third margin is the proximal margin of the graft, and therefore the leading lumen is positioned along a portion of the proximal margin of the graft.

[0018] In some implementations, the method further includes transitioning the graft from a first flat configuration to a compressed configuration by pulling the suture by a first amount, and transitioning the graft from a compressed configuration to a second flat configuration by pulling the suture by a second amount.

[0019] In some implementations, the graft contains electrospan material. In further implementations, the length of the first and second edges is approximately 20 millimeters, and the length of the third edge is approximately 30 millimeters. In further implementations, in a compression configuration, the graft is sized to pass through the cannula and an incision having a length of approximately 5 to 8 millimeters.

[0020] In some implementations, the graft contains biocompatible material. In some implementations, the portion of the first edge is shorter than the length of the first edge, the portion of the second edge is shorter than the length of the second edge, and the portion of the third edge is shorter than the length of the third edge.

[0021] In further implementations, the graft of the method further includes a fourth edge and a receding lumen positioned along a portion of the fourth edge. In some implementations, the length of the leading lumen is at least 80 percent of the length of the first and second guiding lumens. In some implementations, the leading lumen has a length of at least about 18 millimeters.

[0022] Further implementations include a continuous suture that is attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture. In some implementations, the suture includes a first material piece and a second material piece, the first material piece being attached to the graft site at a first position and the second material piece being attached to the graft site at a second position. In some implementations, the method further includes tying the first material piece and the second material piece together.

[0023] In further implementations, the graft is configured to be attached to the implantation site at first and second positions. In some implementations, at least one of the first guide lumen and the second guide lumen includes a first lumen segment and a second lumen segment. In some implementations, the suture includes a sliding suture.

[0024] In another embodiment, a kit for arthroscopically inserting a graft into a transplant site within a patient's body is disclosed. In some embodiments, the kit includes sutures, a cannula, and a graft, the graft comprising a substantially flat portion defined by at least a first, second, and third edge, a first guide lumen positioned along the first edge, a second guide lumen positioned along the second edge, and a leading lumen positioned along the third edge. Each of the first, second, and leading lumens may be configured to receive the sutures. The third edge may be substantially perpendicular to the first and second edges, and so the leading lumen may be substantially perpendicular to the first and second guide lumens, and the graft is configured to move along the sutures through the cannula to the transplant site.

[0025] In one embodiment, a graft configured for arthroscopic insertion into a transplant site within a patient's body may include a substantially tubular body defined along the longitudinal axis by at least a distal end and a proximal end. At least a first guide lumen may be positioned along the tubular body, and a first leading lumen may be positioned along the periphery of the distal end. Each of the first guide lumen and the first leading lumen may be configured to receive sutures. The periphery of the distal end lies in a plane substantially perpendicular to the longitudinal axis, and therefore the first leading lumen is substantially perpendicular to the first guide lumen.

[0026] In some implementations, the graft further includes a second guide lumen positioned along the tubular body. In some implementations, at least a first guide lumen is positioned within the tubular body. In further implementations, the graft includes electrospan material.

[0027] In some implementations, the periphery of the distal end of the substantially tubular body has a length of about 15 millimeters to about 30 millimeters. In some implementations, the graft is sized to pass through a cannula and an incision having a length of about 5 millimeters to about 8 millimeters. In further implementations, the graft comprises a biocompatible material.

[0028] In some implementations, the graft further comprises a second guide lumen disposed along the periphery of the distal end of the tubular body. In some implementations, the first guide lumen extends along a first segment of the periphery of the distal end of the tubular body, and the second guide lumen extends along a second segment of the periphery of the distal end of the tubular body.

[0029] In further implementations, the graft further comprises a retraction lumen disposed along the periphery of the proximal end of the tubular body. In some implementations, the suture comprises a continuous suture attached to the implantation site at at least a first position along the length of the suture and a second position along the length of the suture. In some implementations, the suture comprises a first piece of material and a second piece of material, the first piece of material being attached to the implantation site at the first position and the second piece of material being attached to the implantation site at the second position. In further implementations, the first piece of material and the second piece of material are configured to be joined. In some implementations, the graft is configured to be attached to the implantation site at the first and second positions. In some implementations, the suture is a sliding suture.

[0030] The following attached drawings and description show details of one or more variations of the subject matter described herein. Other features and advantages of the subject matter described herein will become apparent from these descriptions and drawings, as well as from the claims.

[0031] The attached drawings incorporated herein and constituting a part thereof show some aspects of the subject matter disclosed herein, and these attached drawings serve to explain, in conjunction with the description, a part of the principles related to the disclosed implementations. [Brief explanation of the drawing]

[0032] [Figure 1A] This figure shows an exemplary embodiment of a four-sided graft for arthroscopic insertion into a transplant site within a patient's body. [Figure 1B] This figure shows an exemplary embodiment of a four-sided graft for arthroscopic insertion into a transplant site within a patient's body. [Figure 1C] This figure shows an exemplary embodiment of a three-sided graft for arthroscopic insertion into a transplant site within a patient's body. [Figure 2A] This diagram shows the insertion of a graft into the transplant site within the patient's body. [Figure 2B] This diagram shows the insertion of a graft into the transplant site within the patient's body. [Figure 2C] This diagram shows the insertion of a graft into the transplant site within the patient's body. [Figure 2D] This diagram shows the insertion of a graft into the transplant site within the patient's body. [Figure 3] This figure shows an exemplary method of inserting a graft according to the embodiments described herein. [Figure 4A] This figure shows a further exemplary embodiment of a graft inserted into a transplant site within a patient's body. [Figure 4B] This figure shows a further exemplary embodiment of a graft inserted into a transplant site within a patient's body. [Figure 5] This diagram shows an exemplary device used for loading lumens through an exemplary graft. [Figure 6A] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6B] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6C] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6D] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6E] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6F] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6G] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6H] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6I] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6J] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6K] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 6L] This figure shows an exemplary graft insertion into an anatomical site within a patient, according to the embodiments described herein. [Figure 7A] This figure shows the removal of an exemplary graft with a fourth lumen from an anatomical site. [Figure 7B] This figure shows the removal of an exemplary graft with a fourth lumen from an anatomical site. [Figure 7C] This figure shows the removal of an exemplary graft with a fourth lumen from an anatomical site. [Modes for carrying out the invention]

[0033] For practical purposes, similar reference numbers indicate similar structures, features, or elements.

[0034] This specification describes various embodiments and related methods of grafts configured for arthroscopic insertion into patients. Such grafts can be used, for example, to promote tendon ingrowth into bone in rotator cuff repair.

[0035] This disclosure describes various embodiments of grafts having a lumen shape configured to facilitate compression of the graft during graft introduction into a patient by inducing tension exerted on the graft by a suture. The lumen shapes described herein further eliminate the need for additional introduction devices, as the graft can be directly introduced to the implantation site in the patient by moving along the suture when the suture is pulled by a physician. Thus, the grafts described herein have a shape that simplifies graft introduction into a patient. As used herein, the term “lumen” refers to an aperture or loop-shaped aperture that can be configured to receive a suture or any mechanism for introducing, advancing / shuttling, removing, fixing, and compressing a graft into / from the implantation site. Furthermore, the term “graft” refers to any device, including but not limited to sponges, scaffolds, and meshes, configured for implantation into a patient’s body and capable of enhancing the strength, healing and / or regenerative capacity of natural tissue at the time of implantation. The grafts described herein can be configured to provide a healing agent to the transplant site upon transplantation, thereby enhancing the strength, healing capacity, and / or regenerative capacity of the natural tissue.

[0036] The lumen shape facilitates graft attachment and implantation at the transplant site. Once implanted, the shape described herein ensures that the graft unfolds in the desired manner throughout the transplant site due to the tension exerted on the graft by the sutures while the graft is in vitro. Furthermore, the shape described herein helps to compress the graft onto the natural tissue at the transplant site, promoting this compression while avoiding point fixation and bunching of the graft. The lumen and graft shapes described herein help to ensure the lifespan of the graft by ensuring that multidimensional tension is distributed throughout the graft during graft implantation.

[0037] The lumen and graft shapes described herein allow the same sutures to be used for both introducing the graft into the transplant site and securing it to the transplant site. Thus, the shapes described herein eliminate the need for additional introducers to introduce the graft and eliminate the use of foreign materials (e.g., staples) that might otherwise be used to secure the graft to the transplant site. Therefore, the grafts described herein improve ease of introduction and transplantation while improving patient outcomes.

[0038] This disclosure further describes various embodiments of arthroscopic methods for introducing grafts into the transplant site within a patient. The methods described herein enable graft introduction without the need for additional introducers, using only one or more sutures, which are also used to secure the graft to the transplant site.

[0039] First, Figure 1A shows a graft 100 according to an embodiment described herein. The graft 100 includes a substantially flat portion 102 defined by at least a first edge 104, a second edge 106, and a third edge 108. A first guide lumen 110 is positioned along a portion of the first edge 104. A second guide lumen 112 is positioned along at least a portion of the second edge 106. A leading lumen 114 is positioned along at least a portion of the third edge 108. Each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 is configured to receive a suture 116. As will be further described below with reference to Figures 6A to 6L, the suture 116 may include a single suture or at least two sutures. The third edge 108 is substantially perpendicular to the first edge 104 and the second edge 106, and therefore the leading lumen 114 is substantially perpendicular to the first guide lumen 110 and the second guide lumen 112. As described herein, each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 facilitates the introduction of the graft 100 into the implantation site by guiding the graft 100 to the appropriate position within the patient's body. Furthermore, each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 is configured to help deploy the graft 100 throughout the implantation site once it has been introduced into the implantation site. As described herein, the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 are each configured to compress the graft 100 against the transplant site when the graft 100 is introduced into the transplant site.

[0040] As shown in Figure 1A, in some embodiments, a first guide lumen 110 is positioned along the entire length L1 of the first edge 104, a second guide lumen 112 is positioned along the entire length L2 of the second edge 106, and a leading lumen 114 is positioned along the entire length L3 of the third edge 108.

[0041] In some implementations, the graft 100 in Figure 1A further includes a fourth margin 113, along which a receding lumen 115 can be positioned. As will be further described below with respect to Figures 2 and 6A to 6L, the receding lumen 115 can be used to remove the graft 100 from the graft site. Furthermore, once the graft 100 has taken root in the graft site, each of the lumens 110, 112, 114 and 115 can compress the graft against the natural tissue of the graft site.

[0042] Next, Figure 1B shows a graft 130 according to an embodiment described herein. The graft 130 includes a substantially flat portion 102 defined by at least a first edge 104, a second edge 106, and a third edge 108. A first guide lumen 110 is positioned along a portion of the first edge 104. A second guide lumen 112 is positioned along at least a portion of the second edge 106. A leading lumen 114 is positioned along at least a portion of the third edge 108. Each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 is configured to receive a suture 116. The third edge 108 is substantially perpendicular to the first edge 104 and the second edge 106, and therefore the leading lumen 114 is substantially perpendicular to the first guide lumen 110 and the second guide lumen 112. The graft 130 further includes a fourth edge 113.

[0043] As shown in Figure 1B, in some embodiments, a first guide lumen 110 is positioned along a portion of the length L1 of the first edge 104, a second guide lumen 112 is positioned along a portion of the length L2 of the second edge 106, and a leading lumen 114 is positioned along a portion of the length L3 of the third edge 108. In some implementations, the portion of the length L1 of the first edge 104 in which the first guide lumen 110 is positioned can be approximately 50 percent to 100 percent of the length L1 of the first edge 104. In further implementations, the portion of the length L2 of the second edge 106 in which the second guide lumen 112 is positioned can be approximately 50 percent to 100 percent of the length L2 of the second edge 106. In further implementations, the portion of the length L3 of the third edge 108 in which the leading lumen 114 is located can be approximately 50 percent to 100 percent of the length L3 of the third edge 108.

[0044] In the embodiment described in Figures 1A and 1B, the third edge 108 is the distal edge of grafts 100 and 130, and therefore the leading lumen 114 is positioned along the distal edge 108 of graft 100 (for example, along the entire length L3) and along the distal edge 108 of graft 130 (for example, along a portion of the length L3).

[0045] Generally, each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 ("lumens 110, 112, 114") can be positioned along any preferred portion of the lengths L1, L2, and L3 of the first edge 104, the second edge 106, and the third edge 108 ("edges 104, 106, 108"). The portion of the lengths L1, L2, and L3 of the first edge 104, the second edge 106, and the third edge 108 in which the lumens 110, 112, and 114 are positioned can be selected based on the treatment in which the use of graft 100 or graft 130 is intended.

[0046] By configuring each of the lumens 110, 112, and 114 to be positioned along specific portions of lengths L1, L2, and L3 of their respective edges 104, 106, and 108, the force exerted by the suture 116 on the graft 100 or graft 130 during its introduction into the graft site in the patient can be controlled. As will be further explained below with reference to Figures 2A to 2D, by controlling these forces, the graft 100 or graft 130 can be configured to transition from a first unfolded or flat configuration to a compressed (i.e., coiled or substantially cylindrical) configuration so as to pass through the cannula and incision, and from the compressed configuration to a second unfolded or flat configuration so as to adhere to the graft site when the suture 116 is pulled. The first unfolded or flat configuration of the graft 100 or graft 130 can be analogous to the second unfolded or flat configuration of the graft 100 or graft 130. Depending on factors such as the graft site, the material of the graft site (i.e., tissue type), the size of the incision, and the severity of the injury to be treated by the insertion of graft 100 or graft 130, grafts with lumens of specific lengths relative to the lengths L1, L2, and L3 of the margins 104, 106, and 108 may be required.

[0047] In some implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 5 mm to 90 mm. In some implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 5 mm to 60 mm. In further implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 50 mm to 90 mm. In further implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 20 mm to 50 mm. In some implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 17 mm to 23 mm. In some implementations, the length L1 of the first edge 104 and the length L2 of the second edge 106 are approximately 20 mm. In further implementations, the length L3 of the third edge 108 is approximately 27 mm to 33 mm. In some implementations, the length L3 of the third edge 108 is approximately 30 millimeters. Generally, the dimensions of the graft described herein can be selected according to the procedure to which the graft is intended (e.g., rotator cuff repair, Achilles tendon repair, or ACL repair). In some implementations, any of the edges 104, 106, and 108 can have a length of approximately 5 millimeters to approximately 90 millimeters.

[0048] Similarly, the relative lengths of lumens 110, 112, and 114 (i.e., the relative lengths of the portions of L1, L2, and L3 in which lumens 110, 112, and 114 are respectively located) can also be selected to control the force exerted by the suture 116 on the graft 100 or 130 during the introduction and implantation of such a graft into the patient's body. By controlling the force exerted by the suture 116 on the graft 100 or 130 during introduction and implantation, the graft 100 or 130 can be transitioned from a first unfolded or flat configuration to a compressed (i.e., coiled or substantially cylindrical) configuration so as to pass through the cannula and incision, and from the compressed configuration to a second unfolded or flat configuration so as to adhere to the implantation site.

[0049] In some implementations, the length of the lead lumen 114 can be at least 80 percent of the length of the first guide lumen 110 and the second guide lumen 112. In some embodiments, the length of the lead lumen 114 can be at least 50 percent of the length of the first guide lumen 110 and the second guide lumen 112. Generally, the lead lumen 114 can be configured to have a length of about 18 millimeters.

[0050] Figure 1C shows a graft 150 including a first edge 104 and a second edge 106 that border a substantially flat portion 102. Similar to the grafts described in Figures 1A and 1B, the graft 150 includes a first guide lumen 110 positioned along a portion of length L1 of the first edge 104 and a second guide lumen 112 positioned along a portion of length L2 of the second edge 106. As shown in Figure 1C, the graft 150 includes a third edge 118. A leading lumen 120 can be positioned along a portion of length L3 of the third edge 118. In the embodiment of Figure 1C, the third edge 118 is the proximal edge of the graft 150, and therefore the leading lumen 120 is positioned along a portion of length L3 of the proximal edge 118 of the graft 150. In general, each of the lumens 110, 112, 114, and 120 can be positioned along any preferred portion of its respective edge and can be configured to be positioned at least in contact with the corners of its respective edge. As further described herein, by positioning each of the lumens 110, 112, 114, and 120 in contact with the corners of its respective edge, the graft described herein is configured to unfold upon implantation in the patient and to be locked in place by these corners. In this way, each of the lumens 110, 112, 114, and 120 helps to guide the graft 100 to the implantation site, unfold the graft 100 at the implantation site, and compress the unfolded graft 100 against the implantation site.

[0051] Figures 2A to 2D show examples of graft 100 insertion into the transplantation site 101 in the patient's body. For example, graft 100 can be any of grafts 100, 130, or 150 shown in Figures 1A to 1C, or grafts 170 and 180 shown in Figures 4A to 4B, which will be further described below.

[0052] As shown in Figure 2A, sutures 116 are attached to the first position 127 and the second position 128 of the graft site 101. As shown in the exemplary embodiments in Figures 2A to 2D, the sutures 116 may have segments 122, 123, 124, and 125. The dashed lines at positions 127 and 128 indicate that the sutures 116 are positioned at least partially along the back side of the tissue of the graft site 101. As described herein, the sutures 116 are configured as sliding sutures that can move relative to the graft site 101 to which they are attached when pulled by a physician.

[0053] In some implementations, the suture 116 includes at least two material pieces (for example, segments 122 and 123 of the suture 116 are formed from a first continuous material piece, and segments 124 and 125 of the suture 116 are formed from a second continuous material piece). In some implementations, the suture 116 is a continuous suture (i.e., each of segments 122, 123, 124, and 125 of the suture 116 is formed from the same continuous piece of material). In some implementations where the suture 116 is a continuous suture, as will be further illustrated below with reference to Figure 6, the graft 100 can be configured to receive at least two suture materials during the introduction of the graft 100 into the transplant site 101, the two suture materials can then be joined together and pulled through the lumens 110, 112, and 114 of the graft 100 so that a continuous piece of material, including segments 122 and 123 of the suture 116, passes through the lumen of the graft 100 during transplantation.

[0054] As shown in Figure 2B, the graft 100, having a substantially flat portion 102, is configured to receive a suture 116. Each of the segments 122, 123, 124, and 125 of the suture 116 is configured to help introduce and attach the graft 100 to the transplant site 101. As will be further described below, the physician can introduce the graft 100 to the transplant site 101 by moving the appropriate segments 122, 123, 124, and 125 back and forth through lumens 110, 112, 114, and 115.

[0055] In an implementation in which the suture 116 includes a first material piece and a second material piece, the first material piece, including segments 122 and 123 of the suture 116, is configured to be attached to the graft site 101 at a first position 127, and the second material piece, including segments 124 and 125 of the suture 116, is configured to be attached to the graft site 101 at a second position 128. When segments 122 and 125 of the suture 116 are pulled proximally from the practitioner, resistance to the pull is generated because the suture 116 is attached to the first position 127 and the second position 128. When the suture 116 is pulled, this resistance causes the graft 100 to move distally from the practitioner toward the graft site 101 in the patient.

[0056] As further shown in Figure 2C, the graft 100 is configured to transition from a first flat configuration to a compressed configuration when the suture 116 is pulled by a first amount proximal toward the practitioner (as indicated by the arrow). As shown in Figure 2C, the compressed configuration can be such that each side of the graft 100 curves inward toward the center of the flat portion 102 in the plane defined by the flat portion 102. For example, the compressed configuration of the graft 100 can be such that the graft 100 is wound cylindrically along the longitudinal or central axis of the flat portion 102. For example, the compressed configuration of the graft 100 can be such that the graft 100 is wound in a C-shape along the longitudinal or central axis of the flat portion 102. For example, the compressed configuration of the graft 100 can be such that the graft 100 is wound in a C-shape while each side of the graft 100 also curves inward toward the center of the flat portion 102 in the plane defined by the flat portion 102. As further shown in Figure 2C, in the compressed configuration, the graft 100 is sized to pass through the cannula 126. The cannula 126 is placed within an incision in the patient's body. In some embodiments, the graft 100 is sized to fit within the cannula 126, which is placed within an incision having a length of approximately 5 to 8 millimeters. Generally, any suitable arthroscopic portal can be used to reach the implantation site 101. In some implementations, the graft 100 can be sized to fit within the cannula 126 having a diameter of approximately 2.5 to 15 millimeters. In some implementations, the graft 100 can be sized to fit within the cannula 126 having a diameter of approximately 5 to 10 millimeters. The cannula 126 may include a retractable fluid dam to prevent fluid leakage from the patient's body during insertion of the graft 100 into the implantation site 101. In some implementations, a cannula 126 can be used in conjunction with a graft compressor to introduce the graft 100 into the transplantation site 101.A graft compressor can help compress graft 100 so that fluid can pass through the fluid dam of a cannula, such as cannula 126.

[0057] Next, as shown in Figure 2D, when the suture 116 is pulled by a second amount proximal toward the practitioner (as indicated by the arrow), the graft 100 is configured to transition from a compressed configuration to a second flat configuration. The first flat configuration can be similar to the second flat configuration. As described above, the relative lengths of lumens 110, 112, and 114 can be configured so that the graft 100 can withstand the multidirectional tension exerted on the graft 100 by the suture 116 during transplantation. Generally, increasing the lengths of lumens 110, 112, and 114 facilitates both the transition of the graft 100 from a compressed configuration to a second flat configuration, and the subsequent attachment of the graft 100 at the transplantation site 101. Figure 2D shows that the graft 100 is attached to the graft site 101 at two corners, but generally positions 127 and 128, as well as the lumen shape of the graft 100, can be selected to attach the graft 100 to the graft site 101 via any preferred portion of the graft 100.

[0058] Figure 3 shows an exemplary method 300 for arthroscopic insertion of a graft into a transplant site within a patient's body. The grafts inserted into the patient's body according to method 300 may be any of the grafts 100, 130, 150, 170, and 180 shown in Figures 1A-1C, 2A-2D, and 4A-4B. The graft of method 300 includes a substantially flat portion defined by at least a first edge, a second edge, and a third edge. The graft of method 300 further includes a first guide lumen positioned along the first edge, a second guide lumen positioned along the second edge, and a leading lumen positioned along the third edge, each of which is configured to receive sutures. In some embodiments, the third edge of the graft of Method 300 is substantially perpendicular to the first and second edges of the graft of Method 300, and therefore the leading lumen is substantially perpendicular to the first and second guide lumens. The suture of Method 300 can be, for example, one of the sutures 116 in Figures 1A-1C and Figures 2A-2D. As described above, the suture of Method 300 can be a sliding suture, and therefore, as described herein, the suture of Method 300 can move relative to the graft site when a segment of the suture is pulled by a physician.

[0059] In some embodiments, the method includes step 302 of passing the suture, which has been attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture, through a first guide lumen, a second guide lumen, and a leading lumen of the graft.

[0060] In some embodiments, the method further includes step 304, which involves pulling the suture to move the graft through the incision along the suture to the transplant site. As described above with respect to Figures 2A to 2D, the exemplary graft according to the embodiments described herein is configured to transition from a first flat configuration to a compressed configuration so that it can pass through the cannula and the incision as it moves through the incision along the suture to the transplant site. The graft is then configured to unfold from the compressed configuration to a second flat configuration for transplantation at the transplant site. In the second flat configuration, the lumen shape facilitates compression of the graft against the natural tissue at the transplant site. The lumen shape prevents the graft from being scrunched or bunched up during transplantation by avoiding point fixation of the graft at the transplant site while providing this compression. The embodiments described herein improve graft lifespan and patient outcomes.

[0061] As described above, performing Method 300 using any of the exemplary grafts 100, 130, and 150 facilitates the delivery of the graft to the patient without the need for additional delivery devices. The lumen shapes of the grafts 100, 130, and 150 are configured to guide the force applied to the graft by pulling the suture 116 to transition from a first flat configuration to a compressed configuration so that the graft can pass through the cannula and incision, and then to a second flat configuration so that it can be implanted at the transplant site. The lumen shapes described herein also ensure that the graft can withstand the tension exerted on it by the suture during graft implantation and use once the graft has been delivered to the transplant site via Method 300.

[0062] Figure 4A shows an exemplary graft 170 according to an embodiment described herein. Figure 4A shows a graft 170 having guide lumens 110 and 112 as described above with respect to Figures 1A to 1C. As shown in Figure 4A, the first guide lumen 110 may include a first lumen segment 110a separated from the second lumen segment 110b by a first spacing distance, and / or the second guide lumen 112 may include a third lumen segment 112a separated from the fourth lumen segment 112b by a second spacing distance. For example, the first and second spacing distances may be the same or different lengths, and such lengths may range from about 1 millimeter (mm) to about 5 mm. Other lengths are also within the scope of this disclosure. In general, any of the guide lumens 110 and 112, and the leading lumen 114, may be divided into any preferred number of segments and separated by any preferred spacing distance. As will be further explained with respect to Figures 6A to 6L, each of the lumen segments of the guide lumens 110 and 112, and the leading lumen 114, can be positioned in contact with the corners of the graft 170 so that the graft 170 can be deployed and its corners can be locked into the transplant site.

[0063] Figure 4B shows an exemplary graft 180 according to an embodiment described herein. The graft 180 in Figure 4B includes a tubular body 182 having a distal end 184 and a proximal end 185. The distal end 184 of the tubular body 182 of the graft 180 includes a peripheral portion 186 having a leading lumen 188 configured to receive a suture, such as the suture 116 shown in Figures 1A-1C. As described with respect to Figures 1A-1C, 2A-2D, and 6A-6L, the suture 116 can be used to introduce the graft 180 into the transplant site 101.

[0064] The periphery 186 of the tubular body 182 may include any number of guide lumens 188 arranged circumferentially on the periphery 186. Each of the guide lumens 188 may be spaced at any preferred interval along the periphery 186 of the tubular body 182 of the graft 180. The graft 180 in Figure 4B includes at least a first guide lumen 110, but may also include two guide lumens 110 and 112 as described above with respect to Figures 1A to 1C. Each of the first and second guide lumens 188 may extend along the respective segments of the periphery 186 of the distal end 184 of the tubular body 182 of the graft 180. For example, a first leading lumen 188 can extend along a first segment of the peripheral 186 of the distal end 184 of the tubular body 182 of the graft 180, and a second leading lumen 188 can extend along a second segment of the peripheral 186 of the distal end 184 of the tubular body 182 of the graft 180. The peripheral 186 of the tubular body 182 can have a length of about 15 mm to about 30 mm. In some implementations, the tubular body 182 can have a length of about 5 mm to about 150 mm. In some implementations, the tubular body 182 can have a length of about 20 mm to about 130 mm. In some implementations, the tubular body 182 can have a length of about 40 mm to 110 mm. In some implementations, the tubular body 182 can have a length of about 60 mm to 90 mm. In some implementations, the tubular body 182 can have a length of about 75 mm.

[0065] The peripheral portion 186 of the tubular body 182 can be configured to be located in a plane perpendicular to the central axis of the tubular body 182. Thus, as will be described with respect to the remaining embodiments herein, the leading lumen 188 of the graft 180 is positioned perpendicular to the guide lumens 110 and 112. The tubular body 182 may include a sleeve that itself functions as a guide lumen 110, or it may define a sleeve that can accommodate any number of guide lumens 110 and 112 through which sutures of one or more lengths can pass, in order to help position and secure the graft 180 at the implantation site in the patient. The guide lumen 110 of the tubular body 182 can be configured to receive a suture 116 of one length. The guide lumen 110 of the tubular body 182 can also be configured to receive multiple (e.g., two) lengths of sutures 116 through which sutures 116 can pass. As described herein, one or more sutures 116 received by the guide lumen 110 of the tubular body 182 are used to introduce, advance, and position the tubular body 182 of the graft 180 into the implantation site in the patient's body. As described above, the sutures or sutures 116 received by the guide lumen 110 of the tubular body 182 may be sliding sutures that can move relative to the implantation site when pulled by a physician as described herein. In some implementations, the graft 180 in Figure 4B may have a retraction lumen (e.g., retraction lumen 115) positioned along the periphery of its proximal end. As described herein, the retraction lumen may be configured to receive sutures, and the physician may use the retraction lumen to assist in both positioning the graft, such as the graft 180 in Figure 4B, at the implantation site, and removing the graft from the implantation site.

[0066] Tubular grafts, such as graft 180 in Figure 4B, can be particularly useful for procedures where the physician desires to ensure close contact between the distal end 184 of the tubular body 182 of graft 180 and a transplant site, such as the transplant site 101 in Figures 2A to 2D. In some embodiments, graft 180 in Figure 4B may be a substantially hollow cylinder packaged for use with a needle positioned below the central axis of the tubular body 182. In such embodiments, the needle may have a suture shuttle or suture engagement device at its distal end, and as the physician pulls the needle proximal, the suture can be drawn through the tubular body 182 of graft 180 to form a guide lumen 110.

[0067] Grafts 100, 130, 150, 170, and 180 in Figures 1A-1C and 4A-4C may include electrospan material. Electrospan material is configured to withstand the multidirectional tensions the graft experiences during implantation in the patient, thus increasing the reliability and lifespan of the graft. Grafts 100, 130, 150, 170, and 180 in Figures 1A-1C and 4A-4B may further include biocompatible material. Grafts 100, 130, 150, 170, and 180 in Figures 1A-1C and 4A-4B may further include allograft. Grafts 100, 130, 150, 170, and 180 in Figures 1A-1C and 4A-4B may further include scaffold, mesh, or sponge.

[0068] Figure 5 shows an exemplary packaging of the grafts described in the embodiments of this specification. The graft 100 in Figure 5 can be any of the grafts 100, 130, 150, 170, and 180 in Figures 1A to 1C and Figures 4A to 4B. As shown in Figure 5, the graft 100 can be packaged with a fork 502 having prongs 504 and 506. The graft 100 in Figure 5 can be packaged with prongs 504 located in the lumen 110 of the graft 100 and prongs 506 located in the lumen 112 of the graft 100. The lumen 110 of the graft 100 in Figure 5 can be, for example, the first guide lumen 110 in Figure 1. The lumen 112 of the graft 100 in Figure 5 can be, for example, the second guide lumen 112 in Figure 1. As shown in the illustration, the prongs 504 and 506 are slotted to allow easy insertion of sutures, such as the suture 116 in Figure 1, into and removal from the lumens 110 and 112. Once the sutures are loaded into the lumens 110 and 112, as described herein, the physician can remove the fork 502 from the graft 100 by holding the proximal end of the fork 502. The use of the fork 502 in the packaging of the exemplary graft 100 is anchor and suture agnostic, meaning it can be used to package the graft 100 regardless of the anchor ultimately used to fix the graft 100 to the transplant site in the patient (for example, when the graft 100 is directly attached to the transplant site 101 via the suture 116, and / or when the graft 100 is attached to the bone by a bone anchor), and can be used to insert either suture 116 through the lumens 110 and 112.

[0069] Figures 6A to 6L show the insertion of an exemplary graft 100 described herein into a transplant site 101 in a patient. The graft 100 in Figures 6A to 6L may be any of the exemplary grafts 100, 130, and 150 described above. The graft in Figures 6A to 6L includes a substantially flat portion 102 defined by at least a first edge 104, a second edge 106, and a third edge 108. A first guide lumen 110 is positioned along a portion of the first edge 104. A second guide lumen 112 is positioned along at least a portion of the second edge 106. A leading lumen 114 is positioned along at least a portion of the third edge 108. Each of the first guide lumen 110, the second guide lumen 112, and the leading lumen 114 is configured to receive a suture 116. The third edge 108 is substantially perpendicular to the first edge 104 and the second edge 106, and therefore the leading lumen 114 is substantially perpendicular to the first guide lumen 110 and the second guide lumen 112.

[0070] In the embodiments shown in Figures 6A to 6L, the suture 116 includes two sutures 116a and 116b. In Figure 6A, the sutures 116a and 116b are attached to the graft site 101 in the patient. Suture 116a includes segments 122 and 123. Suture 116b includes segments 124 and 125. The sutures 116a and 116b can be attached to the graft site 101 at their respective positions, which can be configured to position the corners of the graft. Figures 6A to 6L outline a specific set of steps for inserting the graft 100, but the sutures 116a and 116b can be inserted into the lumen of the graft 100 in any preferred manner, as long as the graft 100 can slide along the sutures 116a and 116b when its segments are pulled by a physician as described herein.

[0071] As shown in Figure 6B, the device 606 is configured to be inserted through the first guide lumen 110 of the graft 100 to secure the segment 122 of the suture 116a. The device 606 in Figure 6B may be a wire loop or any other device or material configured to secure a suture, such as the suture 116a.

[0072] Figure 6C shows that the device 606 can be pulled proximal to the physician to pull the suture 116a through the first guide lumen 110 of the graft 100. In Figure 6D, the device 606 (which can be the same as the device 606 in Figure 6C) is similarly inserted through the leading lumen 114 of the graft 100. Figure 6E shows the device 606 securing a segment 123 of the suture 116a, and Figure 6F shows the suture 116a being pulled through the leading lumen 114 of the graft 100 by pulling the device 606 through the leading lumen 114.

[0073] Figure 6G shows that segment 123 of suture 116a is tied to segment 124 of suture 116b. Optionally, the physician inserting the graft 100 into the transplant site 101 can pull segment 125 of suture 116b to completely pull suture 116b out of the transplant site 101, allowing the knot formed by tying sutures 116a and 116b to be pulled all the way through the insertion site of suture 116b, or to keep suture 116b in vitro.

[0074] The sutures 116a and 116b in Figures 6A to 6L can be sliding sutures that can move relative to the graft site 101 when pulled by the physician. In Figure 6H, it can be seen that the suture 116a is being pulled through the insertion site that the suture 116b initially occupied as the physician completely pulls the suture 116b out of the graft site 101. In Figure 6I, the device 606 is inserted into the second guide lumen 112 to fix segment 125 of the suture 116b. In Figure 6J, the suture 116b is being pulled through the second guide lumen 112 as the physician pulls the device 606. In Figure 6K, the graft 100 is moving back and forth toward the graft site 101 as the physician pulls segments 122 and 123 of the suture 116a. As described above with respect to Figures 2A to 2D, as the graft 100 moves back and forth through the cannula toward the transplant site 101, the graft 100 transitions from a first flat configuration (as shown in Figures 6A to 6K) through a compressed configuration (for passing through the cannula as described above with respect to Figures 2A to 2D) to a second flat configuration. Figure 6L shows the graft 100 positioned at the transplant site 101 in the second flat configuration. When graft 100 is placed in vitro, the tension exerted by sutures 116a and 116b on the lateral anchors helps to keep graft 100 unfolded and implanted in a flat configuration. As described above, the tension exerted by sutures 116a and 116b on the lateral anchors also helps to prevent the graft from being crushed or lumped by avoiding point fixation of the graft to the tissue during implantation, while compressing the graft against the natural tissue. Therefore, the lumen shape described herein improves patch life and patient outcomes.

[0075] The segments 122 and 123 of the suture 116a can be secured in any preferred manner, including in a tissue or in a hard bone anchor. Generally, some procedures using embodiments of grafts such as the graft 180 described herein, and / or exemplary suture grafts, do not require the graft to be placed in a flat configuration, and a flat configuration of the graft can be achieved as needed.

[0076] As shown in Figure 7A, in some embodiments, the graft 100 has an optional fourth retraction lumen, such as the retraction lumen 115 in Figure 1A. To assist in removing the graft 100 from the graft site 101 or changing the position of the graft 100 at the graft site 101, a device 606 can be inserted into the lumen 115 and used to secure a suture inserted into the lumen 115. The suture inserted into the lumen 115 may be a new suture that has not been used when the graft 100 was previously inserted into the graft site 101, or it may be a segment 125 of the suture 116b. As shown in Figure 7B, the device 606 is drawn through the lumen 115, and thus the segment 125 of the suture 116b is drawn through the lumen 115. As shown in Figure 7C, when segment 125 of the suture 116b is pulled, the graft 100 moves backward along the suture 116a (in embodiments using discontinuous sutures, backward movement along the suture 116b can be caused by pulling in a new suture through the lumen 115).

[0077] This specification describes advantageous systems and methods for arthroscopic graft insertion that enable simple in-patient introduction of grafts capable of withstanding multidimensional tension. Such simple introduction can be made possible by specific configurations of leading and guiding lumens, as described herein. Such lumen configurations eliminate the need for cumbersome introduction devices and simplify graft introduction and implantation into the patient, while facilitating the fixation of the graft to the final implantation site by controlling the multidirectional tension that sutures apply to the graft.

[0078] While this disclosure has been described in relation to grafts for rotator cuff treatment, the systems and methods described herein can be used in conjunction with any medical or therapeutic device that utilizes an implantable graft.

[0079] In the above description and claims, expressions such as "at least one of" or "one or more of" may appear before a contiguous list of elements or features. The term "and / or" may also appear within a list of two or more elements or features. Such expressions are intended to mean any of the listed elements or features individually, or any of the described elements or features in combination with any of the other described elements or features, unless implicitly or explicitly contradicts the context in which they are used. For example, the expressions "at least one of A and B," "one or both of A and B," and "A and / or B" are intended to mean "A alone, B alone, or A and B together," respectively. The same interpretation is intended for lists containing three or more items. For example, the expressions "at least one of A, B, and C," "one or more of A, B, and C," and "A, B, and / or C" are intended to mean "A alone, B alone, C alone, A and B together, A and C together, B and C together, or A, B, and C together," respectively. The use of the term "based on" in the above and in the claims is intended to mean "based at least in part on," and therefore features or elements not described may also be present.

[0080] The implementations described above do not represent all implementations that are consistent with the subject matter described herein. Rather, they are merely some examples that are consistent with aspects related to the subject matter described herein. Only a few variations have been described in detail herein, but other modifications or additions are possible. Specifically, further features and / or variations can be provided in addition to those shown herein. For example, the implementations described above may relate to various combinations and partial combinations of the disclosed features, and / or combinations and partial combinations of one or more further features to the features disclosed herein. Also, the logic flows shown in the accompanying figures and / or described herein do not necessarily require a specific order or sequence in the figures to achieve the desired result. The following claims may also include other implementations or embodiments. [Explanation of Symbols]

[0081] 100 grafts 101 Transplant site 102 Flat area 104 First edge 106 Second edge 108 Third edge 110 First guiding lumen 112 Second guiding lumens 114 lead lumens 123 Suture Segments

Claims

1. A graft configured for arthroscopic insertion into a transplant site within the patient's body, A substantially flat portion defined by at least a first edge, a second edge and a third edge, A first guide lumen arranged along a portion of the first edge, A second guide lumen is positioned along a portion of the second edge, A leading lumen positioned along a portion of the third edge, Equipped with, Each of the first guide lumen, the second guide lumen, and the leading lumen is configured to receive sutures, The third edge is substantially perpendicular to the first and second edges, and thereafter the leading lumen is substantially perpendicular to the first and second guide lumens of the graft.

2. The third edge is the distal edge of the graft, and the leading lumen is positioned along a portion of the distal edge of the graft. The graft according to claim 1.

3. The third edge is the proximal edge of the graft, and the leading lumen is positioned along a portion of the proximal edge of the graft. The graft according to claim 1.

4. The graft is configured to transition from a first flat configuration to a compressed configuration when the suture is pulled by a first amount. The graft is configured to transition from the compressed configuration to a second flat configuration when the suture is pulled by a second amount. The graft according to claim 1.

5. The graft comprises an electrospan material. The graft according to claim 1.

6. The lengths of the first and second edges are approximately 20 millimeters, and the length of the third edge is approximately 30 millimeters. The graft according to claim 3.

7. In the compression configuration, the graft is sized to pass through the cannula and the incision having a length of approximately 5 mm to 8 mm. The graft according to claim 4.

8. The graft comprises a biocompatible material. The graft according to claim 1.

9. The portion of the first edge is shorter than the length of the first edge. The portion of the second edge is shorter than the length of the second edge. The portion of the third edge is shorter than the length of the third edge. The graft according to claim 1.

10. The fourth edge and, A receding lumen positioned along a portion of the fourth edge, The graft according to claim 2, further comprising:

11. The length of the leading lumen is at least 80 percent of the length of the first guiding lumen and the length of the second guiding lumen. The graft according to claim 1.

12. The aforementioned leading lumen has a length of at least about 18 millimeters. The graft according to claim 1.

13. The suture includes a continuous suture attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture. The graft according to claim 1.

14. The suture comprises a first material piece and a second material piece, wherein the first material piece is attached to the graft site at a first position, and the second material piece is attached to the graft site at a second position. The graft according to claim 1.

15. The first material piece and the second material piece are configured to be joined together. The graft according to claim 14.

16. The graft is configured to be attached to the transplant site at the first and second positions. The graft according to claim 13.

17. At least one of the first guide lumen and the second guide lumen includes a first lumen segment and a second lumen segment, The graft according to claim 1.

18. The suture is a sliding suture. The graft according to claim 1.

19. A method for arthroscopic insertion of a graft into a transplant site within a patient's body, The aforementioned graft A substantially flat portion defined by at least a first edge, a second edge and a third edge, A first guide lumen arranged along the first edge, A second guide lumen arranged along the second edge, A leading lumen arranged along the third edge, Equipped with, Each of the first guide lumen, the second guide lumen, and the leading lumen is configured to receive sutures, The third edge is substantially perpendicular to the first and second edges, and thereafter the leading lumen is substantially perpendicular to the first and second guide lumens. The aforementioned method, The suture, attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture, is passed through the first guide lumen, the second guide lumen, and the leading lumen of the graft. By pulling the suture, the graft is moved along the suture through the incision to the transplant site. Methods that include...

20. The third edge is the distal edge of the graft, and the leading lumen is positioned along a portion of the distal edge of the graft. The method according to claim 19.

21. The third edge is the proximal edge of the graft, and the leading lumen is positioned along a portion of the proximal edge of the graft. The method according to claim 19.

22. By pulling the suture by a first amount, the graft is transitioned from a first flat configuration to a compressed configuration. By pulling the suture by a second amount, the graft is transitioned from the compressed configuration to the second flat configuration. The method according to claim 19, further comprising:

23. The graft comprises an electrospan material. The method according to claim 19.

24. The lengths of the first and second edges are approximately 20 millimeters, and the length of the third edge is approximately 30 millimeters. The method according to claim 21.

25. In the compression configuration, the graft is sized to pass through the cannula and the incision having a length of approximately 5 mm to 8 mm. The method according to claim 22.

26. The graft comprises a biocompatible material. The method according to claim 19.

27. The portion of the first edge is shorter than the length of the first edge. The portion of the second edge is shorter than the length of the second edge. The portion of the third edge is shorter than the length of the third edge. The method according to claim 19.

28. The aforementioned graft The fourth edge and, A receding lumen positioned along a portion of the fourth edge, The method according to claim 21, further comprising:

29. The length of the leading lumen is at least 80 percent of the length of the first guiding lumen and the length of the second guiding lumen. The method according to claim 19.

30. The aforementioned leading lumen has a length of at least about 18 millimeters. The method according to claim 19.

31. The suture includes a continuous suture attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture. The method according to claim 19.

32. The suture comprises a first material piece and a second material piece, wherein the first material piece is attached to the graft site at a first position, and the second material piece is attached to the graft site at a second position. The method according to claim 19.

33. The method further includes joining the first material piece and the second material piece together. The method according to claim 32.

34. The graft is configured to be attached to the transplant site at the first and second positions. The method according to claim 31.

35. At least one of the first guide lumen and the second guide lumen includes a first lumen segment and a second lumen segment, The method according to claim 19.

36. The sutures include sliding sutures. The method according to claim 19.

37. A kit for arthroscopically inserting grafts into transplant sites within a patient's body, Suture thread and, Cannula and, Graft and, Equipped with, The aforementioned graft A substantially flat portion defined by at least a first edge, a second edge and a third edge, A first guide lumen arranged along the first edge, A second guide lumen arranged along the second edge, A leading lumen arranged along the third edge, Equipped with, Each of the first guide lumen, the second guide lumen, and the leading lumen is configured to receive sutures, The third edge is substantially perpendicular to the first and second edges, and thereafter the leading lumen is substantially perpendicular to the first and second guide lumens. The kit is configured such that the graft is moved along the sutures through the cannula to the transplant site.

38. A graft configured for arthroscopic insertion into a transplant site within the patient's body, A substantially tubular body defined at least by its distal and proximal ends along its longitudinal axis, At least a first guide lumen arranged along the tubular body, A first leading lumen is arranged along the peripheral edge of the distal end, Equipped with, Each of the first guide lumen and the first leading lumen is configured to receive sutures, The peripheral edge of the distal end of the graft lies in a plane substantially perpendicular to the longitudinal axis, thereby the first leading lumen is substantially perpendicular to the first guide lumen.

39. The system further comprises a second guide lumen arranged along the tubular body, The graft according to claim 38.

40. At least the first guide lumen is located inside the tubular body. The graft according to claim 38.

41. The graft comprises an electrospan material. The graft according to claim 38.

42. The peripheral edge of the distal end of the substantially tubular body has a length of approximately 15 mm to approximately 30 mm. The graft according to claim 38.

43. The graft is sized to pass through the cannula and the incision, which is approximately 5 to 8 millimeters in length. The graft according to claim 38.

44. The graft comprises a biocompatible material. The graft according to claim 38.

45. The tubular body further comprises a second leading lumen arranged along the peripheral edge of the distal end, The first leading lumen extends along the first segment of the peripheral edge of the distal end of the tubular body, The second leading lumen extends along the second segment of the peripheral edge of the distal end of the tubular body, The graft according to claim 38.

46. The tubular body further comprises a receding lumen arranged along the peripheral edge of the proximal end. The graft according to claim 38.

47. The suture includes a continuous suture attached to the graft site at at least a first position along the length of the suture and a second position along the length of the suture. The graft according to claim 38.

48. The suture comprises a first material piece and a second material piece, wherein the first material piece is attached to the graft site at a first position, and the second material piece is attached to the graft site at a second position. The graft according to claim 38.

49. The first material piece and the second material piece are configured to be joined together. The graft according to claim 48.

50. The graft is configured to be attached to the transplant site at the first and second positions. The graft according to claim 48.

51. The suture is a sliding suture. The graft according to claim 38.

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