Surgical cord tensioning devices, systems, and methods

A device for tensioning a cord coupled to an implant, the device comprising:

• a tensioner comprising a nose assembly, the nose assembly comprising a cylindrical barrel with a central lumen for receiving the cord into the tensioner;
• a wheel having one or more cord retention notches and cord alignment grooves on an outer perimeter of the wheel;
• and
• two handles configured to cause the wheel to rotate and the cord causing the cord to wind around the cord alignment grooves of the wheel to tension the cord.

A device for manipulating implants coupled by a cord, the device comprising:

• a counter tensioner to guide the cord from a head of an implant to a tensioner, the counter tensioner comprising:
• an elongate body having a proximal end and a distal end and comprising:
• an outer sleeve;
• and
• an inner sleeve having a lumen configured to receive the cord and comprising a plurality of living hinges in proximity to the distal end;
• wherein each living hinge of the plurality of living hinges has one or more engagement members configured to securely engage with cooperating features on the head of the implant when the inner sleeve is translated upward in the outer sleeve such that the distal end of the outer sleeve holds the living hinge in place;
• a knob at the proximal end configured to cause the inner sleeve to translate upwards relative to the outer sleeve;
• and
• a port at the proximal positioned at an angle from a longitudinal central axis of the elongate body, the port configured to receive a nose assembly of the tensioner.