Self tightening knot

Abstract

Disclosed herein is a tendon connector for interconnecting a first tendon segment (2) to a second tendon segment (3) in a patient's body during a surgical intervention to in a mounted position transfer a tension force between the first tendon segment (2) and the second tendon segment (3). The connector (1) comprises in 5 the mounted position a first hitch (4) formed by a suture (41, 51) encompassing the first tendon segment (2). The connector (1) further comprises in the mounted position a second hitch (5) formed by a suture (41, 51) encompassing the second tendon segment (3). The connector (1) further comprises in the mounted position the suture (41) forming the first hitch (4) and the suture (51) forming the second 10 hitch (5) being interconnected to each other between the first hitch (4) and the second hitch (5).

Description

[0001] Self Tightening Knot

[0002] FIELD OF THE DISCLOSURE

[0003] The present disclosure relates to a tendon connector for interconnecting a first tendon segment to a second tendon segment.

[0004] BACKGROUND OF THE DISCLOSURE

[0005] A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and can withstand tension. Tendons have a wide variety of biomedical applications. For example, tendons and other tendon-like materials are often used as grafts. The grafts may be used in ACL repair or other applications. It is also possible to use these grafts as fixation materials, for example to fixate soft tissue. Other biomedical applications of tendons are related to tendon injuries, such as tendon trauma where a tendon is severed, overuse, which generally results in inflammation and degeneration of the tendons, which can eventually lead to tendon rupture. In these applications, it may be desirable to connect a tendon to another tendon.

[0006] To effectively use tendons in biomedical applications, it is often necessary to connect a first tendon segment to a second tendon segment. The two tendon segments may be two opposite ends of the same tendon, such as in cerclage applications, or they may be two independent tendons, such as in an application involving the restoration of a linearly extending tendon that has been torn. Depending on the application, it is also often desirable to apply a tensile force to the two tendon segments. These applications place many different demands on tendon connectors. For example, ideally the tendon connector would be able to maintain a tensile force over time. In addition, tendon connectors are often used in minimally invasive settings that require easy manual manipulation.

[0007] Although many different tendon connectors are known in the prior art, they suffer from a number of different drawbacks. For example, many tendon connectors are difficult to manipulate and have limited applicability and usability in minimally invasive settings. In addition, many tendon connectors are unable to effectively maintain an applied traction force, especially over extended periods of time. As a result, incremental release of tension over time is a challenge.

[0008] In addition, many of the known tendon connectors are mechanically complex designs that are difficult and costly to manufacture. In addition, many known tendon connectors are made of less biocompatible materials, which limits their applicability.

[0009] In addition, many known techniques involve suturing the tendon segments. However, suturing has a number of drawbacks, including potential tendon trauma and unwanted excessive elongation when a tensile force is applied. Stitching techniques are also often difficult to perform and therefore time consuming and costly.

[0010] Even with other techniques that may not involve suturing the tendons, damage to the tendons (or tendon-like materials) is still a challenge. For example, some prior art connectors use large clamping forces on the tendons, which can also lead to tendon damage. Accordingly, there is a need for improved tendon connectors.

[0011] SUMMARY OF THE DISCLOSURE

[0012] It is therefore an object of the present disclosure to advance the state of the art with respect to tendon connectors. In particular, it is an object of at least some variants to provide a tendon connector for interconnecting a first tendon segment to a second tendon segment, which allows to establish a secure and firm connection between the two tendon segments and to maintain a tensile force between the two tendon segments over time. Ideally, harm to the tendons would be minimized or even completely avoided, in particular harm involving piercing partly or fully through the tendon. It is a further object of at least some variants to provide a tendon connector, which is easy and fast to operate for a surgeon, ideally under minimally invasive connections. In at least some variants, it is also an object to provide a biocompatible tendon connector, ideally made of biocompatible material. Finally, the tendon connector would ideally be amenable to a broad range of different clinical applications.

[0013] According to the present disclosure, these objects are addressed by the features of the independent claim. Further advantageous embodiments follow from the dependent claims and from the description.

[0014] The present disclosure relates to a tendon connector for interconnecting a first tendon segment to a second tendon segment, typically in a patient’s body during a surgical intervention, to in a mounted position transfer a tension force between the first tendon segment and the second tendon segment. The tendon connector comprises in the mounted position a first hitch formed by a suture encompassing the first tendon segment. The tendon connector further comprises a second hitch formed by a suture encompassing the second tendon segment. The suture forming the first hitch and the suture forming the second hitch are interconnected to each other between the first hitch and the second hitch.

[0015] By providing a first hitch formed by a suture encompassing the first tendon segment and providing a second hitch formed by a suture encompassing the second tendon segment, and by further providing that the sutures forming the first respectively the second hitch are interconnected to each other, a firm and secure interconnection between the first and second tendon segment is achieved. In particular, by providing a first hitch and a second hitch, each formed by a suture encompassing the first respectively second tendon segment, a tension force between the first tendon segment and the second tendon segment may effectively be maintained over time.

[0016] Depending on the application, different tendon segments may be used. For example, the first tendon segment and the second tendon segment may be two segments of the same tendon. In some variants, e.g., the first tendon segment may be a first tendon end and the second tendon segment may be a second tendon end. If these two ends are arranged on the same tendon, the tendon connector may for example be used for cerclage applications. It is also possible to use these variants, for example, in applications where two neighboring vertebrae are interconnected to each other. For example, a tendon may be used as fixation element to fixate the two neighboring vertebrae. In some variants, the first tendon segment is a segment of the first tendon that is distinct from the second tendon comprising the second tendon segment. For example, it is possible, in these variants, to interconnect a first tendon to a separate second tendon, for example to reconnect torn or severed tendons. The first tendon segment and the second tendon segment may be arranged in different positions on the respective tendon. For example, the first tendon segment respectively the second tendon segment may optionally in some variants be a first tendon end respectively a second tendon end. However, it is also possible for the first tendon segment to be arranged in a more intermediate or central position on the respective tendon. For example, the first tendon segment may be arranged within a certain distance of an end of the respective tendon, but may optionally not include that end. The same variants also apply mutatis mutandis to the second tendon segment.

[0017] Depending on the application, the tendon segments may be interconnected before, concomitantly with, or subsequently to application of a tension force between the first tendon segment and the second tendon segment. For example, in some variants, the two tendon segments may be at least pre-tensioned first before they are interconnected by the tendon connector, which may optionally be followed by a post-tensioning step. The tension force between the first tendon segment and the second tendon segment typically exerts a first tension force on the first tendon segment in a first direction from the first tendon segment towards the second tendon segment, and a second tension force on the second tendon segment in a second direction from the second tendon segment towards the first tendon segment. In other words, the first tension force and the second tension force may act in opposite directions. Depending on the application, the tendon connector may comprise one suture, two sutures, or even more sutures. For example, the suture forming the first hitch and the suture forming the second hitch may either be a single suture or they may be different sutures. In some variants, the first hitch and the second hitch are formed from the same suture. In other variants, the first hitch is formed by a first suture and the second hitch is formed by second suture different from the first suture. Furthermore, it is possible that the first hitch and / or the second hitch may each be formed by multiple sutures. For example, the first hitch may be formed by two sutures. Alternatively or in combination, the second hitch may be formed by two sutures. Once again, the two (or potentially even more) sutures forming the first hitch may or may not be the same as the suture (or sutures) forming the second hitch.

[0018] The suture forming the first hitch encompasses the first tendon segment. Likewise, the suture forming the second hitch encompasses the second tendon segment. Encompassing, in this context, may in some variants also be described as enclosing or encircling. It is understood that the suture forming the first hitch typically encompasses the first tendon segment circumferentially. For example, in a cross-section orthogonal to a longitudinal direction of extension of the first tendon segment, the suture forming the first hitch may be arranged circumferentially around the first tendon segment. Similarly, in a cross-section orthogonal to a longitudinal direction of extension of the second tendon segment, the suture forming the second hitch may in some variants be arranged circumferentially around the second tendon segment. In a typical variant, the first hitch contacts the first tendon segment and the second hitch contacts the second tendon segment. As used herein, a hitch is formed by a suture, e.g. one or more sutures. It is configured to bind to a tendon segment. A hitch typically refers to a particular configuration or spatial arrangement of the respective suture forming the respective hitch, which allows the respective suture to bind to the respective tendon segment. For example, a hitch as used herein may secure the respective suture forming the respective hitch to the respective tendon segment.

[0019] In some variants, the first hitch is of a self-tightening type of hitch, which increases its tightening force applied to the respective tendon segment in relation to the tension force applied between the first tendon segment and the second tendon segment. Alternatively or in combination, the second hitch may be of a self-tightening type of hitch, which increases its tightening force applied to the respective tendon segment in relation to the tension force applied between the first tendon segment and the second tendon segment. The tightening force applied to the respective tendon segment may for example in some variants involve a clamping force applied to the respective tendon segment. This clamping force may for example be formed from constriction of the hitch around the respective tendon segment. Alternatively or in combination, the clamping force may also be formed from deformation of the shape of the hitch, such as axial displacement of a portion of the hitch with respect another portion of the same hitch and with respect to the respective tendon segment. The variants described in this paragraph may optionally also apply to the second hitch.

[0020] Alternatively or in combination, the suture forming the hitch is in the mounted position may in some variants be configured such that when a tension force is applied between the first tendon segment and the second tendon segment, a friction between a first section of that suture and a second section of that suture increases, which leads to maintenance of the tightening of the hitch.

[0021] Depending on the application, different hitches may be used. For example, in some variants, the first hitch and / or the second hitch are one of the following types of hitches: Prusik hitch, Klemheist hitch, Knut hitch, Blake’s hitch, Distel Hitch, gripping sailor’s hitch, Icicle hitch, pile hitch, Rolling hitch, Schwabisch hitch Todd-Kramer hitch, Clove Hitch, Taut-Line Hitch, Girth Hitch, Constrictor Knot, Magnus Hitch, Marlinespike Hitch, Anchor Bend, Gripping Hitch, Ezelius' adjustable grip hitch pile hitch or Michoacan / Martin hitch. In some variants in particular, the first hitch and / or the second hitch are one of the following types of hitches: Prusik hitch, Klemheist hitch, Knut hitch, Blake’s hitch, Distel Hitch, gripping sailor’s hitch, Icicle hitch, pile hitch, Rolling hitch, Schwabisch hitch Todd-Kramer hitch. It is understood that the first hitch and the second hitch may be selected independently of each other.

[0022] Depending on the application, the first hitch and the second hitch may in the mounted position have different arrangements with respect to each other. For example, the first hitch and the second hitch may in the mounted position be laterally adjacent to each other. For example, in the mounted position, the first hitch and the second hitch may contact each other, or they may still be interspaced from each other while being arranged laterally adjacent to each other. Alternatively, the first hitch and the second hitch may in the mounted position in the direction of extension of the tendon segments be arranged behind each other. For example, in the mounted position, the first tendon segment and the second tendon segment may contact each other, or they may not contact each other. Alternatively, the first hitch and the second hitch may in the mounted position be at least partially overlapping to each other.

[0023] In some variants, the first hitch may be formed by a suture comprising a first section and a second section, wherein the first section passes either underneath the second section or through a loop formed by the second section. Typically, when the first section passes through a loop formed by the second section, the first section may also pass, at least partially, underneath the second section. Furthermore, the first hitch may optionally be configured such that when a tension force is applied between the first tendon segment and the second tendon segment, the first section is clamped by the second section or within the loop formed by the second section.

[0024] The variants described in the previous paragraph in the context of the first hitch may, alternatively or in combination, apply to the second hitch. Thus, in some variants, the second hitch may be formed by a suture comprising a first section and a second section, wherein the first section passes either underneath the second section or through a loop formed by the second section. Furthermore, the second hitch may optionally be configured such that when a tension force is applied between the first tendon segment and the second tendon segment, the first section is clamped by the second section or within the loop formed by the second section.

[0025] Different configurations may be used for the first and second hitch. For example, in some variants, a proximal segment of the suture forming the first hitch passes underneath a distal segment of the same suture when exiting the hitch. Alternatively or in combination, a distal segment of the suture forming the second hitch may pass underneath a distal segment of the same suture when exiting the hitch. As explained in further detail above, the suture forming the first hitch and the suture forming the second hitch may be the same suture, but they may also be two different sutures. In some variants, the proximal segment of the suture forming the first hitch may optionally be arranged, along a longitudinal direction of extension of that suture, closer to the interconnection with the second hitch than the distal segment of the suture forming the first hitch. Alternatively or in combination, the proximal segment of the suture forming the second hitch may optionally be arranged, along a longitudinal direction of extension of that suture, closer to the interconnection with the first hitch than the distal segment of the suture forming the second hitch.

[0026] Typically, the first hitch and the second hitch each comprise at least one suture loop. The at least one suture loop may for example be configured such that it is in its circumference constricted around the respective tendon segment in relation to the tension force applied between the first tendon segment and the second tendon segment. In some variants, the first hitch comprises a first suture loop which in the mounted position encompasses the first tendon segment in at least two turns. Alternatively or in combination, the second hitch may comprise a second suture loop which in the mounted position encompasses the second tendon segment in at least two turns. The term “turn” (of the first suture loop respectively the second suture loop) typically means that the respective suture loop forms a complete coil around the respective tendon segment. The term “turn” typically refers to a cross section orthogonal to a longitudinal direction of extension of the respective tendon segment. Thus, for example, one turn of the first suture loop may e.g. be formed by passing the first suture loop circumferentially around the first tendon segment until the suture forming the first suture loop arrives again at the same radial position in a cross section orthogonal to a longitudinal direction of extension of the first tendon segment. Typically, when the suture forming the first suture loop arrives again at the same radial position, it will have travelled slightly in a longitudinal direction. The resulting pitch (i.e. travel in longitudinal direction) of the suture may, depending on the application, for example be less than 20 mm, preferably less than 10 mm, more preferably less than 6 mm, even more preferably less than 3 mm. In some variants, for at least some of the turns, an end section of the respective turn may contact an end section of an adjacent turn.

[0027] In some variants, at least one of the turns forms a helix. In some variants, at least 50% of all turns form a helix. In further variants, at least 80% of the turns form a helix. For example, each turn may form a helix. Depending on the application, the helix or helices may have different geometries. For example, in some variants, the helix of at least one turn has a pitch of less than 10 mm, preferably less than 6 mm, more preferably less than 3 mm, even more preferably less than 2 mm, even more preferably less than 1 mm, even more preferably less than 0.5 mm in the mounted position. In some variants, the helix of at least 50% of all turns has a pitch of than 10 mm, preferably less than 6 mm, more preferably less than 3 mm, even more preferably less than 2 mm, even more preferably less than 1 mm, even more preferably less than 0.5 mm in the mounted position. In some variants, the helix of at least 80% of all turns has a pitch of than 10 mm, preferably less than 6 mm, more preferably less than 3 mm, even more preferably less than 2 mm, even more preferably less than 1 mm, even more preferably less than 0.5 mm in the mounted position. In still further variants, the helix of each turn has a pitch of than 10 mm, preferably less than 6 mm, more preferably less than 3 mm, even more preferably less than 2 mm, even more preferably less than 1 mm, even more preferably less than 0.5 mm in the mounted position.

[0028] The pitch of the turns respectively of the helices formed by the turns may in some variants also be expressed relative to a thickness of the suture forming the respective turn. Thus, for example, in some variants, the helix of at least one turn has a pitch that is less than 5 times the thickness of the suture forming the respective turn, preferably less than 3 times the thickness of the suture forming the respective turn, more preferably less than 1.5 times the thickness of the suture forming the respective turn in the mounted position. In some variants, this may applied to at least 50% of the turns. Thus, in some variants, the helix of at least 50% of the turns have a pitch that is less than 5 times the thickness of the suture forming the respective turn, preferably less than 3 times the thickness of the suture forming the respective turn, more preferably less than 1 .5 times the thickness of the suture forming the respective turn in the mounted position. Further, in some variants, the helix of at least 80% of the turns have a pitch that is less than 5 times the thickness of the suture forming the respective turn, preferably less than 3 times the thickness of the suture forming the respective turn, more preferably less than 1 .5 times the thickness of the suture forming the respective turn in the mounted position. In some variants, the helix of each turn has a pitch that is less than 5 times the thickness of the suture forming the respective turn, preferably less than 3 times the thickness of the suture forming the respective turn, more preferably less than 1 .5 times the thickness of the suture forming the respective turn in the mounted position. The pitches may be used to fine-tune the properties of the tendon connector. For example, the pitch may be used to influence the orientation and strength of clamping forces acting on the respective tendon segments during operation.

[0029] In some variants, a turn may contact an adjacent turn in the mounted position. For example, in some variants, at least one turn contacts an adjacent turn in a mounted position. It is also possible that at least 50% of the turns contact their respective adjacent turns in the mounted position. In some variants, at least 80% of the turns contact their respective adjacent turns in the mounted position. In further variants, each turn contacts an adjacent turn in the mounted position.

[0030] Depending on the application, the turn or turns may contact adjacent turns to varying degrees. For example, in some variants, at least 50% of all turns may contact their respective adjacent turns along their entire circumferences in the mounted position. Optionally, all turns may contact their respective adjacent turns along their entire circumferences in the mounted position. However, it is also possible that a turn may contact an adjacent turn only along an arch segment of the respective turn in the mounted position. For example, in some variants, a first turn may contact an adjacent turn along an arch segment of at least 30°, preferably at least 45°, more preferably at least 90°, even more preferably at least 180°, even more preferably at least 270°, even more preferably 360°, of the respective first turn in the mounted position. The embodiments described in the previous sentence may optionally apply to one turn, or two or even more turns, such as at least 50% of all turns, such as at least 80% of all turns, such as all turns. Thus, in some variants, at least 50% of all turns may contact their respective adjacent turns along an arch segment of at least 30°, preferably at least 45°, more preferably at least 90°, even more preferably at least 180°, even more preferably at least 270°, even more preferably 360°, of the respective turns in the mounted position. In some variants, at least 80% of all turns may contact their respective adjacent turns along an arch segment of at least 30°, preferably at least 45°, more preferably at least 90°, even more preferably at least 180°, even more preferably at least 270°, even more preferably 360°, of the respective turns in the mounted position. In some variants, all turns may contact their respective adjacent turns along an arch segment of at least 30°, preferably at least 45°, more preferably at least 90°, even more preferably at least 180°, even more preferably at least 270°, even more preferably 360°, of the respective turns in the mounted position.

[0031] It is understood that as used herein, the term that a “turn contacts another turn” typically means that the two turns contact each other directly. In other words, typically, an outer surface of a first turn contacts an outer surface of the respective other turn.

[0032] In some variants, the first hitch and / or the second hitch comprise a suture loop which in the mounted position encompasses the first respectively the second tendon segment in at least three turns.

[0033] The first hitch and the second hitch may optionally be identical to or similar to each other, or they may be different from each other. In some variants, the first hitch and the second hitch are of the same hitch type. For example, the first hitch and the second hitch may have essentially the same configuration. Depending on the application, the first hitch and the second hitch may in the mounted position be arranged in a symmetrical manner. In some variants, the first hitch and the second hitch are in the mounted position arranged in a mirrored or point-mirrored fashion with respect to each other. For example, in the mounted position, the first hitch and the second hitch may be arranged in a mirrored fashion with respect to each other and with respect to a hypothetical mirror plane arranged between the first hitch and the second hitch and extending in parallel to a longitudinal direction of extension of the first tendon segment and in parallel to a longitudinal direction of extension of the second tendon segment. In some variants, in the mounted position, the first hitch and the second hitch may, in a cross-section orthogonal to a longitudinal direction of extension of the tendon segments, be arranged in a point-mirrored fashion with respect to each other and with respect to an axis of point symmetry arranged between the first hitch and the second hitch and extending in parallel to a longitudinal direction of extension of the first tendon segment and in parallel to a direction of extension of the second tendon segment. Depending on the application, symmetric or semi-symmetric configurations of the first hitch and the second hitch may be used to balance and allocate load transfer.

[0034] The suture forming the first hitch and the suture forming the second hitch are interconnected to each other between the first hitch and the second hitch. Depending on the application, different interconnection techniques may be used. In some variants, the first hitch and the second hitch are interconnected to each other by one or two sutures. Optionally, at least one of the sutures may comprise a knot. In some variants, the first hitch and the second hitch are formed from the same suture. In this case, for example the interconnection may be a direct result of the fact that a single suture forms the first hitch and the second hitch. In other words, in this case, the respective suture may comprise a first segment forming the first hitch, a second segment forming the second hitch, and an interconnection segment arranged between the first segment and the second segment, wherein said interconnection segment interconnects the first hitch and the second hitch. Optionally, the interconnection may additionally comprise a reinforcement element, such as a clip. In some variants, the suture forming the first and the suture forming the second hitch are interconnected to each other by being knotted to each other. For example, if the first hitch is formed from a first suture and the second hitch is formed from the second suture different from the first suture, the first suture and the second suture may be knotted to each other. In some variants, the suture forming the first hitch and the suture forming the second hitch are interconnected to each other by at least one of the following: one or more knots, a clip, a clamcleat, a crimp, a buckle strap or a sleeve. Depending on the application, the clip, the clamcleat, the crimp, the buckle strap or the sleeve may be made of different materials, such as metal, peek, or other materials.

[0035] Depending on the application, different knots may be used. For example, the knot used for interconnecting the suture forming the first hitch and the suture forming the second hitch may be configured for withstanding the tension force between the first tendon segment and the second tendon segment. For example, said knot may be a simple knot, surgeon’s knot, half-knot or constrictor knot.

[0036] As used herein, a knot is in some variants typically a configuration of one or more sutures, which allows to bind the one or more sutures to itself respectively themselves, or to an object, such as a clip. In some variants, the knot may be a binding knot or a jamming knot. In other words, the knot may be configured such that it is tightened when a tension force is exerted on the one or more sutures. Depending on the application, different sutures may be used. For example, the suture respectively the sutures may be a medical suture respectively medical sutures. The suture respectively sutures is respectively are typically made of a resorbable material. In some variants, the suture respectively the sutures is respectively are made of synthetic polymer fibers, such as nylon, polypropylene, or polyester. The suture or sutures typically has respectively have a high tensile strength. Depending on the application, the suture or sutures may have different friction properties. Typically, it may be desirable to have at least some friction, for example in order to achieve self-tightening properties. For example, the suture or sutures may be made from a material having a medium or high friction coefficient.

[0037] Depending on the application, the suture may have different geometrical properties and shapes. For example, in some variants, the suture has a suture thickness from 0.1 mm to 20 mm, preferably from 0.5 mm to 6 mm. Alternatively or in combination, in some variants, a ratio between a suture thickness and a maximum radial extension of a space encompassed by the respective suture forming the respective hitch ranges in a mounted position from 1 :2 to 1 :20, preferably from 1 :2 to 1 :10, more preferably from 1 :3 to 1 :7. If the tendon connector comprises two or even more sutures, these ranges may or may not apply to each suture. The space encompassed by the respective suture forming the respective hitch is in the mounted position typically occupied by the respective tendon segment. Thus, it may also in some variants be said that a ratio between a suture thickness and a thickness of the respective tendon segment ranges in a mounted position from 1 :2 to 1 :20, preferably from 1 :2 to 1 :10, more preferably from 1 :3 to 1 :7. Suture thickness as used herein refers to the thickness of the suture. If the suture has a circular cross-section, the thickness corresponds to the diameter. More broadly, the suture thickness may also be described as a maximum radial extension of the respective suture.

[0038] Depending on the application, the tendon connector may optionally further comprise a mounting aid. The mounting aid may for example be used to facilitate mounting of the tendon connector in a patient’s body during a surgical intervention. In particular, the mounting aid may be used to facilitate arranging the first hitch around the first tendon segment and arranging the second hitch around the second tendon.

[0039] In some variants, the tendon connector comprises a mounting aid on which the first hitch and / or the second hitch are arranged in an expanded position before application onto the respective tendon segments. The tendon connector may comprise exactly one mountain aid, or the tendon connector may comprise two or more mounting aids. For example, in some variants, the tendon connector comprises a first mounting aid for the first hitch and a separate second mounting aid for the second hitch. In some variants, the first mounting aid and the second mounting aid are interconnectable. For example, the first mounting aid and the second mounting aid may in some variants be releasably interconnectable such that they are arranged peripherally adjacent to each other. Optionally, after insertion into the patient’s body, the interconnection may be released.

[0040] In some variants, the mounting aid comprises an opening configured to receive during application at least one tendon segment on which the tendon connector is to be applied. The opening may for example be a bore. In some variants, the mounting aid has a tubular structure. Optionally, the mounting aid may comprise a slit, such as a slit extending in longitudinal direction of the mounting aid. For example, in some variants, the mounting aid has a tubular structure and comprises a slit extending in longitudinal direction of the mounting aid. In these variants, the cross-section of the mounting aid may for example be C-shaped. In some variants, the mounting aid comprises at least two support structures (e.g. support surfaces or support plates) arranged opposite each other and defining the opening between the at least two support structures. The at least two support structures may for example be interspaced from each other and may optionally be interconnected by way of interconnecting structures, such as interconnecting struts.

[0041] Depending on the application, the mounting aid may be made of different materials. For example, in some variants, it may be desirable to have a rigid mounting aid. However, in other variants, it may also be desirable to have a more flexible mounting aid. Combinations of these two variants are also conceivable, such that for example certain sections or segments of the mounting aid are rigid, while other sections or segments of the mounting aid may be more flexible. In some variants, the mounting aid is configured to be deformed during application. One advantage of these variants is that they may facilitate the mounting process, in particular in constricted environments in the patient’s body.

[0042] In some variants, the mounting aid comprises a predetermined breaking point. To facilitate understanding of the present disclosure, the tendon connector is disclosed herein in the context of interconnecting tendon segments. However, it is understood that although the connector is described in the context of interconnecting tendon segments, it is equally applicable to tendon-like structures. In other words, the term “tendon” is to be understood in a broad fashion, in particular including tendon-like structures among others. For example, the connector may in some variants be used for interconnecting filamentous structures more broadly, such as filament segments or other tendon-like materials, including synthetic ten- don-like materials.

[0043] It is to be understood that both the foregoing general description and the following detailed description present embodiments, and are intended to provide an overview or framework for understanding the nature and character of the disclosure. The accompanying drawings are included to provide a further understanding, and are incorporated into and constitute a part of this specification. The drawings illustrate various embodiments, and together with the description serve to explain the principles and operation of the concepts disclosed.

[0044] BRIEF DESCRIPTION OF THE DRAWINGS

[0045] The present disclosure will be more fully understood from the detailed description given herein below and the accompanying drawings which should not be considered limiting to the disclosure described in the appended claims. The drawings show:

[0046] Fig. 1 an embodiment of the tendon connector disclosed herein; Fig. 2 an illustration of a Prusik hitch applied to a tendon segment (Fig. 2A) and to a rope for illustration purposes (Fig. 2B);

[0047] Fig. 3 an illustration of a Nice hitch applied to a tendon segment (Fig. 3A) and in the absence of the tendon segment for illustration purposes (Fig. 3B);

[0048] Fig. 4 an illustration of a Kreuzklemm hitch (also known as Klemheist hitch) applied to a tendon segment (Fig. 4A) and a brief instruction process how to tie the hitch for illustration purposes (Fig. 4B);

[0049] Fig. 5 an illustration of a single thread Kreuzklemm hitch;

[0050] Fig. 6 an embodiment of the tendon connector, including a mounting aid, in a non-interconnected state (Fig. 6A) and in an interconnected state (Fig. 6B);

[0051] Fig. 7 different spatial arrangements of the first hitch and the second hitch with respect to each other (Fig. 7A-7D);

[0052] Fig. 8 an embodiment of the tendon connector in which the first hitch and the second hitch are arranged in a mirrored fashion, from a lateral view (Fig. 8A) and from a front view (Fig. 8B) ;

[0053] Fig. 9 an embodiment of the tendon connector in which the first hitch and the second hitch are arranged in a point-mirrored fashion, from a lateral view (Fig. 9A) and from a front view (Fig. 9B).

[0054] DESCRIPTION OF THE EMBODIMENTS

[0055] Reference will now be made in detail to certain embodiments, examples of which are illustrated in the accompanying drawings, in which some, but not all features are shown. Indeed, embodiments disclosed herein may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Whenever possible, like reference numbers will be used to refer to like components or parts.

[0056] Figure 1 shows a first embodiment of the tendon connector 1 disclosed herein. It is used to interconnect a first tendon segment 2 to a second tendon segment 3. The tendon connector 1 is shown in a mounted position in which a first hitch 4 encompasses the first tendon segment 2 and a second hitch 5 encompasses the second tendon segment 3. Furthermore, in the mounted position, a tension force has been applied between the first tendon segment 2 and the second tendon segment 3. The first hitch 4 and the second hitch 5 are configured and arranged such that if the first tendon segment 2 is pulled away from the second tendon segment 3, or vice versa, the grip of the hitches 4, 5 on the tendon segments 2, 3 increases as the pull-force applied to the tendon segments is increased. In other words, a self-tightening is achieved.

[0057] More specifically, in the illustrated embodiment, the tendon connector 1 comprises a first suture 41 and a second suture 51 . The first suture 41 forms a suture loop 42 around the first tendon segment 2. The suture loop 42 comprises a number of turns 421 , 422. Eventually, after having formed the turns, the suture loop 41 returns, such that a loop is formed from a distal segment 412 of the suture 41 . A proximal segment 411 of the suture 41 is passed through said loop formed from the distal segment 412, before being interconnected through a knot 6 to the second suture 51. The second suture 51 , in turn, has a similar arrangement with respect to the second tendon segment 3. It can be appreciated that if the tendon segments 2, 3 are pulled in opposite directions away from each other, the suture loop 42 of the first hitch and the suture loop 52 of the second hitch are increasingly constricted, thereby clamping the respective tendon segments 2, 3 increasingly tightly and thereby increasingly strengthening their respective grip on the respective tendon segments 2, 3. As a consequence of this increasing constriction, a further axial displacement of the first tendon segment 2 with respect to the second tendon segment 3 is effectively prevented.

[0058] Figures 2-5 illustrate different hitches that may be used in the tendon connector disclosed herein. It is important to note that the hitches illustrated in these figures were selected for illustrative purposes only and are by no means the only types of hitches that may be used in the present disclosure. Figs. 2A and 2B illustrate a Prusik hitch applied to a tendon segment (Fig. 2A) and to a rope for illustration purposes (Fig. 2B). Figs. 3A and 3B illustrate a Nice hitch applied to a tendon segment (Fig. 3A) and in the absence of the tendon segment for illustration purposes (Fig. 3B). Figs. 4A and 4B illustrate a Kreuzklemm hitch (also known as Klemheist hitch) applied to a tendon segment (Fig. 4A) and a brief instruction process how to tie the hitch for illustration purposes (Fig. 4B). Fig. 5 illustrates a single thread Kreuzklemm hitch. This single thread Kruezklemm hitch is a modification of the regular Kreuzklemm hitch, with a single suture string threaded through a figure eight knot loop.

[0059] Figure 6 shows an embodiment of the tendon connector 1 , which comprises two mounting aids 7. The mounting aids 7 may be releasably interconnected to each other and are shown in an interconnected state (Fig. 6B) and in a non-intercon- nected state (Fig. 6A). The mounting aids 7 each have a tubular structure and comprise a slit extending in longitudinal direction of the mounting aid. The crosssection of the mounting aids is C-shaped. Each mounting aid 7 includes an opening 71 , through which the respective tendon segment may be passed (not illustrated). After passing the respective tendon segments through the respective openings 71 , the application aids 7 may subsequently be removed (not illustrated). Finally, the hitches may be fixated onto the tendon segments.

[0060] Figure 7 shows different spatial arrangements of the first hitch 4 and the second hitch 5 with respect to each other. For example, in Fig. 7A, the first hitch 4 and the second hitch 5 are interspaced from each other both in a longitudinal direction and in a radial direction orthogonal to the longitudinal direction. The longitudinal direction may, for example, be defined with respect to the first tendon segment 2 or the second tendon segment 3. By contrast, in Fig. 7B, the first hitch 4 and the second hitch 5 are aligned with respect to their radial arrangement, but are also interspaced with respect to each other in the longitudinal direction. In other words, the first hitch 4 and the second hitch 5 are in the direction of extension of the tendon segments arranged behind each other. In Fig. 7C, the first hitch 4 and the second hitch 5 are arranged laterally adjacent to each other. In Fig. 7D, the first hitch 4 and the second hitch 5 are in the direction of extension of the tendon segments arranged behind each other and the respective tendon segments contact each other.

[0061] Figures 8 and 9 show different arrangements of the first hitch 4 in the second hitch 5 with respect to each other. Specifically, in Figs, 8A and 8B, the first hitch 4 and the second hitch 5 are arranged in a mirrored fashion, as illustrated from a lateral view (Fig. 8A) and from the front view (Fig. 8B). In Fig. 9A and 9B, the first hitch 4 and the second hitch 5 are arranged in a point-mirrored fashion, as illustrated from a lateral view (Fig. 9A) and from a front view (Fig. 9B).

[0062] LIST OF DESIGNATIONS

[0063] 1 Tendon Connector

[0064] 2 First tendon segment

[0065] 3 Second tendon segment

[0066] 4 First hitch

[0067] 41 Suture forming the first hitch

[0068] 41 1 Proximal segment of the suture forming the first hitch

[0069] 412 Distal segment of the suture forming the first hitch

[0070] 42 Suture loop of the first hitch

[0071] 421 , 422 Turn of the suture loop of the first hitch

[0072] 5 Second hitch

[0073] 51 Suture forming the second hitch

[0074] 51 1 Proximal segment of the suture forming the second hitch

[0075] 522 Distal segment of the suture forming the second hitch

[0076] 52 Suture loop of the second hitch

[0077] 521 , 522 Turn of the suture loop of the second hitch

[0078] 6 Knot

[0079] 7 Mounting aid

[0080] 71 Opening of the mounting aid

Claims

PATENT CLAIMS1. Tendon connector (1 ) for interconnecting a first tendon segment (2) to a second tendon segment (3) in a patient’s body during a surgical intervention to in a mounted position transfer a tension force between the first tendon segment (2) and the second tendon segment (3), the connector (1 ) comprising in the mounted position: a. a first hitch (4) formed by a suture (41 , 51 ) encompassing the first tendon segment (2); b. a second hitch (5) formed by a suture (41 , 51 ) encompassing the second tendon segment (3); c. the suture (41 ) forming the first hitch (4) and the suture (51 ) forming the second hitch (5) being interconnected to each other between the first hitch (4) and the second hitch (5).

2. The tendon connector (1 ) according to claim 1 , wherein the first hitch (4) and the second hitch (5) are in the mounted position laterally adjacent to each other or in the direction of extension of the tendon segments arranged behind each other or at least partially overlapping to each other.

3. The tendon connector (1 ) according to any of the preceding claims, wherein the first hitch (4) and / or the second hitch (5) comprises a suture loop (42, 52) which in the mounted position encompasses the first respectively the second tendon segment (2, 3) in at least two turns (421 , 422, 521 , 522).

4. The tendon connector (1 ) according to claim 3, wherein at least one turn (421 , 422, 521 , 522) forms a helix.

5. The tendon connector (1 ) according to claim 3 or 4, wherein the helix of at least one turn (421 , 422, 521 , 522) has a pitch that is less than 5 times a thickness of the suture forming the respective turn, preferably less than 3 times the thickness of the suture forming the respective turn in the mounted position.

6. The tendon connector (1 ) according to any of claims 3-5, wherein at least one turn (421 , 521 ) contacts an adjacent turn (422, 522) in the mounted position.

7. The tendon connector (1 ) according to any one of the previous claims, wherein a proximal segment (41 1 , 51 1 ) of the suture forming the respective hitch (4, 5) passes underneath a distal segment (412, 512) of the same suture when exiting the hitch (4, 5).

8. The tendon connector (1 ) according to any of the preceding claims, wherein the first hitch (4) and / or the second hitch (5) are of a self-tightening type of hitch which increases its tightening force applied to the respective tendon segment in relation to the tension force applied between the first tendon segment (2) and the second tendon segment.

9. The tendon connector (1 ) according to any of the preceding claims, wherein the first hitch (4) and / or the second hitch (5) are one of the following types of hitches: Prusik hitch, Klemheist hitch, Knut hitch, Blake’s hitch, DistelHitch, gripping sailor’s hitch, Icicle hitch, pile hitch, Rolling hitch, Schwa- bisch hitch Todd-Kramer hitch, Clove Hitch, Taut-Line Hitch, Girth Hitch, Constrictor Knot, Magnus Hitch, Marlinespike Hitch, Anchor Bend, Gripping Hitch, Ezelius' adjustable grip hitch pile hitch or Michoacan / Martin hitch.

10. The tendon connector (1 ) according to any of the preceding claims, wherein the suture (41 , 51 ) has an oval or circular cross-section.1 1 . The tendon connector (1 ) according to any of the preceding claims, wherein the suture (41 , 51 ) has a suture thickness from 0.1 mm to 20 mm, preferably from 0.5 mm to 6 mm.

12. The tendon connector (1 ) according to any of the preceding claims, wherein a ratio between a suture thickness and a maximum radial extension of a space encompassed by the respective suture forming the respective hitch ranges in a mounted position from 1 :2 to 1 :20, preferably from 1 :2 to 1 :10, more preferably from 1 :3 to 1 :7.

13. The tendon connector (1 ) according to any of the preceding claims, wherein the first hitch (4) and the second hitch (5) are in the mounted position arranged in a mirrored or point-mirrored fashion with respect to each other.

14. The tendon connector (1 ) according to any of the preceding claims, wherein the first hitch (4) and the second hitch (5) are interconnected to each other by one or two sutures.

15. The tendon connector (1 ) according to any of the preceding claims, wherein the suture (41 ) forming the first hitch (4) and the suture (51 ) forming the second hitch (5) are interconnected to each other by at least one of the following: one or more knots (6), a clip, a clamcleat, a crimp, a buckle strap or a sleeve.

16. The tendon connector (1 ) according to claim 15, wherein the knot is one out of the following: simple knot, surgeon’s knot, half-knot or constrictor knot.

17. The tendon connector (1 ) according to any of the preceding claims, wherein the tendon connector (1 ) comprises a mounting aid (7) on which the first hitch (4) and / or the second hitch (5) are arranged in an expanded position before application onto the respective tendon segments (2, 3).

18. The tendon connector (1 ) according to claim 17, wherein the mounting aid (7) comprises an opening (71 ) configured to receive during application at least one tendon segment (2, 3) on which the tendon connector (1 ) is to be applied.

19. The tendon connector (1 ) according to any of the claims 17 or 18, wherein the mounting aid (7) has a tubular structure.

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