CA2004658C - Arthroscopic clip and insertion tool - Google Patents
Arthroscopic clip and insertion toolInfo
- Publication number
- CA2004658C CA2004658C CA002004658A CA2004658A CA2004658C CA 2004658 C CA2004658 C CA 2004658C CA 002004658 A CA002004658 A CA 002004658A CA 2004658 A CA2004658 A CA 2004658A CA 2004658 C CA2004658 C CA 2004658C
- Authority
- CA
- Canada
- Prior art keywords
- legs
- clip
- tissue
- clip according
- arthroscopic
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0646—Surgical staples, i.e. penetrating the tissue for insertion into cartillege, e.g. meniscus
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S227/00—Elongated-member-driving apparatus
- Y10S227/901—Surgical clip appliers
Abstract
A surgical clip and insertion tool for same for repairing tears in fibrocartilage and soft tissue is described. The clip has a pair of opposed legs formed of rigid biodegradable material. Each leg has at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it. The legs are interconnected by a flexible section that is also biodegradable. The instrument for applying these clips has a pair of opposed jaws, each with at least one notch for holding the barbs of the clip. The jaws are biased apart in a normally open position and are interconnected to an actuating handle. The instrument further includes a device which closes the jaws when the handles are moved a first way relative to one another and opens them when the handles are moved the other way.
Description
This invention relates to a surgical clip and insertion tool and, more particularly, to a biodegradable barbed clip and a tool for inserting the clip that can be used to repair menisci and soft tissue.
Tears in fibrocartilage and soft tissue, especially peripheral meniscal tears, are relatively difficult to repair. Typically, a tear in the vascular region of the meniscus is sutured using arthroscopic techniques. The instrument may be inserted through small incisions which serve as anterior knee portals. Sutures on long needles are then passed through a meniscal repair instrument and through the meniscus. An incision is made in the back of the knee to permit the surgeon to pull the needles and suture out, and to tie the suture over the posterior joint capsule. This technique reapproximates the torn edges of the meniscus and allows for healing.
Although effective, this repair technique requires a surgeon skilled in arthroscopic meniscal repair.
The technique is also relatively time consuming and more invasive than it need be, as it requires a second, posterior incision that increases the risk of infection and neurovascular damage. As a result, few surgeons will attempt meniscal repair, choosing instead to simply remove the damaged portion of the meniscus. The problem with this approach is that meniscal removal can cause increased stress on the articular cartilage, which may then lead to degenerative arthritis.
Surgical clips are often easier to insert than sutures. However, most clips are not biodegradable, and occasionally a second operation must be performed to remove the clip once the tissue has healed. Another disadvantage of these clips is that they are not well suited for meniscal and soft tissue repair, as they are typically metallic, relatively large, and may protrude from the tissue and cause joint irritation. Thus although arthroscopic clips can be inserted through a single incision, they have typically not been used for repair of , ~
peripheral meniscal tears nor for arthroscopic repair of soft tissue.
It is therefore an object of this invention to provide a surgical clip and insertion tool for operative arthroscopic repair of menisci and soft tissue.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which allows a surgeon not trained in meniscal repair to reapproximate torn meniscal tissue.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which decrease risk of neurovascular damage to the patient.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which decrease operative time, by facilitating the operative procedureO
It is a further object of this invention to provide an arthroscopic clip and insertion tool that do not require a second operation to remove the clip.
It is a further object of this invention to provide an arthroscopic surgical clip with legs that remain buried in the tissue and do not irritate surrounding tissue.
It is a further object of this invention to provide an arthroscopic surgical clip insertion tool that tightly holds a clip until it is completely inserted.
According to one aspect of the present invention, there is provided a meniscal clip for arthroscopic repair of peripheral tears in the meniscus comprising: a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the meniscus and opposing withdrawal from it;
and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
According to another aspect of the present invention, there is provided an arthroscopic clip for arthroscopic repair of tears in fibrocartilage and soft ~`-A~
tissue comprising: a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it; and a flP~;hle section interconnecting said legs and formed of a flexible biodegradable material.
According to yet another aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg including first anchoring means for positionally securing said first leg in tissue without a retainer; a second curved leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
According to still another aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg including first anchoring means for positionally securing said first leg in tissue;
a second curved leg including second anchoring means for securing said second leg in tissue; and a connecting member secured to a first end of each of said legs, said connecting member being composed of a soft flexible suture material.
According to a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second curved leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said curved legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
~ . .~
According to still a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first and a second curved leg composed of a rigid biodegradable material; and a connecting member composed of a soft flexible biodegradable suture material secured to a first end of each of said legs.
According to yet a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first leg including first anchoring means for positionally securing said first leg in tissue without a retainer; a second leg including second anchoring means for securing said second leg in tissue without a retainer;
and a soft flexible connecting member secured to a first end of each of said legs.
According to an additional aspect of the present invention, there is provided an arthroscopic clip comprising: a first leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and aconnecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said ~egs in tissue without a retainer.
According to another additional aspect of the present invention, there is provided an arthroscopic instrument for applying barbed arthroscopic clips for repair of tears in fibrocartilage and soft tissue comprising: a pair of opposed jaws each having at least one notch for holding the barbs of said clip; biasing means for separating said jaws in a normally open position; a n actuating handle having opposed handle members; means for interconnecting said handle and said jaws; means for closing said jaws when said handle members are moved a first way relative to one another and opening said jaws _ - 4 -. .. .
,.
when said handle members are moved the other way relative to one another; and means for releasing said clip from said jaws.
This invention results from the realization that surgical clips for repairing tears in menisci and soft tissue can be improved dramatically by providing a biodegradable clip with rigid, barbed legs interconnected by a flexible section that is inserted in the tissue with an arthroscopic tool and anchors itself in the tissue to approximate the tear.
This invention features a surgical clip and insertion tool for repair of tears in fibrocartilage and soft tissue. The clip has a pair of opposed legs formed of rigid biodegradable material interconnected by a flexible, biodegradable section. Each leg has at least one barb that allows the clip to be easily inserted into the tissue being repaired but keeps the clip from working out of the tissue.
The legs of the clip are preferably curved inwardly toward each other, and each leg preferably has more than one barb on its outer side. A preferred material for the legs is a polyglycolic acid polymer. Preferably, the clip is an arthroscopic clip.
The instrument for applying the barbed clips has a pair of opposed jaws that are preferably offset to allow them to overlap when closed. Each jaw has at least one notch for holding the barbs of the clip. These specialized jaws tightly hold the clips in place until they are fully inserted, which allows the physician to place them in exactly the right position and to exactly the right depth before they are released. The instrument includes a biasing means for separating the jaws in a normally open position, which is the position in which the jaws remain as the clip insertion begins. The jaws are connected to a handle by a member such as a tubular member. The instrument also includes means for closing the jaws when the two handle members are moved one way relative to one -A
another and opening the jaws when the handles are moved another way.
Preferably, the actuating handle is normally biased open, and the means for closing the jaws closes them when the handle members are squeezed together and opens them when the handle members are spread apart. The means for closing may include means for pulling the jaws together as the handle members are moved. The jaws may be disposed at an angle to the tubular member to facilitate clip insertion. Additionally, the tips of the jaws are preferably sharpened to facilitate clip insertion.
Preferably, the instrument further includes means for releasing the clip from the jaws so it stays in place when the jaws are opened. The means for releasing may include means for releasably holding at least one barb of the clip, and may further include means for selectively releasing the means for releasably holding the barb from the barb. Means for actuating the means for selectively releasing, which may include an actuating member or switch on the handle of the instrument, are also preferably included.
In use, the clip is placed in the jaws with the barbs in the jaw notches. This holds the clip tightly in place as it is inserted. To insert the clip, the physician begins pushing the jaws into the tissue, squeezing the handle members at the same time. The sharpened tips of the jaws pierce the tissue and, as it is inserted, the legs are moved together. Preferably, the jaws of the instrument overlap when they are completely closed. This overlapping causes the legs of the clip to overlap when it is completely inserted in the tissue. The switch on the handle then is moved upward to release the clip from the jaws. The barbs on the clip legs then hold the clip in position once the jaws are opened up and pulled away from the clip. When the instrument is removed from the tissue, the clip remains with its legs completely embedded within the tissue with only the flexible, non-irritating interconnecting member protruding from the tissue surface.
Since the clip is biodegradable, it slowly dissolves as the tissue heals itself, and there is no need for a second operation to remove the clips.
Other objects, features, and advantages will occur from the following description of a preferred embodiment and the accompanying drawings, in which:
Figure 1 is an elevational view of a surgical clip for repairing tears in cartilage and soft tissue according to this invention;
Figure 2 is a diagram of a meniscular tear reapproximated by five of the clips of Figure 1;
Figure 3 is a cross-sectional view taken along line 3-3 of Figure 2;
Figure 4A is an axonometric view of an arthroscopic tool for inserting the clip of Figure 1 according to this invention;
Figure 4B is a close-up view of the jaws of the tool of Figure 4A;
Figure 4C is a partial cross-sectional view of the handle, trigger and actuating member of the tool of Figure 4A;
Figure 4D is a diagrammatic view of an angled jaw for the tool of Figure 4A;
Figure 5 is an elevational view of an alternative surgical clip according to this invention; and Figure 6 is an elevational view of an alternative to the jaws of Figure 4A.
A surgical clip for repair of tears in fibrocartilage and soft tissue which is especially useful for arthroscopic meniscal repair according to this invention may be accomplished by providing a clip with a pair of opposed legs formed of a rigid biodegradable material. Each leg has at least one barb that allows the clip to easily penetrate the tissue being repaired and oppose withdrawal from it. The legs are interconnected by .~~
a flexible, non-irritating biodegradable section that allows the clip to bend.
Preferably, the legs of the clip are curved inwardly toward each other, and the barbs are on the outside of the legs. The barbs may alternatively be on the insides of the legs. These legs are preferably made from a polyglycolic acid polymer. The flexible interconnecting section can be formed of suture material or another relatively soft, flexible material that allows the clip to bend as it is inserted so that the clip can overlap inside the tissue being approximated. The clip is ideally suited for reapproximating peripheral meniscal tears.
The instrument for applying the clips includes a pair of opposed jaws each having at least one notch for holding the barbs of the clip. This allows the clip to be tightly held in place in the jaws until it is completely inserted in the tissue being repaired. The jaws are biased apart in a normally open position, and they are attached to the handle by a tubular member. The actuating handle has opposed handle members and is also connected to the jaws by means such as a pair of wires or an actuating member which close the jaws when the handle is squeezed. The instrument may have jaws preset at different angles to further facilitate insertion of the clip. The jaws may also have sharpened tips to facilitate insertion. In addition, the jaws are preferably offset so they overlap when closed, so that the legs of the clip overlap inside the tissue to better approximate the torn tissue.
There is shown in Figure 1 one embodiment of a surgical clip 10 for repair of tears in cartilage and soft tissue according to this invention. The clip 10 is especially useful for arthroscopic repair of peripheral meniscal tears, partial or small rotator cuff tears, labrum tears in shoulder arthroscopy, and retinacular repair after patellar dislocations. The clip is also useful as a replacement for internal sutures, for example, in the repair of lacerations of the liver or spleen. The clip 10 has barbed legs 12, 14 with barbs 18, 20, 22, 24, respectively. The barbs 18, 20, 22, 24 may be on the inside or outside of the legs 12, 14. The legs 12, 14 are formed of a rigid biodegradable material which may be a S polyglycolic acid polymer. The legs 12, 14 are interconnected by a biodegradable, flexible, non-irritating section 16 which may be formed of a suture material. The flexible section 16 bends to allow the legs 12, 14 to move in toward each other and overlap as they are pushed into the tissue. Once inserted the clip 10 holds the tissue in place long enough for it to heal, and slowly dissolve so the patient does not have to undergo a second operation for removal of the clip 10.
The peripheral meniscal tear 32 illustrated in Figure 2 is a relatively small tear that is considered repairable. Because of the problems to date with meniscal surgery, a portion 94 of the meniscus 30, encompassed by the dashed lines, has often been removed when a peripheral tear 32 is found. Since meniscal removal may cause increased stress on the articular cartilage and secondarily lead to degenerative arthritis, repair is far superior to removal. By using clips such as clips 34, 35 and 38, the meniscus can be successfully repaired with a single operative procedure.
In Figure 3, the clip 34 is shown embedded in the meniscus 30. The clip 34 includes barbed legs 38, 40 interconnected by a flexible section 36. When inserted, the legs 38, 40 overlap, which causes the legs 34, 40 to approximate the tissue and minimize the gap 32 through which fibrous tissue will form and thus further enhance healing. When the clip 34 is inserted as shown, only the soft connecting flexible section 36 protrudes from the tissue and is exposed to the articular cartilage. Since this soft material does not irritate the surrounding articular cartilage, the patient does not need to have the joint rigidly immobilized for a long period of time. This _ g 1 ~
A
is an additional advantage of the arthroscopic clip according to this invention.
An arthroscopic instrument 50 for applying the barbed clips 10 is shown in Figure 4A. The instrument 50 includes notched jaws 64, 66 made of spring steel formed to keep them in a normally open position. A tubular member 60 interconnects the jaws 64, 66 to a handle 62. A pin, bolt, or rivet 79 attaches the jaws 64, 66 to the tubular member 60. The handle 62 includes handle members 52, 54 that are normally biased apart by a spring 56. A hinge pin 58 allows the handle member 54 to move toward the handle member 52 as the handle 62 is squeezed.
The action of the opening and closing of the jaws 64, 66 of the instrument can be more clearly seen in Figure 4B. The jaws 64, 66 are formed from a spring steel member 68. Wires 53, 55 are attached to the jaws 64, 66 at points 82, 84, respectively, and are separated by running the wires 53, 55 through channels 78, 80 attached to the inside of the tubular member 60. The wires 53, 55 are pulled taut when the handle 62 is squeezed. This causes the jaws 64, 66 to close. The clip 10 is held firmly in place in the jaws 64, 66 as it is inserted in the tissue by providing notches 70, 72 in the jaw 64 and notches 74, 76 in the jaw 66 that are shaped to hold the clip barbs 18, 20, 22, 24.
Insertion is further facilitated by sharpened tips 65, 67, which pierce the tissue just ahead of tips of the clip 10.
In operation, a clip such as clip 10 of Figure 1, is inserted in the open jaws 64, 66. The barbs 18, 20 fit into slots 70, 72 and the barbs 22, 24 fit into slots 74, 76. The tip of the clip 10 is located very close to the tips 65, 67 of the ~aws 64, 66, respectively. When the jaws 64, 66 are in place against the two sides of the torn tissue being repaired, the instrument 50 is moved forward and the handle 62 is squeezed. This pushes the legs 12, 14 of the clip 10 into the tissue and moves the legs 12, 14 together as the clip 10 is inserted. The jaws 64, 66 of the instrument 50 are preferably made slightly offset, as _ shown in Figure 4B, so that they overlap when completely closed. In this case, when the clip 10 is completely inserted its legs 12, 14 are crossed, as shown in Figure 3.
Whether the clip legs 12, 14 are crossed or not, they are completely embedded within the tissue. This is advantageous because the rigid material of the legs 12, 14 could irritate the tissue surrounding the area being repaired as the prior art surgical clips have done in other parts of the body. Once the clip 10 is inserted, the jaws 64, 66 are backed out of the tissue and the instrument 50 is removed from the patient. The instrument 50 can then be used to insert another clip 10 in the torn tissue.
The operation of the handle 62 to open and close the jaws 64, 66 is shown more clearly in Figure 4C. The tubular member 60 is attached to the handle member 52 by a rivet 57. The wires 53, 55 are attached to the handle member 54, which pivots on a pin 58 when the handle members 52, 54 are squeezed together. As the handle member 54 moves toward the handle member 52, it pulls the wires 53, 55 back, which in turn pulls the jaws 64, 66 together and causes them to close. Since the jaws 64, 66 are normally biased apart, when the handle members 52, 54 are released, the wires 53, 55 are relaxed, and the jaws 64, 66 open to release the clip 10. A wire 108 is attached to a sliding switch 92, which pulls the wire 108 when it is slid in the direction of the arrow (shown in Figure 6) to release the clip 10 as fully explained below in conjunction with Figure 6.
An alternative way of forming the jaws 64, 66 of the arthroscopic instrument 50 is shown in Figure 4D. The jaws 64a, 66a are formed at a 30 angle to the tubular member 60a. A pin, rivet, or bolt 79a attaches the jaws 64a, 66a to the tubular member 60a.
Preferably, at least three insertion tools 50 with jaws 64, 66 at different angles are available. One with the jaws 64, 66 aligned with the tubular member 60, one with the jaws 64, 66 turned down at an angle of approximately 15, and one with the jaws 64, 66 turned down at an angle of approximately 30. This allows the physician to place the clip 10 exactly as desired, depending on the location of the tear, utilizing the same arthroscopic portal during repair.
Another way of forming the arthroscopic clip 10 is shown in Figure 5. A clip lOa includes barbed legs 12a, 14a formed of a rigid biodegradable material, for example a polyglycolic acid polymer. The barbs 18a, 20a, 22a, 24a are fully embedded within the tissue being repaired and do not interfere with joint movement. A pair of tip barbs 96, 98 allow the clip lOa to grip the meniscus so it stays embedded when the jaws 64, 66 are pulled back and out of the patient. This is more clearly shown in Figure 6~ A
flexible section 81 is made an integral part of the clip lOa, but is preferably made from a relatively soft, flexible biodegradable material which allows the clip lOa to bend as it is inserted so the legs 12a, 14a can be fully embedded in the tissue. A preferred material of the flexible section 81 is 2.0 Dexon suture. Since the interconnecting flexible section 81 is the only section of the clip lOa that is exposed from the meniscus after the clip lOa is inserted, the soft material also provides a clip that is less irritating to the surrounding cartilage than the typical stiff or metallic clips would be and which would not be able to be used intra-articularly.
Another way of forming the jaws to ensure proper insertion of clip lOa is shown in Figure 6. A pair of jaws 100, 102 are formed to hold the barbs 18a, 20a, 22a, 24a of the clip lOa while the clip lOa is being inserted and to release the clip lOa after insertion so that it remains in place embedded in the meniscus. A pair of barb-holding members 104 are spring steel members with small indentations shaped to fit and hold the clip barbs 18a, 20a, 22a, 24a. A wire 106 is attached to the barb-holding members 104.The wire 108 connects the wire 106 to a switch 92.
~" ,,.
.....
When the clip lOa is fully inserted in the meniscus, the physician operates the switch or lever 92.
The switch 92 operation pulls on the wire 108, as shown in Figure 6, which in turn pulls the wire 106. The wire 106 is attached to the underside of the barb-holding members 104. As the wire 106 is pulled tight, it pulls the barb-holding members 104 down away from the clip lOa. This frees the barbs 18a, 20a, 22a, 24a and leaves them embedded in the meniscus. The tip barbs 96, 98 also may be included to help hold the clip lOa in place by gripping the tissue just enough to allow the clip lOa to separate from the jaws 100, 102 as the jaws 100, 102 are opened and backed out of the meniscus. In conjunction with the barb-holding members 104, the tip barbs 96, 98 allow the clip lOa to properly separate from the instrument 50 as it is removed from the mensicus.
Although specific features of the invention are shown in some drawings and not others, this is for convenience only as each feature may be combined with any or all of the other features in accordance with the invention .
.:. .
Tears in fibrocartilage and soft tissue, especially peripheral meniscal tears, are relatively difficult to repair. Typically, a tear in the vascular region of the meniscus is sutured using arthroscopic techniques. The instrument may be inserted through small incisions which serve as anterior knee portals. Sutures on long needles are then passed through a meniscal repair instrument and through the meniscus. An incision is made in the back of the knee to permit the surgeon to pull the needles and suture out, and to tie the suture over the posterior joint capsule. This technique reapproximates the torn edges of the meniscus and allows for healing.
Although effective, this repair technique requires a surgeon skilled in arthroscopic meniscal repair.
The technique is also relatively time consuming and more invasive than it need be, as it requires a second, posterior incision that increases the risk of infection and neurovascular damage. As a result, few surgeons will attempt meniscal repair, choosing instead to simply remove the damaged portion of the meniscus. The problem with this approach is that meniscal removal can cause increased stress on the articular cartilage, which may then lead to degenerative arthritis.
Surgical clips are often easier to insert than sutures. However, most clips are not biodegradable, and occasionally a second operation must be performed to remove the clip once the tissue has healed. Another disadvantage of these clips is that they are not well suited for meniscal and soft tissue repair, as they are typically metallic, relatively large, and may protrude from the tissue and cause joint irritation. Thus although arthroscopic clips can be inserted through a single incision, they have typically not been used for repair of , ~
peripheral meniscal tears nor for arthroscopic repair of soft tissue.
It is therefore an object of this invention to provide a surgical clip and insertion tool for operative arthroscopic repair of menisci and soft tissue.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which allows a surgeon not trained in meniscal repair to reapproximate torn meniscal tissue.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which decrease risk of neurovascular damage to the patient.
It is a further object of this invention to provide an arthroscopic clip and insertion tool which decrease operative time, by facilitating the operative procedureO
It is a further object of this invention to provide an arthroscopic clip and insertion tool that do not require a second operation to remove the clip.
It is a further object of this invention to provide an arthroscopic surgical clip with legs that remain buried in the tissue and do not irritate surrounding tissue.
It is a further object of this invention to provide an arthroscopic surgical clip insertion tool that tightly holds a clip until it is completely inserted.
According to one aspect of the present invention, there is provided a meniscal clip for arthroscopic repair of peripheral tears in the meniscus comprising: a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the meniscus and opposing withdrawal from it;
and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
According to another aspect of the present invention, there is provided an arthroscopic clip for arthroscopic repair of tears in fibrocartilage and soft ~`-A~
tissue comprising: a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it; and a flP~;hle section interconnecting said legs and formed of a flexible biodegradable material.
According to yet another aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg including first anchoring means for positionally securing said first leg in tissue without a retainer; a second curved leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
According to still another aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg including first anchoring means for positionally securing said first leg in tissue;
a second curved leg including second anchoring means for securing said second leg in tissue; and a connecting member secured to a first end of each of said legs, said connecting member being composed of a soft flexible suture material.
According to a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first curved leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second curved leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said curved legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
~ . .~
According to still a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first and a second curved leg composed of a rigid biodegradable material; and a connecting member composed of a soft flexible biodegradable suture material secured to a first end of each of said legs.
According to yet a further aspect of the present invention, there is provided an arthroscopic clip comprising: a first leg including first anchoring means for positionally securing said first leg in tissue without a retainer; a second leg including second anchoring means for securing said second leg in tissue without a retainer;
and a soft flexible connecting member secured to a first end of each of said legs.
According to an additional aspect of the present invention, there is provided an arthroscopic clip comprising: a first leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and aconnecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said ~egs in tissue without a retainer.
According to another additional aspect of the present invention, there is provided an arthroscopic instrument for applying barbed arthroscopic clips for repair of tears in fibrocartilage and soft tissue comprising: a pair of opposed jaws each having at least one notch for holding the barbs of said clip; biasing means for separating said jaws in a normally open position; a n actuating handle having opposed handle members; means for interconnecting said handle and said jaws; means for closing said jaws when said handle members are moved a first way relative to one another and opening said jaws _ - 4 -. .. .
,.
when said handle members are moved the other way relative to one another; and means for releasing said clip from said jaws.
This invention results from the realization that surgical clips for repairing tears in menisci and soft tissue can be improved dramatically by providing a biodegradable clip with rigid, barbed legs interconnected by a flexible section that is inserted in the tissue with an arthroscopic tool and anchors itself in the tissue to approximate the tear.
This invention features a surgical clip and insertion tool for repair of tears in fibrocartilage and soft tissue. The clip has a pair of opposed legs formed of rigid biodegradable material interconnected by a flexible, biodegradable section. Each leg has at least one barb that allows the clip to be easily inserted into the tissue being repaired but keeps the clip from working out of the tissue.
The legs of the clip are preferably curved inwardly toward each other, and each leg preferably has more than one barb on its outer side. A preferred material for the legs is a polyglycolic acid polymer. Preferably, the clip is an arthroscopic clip.
The instrument for applying the barbed clips has a pair of opposed jaws that are preferably offset to allow them to overlap when closed. Each jaw has at least one notch for holding the barbs of the clip. These specialized jaws tightly hold the clips in place until they are fully inserted, which allows the physician to place them in exactly the right position and to exactly the right depth before they are released. The instrument includes a biasing means for separating the jaws in a normally open position, which is the position in which the jaws remain as the clip insertion begins. The jaws are connected to a handle by a member such as a tubular member. The instrument also includes means for closing the jaws when the two handle members are moved one way relative to one -A
another and opening the jaws when the handles are moved another way.
Preferably, the actuating handle is normally biased open, and the means for closing the jaws closes them when the handle members are squeezed together and opens them when the handle members are spread apart. The means for closing may include means for pulling the jaws together as the handle members are moved. The jaws may be disposed at an angle to the tubular member to facilitate clip insertion. Additionally, the tips of the jaws are preferably sharpened to facilitate clip insertion.
Preferably, the instrument further includes means for releasing the clip from the jaws so it stays in place when the jaws are opened. The means for releasing may include means for releasably holding at least one barb of the clip, and may further include means for selectively releasing the means for releasably holding the barb from the barb. Means for actuating the means for selectively releasing, which may include an actuating member or switch on the handle of the instrument, are also preferably included.
In use, the clip is placed in the jaws with the barbs in the jaw notches. This holds the clip tightly in place as it is inserted. To insert the clip, the physician begins pushing the jaws into the tissue, squeezing the handle members at the same time. The sharpened tips of the jaws pierce the tissue and, as it is inserted, the legs are moved together. Preferably, the jaws of the instrument overlap when they are completely closed. This overlapping causes the legs of the clip to overlap when it is completely inserted in the tissue. The switch on the handle then is moved upward to release the clip from the jaws. The barbs on the clip legs then hold the clip in position once the jaws are opened up and pulled away from the clip. When the instrument is removed from the tissue, the clip remains with its legs completely embedded within the tissue with only the flexible, non-irritating interconnecting member protruding from the tissue surface.
Since the clip is biodegradable, it slowly dissolves as the tissue heals itself, and there is no need for a second operation to remove the clips.
Other objects, features, and advantages will occur from the following description of a preferred embodiment and the accompanying drawings, in which:
Figure 1 is an elevational view of a surgical clip for repairing tears in cartilage and soft tissue according to this invention;
Figure 2 is a diagram of a meniscular tear reapproximated by five of the clips of Figure 1;
Figure 3 is a cross-sectional view taken along line 3-3 of Figure 2;
Figure 4A is an axonometric view of an arthroscopic tool for inserting the clip of Figure 1 according to this invention;
Figure 4B is a close-up view of the jaws of the tool of Figure 4A;
Figure 4C is a partial cross-sectional view of the handle, trigger and actuating member of the tool of Figure 4A;
Figure 4D is a diagrammatic view of an angled jaw for the tool of Figure 4A;
Figure 5 is an elevational view of an alternative surgical clip according to this invention; and Figure 6 is an elevational view of an alternative to the jaws of Figure 4A.
A surgical clip for repair of tears in fibrocartilage and soft tissue which is especially useful for arthroscopic meniscal repair according to this invention may be accomplished by providing a clip with a pair of opposed legs formed of a rigid biodegradable material. Each leg has at least one barb that allows the clip to easily penetrate the tissue being repaired and oppose withdrawal from it. The legs are interconnected by .~~
a flexible, non-irritating biodegradable section that allows the clip to bend.
Preferably, the legs of the clip are curved inwardly toward each other, and the barbs are on the outside of the legs. The barbs may alternatively be on the insides of the legs. These legs are preferably made from a polyglycolic acid polymer. The flexible interconnecting section can be formed of suture material or another relatively soft, flexible material that allows the clip to bend as it is inserted so that the clip can overlap inside the tissue being approximated. The clip is ideally suited for reapproximating peripheral meniscal tears.
The instrument for applying the clips includes a pair of opposed jaws each having at least one notch for holding the barbs of the clip. This allows the clip to be tightly held in place in the jaws until it is completely inserted in the tissue being repaired. The jaws are biased apart in a normally open position, and they are attached to the handle by a tubular member. The actuating handle has opposed handle members and is also connected to the jaws by means such as a pair of wires or an actuating member which close the jaws when the handle is squeezed. The instrument may have jaws preset at different angles to further facilitate insertion of the clip. The jaws may also have sharpened tips to facilitate insertion. In addition, the jaws are preferably offset so they overlap when closed, so that the legs of the clip overlap inside the tissue to better approximate the torn tissue.
There is shown in Figure 1 one embodiment of a surgical clip 10 for repair of tears in cartilage and soft tissue according to this invention. The clip 10 is especially useful for arthroscopic repair of peripheral meniscal tears, partial or small rotator cuff tears, labrum tears in shoulder arthroscopy, and retinacular repair after patellar dislocations. The clip is also useful as a replacement for internal sutures, for example, in the repair of lacerations of the liver or spleen. The clip 10 has barbed legs 12, 14 with barbs 18, 20, 22, 24, respectively. The barbs 18, 20, 22, 24 may be on the inside or outside of the legs 12, 14. The legs 12, 14 are formed of a rigid biodegradable material which may be a S polyglycolic acid polymer. The legs 12, 14 are interconnected by a biodegradable, flexible, non-irritating section 16 which may be formed of a suture material. The flexible section 16 bends to allow the legs 12, 14 to move in toward each other and overlap as they are pushed into the tissue. Once inserted the clip 10 holds the tissue in place long enough for it to heal, and slowly dissolve so the patient does not have to undergo a second operation for removal of the clip 10.
The peripheral meniscal tear 32 illustrated in Figure 2 is a relatively small tear that is considered repairable. Because of the problems to date with meniscal surgery, a portion 94 of the meniscus 30, encompassed by the dashed lines, has often been removed when a peripheral tear 32 is found. Since meniscal removal may cause increased stress on the articular cartilage and secondarily lead to degenerative arthritis, repair is far superior to removal. By using clips such as clips 34, 35 and 38, the meniscus can be successfully repaired with a single operative procedure.
In Figure 3, the clip 34 is shown embedded in the meniscus 30. The clip 34 includes barbed legs 38, 40 interconnected by a flexible section 36. When inserted, the legs 38, 40 overlap, which causes the legs 34, 40 to approximate the tissue and minimize the gap 32 through which fibrous tissue will form and thus further enhance healing. When the clip 34 is inserted as shown, only the soft connecting flexible section 36 protrudes from the tissue and is exposed to the articular cartilage. Since this soft material does not irritate the surrounding articular cartilage, the patient does not need to have the joint rigidly immobilized for a long period of time. This _ g 1 ~
A
is an additional advantage of the arthroscopic clip according to this invention.
An arthroscopic instrument 50 for applying the barbed clips 10 is shown in Figure 4A. The instrument 50 includes notched jaws 64, 66 made of spring steel formed to keep them in a normally open position. A tubular member 60 interconnects the jaws 64, 66 to a handle 62. A pin, bolt, or rivet 79 attaches the jaws 64, 66 to the tubular member 60. The handle 62 includes handle members 52, 54 that are normally biased apart by a spring 56. A hinge pin 58 allows the handle member 54 to move toward the handle member 52 as the handle 62 is squeezed.
The action of the opening and closing of the jaws 64, 66 of the instrument can be more clearly seen in Figure 4B. The jaws 64, 66 are formed from a spring steel member 68. Wires 53, 55 are attached to the jaws 64, 66 at points 82, 84, respectively, and are separated by running the wires 53, 55 through channels 78, 80 attached to the inside of the tubular member 60. The wires 53, 55 are pulled taut when the handle 62 is squeezed. This causes the jaws 64, 66 to close. The clip 10 is held firmly in place in the jaws 64, 66 as it is inserted in the tissue by providing notches 70, 72 in the jaw 64 and notches 74, 76 in the jaw 66 that are shaped to hold the clip barbs 18, 20, 22, 24.
Insertion is further facilitated by sharpened tips 65, 67, which pierce the tissue just ahead of tips of the clip 10.
In operation, a clip such as clip 10 of Figure 1, is inserted in the open jaws 64, 66. The barbs 18, 20 fit into slots 70, 72 and the barbs 22, 24 fit into slots 74, 76. The tip of the clip 10 is located very close to the tips 65, 67 of the ~aws 64, 66, respectively. When the jaws 64, 66 are in place against the two sides of the torn tissue being repaired, the instrument 50 is moved forward and the handle 62 is squeezed. This pushes the legs 12, 14 of the clip 10 into the tissue and moves the legs 12, 14 together as the clip 10 is inserted. The jaws 64, 66 of the instrument 50 are preferably made slightly offset, as _ shown in Figure 4B, so that they overlap when completely closed. In this case, when the clip 10 is completely inserted its legs 12, 14 are crossed, as shown in Figure 3.
Whether the clip legs 12, 14 are crossed or not, they are completely embedded within the tissue. This is advantageous because the rigid material of the legs 12, 14 could irritate the tissue surrounding the area being repaired as the prior art surgical clips have done in other parts of the body. Once the clip 10 is inserted, the jaws 64, 66 are backed out of the tissue and the instrument 50 is removed from the patient. The instrument 50 can then be used to insert another clip 10 in the torn tissue.
The operation of the handle 62 to open and close the jaws 64, 66 is shown more clearly in Figure 4C. The tubular member 60 is attached to the handle member 52 by a rivet 57. The wires 53, 55 are attached to the handle member 54, which pivots on a pin 58 when the handle members 52, 54 are squeezed together. As the handle member 54 moves toward the handle member 52, it pulls the wires 53, 55 back, which in turn pulls the jaws 64, 66 together and causes them to close. Since the jaws 64, 66 are normally biased apart, when the handle members 52, 54 are released, the wires 53, 55 are relaxed, and the jaws 64, 66 open to release the clip 10. A wire 108 is attached to a sliding switch 92, which pulls the wire 108 when it is slid in the direction of the arrow (shown in Figure 6) to release the clip 10 as fully explained below in conjunction with Figure 6.
An alternative way of forming the jaws 64, 66 of the arthroscopic instrument 50 is shown in Figure 4D. The jaws 64a, 66a are formed at a 30 angle to the tubular member 60a. A pin, rivet, or bolt 79a attaches the jaws 64a, 66a to the tubular member 60a.
Preferably, at least three insertion tools 50 with jaws 64, 66 at different angles are available. One with the jaws 64, 66 aligned with the tubular member 60, one with the jaws 64, 66 turned down at an angle of approximately 15, and one with the jaws 64, 66 turned down at an angle of approximately 30. This allows the physician to place the clip 10 exactly as desired, depending on the location of the tear, utilizing the same arthroscopic portal during repair.
Another way of forming the arthroscopic clip 10 is shown in Figure 5. A clip lOa includes barbed legs 12a, 14a formed of a rigid biodegradable material, for example a polyglycolic acid polymer. The barbs 18a, 20a, 22a, 24a are fully embedded within the tissue being repaired and do not interfere with joint movement. A pair of tip barbs 96, 98 allow the clip lOa to grip the meniscus so it stays embedded when the jaws 64, 66 are pulled back and out of the patient. This is more clearly shown in Figure 6~ A
flexible section 81 is made an integral part of the clip lOa, but is preferably made from a relatively soft, flexible biodegradable material which allows the clip lOa to bend as it is inserted so the legs 12a, 14a can be fully embedded in the tissue. A preferred material of the flexible section 81 is 2.0 Dexon suture. Since the interconnecting flexible section 81 is the only section of the clip lOa that is exposed from the meniscus after the clip lOa is inserted, the soft material also provides a clip that is less irritating to the surrounding cartilage than the typical stiff or metallic clips would be and which would not be able to be used intra-articularly.
Another way of forming the jaws to ensure proper insertion of clip lOa is shown in Figure 6. A pair of jaws 100, 102 are formed to hold the barbs 18a, 20a, 22a, 24a of the clip lOa while the clip lOa is being inserted and to release the clip lOa after insertion so that it remains in place embedded in the meniscus. A pair of barb-holding members 104 are spring steel members with small indentations shaped to fit and hold the clip barbs 18a, 20a, 22a, 24a. A wire 106 is attached to the barb-holding members 104.The wire 108 connects the wire 106 to a switch 92.
~" ,,.
.....
When the clip lOa is fully inserted in the meniscus, the physician operates the switch or lever 92.
The switch 92 operation pulls on the wire 108, as shown in Figure 6, which in turn pulls the wire 106. The wire 106 is attached to the underside of the barb-holding members 104. As the wire 106 is pulled tight, it pulls the barb-holding members 104 down away from the clip lOa. This frees the barbs 18a, 20a, 22a, 24a and leaves them embedded in the meniscus. The tip barbs 96, 98 also may be included to help hold the clip lOa in place by gripping the tissue just enough to allow the clip lOa to separate from the jaws 100, 102 as the jaws 100, 102 are opened and backed out of the meniscus. In conjunction with the barb-holding members 104, the tip barbs 96, 98 allow the clip lOa to properly separate from the instrument 50 as it is removed from the mensicus.
Although specific features of the invention are shown in some drawings and not others, this is for convenience only as each feature may be combined with any or all of the other features in accordance with the invention .
.:. .
Claims (62)
1. A meniscal clip for arthroscopic repair of peripheral tears in the meniscus comprising:
a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the meniscus and opposing withdrawal from it; and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the meniscus and opposing withdrawal from it; and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
2. A meniscal clip according to claim 1, wherein said legs are curved inwardly toward each other.
3. A meniscal clip according to claim 1, wherein each of said legs has a plurality of said barbs.
4. A meniscal clip according to claim 1, 2 or 3, wherein the rigid biodegradable material is a polyglycolic acid polymer.
5. A meniscal clip according to claim 1, 2 or 3, wherein said barbs are formed on the outside of each of said legs.
6. An arthroscopic clip for arthroscopic repair of tears in fibrocartilage and soft tissue comprising:
a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it; and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
a pair of opposed legs formed of rigid biodegradable material, each of said legs having at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it; and a flexible section interconnecting said legs and formed of a flexible biodegradable material.
7. An arthroscopic clip according to claim 6, wherein said legs are curved inwardly toward each other.
8. An arthroscopic clip according to claim 6, wherein each of said legs has a plurality of said barbs.
9. An arthroscopic clip according to claim 6, 7 or 8, wherein the rigid biodegradable material is a polyglycolic acid polymer.
10. An arthroscopic clip according to claim 6, 7 or 8, wherein said barbs are formed on the outside of each of said legs.
11. An arthroscopic clip comprising:
a first curved leg including first anchoring means for positionally securing said first leg in tissue without a retainer;
a second curved leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
a first curved leg including first anchoring means for positionally securing said first leg in tissue without a retainer;
a second curved leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
12. A clip according to claim 11, wherein said first and second anchoring means include a barb orientated on each of said legs so as to permit penetration of tissue when said clip is inserted in tissue.
13. A clip according to claim 11, wherein said first and second anchoring means are located on a second end of said legs.
14. A clip according to claim 13, wherein said first and second anchoring means include a barb orientated on each of said legs so as to permit penetration of tissue when said clip is inserted in tissue.
15. A clip according to claim 14, wherein each of said first and second legs includes at least one additional barb located on the outer side of said legs.
16. A clip according to claim 11, 12, 13, 14 or 15, wherein said flexible connecting member is biodegradable.
17. A clip according to claim 11, 12, 13, 14 or 15, wherein said leg members are composed of a rigid biodegradable material.
18. A clip according to claim 17, wherein said biodegradable material is substantially composed of polyglycolic acid polymer.
19. A clip according to claim 11, 12, 13, 14, 15 or 18 wherein said flexible connecting member and said legs are integral.
20. A clip according to claim 19, wherein said flexible connecting member and said legs are substantially composed of polyglycolic acid polymer.
21. An arthroscopic clip comprising:
a first curved leg including first anchoring means for positionally securing said first leg in tissue;
a second curved leg including second anchoring means for securing said second leg in tissue; and a connecting member secured to a first end of each of said legs, said connecting member being composed of a soft flexible suture material.
a first curved leg including first anchoring means for positionally securing said first leg in tissue;
a second curved leg including second anchoring means for securing said second leg in tissue; and a connecting member secured to a first end of each of said legs, said connecting member being composed of a soft flexible suture material.
22. An arthroscopic clip comprising:
a first curved leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second curved leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said curved legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
a first curved leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second curved leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said curved legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
23. A clip according to claim 22, wherein said flexible material is composed of a biodegradable material.
24. A clip according to claim 22 or 23, wherein said legs are composed of a rigid biodegradable material.
25. A clip according to claim 24, wherein said biodegradable material is composed substantially of a polyglycolic acid polymer.
26. An arthroscopic clip comprising:
a first and a second curved leg composed of a rigid biodegradable material; and a connecting member composed of a soft flexible biodegradable suture material secured to a first end of each of said legs.
a first and a second curved leg composed of a rigid biodegradable material; and a connecting member composed of a soft flexible biodegradable suture material secured to a first end of each of said legs.
27. A clip according to claim 26, wherein said barbs are located at a second end of said legs.
28. A clip according to claim 27, wherein each of said legs include at least one additional of said barbs located on the outer side of said legs.
29. A clip according to claim 26, 27 or 28, wherein said flexible connecting member and said legs are integral.
30. A clip according to claim 29, wherein said flexible connecting member and said legs are substantially polyglycolic acid polymer.
31. An arthroscopic clip comprising:
a first leg including first anchoring means for positionally securing said first leg in tissue without a retainer;
a second leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
a first leg including first anchoring means for positionally securing said first leg in tissue without a retainer;
a second leg including second anchoring means for securing said second leg in tissue without a retainer; and a soft flexible connecting member secured to a first end of each of said legs.
32. A clip according to claim 31, wherein said first and second anchoring means include a barb orientated on each of said legs so as to permit penetration of tissue when the clip is inserted in the tissue.
33. A clip according to claim 31, wherein said first and second anchoring means are located on a second end of said legs.
34. A clip according to claim 33, wherein said first and second anchoring means include a barb orientated on each of said legs so as to permit penetration of tissue when said clip is inserted in tissue.
35. A clip according to claim 34, wherein each of said first and second legs include at least one additional barb located on the outer side of said legs.
36. A clip according to claim 31, 32, 33, 34, or 35, wherein said flexible connecting member is biodegradable.
37. A clip according to claim 31, 32, 33, 34 or 35, wherein said flexible connecting member is composed of a soft flexible suture material.
38. A clip according to claim 31, 32, 33, 34 or 35, wherein said leg members are composed of a rigid biodegradable material.
39. A clip according to claim 38, wherein said biodegradable material is substantially composed of polyglycolic acid polymer.
40. A clip according to claim 31, 32, 33, 34, 35 or 39, wherein said flexible connecting member and said legs are integral.
41. A clip according to claim 40, wherein said flexible connecting member and said legs are substantially polyglycolic acid polymer.
42. An arthroscopic clip comprising:
a first leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
a first leg member composed of a rigid material, said first leg member including at least one tissue retaining barb; and a second leg member composed of a rigid material, said second leg member including at least one tissue retaining barb; and a connecting member composed of a soft flexible material secured to a first end of each of said legs, said flexible connecting member being bendable to allow said legs to move toward each other and overlap as said legs are pushed into tissue, said barbs securing said legs in tissue without a retainer.
43. A clip according to claim 42, wherein said barbs are located at a second end of said legs.
44. A clip according to claim 43, wherein each of said legs include at least one additional of said barbs located on the outer side of said legs.
45. A clip according to claim 42, 43 or 44, wherein said flexible material is a biodegradable material.
46. A clip according to claim 42, 43 or 44, wherein said legs are composed of a rigid biodegradable material.
47. A clip according to claim 46, wherein said biodegradable material is composed substantially of a polyglycolic acid polymer.
48. A clip according to claim 42, 43, 44 or 47, wherein said flexible connecting member and said legs are integral.
49. A clip according to claim 48, wherein said flexible connecting member and said legs are substantially polyglycolic acid polymer.
50. An arthroscopic instrument for applying barbed arthroscopic clips for repair of tears in fibrocartilage and soft tissue comprising:
a pair of opposed jaws each having at least one notch for holding the barbs of said clip;
biasing means for separating said jaws in a normally open position;
an actuating handle having opposed handle members;
means for interconnecting said handle and said jaws;
means for closing said jaws when said handle members are moved a first way relative to one another and opening said jaws when said handle members are moved the other way relative to one another; and means for releasing said clip from said jaws.
a pair of opposed jaws each having at least one notch for holding the barbs of said clip;
biasing means for separating said jaws in a normally open position;
an actuating handle having opposed handle members;
means for interconnecting said handle and said jaws;
means for closing said jaws when said handle members are moved a first way relative to one another and opening said jaws when said handle members are moved the other way relative to one another; and means for releasing said clip from said jaws.
51. An arthroscopic instrument according to claim 50, wherein said actuating handle includes means for biasing said handle members apart in a normally open position.
52. An arthroscopic instrument according to claim 50, wherein said jaws are disposed at an angle to said means for interconnecting.
53. An arthroscopic instrument according to claim 50, wherein said means for closing includes means for urging said jaws together when said handle members are moved said first way.
54. An arthroscopic instrument according to claim 50, wherein said jaws are closed when said handle members are moved together and opened when said handle members are moved apart.
55. An arthroscopic instrument according to claim 50, wherein said jaws have sharpened tips to facilitate clip insertion.
56. An arthroscopic instrument according to claim 50, wherein said jaws overlap when they are closed.
57. An arthroscopic instrument according to claim 56, wherein said jaws are slightly offset to facilitate said overlap.
58. An arthroscopic instrument according to claim 50, wherein said means for releasing includes means for releasably holding at least one barb of said clip.
59. An arthroscopic instrument according to claim 58, wherein said means for releasing further includes means for selectively releasing said means for releasably holding from said barb.
60. An arthroscopic instrument according to claim 59, further including means for actuating said means for selectively releasing.
61. An arthroscopic instrument according to claim 60, wherein said means for actuating includes an actuating member on said handle.
62. An arthroscopic instrument according to claim 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60 or 61, wherein said means for releasing is independent of said means for closing said jaws.
Priority Applications (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA002004658A CA2004658C (en) | 1988-06-03 | 1989-12-05 | Arthroscopic clip and insertion tool |
| EP89312706A EP0432320B1 (en) | 1988-06-03 | 1989-12-06 | Arthroscopic clip and insertion tool |
| US07/448,201 US4997436A (en) | 1988-06-03 | 1989-12-07 | Arthroscopic clip insertion tool |
| JP1334669A JP2927475B2 (en) | 1988-06-03 | 1989-12-22 | Arthroscopic clip and its insertion device |
| US07/511,445 US5002562A (en) | 1988-06-03 | 1990-04-18 | Surgical clip |
Applications Claiming Priority (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US20184188A | 1988-06-03 | 1988-06-03 | |
| CA002004658A CA2004658C (en) | 1988-06-03 | 1989-12-05 | Arthroscopic clip and insertion tool |
| US07/448,201 US4997436A (en) | 1988-06-03 | 1989-12-07 | Arthroscopic clip insertion tool |
| JP1334669A JP2927475B2 (en) | 1988-06-03 | 1989-12-22 | Arthroscopic clip and its insertion device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2004658A1 CA2004658A1 (en) | 1991-06-05 |
| CA2004658C true CA2004658C (en) | 1995-10-10 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002004658A Expired - Lifetime CA2004658C (en) | 1988-06-03 | 1989-12-05 | Arthroscopic clip and insertion tool |
Country Status (4)
| Country | Link |
|---|---|
| US (1) | US4997436A (en) |
| EP (1) | EP0432320B1 (en) |
| JP (1) | JP2927475B2 (en) |
| CA (1) | CA2004658C (en) |
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Also Published As
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| JP2927475B2 (en) | 1999-07-28 |
| US4997436A (en) | 1991-03-05 |
| JPH03195546A (en) | 1991-08-27 |
| EP0432320A1 (en) | 1991-06-19 |
| EP0432320B1 (en) | 1995-06-28 |
| CA2004658A1 (en) | 1991-06-05 |
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