Assemblies and methods suitable for knotless arthroscopic repair of tissue defects include two fixation members coupled by two limbs of suture comprising a continuous loop. A unidirectional restriction element that can be a preformed locking, sliding suture knot proximate to one of the fixation members, provides tensioning of the repair.

A medical apparatus that includes a distal member, a needle disposed in the distal member and proximally advanceable from the distal member, and a needle capture portion positioned proximal to the distal member and which includes a through-hole to direct the needle from the needle capture portion towards a graspable member at a trajectory narrower than a trajectory of the needle from the distal member to the needle capture portion.

A method for syndesmotic repair includes forming a bone tunnel through a first bone and a second bone. A partial anchoring construct is inserted through the bone tunnel. The partial anchoring construct includes a first flexible strand defining a first adjustable loop and a first anchor coupled to a first end of the first adjustable loop. A second end of the first adjustable loop is coupled to a first pull-through strand. A second anchor is coupled to the second end of the first adjustable loop after the first adjustable loop is inserted through the bone tunnel by the first pull-through strand. The length of the first adjustable loop is adjusted to position the first bone and the second bone in a predetermined spacing.

An apparatus for laparoscopic intracorporeal knot tying includes a needle grasper including a needle holder shaft and a needle holder jaw located at a distal end of the needle holder shaft, and a knot loop grasper including a knot loop holder shaft, which is slidable on the needle holder shaft, and a knot loop holder jaw located at a distal end of the knot loop holder shaft. In an inactive state of the apparatus, the knot loop holder is located proximal to the needle holder jaw. In an active state of the apparatus at a time of a knot tying, the knot loop holder jaw slides on the needle holder shaft toward the distal end of the needle holder shaft and beyond the needle holder jaw to carry components of a knot over a standing end of a suture held by the needle holder jaw.

A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose on a first portion of at least a first limb and has a second portion connected to the filament engagement feature of the anchor. Preferably, at least one free filament limb, which in some embodiments is a length of the first filament and in other embodiments is a second filament, is capable of being passed through tissue to be repaired and has at least one end passable through the noose to enable incremental tensioning of the tissue after the anchor is fixated in bone. The noose strangulates the free filament limb when tension is applied to at least one of the free filament limb and the noose.

Apparatus for manipulating and securing tissue are described herein. In creating tissue folds within the body of a patient, a tissue manipulation assembly may generally have an elongate tubular member, an engagement member slidably disposed through the tubular member and a distal end adapted to engage tissue via a helical member, tissue stabilizing members positioned at the tubular member distal end which are adapted to stabilize tissue therebetween, and a delivery tube pivotable about the tissue stabilizer. The stabilizing members can be adapted to become angled relative to a longitudinal axis of the elongate tubular member. Moreover, one or all the articulation controls and functions can be integrated into a singular handle assembly connectable to the tissue manipulation assembly via a rigid or flexible tubular body.

A device having one or more adjustable loops or coils associated with an implant body for use in soft tissue reconstructions is provided. One exemplary embodiment of a device includes a body and a suture filament, with the filament being used to form a self-locking sliding knot disposed on a top side of the body and a plurality of adjustable coils that are substantially disposed on the body's bottom side. Terminal ends of the filament located above the body's top side can be passed through an opening of a Lark's Head knot from opposite sides, thus forming a self-locking sliding knot, and then the terminal ends can be tensioned to adjust a circumference of the coils. Changing a coil's circumference changes a location of a ligament graft disposed on the coil. Other configurations of devices and systems, as well as methods for performing ACL repairs, are also provided.

A bolster system having a first bolster device, a second bolster device, and an adjustable tether that includes a one-way pre-tied slideable adjustment knot. The adjustment knot is at a first position prior to insertion of the first bolster device into a passageway in one or more bones. The second bolster device includes a body portion having an outer portion that is sized to be received in the passageway and/or in an aperture of a bone plate. The body portion also includes a channel that is sized to accommodate recessed and/or embedded placement of the pre-tied slideable adjustment knot. The second bolster device can also include an oversized plate portion that abuts against a cortex of a bone or a wall of a bone plate. The second bolster device can also include a threaded member or retention tab that lockingly secures the second bolster device to a bone plate.

Apparatus and methods are described herein for use in the transvascular delivery and deployment of a prosthetic mitral valve. In some embodiments, an apparatus includes a prosthetic heart valve that includes an inner frame and an outer frame couplable to the inner frame via sutures. The prosthetic heart valve is movable between a first configuration for delivery and a second configuration when implanted in a heart. When in the first configuration, the inner frame can be disposed axially proximal of the outer frame and loosely coupled together via the sutures. When in the second configuration, the inner frame and outer frame are disposed in a nested configuration and can be secured together with the sutures. In some embodiments, the sutures are secured with slip knots. In some embodiments, a delivery device can be used to secure the slip knots and sutures to the prosthetic valve.

Systems, devices, and methods for soft tissue repair are generally provided and they generally involve the use of surgical filaments that are configured in a variety of manners to minimize and/or eliminate the tying of knots during a surgical procedure. Moreover, systems and devices described herein can provide for a reversible locking knot, which allows for additional tension to be applied to the repair if adjustments are required after the construct has been locked. The reversible locking knot can be “flipped” or actuated without requiring the knot to be untied and then retied. Further, systems and devices described herein can additionally be used to associate implantable bodies and suture constructs within a bone to secure soft tissue while not restricting the relative movements of operative sutures once the implantable body has been deployed.